WHO/PRP/14.1 ENGLISH ONLY PROGRAMME BUDGET PERFORMANCE ASSESSMENT REPORT

Transcription

1 WHO/PRP/14.1 ENGLISH ONLY PROGRAMME BUDGET PERFORMANCE ASSESSMENT REPORT

2 Rounding convention: Due to the presentation of the financial figures in US$ 000 or US$ millions there may be a slight discrepancy between the total shown, and the total when calculated by adding the figures as printed. WHO/PRP/14.1 World Health Organization 2014 The designation employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its fronters or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the name of proprietary products are distinguished by inital capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Printed in Geneva, Switzerland, October 2014.

3 FOREWORD BY THE DIRECTOR-GENERAL This document provides a systematic assessment of WHO s performance during the biennium according to each of the Organization s 13 strategic objectives. The document is issued at a time of ongoing reforms at WHO and within a health development climate that places a premium on transparency, accountability and measurable results. In line with guidance from Member States, the Secretariat aimed to ensure that areas of WHO engagement are strategic and selective. During the biennium, the reform process shifted from a phase of policy analysis and problem solving to a more robust implementation phase. The two financing dialogues held in 2013 were a first for WHO and a clear expression of this shift. Commitment to the health-related Millennium Development Goals continued to bring impressive results, again confirming the value of coordinating international health cooperation around a limited number of time-bound goals. For HIV/AIDS, new evidence that antiretroviral therapy prevents transmission of HIV sparked significant revision and consolidation of all related WHO policy advice, further simplifying treatment protocols and streamlining operational demands. On World Malaria Day 2012, WHO launched an initiative that consolidated WHO policy recommendations for testing, treating, and tracking every malaria case, stressing testing before treatment and tracking through a sensitive surveillance system. Countries that test before treatment, using simplified new diagnostic tests, reported declines in the prescribing of antimalarial medicines and in related costs. Surveillance, however, remains weak. Malaria trends could be established with certainty in only 58 out of 99 countries with ongoing malaria transmission. Prospects for attaining the goals set for tuberculosis increased, but WHO continued to track cases of multidrug resistant and extensively drug-resistant tuberculosis and to warn the world accordingly. Stimulated by the Every Woman, Every Child initiative, efforts to reduce maternal and child mortality accelerated. WHO supported these efforts through the coordination of large multicentre research studies and the provision of practical technical guidance. As just one example, WHO issued guidelines for an integrated approach to childhood diarrhoea and pneumonia that aims to eliminate the two diseases while also reducing the operational demands on health services. These efforts underscored the urgent need to develop systems of civil registration and vital statistics as fundamental to improved accountability and the measurement of results. Countries continued to look to WHO for guidance in responding to the rise of noncommunicable diseases and the tremendous demands these diseases place on health systems, human resources, and budgets. A global action plan for the prevention and control of noncommunicable diseases was adopted by the Health Assembly in Within countries, the best buys identified by WHO allowed countries to move forward, regardless of resource constraints. Some achievements during the biennium can be readily measured. With support from the GAVI Alliance, more countries introduced the newer vaccines into their routine immunization programmes. Especially good coverage with hepatitis B vaccine raised the exciting prospect of preventing a large proportion of liver cancer, one of the most common cancers in the developing world. The first-ever World Immunization Week, held in 2012, drew the participation of more than 180 countries. India remained polio-free. More than 150 diagnostics, medicines, vaccines, and active pharmaceutical ingredients were prequalified by WHO. In 2012 alone, well over 700 million preventive treatments were delivered to protect populations from the targeted neglected tropical diseases. Support for the WHO Framework Convention on Tobacco Control grew to 176 Parties; the Convention s first protocol, aimed at eliminating illicit trade in tobacco products, was approved in I was personally pleased to see the continuing impact of The world health report of 2010 on health systems financing 1. More than 70 countries, at all levels of development, sought WHO technical assistance in moving their health systems towards universal health coverage. In providing this support, WHO was joined by the World Bank, adding weight to arguments that universal health coverage is economically desirable, feasible and viable. Universal coverage is one of the most powerful social equalizers among all policy options. I am proud that, in this way, WHO is turning the principles of fairness and the right to health into tangible and inclusive benefits for people s health. Dr Margaret Chan Director-General 1 The world health report: health systems financing: the path to universal coverage. Geneva: World Health Organization; Foreword by the director-general page 3

4

5 TABLE OF CONTENTS PERFORMANCE ASSESSMENT OVERVIEW 7 ACHIEVEMENTS BY STRATEGIC OBJECTIVE SO 1 Communicable diseases 16 SO 2 HIV / AIDS, tuberculosis and malaria 22 SO 3 Chronic noncommunicable conditions 28 SO 4 Child, adolescent, maternal, sexual and reproductive health, and ageing 35 SO 5 Emergencies and disasters 42 SO 6 Risk factors for health 46 SO 7 Social and economic determinants of health 52 SO 8 Healthier environment 57 SO 9 Nutrition and food safety 62 SO 10 Health systems and services 68 SO 11 Medical products and technologies 75 SO 12 WHO leadership, governance and partnerships 82 SO 13 Enabling and support functions 88 ANNEXES ANNEX 1 Financial implementation by strategic objective and major office 96 ANNEX 2 Notes on Organization-wide expected result (OWER) indicators 119 ANNEX 3 Details of indicator achievement 129

6

7 PERFORMANCE ASSESSMENT OVERVIEW The Programme budget performance assessment is the final assessment carried out within the framework of the medium-term strategic plan This report provides an overview of the major achievements of expected results, and an overview of issues and lessons learnt from the work in countries and of the Secretariat. Budget implementation was also reviewed, allowing for programmatic and financial implementation to be considered simultaneously. 2 The programme budget performance assessment is a self-assessment exercise that allows major offices to indicate whether their respective contributions to the expected results were partly, fully or not achieved. Progress ratings reflect the extent to which programmes have delivered on their expected outputs and towards achieving the indicator targets. The Lessons Learnt and actions to be taken were documented at each level. Peer review and quality assurance elements were built into the process so as to ensure that progress was assessed in an objective and consistent manner. OVERVIEW OF ORGANIZATION-WIDE EXPECTED RESULTS Achievement of the Organization-wide expected results was assessed on the basis of the achievement of indicators, which were adjusted during the mid-term review to reflect the actual achievements reported in the Programme budget performance assessment. In some cases, the baselines and targets were also updated to reflect further clarification of the definitions and measurement criteria for individual indicators. The use of the indicator values as the primary method of assessing achievement of expected results at the end of the biennium is in accordance with the recommendations of the External Auditor. It also reflects the Organization-wide efforts to strengthen the culture of evaluation, as well as the specific capacity to assess results through the definition of, and reporting under, robust indicators. 2 See document A67/43, Financial report and audited financial statements for the year ended 31 December Based on indicator achievement values, the Organizationwide expected results were assessed as follows: FULLY ACHIEVED all indicator targets for the Organization-wide expected result were met or surpassed; PARTLY ACHIEVED one or more indicator targets for the Organizationwide expected result were not met; and NOT ACHIEVED no indicator targets for the Organization-wide expected result were met. Out of a total of 80 Organization-wide expected results for the biennium , 50 were assessed as fully achieved (63%) and 30 as partly achieved (37%), representing an improvement in performance over when 46% of the Organization-wide expected results were rated as partly achieved. Further analysis of the 30 partly achieved Organization-wide expected results shows that: z a total of 12 out of 30 Organization-wide expected results were rated as partly achieved because either a more rigorous application of the indicator measurement criteria led to a reduction in the number of countries reported to have achieved the target, or countries lacked the capacity to provide timely reports on indicator achievement (for example, to complete reporting surveys or meet reporting deadlines); z a total of four out of 30 Organization-wide expected results were rated as partly achieved because indicator targets in some Member States were not met as foreseen primarily as a result of ongoing political unrest (for example, in the Eastern Mediterranean Region); and z the remaining 14 out of 30 Organization-wide expected results were rated as partly achieved because either one or more target Member States did not achieve the results expected, or Member States that had previously achieved the target failed to continue to meet the achievement criteria. More detailed information on the indicators that were partly achieved can be found in Annex 2 and information on indicator achievement in Annex 3. Performance assessment overview page 7

8 Improvements have been made to the review process, including the definition and monitoring of appropriate performance measures. However, the self-assessment nature of the review, and the need for a clearer relationship between technical and financial performance continue to pose significant challenges. Many of those matters have been discussed with Member States and have been addressed in the Programme budget through a better delineation of Secretariat outputs and related indicators, and the monitoring and evaluation framework. Table 1 shows the rating given for the achievement of the Organization-wide expected results by strategic objective. Table 1. Progress rating by strategic objective Organization-wide expected results Strategic objective Fully achieved Partly achieved Not achieved Total SO 1 Communicable diseases SO 2 HIV/AIDS, tuberculosis and malaria SO 3 Chronic noncommunicable conditions SO 4 Child, adolescent, maternal, sexual and reproductive health, and ageing SO 5 Emergencies and disasters SO 6 Risk factors for health SO 7 Social and economic determinants of health SO 8 Healthier environment SO 9 Nutrition and food safety SO 10 Health systems and services SO 11 Medical products and technologies SO 12 WHO leadership, governance and partnerships SO 13 Enabling and support functions TOTAL OVERVIEW OF FINANCIAL IMPLEMENTATION In May 2011, the Sixty-fourth World Health Assembly adopted resolution WHA64.3, the appropriation resolution for the financial period , and noted the total effective budget of US$ 3959 million, presented in three segments: base programmes (US$ 2627 million); special programmes and collaborative arrangements (US$ 863 million); and outbreak and crisis response (US$ 469 million), to be financed from assessed contributions, voluntary contributions and carry-over funds from the financial period At the end of the biennium , the financing available for all segments of the budget, including both assessed and voluntary contributions, was US$ 4210 million, comprising: income of US$ 1000 million received in and planned for ; income planned and carried forward from of US$ 500 million; and new income of US$ 2710 million for , including US$ 916 million in assessed contributions, and US$ 1794 million in new voluntary contributions for the biennium. Out of the available funding, US$ 1170 million (28%) was made up of assessed contributions and other flexible funding, whereas US$ 3040 million (72%) was earmarked funding. page 8 Performance assessment overview

9 The total implementation 3 was US$ 3914 million, or 99% of the approved budget, confirming the realistic nature of the Programme budget , which was based on the income and expenditure projections for the financial period. Although the level of financing for the total budget was good, 3 Implementation: this figure represents expenditure and encumbrances relating to results in the Programme budget only. financing was not evenly distributed across all budget segments, affecting levels of implementation by major office, strategic objective and budget segment, and highlighting the problems created by the high level of earmarked funding and inadequacy of flexible funding. The following tables and figures show how the Programme budget was implemented by budget segment, strategic objective and major office. More detailed financial information by strategic objective and major office can be found in Annex 1. Table 2. Financial implementation by budget segment (US$ million as at 31 December 2013) Segment Approved Funds available budget assessed voluntary contributions contributions total Funds available as % of approved budget Implementation Implementation as % of approved budget Implementation as % of funds available Base programmes Special programmes and collaborative arrangements Outbreak and crisis response TOTAL Figure 1. Financial implementation by budget segment (US$ million as at 31 December 2013) APPROVED BUDGET FUNDS AVAILABLE IMPLEMENTATION Base programmes Special programmes and collaborative arrangements Outbreak and crisis response Performance assessment overview page 9

10 In , WHO continued to track financing and financial implementation according to the three budget segments, and the tables presented in this document provide a management analysis of the budget from this perspective. The three budget segments offer a useful lens through which to view the budget; in particular, for understanding the reasons for different levels of financing for different areas of the approved budget. Table 2 and Figure 1 show financial implementation by budget segment. The funds available 4 for the base programmes segment were US$ 2524 million (96% of the approved budget); for the special programmes and collaborative arrangements segment, US$ 1302 million (151% of the approved budget); and for the outbreak and crisis response segment, US$ 384 million (82% of the approved budget). The base programmes segment was slightly under-funded against the approved programme budget with a gap of US$ 103 million. However, 4 The division of resources available into WHO base programmes and other segments is based on management information and should be considered as a close approximation. the level of funding for the special programmes and collaborative arrangements segment exceeded the approved programme budget by US$ 439 million. The increase in financing beyond the approved budget for the special programmes and collaborative arrangements segment continued to be related mainly to work on poliomyelitis eradication under strategic objective 1. Activities under the outbreak and crisis response segment and its financing are mainly driven by emergencies and outbreaks, which are, by their nature, unpredictable. The resource requirements are usually significant and difficult to predict, making budgeting under this segment an uncertain process. The requirements for the biennium were estimated at US$ 469 million. Eventual funding amounted to US$ 384 million, of which 89%, or US$ 343 million, had been implemented by 31 December Implementation was 90% of the approved programme budget for base programmes, 140% for special programmes and collaborative arrangements, and 73% for outbreak and crisis response. Table 3. Financial implementation by strategic objective for all segments (US$ million as at 31 December 2013) Strategic objective Funds available Approved budget assessed voluntary contributions contributions total Funds available as % of approved budget Implementation Implementation as % of approved budget Implementation as % of funds available SO SO SO SO SO SO SO SO SO page 10 Performance assessment overview

11 Strategic objective Approved budget Funds available assessed voluntary contributions contributions total Funds available as % of approved budget Implementation Implementation as % of approved budget Implementation as % of funds available SO SO SO SO 13 a Total a As well as the approved programme budget figure shown for strategic objective 13 in Table 3, an additional US$ 138 million of related costs was financed through a separate cost-recovery mechanism under strategic objective 13bis (see Programme budget , Annex 1). These costs are included in Table 3 against all strategic objectives, which contribute to the financing through the postoccupancy charge to recover costs of administrative services directly attributable to the work on all strategic objectives. Figure 2. Financial implementation by strategic objective for all segments (US$ million as at 31 December 2013) APPROVED BUDGET FUNDS AVAILABLE IMPLEMENTATION SO 1 SO 2 SO 3 SO 4 SO 5 SO 6 SO 7 SO 8 SO 9 SO 10 SO 11 SO 12 SO 13 Performance assessment overview page 11

12 Table 3 and Figure 2 show financial implementation by strategic objective. Funding for all strategic objectives exceeds the approved programme budget with the exception of strategic objectives 2, 6, 7 and 13. In the case of strategic objective 1, the over-funding is explained by an increase in the funding received for the special programmes and collaborative arrangements segment, especially for activities related to polio eradication. Strategic objectives 4 and 9 were also well funded against the budget, which had experienced a greater than average reduction compared to the previous biennium. Both these strategic objectives also received additional funding under the special programmes and collaborative arrangements segment, namely for research in human reproduction under strategic objective 4, and for the Codex Alimentarius Commission under strategic objective 9. Table 4. Financial implementation by strategic objective for base programmes only (US$ million as at 31 December 2013) Strategic objective Approved budget Funds available assessed voluntary contributions contributions total Funds available as % of approved budget Implementation Implementation as % of approved budget Implementation as % of funds available SO SO SO SO SO SO SO SO SO SO SO SO SO Total As well as the approved programme budget figure shown for strategic objective 13 in Table 3, an additional US$ 138 million of related costs was financed through a separate cost-recovery mechanism under strategic objective 13bis (see Programme budget , Annex 1). These costs are included in Table 3 against all strategic objectives, which contribute to the financing through the post-occupancy charge to recover costs of administrative services directly attributable to the work on all strategic objectives. Table 4 shows the base programmes segment of the programme budget by strategic objective as at 31 December The average funding available for all strategic objectives was 96%. The funding of strategic objectives varied from 77% for strategic objective 2 to 123% for strategic objective 9. The average implementation rate against the programme budget for the base programmes segment was 90% page 12 Performance assessment overview

13 for all strategic objectives. Implementation rates ranged from 71% for strategic objective 2 to 114% for strategic objective 9, with the variation being mainly attributable to the effect of continued misalignment of the available funds. Table 5. Financial implementation by major office all segments (US$ million as at 31 December 2013) Strategic objective Approved Funds available budget assessed voluntary contributions contributions total Funds available as % of approved budget Implementation Implementation as % of approved budget Implementation as % of funds available African Region Region of the Americas South-East Asia Region European Region Eastern Mediterranean Region Western Pacific Region Headquarters Total Figure 3. Financial implementation by major office (US$ million as at 31 December 2013) APPROVED BUDGET FUNDS AVAILABLE IMPLEMENTATION African Region Region of the Americas South-East Asia Region European Region Eastern Mediterranean Region Western Pacific Region Headquarters Performance assessment overview page 13

14 Table 5 and Figure 3 show financial implementation by major office. By office, the funds available against the approved budget ranged between 77% for the Regional Office for the Americas and 130% for the Regional Office for the Eastern Mediterranean, and implementation ranged between 90% and 97% of the available resources. The high availability of funds in some major offices is partly explained by the high proportion of funds for the special programmes and collaborative arrangements segment, including polio eradication, especially in the African and Eastern Mediterranean regions. It also reflects a degree of success for the Organization s resource management reform efforts, which were launched during Table 6. Financial implementation by major office for base programmes only (US$ million as at 31 December 2013) Strategic objective Approved Funds available budget assessed voluntary contributions contributions total Funds available as % of approved budget Implementation Implementation as % of approved budget Implementation as % of funds available African Region Region of the Americas South-East Asia Region European Region Eastern Mediterranean Region Western Pacific Region Headquarters Total Table 6 highlights base programmes by major office. The average level of funding available for all offices was 96%, which varied between 74% for the Regional Office for the Americas and 113% for the Regional Office for the Western Pacific. The average implementation rate against the programme budget for the base programmes segment was 90% for all offices. Implementation rates ranged from 72% in the Region of the Americas to 107% in the Western Pacific Region, with the variation being mainly attributable to the availability of funds. page 14 Performance assessment overview

15 The analysis highlights several points: z achievement of full financing of the Programme budget ; z confirmation of the overall, more realistic budget for , which closely matched both the funding available and expenditure projections; z an acceleration in the overall implementation of activities during the second year of the biennium; z slight under-implementation against the Programme budget available funding, which can be explained by: continuation of the cost-saving measures introduced in into the current biennium, resulting in a further reduction in salary expenditures; z almost full achievement of base segment financing and related implementation and over-financing of the special programmes and collaborative arrangements segment and related implementation, together with almost full achievement of the requirements of financing under the outbreak and crisis response segment; z continued conservatism of spending in a financially cautious environment; and z the need to build on, increase and accelerate improvements in the alignment of resources in order to ensure full achievement of the approved programmatic outcomes requested by Member States. further savings generated by other efficiency measures, especially in headquarters; conservative spending by managers in the current financial climate; Performance assessment overview // page 15

16 SO 1 COMMUNICABLE DISEASES To reduce the health, social and economic burden of communicable diseases Communicable diseases continue to pose a significant threat to public health and global development. In WHO s African Region, pneumonia, malaria and diarrhoea are among the biggest killers of children under five years of age. Polio eradication in three remaining countries is continually challenged by insecurity, and countries must always be prepared for outbreaks of new and emerging diseases in this changing world. Predominantly diseases of poverty and health inequality, many communicable diseases are preventable, treatable and even eradicable with the right strategies, tools and resources. Strong disease surveillance and monitoring are fundamental to enable Member States to respond adequately to the threat of communicable diseases. Governments are becoming increasingly aware that information sharing and WHO s support are crucial to successful risk assessment and responses to epidemicand pandemic-prone diseases. All but two Member States now report annual immunization data, and WHO s measles and rubella laboratory network has grown from 40 to almost 700 labs in 15 years. Vaccination programmes have been introduced into ever more countries in the last biennium and have achieved significant results, particularly those for Group A meningococcus, Haemophilus influenzae type B (Hib), pneumococcal disease, human papillomavirus (HPV) and measles. Over 100 million people have now received the meningococcal A conjugate vaccine, resulting in the virtual elimination of the disease in immunized populations. WHO has accelerated progress towards the eradication or control of 17 neglected tropical diseases that affect 1.4 million of the world s poorest people. In January 2013, the Organization published its second report on these neglected diseases in 2013 and revealed the significant progress made towards the elimination of many of these conditions. The Secretariat continued its efforts in support of countries, both in terms of technical cooperation and the provision of guidance and tools, towards their attainment of the minimum core capacities required by the International Health Regulations (2005) for detecting, preventing and responding to public health threats. Extensive guidance materials and training courses were produced and implemented in key areas, and were translated into other official languages of the Organization. Notwithstanding the progress made in countries, 119 Member States have requested a two-year extension to the June 2012 deadline. VACCINES WHO has provided high-level leadership and advocacy in generating political and financial commitment and ensuring effective collaboration with all stakeholders page 16 SO 1 // Communicable diseases

17 working on improving global vaccination coverage. More than 180 countries participated in the first-ever World Immunization Week in April In May 2012, the World Health Assembly endorsed WHO s landmark Global Vaccine Action Plan aimed at preventing millions of deaths by 2020 through more equitable access to existing vaccines for all communities. 100 million individuals have received meningococcal A vaccine resulting in the virtual elimination of the disease in immunized populations. Supported by the GAVI Alliance, more countries introduced newer vaccines into their routine immunization programmes. Introducing new vaccines and promoting existing yet under-utilized ones has generated remarkable progress. In 2012, 83% of infants worldwide had received the diphtheria-tetanus-pertussis vaccine and 84% had received the measles vaccine, resulting in a 78% decline in annual measles deaths. Between 2000 and 2012, 13.8 million measles deaths were averted. Other vaccination programmes with significant progress include Hib (an additional 16 countries), pneumococcal infection (33 countries), rotavirus (13 countries) and human papillomavirus (12 additional countries). By implementing external quality assessment to monitor the performance of laboratories in its Rotavirus and Invasive Bacterial Vaccine Preventable Diseases surveillance networks, WHO ensured an increase in both the number of laboratories and the quality of testing. POLIO India remains polio-free since January 2011 a major achievement for a country that had up to cases of paralytic polio cases reported every year until In the three countries where polio remains endemic Afghanistan, Nigeria and Pakistan national action plans have been strengthened to address the challenge of vaccinating every child. In Afghanistan and Nigeria, there was a significant decline in cases from 2012 to Polio outbreaks in the Horn of Africa, the Middle East and Cameroon remind the world that there is a continued risk of the disease spreading from endemic countries. The Regional Committee of the Eastern Mediterranean Region declared polio transmission an emergency for all Member States of that region. These outbreaks were addressed rapidly with multicountry responses and phased outbreak plans. A major threat to the success of the global polio vaccination plan has been the escalation of security threats, including in Nigeria and Pakistan, where polio is endemic. These situations hindered access to children and left gaps in polio surveillance. Security plans are being developed to address the substantial challenges to programme implementation. High-level engagement and advocacy from WHO leadership and Global Polio Eradication Initiative partners, particularly in the three endemic countries, has led to greater engagement and accountability, with improved results, especially in Nigeria. The programme is also actively seeking support from different Islamic institutions to inspire greater confidence and increase community acceptance. Oversight, accountability and programme management bodies were further extended from national to subnational levels in order to intensify political and administrative accountability. The Polio Eradication and Endgame Strategic Plan was launched to guide the actions of the Global Polio Eradication Initiative and Secretariat. The Polio Oversight Board, made up of the heads of the five core Global Polio Eradication Initiative partners, was established to strengthen governance and oversight, and to enhance communication, coordination and advocacy. A comprehensive research agenda supports strategy development and policy formulation, while the WHO Polio Management Team monitors strategic, technical and operational priorities, financial requirements and human resource planning. Continued engagement at every level in affected countries remains necessary, as does coordination with relevant international bodies. Flexible and innovative approaches to reaching isolated children and minimizing the risk of cross-border transmission continue to be essential. Only 406 cases of polio were reported in 2013, down from an estimated cases in INTERNATIONAL HEALTH REGULATIONS The Secretariat continued its substantial efforts to assist countries in attaining the minimum core capacities required by the International Health Regulations. In addition, a significant degree of support was directed towards human resources development. This was provided by means of ongoing training on IHR implementation in several key areas, including: points of entry, laboratory strengthening, biosafety and biosecurity, field epidemiology, implementation in national legislation, together with the assessment, management and communication of risk. The training initiatives were part of a concerted effort to develop extensive guidance materials in each of these key areas. Communicable diseases // SO 1 page 17

