AFGHANISTAN ALBANIA ALGERIA ANDORRA ANGOL A ANTIGUA AND BARBUDA ARGENTINA ARMENIA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH WHO/DGR/CCO/08.1 BARBADOBARBADOS BELARUS BELGIUM BELIZE BENIN BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BRAZIL BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA COLOMBIA COMOROS CONGO COOK ISLANDS COSTA RICA CÔTE D’IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DEMOCRATIC PEOPLE’S REPUBLIC OF KOREA DEMOCRATIC REPUBLIC OF THE CONGO DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FIJI FINLAND FRANCE GABON GAMBIAMBIA GEGGEORGIAEO GERMANY GHANA GREECE GRENADA GUATEMALA GUINEA GUINEA- BISSAUSSAU GGUYANAUYA HAITI HONDURAS HUNGARY ICELAND INDIA INDONESIA IRAN (ISLAMIC REPUBLICEPUBLIC OF)FOURTH IRAQ IRELAND GLOBAL ISRAEL MEETING ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KUWAIT KYRGYZSTAN LAO PEOPLE’S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIAOF HEADS LIBYAN OF ARABWHO JAMAHIRIYA COUNTRY LITHUANIAOFFICES LUXEMBOURG MADAGASCAR MALAWI MALAYSIAMAWITH THE MALDIVES DIRECTOR-GENERAL MALI MALTA MARSHALL ISLANDS MAURITANIA MAURITIUS MEXICOMEXICO MIMICRONESIAC (FEDERATED STATES OF) MONACO MONGOLIA MONTENEGRO MOROCCO MOZAMBIQUEMOZAMBIQUAND MYANMAR REGIONAL NAMIBIA DIRECTORS NAURU NEPAL NETHERLANDS NEW ZEALAND NICARAGUA NIGERR NIGERIANI NIUE NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL QATAR REPUBLIC OF KOREA REPUBLIC OF MOLDOVA ROMANIA RUSSIAN FEDERATION RWANDA SAINT KITTS AND NEVIS SAINT LUCIA SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAJIKISTAN THAILAND THE FORMER YUGOSLAV REPUBLIC OF MACEDONIA TIMOR-LESTE TOGO TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED REPUBLIC OF TANZANIA UNITED STATES OF AMERICA URUGUAY UZBEKISTAN VANUATU VENEZUELA (BOLIVARIAN REPUBLIC OF) VIET NAM YEMEN ZAMBIA ZIMBABWE AFGHANISTAN ALBANIA ALGERIA ANDORRA ANGOL A ANTIGUA AND BARBUDA ARGENTINA ARMENIA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BRAZIL BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA COLOMBIA COMOROS CONGO COOK ISL ANDS COSTA RICA CÔTE D’IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DEMOCRATIC PEOPLE’S REPUBLIC OF KOREA DEMOCRATIC REPUBLIC OF THE CONGO DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FIJI FINLAND FRANCE GABON GAMBIA GEORGIA GERMANY GHANA GREECE

 GRENADA GUATEMALA GUINEA GUINEA- BISSAU GUYANA HAITI HONDURAS HUNGARY ICELAND INDIA INDONESIA IRAN (ISLAMIC REPUBLIC OF) IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KUWAIT KYRGYZSTAN LAO PEOPLE’S DEMOCRATICWorld Health Organization REPUBLIC Headquarters LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LITHUANIAGeneva, 12-14 LUXEMBOURG November 2007 MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MAURITANIA MAURITIUS MEXICO MICRONESIA (FEDERATED STATES OF) MONACO MONGOLIA MONTENEGRO MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL QATAR REPUBLIC OF KOREA REPUBLIC OF MOLDOVA ROMANIA RUSSIAN FEDERATION RWANDA SAINT KITTS AND NEVIS SAINT LUCIA SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAJIKISTAN THAILAND THE FORMER YUGOSLAV REPUBLIC OF MACEDONIA TIMOR-LESTE TOGO TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED REPUBLIC OF TANZANIA UNITED STATES OF AMERICA URUGUAY UZBEKISTAN VANUATU VENEZUELA (BOLIVARIAN REPUBLIC OF) VIET NAM YEMEN ZAMBIA ZIMBABWE

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2 TABLE OF CONTENTS

Abbreviations 4

Part I: Key action points 5

Part II: Introduction 7

Part III: Summary of proceedings 9

Opening Session 10

WHO, Global Health Partnerships and the UN Reform 12

Strengthening Health Systems: implications for WHO’s work at country level 14

Effective functioning of WHO Country Offi ces • Changing role of WHO Country Offi ces 15 • Improving the management of WHO Country Offi ces 17 • Improving the effectiveness and effi ciency of Country Offi ce operations through the Global Management System 19

WHO’s work in countries in crisis situations 21

International Health Regulations (2005) 23

Public health innovation, intellectual property, trade and health 25

Concluding Session 27 • Orientation by the Director-General and Regional Directors • Remarks on behalf of HWCOs by Dr Helene Mambu-Ma-Disu, WHO Representative, Cameroon • Director-General’s Closing Remarks

Part IV: Strategic and managerial actions recommended by the meeting 29

Market place 33

The fourth global meeting in pictures 34

Lunch-time events 36

Part V: Annexes 37

Annex 1: Agenda and programme 38 Annex 2: Director-General’s opening remarks 42 Annex 3: Concluding session speeches and remarks 47 Annex 4: List of participants 53 Annex 5: Evaluation 60 Annex 6: CD-ROM contents 64