18 Progress was made in countries towards achieving the minimum core capacity requirements, nevertheless many countries are still working towards attaining the minimum core capacities and have identified priority areas for strengthening with the objective of meeting the 2014 deadline. 119 Member States have requested a two-year extension to the June 2012 deadline. To provide new impetus for implementation activities, stakeholders meetings were conducted in the WHO regions in 2012 and These meetings brought together stakeholders, partners and traditional and non-traditional donors from the subregional, regional and global levels to support IHR implementation, and provided a valuable forum for sharing experiences and challenges. As highlighted during these meetings, much work remains to be done to bridge the gaps identified; increased advocacy and partnership building across all relevant sectors are essential to mobilizing the necessary technical and financial resources required to meet the core capacities. NEGLECTED TROPICAL DISEASES The momentum to control neglected tropical diseases continued to gather force in WHO launched an initiative to accelerate progress towards the eradication, elimination or control of 17 neglected tropical diseases. An expert group devised training and capacity-building programmes to ensure integrated control strategies, to set up monitoring systems evaluating and disease surveillance to verify and improve interventions. WHO negotiated major donations of 14 different medicines, including a new agreement with Merck to expand access to treatment for millions of people. Five countries were certified free of dracunculiasis (guinea-worm disease). In 2012 alone, well over 700 million preventive treatments were delivered to protect populations from neglected tropical diseases. WHO prequalified diethylcarbamazine, the first medicine for treatment of lymphatic filariasis. New treatments were introduced (for visceral leishmaniasis) and others scaled up (helminthiases). Via the WHO Expert Consultation on Rabies, treatment methods for rabies were reexamined. New strategies, diagnostic tools and treatment regimens for lymphatic filariasis were published, as was a new strategy to eliminate African trypanosomiasis. Another five countries were certified free of guinea-worm disease, making a total of 185 Member States. There is now a target to eliminate yaws by 2020 and diagnostic tools to use in the programme have been developed. PANDEMIC-PRONE DISEASES The global threat of pandemic-prone diseases requires the concerted actions of the international community to detect, assess, respond to and cope with such events. WHO has provided strong leadership with strategies such as the Asia Pacific Strategy for Emerging Disease and Integrated Disease Surveillance and Response, which enhance the capacities of Member States to manage risks. In the last biennium, the Organization s work focused on influenza, dengue, Ebola, novel coronavirus, yellow fever, chikungunya, nodding syndrome, hepatitis, cholera and meningitis. The International Coordinating Group s mechanisms delivered more than 7.34 million doses of yellow fever and over 2 million doses of meningitis vaccines in response to outbreaks in 2012 and In 2013, 542 outbreak events were managed through the WHO Event Management System and WHO provided technical support, including tools, guidelines and expert resources for investigation and control. Global and regional preparedness initiatives included stockpiling intervention materials, developing threatspecific plans and issuing guidelines for detection, surveillance and response. Under the Pandemic Influenza Preparedness framework, WHO concluded three legally binding agreements with vaccine manufacturers to secure timely access to 10 15% of pandemic influenza vaccines at the time of the next pandemic. In addition, a plan for the use of the received contributions was finalized in late The International Coordinating Group s mechanisms delivered more than 7.34 million doses of yellow fever and over 2 million doses of meningitis vaccines in response to outbreaks in 2012 and The International Coordinating Group now also manages the international stockpile of oral cholera vaccine for emergencies, and doses were available by the end of The Organization revitalized the Global Task Force for Cholera, which will be launched in WHO s work on hepatitis advanced with the publication in 2012 of the Prevention and Control of Viral Hepatitis Infection: Framework for Global Action, which provides a strategic framework for developing and strengthening national strategies, and a report on the status of national hepatitis programmes in WHO Member States. Together, the two documents provide a framework and a country-specific basis for national strategies, and complement WHO s guidance on facilitating access to hepatitis B and C treatment. page 18 SO 1 // Communicable diseases

19 The battle against antimicrobial resistance moved forward by increasing awareness through the agendas of governing bodies and by convening a Strategic and Technical Advisory Group to help shape global strategy. WHO obtained important data from more than 100 Member States on current capacities and vulnerabilities related to antimicrobial resistance. These will be published in ASSESSMENT OF THE ORGANIZATION- WIDE EXPECTED RESULTS Of the nine Organization-wide expected result targets across the Organization, two were fully achieved. In the area of access to vaccines, 131 Member States instead of the target number of 135 achieved at least 90% of the three-dose diphtheria-tetanus-pertussis vaccination coverage (four countries missing the target by just 1%). For Polio, the escalation of security threats created significant challenges in the implementation of programme strategies. As only 33 countries indicated their intention to stop using trivalent oral polio vaccine in routine immunization programmes, 26% instead of 75% of the Member States originally targeted met the criteria for the indicator. The area of access to interventions for neglected tropical diseases reflects an increase in grade 2 disabilities in new cases of leprosy per million of the population at risk, a finding that is attributable to the use of innovative case-finding methods for accessing difficult-to-reach areas and population groups, as well as improved data management. The partly achieved rating in the area of surveillance and monitoring of all communicable diseases was due to a change in the reporting date. Although only 154 of the 165 targeted Member States submitted their Joint Reporting Forms by the new deadline, the overall timeliness and completeness of the reporting improved significantly compared to previous years. Overall, 173 countries submitted their reporting forms within days of the deadline. The area of International Health Regulations (2005), core capacities was undermined by the difficulty experienced by many countries in meeting the minimum core capacity requirements. For detection, assessment and response to epidemic and pandemicprone diseases, the number of Member States that established preparedness plans and standard operating procedures fell short of the target. The response to epidemics and other public health emergencies of international concern was rated as partly achieved because the target of 140 WHO locations proved to be very difficult to attain. Staffing contraints in the Secretariat, made it difficult to increase the number of offices with access to the global event management system. OWER OWER rating Indicator Baseline 2012 Target 2013 Achieved 2013 OWER Rating Key: Fully achieved Partly achieved x Not achieved Member States with at least 90% national vaccination coverage (DTP3) Member States that have introduced Hib vaccine in their national immunization schedule Final country reports demonstrating interruption of wild poliovirus transmission and containment of wild poliovirus stocks. 80% 100% 81% Member States using trivalent oral poliovirus vaccine that have a timeline and strategy for eventually stopping its use in routine immunization programmes. 0 75% 28% Member States certified for eradication of drancunculiasis Global reduction of Grade 2 Disabilities in new cases of leprosy/million population at risk Reported cases of human African trypanosomiasis for all disease-endemic countries Member States having achieved the recommended target coverage of lymphatic filariasis, schistosomiasis and soil-transmitted helminthiases through regular anthelminthic preventive chemotherapy Communicable diseases // SO 1 page 19

20 OWER OWER rating Indicator Baseline 2012 Target 2013 Achieved 2013 OWER Rating Key: Fully achieved Partly achieved x Not achieved Member State with surveillance systems and training for all communicable diseases of public health importance for the country Member States for which WHO/UNICEF joint reporting forms on immunization surveillance and monitoring are received on time New and improved tools or implementation strategies, developed with significant contribution from WHO, introduced by the public sector in at least one developing country Peer-reviewed publications based on WHO-supported research where the main author s institution is in a developing country. 71% 60% 67% Member States that have completed the assessment and developed a national action plan to achieve core capacities for surveillance and response in line with the IHR (2005) Member States whose national laboratory system is engaged in at least one external quality-control programme for epidemic-prone communicable diseases Member States having national preparedness plans and standard operating procedures in place for readiness and response to major epidemic-prone diseases International coordination mechanisms for supplying essential vaccines, medicines and equipment for use in mass interventions against major epidemic and pandemic-prone diseases Severe emerging or re-emerging diseases for which prevention, surveillance and control strategies have been developed WHO locations with the global event-management system in place to support coordination of risk assessment, communications and field operations for HQ, regional and country offices Member States requests for assistance that have led to effective and timely interventions by WHO. 99% 99% 99% More detailed information on indicators can be found in Annexes 2 and 3. page 20 SO 1 // Communicable diseases

21 WHA APPROVED BUDGET FUNDS AVAILABLE (AS AT 31 DEC 2013) IMPLEMENTATION (AS AT 31 DEC 2013) (US$ 000) AFRO AMRO SEARO EURO EMRO WPRO HQ Total FINANCIAL SUMMARY The approved budget for strategic objective 1 was US$ million, of which US$ 446 million were for base programmes, US$ 679 million for special programmes and collaborative arrangements and US$ 153 million for outbreak and crisis response. Funds available as at 31 December 2013 were US$ million of which US$ 437 million were distributed to base programmes, US$ million to special programmes and collaborative arrangements and US$ 33 million to the outbreak and crisis response segment. Strategic objective 1 continues overall to be well-resourced, with funds available for the base programmes segment at 98% of the total approved budget. All major offices have funding for all segments above 80% of the World Health Assembly approved budget, with implementation of available funds ranging from 91% to 98%. Despite these relatively high and even funding figures, there are nevertheless some pockets of underfinancing and scope for further strengthening of technical capacities in base budget segment, for instance in the work under Organizationwide expected results 1.6, 1.7 and 1.8. In headquarters, 82% of the approved budget for all segments was funded and 75% implemented, partially due to the restructuring of some departments that has effected implementation. There are a number of special programmes and collaborative arrangements in strategic objective 1, including the Collaboration with partners in the GAVI Alliance, the Partnership for the control of neglected tropical diseases and the Special Programme for Research and Training in Tropical Diseases, but the Global Poliomyelitis Eradication Initiative is by far the largest one. The high availability of funds against the approved programme budget in some major offices, and particularly in the African and Eastern Mediterranean Regions, can largely be explained by the specified funding for polio. The overall level of funding and implementation against the approved budget for the outbreak and crisis response segment is 22% and 89% respectively, reflecting the event-driven nature of this budget segment. LESSONS LEARNT Strong leadership, commitment and advocacy at each level of government in Member States remain essential, particularly to keep specific issues on national agendas and to ensure community support. Engagement with partners, coordination, transparency and information sharing are critical in many areas, particularly for risk assessment and response. Technical support to regional and country offices contributed to the development of well thought-out national emergency plans in endemic and outbreak countries, as well as improved local micro-plans. Rapid engagement to support outbreak investigation and flexible and innovative strategies all achieve enhanced results. The negative effect of inadequate human resource capacity at country level cannot be overestimated. Communicable diseases // SO 1 page 21

22 SO 2 HIV/ AIDS, TUBERCULOSIS AND MALARIA TO COMBAT HIV/AIDS, TUBERCULOSIS AND MALARIA The fight to prevent, reduce the incidence of and eradicate HIV/AIDS, tuberculosis and malaria is a simple objective to state but a complex one to achieve. New guidelines, rapid testing and access to treatment therapies, along with global, regional, national and community strategies, reduced new infections and deaths from these three diseases. WHO continued to improve collaboration with global and regional partnerships such as the Global Fund, Roll Back Malaria, Stop TB and the African Union Commission, and advocacy efforts at the European Parliament and among Member States also brought new commitments to increase HIV prevention. The number of new HIV infections is decreasing worldwide, while access to antiretroviral therapy, particularly in low- and middle-income countries, increased to almost 10 million people by the end of 2012 bringing the global target of 15 million people by 2015 within reach. The mortality rate of tuberculosis has decreased by 45% since 1990 and the implementation of the Stop TB Strategy has saved 22 million lives. In line with WHO s TB policy, 98 Member States have begun to use a rapid molecular test to diagnose tuberculosis and multidrug-resistant tuberculosis. The continued decline in the number of new cases means that Millennium Development Goal Target 6C to halt and reverse the tuberculosis epidemic by 2015 has been met. The strong commitment by WHO and its partners to malaria control has been extremely successful. Between 2000 and 2012, malaria mortality worldwide fell by 45% in all age groups, and by 51% in children under five years. More than half the countries that had ongoing malaria transmission in 2000 namely 59 of 103 met the Millennium Development Goal of reversing the incidence of malaria. Of these countries, 52 are now on track to reduce the incidence of the disease by 75% by Leadership by WHO in developing guidelines and strategies to combat these three diseases (such as the 2013 Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV 6 ) was crucial to achieving these substantial results. Also key was WHO s guidance and technical support to promote equitable access to essential medicines, diagnostic tools and health technologies. Good collaboration and coordination across the Organization and at national and community levels were also significant contributors to success Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV. Geneva: World Health Organization; 2013 ( guidelines/arv2013/en/). page 22 SO 2 // HIV/ AIDS, tuberculosis and malaria

23 HIV/AIDS While disparities in access to treatment for HIV persist, there was progress in treatment access in all WHO regions. The WHO African Region stands out for increasing the uptake of antiretroviral therapy by the end of 2012 to 68% of those in need, and making antiretrovirals available to 63% of women living with HIV for the prevention of HIV infection in their infants. By the end of 2012, access to antiretroviral therapy increased to almost 10 million people bringing the global target of 15 million people by 2015 within reach. A strategic framework to eliminate new HIV infections in children by 2015 and to keep their mothers alive will help countries in that Region reach a target of 90% reduction in new infections in children. In the European Region, mother-to-child transmission was the cause of only 1% of new HIV cases. Overall, 38 lowand middle-income countries have achieved 80% service coverage for the prevention of mother-to-child transmission compared to 13 in Global cooperation with expert groups and stakeholders led to the release of over 30 guidelines, policies, strategies and other tools for the prevention of, and treatment and care for patients with HIV/AIDS, including on antiretroviral therapy, male circumcision and surveillance of the epidemic. A major highlight was the production for the first time of a consolidated set of guidelines for the use of antiretroviral drugs for the treatment and prevention of HIV infection in July These guidelines were rapidly embraced by Member States. As a result, the uptake of the first-line treatments now recommended by WHO more than doubled from 30% at the end of 2012 to 62% by the end of Through the Joint Assessment of National Strategies, an increasing number of countries have strengthened their AIDS coordination mechanisms, integrating previously separated planning and funding streams into consolidated HIV plans. There have also been significant efforts to increase collaboration between HIV and TB programmes. In the Region of the Americas, for example, 39 countries and territories have implemented collaborative activities. Monitoring the progress of HIV/AIDS, the use of antiretrovirals, and the number of cases of motherto-child transmission continues to be crucial. Significant progress in monitoring and evaluation has been supported by intense advocacy, networking and collaboration by WHO in the regions. In 2013, 131 countries reported on their progress in HIV, and a growing number now respond to the annual surveys on the use of antiretroviral drugs and HIV-related diagnostics. TUBERCULOSIS The number of people contracting tuberculosis continues to decline slowly the number of new cases dropping by 2% between 2011 and The number of lives saved owes much to the deployment of the WHO-recommended strategy. Consequently, the world is on track to achieve the global target of a 50% reduction in tuberculosis deaths by Yet one third of estimated new cases each year are not reached. Thus urgent action is needed to serve all those affected, cure them and to interrupt transmission and creation of drug resistance. The progress of controlling multidrug-resistant strains of tuberculosis is slow, with only one in four estimated cases being diagnosed and many lacking treatment. Fortunately, significant progress has been made in the surveillance of drug-resistant tuberculosis, with 136 out of 194 Member States providing data, thus allowing clearer understanding of the situation. The world is on track to achieve the global target of a 50% reduction in tuberculosis by In 2013, WHO issued interim guidelines on the first new tuberculosis drug in 40 years and a new rapid molecular test has been taken up by 98 low- and middle-income countries. Overall, there is a financing gap for tuberculosis care and control of US$ 2 billion per year for tuberculosis care and control, and US$ 1.4 billion for tuberculosis research per year to reach the 2015 global targets. Working with many partners and in close collaboration with the Global Fund and bilateral agencies, WHO continued to mobilize support for the fight against tuberculosis. Strengthened collaboration between the three levels of the Organization and leadership by WHO, as well as coordination with partners in the various programmes and the provision of technical assistance were noted, particularly in the African Region. The main obstacle for implementation of planned activities, however, remained the limited human and laboratory capacities in that region. In the Eastern Mediterranean Region, the greatest challenge was the continuously changing security situation and the resulting huge population movements between countries. HIV/ AIDS, tuberculosis and malaria // SO 2 page 23

24 Many Member States still have difficulty financing second-line drugs for treating drug-resistant tuberculosis, and the political commitment to respond to this growing problem is often lacking. This was emphasized as a public health crisis in the WHO Global tuberculosis report 2013 and five immediate priority actions were proposed: to reach the missed cases; to address multidrug-resistant tuberculosis as a public health crisis; to accelerate the response to TB/HIV; to increase funding to close all resource gaps; and to ensure the rapid uptake of innovations. In 2012, the revised WHO policy on collaborative TB/ HIV activities was launched, updating the 2004 interim TB/HIV policy with the latest evidence on life-saving interventions. The implementation of the policy in Member States resulted in the HIV testing of 46% of tuberculosis patients and the provision of life-saving antiretroviral treatment for 57% of these patients by the end of the biennium. The mortality rate of tuberculosis has decreased by 45% since 1990 and the implementation of WHO s TB Strategy has saved 22 million lives in under 20 years. A post-2015 global tuberculosis strategy and targets to 2035 were prepared in conjunction with Member States and partners, and will be discussed by the WHO governing bodies in January MALARIA Across the world, 97 countries still have ongoing malaria transmission. In 41 countries, accounting for 80% of estimated cases, it is not possible to reliably assess malaria trends using data submitted to WHO. Information systems are weakest, and the challenges for strengthening systems are greatest, where the malaria burden is greatest. Between 2000 and 2012, malaria mortality worldwide fell by 45% in all age groups, and by 51% in children under five years. In 2012, the Malaria Policy Advisory Committee was established to provide strategic advice and technical input on all aspects of malaria control and elimination. The benefits of stronger health systems were particularly noted in countries where malaria is endemic. Routine services such as immunization programmes and antenatal care facilitated the delivery of malaria interventions, including preventive treatments and the distribution of insecticide-treated nets the use of which is higher among vulnerable populations although there is a need to increase access to insecticide-treated nets for all persons at risk. The WHO initiative of scaling-up integrated community case management and the availability of rapid diagnostic tests was initiated in five countries in the African Region and was expected to cover more than 1.25 million children below the age of 5 years in hard to reach areas. This will likely save around 8000 lives each year. More than half the countries that had ongoing malaria transmission in 2000 are now on track to reduce the incidence of the disease by 75% in From 2010 to 2012, the proportion of suspected malaria cases receiving a diagnostic test increased from 44% to 64% globally, and malaria diagnostic testing is free of charge in the public sector in 85 countries around the world. According to WHO, universal diagnostic testing would substantially reduce global requirements for antimalarial treatment. The estimated number of artemisininbased combination therapy (ACT) treatment courses delivered to the public and private sectors increased from 11 million globally in 2005 to 331 million in ASSESSMENT OF THE ORGANIZATION-WIDE EXPECTED RESULTS Two of the six Organization-wide expected results are assessed as fully achieved and four, namely, 2.1 (prevention, treatment and care for HIV/AIDS, tuberculosis and malaria), 2.2 (gender-sensitive delivery of services for HIV/AIDS, tuberculosis and malaria), 2.3 (equitable access to essential medicines for HIV/AIDS, tuberculosis and malaria) and 2.4 (surveillance, evaluation and monitoring for HIV/ AIDS, tuberculosis and malaria), were rated as partly achieved. Although progress was made in meeting all Organization-wide expected result indicators and most results were almost fully delivered, resource and capacity constraints in countries, including inadequate resources for the diagnosis and treatment of sexually transmitted infections, coupled with the aspirational level set for some indicators, explain why the targets were not fully met. Other constraints included lack of local capacity to implement, monitor and evaluate programmes, low local technical and infrastructure capabilities for data analysis, concerns about security, limited political support in some regions, especially concerning HIV, and continuing social stigma. page 24 SO 2 // HIV/ AIDS, tuberculosis and malaria

25 OWER OWER rating Indicator Baseline 2012 Target 2013 Achieved 2013 OWER Rating Key: Fully achieved Partly achieved x Not achieved a Low- and middle-income countries that have achieved 80% coverage for antiretroviral therapy b Low- and middle-income countries that have achieved 80% coverage for the prevention of mother-to-child transmission services Endemic countries that have achieved their national intervention targets for malaria. 50% 60% 64% Member States that have achieved the targets of at least 70% case detection and 85% treatment success rate for TB Countries among the 27 priority ones with high burden of multidrug-resistant TB that have detected and initiated treatment under the WHO-recommended programmatic management approach, for at least 70% of estimated cases of multidrugresistant TB High-burden Member States that have achieved the target of 70% of persons with sexually transmitted infections diagnosed, treated and counselled at primary point-of-care sites. n/a 90% 89% a Targeted Member States with comprehensive policies and medium-term plans in response to HIV b Targeted Member States with comprehensive policies and medium-term plans in response to TB c Targeted Member States with comprehensive policies and medium-term plans in response to malaria High-burden countries monitoring provider-initiated HIV testing and counselling in sexually transmitted infection and family planning services. n/a 75% 68% Countries among the 63 with a high burden of HIV/AIDS and TB that are implementing the WHO 12-point policy package for collaborative activities against HIV/AIDS and TB New or updated global norms and quality standards for medicines and diagnostic tools for HIV/AIDS, tuberculosis and malaria Priority medicines and diagnostic tools for HIV/AIDS, TB and malaria that have been assessed and prequalified for UN procurement a Targeted countries receiving support to increase access to affordable essential medicines for HIV/AIDS whose supply is integrated into national pharmaceutical systems b Targeted countries receiving support to increase access to affordable essential medicines for TB whose supply is integrated into national pharmaceutical systems c Targeted countries receiving support to increase access to affordable essential medicines for malaria whose supply is integrated into national pharmaceutical systems Member States implementing quality-assured HIV/AIDS screening of all donated blood Member States administering all medical injections using sterile single-use syringes HIV/ AIDS, tuberculosis and malaria // SO 2 page 25

26 OWER OWER rating Indicator Baseline 2012 Target 2013 Achieved 2013 OWER Rating Key: Fully achieved Partly achieved x Not achieved a Member States providing WHO with annual data on surveillance, monitoring or financial allocation data for inclusion in the annual global reports on control of HIV/AIDS and the achievement of targets b Member States providing WHO with annual data on surveillance, monitoring or financial allocation data for inclusion in the annual global reports on control of TB and the achievement of targets. 208 (includes countries and territories) c Member States providing WHO with annual data on surveillance, monitoring or financial allocation data for inclusion in the annual global reports on control of malaria and the achievement of targets a Member States reporting drug-resistance surveillance data to WHO for HIV/AIDS b Member States reporting drug-resistance surveillance data to WHO for TB c Member States reporting drug-resistance surveillance data to WHO for malaria a Member States with functional coordination mechanisms for HIV/AIDS control b Member States with functional coordination mechanisms for TB control c Member States with functional coordination mechanisms for malaria control a Member States involving communities, persons affected by the diseases, civil-society organizations and the private sector in planning, design, implementation and evaluation of HIV/ AIDS programmes b Member States involving communities, persons affected by the diseases, civil-society organizations and the private sector in planning, design, implementation and evaluation of TB programmes c Member States involving communities, persons affected by the diseases, civil-society organizations and the private sector in planning, design, implementation and evaluation of malaria programmes New and improved tools or implementation strategies for HIV/ AIDS, TB or malaria implemented by the public sector in at least one developing country Peer-reviewed publications arising from WHO-supported research on HIV/AIDS, TB or malaria and for which the main author s institution is based in a developing country. 61% 60% 66% More detailed information on indicators can be found in Annexes 2 and 3. page 26 SO 2 // HIV/ AIDS, tuberculosis and malaria

27 WHA APPROVED BUDGET FUNDS AVAILABLE (AS AT 31 DEC 2013) IMPLEMENTATION (AS AT 31 DEC 2013) (US$ 000) AFRO AMRO SEARO EURO EMRO WPRO HQ Total FINANCIAL SUMMARY The approved budget of US$ 540 million for strategic objective 2 consists of US$ 446 million for base programmes and US$ 94 million for special programmes and collaborative arrangements. Funds available as at end December 2013 were US$ 448 million, of which US$ 342 million were for base programmes and US$ 106 million for special programmes and collaborative arrangements (mainly the Stop TB Partnership, the Special Programme for Research and Training in Tropical Diseases in headquarters, and the Collaboration with the Global fund to Fight AIDS, Tuberculosis and Malaria in the South-East Asia Region). Ensuring full funding at the approved budget level remains a challenge for some of the major offices, in particular in the African Region where only 57% of the budget was financed as at 31 December For headquarters, the available funds as a percentage of the approved budget are 115%. This high rate is explained by substantial specified contributions for the rapid access expansion project of the Global Malaria Programme and the TB Reach facility. Overall, total implementation was US$ 415 million, representing 93% of the funds available. All major offices have an implementation rate within the range of 91% to 95% of available resources. LESSONS LEARNT The key success factors were the leadership of WHO in the normative area, including in the area of providing guidance and technical support to promote equitable access to essential medicines, diagnostic tools and health technologies; collaboration and coordination across the three levels of the Organization; and strategic partnerships with bilateral and multilateral institutions. The main challenge for strategic objective 2 is to maintain the momentum and progress toward achieving the Millennium Development Goals for HIV/AIDS, tuberculosis and malaria. This requires continued action from WHO and its Member States. There is a continued need for increased advocacy with countries to keep HIV/AIDS, tuberculosis and malaria on their agendas and to increase their investment on a national level from domestic sources and international funding. HIV/ AIDS, tuberculosis and malaria // SO 2 page 27

28 SO 3 CHRONIC NONCOMMUNICABLE CONDITIONS To prevent and reduce disease, disability and premature death from chronic noncommunicable diseases, mental disorders, violence and injuries and visual impairment In May 2013 the World Health Assembly adopted a global action plan for to prevent and control noncommunicable diseases. The action plan was designed to strengthen policy and increase global coordination and collaboration with all stakeholders for the prevention and control of noncommunicable diseases. Technical support was provided to Member States to strengthen political and financial commitments and take action against noncommunicable diseases. In 2012, WHO called for better health care for people with disabilities and, at the UN General Assembly s High-level Meeting on Disability and Development, committed itself to ensuring that people with disabilities are able to contribute to the development of their communities. Given that the number of people living with dementia worldwide is forecast to double by 2030 and triple by 2050 to over 100 million sufferers, WHO is taking action through the implementation of the Mental Health Gap Action Programme in all regions. The preventable outcomes of violence, injury and trauma were addressed in various ways across the world during the biennium. Many countries improved road safety with WHO support. More than 100 countries took part in the Global UN Road Safety Week that focused on pedestrian safety. WHO and the Government of Mexico hosted the world s leading violence prevention experts at the 6th Meeting on Milestones in the Global Campaign for Violence Prevention. Universal eye health: a global action plan was endorsed at the 66th World Health Assembly. New WHO estimates on visual and hearing impairment were published: in 2010 there were 285 million visually impaired people worldwide; of these, 39 million were blind and 246 million suffered from low vision. Another 360 million people were affected by disabling hearing loss, as per 2012 estimates. As part of their implementation of the WHO Framework Convention on Tobacco Control, 21 additional countries are now providing free or partially free tobacco cessation support through primary health-care services, bringing the total number of countries providing this support from 35 in 2008 to 86 at the end of NONCOMMUNICABLE DISEASES The Global Action Plan for Prevention and Control of Noncommunicable Diseases focuses on the four main diseases which cause the greatest page 28 SO 3 // Chronic noncommunicable conditions

29 number of deaths among the noncommunicable diseases cardiovascular diseases (like heart attack and stroke), cancer, chronic respiratory diseases (such as asthma and chronic pulmonary disease) and diabetes and the four shared behavioural risk factors tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol. The plan provides policy options for Member States and other stakeholders to take action at all levels global to local and achieve voluntary targets, including a 25% reduction in premature death from the four focus noncommunicable diseases. Draft terms of reference were developed for a global coordination mechanism and for the United Nations Interagency task force on the prevention and control of noncommunicable diseases. Work progressed in the Secretariat on the development of an NCD Global Monitoring Framework with 25 indicators and nine voluntary global targets. Member States were encouraged to set their own national targets, taking into account the global targets. Implementation of a toolkit of a WHO package of essential noncommunicable disease interventions was expanded to include eight interventions with more protocols and evidence-based guidelines, including self-care. A costing tool was also developed to assist Member States in estimating implementation costs. Regional and country workshops and training seminars were held in all WHO regions to support Member States to develop and implement multisectoral national policies and plans, to enlarge national programmes, and to strengthen their political, financial and technical commitment to preventing and controlling noncommunicable diseases. A number of countries reported encouraging advances in risk factor surveillance; and many are strengthening surveillance on specific mortality data on the magnitude, causes and consequences of noncommunicable diseases, which helps national health authorities to improve decision-making. A total of 176 Member States have established units in their ministry of health for the prevention and control of noncommunicable diseases. Cancer registration is an important component of a national surveillance framework, and a number of countries have developed or extended their cancer registries. There have also been improvements in the number of interventions to reduce exposure to noncommunicable diseases, and increased adoption of a primary health-care approach including 85 countries reporting that they will screen for cardiovascular risk using WHO guidelines. With new global commitments at the UN level adopted by governments in September 2011, advocacy for the prevention and control of noncommunicable diseases has entered a new phase. At the end of 2013, a total of 176 Member States had established a unit in their ministry of health or equivalent national health authority with dedicated staff and budget for the prevention and control of noncommunicable diseases, compared to 67 in DISABILITY AND REHABILITATION Most of the estimated one billion people with disabilities around the world lack access to appropriate medical care and rehabilitation services, especially those living in low- and middle-income countries. As a consequence, people with disabilities experience greater challenges in attaining and maintaining maximum independence and health. Lack of services creates barriers to full participation in all aspects of life. Therefore, in addition to WHO s active involvement and participation in the World Health Assembly and the UN General Assembly s High-level Meeting on Disability and Development in September 2012, WHO prepared a draft global disability action plan for consideration by its 134 th Executive Board meeting in January A total of 60 countries have so far hosted policy discussion on WHO s World report on disability, 7 which drew national prevalence data from 193 countries and is the most comprehensive such report currently available. The first World Congress on Community-based Rehabilitation was held in Agra, India, in November 2012 and brought together 1500 experts from over 86 countries, predominantly low- and middleincome countries, to share best practices and plan the next steps for work in this area. The result was the establishment of a global, community-based rehabilitation network to link the three existing regional networks from the America, Africa and the Western Pacific Regions, encompassing 82 countries. People with disabilities and the organizations that represent them played a key role in organizing the World Congress and establishing the global network. More countries are developing programmes based on WHO s guidelines on community-based rehabilitation. As many as people suffer a spinal cord injury each year. People with such injuries are two to five times more likely to die prematurely, with worse survival rates in low- and middle-income countries. Many of the consequences of spinal cord injury result not from the condition itself but from inadequate medical care and rehabilitation services and from 7 World report on disability Geneva: World Health Organization; 2011 ( world_report/2011/report.pdf). Chronic noncommunicable conditions // SO 3 page 29

30 barriers in the physical, social and policy environments that exclude these people from full participation in society. During the biennium, WHO launched the firstever International perspectives on spinal cord injury 8, as well as wheelchair service training packages. MENTAL HEALTH WHO s Comprehensive Mental Health Action Plan was adopted at the 66 th World Health Assembly with four objectives and six targets to achieve by A variety of regional action plans have been adopted or are under development, including the European Mental Health Action Plan. In addition, the Mental Health Gap Action Programme is expanding across all regions, while the WHO QualityRights project to improve conditions and human rights in mental health facilities was launched and implemented. At the end of 2013, 88 low- and middle-income Member States have completed an assessment of their mental health systems using the WHO Assessment Instrument for Mental Health Systems in order to support planning in mental health services and to monitor progress and achievements. The number of countries that have begun scaling up services for mental, neurological and substance-use disorders has increased from 8 to 47 in the last 2 years. In the area of mental health and substance abuse, WHO is supporting Member States to adopt evidencebased policies, strategies and regulations, and current information indicates considerable progress. WHO published a number of documents on mental health including Dementia: a public health priority 9, a report that reveals the exponentially increasing number of people living with dementia worldwide. It describes the impact of dementia on individuals and society, and discusses ways of increasing awareness, advocating for different national approaches to dementia, and the role of caregivers. VIOLENCE AND INJURY Injuries resulting from traffic collisions, drowning, poisoning, falls or burns and violence assault, self-inflicted injury or acts of war annually kill more than 5 million people worldwide and cause harm to 8 World Health Organization, The International Spinal Cord Society. International perspectives on spinal cord injury. Geneva: World Health Organization; Dementia: a public health priority. Geneva: World Health Organization; millions more. They account for 9% of global mortality, and are a threat to health in every country of the world. For every death, it is estimated that there are dozens of hospitalizations, hundreds of visits to emergency departments and thousands of doctor appointments. WHO s scope in this objective is very wide-ranging. It works to prevent injuries and violence and to mitigate their consequences by supporting improved data collection, developing science-based approaches to prevention, disseminating proven and promising interventions, enhancing training programmes, supporting multidisciplinary policies and action plans, and improving services for the victims and survivors of injuries and violence and their families. In , Member States continued to strengthen their violence and injury prevention programmes. The number of Member States that have national plans to prevent unintentional injuries or violence has increased from 30 in 2008 to 144 at the end of Almost one quarter of deaths worldwide caused by injury and violence are attributable to road traffic injuries. Half of those deaths are vulnerable road users, particularly pedestrians and cyclists. Road traffic injuries are the leading cause of death among young people aged 15 to 29 years. The biennium was part of the UN General Assembly s Decade of Action for Road Safety ( ), which aims to save 5 million lives. WHO hosts the Secretariat for the Decade of Action and supports countries in prevention, advocacy and services. Road traffic safety was improved in several countries by increasing the use of seat belts and helmets and decreasing drink driving and speeding. More than 100 countries took part in the UN s Global Road Safety Week, which focused on pedestrian safety. In addition, 181 Member States have submitted a complete assessment of their national road traffic injury prevention status to WHO; these were compiled in the Global Status Report on Road Safety that provides a baseline to measure progress during the decade. More than 100 countries took part in the Global UN Road Safety Week that focused on pedestrian safety. WHO and the Government of Mexico hosted almost 300 of the world s leading violence prevention experts at the 6 th Meeting on Milestones in the Global Campaign for Violence Prevention. The meeting presented new data on homicide and risk factors for interpersonal violence as well as new evidence on effective prevention of interpersonal violence. It also emphasised the need to improve the measurement of the success of efforts for violence prevention. Ministers and senior representatives from 12 governments discussed how they were addressing problems such as firearm-related homicide, child maltreatment, intimate partner and sexual violence, and elder abuse. The meeting took place during the week that Mexico page 30 SO 3 // Chronic noncommunicable conditions

31 dedicated to violence prevention. It was followed by the annual meeting of the WHO-led Violence Prevention Alliance. At the 66 th World Health Assembly, WHO and the governments of Brazil, Mozambique, Romania and Thailand launched the WHO Global Alliance for Care of the Injured, an alliance of 15 government and nongovernment organizations working across the spectrum of pre-hospital and hospital care and rehabilitation to help victims of trauma. In addition, WHO developed the Trauma Care Checklist to pilot in over 20 countries. A number of countries, including India, Iraq, Kenya, Mozambique and the Russian Federation, were supported in their plans to strengthen trauma care services with capacity building and direct technical assistance. WHO engaged ministries of health around the world and provided tools and materials, as well as supporting other conferences, among them the 11 th World Conference on Injury Prevention and Safety Promotion and other global advocacy campaigns. Several national and regional capacity-building workshops and training sessions were conducted across subjects such as trauma care, violence protection and road traffic safety. A series of global webinars with injury and violence prevention leaders was also initiated to help build capacity, and Mentor VIP, a global mentoring programme created by WHO, held two more cycles. EYE AND EAR HEALTH WHO works to prevent and control visual and hearing impairment at all levels. In addition to Universal eye health: a global action plan , which was endorsed at the 66 th World Health Assembly, 74 Member States reported implementation of comprehensive national plans for eye and ear health, and 93 Member States implemented WHO strategies for the prevention of visual and hearing impairment. In addition, 25 national childrens eye-care centres were supported and 10 were newly established. 74 Member States have implemented comprehensive national plans for eye and ear health care. The WHO Alliance for the Global Elimination of Blinding Trachoma by 2020 met and discussed data on country progress, reviewed implementation of strategies and identified solutions. Activities for the following year were agreed, and data, discussion records and recommendations were published in the meeting report. This international alliance of interested parties works to rid the world of trachoma, an infectious disease that is currently responsible of about 3% of the world s blindness. The effects of the disease are irreversible but blindness can be prevented if the active disease is treated. An estimated 84 million people require intervention. WHO also developed a number of documents on relevant topics including: investing in eye health and securing the support of decision-makers; the management of chronic eye conditions from a public health perspective; selected educational resources for clinical and public health eye-care professionals; guiding principles for neonatal and infant hearing screening; recommendations for promoting ear and hearing care through community-based rehabilitation; and improving accessibility of hearing devices in lowand middle-income countries. WHO provided support to countries and regions for their visual- and hearing-impairment prevention programmes. WHO regional workshops in the Regional Offices of Africa, the Americas and the Western Pacific were organized in 2013 to promote implementation of the WHA66.4 action plan at country level. In November 2013, with the assistance of WHO, Qatar organised a regional workshop to strengthen and integrate its ear- and hearing-care programme within its primary health care and health systems. TOBACCO CESSATION In addition to the countries being supported to provide free or partially free tobacco cessation support through primary health-care services, WHO provided technical support to 22 countries (mainly from the Eastern Mediterranean and Western Pacific Regions) to develop and improve their tobacco dependence treatment services in primary care. All Member States received WHO s capacity-building training package Strengthening Health Systems for Treating Tobacco Dependence in Primary Care. More information on this area can be found under strategic objective 6. ASSESSMENT OF THE ORGANIZATION- WIDE EXPECTED RESULTS Of the six Organization-wide expected results, two were fully achieved and four partly achieved. Organization-wide expected results 3.1 (advocacy and support provided to increase political, financial and technical commitment), 3.2 (guidance and support on implementation of policies, strategies and regulations) and 3.3 (capacity to collect, analyse, disseminate and use data) were partly achieved. For 3.1, the reason for partial achievement was lack of evidence for the indicator on Member States with a mental health budget of more than 1% of the total health budget ; and for 3.3, for the indicator number Chronic noncommunicable conditions // SO 3 page 31

32 of low- and middle-income Member States with basic mental health indicators annually reported. A systematic evaluation of these indicators using the Mental Health Atlas 2011 was not possible. Adoption of the comprehensive mental health action plan by the Health Assembly in resolution WHA66.8 has necessitated the inclusion of new indicators to replace the current ones, which are now obsolete. Indicators on Member States with a unit in the ministry of health or equivalent national health authority, with dedicated staff and budget, for the prevention and control of chronic noncommunicable diseases, and on the number of Member States that have adopted a multisectoral national policy on chronic noncommunicable diseases were not fully achieved owing to a lack of high-level commitment, shortage of resources and competing priorities, including the urgent need to prioritize other activities in a number of countries. Organization-wide expected result 3.2 was partly achieved as the indicator on Member States that have adopted a multisectoral national policy on chronic noncommunicable diseases was partly achieved based on the global capacity assessment survey conducted in Main reasons were inadequate high-level commitment, shortage of resources and competing priorities. Organization-wide expected result 3.5 (multisectoral, population-wide programmes) was not fully achieved because of the partial achievement of the indicator on the number of Member States implementing strategies recommended by WHO for the prevention of hearing or visual impairment. Limited resources dedicated to eye- and ear-care service provision at country level prevented full achievement. OWER OWER Rating Indicator Baseline 2012 Target 2013 Achieved 2013 OWER Rating Key: Fully achieved Partly achieved x Not achieved Member States whose health ministries have a focal point or a unit for injuries and violence prevention with its own budget The world report on disability and rehabilitation published and launched, in response to resolution WHA Member States with a mental health budget of more than 1% of the total health budget n/a Member States with a unit in the ministry of health, or equivalent national health authority, with dedicated staff and budget, for the prevention and control of chronic noncommunicable diseases Member States that have national plans to prevent unintentional injuries or violence Member States that have initiated the process of developing a mental health policy or law Member States that have adopted a multisectoral national policy on chronic noncommunicable diseases Member States that are implementing comprehensive national plans for the prevention of hearing or visual impairment Member States that have submitted a complete assessment of their national road traffic injury prevention status to WHO Member States that have a published document containing national data on the prevalence and incidence of disabilities Low- and middle-income Member States with basic mental health indicators annually reported n/a Member States with a national health reporting system and annual reports that include indicators for the four major NCDs Member States documenting, according to populationbased surveys, the burden of hearing or visual impairment page 32 SO 3 // Chronic noncommunicable conditions

33 OWER OWER Rating Indicator Baseline 2012 Target 2013 Achieved 2013 OWER Rating Key: Fully achieved Partly achieved x Not achieved Availability of evidence-based guidance on the effectiveness of interventions for the management of selected mental, behavioural or neurological disorders including those due to use of psychoactive substances. 12 interventions published and disseminated 14 interventions published and disseminated 19 interventions published and disseminated Availability of evidence-based guidance or guidelines on the effectiveness or cost-effectiveness of interventions for the prevention and management of chronic noncommunicable diseases. 6 interventions published and disseminated 8 interventions Published and disseminated 8 interventions published and disseminated Guidelines published and widely disseminated on multisectoral interventions to prevent violence and unintentional injuries Countries whose Health Ministries have begun scaling up services for mental neurological and substance use disorders Member States implementing strategies recommended by WHO for the prevention of hearing or visual impairment Member States that have incorporated trauma-care services for victims of injuries or violence into their health-care systems using WHO trauma-care guidelines Member States implementing community-based rehabilitation programmes Low- and middle-income Member States that have completed an assessment of their mental health systems using the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS) Low- and middle-income Member States implementing primary health-care strategies for screening of cardiovascular risk and integrated management of NCDs using WHO guidelines Member States with tobacco cessation support incorporated into primary health care More detailed information on indicators can be found in Annexes 2 and 3. FINANCIAL SUMMARY The budget approved by the Health Assembly for strategic objective 3 was US$ 114 million. Available funding by the end of the biennium was US$ 120 million, translating to 105% of the approved budget. Implementation as at 31 December 2012 was US$ 112 million, namely 99% of the approved budget and 94% of funds available. Funds available, as well as implementation, against the approved budget do show variation between the different major offices. The outcomes of the High-level Meeting of the United Nations General Assembly on the Prevention and Control of Noncommunicable Diseases and the First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control, both of which took place in 2011, have contributed to fundraising efforts. This is most evident for the Western Pacific Region and headquarters where the approved budgets for had also been significantly reduced from the previous biennium. Chronic noncommunicable conditions // SO 3 page 33

34 WHA APPROVED BUDGET FUNDS AVAILABLE (AS AT 31 DEC 2013) IMPLEMENTATION (AS AT 31 DEC 2013) (US$ 000) AFRO AMRO SEARO EURO EMRO WPRO HQ Total Implementation rates against funds available are more aligned and above 90% for all major offices except for the Eastern Mediterranean Region where regional political instability, lack of security and the predominance of emergency programmes remain a challenge for programme implementation and building of technical capacity at both regional and country level. LESSONS LEARNT Advocacy by WHO has had a significant impact on moving forward the global agendas on noncommunicable diseases, injuries and violence, mental health, disabilities, and blindness and deafness. The road maps provided by WHO s global action plans in these areas will continue to shift the focus of action from advocacy and normative guidance to implementation and monitoring of impact. Human and financial resources remain insufficient at national and global levels to tackle this objective s large agenda and the challenges posed by local conditions. Major impediments to progress have also included political instability, conflicts, natural disasters, chronic emergencies, and their profound social and economic consequences. However, efforts to gradually increase available resources and direct them to ensure national and local action will continue. page 34 SO 3 // Chronic noncommunicable conditions

35 SO 4 CHILD, ADOLESCENT, MATERNAL, SEXUAL AND REPRODUCTIVE HEALTH, AND AGEING To reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals Reducing child mortality and improving maternal health (Millennium Development Goals 4 and 5) remain significant aspirations for the Organization as 2015 approaches. Increased momentum and political will have driven substantial progress but, despite this, too many women and children died tragically this biennium. In March 2012, the United Nations Commission on Life-Saving Commodities for Women and Children was established to improve access to essential health supplies, such as antibiotics for pneumonia and oxytocin for obstetric bleeding, to save the lives of millions of women and children every year. By the end of 2013, access to effective health interventions for pregnant women, newborns and children in 100 countries had significantly improved. WHO gave essential technical support for relevant policies and strategies linked to these improvements. Workshops to increase information on and accountability for women s and children s health were held in more than 70 countries. The UN OneHealth tool for strategic planning was used in workshops in the African, South-East Asia and Western Pacific Regions. Seventy-three countries now have a policy of universal access to sexual and reproductive health services. Global research priorities for for adolescent sexual and reproductive health and for newborn health have been set. During this biennium 69 countries achieved the goal of having a functioning active healthy ageing programme consistent with WHA58.16 Strengthening active and healthy ageing. MATERNAL HEALTH Between 1990 and 2010, the global maternal mortality rate decreased by almost half, yet women still died from complications during pregnancy and childbirth during The 2.6 million stillbirths that occur every year remain an unacceptable calamity. WHO supports all countries particularly those with a high number of maternal and child deaths in their attempts to fulfil Millennium Development Goals 4 and 5. The Organization completed the multicountry Child, adolescent, maternal, sexual and reproductive health, and ageing // SO 4 page 35

36 survey on maternal and newborn health, and held workshops on surveillance and response in the 75 countries that account for 95% of maternal and child deaths. Countries in all regions revised their plans to reduce maternal, newborn and child mortality and to strengthen their capacity through strategic planning and analysis. During the biennium, revised guidelines on improving quality care for women, newborns and children were released. Seven countries in the South-East Asia Region integrated policies on universal access to interventions in this area. In the Eastern Mediterranean Region, nine countries with high death rates accelerated their plans following the saving the lives of mothers and children initiative and the resulting Dubai Declaration. In Europe, six Member States gave priority to improving the quality of hospital and primary care to reduce maternal mortality and morbidity. WHO completed the multicountry survey on maternal and newborn health, and held workshops on surveillance and response in the 75 countries that account for 95% of maternal and child deaths. In the Region of the Americas, 12 countries reported integrated policies on universal access to interventions for maternal, newborn and child health. More than 92% of deliveries were attended by skilled personnel and 21 countries endorsed the PAHO/WHO guidelines for increasing coverage with skilled care. In the Western Pacific Region, the main achievements were the finalization of the Regional Framework of Reproductive Health and the development of the Maternal Death Review programme in four countries. Seven countries developed frameworks to strengthen accountability for women s and children s health. Twenty-two priority countries in the African Region developed national plans for eliminating new HIV infections among children by 2015 and keeping their mothers alive. There has been a decrease in new HIV paediatric infections and an increasing proportion of women receive antiretroviral therapy. Most countries now have maternal death surveillance and response, and WHO is supporting 26 countries to strengthen their capabilities. in maternal and under-five survival. This triggered a global initiative coordinated by WHO and partners called Every Newborn: an Action Plan to End Preventable Deaths. Preterm births account for almost half of all newborn deaths worldwide. Many of these babies could be saved by improving care of serious complications such as infections and respiratory distress. Born Too Soon: the Global Action Report on Preterm Birth 10, co-authored by WHO, provides the first estimates on preterm birth and proposes actions to save babies lives. In the African Region, 28 countries revised their plans for reducing maternal and newborn mortality. Neonatal survival strategies were strengthened for both health-facility and home-based care. Essential newborn care training was conducted in 16 countries, bringing the total to 35 countries using the intervention. Major research studies were completed on home visits for newborns, treatment of possible serious bacterial infections, and the effect of Vitamin A supplementation on infant survival. The Eastern Mediterranean Regional Office supported the introduction of a newborn component into the integrated management of childhood illness clinical guidelines. Knowledge and skills relating to life-saving practices in safe motherhood were improved by strengthening the community component of maternal and newborn health programmes. In the European Region, WHO developed a tool for assessing the quality of antenatal and postpartum care for women and newborns, in close collaboration with neonatologists from the countries in which the tool was piloted. In the South-East Asia Region, newborn health was addressed through supporting a continuum of care from community to tertiary facility levels. In Nepal, a communitybased newborn-care programme was introduced with support from Save the Children, UNICEF and WHO. In the Western Pacific Region, Member States and technical experts reviewed the draft Action Plan for Healthy Newborns for WHO and UNICEF supplied tools to carry out the action plan. This region was the only one to develop this action plan prior to the launch of the Global Newborn Action Plan. At headquarters, a framework for priority action on HIV and infant feeding was updated, as were guidelines for postnatal care and basic newborn resuscitation. NEWBORN HEALTH In 2012, almost 3 million newborns died in the first month of life, the most risky period for child survival. Most of these deaths are preventable, yet newborn survival has lagged behind improvements 10 Born Too Soon: The Global Action Report on Preterm birth. Geneva: World Health Organization; page 36 SO 4 // Child, adolescent, maternal, sexual and reproductive health, and ageing

37 CHILD HEALTH Since 1990, the number of children dying before their fifth birthday has almost halved. In spite of this progress, 6.6 million children under five died in More than two million of these deaths were due to pneumonia and diarrhoea. Recognizing that the same interventions including exclusive breastfeeding, handwashing and appropriate treatments are often needed to prevent deaths from both diseases, WHO spearheaded the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea. The plan calls for an integrated approach, based on scientific evidence, to save children s lives. Stimulated by the Every Woman, Every Child initiative, efforts to reduce maternal and child mortality accelerated. WHO supported these efforts through the coordination of large multicentre research studies and the provision of practical technical guidance. The Organization updated its integrated management of childhood illness chart and a planning handbook to support implementation of community interventions. It also developed a three-part WHO/UNICEF training package and guidelines. Early childhood development and nutrition received increased attention and WHO brought experts together to review effective interventions with a focus on the role of the health sector. WHO also contributed to United Nations work on the rights of the child. In the African Region, progress in achieving Millennium Development Goal 4 varied among Member States. Antibiotic treatment for suspected pneumonia in children under five years had increased to 34% in By the end of 2013, 30 countries had implemented integrated management of childhood illness in 75% of their districts and 21 countries are implementing the integrated community case management for pneumonia, diarrhoea and malaria. All countries in the Eastern Mediterranean Region that implemented the integrated management of childhood illness strategy did so in more than 25% of their districts. Programmes in a number of countries, however, have been affected by political instability and lack of security. Many countries in the European Region made improving child and adolescent health a priority in this biennium. The Regional Office for Europe supported the increasing implementation of the integrated management of childhood illness strategy and improving the quality of integrated childcare in 15 countries. National authorities improved their ability to gather quality information and strengthen accountability for maternal and children s health. The Region of the Americas will achieve Millennium Development Goal 4 in 2014 if current trends continue. A number of countries in this region were among the first to demonstrate that it is possible to sharply lower child mortality when concerted action, sound strategies, adequate resources and political will are consistently applied. In the South-East Asia Region, a joint WHO/UNICEF regional strategy for newborn and child health was launched in November Member States have begun to pay attention to early childhood development and prevention of birth defects. Five of the nine countries implementing the integrated management of childhood illness strategy have extended coverage to more than 75% of districts. In the Western Pacific Region, the implementation of integrated management of childhood illnesses and essential child survival interventions are being continuously supported among priority countries. ADOLESCENT HEALTH Adolescents face many barriers to obtaining the health services and commodities that they need. During the past decade, there has been growing attention to adolescents in global reports and journals, and in national plans and strategies. WHO works with countries to develop national adolescent policies and survey tools to assess coverage of and improve access to quality adolescentfriendly health services. The Organization also published guidelines on preventing early pregnancy in adolescents in developing countries. WHO works with countries to develop national adolescent policies and survey tools to assess coverage of and improve access to quality adolescent-friendly health services. It also published guidelines on preventing early pregnancy in adolescents indeveloping countries. The Health Behaviour in School-age Children Study monitors the health and health behaviours of 11-, 13- and 15-year-olds in 43 countries in Europe and North America; the 2012 update published data from the survey. It remains one of the few valid sources of information currently available on adolescent health. Work started in 2013 on WHO s Child, adolescent, maternal, sexual and reproductive health, and ageing // SO 4 page 37