Table of contents 3 ABBREVIATIONS

ADG Assistant Director-General IP Intellectual Property AFRO WHO Regional Offi ce for Africa IPR Intellectual Property Rights AFI Administration and Finance IT Information Technology Information Support JAS Joint Assistance Strategy AMRO WHO Regional Offi ce for the Americas MoH Ministry of Health AMS Activity Management System MOU Memorandum of Understanding CCA Common Country Assessment MDGs Millennium Development Goals CCS Country Cooperation Strategy MTSP Medium-Term Strategic Plan CEB Chief Executive Board NGARA Network for Natural Gums and CERF Central Emergency Revolving Fund Resins in Africa CCO Department of Country Focus NGO Nongovernmental organizations CO Country Offi ce PHEMAP Public Health and Emergency Management DDG Deputy Director-General in Asia and the Pacifi c DG Director-General PHI Secretariat on Public Health, Innovation DPM Director, Programme Management and Intellectual Property DRC Democratic Republic of the Congo PHP Programme Health Partnership DRD Deputy Regional Director PUN Partnerships and UN Reform EMRO WHO Regional Offi ce for the Eastern PSC Programme Support Costs Mediterranean RCS Resident Coordinator System EPR Epidemic and Pandemic Alert and Response RD Regional Director ETH Ethics, Equity, Trade and Human Rights RO Regional Offi ce EURO WHO Regional Offi ce for Europe SEARO WHO Regional Offi ce for South-East Asia GATS General Agreement on Trade in Services SOPs Standard Operating Procedures GAVI Global Alliance for Vaccines TBT Technical Barriers to Trade and Immunizations TMAS Travel and Meetings Administration System GFATM The Global Fund to fi ght AIDS, TRIPS Trade-Related Aspects of Intellectual Tuberculosis and Malaria Property Rights GHP Global Health Partnership UN United Nations GMP Global Malaria Programme UNCT United Nations Country Team GPW General Programme of Work UNDAF United Nations Development Assistance GSM Global Management System Framework HAC Health Action in Crises UNDG United Nations Development Group HBP Health as a Bridge for Peace UNDP United Nations Development Programme HIV/AIDS Human Immunodefi ciency Virus/Acquired UNICEF United Nations Children’s Fund Immune Defi ciency Syndrome WCOs WHO Country Offi ces HQ Headquarters WHA World Health Assembly HR Human Resources WHO World Health Organization HSE Health Security and Environment WPRO WHO Regional Offi ce for the Western Pacifi c HSS Health Systems and Services WR WHO Representative HWCO Head of WHO Country Offi ce WTO World Trade Organization IGWG Intergovernmental Working Group IHP International Health Partnership IHR International Health Regulations

4 Abbreviations AFGHANISTAN ALBANIA ALGERIA ANDORRA ANGOL A ANTIGUA AND BARBUDA ARGENTINA ARMENIA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BRAZIL BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA COLOMBIA COMOROS CONGO COOK ISLANDS COSTA RICA CÔTE D’IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC PART DEMOCRATIC I PEOPLE’S REPUBLIC OF KOREA DEMOCRATIC REPUBLIC OF THE CONGO DENMARKKEY ACTION DJIBOUTI POINTS DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FIJI FINLAND FRANCE GABON GAMBIA GEORGIA GERMANY GHANA GREECE GRENADA GUATEMALA GUINEA GUINEA- BISSAU GUYANA HAITI HONDURAS HUNGARY ICELAND INDIA INDONESIA IRAN (ISLAMIC REPUBLIC OF) IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KUWAIT KYRGYZSTAN LAO PEOPLE’S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LITHUANIA LUXEMBOURG MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MAURITANIA MAURITIUS MEXICO MICRONESIA (FEDERATED STATES OF) MONACO MONGOLIA MONTENEGRO MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL QATAR REPUBLIC OF KOREA REPUBLIC OF MOLDOVA ROMANIA RUSSIAN FEDERATION RWANDA SAINT KITTS AND NEVIS SAINT LUCIA SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAJIKISTAN THAILAND THE FORMER YUGOSLAV REPUBLIC OF MACEDONIA TIMOR-LESTE TOGO TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED REPUBLIC OF TANZANIA UNITED STATES OF AMERICA URUGUAY UZBEKISTAN VANUATU VENEZUELA (BOLIVARIAN REPUBLIC OF) VIET NAM YEMEN ZAMBIA ZIMBABWE AFGHANISTAN ALBANIA ALGERIA ANDORRA ANGOL A ANTIGUA AND BARBUDA ARGENTINA ARMENIA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BRAZIL BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA COLOMBIA COMOROS CONGO COOK ISL ANDS COSTA RICA CÔTE D’IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DEMOCRATIC PEOPLE’S REPUBLIC OF KOREA DEMOCRATIC REPUBLIC OF THE CONGO DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FIJI FINLAND FRANCE GABON GAMBIA GEORGIA GERMANY GHANA GREECE GRENADA GUATEMALA GUINEA GUINEA- BISSAU GUYANA HAITI HONDURAS HUNGARY ICELAND INDIA INDONESIA IRAN (ISLAMIC REPUBLIC OF) IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KUWAIT KYRGYZSTAN LAO PEOPLE’S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LITHUANIA LUXEMBOURG MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MAURITANIA MAURITIUS MEXICO MICRONESIA (FEDERATED STATES OF) MONACO MONGOLIA MONTENEGRO MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL QATAR REPUBLIC OF KOREA REPUBLIC OF MOLDOVA ROMANIA RUSSIAN FEDERATION RWANDA SAINT KITTS AND NEVIS SAINT LUCIA SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAJIKISTAN THAILAND THE FORMER YUGOSLAV REPUBLIC OF MACEDONIA TIMOR-LESTE TOGO TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED REPUBLIC OF TANZANIA UNITED STATES OF AMERICA URUGUAYPart I – Key action points UZBEKISTAN5 VANUATU VENEZUELA (BOLIVARIAN REPUBLIC OF) VIET NAM YEMEN ZAMBIA ZIMBABWE 4th Global Meeting of Heads of WHO Country Offi ces with Director-General and Regional Directors

THE 16 ACTION POINTS

1. Institutionalize the policy dialogue process between Director-General, Regional Directors and the Heads of WHO Country Offices

2. Develop and communicate policy directions on i) partnerships ii) linkages between GPW, MTSP, and CCS iii) alignment with country plans and harmonization with the UNDAF iv) International Trade and Health

3. Develop and communicate policy directions on UN Reform and provide appropriate support to country teams

4. Strengthen country office capacity

5. Ensure the appropriate mix of competencies in country offices linked to the CCS process and through rotation and mobility Strengthen country office capacity

6. Establish need-based training and staff development for HWCOs and country teams

7. Guarantee that the existing guidelines for working with country offices are fully implemented.

8. Communicate effectively and share intelligence across the Secretariat on new and emerging issues

9. Improve individual and global performance appraisal systems

10. Support health systems development based on Primary Health Care

11. Adopt and implement SOPs for management of public health emergencies and emergency preparedness and response to humanitarian crisis

12. Review the delegation of authority and corresponding accountability framework

13. Streamline organizational procedures

14. Ensure a smooth and phased introduction of GSM

15. Foster targeted resource mobilization at country level

16. Review level, use and distribution of PSC

6 Part I – Key action points AFGHANISTAN ALBANIA ALGERIA ANDORRA ANGOL A ANTIGUA AND BARBUDA ARGENTINA ARMENIA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BRAZIL BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA COLOMBIA COMOROS CONGO COOK ISLANDS COSTA RICA CÔTE D’IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC PART DEMOCRATIC II PEOPLE’S REPUBLIC OF KOREA DEMOCRATIC REPUBLIC OF THE CONGO DENMARKINTRODUCTION DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FIJI FINLAND FRANCE GABON GAMBIA GEORGIA GERMANY GHANA GREECE GRENADA GUATEMALA GUINEA GUINEA- BISSAU GUYANA HAITI HONDURAS HUNGARY ICELAND INDIA INDONESIA IRAN (ISLAMIC REPUBLIC OF) IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KUWAIT KYRGYZSTAN LAO PEOPLE’S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LITHUANIA LUXEMBOURG MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MAURITANIA MAURITIUS MEXICO MICRONESIA (FEDERATED STATES OF) MONACO MONGOLIA MONTENEGRO MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL QATAR REPUBLIC OF KOREA REPUBLIC OF MOLDOVA ROMANIA RUSSIAN FEDERATION RWANDA SAINT KITTS AND NEVIS SAINT LUCIA SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAJIKISTAN THAILAND THE FORMER YUGOSLAV REPUBLIC OF MACEDONIA TIMOR-LESTE TOGO TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED REPUBLIC OF TANZANIA UNITED STATES OF AMERICA URUGUAY UZBEKISTAN VANUATU VENEZUELA (BOLIVARIAN REPUBLIC OF) VIET NAM YEMEN ZAMBIA ZIMBABWE AFGHANISTAN ALBANIA ALGERIA ANDORRA ANGOL A ANTIGUA AND BARBUDA ARGENTINA ARMENIA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BRAZIL BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA COLOMBIA COMOROS CONGO COOK ISL ANDS COSTA RICA CÔTE D’IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DEMOCRATIC PEOPLE’S REPUBLIC OF KOREA DEMOCRATIC REPUBLIC OF THE CONGO DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FIJI FINLAND FRANCE GABON GAMBIA GEORGIA GERMANY GHANA GREECE GRENADA GUATEMALA GUINEA GUINEA- BISSAU GUYANA HAITI HONDURAS HUNGARY ICELAND INDIA INDONESIA IRAN (ISLAMIC REPUBLIC OF) IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KUWAIT KYRGYZSTAN LAO PEOPLE’S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LITHUANIA LUXEMBOURG MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MAURITANIA MAURITIUS MEXICO MICRONESIA (FEDERATED STATES OF) MONACO MONGOLIA MONTENEGRO MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL QATAR REPUBLIC OF KOREA REPUBLIC OF MOLDOVA ROMANIA RUSSIAN FEDERATION RWANDA SAINT KITTS AND NEVIS SAINT LUCIA SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAJIKISTAN THAILAND THE FORMER YUGOSLAV REPUBLIC OF MACEDONIA TIMOR-LESTE TOGO TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED REPUBLIC OF TANZANIA UNITED STATES OF AMERICA URUGUAYPart II – Introduction UZBEKISTAN7 VANUATU VENEZUELA (BOLIVARIAN REPUBLIC OF) VIET NAM YEMEN ZAMBIA ZIMBABWE INTRODUCTION

The fourth global meeting of the Heads of WHO The format of the fourth global meeting was a three-day Country Offi ces (HWCOs)1 with the Director-General policy dialogue consisting of plenary sessions, briefi ng and Regional Directors was held at WHO Headquar- sessions and group work with senior management interac- ters in Geneva from 12 to 14 November 2007. The tion. The lunch-time sessions comprised a “marketplace” meeting had around 292 participants in total includ- and technical briefi ngs on key issues of concern to all ing the Deputy Director-General, Assistant Directors- countries. The marketplace session provided an opportu- General, Deputy Regional Directors and Directors nity for country offi ces and technical departments to share of Programme Management and 142 HWCOs, the examples of the work that is being done to improve the Directors and senior staff of WHO Headquarters and performance of WHO at country level. The meeting ended representatives from fi ve collaborating agencies.2 with a concluding session where guidance was given by the Global Policy Group on ways of moving forward as The overall purpose of the three-day policy dialogue “One WHO”. The recommendations can then be imple- between the Director-General, the Regional Directors mented within the WHO policy and budget frameworks. and the HWCOs was to enhance the performance of the whole of WHO at country level in line with the Organiza- tion’s Country Focus policy.

The meeting agenda which derived from extensive con- sultations with all Heads of WHO Country Offi ces and the orientation of the Global Policy Group focused on themes that are currently of high relevance to WHO’s work in countries. These were: • WHO and Global Health Partnerships • WHO and the United Nations Reform; • health systems strengthening: implications for WHO’s work at country level; • effective functioning of WHO Country Offi ces; 1 By convention the term “Heads of WHO Country Offi ces (HWCOs)” will • managing WHO’s work in countries in be used as the generic term to cover WHO Representatives, PAHO/WHO crisis situations; Representatives and other Heads of WHO Country Offi ces. 2 The collaborating agencies were Global Alliance on Vaccine Initiative; • International Health Regulations (2005); London School of Hygiene and Tropical Medicine, London, England; • public health innovation, intellectual property, University of Florida, USA; Carleton University, Canada and the World Trade Organization; these representatives attended the session on Trade trade and health and Health.

Table 1: Distribution of meeting participants







        
                     