38 first global report on adolescent health, due for publication in In the African Region, 23 countries received technical and financial support to broaden access to adolescent-friendly health services; 18 countries have started integrating adolescent health interventions with provision of the human papillomavirus (HPV) vaccination. Health promotion in schools was established in 14 countries, and adolescent health has been placed on the agenda of all countries in the Eastern Mediterranean Region. Four countries in the European Region re-examined the role of school health and the quality of youthfriendly services and began to draw up national quality standards for adolescent services. In the South-East Asia Region, the adolescent health agenda has taken root. All countries except the Democratic People s Republic of Korea have increased implementation of national standards for adolescentfriendly health services. In the Western Pacific Region, a number of countries introduced adolescent-specific activities including a review of factors related to coerced sex, guidelines to enhance the management of nutritional problems in children and adolescents through diet therapy, and a mental health intervention package in primary care settings. SEXUAL AND REPRODUCTIVE HEALTH WHO published guidelines on a number of significant topics: the response of health systems and workers to intimate partner and sexual violence; cervical cancer and control; and optimizing the health workforce for reducing child mortality and improving maternal health. Research into sexual and reproductive health was supported under the Special Programme for Research, Development and Research Training in Human Reproduction in 29 institutions representing Member States from all WHO regions. An ambitious global research agenda was implemented on priority topics in sexual and reproductive health and rights including maternal and perinatal health, contraception, preventing unsafe abortion, controlling sexually transmitted infections and improving adolescents sexual and reproductive health. Research results arising from work supported by the Special Programme for Research, Development and Research Training in Human Reproduction were published in almost 200 peer-reviewed scientific journal articles. Despite significant funding gaps, 27 institutions in low-income countries were awarded grants to build capacity in sexual and reproductive health research. In collaboration with the African Region, a regional agenda for reproductive health was developed. A study on female genital mutilation in 28 countries showed that a total of 87 million women aged over 15 have been subjected to female genital mutilation; currently 3.3 million girls under the age of 14 are at risk. About 60 % of the girls and women affected live in the African Region and 40% live in the Eastern Mediterranean Region; 70% of all women who have suffered genital mutilation come from just four countries: Egypt, Ethiopia, Nigeria and Sudan. Accelerating Universal Access to Sexual and Reproductive Health Agenda for the African Region of the World Health Organization 11 was disseminated to all countries in the region. It provides guidance on five thematic areas: maternal and newborn health, family planning, harmful practices (including genital mutilation), preventing unsafe abortion, sexually transmitted diseases, HIV/AIDS, and cervical cancer. The report of the of the Commission on Women s Health in the African Region, Addressing the challenge of women s health in Africa, was launched by Her Excellency Mrs Ellen Johnson Sirleaf, the President of the Republic of Liberia and the Honorary President of the African Women s Health Commission. The report highlights the challenging situation African women face throughout their lifetimes and gives recommendations for advancing the health of women in the Region. Intimate partner violence and sexual violence against women is an important issue, particularly in the African Region and in Europe. WHO issued two key documents in this area during the biennium: on the first global/ regional estimates of violence against women, and WHO guidelines on health systems response to violence against women. Additionally, WHO worked with the Inter-Parliamentary Union and other regional parliaments, such as the European Parliament and the Pan African Parliament, to advocate the inclusion of sexual and reproductive health on agendas, including issues such as gender-based violence and child marriage. 11 Accelerating Universal Access to Sexual and Reproductive Health Agenda for the African Region of the World Health Organization. Brazzaville: World Health Organization Regional Office for Africa; page 38 SO 4 // Child, adolescent, maternal, sexual and reproductive health, and ageing

39 H4+ working together for women s and children s health is a joint effort by WHO, and partners programmes from UNAIDS, UNFPA, UNICEF, UN Women, and the World Bank to accelerate progress towards Millennium Goals 4 and 5. H4+ has become a one-stop shop for countries to access technical and financial support on reproductive, maternal, newborn and child health issues. ACTIVE, HEALTHY AGEING The proportion of older people in the population is increasing in almost every country. By 2050, around 2000 million people in the world will be aged 60 years and over, with 400 million aged over 80. Of them, 80% will be living in what are now low- or middleincome countries. The Global Age-friendly network expanded to over 150 member cities in 21 countries worldwide, as well as 10 affiliated country programmes. Current health systems, particularly in these countries, are not adequately designed to meet the chronic care needs that arise with population ageing. In many places, health systems will need to move to a more comprehensive continuum of care that links all stages of life and deals with people who have multiple health problems. The Global Age-friendly network expanded to over 150 member cities in 21 countries worldwide, as well as 10 affiliated country programmes. Functioning active, healthy ageing programmes were launched by 69 countries. The European Healthy Cities Network reveals that 80% of cities now have initiatives on healthy ageing and it is a topic that frequently has the most impact in cooperation with the European Regional Office. The Secretariat supports Member States by providing guidance on key issues and promoting evidence into policy and action at country level. The WHO Knowledge Translation on Ageing and Health Approach fosters evidence-based policies on healthy ageing at country level and encourages the exchange of experience and mutual learning among countries. ASSESSMENT OF THE ORGANIZATION- WIDE EXPECTED RESULTS Seven of the eight Organization-wide expected results have been fully achieved, while one is rated as partly achieved. The indicator target on the number of Member States that have developed, with WHO s support, a policy on achieving universal access to sexual and reproductive health was not fully achieved because of financial constraints and inadequate human resources to support implementation. Child, adolescent, maternal, sexual and reproductive health, and ageing // SO 4 page 39

40 OWER OWER Rating Indicator Baseline 2012 Target 2013 Achieved 2013 OWER Rating Key: Fully achieved Partly achieved x Not achieved Targeted Member States that have an integrated policy on universal access to effective interventions for improving maternal, newborn and child health Member States that have developed, with WHO support, a policy on achieving universal access to sexual and reproductive health Research centres that have received an initial grant for comprehensive institutional development and support Completed studies on priority issues that have been supported by WHO New or updated systematic reviews on best practices, policies and standards of care for improving maternal, newborn, child and adolescent health, promoting active and healthy ageing or improving sexual and reproductive health Member States implementing strategies for increasing coverage with skilled care for childbirth Member States implementing strategies for increasing coverage with interventions for neonatal survival and health Member States implementing strategies for increasing coverage with child health and development interventions Member States that have expanded coverage of the integrated management of childhood illness to more than 75% of target districts Member States with a functioning adolescent health and development programme Member States implementing the WHO reproductive health strategy to accelerate progress towards the attainment of international development goals and targets related to reproductive health agreed at the 1994 International Conference on Population and Development (ICPD), its five-year review (ICPD+5), the Millennium Summit and the United Nations General Assembly in Targeted Member States having reviewed their existing national laws, regulations or policies relating to sexual and reproductive health Member States with a functioning active, healthy ageing programme consistent with WHA58.16 Strengthening active and healthy ageing More detailed information on indicators can be found in Annexes 2 and 3. page 40 SO 4 // Child, adolescent, maternal, sexual and reproductive health, and ageing

41 WHA APPROVED BUDGET FUNDS AVAILABLE (AS AT 31 DEC 2013) IMPLEMENTATION (AS AT 31 DEC 2013) (US$ 000) AFRO AMRO SEARO EURO EMRO WPRO HQ Total FINANCIAL SUMMARY The approved budget for strategic objective 4 was US$ 218 million, of which US$ 186 million were for base programmes and US$ 32 million for special programmes and collaborative arrangements. Available funding at the end of 2013 was US$ 266 million, of which US$ 212 million were distributed to base programmes and US$ 54 million to special programmes and collaborative arrangements. Implementation as at 31 December 2013 was US$ 237 million, which corresponds to 108% of the approved budget and 89% funds available. It should be noted that some funds were received too late to be spent during the biennium. Available funds for the Regional Office for the Eastern Mediterranean Region amounted to 274% against the approved budget at the end of 2013, mainly reflecting a grant from the Canadian International Development Agency for strengthening emergency obstetrics care in hospitals in South Sudan. During the biennium, additional resources in excess of the approved budget for the Regional Offices for South-East Asia, the Western Pacific and headquarters were available for, among others, activities on maternal and child health in several countries. Implementation of funds available was greater than 89% for all major offices. The funding level for the special programmes and collaborative arrangements was also well above the originally World Health Assembly-approved budget at 167%. This portion of the budget covers the work of the UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction. LESSONS LEARNT If Millennium Development Goals 4 and 5 are to be achieved by 2015, WHO will need to intensify its work, including through collaboration with partners such as the H4+ (UNAIDS, UNFPA, UNICEF, UN Women and the World Bank). There have been many new programmes launched in the areas of reproductive, maternal, newborn, child and adolescent health and better coordination is needed among partners to implement and monitor these initiatives. For this, strengthening technical capabilities and human resources in WHO country offices will be essential. Further resources are needed to engage sufficient investment in countries. Working with other sectors is vital. Despite growing worldwide attention to population ageing and health, there is an urgent need to do more: to bring together key experts to advise decision-makers on action priorities, to renew out-of-date guidance, and to coordinate global responses to ageing and health. Child, adolescent, maternal, sexual and reproductive health, and ageing // SO 4 page 41

42 SO 5 EMERGENCIES AND DISASTERS To reduce the health consequences of emergencies, disasters, crises and conflicts, and minimize their social and economic impact WHO provides policy advice, guidance and tools to Member States, enabling them to strengthen their capacities to minimize the health impact of emergencies and disasters while promoting the wellbeing and dignity of affected populations. When national capacities are overwhelmed, WHO contributes to response and recovery in the health sector by leading and coordinating the international health sector response and by promoting and monitoring access to and quality of health service delivery. WHO and Member States are making good progress in building their preparedness and response capacities to minimize morbidity, mortality and disability during emergencies and in the recovery period. During the biennium, the Secretariat worked closely with Member States in times of emergency, particularly in the most urgent and complex situations, including in Central African Republic, Mali, Nigeria, the Philippines, Somalia and the Syrian Arab Republic. Ongoing reforms have helped WHO to improve its performance at country level. The Organization is now better able to support Member States with leadership and coordination of health clusters and health sectors; by leading needs assessments and strategic planning; by producing information bulletins; by promoting social communications; by strengthening surveillance and early warning systems; and by improving the quality of interventions based on best practice. WHO is working to be able to fulfil its obligation as a health cluster lead agency predictably and to serve as the Provider of Last Resort when necessary, providing health services to affected populations such as running mobile clinics in the Syrian Arab Republic or conducting vaccination campaigns in the Central African Republic. WHO SUPPORTS MEMBER STATES TO STRENGTHEN THEIR CAPACITIES TO MINIMIZE HEALTH IMPACTS OF EMERGENCIES AND DISASTERS The Secretariat supported Member States to put in place emergency and disaster risk-management programmes. This included building more resilient health facilities, strengthening national emergency response capabilities, and forging stronger strategic partnerships at global, national and subregional levels within the health sector and beyond. WHO provided technical support so that Member States could make hospitals safer; strengthen preparedness capacities (for example, for the 2012 London Olympics); improve urban emergency management; and establish Emergency Operations Centres in multiple countries, including the Lao People s Democratic Republic and Mongolia. At the global level, WHO further developed a policy framework for health, a capacity page 42 SO 5 // Emergencies and disasters

43 survey tool, and a safe hospitals index, which now covers over 2900 hospitals and other health facilities in 32 countries and territories. WHO continued to promote health as a central issue in regional and global discussions on emergency and disaster risk management. During the biennium, 40% of Member States completed a health risk assessment and worked to make hospitals safer, and 31% conducted an emergency simulation exercise. WHO STRENGTHENS ITS OWN CAPACITIES TO PROVIDE A PREDICTABLE AND HIGH QUALITY RESPONSE TO EMERGENCIES AND DISASTERS, IN SUPPORT OF MEMBER STATES To be ready to support Member States during emergency responses, WHO reformed its institutional readiness programme. This included establishing a Global Emergency Management Team to lead and monitor WHO s emergency work, conducting Organization-wide emergency simulation exercises, developing the Emergency Response Framework (setting out WHO s commitments, including standards against which to measure performance, and policies for optimizing a timely and effective response), and creating and testing a mechanism to rapidly deploy emergency experts. WHO IS OPERATIONAL IN HUMANITARIAN EMERGENCIES AND LEADS THE HEALTH CLUSTER FOR IMPROVED HEALTH SERVICE DELIVERY WHO s operational role in supporting Member States and partners often occurs in situations with limited humanitarian access, security constraints, population displacement, increased prevalence of both communicable and noncommunicable diseases, limited access to water and sanitation, malnutrition, and poor delivery of services. In such cases, the Organization provided health leadership and coordination, including needs assessments, surveillance and early warning systems, and other technical assistance. WHO, which leads the Global Health Cluster of 38 international humanitarian agencies that work to protect people s health in emergencies, headed the health cluster to the 29 countries applying the cluster approach. In the second half of the biennium, WHO s responses in the Central African Republic, the Philippines, South Sudan and the Syrian Arab Republic demonstrated the significant shift made in its emergency response mechanisms. In these emergencies, WHO mobilized Organization-wide action and used the Emergency Response Framework to deliver predictable and effective action, including rapid assessments, coordination mechanisms, improved reporting, disease surveillance and response systems, and regularly updated health action plans. The safe hospitals index has now been applied to over 2900 hospitals and other health facilities in 32 countries and territories. WHO supported many Member States to manage the public health consequences of a myriad of small and large emergencies. Some were natural disasters like drought in the Sahel region, earthquakes in Burma, Guatemala and Peru, floods in Paraguay, Cambodia and the Maldives and the cholera outbreak and tropical storm Isaac in Haiti. Others involved rapid response to urban disasters, such as an ammunitions explosion in Brazzaville, Congo, unrest in Myanmar, and a factory collapse in Bangladesh. The Organization also supported rapid assessments in Somalia, coordination and capacity building for displaced populations and refugees in Iraq, Jordan and Lebanon, and training in surgical care, mass casualty management and disease surveillance. In Afghanistan, WHO helped establish almost 40 temporary, mobile and fixed health units, including First Aid Trauma Posts. In Pakistan, the Organization mapped health-care facilities, developed strategic plans, strengthened communicable disease surveillance and response systems, and trained more than 1000 health-care workers on management of severe malnutrition. In Sudan, WHO supported 65 mobile clinics serving vulnerable populations. Quarterly needs assessments, situation monitoring and analysis were conducted using the Health Resources Availability Mapping System and interagency assessment missions. WHO led the joint interagency health assessment of the refugee camps on the border between the Syrian Arab Republic and Turkey, supported emergency responses in Kosovo and Tajikistan, led the health cluster in Tajikistan and southern Turkey, and supported a post-crisis recovery project in Kosovo. It conducted a joint health cluster evaluation of the response to the Sahel crisis, and provided continued support in the aftermath of Japan s Fukushima nuclear crisis in It also generated communicable disease profiles during crises in Nigeria and the Syrian Arab Republic. Despite limited resources, WHO has responded to an extraordinary number of emergencies throughout the biennium. Of the 29 acute emergencies graded in that period under the Emergency Response Framework, the most challenging (at Grade 3) have been those in the Central African Republic, Mali and the Syrian Arab Republic. The humanitarian crisis in the Syrian Arab Republic triggered Organization-wide support through WHO offices in the Syrian Arab Republic, Egypt, Iraq, Emergencies and disasters // SO 5 page 43

44 Jordan, Lebanon and Turkey. The Emergency Response Framework ensured that WHO s actions rapid assessments, coordination mechanisms, improved reporting, disease surveillance and response systems, and regular health action plan updates were more predictable and effective. In Mali, in the face of another complex humanitarian crisis, WHO led an exercise to assess and map health resources, which has been central to the government-led transition plan for the health sector. WHO worked with the Ministry of Health on a rapid assessment of services in the Central African Republic, and assisted with delivery of services. ASSESSMENT OF THE ORGANIZATION- WIDE EXPECTED RESULTS Progress was made in all regions towards achieving Organization-wide expected result strengthening national emergency risk management and WHO s readiness but the overall rating of partly achieved reflected the ambitious indicator targets, the Organizational shift required to meet them, incomplete normative work and a lack of staff and resources. The Secretariat made substantial progress in the area of Organizational readiness. The enormity of the effort required by WHO to respond to emergencies throughout the biennium, including three Grade 3 emergencies, was constrained by the time and human resources available. The fact that limited resources were allocated to the work at national, international and headquarters levels was a contributing factor. Organization-wide expected result 5.7 emergency response operations is also rated as partly achieved. Even though good progress was made, a consistently high standard of performance has yet to be achieved in WHO s response to large-scale emergencies. This was evident in its inadequate response to the public health consequences of the drought in the Sahel region of Africa and the civil unrest in Myanmar. In the second half of the biennium, WHO s response in the Central African Republic, the Philippines, South Sudan and the Syrian Arab Republic demonstrated a significant change in its emergency response work. Constraints on optimum performance included security concerns, shortages of health personnel and supplies, rising costs, difficulties associated with transport, and insufficient funding, particularly in the Central African Republic. In addition, the indicator target is demanding and ambitious, and WHO lacked the required core human and financial resources to be appropriately agile, rapid and ready. OWER OWER Rating Indicator Baseline 2012 Target 2013 Achieved 2013 OWER Rating Key: Fully achieved Partly achieved x Not achieved Countries that have completed a health risk assessment and have, at a minimum, initiated the safe hospitals component of a national risk reduction programme for health. 47% 60% 40% Countries that have conducted an emergency health response simulation at least once during the biennium. n/a 50% 31% WHO country offices that conducted an emergency health response simulation according to a written contingency and business continuity plan at least once during the biennium. n/a 20% 5% Humanitarian emergencies with a coordinated risk assessment and initial health sector response plan within 72 hours of onset. 70% 80% 67% More detailed information on indicators can be found in Annexes 2 and 3. FINANCIAL SUMMARY The total approved budget for strategic objective 5 was US$ 381 million, of which US$ 65 million (17%) was for base programmes and US$ 316 million (83%) for outbreak and crisis response. As at 31 December 2013, the total available resources for the strategic objective amounted to US$ 405 million, corresponding to 106% of the approved budget. The implementation rate against available funds as of 31 December 2013 for all segments was 95% against the approved budget and 90% against available resources. The WHA approved programme budget for strategic objective base programmes was US$ 65 million. Funding for WHO s core work in supporting national emergency risk management and Organizational readiness was insufficient, and this is reflected in the partly achieved rating for Organization-wide expected result 5.1 in most major offices. page 44 SO 5 // Emergencies and disasters

45 WHA APPROVED BUDGET FUNDS AVAILABLE (AS AT 31 DEC 2013) IMPLEMENTATION (AS AT 31 DEC 2013) (US$ 000) AFRO AMRO SEARO EURO EMRO WPRO HQ Total A total of US$ 351 million of funds available were for outbreak and crisis response, which corresponds to 111% of the approved budget for the segment which was US$ 316 million. These funds were used largely for emergency actions in response to protracted complex emergencies in the African and Eastern Mediterranean Regions, as well as for acute emergencies, for example in Mali, the Philippines, the Sahel region of Africa and the Syrian Arab Republic. Headquarters expenditure of funds towards response activities was largely for the procurement of stand-by emergency medical supplies and the rapid deployment of emergency experts. The Regional Offices for Africa and the Eastern Mediterranean receive significantly larger portions of these funds than other major offices because of the number and frequency of emergencies in those regions, and weaker national capacities for managing risk. LESSONS LEARNT WHO s role in advocating the inclusion of health within the emergency risk management agenda was successful. Member States need a policy framework, guidance and tools to translate emergency risk management concepts into action. WHO s reforms have been beneficial, but need to be strengthened and institutionalized. Collaboration across WHO enhances the quality of the Organization s emergency response. The Global Emergency Management Team has played an essential role in standardizing WHO s emergency work and in applying and tracking performance. Strong partnerships are also an essential component for emergency risk management for health, including during emergency responses. However, WHO does not have the right staff in the right places with the right skills, and is not investing in sufficient staff development, including in the areas of project design, management and reporting. WHO needs to provide stronger leadership for the Global Health Cluster and more consistent support for country health clusters. Before the end of the biennium, steps had been taken to apply these lessons, including the establishment of a Global Health Cluster unit, promoting standard operating procedures, more systematically tracking performance, and designing a staff development plan. Emergencies and disasters // SO 5 page 45

46 SO 6 RISK FACTORS FOR HEALTH To promote health and development, and prevent or reduce risk factors for health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex Cardiovascular diseases, cancers, diabetes and chronic respiratory diseases are the causes of 63% of all deaths each year around the world. They share four major behavioural risk factors: tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity. They also share common factors such as raised blood pressure, raised blood glucose, raised blood lipids, and obesity. Complex forces cultural, economic, political and social combine to influence these risk factors, and WHO and ministries of health around the world are working across all government sectors and civil society to formulate policies and engaging with private industry excluding the tobacco industry to promote action. With the technical support of the Secretariat, Member States focused on increasing health promotion policies and plans, and building collaboration and communication between ministries of health, academia, media and the public. This included national campaigns and innovative health literacy work. The global monitoring framework for noncommunicable diseases was adopted by the World Health Assembly in May 2013 to enable global tracking of progress on the prevention and control of noncommunicable diseases. The framework provides a structure to help countries monitor not just the extent of these diseases and their risk factors, but also the progress of measures put in place to halt the noncommunicable diseases epidemic. A total of 102 Member States now monitor the risk factors of noncommunicable diseases in their adult populations using the WHO STEPwise approach, and 83 countries survey risk factors in their youth at national level. During , WHO assisted the implementation of 19 STEPwise adult-based surveys and 13 Global School Health Surveys. All of this data significantly assists policy and programmesetting work. The Helsinki Statement on Health in All Policies was endorsed by 659 high-level government officials and experts from 122 Member States, WHO and UN experts, academics and civil society representatives at the 8 th Global Conference on Health Promotion in Helsinki, Finland, in June The Conference produced a large number of technical papers, with case studies from all six regions, and included the Health in All Policies Framework for Country Action. The WHO Framework Convention on Tobacco Control (FCTC) is the only treaty under the auspices of WHO. By the end of 2013, there were 177 parties to the WHO Framework Convention on Tobacco Control. page 46 SO 6 // Risk factors for health

47 As part of its mandate to support and sustain excellence and innovation in public research on health, the WHO Centre for Health Development in Kobe, Japan, provided substantial support to 40 countries to implement its Urban Health Equity Assessment and Response Tool for identifying and reducing health inequities in cities. The WHO Centre also produced best practice examples to help countries explore ways of implementing Health in All Policies. The capacity of countries to use data-collection tools and systems, as well as data on sexual behaviour, was strengthened. WHO worked with partners in support of the London Summit on Family Planning held in 2012 in order to meet the contraceptive needs of countries with the highest gaps and to promote safer sexual behaviour. The Secretariat supported five countries in the African Region to strengthen their health information systems in connection with measuring core indicators of reproductive and sexual health and behaviour. It also supported enhanced sexuality education programmes in the European Region, and the integration of sexual health education in adolescent health programmes in the South-East Asia Region. 102 Member States use the WHO STEPwise approach to monitor the risk factors of noncommunicable diseases in their adult populations. Progress was made in building capacity in oral health promotion. Measures set out in the Minamata Convention on Mercury in January 2013 were introduced to reduce the use of dental amalgam, encourage the effective use of fluoride, promote cancer prevention, and to promote oral health in the ageing population. TOBACCO USE Tobacco use kills nearly six million people each year and is one of the largest preventable risk factors for noncommunicable diseases. WHO assisted Member States in implementing 32 Global Youth Tobacco Surveys and nine Global Adult Tobacco Surveys. Guidelines were published on the management of tobacco use and exposure to second-hand smoke during pregnancy. During the biennium, with WHO assistance, countries made substantial progress in implementing WHO FCTC provisions. More than 2.3 billion people live in countries that have introduced at least one of the most cost-effective demand-reduction measures in the WHO FCTC: tobacco taxes, smoke-free environments, pictorial health warnings, and tobacco advertising, promotion and sponsorship bans. For example, 32 countries have introduced excise taxes that represent at least 75% of the price of each cigarette pack. In addition, 43 countries encompassing 1.1 billion people or almost 16% of the world s population have legislated to ban all indoor smoking. Two cities Hong Kong Special Administrative Region of China and Houston and six states and provinces with large cities Chicago, Jakarta, Melbourne, Mexico City, New York and Sydney have implemented comprehensive smoke-free laws independently of national authorities. 43 countries encompassing 1.1 billion people or almost 16% of the world s population have legislated to ban all indoor smoking. By 2013, 30 countries (covering more than 1 billion people) had adopted pictorial warnings that occupy at least 50% of the main surface area of cigarette packets. In December 2012, Australia became the first country to implement plain packaging on cigarette packets. Also, by the end of the biennium, 24 countries with 10% of the world s population had legislated a total ban on tobacco advertising, promotion and sponsorship. World Tobacco Day 2013 focused on the need to continue this trend. In addition, nearly 3.8 billion people (54% of the world s population) live in the 23 countries that aired at least one national anti-tobacco mass media campaign in 2011 and Through the Tobacco Laboratory Network, WHO developed international testing standards for the contents and emissions of tobacco products. The tobacco industry has reacted aggressively to some of these measures, using trade and investment mechanisms to combat anti-tobacco activities. In response, WHO provided technical advice to Member States to counter the industry s interference at a national level and to better navigate the trade and investment issues related to tobacco control. SUBSTANCE ABUSE Harmful use of alcohol is responsible for 4% of all deaths in the world and contributes to poor health globally, devastating families and communities. At the World Health Assembly in 2010, delegates from all WHO Member States reached consensus on resolution WHA63.13 endorsing the global strategy to reduce the harmful use of alcohol. In the last biennium, at least 90 Member States developed, revised or were in the process of developing a national alcohol policy with reference to the WHO global strategy, and a significant number of Member States now have a substance-abuse unit in their ministries of health. Risk factors for health // SO 6 page 47