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8 Part II – Introduction AFGHANISTAN ALBANIA ALGERIA ANDORRA ANGOL A ANTIGUA AND BARBUDA ARGENTINA ARMENIA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BRAZIL BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA COLOMBIA COMOROS CONGO COOK ISLANDS COSTA RICA CÔTE D’IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC PART DEMOCRATIC III PEOPLE’S REPUBLIC OF KOREA DEMOCRATIC REPUBLIC OF THE CONGO DENMARKSUMMARY DJIBOUTIOF PROCEEDINGS DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FIJI FINLAND FRANCE GABON GAMBIA GEORGIA GERMANY GHANA GREECE GRENADA GUATEMALA GUINEA GUINEA- BISSAU GUYANA HAITI HONDURAS HUNGARY ICELAND INDIA INDONESIA IRAN (ISLAMIC REPUBLIC OF) IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KUWAIT KYRGYZSTAN LAO PEOPLE’S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LITHUANIA LUXEMBOURG MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MAURITANIA MAURITIUS MEXICO MICRONESIA (FEDERATED STATES OF) MONACO MONGOLIA MONTENEGRO MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL QATAR REPUBLIC OF KOREA REPUBLIC OF MOLDOVA ROMANIA RUSSIAN FEDERATION RWANDA SAINT KITTS AND NEVIS SAINT LUCIA SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAJIKISTAN THAILAND THE FORMER YUGOSLAV REPUBLIC OF MACEDONIA TIMOR-LESTE TOGO TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED REPUBLIC OF TANZANIA UNITED STATES OF AMERICA URUGUAY UZBEKISTAN VANUATU VENEZUELA (BOLIVARIAN REPUBLIC OF) VIET NAM YEMEN ZAMBIA ZIMBABWE AFGHANISTAN ALBANIA ALGERIA ANDORRA ANGOL A ANTIGUA AND BARBUDA ARGENTINA ARMENIA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BRAZIL BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA COLOMBIA COMOROS CONGO COOK ISL ANDS COSTA RICA CÔTE D’IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DEMOCRATIC PEOPLE’S REPUBLIC OF KOREA DEMOCRATIC REPUBLIC OF THE CONGO DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FIJI FINLAND FRANCE GABON GAMBIA GEORGIA GERMANY GHANA GREECE GRENADA GUATEMALA GUINEA GUINEA- BISSAU GUYANA HAITI HONDURAS HUNGARY ICELAND INDIA INDONESIA IRAN (ISLAMIC REPUBLIC OF) IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KUWAIT KYRGYZSTAN LAO PEOPLE’S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LITHUANIA LUXEMBOURG MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MAURITANIA MAURITIUS MEXICO MICRONESIA (FEDERATED STATES OF) MONACO MONGOLIA MONTENEGRO MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL QATAR REPUBLIC OF KOREA REPUBLIC OF MOLDOVA ROMANIA RUSSIAN FEDERATION RWANDA SAINT KITTS AND NEVIS SAINT LUCIA SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAJIKISTAN THAILAND THE FORMER YUGOSLAV REPUBLIC OF MACEDONIA TIMOR-LESTE TOGO TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED REPUBLIC OF TANZANIA UNITED STATES OF AMERICAPart III –URUGUAY Summary of proceedings UZBEKISTAN9 VANUATU VENEZUELA (BOLIVARIAN REPUBLIC OF) VIET NAM YEMEN ZAMBIA ZIMBABWE OPENING SESSION

The Deputy Director-General, Dr A. Asamoa-Baah Director-General’s speech and raised various strategic, welcomed the Director-General, Regional Directors, managerial and technical issues that have an impact on senior managers, Heads of WHO Country Offi ces their work and on the overall performance of WHO at (HWCOs) and other participants to the fourth global country level. meeting and invited the Director-General to give her opening address. Key strategic issues raised, which require policy orienta- tion and guidance include: the mechanism to transform In her opening remarks,3 Dr Margaret Chan, Director- WHO’s normative and technical strengths into strategic General reiterated her decision, made on taking offi ce, advantage while working with the numerous partners at to improve the way that WHO uses the strategic value country level; the hitherto ad-hoc approach to using the of its decentralized structure to enrich the Organization’s experiences of country offi ces in the policy formulation response to Member States despite the varying chal- process by headquarters and regional offi ces; address- lenges and capacities of the WHO regions. She had thus ing the current inverted triangle in distribution of human engaged the Regional Directors more directly in the for- resources within the Organization recognizing that country mulation of international health policies and in decisions offi ces currently have the least resources; the earmarking about the functioning of the Organization. Emphasizing of fi nancial resources from partners to pay for commodi- the importance of taking policy decisions that are informed ties rather than to fi nance the human resources necessary by the guidance received from WHO experience in coun- to address the MDGs; non-implementation of the WHO tries, she underscored the uniqueness of the fourth global rotation and mobility policy to have balanced and effi cient meeting which actively engaged the three levels of the use of human resources at the three levels; prioritization of Organization in its preparation and conduct as a way of areas of intervention by WHO in countries or addressing extending participation in the policy dialogue to country all health issues based on a country’s demand; balanc- offi ces in a more routine manner. ing WHO’s resource mobilization efforts at country level with the absorptive capacities and available technical Presenting WHO’s vision within the six-point agenda, resources; weak linkages and insuffi cient clarity between the Director-General expressed concern over the slow different WHO instruments like the Global Programme of progress being made by countries towards achieving the Work (GPW), the medium-term strategic plan (MTSP), Millennium Development Goals (MDGs). She reminded Country Cooperation Strategies (CCSs) and Country offi ce the meeting that WHO country offi ce teams in their role as plans and their alignment with the national development front-line troops, remain the link between the health needs agenda and the United Nations Development Assistance of countries and what headquarters and regional offi ces Framework (UNDAF); balancing the political and technical have to offer as well as being the bridge between the dimensions of WHO work and associated expectations multiple implementing agencies and the health priorities from partners and limited interaction with non-ministry of of governments. She urged the Heads of WHO Country health agencies. Offi ces to earn the right to lead by demonstrating measur- able results in countries while supporting the Ministries of Some of the pertinent managerial issues raised include: Health in effectively undertaking their coordination func- the slow implementation to date of the recommendations tion and translation of international guidelines, norms and of previous global meetings of WHO Representatives standards into country-relevant approaches. and Liaison Offi cers, despite their relevance; the need to create linkages with the current and future events of Issues of high relevance to WHO operation similar nature to ensure continuity of thinking and actions; in countries

The Heads of WHO Country Offi ces welcomed the 3 Refer to Annex 2.

10 Part III – Summary of proceedings existence of complex and infl exible administrative, fi nan- of the complexities of the issues. This, she said makes for cial and legal procedures, which hamper effi cient and a healthy dialogue. She reassured the participants of the timely responses to country needs and the resource decision she had made with the Regional Directors to look mobilization process particularly within countries in con- critically into the key issues for appropriate responses fl ict; ensuring real-time information sharing with country before the close of the meeting. The agreed action points offi ces on WHO’s policy-level involvement and commit- with region-wide implications will be considered for imple- ments with partners. mentation with their respective timelines.

Most of the technical issues raised were taken up later The Director-General and the Regional Directors however during the subsequent sessions; however the need for urged the Heads of WHO Country Offi ces to make sure the development of additional tools to guide and moni- to use the high-level opportunities they have to advocate tor interventions for the control of chronic diseases was for health and all the determinants that impact on health fl agged as critical. in their own countries. They acknowledged the efforts being made to mobilize funds from partners at country Response by the Director-General level to support health actions, but reiterated the critical and Regional Directors need to balance the commitments of the country offi ces Responding to the various issues raised during the ple- to partners’ funds with their capacity to deliver in order nary exchanges, the Director-General commended the to maintain WHO’s credibility. There is a need for a better forthright and passionate interventions by the Heads of understanding of what WHO stands for and the role of the WHO Country Offi ces as well as their deep understanding country offi ce.