48 In collaboration with Member States, WHO conducted a global survey on alcohol and health in 178 countries covering 98% of the world s population. This survey gathered significant information about alcohol consumption, alcoholrelated harm, and policy responses which led to evidence-based workshops and network meetings on alcohol policy development for government officials from more than 100 countries. The findings guided the development and effective implementation of alcohol policies and strategies in countries. Across the regions, data collection, programme initiation and policy development with the goal of reducing the harmful use of alcohol continued to increase. A WHO co-hosted conference held in Thailand in February 2012 provided a global platform to exchange ideas, share experiences and build new partnerships to raise awareness of the public health problems associated with alcohol. The Organization also initiated and supported international research projects on harm to others from drinking, prenatal alcohol exposure and child development, as well as on alcohol and infectious diseases such as HIV and TB. WHO conducted a global survey on alcohol and health in 178 countries covering 98% of the world s population. Around the world, at least 15.3 million people have drug-use disorders, and injecting drug use is reported in 148 countries of which 120 countries report HIV infection among this key population group. In collaboration with the United Nations Office on Drugs and Crime, WHO provided technical support for drug dependence treatment and care to 64 countries, aiming to reduce the burden on public health associated with drug and alcohol use. Technical guidance and training materials linked to the WHO Mental Gap Action Programme were developed to identify and manage substance abuse and substance use disorders in health-care services. WHO continues to promote early identification, screening and brief interventions for substance use in primary care, and for mental and substance use disorders in general care using the WHO ASSIST package. Guidelines on the identification and management of substance-abuse disorders in pregnancy were developed and prepared for publication. At the end of 2013, 67 Member States had developed, with WHO support, strategies, plans and programmes for combating or preventing public health problems caused by alcohol, drugs and other psychoactive substance use. This represents a major achievement; in 2008, only 25 Member States had strategies and plans in place. Two information systems the Global Information System on Alcohol and Health and the Information System on Prevention and Treatment Resources for Substance Use Disorders were developed and integrated into the Global Health Observatory. PROMOTING HEALTHY DIET AND PHYSICAL ACTIVITY Countries made substantial progress on developing evidence-based policies and strategies to improve diets and promote physical activity. At the end of 2013, 90 Member States had adopted multisectoral strategies and plans for healthy diets or physical activity based on the WHO Global Strategy on Diet, Physical Activity and Health. Obesity was identified as a public health issue in many countries, and childhood obesity was an important focus of the biennium s activities; among other measures, the Organization supported Member States in setting policy priorities on obesity in children, marketing of food and promotion of physical activity. Multisectoral workshops for population-based prevention of childhood obesity were carried out in 17 countries. Technical support was provided to Fiji, Hungary and Mexico on fiscal measures to reduce consumption of foods high in fats, sugar and salt, and to Malta to promote physical activity. The European Network on Reducing Marketing Pressures on Children, especially in school settings, continued to work with WHO to encourage Member States to act on the recommendations on marketing foods and non-alcoholic beverages to children. A number of countries now promote physical activity throughout life, some with a particular reference to physical activities at school. A number of European countries have introduced regulations to limit the marketing to children of foods high in fat, sugar and salt. The tools for prioritizing population-based prevention of childhood obesity were translated and are now available in English, French and Russian. Technical assistance was also provided for various strategies on reducing salt intake in the population, including assistance for setting targets for industry reform. Several Latin American countries have also used WHO guidance processes to develop their population strategies. An expert group was convened to ensure that the two strategies on salt reduction and iodine fortification in public health can successfully coexist, and even be synergised. In all WHO regions, multisectoral workshops to build capacity were held at the regional and country levels, and included representatives of relevant ministries, such as agriculture, education, sport and recreation. The success of these workshops benefited from the participation of all community sectors related page 48 SO 6 // Risk factors for health

49 to diet and physical activity. Furthermore, WHO s endorsement of the voluntary global targets on obesity, physical inactivity and sodium/salt intake supports ministers of health in their advocacy efforts. SEXUAL AND REPRODUCTIVE HEALTH There were significant positive changes in the promotion of sexual and reproductive health across multiple regions. In a number of countries the use of data collection systems, including data on sexual behaviour, improved during With support from WHO, 34 Member States generated evidence on the determinants and/or consequences of unsafe sex with support from WHO compared to 9 in WHO worked with partners to support the Family Planning Summit 2012, with the aim of improving access to contraceptive information and services and promoting safer sexual behaviour. The African Region was particularly active in this area: eight countries adopted national policies to implement medical male circumcision services in conjunction with HIV/AIDS strategies, and six countries developed strategies to address the consequences of unsafe sex. WHO worked with five African countries to strengthen their health information systems for measuring key indicators for reproductive and sexual health and behaviour. It also updated the African Region s safe sex database. The Organization worked to enhance sexuality education programmes in the European Region. WHO integrated sexual health education into adolescent health programmes in the South-East Asia Region, promoting safe sexual behaviour to prevent pregnancy, STIs and HIV transmission. In the Western Pacific Region the focus was on human rights and the reduction of stigma in its countries. CROSS-SECTORAL COLLABORATION ON HEALTH PROMOTION Reducing the risk factors for noncommunicable diseases requires extensive collaboration between government departments, agencies and civil society. Challenges will always be encountered when working across sectors and countries. Effective communication and coordination between different partners is time-consuming and there is limited competency and leadership in some countries. The African Region conducted workshops in 8 countries on strengthening leadership and stewardship roles of Ministries of Health in coordinating multisectoral actions to address key determinants of health across priority conditions and sectors. The region also documented cases studies on multisectoral actions in 9 countries and disseminated them widely. Some regions were able to overcome these problems with continued skills-building activities, the acknowledgement of cross-sectoral and cross-unit challenges, and with regular regional and stakeholder communication. Providing evidence and examples of positive policy changes also helps collaborative efforts. Some regions initiated approaches ranging from distance coaching to professional simultaneous translation to overcome geographical and language barriers at workshops. ASSESSMENT OF THE ORGANIZATION- WIDE EXPECTED RESULTS Overall, four of the six Organization-wide expected results were fully achieved, while two were rated as partly achieved. These were to do with national systems of surveillance for risk factors youth surveys were on track but adult survey results were slightly lower than expected, and therefore 102 Member States instead of 105 achieved the target and for unhealthy diet and physical inactivity, where, although largely successful, some regions reported a lack of political acceptance and a shortage of human and financial resources. Due to these reasons and despite the fact that both indicators under Organization-wide expected result 6.5 were fully achieved the result was overall rated as partly achieved. Risk factors for health // SO 6 page 49

50 OWER OWER Rating Indicator Baseline 2012 Target 2013 Achieved 2013 OWER Rating Key: Fully achieved Partly achieved x Not achieved Countries that have been supported to build capacity to strengthen multi-sectorial action for health Cities that have implemented healthy urbanization programmes aimed at reducing health inequities Member States with a functioning national surveillance system for monitoring major risk factors to health among adults based on the WHO STEPwise approach to surveillance Member States with a functioning national surveillance system for monitoring major risk factors to health among youth based on the Global school-based student health survey methodology Member States having comparable adult tobacco prevalence data available from recent national representative surveys, such as the Global Adult Tobacco Survey (GATS) or STEPS Member States with comprehensive bans on smoking in indoor public places and workplaces Member States with bans on tobacco advertising, promotion and sponsorship Member States that have developed, with WHO support, strategies, plans and programmes for combating or preventing public health problems caused by alcohol, drugs and other psychoactive substance use WHO strategies, guidelines, standards and technical tools developed in order to provide support to Member States in preventing and reducing public health problems caused by alcohol, drugs and other psychoactive substance use Member States that have adopted multisectoral strategies and plans for healthy diets or physical activity, based on the WHO Global Strategy on Diet, Physical Activity and Health WHO technical tools that provide support to Member States in promoting healthy diets or physical activity Member States generating evidence on the determinants and/ or consequences of unsafe sex with support from WHO Member States generating comparable data on unsafe sex indicators using WHO STEPS surveillance tools More detailed information on indicators can be found in Annexes 2 and 3. FINANCIAL SUMMARY The approved budget for strategic objective 6 was US$ 122 million, of which US$ 111 million (90%) was for base programmes and US$ 11 million (10%) for special programmes and collaborative arrangements. Available funding at the end of 2013 was US$ 103 million (84% of the approved budget): US$ 93 million for base programmes (84% of the approved budget for the segment) and US$ 10 million for special programmes and collaborative arrangements (92% of the approved budget for the segment). Implementation as at 31 December 2013 was US$ 97 million, which corresponds to 79% of the approved budget and 94% of the available resources. A total of US$ 88 million was for implementation of base programmes, which corresponds to 79% of the approved budget for base programmes and page 50 SO 6 // Risk factors for health

51 WHA APPROVED BUDGET FUNDS AVAILABLE (AS AT 31 DEC 2013) IMPLEMENTATION (AS AT 31 DEC 2013) (US$ 000) AFRO AMRO SEARO EURO EMRO WPRO HQ Total 94% of the available funds for the budget segment. Implementation for special programmes and collaborative arrangements was US$ 9 million, 80% of the approved budget and 87% of the funds available. Adequate financing remains a challenge and a concern for strategic objective 6 as only 84% of the global budget was funded. For four of the seven major offices, funding was less than 70% of the approved budget, which does have some impact on the ability to achieve Organization-wide expected results. In the base programme segment, the two major offices with the highest level of funding headquarters and the Regional Office for the Western Pacific benefited from larger amounts of specified voluntary contributions. Implementation rates against funds available are all above 90%, indicating a satisfactory capacity to implement where funds are available. LESSONS LEARNT the country level and strengthening the surveillance of risk factors for noncommunicable diseases. The availability of easily adaptable and well-developed tools and methods such as STEPS and the globalbased student health survey help countries to put this surveillance in place. Political instability, lack of resources and competing priorities can hinder implementation, but these obstacles can be overcome through regional workshops to help countries plan surveys and analyse data; harnessing collaborating centre support; advocacy at regional and country levels to highlight how important surveillance is; and continuous and direct contact with country-based staff. The overall improvement in the implementation of the WHO Framework Convention on Tobacco Controls has faced the renewed aggressiveness from the tobacco industry using trade and investment mechanisms. In response, WHO provided to its Member States technical advice to design national plans to counter the industry s interference and to better navigate the trade and investment issues related to tobacco control. Globally agreed targets and indicators and the Global Monitoring Framework adopted by the World Health Assembly in 2013 are stimulating action at Risk factors for health // SO 6 page 51

52 SO 7 SOCIAL AND ECONOMIC DETERMINANTS OF HEALTH To address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, gender-responsive, and human rights-based approaches Health and life expectancy are not just based on genetics and individual life choices. When and where individuals are born, their gender, and the conditions in which they live and work all have an enormous impact on their health. There is now a clear understanding of the effect that these social determinants have on health. Public policy plays a significant role in shaping the social environment to achieve better health. WHO s constitution recognizes that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being. Promoting good health throughout life cuts across all WHO activities and takes into account the need to address social determinants of health as well as gender, equity and human rights. A crucial focus during the biennium was the reduction of disparities between and within countries. Through its support and advocacy work, WHO is committed to removing these inequities and social injustices by bringing social determinants of health to the attention of governments and society. The World Conference on Social Determinants of Health in October 2011 and the subsequent endorsement of the Rio Political Declaration on Social Determinants of Health in May 2012 moved social determinants of health up the political agenda, and also led to an increase in Member State demands for technical support. The Secretariat of the Research Ethics Review Committee approved more than 200 research projects, which were carried out with technical and/or financial support from WHO. The Secretariat also integrated gender, equity and human rights concerns into all decision-making processes at the three levels of the Organization. WHO has a mandate to ensure that every man, woman, girl and boy, in all their diversity, regardless of gender, location, ethnicity, religious belief, income, or social status, has optimal and equal opportunity to achieve good health. This mandate cuts across organizational norms, standards, and programmes. It must be reflected as a standard way of business, from programming and policy design to implementation and through to monitoring and evaluation in order to reach its goal. A draft six-year strategy was developed with an institutional accountability mechanism to provide guidance and measure progress. In line with its mainstreaming principles, WHO worked through collaborative networks between programme areas and partnerships with Member States. page 52 SO 7 // Social and economic determinants of health

53 SOCIAL DETERMINANTS OF HEALTH Understanding and tackling the social determinants of health is considered so fundamental to the work of the Organization that WHO made it one of its six leadership priorities for the 12th General Programme of Work to address the social, economic and environmental determinants of health to reduce health inequities within and between countries. So far, over 60 countries have taken concrete measures to implement the Rio Political Declaration on Social Determinants of Health. So far, over 60 countries have taken concrete measures to implement the Rio Political Declaration on Social Determinants of Health. WHO is working closely with other United Nations partners on this issue, these include ILO, UNICEF, UNDP, UNFPA and UNAIDS. This work which has been recognized by the World Health Assembly, as well as in the United Nations resolution on universal health coverage which calls on Member States to adopt a multisectoral approach and to work on the social, environmental and economic determinants of health to reduce inequities and enable sustainable development, resulted in, among other things, an informal joint statement on Health in the Post-2015 Development Agenda: Need for a social determinants of health approach. In order to mainstream the social determinants of health approach, WHO offices and programmes are integrating them into planning, implementation and monitoring. Mechanisms to promote the approach at ministries of health or high levels of national government have been established by a number of countries in the Region of the Americas the social determinants of health approach is integral to the Pan American Health Organization s Strategic Plan ; the Union of South American Nations Council of Ministers of Health has made social determinants one of the five priorities of its action plan. All 46 countries of the African Region implemented social determinants of health activities in In the European Region, a number of countries are well advanced in developing national health policies that align with Health 2020: a European policy framework. In September 2012, Member States approved a regional strategy to operationalize the Rio Declaration. Twentyone countries now implement a health-in-all-policies approach and intersectoral action. Key to integrating the social determinants of health and health-in-all-policies approaches is a willingness to consider them not only at a national level but also across Member States. Health 2020 proposes action for health and well-being across government and society and was adopted by the Regional Committee for Europe at its 62 nd session. Its objectives are now being blended into the European Region s programmes and its country support framework. Other regions have also put social determinants of health on their agendas. The Regions of South- East Asia, Africa and the Americas adopted and implemented regional frameworks and initiatives. In the Region of the Americas, for example, the programme Faces, Voices and Places was rolled out in 18 countries where networks of municipalities work with the most vulnerable communities. WHO has also started the work of integrating social determinants of health into the work of diseasespecific programmes. For example, work on social determinants of health which have an impact on malaria will inform the development of the Global Technical Strategy for Malaria HEALTH IN ALL POLICIES An assessment of the Country Cooperation Strategies in March 2013 revealed that 105 out of 144 country cooperation strategies have Health-in-all-policies or social determinant of health as one of the strategic priorities. This means that there is a high level of demand for support from Member States in this area. In response to this demand, WHO has provided technical guidance in the preparation of case studies on health in all policies. For example, in the African Region a protocol for conducting the case study was developed to document case studies and a pool of 20 technical experts was available to support countries. In the Eastern Mediterranean Region, capacity building workshops on social determinants of health were conducted in Afghanistan, Jordan, Oman, Pakistan, Qatar and Sudan. In the European Region, the regions for Health and the Healthy Cities Networks endorsed the policy framework Health 2020, including the development of subnational policies and plans as the basis for their goals and commitments to action. The South-Eastern European Health Network is also aligned with the policy objectives of Health To support capacity building for implementing health in all policies, the Secretariat has developed a tool for standardizing the way in which case studies are summarized and used to compare intersectoral practices for their effectiveness in addressing the social determinants of health. The Secretariat has been leading effective advocacy for the inclusion of social determinants of health in global policy agendas, including the Rio+20 United Nations Conference on Sustainable Development. The focus of the 8th Global Conference on Health Promotion in Helsinki, Finland, June 2013 was on clarifying how to operationalize the health in all Social and economic determinants of health // SO 7 page 53

54 policies approach, and on exchanging experiences in implementing intersectoral public policies as well as health in all policies. WHO provided support to over 40 Member States to document their experiences in implementing a health in all policies approach, most of which were presented at the conference in Helsinki. In the African Region, a study conducted in 21 countries reviewed implementation of healthin-all-policies status in countries of the Region. Similarly, in the Region of the Americas, a collection of 25 case studies from 15 countries focused on specific government programmes that incorporated some of the core principles of health in all policies, highlighting mechanisms to address the social and economic determinants of health through intersectoral action. SOCIAL AND ECONOMIC DATA RELEVANT TO HEALTH During the biennium, Member States became significantly more interested in monitoring health equity and acquiring technical support from WHO. WHO launched the WHO Health Equity Monitor, the largest-ever database of disaggregated health data for low- and middle-income countries. It currently contains 30 reproductive, maternal, neonatal and child health indicators in 91 countries, of which 90 are lowand middle-income countries. WHO also developed training workshops on monitoring health equity and incorporating equity into health priorities. ETHICS In the area of ethics, standards for research ethics systems and guidance for use of placebos in vaccine trials were developed. The EU Clinical Trial Register, recognized as the primary WHO registry, was expanded, and the International Clinical Trials Registry Platform database now contains information on more than trials. The mission of the WHO International Clinical Trials Registry Platform is to ensure that a complete view of research is accessible to all those involved in health care decision-making. This will improve research transparency and will ultimately strengthen the validity and value of the scientific evidence base. WHO has been instrumental in convening national ethics committees to discuss ethical issues which cannot be resolved at the national level alone. The Secretariat of the Research Ethics Review Committee approved the ethical conduct of more than 200 research projects supported either financially or technically by WHO. WHO has been instrumental in convening national ethics committees to discuss ethical issues which cannot be resolved at the national level alone. In 2012, a total of 38 national ethics committees participated in the 9 th Global Summit of National Ethics Committees, which addressed ethical issues including advanced research, biobanking, and organ, tissue and cell transplantation. Delegates from national tuberculosis programmes for more than 15 Member States have benefited from training workshops on incorporating ethics and human rights values and principles into the management of tuberculosis and multidrug-resistant tuberculosis. GENDER, EQUITY AND HUMAN RIGHTS WHO helps to create coordinated, cost-effective ways for countries to address health disparities. WHO s support in this area concentrated on advocacy, evidence gathering and mainstreaming gender, equity and human rights principles in health systems strategies. WHO is now adopting an integrated approach to mainstream gender, equity and human rights issues across the Organization institutionally and in its programmatic work. During , WHO s work at the three levels of the Organization focused on institutional mainstreaming. Though mainstreaming of equity, gender and human rights is not new for WHO, instead of three separate mainstreaming efforts, WHO is now adopting an integrated approach to mainstream all three issues across the Organization institutionally and in its programmatic work. In addition to this work, WHO launched four projects on the ground aiming to gather evidence on an integrated and multi-stakeholder approach not just for human rights but for gender and equity. WHO support concentrated on advocacy, generation of evidence and mainstreaming gender and equity rights core principles in the health systems strategies. In the European Region, 53 Member States endorsed the Health 2020 policy framework in which human rights approaches are integral. WHO worked at country level applying the integrated approach to gender, equity and human rights, aiming to build both theory and practice. It developed a learning country approach in which WHO, national authorities and other stakeholders collaborated; the first two countries in the programme were India and Mozambique. page 54 SO 7 // Social and economic determinants of health

55 WHO has provided strategic orientation through the development of a strategy on gender, equity and human rights for , an accountability mechanism (WHO-UNSWAP), training material (course for senior management and new staff), training (data disaggregation, planning), dissemination of information (web-platform of resources), guidance for integration of gender, equity and human rights in the work of WHO and specifically on Universal Health Coverage, evaluation of gender and human rights (WHO Evaluation Practice Handbook) and specific area publications such as the 2013 monograph Women s and children s health: evidence of impact of human right. WHO engaged with Member States to mainstream gender as part of the agenda by focusing on promoting data disaggregation to support health decisionmaking; supporting training workshops and advocacy events; providing technical support to develop plans to advance gender mainstreaming in the health sector (in 31 countries in the Region of the Americas); using situation analysis (developing country profiles on gender and women s health for 46 countries in the African Region); and generating evidence on the impact of interventions. ASSESSMENT OF THE ORGANIZATION- WIDE EXPECTED RESULTS All five Organization-wide expected results have been achieved. This successful achievement of indicators came from increased political will by Member States to address social and economic determinants of health, joint action across WHO to mainstream gender, equity and human rights, and strategic initiatives across the regions to support Member States form a comprehensive response to the challenge. OWER OWER Rating Indicator Baseline 2012 Target 2013 Achieved 2013 OWER Rating Key: Fully achieved Partly achieved x Not achieved WHO regions with a regional strategy for addressing social and economic determinants of health as identified in the Report of the Commission on the Social Determinants of Health endorsed by the Director-General Published country experiences on tackling social determinants for health equity Country reports published during the biennium incorporating disaggregated data and analysis of health equity Tools produced for Member States or the Secretariat giving guidance on using a human rights-based approach to advance health Tools produced for Member States or the Secretariat giving guidance on use of ethical analysis to improve health policies WHO tools, documents (developed or updated) and joint activities with WHO technical units to promote gender responsive actions into the work of WHO Gender mainstreaming activities conducted in Member States supported by WHO More detailed information on indicators can be found in Annexes 2 and 3. Social and economic determinants of health // SO 7 page 55

56 WHA APPROVED BUDGET FUNDS AVAILABLE (AS AT 31 DEC 2013) IMPLEMENTATION (AS AT 31 DEC 2013) (US$ 000) AFRO AMRO SEARO EURO EMRO WPRO HQ Total FINANCIAL SUMMARY The total approved budget for the biennium for the strategic objective was US$ 42 million. As at 31 December 2013, available resources were US$ 39 million (93% of the approved budget). The implementation rate as at 31 December 2013 was 91% against the approved programme budget and 97% against available funds. During the work under strategic objective 7 was further consolidated and given additional emphasis in several regions. This has resulted in increased visibility and has had a positive impact on the financial situation of this strategic objective. The European Region succeeded in securing funding well beyond the originally approved budget at 131%, following the adoption of the new European policy framework for health and wellbeing, Health In the South-East Asia Region, 123% of the budget was funded, which enabled the strengthening of human resources and technical capacity, including at country level. In the Eastern Mediterranean Region, where the funding and implementation of the approved budget has been somewhat lagging at 69% and 65% respectively, a special task force was set up and a regional policy has been developed which will be presented to the Regional Committee in In the African Region and headquarters, the implementation against the approved budget was 84% and 85% respectively, reflecting a continued prudent management of resources during this biennium. LESSONS LEARNT There has been a strong commitment from Member States to tackle the adverse effects of social determinants of health, as well as growing interest in their importance among non-health sector agencies. Developing a common framework for social determinants of health has improved understanding and joint action at the regional and country levels. WHO supported countries to establish coordinating mechanisms to address social determinants of health, and this has assisted significantly. However, capacity within countries to address these issues is still limited and the challenge for WHO is to develop adequate internal capacity to meet the demand for support. Progress made in both the Secretariat and Member States in mainstreaming gender, equity and human rights required commitment at the highest level, clear guidance and an accountability mechanism. The Secretariat has worked on all three elements in a phased adaptive approach, starting with a few countries before expanding the number in the next biennium. page 56 SO 7 // Social and economic determinants of health

57 SO 8 HEALTHIER ENVIRONMENT To promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health A healthy environment is essential for good health. Reductions in air, water and chemical pollution can prevent up to one quarter of the total global burden of disease. Provision of safe drinking water, sanitation and hygiene services remains a major challenge in most regions. New evidence released in 2012 revealed that air pollution is now a leading environmental risk factor, causing millions of premature deaths each year. Approximately 4.3 million of these deaths are attributable to exposure to indoor air pollution and 3.7 million to outdoor air pollution. Additional environmental and occupational health challenges include sound management of chemicals, health in the workplace, children s health, climate change and radiation. MAJOR ENVIRONMENTAL HAZARDS TO HEALTH Of the various environmental hazards, lack of safe drinking water and poor sanitation poses great threats to health. Monitoring activities in water, sanitation and hygiene reveals substantial gaps in coverage, based on the annual report produced by the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation and the biennial report of UN-Water Global Analysis and Assessment of Sanitation and Drinking Water. Gaps in inputs to improve coverage to reach all populations were noted in the GLAAS survey completed by 75 countries. The Joint Monitoring Programme for Water Supply and Sanitation, which has provided critical data on access and use of safe drinking-water and basic sanitation in most countries in the world since 1990, published its biennial flagship report in 2012 and its annual report in The Programme continued to support capacity building and strengthen country analytical abilities for reconciling data and information on water and sanitation. WHO has developed guidelines to support the economic evaluation of water and sanitation interventions; water safety planning for small communities; rapid assessment of drinking-water quality; the monitoring and evaluation of household water treatment and safe storage initiatives; and the management of health-care waste. WHO established an international scheme to evaluate the safety of household water treatment technologies. Healthier environment // SO 8 page 57

58 WHO supported water safety planning and related capacity-building activities in more than 16 countries across all regions. Of 46 countries that responded to a 2012 survey mainly from sub-saharan Africa 72% had national policies on household water treatment and safe storage. In West Africa, a regional workshop was convened on integrating household water treatment and safe storage into health programmes particularly targeting vulnerable groups and an international meeting in India linked household water treatment and safe storage to water safety plan efforts. To make sure that millions of people are confident that the household water treatment technologies they use are safe, WHO established an international scheme to evaluate them. Major assessments of drinking-water quality examined the level of pharmaceuticals and other chemicals in water and provided risk assessments. Practical guidance for managing emerging risks such as pharmaceuticals and animal-waste contamination was provided in the publications on Pharmaceuticals in drinking-water and Animal waste, water quality and human health. WHO carried out a formal health risk assessment to estimate the consequences of the 2011 Fukushima Daiichi nuclear power plant accident in Japan. Air pollution is one of the most significant public health issues of our time. Household or indoor air pollution, caused by cooking and heating using solid fuels on open fires and with poor ventilation, kills around 4.3 million people each year. Recommendations on indoor air quality and household fuel combustion are being tested in countries. Air pollution is now a leading environmental risk factor, causing millions of premature deaths each year. To enhance global efforts in chemical risk assessment, a new network of institutions was established in 2013 to identify gaps, needs and emerging issues; encourage scientific exchanges and collaboration on risk assessment activities; identify resources; and provide mutual support. In the area of chemical safety, risk assessments were published on insecticides used for vector control in aircraft and on chromium VI, a priority chemical of concern. Work is continuing on the development of WHO guidelines for the prevention and management of lead poisoning. Technical input was provided for the assessment and management of 41 chemical events. Technical assistance was given to eight countries for health-care management plans to eliminate the use of mercury. Technical support was also provided to six countries in the Eastern Mediterranean Region to build health-care waste management capacity and to establish environmental health programmes in schools. The Consumer s Safety and Health Network of the Organization of American States initiated activities to create awareness of the impact of hazardous products on consumers health. A campaign to prevent kerosene poisoning among children was carried out in Ghana, Uganda and Zambia. A UNEP/WHO publication on endocrine disruptors and health with a focus on vulnerable populations was launched. Intersectoral action on environmental determinants of health increased at all levels globally, regionally and in countries. Key areas included workers health with significant focus given to the elimination of asbestos-related diseases and the management of other carcinogens and safe management of chemicals, including in transport, energy and the mining industries. With support from WHO, nine countries in the Western Pacific Region developed asbestos country profiles. A significant part of WHO s support for such intersectoral activities focused on building the capacity of Member States in the use of health impact statements a key instrument for health in all policies. OCCUPATIONAL HEALTH AND SAFETY WHO continued to support countries initiatives on environmental and occupational health in a number of settings homes, schools, workplaces, health-care settings and cities. With the implementation of a World Health Assembly resolution, workplaces were targeted with the Workers health: global plan of action. At the end of 2013, 103 Member States had implemented national action plans/policies for the management of occupational health risks. WHO s activities were aimed at strengthening environmental and occupational health risk management systems and strategies. These focused on enhancing national and regional poison centre capacities, especially in the African Region; the safe management of pesticides, particularly important in countries where DDT is used in vector control; the need for action on chemicals of public concern and to eliminate lead paint; and exploring options for expanding delivery of occupational health services through primary health care. Efforts by the United Kingdom and WHO saw 120 occupational health items included in the 11 th revision of the International Classification of Diseases. Healthy workplace initiatives were supported in the South-East Asia, Eastern Mediterranean and Americas Regions. Some had a special focus on health-care worker occupational health and safety, in particular page 58 SO 8 // Healthier environment

59 the prevention of needle-stick injury and the inclusion of hepatitis immunization. Additional focus was given to HIV and tuberculosis services for health-care workers as a result of the Healthwise programme developed jointly by WHO and the International Labour Organization to promote safer working conditions in health-care settings. A number of activities related to transport, environment and health issues took place during the last biennium in the European and Western Pacific Regions. Guidelines on healthy housing were initiated to provide evidence of known risks to stakeholders in urban planning, building and construction, and public health. Lack of access to a reliable electricity source is a major impediment to attaining the health targets outlined in the Millennium Development Goals. A WHO review in sub-saharan Africa showed that only 34% of health facilities had reliable access to electricity in the countries surveyed. The Organization supported the work of civil-society organizations in several African countries to install solar systems in health facilities and to train health workers in their use. WHO also provided technical support to countries to address increasing health issues in the mining, oil and gas industries. Regional governance for environmental and occupational health issues was enhanced through organizations such as the European Environment and Health Task Force and the European Environment and Health Ministerial Board, which was established following the Parma Declaration; the African Health and Environment Strategic Alliance, established as one of the commitments of the Libreville Declaration; and various activities supporting the Regional Forum on Environment and Health in the Western Pacific and South-East Asia Regions. A new joint Ministerial Forum on Health and the Environment was also established in the Eastern Mediterranean Region. CLIMATE CHANGE WHO provided technical support for planning health adaptation to climate change in 124 Member States, 22 of which implemented large-scale projects. The Secretariat provided health input into partnerships with the United Nations Environment Programme, the World Meteorological Organization, the United Nations Development Programme and the United Nations Institute for Training and Research. These include the health benefits of reducing climate pollutants, the application of climate information for health, programming adaptation to climate change, and representing health within climate at negotiations. WHO released major reports on mapping links between climate and health, assessing health vulnerability and adaptation options, economic and gender dimensions of health adaptation, and highlighting health in negotiations on climate change, biodiversity and desertification. 124 Member States received technical support from WHO for planning health adaptation to climate change. HEALTH AS A PREREQUISITE FOR SUSTAINABLE DEVELOPMENT WHO contributed to the inclusion of health in the United Nations post-2015 agenda by providing health indicators to track achievements in energy, cities, water, agriculture, jobs and disaster preparedness. This work, combined with the World Health Assembly s endorsement of the need to integrate health as a prerequisite for sustainable development, ensured that health featured prominently in global discussions about sustainable development. One such discussion took place at the June 2012 UN Global Conference on Sustainable Development Rio+20 and in the resulting outcome document The Future We Want. WHO successfully asserted its leadership in key international partnerships related to sustainable development, including the UN Secretary General s initiative on Sustainable Energy for All, which now includes targets for access to clean energy in the home and in health-care facilities, as well as the Climate and Clean Air Coalition, the Global Alliance for Clean Cookstoves, and the WHO-UNEP Global Alliance to Eliminate Lead Paint. WHO also continued to ensure representation of health issues in multilateral environment agreements and international chemicals conventions, including support for health sector engagement in the Strategic Approach to International Chemicals Management (SAICM) and in the context of the Minamata Convention on Mercury adopted in October WHO also launched an intersectoral initiative on e-waste and child health. ASSESSMENT OF THE ORGANIZATION- WIDE EXPECTED RESULTS All six Organization-wide expected results were fully achieved for the biennium. Country-relevant targets were achieved as a result of the delivery of multiple objectives on a streamlined number of projects, and by encouraging direct support from the regional offices, the Secretariat and partners such as the WHO Collaborating Centres to implement country activities. Healthier environment // SO 8 page 59

60 OWER OWER Rating Indicator Baseline 2012 Target 2013 Achieved 2013 OWER Rating Key: Fully achieved Partly achieved x Not achieved Member States with proven capacity to conduct assessment of specific environmental threats to health, in order to quantify the environmental burden of disease as to add sustainability to MDG 4, 5 and 6 achievements New or updated WHO norms, standards or guidelines on occupational or environmental health issues published during the biennium Member States implementing with WHO technical support primary prevention interventions to reduce pneumonia in children, diarrhoeal and noncommunicable diseases in at least one of the following settings: homes, workplaces, or urban settings Member States that have implemented national action plans/policies for the management of occupational health risks, such as in relation to the Global Plan of Action on Workers Health , with support from WHO Member States implementing WHO-supported initiatives to reduce noncommunicable and communicable diseases through healthy agriculture, energy and transportation policies. n/a Studies or reports on new and re-emerging occupational and environmental health issues published or co-published by WHO Reports published or jointly published by WHO on progress made in achieving water and sanitation objectives of major international development frameworks, such as the MDGs High-level regional forums on environment and health issues organized or technically supported by WHO biennially Studies or reports on the public health effects of climate change published or co-published by WHO Countries that have implemented plans to enable the health sector to adapt to the health effects of climate change More detailed information on indicators can be found in Annexes 2 and 3. FINANCIAL SUMMARY The World Health Assembly-approved budget for strategic objective 8 was US$ 87 million principally for base programmes. Available funding by the end of 2013 was US$ 91 million, 105% of the World Health Assembly-approved budget. Generally, fundraising efforts by major offices continue to be successful under strategic objective 8, and all major offices are well funded with respect to the approved budget, except for the Regional Office for the Americas, with 66% of funds available at the end of the biennium. Implementation rates against funds available for the strategic objective are high and fairly even across the major offices, ranging from 91% in the Region of the Americas to 97% in the Eastern Mediterranean Region. Funds available as well as implementation rates against approved budgets are much more varied and reflect challenges reported in particular by the African and the Eastern Mediterranean Regions where shortage of funds and human resources contraints restricted WHO s ability to respond to country-specific needs and requests for evidence-based assessments in environmental health. In responding to these challenges there has been significant consolidation and integration in environmental health programmes producing economies of scale and strengthened intersectoral collaboration between health and other sectors. This promotes increased visibility of the public health importance of environmental issues and access to additional financial resources from outside the health sector. page 60 SO 8 // Healthier environment

61 WHA APPROVED BUDGET FUNDS AVAILABLE (AS AT 31 DEC 2013) IMPLEMENTATION (AS AT 31 DEC 2013) (US$ 000) AFRO AMRO SEARO EURO EMRO WPRO HQ Total Certain areas of environmental health programmes under strategic objective 8 were particularly successful with fundraising efforts, such as water and sanitation, climate change and air quality. However, for other programmes such as chemicals, children s environmental health, occupational health, greening the health sector, emergency preparedness and response, and radiation, the financial situation remains challenging LESSONS LEARNT Work on environmental and occupational determinants of health supported in specific sectors such as energy, water and mining industries gives insight into how to put a health-in-all-policies approach into action. The importance of engaging intergovernmental processes with decision-makers from different sectors such as at the Regional Forums on Environmental Health cannot be overemphasized. It is around these processes that intersectoral action and commitment can be formalized and resources consolidated. Reporting on trends and the progress made to address environmental and occupational determinants of health is one of the critical contributions that WHO makes in the area of health and the environment, especially within the context of Millennium Development Goals and future sustainable development goals. The effectiveness of communication and coordination between the three levels of the Organization is key to ensuring the successful delivery of results, particularly in countries where technical capacity is limited. Where possible, aligning work streams in overlapping issues can ensure continuity of activities in the face of resource shortfalls. Healthier environment // SO 8 page 61

62 SO 9 NUTRITION AND FOOD SAFETY To improve nutrition, food safety and food security, throughout the life-course, and in support of public health and sustainable development Food its quality, its availability, and its safety is essential for health and ultimately, of course, for life. Poor nutrition the inadequate intake of food or an unbalanced diet can lead to significant ill health: reduced immunity, increased susceptibility to disease, impaired physical and mental development, and reduced productivity. Estimates suggest that undernutrition in the aggregate including foetal growth restriction, stunting, wasting, and deficiencies of vitamin A and zinc along with suboptimum breastfeeding is a cause of 3 1 million child deaths annually or 45% of all child deaths in Malnutrition is the background cause of more than one third of all child deaths, and lack of access to nutritious food is a common cause. On the other hand, better nutrition is related to better infant, child and maternal health, stronger immune systems, safer pregnancy and childbirth, lower risk of noncommunicable diseases and longevity. Healthy children learn better. The double burden of malnutrition both undernutrition and overweight especially in developing countries, is a significant threat to human health. WHO provided technical support and decision-making tools to help countries act to improve nutritional health. By the end of the biennium, 125 Member States were using the WHO Child Growth Standards to monitor the global effort to reduce stunting and to halt the prevalence of overweight in young children, now in epidemic proportions. Many countries introduced the weight-for-height indicator essential to assess severe acute malnutrition or wasting as well as overweight. Existing health information monitoring systems, particularly in the African and the Eastern Mediterranean Regions, are now able to capture nutrition and maternal deaths indicators. Food safety is regarded as an essential public health function. Millions of people fall ill and many die as a result of eating unsafe food. For this reason, food safety policies and actions need to cover the entire food chain from production to consumption. Food security ensuring that people at all times have access to sufficient and consistently available quantities of food; sufficient resources to obtain appropriate, nutritious foods; and appropriate use and handling of foods, as well as adequate water and sanitation is a complex sustainable development issue that is clearly linked to health. Whether households have enough food, how it is distributed in the household, and whether the food fulfils the nutritional needs of everyone in that household are significant to the food security issue. WHO s focus has been to develop effective nutrition, food safety and food security plans of action and strategic interventions within Member States. page 62 SO 9 // Nutrition and food safety

63 Evidence collection and assessment is of particular importance to help WHO to make evidence-based recommendations to Member States and partners. IMPROVING NUTRITION In 2012, the World Health Assembly approved a comprehensive implementation plan on maternal, infant and young child nutrition that contained six global nutrition targets supported by the international nutrition community. A key objective of the biennium has been to support countries to reduce childhood stunting, wasting and overweight, low neonatal birthweight, anaemia in women of reproductive age, and to increase rates of exclusive breastfeeding. Increased breastfeeding could reduce the mortality rate of under 5 year olds by 20%. In the African Region, 15 countries have adopted laws to protect families, the general population and healthcare systems from aggressive and inappropriate marketing of the breast milk substitutes that have caused the alarming decline in breastfeeding rates and associated increase in malnutrition and mortality rates in infants and young children. Breastfeeding is one of the most effective ways to ensure child health, growth and development and the laws on breast milk substitutes could reduce the mortality rate of under five year olds by 20%. WHO also contributed to the introduction of the Renewed Effort Against Child Hunger and Undernutrition partnership in 13 countries and contributed to the Landscape Analysis country assessment tools for local planning and costing in nutrition policy. Guidance on effective nutrition programmes and scientific advice on nutrition and health has increased now covering micronutrients, acute malnutrition, communicable and noncommunicable diseases. The Global Database on the Implementation of Nutrition Action, launched in 2012, includes almost 1000 policies and 2000 actions that countries had in place by the end of the biennium. The WHO e-library of Evidence for Nutrition Action is accessed by over 9000 users per month and is now available in all six WHO official languages. Global estimates on child growth and malnutrition were updated in collaboration with UNICEF and the World Bank, and are currently used to measure progress in achieving global targets. A global nutritionmonitoring framework has been prepared for discussion with Member States in 2014, and a global monitoring system of nutrition policies and actions has been established. Global initiatives such as Scaling Up Nutrition and Nutrition for Growth promote WHO global nutrition targets. 50 countries, including 32 from the African Region, are now part of the SUN movement to improve the political environment and encourage governments and other stakeholders to increase effective nutrition programmes. In the African Region, 11 countries were also supported through the Accelerating Nutrition Intervention project. The 63 rd Regional Committee of the Western Pacific Region developed a summary of key actions needed to achieve the global targets for the Region, and WHO is developing a new nutrition action plan for in the European Region. The WHO e-library of Evidence for Nutrition Action was launched in August 2011 to assist Member States and partners to make informed decisions to improve the health and nutrition of populations globally. The site, which included more than 48 nutrition titles and many other resources, is accessed by over 9000 users per month and is now available in all six WHO official languages. WHO provided technical support to Member States to increase the programmes and activities for the prevention and control of anaemia, the treatment of acute malnutrition, and the reduction of salt, trans fatty acids and saturated fatty acids. In the Western Pacific Region, for example, WHO provided support to assess infant and young child feeding and to review progress and priorities for strengthening national food control systems. In the Eastern Mediterranean Region, salt and fat reduction strategies were developed and technical support provided to countries to start with the implementation, in addition to the development of the nutrition surveillance systems which have been used for screening malnourished children and treat them. Plans were developed to increase the iron and folic acid supplementation to children and adolescent girls and women as part of public health programmes aimed at reducing anaemia in women of reproductive age. A similar guideline review is occurring in India. In the Region of the Americas, Brazil adopted new guidelines on vitamin A supplementation in postpartum women and children aged under five following WHO recommendations. Several Member States have implemented programmes that include recommendations by WHO on the use of fortifying foods with multiple micronutrient powders. In the African Region, with seven manuals and guidelines having been made available, 20 countries are using evidence-based interventions to manage malnutrition, maternal and child nutrition, and micronutrient deficiencies. The adaptation of these Nutrition and food safety // SO 9 page 63

64 tools has led to standardized approaches to nutrition and food safety. Guidelines on acute malnutrition were adopted by seven countries, and capacity to deal with acute malnutrition during emergencies was strengthened in nine. KEEPING FOOD SAFE AND FOOD SECURITY Building on a World Health Assembly Resolution, the WHO Strategic Plan for Food Safety was developed and further backed by three regional strategies. The Organization convened nine meetings of independent international experts during the biennium to address requests from Member States for scientific advice about priority food hazards. The Codex Alimentarius the intergovernmental body that administers the Joint FAO/WHO Food Standards Programme adopted a number of new and revised food standards based on the scientific advice of WHO and the Food and Agriculture Organization of the UN (FAO). The main aims of the Codex are to protect the health of consumers and to ensure fair practices in the food trade. The FAO/WHO Project and Fund for Enhanced Participation in Codes (Codex Trust Fund) funded around 800 participants from developing countries to attend Codex meetings, working groups and training courses. The Codex Trust Fund also supported four countries to conduct surveys into mycotoxins in the important food crop sorghum. 510 participants from 98 countries attended training courses aided by the Codex Trust Fund. The Codex aims to protect consumer health and ensure fair practices in the food trade with science-backed food standards. The increasing understanding of the importance of evidence-based food safety standards Codex standards and their use in foods for export and local consumption is helping to reduce the burden of foodborne diseases. International food standards established by the Codex are increasingly implemented at national level and, by making foods safer, help to remove trade barriers, contributing to the economic development of food exporting countries and making safe food more available at affordable prices in food importing countries. There are now 183 Member States participating in the International Food Safety Authorities Network (INFOSAN), which was expanded at global and regional levels during the biennium to allow prompter reporting of and responses to foodborne disease outbreaks. INFOSAN provides a link to international emergency systems. FOSCOLLAB was launched, a global platform for food professionals to access food safety data and information that is supported by evidence-based decision-making. 183 Member States participate in the International Food Safety Authorities Network to allow prompter reporting of and responses to foodborne disease outbreaks. Major achievements by the Secretariat in food safety during the biennium include strengthening countries surveillance systems and national laboratory capacity for food analysis and foodborne disease investigation; significant advocacy and education in food safety using Five keys to safer food; and the development of a guidance document, Integrated surveillance of antimicrobial resistance. The work of the Global Foodborne Infections Network programme plays a major role in determining the current causes of foodborne diseases and guiding control measures. For the African Region, where 33 countries submit data, this has led to increased information about antimicrobial resistance in some foodborne pathogens. WHO has helped this network to hold training courses for laboratory-based foodborne disease surveillance across all WHO regions. Sustained efforts to monitor nutritional status have allowed early action to respond to food insecurity crises, particularly in the Sahel. WHO has worked with its partners, particularly the Food and Agriculture Organization, to identify effective actions to improve the quality of food supply and enhance nutrition security. WHO and FAO are jointly convening the second international Conference of Nutrition in November ASSESSMENT OF THE ORGANIZATION- WIDE EXPECTED RESULTS All six Organization-wide expected results were fully achieved. This success can be attributed to the increased interest in nutrition and food safety in Member States. page 64 SO 9 // Nutrition and food safety

65 OWER OWER Rating Indicator Baseline 2012 Target 2013 Achieved 2013 OWER Rating Key: Fully achieved Partly achieved x Not achieved Member States that have functional institutionalized coordination mechanisms to promote intersectoral approaches and actions in the area of food safety, food security or nutrition Countries that have incorporated nutrition into their national development policies/strategies, including PRSP New nutrition and food-safety standards, guidelines or training manuals produced and disseminated to Member States and the international community. 88 and 557 Codex standards 90 and 600 Codex standards 231 and 1482 Codex standards New norms, standards, guidelines, tools and training materials for prevention and management of zoonotic and nonzoonotic foodborne diseases Member States that have adopted and implemented the WHO Child Growth Standards Member States that have nationally representative surveillance data on major forms of malnutrition Member States that have implemented at least 3 high-priority actions recommended in the Global Strategy for Infant and Young Child Feeding Member States that have implemented strategies to prevent and control micronutrient malnutrition Member States that have implemented strategies to promote healthy dietary practices for preventing diet-related chronic diseases Member States that have included nutrition in their responses to HIV/AIDS Member States provided with support to optimize nutrition in emergencies Member States that have established or strengthened intersectoral collaboration for the prevention, control and surveillance of foodborne zoonotic diseases Member States that have initiated a plan for the reduction in the incidence of at least one major foodborne zoonotic disease Selected Member States receiving support to participate in international standard-setting activities related to food, such as those of the Codex Alimentarius Commission Selected Member States that have built national systems for food safety with international links to emergency systems More detailed information on indicators can be found in Annexes 2 and 3. Nutrition and food safety // SO 9 page 65

66 WHA APPROVED BUDGET FUNDS AVAILABLE (AS AT 31 DEC 2013) IMPLEMENTATION (AS AT 31 DEC 2013) (US$ 000) AFRO AMRO SEARO EURO EMRO WPRO HQ Total FINANCIAL SUMMARY The approved budget for strategic objective 9 was US$ 55 million of which US$ 51 million was for base programmes and US$ 4 million for special programmes and collaborative arrangements. Available funding by the end of 2013 was US$ 67 million and implementation was US$ 62 million, which corresponds to 113% of the approved budget and 92% of the available resources respectively. The achievement of the strategic objective 9 Organization-wide expected results was facilitated by the general high level of funds available and is in line with the corresponding levels of financial implementation. As a combined result of the reduction in the approved budget for as compared to the previous biennium, and reinforced resource mobilization efforts, available funding as a percentage of the approved budget as at 31 December 2013 was above 100% for the Regional Offices for Africa, the Eastern Mediterranean, the Western Pacific and headquarters. In the case of the Regional Office for Africa and headquarters this was primarily due to a major new contribution of US$ 18 million for scaling up nutrition interventions and strengthening nutrition surveillance under Organization-wide expected results 9.2 and 9.3. In the Eastern Mediterranean Region, multi-year grants were mobilized at the country level in Yemen, Afghanistan, Pakistan and Sudan, and in the Western Pacific Region a number of large unforeseen grants were received from, amongst others, the Australian Agency for International Development and the Micronutrient Initiative. Resource mobilization efforts will continue to be reinforced in , specifically in regions such as the European Region, where funds available were low in comparison to the World Health Assembly-approved budget. With respect to implementation against available funds, all major offices implemented at 80% or higher. Implementation rates against approved budget are much more variable, however, with the Regional Office for Europe at only 52%, reflecting the lack of funds, and the Regional Office for the Eastern Mediterranean at 154% despite continuing security concerns and restricted access in many countries particularly affecting work in Organization-wide expected result 9.5. Special programmes and collaborative arrangements have also received more resources than originally expected and have therefore implemented 117% of the approved budget. This corresponds to a 100% implementation with respect to total funds available. page 66 SO 9 // Nutrition and food safety

67 LESSONS LEARNT WHO s scientific and normative work, coupled with its leadership in creating collaborations between multiple partners to increase effective action, have shown to be the right approach to advance global nutrition. Lessons were also learned from the pilot-testing of a food safety needs assessment tool to better identify gaps and cater to country needs in the future. WHO will intensify the resource mobilization efforts in order to maintain or expand the human resource base in the regional offices and accelerate the implementation of the programme of work. Global initiatives will be promoted for this purpose. For food safety, it is crucial to diversify the donor base to reduce the risk of underfunding, especially for the provision of scientific advice for Codex and Member States. The end-ofproject evaluation of the Codex Trust Fund should be completed to provide insights to the development of a possible successor initiative. Nutrition and food safety // SO 9 page 67

68 SO 10 HEALTH SYSTEMS AND SERVICES To improve health services through better governance, financing, staffing and management, informed by reliable and accessible evidence and research The best health outcomes are delivered by strong health systems. The key components of a strong health system include: a robust financing mechanism; a well-trained and adequately paid workforce; reliable information on which to base decisions and policies; and well-maintained facilities and logistics to deliver quality medicines and technologies. As countries move towards universal health coverage, WHO provides the technical support and guidance to strengthen these key areas so that they can deliver quality services to all people, when and where they need them and at an affordable price. During the biennium, 95 Member States reviewed or updated their national health strategies and plans, with 60 of them establishing or strengthening their donor coordination mechanisms. WHO supported initiatives in safety, patient-centredness and integration of health services to improve quality of life in 90 countries; 89 received technical and policy support for their health financing systems; 59 improved the availability of health data by improving their health information systems; and 56 followed up the recommendations of the United Nations Commission on Information and Accountability for Women s and Children s Health. INTEGRATING HEALTH SYSTEMS In , Member States continued to improve the management and organization of their health systems, achieving more integrated, higher quality, safer health care. WHO provided technical support on various aspects of planning, including developing International Health Partnerships (IHP+) compacts, undertaking joint assessment of national strategies, and supporting the implementation of the GAVI Alliance and grant activities related to the Global Fund to Fight AIDS, Tuberculosis and Malaria. WHO supported health services to improve quality of life in 90 countries. An example of integrating health systems in the WHO Region of the Americas was the incorporation of priority programmes for mental health and noncommunicable diseases into more comprehensive care models. In the African Region, another example was the linking of district health plans with strategies that spanned 22 countries. In the Western Pacific Region, six national health systems were reviewed. page 68 SO 10 // Health systems and services