Part III – Summary of proceedings 11 WHO, GLOBAL HEALTH PARTNERSHIPS AND THE UN REFORM

The common denominator for the sessions and group of the United Nations Development Group (UNDG), WHO work on Global Health Partnerships (GHPs) and the is actively involved in the UN Reform process and con- United Nations (UN) Reform was: reaching a good structively participating in the eight pilot countries. As lead understanding of WHO’s positioning and role in GHPs agency in health, WHO should use the Country Coop- and in UN Reform at country level; identifying oppor- eration Strategy (CCS) to shape the health agenda within tunities and challenges for WHO to play a constructive the United Nations Development Assistance Framework role in promoting greater effectiveness for the GHPs (UNDAF) and to mobilize support within the RCS for work and the UN Resident Coordinator System (RCS) in towards better health outcomes. their support to countries. The pilot experience in Pakistan presented by Dr K.B. Global Health Partnerships to comply with Mohamud, WHO Representative in Pakistan underlined the aid effectiveness principles the importance of the “One Programme” among the “Four Acknowledging existing and promising opportunities, Dr Ones” suggested in the report of the High Level Panel4. Mirta Roses, Regional Director for the Americas in her The remaining three ones, One Leader, One Budget Frame introductory remarks, underlined some challenges of GHPs and One Premise, where possible, are to support the One such as the proliferation of partnerships that have a negative Programme which is the collective UN system contribu- impact on country coordination mechanisms; partnerships tion to the country. The One Programme in Pakistan is that bypass and undermine country plans; and the weak- based on a fi ve-cluster approach of the UNDAF, with the ness of the communication fl ow especially with countries. Health and Population cluster co-chaired by the United The experience highlighted by Dr M. O’Leary, WHO Repre- Nations Children’s Fund (UNICEF) and WHO (permanent sentative in Cambodia confi rmed the tendency for fragmen- lead agency). Dr M. Belhocine, WHO Representative in tation and distortion of national priorities, and it underlined Tanzania showed from the pilot experience of the United the burden on national institutions and systems. The roles Republic of Tanzania that the UN Reform has been clearly of WHO in coordinating partners under ministry of health articulated with the aid effectiveness agenda since the sig- (MoH) mechanisms; helping development partners to align nature of the Joint Assistance Strategy (JAS) in December with MoH priorities; and where possible, using government 2006 by all development partners including WHO. In both systems were emphasized. In Cambodia, the newly created experiences, the process led by the Resident Coordinator International Health Partnership (IHP) will be used to pro- is presented as a collective one and pays due attention to mote new ways of working. Dr Socorro Gross, PAHO/WHO the specialized agencies. The increased workload and the Representative in Nicaragua stated that the principles of the challenge faced by WHO to fully deliver its contribution to Paris Declaration on aid effectiveness are impacting on the the UNDAF and to the reform process were emphasized. recent evolution, with all development partners being com- mitted to support and co-fund a 5-year health plan. Better defi ne and better support WHO’s role in Global Health Partnerships and in the UN Reform The UN Reform at country level contributing to During the discussion, the following concerns, issues and the alignment and harmonization agenda opportunities were discussed: In his introductory remarks, Dr Luis Sambo, Regional • Regarding WHO’s specifi c role in the context of Director for Africa, reminded the participants of the his- GHPs and UN Reform the need to be more strategic torical engagement of WHO in the UN Reform highlight- and to better defi ne our specifi c role in each situation ing the WHA 58.25 resolution requesting WHO to adhere was emphasized. to the Paris Declaration Principles and to engage in the 4 reform of the RCS. In its position as member of the Chief Delivery As One. Report of the United Nations Secretary-General’s High-level Panel on System-wide coherence in the areas of development, Executive Board (CEB) of all UN agencies, and member humanitarian assistance and the environment, 9 November 2006.

12 Part III – Summary of proceedings • The need for tools and methods to measure progress nization of its contribution with that of other develop- and the impact of interventions supported by GHPs ment partners, the UN system in particular. was expressed. • Resource mobilization that takes into account differ- • The need to distinguish the normative and advisory ent country realities should be supported by clearly role of WHO from the development functions was defi ned approaches and tools, including capacity also highlighted. This should help those responsible development efforts. to deal better with complex and/or diffi cult situations • Building partnerships within the UN and beyond in particular those that involve coordinating the con- require development of the capacity of our coun- tributions of the various UN agencies. try staff, including appropriate backstopping from • Dynamic exchange of intelligence across the three regional offi ces and Headquarters. levels of the Organization regarding GHPs and par- • There is a need to learn from experience (gained from ticularly UN Reform is needed. Global issues and GHPs and UN reform pilot countries) through improved developments in the global policy dialogue that may networking and documentation of experiences. have an impact on country work should be shared • Dr Margaret Chan, the Director-General emphasized promptly. that WHO’s leadership role is not a given but has to • Convergent views were expressed on the need to be earned, particularly in a crowded environment. It fully engage in the Common Country Assessment will result from the quality of WHO work and its ability (CCA)/UNDAF processes and on the use of the CCS to work together with partners. She re-affi rmed that to shape their health dimensions. In this regard there WHO staff should be positive and constructive play- is a need to further develop the communication and ers in the UN reform, including the UNDAF and other orientation on the links between various WHO instru- joint United Nations Country Team (UNCT) exercises. ments (Eleventh General Programme of Work (GPW), The UN reform should not be seen as an end in itself the Medium-Term Strategic Plan (MTSP) 2008-2013, but as a means for obtaining better health outcomes the CCS and WHO country plans), WHO’s alignment and of supporting country efforts towards achieving with national development agendas and the harmo- the Millennium Development Goals (MDGs).

KEY RECOMMENDATIONS

• Develop and communicate, with the involvement of the Heads of WHO Country Offices (HWCOs), policy directions for the country offices on WHO’s vision, orientations and approach on the following: – building partnerships in the context of the GHPs; – linkages between various instruments such as GPW, MTSP, CCS and WHO country plans and their alignment with national development agendas and harmonization with the UNDAF; – international trade and health.

• Develop and communicate policy directions on UN Reform. Keeping the HWCOs well briefed about new developments in the reform initiative from the high-level shapers of the UN Reform initiative, and on the follow-up actions needed at country level.

• Introduce dynamic exchange of intelligence and communication across all levels of the Organization on new developments within the Organization, emerging issues such as UN Reform as well as ongoing dialogue with external partners that could impact on the work of the country offices.

Part III – Summary of proceedings 13 STRENGTHENING HEALTH SYSTEMS: IMPLICATIONS FOR WHO’S WORK AT COUNTRY LEVEL

This session highlighted the importance of health Bank, in health systems. The Organization has a single systems for WHO’s work in countries, and the sup- framework developed in wide consultation within WHO port that WHO country offi ces will receive from other and with other stakeholders. The emphasis of this frame- levels of the Secretariat to help Member States to work is on taking the desired health outcomes as the strengthen their health systems. starting point for identifying the constraints to the health systems that hinder effective scaling up of services and Health systems is fundamental to improving addressing bottlenecks in the systems in such a way that health outcomes system-wide effects are achieved benefi ting synergisti- Dr Marc Danzon, Regional Director for Europe, intro- cally other programmes. It outlines the important role the duced the session by emphasizing the current strong country offi ce can play in improving health systems. and positive collaboration between the three levels of the Organization. WHO country offi ces must be strength- Initiatives such as the International Health Partnership ened. WHO’s role must be better understood inside and provide the opportunity to strengthen health systems by outside the Organization. WHO, as their closest part- focusing on health outcomes and integration of service ner, should work with Member States to encourage the delivery; supporting national plans, strategies and budg- international community to respect national ownership. ets; addressing health systems constraints; and improv- The WHO European Region is organizing a conference ing coordination, accountability and aid effectiveness. in Tallinn, Estonia, in June 2008 on this very important subject and all participants at the meeting were invited. Dr Nata Menabde, Deputy Regional Director/EURO informed the meeting that, the health systems approach Dr Anders Nordström, the Assistant Director-General, is the basis for developing country-specifi c strategies in Health Systems and Services Cluster (ADG/HSS) pre- the WHO European Region as well as, on a more opera- sented the WHO health systems strengthening strategy tional basis, the biennial collaborative programmes. “Everybody’s Business”, and the current global land- Health systems are considered the backbone of coun- scape in health systems. The global development com- try work. The aim of strengthening health systems is to munity and the Member States alike have recognized the support Member States in developing their own health importance of health systems for achieving the Millen- policies, health systems and health programmes in a way nium Development Goals and other nationally and inter- that prevents and overcomes threats to health. nationally agreed goals. Yet, in many countries, health systems are either weak or too fragmented to respond Presenting country experiences, Dr Elizabeth Danielyan, to disease-specifi c vertical interventions supported by Head of Country Offi ce in Armenia, and Dr Pavel Ursu, different development partners. Countries are facing a Head of Country Offi ce in the Republic of Moldova, stated shortage of health workers which is further compounded that the work on health systems strengthening must be by the migration of health workers to well-off countries led by the country team. The health systems approach for economic reasons. Health facilities are not properly should start with the country work plan by incorporating it maintained and they face a severe shortage of essential in the country specifi c objectives. The main added value of medicines and medical supplies. Poor people are further WHO’s work is to help member states in consolidating and impoverished by catastrophic health expenditures due to strengthening their health systems, and in monitoring per- lack of adequate fi nancial protection. Health expenditures formance in terms not only of WHO programme objectives in many countries are still relatively low and the external but also of the country’s health system development. support to these countries is volatile and unpredictable. Dr Michael O’Leary, WHO Representative in Cambodia and WHO is now taking the lead, together with the World Dr T. Manzila, WHO Representative in Burundi, commented

14 Part III – Summary of proceedings that the health systems processes are common but the systems is more clearly understood both inside and solutions are different. The health system response should outside the Organization. be tailored to national contexts. The nature of response • The Organization needs to generate and disseminate would be different for different countries, for instance, knowledge and information on what constitutes an countries in crisis situations. Huge constraints in achiev- effective health system and to provide information on ing the MDGs in countries are the systems constraints. different examples of what works. While demand on WHO country offi ces for health system • There is need to balance the focus of resource allocation support is increasing, country offi ces are working with between vertical and horizontal programmes. Interven- the existing capacity. Consideration should be given to tions should be tailored in a cross-cutting way resulting strengthen the country offi ce capacity for effective and in a single health systems strengthening effort. adequate response. • More tools and guidelines for identifi cation of con- straints to health systems need to be made available to While health systems are recognized as fundamental to provide an effective response to country needs. improving health, lack of clarity and consistency about the • WHO capacity needs to be strengthened to provide defi nition of “health systems” still exists among partners, better support to countries in the area of health fi nanc- policy-makers, infl uential persons and government offi - ing particularly for social protection. cials. It is important that all the elements of the health sys- • Support to country offi ces should be tailored to the tems framework be used extensively to demystify health specifi c needs of countries especially those in crisis systems and allow everyone to understand the concept situations. and importance of health systems. WHO headquarters • Models and good practices with respect to managed and the regional offi ces need to provide adequate back- migration are required to address the health workforce stopping to the HWCOs to transmit the correct health issue. systems message and create an appropriate branding for • WHO has a special role in convincing other UN agen- so-doing. cies to apply the health systems approach in the UN joint programme. • It is critical that emphasis be placed on strengthening • Assessment tools are needed to measure performance and maintaining our technical competence in health of health systems and show the extent to which health systems, and making sure that the concept of health outcomes have improved.

KEY RECOMMENDATIONS

• Strengthen WHO leadership and technical capacity at the country level on health systems development based on primary health care as the framework for achieving the Millennium Development Goals, in col- laboration with the countries and partners. This requires the strengthening of health information systems and the development of guidelines and tools to support the country offices to advocate and brand the critical nature and scope of this approach for resource mobilization and improved health outcomes.