69 The return to an emphasis on primary health care was evident during this biennium across all regions. In the Eastern Mediterranean Region, the focus was on integrating the family practice (primary health-care) approach into district health systems. All countries in the South-East Asia Region have developed medium-term health plans with a primary health-care approach. In the European Region, the focus has shifted from hospital care to primary health care, in particular to meet the needs of ageing populations and the growth of chronic diseases. In November 2013, WHO and the Ministry of Health of Kazakhstan organized a major conference on primary health care attended by high-level stakeholders, partners, and national representatives from 58 countries across all six WHO regions. The OECD, South-East Asia Regional Office and the Western Pacific Regional Office jointly published Health at a glance: Asia Pacific , with a key chapter on quality of care. Despite these advances, fragmented health systems remain a major problem. It requires a concerted effort to build strong health systems capable of producing quality health services for all including health promotion, prevention, treatment, rehabilitation and palliation and needs active collaboration between priority health programmes. Frequent interaction between ministries of health, ministries of finance and political leaders is required in the move towards universal health coverage. Some countries are also limited by a shortage of experts and other human resources restricting their ability to develop and WHO s ability to respond to their needs. Consequently, WHO undertook more capacity-building activities during the biennium. The Country Planning Cycle database with access to over 1300 strategic documents and graphics on donor information was made more user-friendly in WHO has partnered with the European Union and Luxembourg to provide long-term support to help build comprehensive national health plans in 19 countries to deliver increased coverage of essential health services, financial risk protection and health equity. The regional offices have significantly updated frameworks, created performance assessment mechanisms, analysed health legislation and set up information exchanges on regional legislative 12 Health at a glance: Asia/Pacific 2012, OECD Publishing: OECD/World Health Organization; 2012, available at: issues. For example a high-level WHO/Europe meeting in Tallinn, Estonia, in 2013 resulted in a proposal on the regional direction of the health system for WHO improved its Country Planning Cycle Database for more user-friendly access to over 1300 strategic documents and graphics on donor information. A review of all available national health plans will update this database by early The WHO GAVI systems monitoring database containing all grant-related information and national health-planning and technical support needs for GAVI countries was rolled out to all regions and relevant partners (GAVI, UNICEF and the Gates Foundation). DEVELOPING NATIONAL HEALTH POLICIES Countries have progressed in developing, implementing and monitoring their national health policies, strategies and plans. Overall, 126 Member States in the last 5 years have developed comprehensive national health planning processes in consultation with stakeholders. 79 Member States have conducted a regular or periodic evaluation of progress, including implementation of their national health plan, based on a commonly agreed performance assessment of their health system. In the African Region, 13 countries compiled country health policy portals; 13 submitted health system strengthening proposals to GAVI; 21 carried out health sector reviews; and 11 used their essential health-care services packages to develop annual operation plans for health districts. In the Region of the Americas, most countries strengthened their national health authorities: 35 countries set specific goals for their national health plans; the national health authorities of 31 countries coordinated intersectoral work; and 29 countries updated health legislation and regulatory frameworks. In the European Region, the development and review of national health policies and strategies is increasing, and a number of countries have incorporated health system performance frameworks. Emergencyorientated operations and development initiatives have been initiated in the Eastern Mediterranean Region. 12 countries completed assessments for strengthening ministry of health policies and planning. The need for multisectoral, multi-stakeholder dialogue has been identified as important to strengthening national health strategies in the Eastern Mediterranean and the South-East Asia Regions. In the Western Pacific Region, activities have included reviews of health sector strategies and updates of national health policies. Health systems and services // SO 10 page 69

70 HEALTH FINANCING TO STRENGTHEN HEALTH SYSTEMS The momentum created by the World health report on health financing 2 in 2010 and the subsequent 2011 World Health Assembly resolution 64.9 encouraged Member States to actively address their financing strategies for universal health care. The European Region made strong commitments to mitigate the negative effects of the financial crisis on health. In Africa, 10 countries elaborated health-financing strategies, while countries in the South-East Asia Region initiated a Universal Health Coverage Strategy. Focused discussions about the future of health financing took place in countries in the Eastern Mediterranean Region; and Morocco introduced a health-financing scheme to cover the poor and vulnerable. In the Western Pacific Region, 14 countries made progress in health systems financing strategies and evidence-based decision-making. In the Region of the Americas, 15 countries produced plans to improve health financing performance. Member States in all regions strengthened their health financing policies by basing policy decisions on evidence and evaluating financial risk. Strong health systems make more efficient use of resources and reduce financial risk. During the biennium, the Secretariat responded to requests for technical and policy support from 89 Member States as they strove towards universal health coverage. The requests came not only from low-income countries faced with the additional burden of noncommunicable diseases, mental health and injuries on top of the agenda of the Millennium Development Goals, but also from high-income countries trying to alleviate the effects of the global financial crisis. In selected countries, funding was increased for policy dialogues on national health strategies, financing for universal health coverage, and followup activities connected with the United Nations Commission on Information and Accountability for Women s and Children s Health. However, funding remained inadequate in the areas of service delivery and patient safety, resource tracking and costing, information system strengthening, and research and knowledge management. HEALTH INFORMATION WHO is the global guardian of health information. The Organization monitors regional and global health situations and trends, gathering reliable and up-to-date data and evidence to inform decisionmaking, resource allocation, monitoring and evaluation. Countries continued to expand their use of this information. Mobile health (mhealth), telemedicine and the use of the internet for health purposes were key developments. In 2012, WHO launched a knowledge portal listing 85 countries with ehealth policies, regulatory frameworks, and knowledge management strategies biomedical and health journals can now be accessed by 116 countries, including 41 in the African Region, using the Health InterNetwork Access to Research Initiative. The Health InterNetwork Access to Research Initiative (HINARI) expanded access to over 7000 biomedical and health journals for 116 countries, including 41 in the African Region. A partnership with a publisher will make over online books available in those countries with a functioning HINARI programme. The public private partnership supporting HINARI was extended to In 2013, 114 countries participated in the second global ehealth survey, while 65 countries provided information on their use of ehealth for women s and children s health. HEALTH WORKFORCE Although progress has been made in reducing health workforce shortages and improving the distribution, motivation and skill mix of the health workers, 57 countries still suffer from critical shortages of health workers. Across all regions, 32 of the countries in crisis increased the number of healthcare workers and 37 (mainly European) countries implemented the WHO Global Code of Practice on the International Recruitment of Health Personnel. ASSESSMENT OF THE ORGANIZATION- WIDE EXPECTED RESULTS Of the 13 Organization-wide expected results, nine were fully achieved and four were partially achieved. Underlying causes of the partially achieved results were limited capacity within certain countries to strengthen data analysis; the shortage of researchers and unfavourable research cultures; and the as yet inadequate knowledge management strategies and ehealth systems in most countries. Reporting windows have also shifted, so that some countries have changed their report status over time. page 70 SO 10 // Health systems and services

71 OWER OWER Rating Indicator Baseline 2012 Target 2013 Achieved 2013 OWER Rating Key: Fully achieved Partly achieved x Not achieved Member States that have regularly updated databases on numbers and distribution of health facilities and health interventions offered Member States that have in the last 5 years developed comprehensive national health planning processes in consultation with stakeholders Member States that conducted a regular or periodic evaluation of progress, including implementation of their national health plan, based on a commonly agreed performance assessment of their health system Member States where the inputs of major stakeholders are harmonized with national policies, measured in line with the Paris Declaration on Aid Effectiveness Low- and middle-income countries with adequate health statistics and monitoring of health-related MDGs that meet agreed standards. 48% 60% 60% Countries for which high-quality profiles with core health statistics are available from its open-access databases. 98% 98% 98% Countries in which WHO plays a key role in supporting the generation and use of information and knowledge, including primary data collection through surveys, civil registration or improvement or analysis and synthesis of health facility data for policies and planning Effective research for health coordination and leadership mechanisms established and maintained at global and regional levels. Global research for health strategy established at WHO HQ; Regional strategies established in AFRO, AMRO, EMRO and SEARO Mechanisms operating at global and all regional levels Global research for health strategy established at WHO HQ; Regional strategies established in AFRO, AMRO, EMRO and SEARO Low- and middle-income countries in which national health-research systems meet internationally agreed minimum standards. 40% 60% 40% Number of Member States adopting knowledge management policies in order to bridge the know-how gap particularly aimed to decrease the digital divide Member States with access to electronic international scientific journals and knowledge archives in health sciences as assessed by the WHO Global Observatory for ehealth biannual survey Member States with ehealth policies, strategies and regulatory frameworks as assessed by the WHO Global Observatory for ehealth biannual survey Member States reporting 2 or more national data points on human resources for health within the past 5 years, as reported in the Global Health Workforce Statistics Member States with a national policy and planning unit for human resources for health Health systems and services // SO 10 page 71

72 OWER OWER Rating Indicator Baseline 2012 Target 2013 Achieved 2013 OWER Rating Key: Fully achieved Partly achieved x Not achieved Proportion of 57 countries with critical shortage of health workforce, as identified in the World health report 2006 with a multi-year plan for human resources for health. 61% 68% 68% Proportion of 57 countries with critical shortage of health workforce, as identified in the World health report 2006, which have an investment plan for scaling up training and education of health workers. 35% 40% 53% Member States provided with technical and policy support to develop health financing systems to attain or maintain universal coverage during the biennium Key policy briefs prepared, disseminated and their use supported, which document best practices on revenueraising, pooling and purchasing, including contracting, provision of interventions and services, and handling of fragmentation in systems. 24 technical briefs, over 75 information products of other types 15 technical briefs 25 technical briefs, 35 additional information products Key tools, norms and standards to guide health financing policy development and implementation for universal coverage developed, disseminated and their use supported. Tools and frameworks modified, updated and disseminated as necessary Tools and frameworks modified, updated and disseminated as necessary WHO-CHOICE & OneHealth joint UN cost and impact tool updated; SHA2011 rolled out with new production tool Member States provided with technical support for using WHO tools relating to health financing for universal coverage WHO presence and leadership in international, regional and national partnerships. WHO participation in 5 partnerships and support on long-term financing options provided to 46 countries WHO participation in 4 partnerships WHO participation: 5 global or regional partnerships Member States provided with support to build capacity in the formulation of health financing policies and strategies and the interpretation of financial data. Annual updates of health expenditures produced after consultation with Member States. Capacitybuilding in one or more of the WHO tools provided to 67 countries Annual updates of health expenditures for all Member States. Capacitybuilding in financial policy and analysis in 20 countries Annual updates of health expenditures provided after country consultation. Capacitybuilding participation from 116 countries a Key norms and standards to guide policy development, measurement and implementation disseminated and their use supported. 6 standards 4 global safety standards 6 global clinical standards b Key tools to guide policy development, measurement and implementation disseminated and their use supported. 15 tools 40 major supporting tools 45 supporting tools Member States participating in global patient safety challenges and other global safety initiatives, including research and measurement More detailed information on indicators can be found in Annexes 2 and 3. page 72 SO 10 // Health systems and services

73 FINANCIAL SUMMARY The total approved budget for the strategic objective was US$ 348 million, of which US$ 322 million (93%) was for base programmes and US$ 26 million (7%) for special programmes and collaborative arrangements. At the end of 2013, funding of US$ 354 million was made available through assessed and voluntary contributions. Of this amount, US$ 333 million was for base programmes and US$ 21 million for special programmes and collaborative arrangements. Implementation by the end of 2013 was US$ 322 million, corresponding to 92% of the approved budget and 91% of available funds. Funds available were 102% of the approved global budget, but there are significant variation between the different major offices, with the Regional Offices of Africa and the Americas having the lowest level of funding with 82% and 78% of approved budget respectively. The funding levels are more satisfactory for the other major offices where substantial amounts of specified funding for work relating particularly to national health strategies and plans, health financing for universal health coverage, and the follow-up to the United Nations Commission on Information and Accountability for Women s and Children s Health have been mobilized. The special programmes and collaborative arrangements segment includes the European Observatory on Health Systems and Policies and the World Alliance for Patient Safety. The low implementation rate against the approved budget in the Regional Offices of Africa and the Americas is due to those offices obtaining a lower proportion of financing for their approved budgets as described above. Implementation against the available funds in both offices was relatively high at 89% and 99%. LESSONS LEARNT During the biennium, the Secretariat had to respond to a growing number of requests for technical and policy support from Member States for health system strengthening in order to move closer to universal health coverage. The countries requesting support ranged from low-income countries facing the WHA APPROVED BUDGET FUNDS AVAILABLE (AS AT 31 DEC 2013) IMPLEMENTATION (AS AT 31 DEC 2013) (US$ 000) AFRO AMRO SEARO EURO EMRO WPRO HQ Total Health systems and services // SO 10 page 73

74 additional burden of noncommunicable diseases, mental health and injuries on top of the unfinished Millennium Development Goal agenda, to high-income countries trying to protect health and health spending from the prolonged effects of the financial crisis. Specified funding increased for policy dialogue on national health strategies and plans, financing for universal health coverage, and follow-up activities associated with the United Nations Commission on Information and Accountability for Women s and Children s Health in selected countries. Other elements of the strategic objective, including service delivery and patient safety, resource tracking and costing, information system strengthening, and research and knowledge management, were less well-funded. Such issues require active collaboration among priority health programmes and broader efforts to strengthen health systems. Making progress towards universal health coverage also requires frequent interaction between health ministries, finance ministries and political leaders. There is also a shortage of experts at country and global levels in some areas of health system strengthening, which limits the capacity of countries to make advances, as well as WHO s ability to respond to countries needs. As a result, the Organization focused on capacity-building activities during the biennium. Fragmentation of health systems remains a major problem in many countries and requires a concerted approach in order to build strong systems capable of ensuring the required range of quality health services across the life span that encompasses promotion, prevention, treatment, rehabilitation and palliative care. page 74 SO 10 // Health systems and services

75 SO 11 MEDICAL PRODUCTS AND TECHNOLOGIES To ensure improved access, quality and use of medical products and technologies Medical products may account for nearly half of the total health expenditure of Member States and up to 90% of the population in developing countries may buy health commodities through out-of-pocket payment. High prices, inability to pay, lack of social protection, inefficient supply management, and weak regulatory and enforcement systems for essential medicines and health technologies are the major factors impeding universal access to health care. Improving access to essential medicines and health technologies is a prerequisite for universal health coverage and for achieving the Millennium Development Goal targets for maternal and child health and for communicable diseases. It is also crucial in light of the increasing burden imposed by noncommunicable diseases and a rapidly ageing world population. WHO s efforts to ensure improved access, quality and use of medical products have been guided by the third WHO Medicines Strategy and by requests from Member States for support in implementing actions agreed to in Health Assembly and Executive Board resolutions and other global strategies for improving health. A number of regional strategies have been developed to guide actions to improve access, innovation, quality and use of medical products. WHO continues to work closely with health and other ministries, academia, research and scientific institutions, professional associations, the private sector and national civil-society organizations, and draws upon its network of inter-country support teams, WHO collaborating centres, more than 50 national professional officers and local and international experts. ACCESS TO MEDICINES AND HEALTH TECHNOLOGIES The strong and growing political commitment in countries to developing national health policies, strategies and plans has led to more systematic efforts to bring coherence to fragmented systems. WHO has provided technical assistance to countries in all regions towards the development of national medicines policies and plans, their revision and implementation, or to specific elements of these, such as selection, procurement, supply chain management, financing, pricing and reimbursement schemes, donations and treatment guidelines. As the prevalence of noncommunicable diseases increases, WHO is also stepping up collaboration across programmes towards improving access to medicines for chronic diseases, and has designed a package of essential technologies, medicines and risk prevention tools for the primary care of noncommunicable diseases in low-resource settings. Medical products and technologies // SO 11 page 75

76 After wide consultation, the WHO Traditional Medicines Strategy was launched and a high-level meeting on implementation of the strategy was organized in Macao SAR, China. Among other highlights, six WHO guidelines and technical documents were developed on traditional medicine research, safety and quality control of herbal medicines, and resource conservation of medicinal plans. Additionally, a chapter on traditional medicines was also included in the 11 th version of the International Classification of Diseases and a plan of action for implementation of the Decade of African Traditional Medicine ( ) was adopted by African Heads of State. The WHO Good Governance for Medicines Programme continues to grow in line with popular demand for accountability and transparency and is now operational in 44 countries. As up to 90% of the population in developing countries purchase health commodities through out-of-pocket payment, there is a pressing need for more systematic and efficient policies to enhance affordability. In 2013, WHO launched the WHO guideline on country pharmaceutical pricing policies to aid development of national policies on pricing and ensuring sustainable supply systems, and pricing surveys have been made in more than 50 countries applying the WHO HAI survey tool. The increasing incidence of medicines shortages, for which low- and middle-income countries are at heightened risk, is another accessrelated challenge and WHO has started work to improve notification and management of global stock-outs, including documenting existing mitigation practices. Value for money and efficiency are fundamental in guiding investment in health. The World health report 2010 Health systems financing: the path to universal coverage identified wasteful spending on medicines and other technologies as a major cause of inefficiencies in health-service delivery. Cost-effectiveness analysis and health technology assessments provide evidence on the benefits versus costs of medicines, health technologies and other health interventions. WHO has started mapping and analysing the status, trends and methods used for health technology assessments in Member States and promotes collaboration among countries on health technology assessments. With an annual global expenditure estimated at more than US$ 6.5 trillion and a global pharmaceutical market valued near US$ 880 billion (2012), the health sector is a real target for unethical practices. The WHO Good Governance for Medicines Programme responds to society demand for accountability and transparency and is now operational in 44 countries. An external evaluation in 2012 confirmed its contribution to increased awareness of transparency and good governance at international level. In April 2013, the WHO Expert Committee on the Selection and Use of Essential Medicines adopted the 18 th version of the WHO Model List of Essential Medicines. More than 100 countries have developed National Essential Medicines Lists. With support from the European Commission, WHO is working with countries to build their capacity for local production of essential medical products, which includes strengthening coherence between health and industrial policies. In 2012 WHO, jointly with WIPO and WTO, published a major study on promoting access to medical technologies and innovation. In follow-up to the Consultative Expert Working Group on Research and Development, WHO adopted a strategic workplan and undertook a number of virtual consultations with stakeholders to identify suitable demonstration projects that can show effectiveness of innovation to address therapeutic gaps. The Priority Medicines for Europe and the World report 2013 provides a public health-based medicines development agenda and identifies pharmaceutical gaps and priorities for pharmaceutical research for WHO also supported the development of a pharmaceutical manufacturing business plan for Africa under the auspices of the African Union. There are an estimated 1.5 million different medical devices in more than 10,000 types of generic device groups available worldwide. Advances and challenges in improving equal access to these were shared in the 2 nd Global Forum on Medical Devices in Furthermore, WHO has issued yearly Compendiums of innovative health technologies for low-resource settings and countries are undergoing training in the 18 modules of the first WHO Medical Devices Technical Series. The Baseline Country Survey on Medical Devices is regularly updated with the help of national focal points and will be included in the forthcoming Atlas of Medical Devices. Information from the Baseline Surveys is available in the Global Health Observatory and specific indicators for medical devices are available in the yearly World Health Statistics book. The 10 th anniversary of the World Blood Donor Day was celebrated by many Member States, and the number and proportion of voluntary non-remunerated donors increases every year. While national blood programmes and voluntary non-remunerated blood donations remain key challenges in the Western Pacific Region, almost all countries in South-East Asia are implementing the Global Strategy for Safe Blood and have nationally coordinated Blood Transfusion Centres and 100% of donated blood in the Region is screened page 76 SO 11 // Medical products and technologies

77 for HIV, and for hepatitis B and C. The October 2013 High-level Policy-Makers Forum resulted in the adoption of the Rome Declaration on Achieving Selfsufficiency in Safe Blood and Blood Products based on Voluntary Non-Remunerated Donation. There is also growing recognition of the need to address the unmet requirement of surgical care, attested to by the ever increasing number of participants in the now 4th biennial meeting of the Global Initiative for Emergency and Essential Surgical Care in The WHO Guiding Principles on Human Cell Tissue and Organ Transplantation endorsed by the World Health Assembly in 2010 continue to influence new or updated legislation on donation and transplantation, now in more than 40 countries. The principles also underpin the Declaration of Istanbul on Organ Trafficking and Transplant Tourism. In collaboration with the Transplantation Society and the Worldwide Network for Blood and Marrow, workshops were held in Brazil and South Africa to promote rational access to essential transplantation. The WHO initiative for medical products of human origin was also presented and refined during exchanges with professionals and competent authorities involved with human blood, organ, cells, tissues and assisted reproductive technologies in WHO meetings and in professional congresses. The NOTIFY Library on vigilance and surveillance of substances of human origin was extended to blood and blood products and to breast milk. To strengthen global traceability of medical products of human origin for safety and ethics, WHO collaborates with the international standards organization responsible for the management and development of the ISBT 128 Information Standard for Blood and Transplant, refining and disseminating agreed terminologies, unique global donation identifiers and standardized formats for information transfer. The rational use of medicines including antimicrobials and medicines for noncommunicable diseases and medicines selection are areas that require urgent attention. In April 2013, the WHO Expert Committee on the Selection and Use of Essential Medicines adopted the 18 th version of the WHO Model List of Essential Medicines, which has been updated every two years since Based on the Model List, more than 100 countries have developed National Essential Medicines Lists. To assist national health authorities in making use of these, the WHO Formulary was launched in 2002 as a guide for prescribers and pharmaceutical policy-makers. Based on innovative experiences in India, a model national formulary is now available as a mobile phone application. There is growing interest in rational selection and use of health commodities in all regions, and the 2012 Ministerial Summit on setting policies for better and cost effective healthcare held in the Netherlands reviewed the significant missed potential in the way medicines are used. Rational use of medicine is critical to addressing the growing threat of antimicrobial resistance and in ensuring safe use of medicines. WHO has established a task force on antimicrobial resistance, working with a range of partners, including animal health and industrial organizations. The WHO Better Medicines for Children Initiative has made considerable progress in making paediatric medicines available in child-friendly formulations and correct dosage. A number of tools have been developed including a list of priority life-saving medicines for women and children; recommendations for management of childhood conditions, and for the development of paediatric medicines; improved regulatory pathways for paediatric medicines; and an inter-agency list of medical devices and medicines for maternal and child health. In 2013 the WHO Expert Committee on the Selection and Use of Essential Medicines adopted a 4 th version of the WHO Essential Medicines List for Children and support has been provided to industry to improve capacities for the manufacture and prequalification of paediatric formulations. WHO has also provided technical expertise to the formulation of the recommendations of the UN Commission for Life-Saving Commodities for Women and Children s Health, and their implementation in eight pathfinder countries. Noncommunicable diseases, combined with a rapidly-ageing world population, give rise to a need for improved access to palliative care and pain relief. In 2012, WHO launched the WHO Guidelines on the Pharmacological Treatment of Persisting Pain in Children with Medical Illnesses and another two guidelines for the treatment of acute and persisting pain in adults are under development. The WHO Expert Committee on Drug Dependence met in 2013 and reviewed substances for possible scheduling under the International Drug Control Treaties. REGULATION OF MEDICINES AND HEALTH TECHNOLOGIES The development and adoption of norms and standards to regulate the quality, safety, efficacy and cost-effective use of medical products is facilitated by the coordinated efforts of two WHO Expert Committees, WHO Collaborating Centres and partner organizations. WHO continues to provide support to national drug regulatory authorities across all regions to develop national plans and build capacity for strengthening regulatory oversight of medical products. Quality in medical products is one of the cornerstones of health care and has a major impact on access and costs. Until 2000, the pattern was poor quality for the poor ; however, thanks to prequalification, millions of people in low-income countries now have access to world-standard treatment. During Medical products and technologies // SO 11 page 77

78 the biennium, the three WHO Prequalification Programmes for diagnostics, medicines and vaccines were brought together under one umbrella and during the biennium WHO has ensured the availability of another 110 prequalified priority HIV/AIDS, malaria, tuberculosis and reproductive health medicines (bringing the total to 370); 43 active pharmaceutical ingredients (bringing the total to 51); and seven quality-control laboratories (bringing the total to 29). Among these are first prequalified laboratories in Belarus, China, Mexico, Russia and Thailand, adding significant quality assurance capacities in countries with existing and expanding pharmaceutical manufacturing. WHO also prequalified another 16 vaccines (bringing the total to 134), 17 prequalified diagnostics and one medical device (bringing the total to 27). Another 21 new International Chemical Reference Substances and 11 reference preparations were established and made available as physical standards against which national quality control laboratories can test medicines. Fifty global specifications, monographs and general texts were approved by the WHO Expert Committee on Specifications for Pharmaceutical Preparations and published for inclusion in the International Pharmacopoeia a compendium of standardized terminology, dosage and drug composition which manufacturers and regulators use for quality control. The WHO International Nonproprietary Names programme gave generic names to another 293 medicines (bringing the total to 8900). The WHO Prequalification of Medicines Programme conducted a total of 173 inspections of, inter alia, 22 contract research organizations, 62 active pharmaceutical ingredient manufacturers, 61 finished pharmaceutical product manufacturers and 26 qualitycontrol laboratories. In addition, 54 capacity-building exercises were organized, either exclusively by WHO, or in collaboration with partner organizations, for a total of 2975 staff members from manufacturers, regulatory authorities and quality-control laboratories. WHO also supported capacity-building and technical assistance to over 60 pharmaceutical quality control laboratories and manufacturers of diagnostics and medical devices medicine names have been allocated by the WHO International Nonproprietary Names Programme 293 in the last biennium. A joint UNICEF, UNFPA and WHO meeting was held in Copenhagen in September 2013 bringing together medicines and diagnostics pharmaceutical manufacturers, quality, safety and efficacy experts, procurement agencies and international donors to discuss production and supply of quality essential medicines and priority diagnostics. In the European Region, 18 products manufactured by six companies were prequalified in 2013, including an anti-tb product produced in the Russian Federation. In 2013, WHO launched the Collaborative Registration Procedure for WHO-prequalified products which accelerates registration through improved information sharing between the WHO Prequalification of Medicines Programme. Member States have become increasingly committed to combating substandard/spurious/falsely-labelled/ falsified/counterfeit (SSFFC) medical products. The first two meetings of the Member States mechanism on SSFFC medical products held in Argentina (2012) and Geneva (2013) represent a determination on the part of the international community to tackle the growing challenge these products pose to public health. WHO has designed, developed and deployed a SSFFC rapid alert system for reporting and monitoring suspected SSFFC cases. The central database for all SSFFC reports will allow structured and systematic reporting and a more accurate assessment of the scope, scale and harm caused by SSFFC medical products. Three workshops in the African and Eastern Mediterranean Regions were conducted during 2013, with 57 Member States now participating and 133 National Regulatory personnel trained as focal points. The first 200 reports of suspected SSFFC medical products have been received. Technical support was provided to countries in urgent cases and five International Drug Alerts have been issued. 35 out of 44 vaccine-producing countries have functional vaccine regulatory systems. WHO became a member of the Management Committee of the International Medical Devices Regulators Forum, and has contributed to advance global convergence and harmonization of medical devices regulations. In the area of diagnostics, WHO has introduced new features to improve access to quality point of care diagnostics for priority diseases. Technical assistance to individual manufacturers of point of care CD4 and HIV virological technologies was provided through advisory visits, and a first training session on international standards for regulatory requirements for diagnostics was organized in China bringing manufacturers and regulators together. WHO has more than 60 years experience in establishing standards for vaccines and other biologicals, or medicinal products created through biological processes. By including a wide range of partners in the process of making norms and standards, WHO has simultaneously facilitated consensus on technical matters and among regulatory decision-makers from countries. During the biennium, page 78 SO 11 // Medical products and technologies