Part III – Summary of proceedings 15 EFFECTIVE FUNCTIONING OF WHO COUNTRY OFFICES

The focus of this session was the need to improve In her presentation, Dr D. Sungkhobol, WHO Representa- management to effectively respond to the changing tive in Bangladesh reaffi rmed the need of an enabling role of WHO country offi ces through developing the environment by country offi ces, such as, provision of ade- capacity of HWCOs and country teams, and imple- quate delegation of fi nancial resources, human resources mentation of the Global Management System (GSM) and programmatic authority to effectively perform WHO at country level. core functions and respond to country health needs and health system issues. The enhanced delegation of author- Changing role of WHO Country Offi ces ity should be combined with proper accountability by Dr Samlee Plianbangchang, Regional Director for South- establishing an accountability framework to ensure that East Asia, stated that WHO country offi ces have a critical the resources are used effi ciently following the Organiza- role to play as the Organization’s credibility is largely built tion’s rules and procedures. Emphasis should be placed on the basis of its commendable work in countries. Dr on WHO’s competitiveness when it comes to charging Poonam K. Singh, the Deputy Regional Director for South- programme support costs (PSC) and funding a project’s East Asia and Dr Myint Htwe, the Director, Programme administrative and management staff. Management for South-East Asia highlighted the outcome of a seminar held in Bangkok in June 2007 on the role of • Innovative ways of mobilizing resources should be WHO Representatives in the management of WHO’s work explored at the country level. For example, co-funding at country level. A number of important suggestions were of staff from assessed and voluntary contributions, sec- made on the basis of which an action plan for implement- onding staff, targeted resource mobilization focusing ing the solutions was drawn up to improve management of on key areas where WHO has strengths, joint resource WHO country offi ces in the South-East Asia Region. The mobilization in UN pilot countries, sharing a portion delegation of authority in the Region has been enhanced of the PSC as an incentive to mobilize resources and substantially enabling the WHO Representatives in that make use of experience of joint planning in some pro- Region to take decisions at the country level. grammes between the three levels of the Organization. • Properly coordinated resource mobilization strategies The role of WHO country offi ces is changing in response to be put in place across the Organization. Headquar- to changing country contexts and new developments ters needs to inform donors about country needs/reali- in the aid environment. More and more development ties and encourage them to provide unspecifi ed funds partners are channelling resources to countries through for strategic resource allocations to fund less attractive their fi eld offi ces. In addition, the funds and foundations programmes and countries. such as The Global Fund to fi ght AIDS, Tuberculosis and • Adequate capacity building in countries by: Malaria (GFATM) and the GAVI Alliance are asking for pro- – providing training and resources for project pro- posals directly from countries for funding programmes. posals and peer review of proposals by regional Thus there is a great opportunity to mobilize resources at offices and headquarters; country level. However, WHO country offi ces have limited – making available tools and instruments and back- capacity for resource mobilization. stopping by headquarters and the regional office; – working more efficiently with other UN agencies In WHO, there has been a signifi cant increase in voluntary to reduce the overall cost of implementation and contributions over the years, whereas assessed contribu- improve cost-effectiveness. tion remains virtually stagnant. This situation applies to all • Administrative, fi nancial and legal procedures of the levels: headquarters, regional offi ces and many country Organization should be reviewed and revised to make offi ces, except those that are not attractive to donors and them more fl exible and responsive to country require- especially middle-income countries. ments.

16 Part III – Summary of proceedings KEY RECOMMENDATIONS

• Guarantee that the existing guidelines for working with countries are fully implemented so as to avoid the problem of “parachuting” as well as direct communication with national authorities. Further conduct an analysis to determine why these phenomena persist, and undertake appropriate measures to prevent their occurrence in the future.

• Institute measures, including backstopping from the Regional Office and Headquarters, to strengthen country office capacity for the effective performance of the core functions of the Organization using the CCS and the MTSP as a basis for the WHO country plan.

• Undertake a review of the existing level of delegation of authority to the regional and country offices with the objective of enhancing and making it more decentralized and uniform across the entire Organization. This process should be accompanied by an evaluation system as part of the accountability framework, to enhance performance and ensure compliance with organizational rules and procedures.

• Target resource mobilization taking into consideration the different country realities to address priority health needs within the MTSP framework and in line with the CCS. This would require capacity building, tools and support.

• Review and determine the level of use and distribution of PSC with a view to making it more flexible to reflect present day operational reality.

• Revise administrative, financial and human resource-related procedures, and legal requirements to make them more simplified, flexible and responsive to different and changing contexts of countries particularly with respect to Memoranda of Understandings (MOUs) and emergency situations.

• Better intelligence and communication across the Induction for newly appointed HWCOs is essential. A three levels is needed to allow a prompt and effective formal induction process should be available to HWCOs response to country needs, especially in emergency or potential HWCOs, whereas an informal induction proc- and crisis situations. ess that is country-specifi c is relevant not just to fi rst-time • The process of establishing the PSC percentage should HWCOs, but also to those taking up their appointment in be reviewed to make it more competitive and fl exible in a new country. order to attract more donor resources. To perform their roles, HWCOs need diplomatic, political, Improving the management of WHO Country Offi ces technical and managerial skills and a sound understand- Dr Kan Tun, WHO Representative in Nepal highlighted the ing of WHO’s position and policy on key issues. changing role of country offi ces and requests for technical support in new areas such as partnerships and coordina- In order for them to be equipped with all these skills, not tion, upstream health policy and systems issues, trade only an induction programme, but also continuous devel- and health, and the International Health Regulations (IHR opment and refresher training needs to be available. 2005), have important consequences for the HWCOs.

Part III – Summary of proceedings 17 With respect to the range of skills and competencies • ensure a consistent, equitable and sustainable needed, a balance between core competencies, techni- approach to prioritization of training offered in all cal and managerial training needs to be found. This should offi ces and at all levels of the Organization; ensure the acquisition of: • approach training in a consistent fashion in order • political skills: negotiation, policy dialogue, advocacy, to facilitate rotation, within a corporate rotation and communications, resource mobilization, coordina- mobility policy, and lessen the need for training newly tion and partnerships, knowledge of WHO corporate assigned staff; policies and identity; • use a common global vocabulary, so that HWCOs • technical skills: health system strengthening; how to and their core staff can present WHO’s position in a diagnose health systems constraints, and plan, imple- consistent fashion; ment and monitor health systems performance; • provide an array of tools and methods for learning, • managerial skills: dealing with diverse, multicultural including distance learning, CD-ROMs and tutors partners and staff, Governing Bodies, WHO ways of accessible via email and telephone; working (management and administration of staff, • adopt best approaches to training, and use of mate- fi nances, and procurement of goods and services), rials in specifi c areas, wherever they might have been rules and regulations, main legal issues, team build- developed in the Organization; ing, communication (within WHO, including between • take into account the impact of UN reform at country country offi ces), using new tools (e.g. GSM), and level in formulating training programmes and, where matters of security. appropriate, conduct training jointly with other agen- cies in the country. The approach to induction and training should: • draw on lessons learned from previous induction The individual performance management and assessment briefi ngs and the Global Leadership Programme needs to be built on the career development process and when developing the induction and training pro- should ensure that there are rewards for those who per- gramme for HWCOs. form well and sanctions for underperformers. • provide formal induction to HWCOs within 6 months of assignment; the programme can be conducted by staff from both headquarters and the regions. It should be available to potential HWCOs as well; • provide informal induction and support during the HWCOs initial period; this could draw on HWCOs in other countries and UN Heads of Agencies (peer support), former senior HWCOs, regional and head- quarters staff (e.g. Department of Country Focus); • make the training programme available not just for the HWCOs but also for the country team, so that a common approach can evolve and consistent advice and support will be provided to national authorities and partners at country level; • take a corporate approach to assessing development needs, with appropriate tools to enable HWCOs to assess the needs of their country offi ce staff in the light of the CCS priorities and country offi ce plans;

18 Part III – Summary of proceedings KEY RECOMMENDATIONS

• Use a fair, honest, transparent, and robust appraisal system for all categories of staff at all levels of the Secretariat and develop global performance appraisal indicators for WHO work in countries.