79 the Expert Committee on Biological Standardization approved another nine written standards and eight reference preparations for vaccines and biotherapeutic products. To date WHO has ensured over 17 standards and reference preparations that are essential for ensuring the quality of biological medicines globally. WHO prequalified: > > 110 pharmaceutical products for HIV/AIDS, malaria, tuberculosis and reproductive health; > > 43 active pharmaceutical ingredients; > > 7 quality-control laboratories; > > 16 vaccines; > > 17 prequalified diagnostics; > > 1 medical device. Since the 1990s, WHO has implemented a step-wise capacity-building programme to strengthen the six WHO-recommended vaccine regulatory functions and, as of 2013, 35 out of 44 vaccine-producing countries have functional vaccine regulatory systems. WHO has developed different tools to assess medicines, diagnostics, medical devices and vaccines, and an initiative to harmonize these tools and to make joint assessments was recently launched. During the biennium, WHO has assessed or provided technical assistance to regulatory authorities in 134 Member States. In more than 50 countries, this was done in the context of the WHO Prequalification Programme. Another key achievement has been the establishment of a network of WHO collaborating centres to support vaccine regulation and standardization. Through its network of 144 Member and Associate Member countries, the WHO Programme for International Drug Monitoring monitors the safety of medicines use and during the biennium another seven countries joined the programme: Bangladesh, Bolivia, Lao People s Democratic Republic, Papua New Guinea, Qatar, Syria, and the United Arab Emirates. To date this network has reported 8 million adverse drug reactions. The number of vaccine doses administered globally and the number of vaccines products available is increasing rapidly and the Global Vaccine Safety Initiative was established to monitor and respond to emerging safety concerns and represents the implementation mechanism for the Global Vaccine Safety Blueprint, or WHO s strategic plan for building national capacities for monitoring vaccine safety. The Global Vaccine Safety Initiative is attracting an increasing number of countries and organizations involved in drug and vaccine safety monitoring and research and there is now a portfolio of over 90 activities to enhance vaccine pharmacovigilance worldwide. Every second year since 1980, WHO has convened the International Conference of Drug Regulatory Authorities. In this conference regulatory authorities from more than 100 countries come together to define actions for national and international regulation and harmonization of regulatory requirements for medicines, vaccines, biologicals and herbals. In 2012 the conference was held in Estonia, gathering more than 300 participants. WHO continues to drive the harmonization of regulatory standards across regions and is one of the key agencies coordinating the African Medicines Regulatory Harmonization Initiative. The East African Community Medicines Regulatory Harmonization project provides a model for harmonization and has demonstrated remarkable success in this area. A first global meeting on improving access to safe blood products brought together over 50 experts to discuss ways of improving the availability, quality and safety of blood products, as well as reducing the current wastage of human plasma, which it is estimated could generate plasma derivatives with an annual market value of US$ 2.5 billion. A WHO e-catalogue currently contains more than 100 reference standards, facilitating the harmonization of international regulations for blood safety. Work is also ongoing to improve access to safe blood products in low- and middle-income countries through local production and transfer of technology in blood establishments in Asian and sub-saharan Africa. Under the leadership of the Safe Injection Global Network, the international community has made significant progress towards improving injection safety through a reduction in both the use of injections and reuse of injection devices. There has been an 88% decrease in the number of unsafe injections during the period Key injection safety indicators also show that important progress has been made in the reuse of injection devices. ASSESSMENT OF ORGANIZATION-WIDE EXPECTED RESULTS Of the three Organization-wide expected results, one has been fully achieved and two partly achieved. Political unrest, tight earmarking of available funds, high turnover of government officials, and underfunded national health systems were main reasons that certain activities were not completed, affecting the overall ratings for the Organization- Medical products and technologies // SO 11 page 79

80 OWER OWER Rating Indicator Baseline 2012 Target 2013 Achieved 2013 OWER Rating Key: Fully achieved Partly achieved x Not achieved Member States receiving support to formulate and implement official national policies on access, quality and use of essential medical products or technologies Member States receiving support to design or strengthen comprehensive national procurement or supply systems Member States receiving support to formulate and/or implement national strategies and regulatory mechanisms for blood and blood products or infection control Publication of a biennial global report on medicine prices, availability and affordability, based on all available regional and national reports. 1 report published in report published in report published in New or updated global quality standards, reference preparations, guidelines and tools for improving the provision, management, use, quality, or effective regulation of medical products and technologies. Additional per biennium 30 per biennium Assigned International Nonproprietary Names for medical products Priority medicines, vaccines, diagnostic tools and items of equipment that are prequalified for United Nations procurement. 320 (274 medicines; 35 APIs ; 11 diagnostic tools; 134 vaccines) 495 (300 medicines; 40 APIs; 15 diagnostic tools; 140 vaccines) Member States for which the functionality of the national regulatory authorities has been assessed or supported National or regional programmes receiving support for promoting sound and cost-effective use of medical products or technologies Member States using national lists, updated within the past 5 years, of essential medicines, vaccines or technologies for public procurement or reimbursement More detailed information on indicators can be found in Annexes 2 and 3. wide expected result. In addition, significant pockets of poverty, including for normative work to improve access to medical products, have a negative impact on the reach and effectiveness of the Organization. FINANCIAL SUMMARY The total approved budget for strategic objective 11 was US$ 137 million, including US$ 16 million for special programmes and collaborative arrangements for the work of the Prequalification Programme. At the end of December 2013, funding of US$ 149 million (108% of the approved budget) had been made available through assessed and voluntary contributions. Of that, US$ 117 million was for base programmes and US$ 32 million for special programmes and collaborative arrangements. Globally, of the available funds, US$ 141 million (102% of the approved budget and 95% of available funds) had been implemented by the end of Available funds in headquarters, which represented 131% of its approved budget, included specified funding for the WHO Prequalification Programme, which has seen significant growth in recent years and has benefitted from high levels of voluntary funding primarily from the Bill & Melinda Gates Foundation, GAVI and UNITAID. Activities related to regulatory strengthening have indirectly benefitted from the page 80 SO 11 // Medical products and technologies

81 WHA APPROVED BUDGET FUNDS AVAILABLE (AS AT 31 DEC 2013) IMPLEMENTATION (AS AT 31 DEC 2013) (US$ 000) AFRO AMRO SEARO EURO EMRO WPRO HQ Total high level of funding to the WHO Prequalification Programme, through implementation of joint activities such as joint assessments of applications for market authorization, training workshops and technical assistance missions to countries. Implementation rates against funds available are fairly even between major offices, ranging from 90% in the Regional Office of the Western Pacific to 97% in the Regional Offices of the Americas and for South-East Asia. This reflects a good capacity to implement when funds are available. Implementation rates against the approved budget vary more substantially between major offices, with only 53% implementation in the Regional Office for the Americas and 143% in the Regional Office for Europe. The lower budget implementation rates in the African Region and the Region of the Americas are primarily due to lack of financing. In the European and Eastern Mediterranean Regions, where funding beyond the approved budget was achieved, an expansion of strategic objective 11 to better respond to country-specific needs and requests for technical assistance would nevertheless be required. LESSONS LEARNT There is a clear link between increased commitment to moving closer to universal health coverage and a growing recognition among Member States of the importance of efficiently functioning medicine and health technology systems. More regional networks and intercountry work processes are being established for sharing information and experiences and addressing specific topics. Collaborative initiatives and the availability of national focal points and country advisers have increased the effectiveness of implementation and made interventions sustainable, as evidenced by noticeable achievements in several regions where full-time medicine and health technology advisors enabled the Secretariat to respond to country requests and deliver technical advice and support. Integrated health systems must be used as a common approach in addressing disease-specific and vertical programmes in order to improve the integration of services. Medical products and technologies // SO 11 page 81

82 SO 12 WHO LEADERSHIP, GOVERNANCE AND PARTNERSHIPS To provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and other stakeholders in order to fulfil the mandate of WHO in advancing the global health agenda as set out in the Eleventh General Programme of Work WHO is undertaking extensive reform to ensure that the Organization is well-equipped to address the increasingly complex challenges of the 21 st century. The objectives are threefold: z improved health outcomes (programmatic) z greater coherence in public health (governance) z an organization that pursues excellence (management) The Twelfth General Programme of Work and the Programme budget , approved at the World Health Assembly in May 2013, reflect WHO s move towards improved predictability, flexibility, alignment and transparency. A clear results chain shows the links between the work that WHO will do and its contribution to the outcomes and impact on public health. The programme budget is underpinned by priority-setting criteria, clarifies deliverables for each level of the Organization, and sets out realistic budgets. For the first time, the Organization launched a financing dialogue with Member States and other key contributors at a meeting in June The dialogue aims to ensure a match between WHO s results and deliverables and the resources available to fund them. Progress was made to enhance the role of the governing bodies, to manage the agenda and time objectives, and to align the agendas of the Regional Committees, Executive Board and World Health Assembly. Regular briefings allowed Member States to participate more effectively and influence decisionmaking in meetings of the governing bodies. Internal governance was reinforced by regular meetings of the Global Policy Group and other senior staff. At the managerial level, some reforms were fully implemented while others remained at the policy analysis stage. WHO REFORM Three years into WHO reform, tremendous achievements have been made. Progress, however, has been in stepwise fashion, with some areas advancing more than others. Programmatic reforms were marked by Member States approval of the Twelfth General Programme of Work and Program budget in the World Health Assembly in May Governance page 82 SO 12 // WHO leadership, governance and partnerships

83 reforms progressed in term of enhancing the role of governing bodies, application of efficiency mechanisms for better management of the time and agenda, and aligning the agendas of Regional Committees, Executive Board and the World Health Assembly accordingly. The Secretariat took steps to improve Member States engagement in the governing bodies by improving electronic access to proceedings and documentation. Managerial reforms progressed and while some advanced to detailed implementation, some remain at the level of policy analysis. The greatest progress had been in WHO financing mechanisms. The first and second WHO financing dialogues in 2013 had a significant impact on the shift towards further predictability, flexibility, alignment and transparency of WHO s financing. Achievements were made within the programmatic, governance and management areas of WHO reform towards the objectives of better health outcomes, increased coherence in global health, and improving organizational excellence. Significant progress was made on WHO financing mechanisms, and the Financing Dialogue meeting in 2013 was decisive in the shift towards greater predictability, flexibility, alignment and transparency of WHO resources. GLOBAL HEALTH GOVERNANCE Global health governance reached a strategic point in realizing achievements and lessons learned for the post-2015 era. The shift of health challenges from communicable to noncommunicable diseases is facing a turning point in addressing contributing risk factors in market economies. In May 2013, the World Health Assembly considered and endorsed three global action plans for noncommunicable disease, mental health, and prevention of avoidable blindness and visual impairment. All three plans called for a life-course approach, aimed to achieve equity through universal health coverage, and emphasized the importance of prevention. All three gave major emphasis to the benefits of integrated service delivery. Joint efforts continued between Member States and WHO to improve the health situation in the regions. Regional Committees in all regions increased awareness of regional health needs and priorities. Harmonization of Executive Board and World Health Assembly resolutions with Regional Committees resolutions had been in focus. Revisions of the rules of procedures were endorsed in some of the Regional Committees in line with the WHO reform agenda, which in turn enhanced and aligned governance and accountability within the governing bodies mechanism. The Secretariat in all regions and at headquarters provided Member States with regular briefings to enable them to more effectively participate and influence decisionmaking in the governing bodies meetings. INTERNAL WHO GOVERNANCE Internal governance was reinforced by regular meetings of the Global Policy Group and other senior staff networks meetings. High-level advocacy for health was undertaken by the Director-General and Regional Directors during different events. During , the Director-General and Regional Directors took measures to lower costs and improve coordination among health partners, particularly at country level. As part of implementation of the reform agenda, the Compliance, Risk Management and ethics department was established under the office of the Director-General. An Organization-wide evaluation workplan for was submitted to the governing bodies meetings. WHO S WORK IN COUNTRIES Enhancing WHO s performance at country level has been the cornerstone of WHO s reforms. A paper on WHO s reform at country level was developed, which aims to advance the implementation of WHO s reform elements that have implications at country level. The paper proposals include engaging more credibly with partners by strengthening convening roles; revising the Country Cooperation Strategy Framework to align with the 12 th General Programme of Work leadership priorities and to link to the WHO results chain; ensuring appropriate profile of staff to match countries needs; and strengthening more effective and efficient administrative and managerial capacity for enhanced transparency and accountability. To enhance corporate strategic dialogue on WHO reforms, in November 2013 the 7 th Global Meeting of Heads of WHO Offices was held with the Director- General, Regional Directors, 148 Heads of WHO Offices and senior managers from regions and headquarters. The meeting provided an opportunity to discuss priority areas critical to WHO reform priority areas that require adequate attentions and response from WHO offices in countries, territories and areas. To ensure bottom-up planning and to develop WHO priorities based on countries needs, the Framework is being revised to align with the Twelfth General Programme of Work leadership priorities and linked to WHO results chain. This will enhance the use of CCS in WHO planning processes. The quality of the selection of Heads of WHO Offices has improved gradually largely due to the competitive selection process through a global roster, which was reviewed to further enhance the quality of the selection. WHO leadership, governance and partnerships // SO 12 page 83

84 They are better prepared to take their new jobs through various capacity-development programs. In terms of capacity-development of country teams, 90% of the full-time Heads of WHO Offices completed a 10-week online global health diplomacy course, and 20 newly appointed Heads of WHO Offices were provided with global induction covering key technical and managerial areas. To stimulate exchanges and sharing of experiences among country offices across regions, the network of BRICS country offices has been working effectively and a special issue of the WHO bulletin on BRICS and global health will be issued during As part of strengthening WHO s performance in countries, support has been provided for Heads of WHO Offices to be active members of the United Nations Country Team. Updates and guidance were provided on standard operating procedures for delivering as one, UNRC funding modalities and development of the United Nations Development Assistance Framework (UNDAF). According to the Country Presence Survey Report 2012, WHO field offices acted as Chair or co-chair of the Health Thematic group in 90% of 116 countries, territories and areas. Similarly, WHO field offices contributed significantly to the development of the health component of UNDAFs; as a result, 96% (28 out of the 29 UNDAFs in the countries) where Country Cooperation Strategies were elaborated within the biennium, reflected the health component as an outcome beyond HIV/AIDS. Further, three-quarters of WHO field offices have been actively involved in partnerships through sectoral coordination platforms such as SWAp or IHP+. MANAGING GLOBAL PARTNERSHIPS Pursuant to the decision of EB132 (10), the Executive Board requested its Programme, Budget and Administration Committee (PBAC) to ensure that the arrangements for hosted health partnerships are regularly reviewed on a case-by-case and timely basis in respect of their contributions to improved health outcomes, WHO s interaction with individual hosted partnerships, and the harmonization of their work with the work of WHO. In this regard, the Executive Board requested the Director-General to prepare an operational framework to facilitate the Committee s review. The Secretariat, in consultation with the hosted partnerships, has developed a paper for the Committee describing a proposed approach for the conduct of the reviews (EBPBAC19/8). Under the proposed approach, the Secretariat would work with the hosted partnership being reviewed and submit for each review a report describing: z the partnership s contributions to improved health outcomes; z the harmonization of the partnership s work with that of WHO; and z issues that have arisen relating to administrative aspects of the hosting arrangement. The report would serve as the basis for the review by the Programme, Budget and Administration Committee. Modalities to ensure full recovery of the costs associated with hosted partnerships need to be premised on the development and roll-out of a coherent management and administration costs framework that will apply to the entire WHO Secretariat. In this respect, the study commissioned by Programme, Budget and Administration Committee in late 2011 of WHO s administrative and management costs was not intended to provide the level of detail required to identify all the cost drivers and metrics that would be needed to develop a comprehensive costing framework for partnerships. Further work in this area is therefore expected to be carried out in 2014, on the basis of which a costing framework that ensures full cost-recovery on a fair and transparent basis can be developed and applied to hosted partnerships as appropriate. Progress was made in better aligning WHO s work at country level with country needs, through the revision of country cooperation strategies. Country cooperation strategies are being aligned with the health plans and strategies of individual countries and United Nations Development Assistance Framework. The Joint Committee of WHO-Hosted Partnerships has been established. The Joint Committee serves as a forum where coordination of programmatic and administrative issues affecting the hosting relationship are discussed, and through which recommendations on such matters are made to the Director-General. The Joint Committee held its first meeting in late Through the Joint Committee, the Secretariat has stressed the requirement that hosted partnerships must set aside reserves to meet unforeseen staff liabilities. The main elements of a new framework of engagement with non-state actors were elaborated through a process involving multiple stakeholders, which included consultations with Member States and the non-state actors, a public web-based consultation, and several debates in governing bodies meetings See documents EB130/5 Add.4, A65/5, EB 132/5 Add.2 and EB133/16. page 84 SO 12 // WHO leadership, governance and partnerships

85 However, detailed policies related to the new framework still have to be formulated and agreed. A working group of WHO and partnership secretariat staff has been established to formulate internal guidelines for coordinating the regional and country activities of hosted partnerships with those of WHO programmes. These guidelines will further inform WHO s engagement in hosted partnerships. Work on the development of generic hosting terms for WHO-hosted partnerships has been initiated and is conducted through the Joint Committee of WHO- Hosted Partnerships. INFORMATION AND COMMUNICATIONS Development and maintenance of WHO websites with timely publication of news and information product in official languages continued in the regions and headquarters. The presence of WHO in the social media reached different levels, with greater opportunities to engage with WHO experts through different platforms and more visually appealing and responsive up-to-date websites. The updated WHO regional websites provided greater visibility for WHO and national activities at country level, with a growing number of country offices with active web pages. The new communications department inspired a more proactive and collaborative working relationship with the media, covering public health issues through media fellowships, editorial boards and other networking and educational opportunities for supporting journalists in order to encourage more accurate coverage of health issues. It also played a key role in creating the Organization s first corporate social media team. The first-ever WHO global communications strategy was developed to address the changes required in the way WHO communicates; to provide accurate, accessible and timely information to a wider audience; to reinforce the leadership reputation on how WHO works to improve health; and, last but not least, to ensure that WHO staff have access to programmatic and organizational information in a timely fashion OWER OWER Rating Indicator Baseline 2012 Target 2013 Achieved 2013 OWER Rating Key: Fully achieved Partly achieved x Not achieved Documents submitted to governing bodies within constitutional deadlines in the 6 WHO official languages. 95% 95% 95% Member States where WHO is aligning its country cooperation strategy with the country s priorities and development cycle and harmonizing its work with the United Nations and other development partners within relevant frameworks, such as the UN Development Assistance Framework, Poverty Reduction Strategy Papers and Sector-Wide Approaches. 33 country cooperation strategies 38 of the 145 country cooperation strategies updated/ revised 38 of the 145 country cooperation strategies updated/ revised WHO country offices that have reviewed and adjusted their core capacity in accordance with their country cooperation strategy. 77% 80% 80% Health partnerships in which WHO participates that work according to the best-practice principles for Global Health Partnerships Health partnerships managed by WHO that comply with WHO partnership policy guidance. 100% 100% 100% Countries where WHO is leading or actively engaged in health and development partnerships (formal and informal), including in the context of reforms of the UN system. 80% 90% 90% Average page views/visits per month to the WHO HQ web site. 7 million 7 million More than 7 million Pages in languages other than English available on WHO s country and regional offices and HQ web sites. More than More than More detailed information on indicators can be found in Annexes 2 and 3. WHO leadership, governance and partnerships // SO 12 page 85

86 empowing them to give consistent messaging both internally and with key stakeholders externally. The global strategy aims at building networks and capacity of Member States and WHO staff at national, regional and global levels to provide quick, accurate and proactive communication during disease outbreaks, public health emergencies, and humanitarian crises. ASSESSMENT OF ORGANIZATION-WIDE EXPECTED RESULTS The achievement of the four Organization-wide expected results marks the completion of a significant phase in the Secretariat s reform process. Stepwise advances were made in the reform of governance, programmes and management. In , reform efforts will be catalysed through a more strategic approach. The focus will be on enhancing country performance through a revised country cooperation strategy framework aligned with country needs and priorities. Capacity in country offices will be further strengthened to enable them effectively to deliver WHO s leadership priorities, and to broker and provide technical and policy support and advice. FINANCIAL SUMMARY The approved budget for strategic objective 12 was US$ 258 million. Available funding at the end of 2013 was US$ 263 million (102% of the approved budget), of which US$ 198 million were from assessed contributions and US$ 65 million from voluntary contributions. Implementation across all locations as at 31 December 2013 was US$ 257 million, which corresponds to 100% of the approved budget and 98% of the available resources. During adjustments were made to realign functions under strategic objectives 12 and 13 and to better harmonize the actual resource requirements, particularly in country offices. This resulted in uneven implementation rates of major offices against their original approved budgets. For example, additional allocations were provided to the Regional Offices of the Western Pacific and Europe and, through internal budget shifts among strategic objectives, to meet country and regional office requirements to implement reform-related activities and strengthen WHO presence in countries. LESSONS LEARNT More work is needed to further strengthen WHO s governance role, build governance capacity and deepen the reform of management policies, systems and practices. Even though a new evaluation framework was developed and a Compliance, Risk Management and Ethics Department established, efforts in building a more coherent and accountable Organization need to be consolidated. Better alignment of the work of the three levels of the Organization through efficient and effective programme coordination mechanisms and communications strategies should be given more WHA APPROVED BUDGET FUNDS AVAILABLE (AS AT 31 DEC 2013) IMPLEMENTATION (AS AT 31 DEC 2013) (US$ 000) AFRO AMRO SEARO EURO EMRO WPRO HQ Total page 86 SO 12 // WHO leadership, governance and partnerships

87 attention in in order to enhance WHO s performance within countries. At the country level, country cooperation strategies need to be aligned with the health plans and strategies of individual countries, as well as with United Nations Development Assistance Framework processes. The establishment of a new model to finance the work of WHO, together with the alignment of the priorities agreed by its governing bodies with adequate funds, and the provision of required resources for potential shifts, are the next actions to be undertaken. It is recognized that resource mobilization requires further work, including on the best way to use the three levels of the Organization. With the adoption of a new resultsbased framework, it is now possible to carry out more systematic and objective assessments of progress in categories and programme areas that contribute to the achievement of results, and to alignment of output deliveries with the use of resources. WHO leadership, governance and partnerships // SO 12 page 87

88 SO 13 ENABLING AND SUPPORT FUNCTIONS To develop and sustain WHO as a flexible, learning organization, enabling it to carry out its mandate more efficiently and effectively Strong and efficient administrative and management support services are essential to enable WHO to carry out its mandate. The main focus for biennium was on WHO reform, particularly in the areas of programming and management. A major achievement was the delivery of significant cost savings to the Organization. WHO incurred expenses of US$ 481 million in compared to US$ 540 million in In part, this reduction resulted from re-categorizing costs to different strategic objectives, but an estimated US$ 40 million was saved, mostly at headquarters, by outsourcing, relocating and reorganizing work. For example, in the area of operational support and logistics, facility management functions have been outsourced to an external company ensuring the same quality of services. PLANNING, RESOURCE COORDINATION, MONITORING AND PERFORMANCE ASSESSMENT An important milestone was the development of the new results-based management framework, which provides a clear chain of results and better delineates the work at the three levels of the Organization. WHO s vision, as described in the 12 th General Programme of Work and the scope of work included in the Programme budget , is also reflected in the new framework. In this context, the approval of the Programme budget in its entirety is a major achievement in the managerial pillar of WHO reform. This is coupled with the successful Financing Dialogue process with Member States and donors, that has introduced a more structured approach to ensuring full financing for the Organization. Furthermore, a task force on resource mobilization and management, co-chaired by the Deputy Director- General and the Regional Director for Europe, was established to provide guidance on a more coordinated, Organization-wide approach. Bilateral and informal meetings with donors were conducted regularly. The programme budget web portal, which aims to provide better transparency and accountability of programme delivery by tracking outcome and output indicators, was well received at the financing dialogue in November This biennium was also the last biennium within the Medium-term Strategic Plan As part of the assessment of programme delivery, the programme page 88 SO 13 // Enabling and support functions