• Establish well-defined and sustainable mechanisms for need-based staff development in the country offices including: – induction course for HWCOs, as well as refresher training at regular intervals, particularly on new initiatives; – developing a tool kit and conducting mandatory briefing sessions for both general and professional staff on WHO mandate, values and strategic orientations; – training on developing project proposals; negotiation, communication and networking skills. – providing opportunities and simplifying procedures for staff development to enhance competencies and career development.

• Fill the human resource gaps in the country offices to ensure the appropriate mix of competencies by restructuring the available human resources along with recruiting new international staff based on the specific needs of each country. This will require an analysis of the obstacles to rotation and mobility and the development of a well-defined Organization-wide policy as well as a human resource plan for each country office consistent with the CCS.

Improving the effectiveness and effi ciency of minimize tedious reconciliation between systems, improve Country Offi ce operations through the Global portfolio governance and regulatory compliance, and will Management System (GSM) include timely fi nancial and managerial reporting and Dr Salim Habayeb, WHO Representative in India, present- analysis. The other benefi t is that one can carry out one’s ing on improving the effi ciency of Country offi ce opera- functions from a distance (remote access allows operat- tions through the Global Management System (GSM) ing during emergencies from elsewhere). opined that GSM will allow faster interaction between the three levels of the Organization. It will integrate different The usefulness of this system at country level is that it will administrative and management systems (for instance, allow preparation of the “one country plan” which, in real the Activity Management System (AMS), Administration time, brings together activities, products and resources and Finance Information Support (AFI), Travel and Meet- related to any country offi ce, including support activities ings Administration System (TMAS), etc.) and will be an from headquarters and regional offi ces and multi-country integral part of routine operations. This is a do-it-yourself activities. The country offi ce is the owner, but the HWCO tool. It will provide a holistic view, make operational infor- can delegate authority for certain programmes. The busi- mation readily available, and enable timely resource plan- ness code of conduct will be strictly followed. No changes ning, decision-making, and implementation and monitor- can be implemented if authority is not granted, but the ing of organizational performance. It will enable alignment system permits fl exibility. Technical monitoring will be pos- of responsibility, authority and accountability. sible to track how other resources not managed by the country have been used. The GSM will ensure tighter alignment with work-plans and organizational objectives, decrease fi nancial risks,

Part III – Summary of proceedings 19 While the GSM has multiple benefi ts, there may be teeth- implementation of approved work-plans. For instance, ing problems during the transition period, such as tempo- clear guidance is needed as to whether the HWCOs rary disruptions, short-term resistance and cynicism, and will be able to approve the recruitment of country staff unfounded fear of job loss. There are also uncertainties included in the human resources section of the work- and anxieties in relation to its effective roll-out, particularly plans through GSM. in offi ces where there is limited staff capacity and poor • Country offi ces need to know what back-up and sup- Internet connection and information technology (IT) infra- port is available, for instance, a help desk or focal point structure. for troubleshooting, and staff should be provided with training material and the necessary technical support. • There is a need for proactive personal involvement and • There needs to be more communication about GSM familiarization with the system, and provision of hands- operation and its roll-out process to all levels of staff on training and helpline support for its effective roll-out. across the Organization. • It is important to identify the roles of each level so that • Country offi ces, as necessary, should be provided with the system can be implemented effectively and to clarify support to improve their IT capability and Internet con- the delegation of authority allowed at each level for the nection for the smooth functioning of the GSM.

KEY RECOMMENDATIONS

• Ensure a smooth and phased introduction of GSM by developing an Organization-wide plan to address the human, technical and financial requirements for its successful implementation.

20 Part III – Summary of proceedings WHO’S WORK IN COUNTRIES IN CRISIS SITUATIONS

WHO’s role in countries in crisis situations has humanitarian community, WHO is mandated to provide expanded signifi cantly over recent years. In his intro- expanded health assistance in crisis situations and to ductory remarks, the chair, Dr Hussein A. Gezairy, build stronger capacity in emergency preparedness and Regional Director for the Eastern Mediterranean, response. WHO’s response to the mandate has led to: reminded the participants of the increasing impact of the expansion of scope of work in headquarters, regional emergencies on lives and livelihoods with the result- offi ces and priority countries; increased involvement in the ant loss of health and human security. Using exam- Humanitarian Health Cluster which now has 32 partners ples from the WHO Eastern Mediterranean Region, he who have together developed a common global work-plan also discussed how the level of internal displacement funded by donors and development of various operational and violations of health and human rights had also technical guidelines. increased tremendously. The situation calls for tar- geted public health interventions to prevent avoidable Despite this progress, there are still challenges to be met. deaths, diseases and disability, particularly in complex These include: the need to strengthen cluster leadership and resource-starved environments. and coordination skills at country level; building operational capacity and effectively involving national and local non- Strengthening WHO’s operational capacity to deliver governmental organizations (NGOs) at country level. Dr in countries in crisis situations Melville O. George, the WHO Representative in Uganda Dr Hussein A. Gezairy, the Regional Director for the Eastern presented the recommendations of the fi rst global meet- Mediterranean recalled that WHO has been assigned the ing of WHO’s work in crises that took place in Geneva in responsibility of managing the health cluster in crisis situa- September 2007. The recommendations were focused tions to reduce potential health risks. WHO is accountable on: the need to expedite the implementation of the SOPs; for upholding the UN humanitarian reforms in the health building the capacity of WHO country offi ces for leadership sector with an ever-increasing engagement in humanitarian of Health Clusters and obtaining sustainable and fl exible response. He stressed the importance of WHO having the funding for WHO’s work in countries in crisis situations. technical and operational capacities at the country, regional and headquarters levels to deliver in vulnerable countries. Meeting the challenges of preparedness and Dr Mohamed A. Jama, the Deputy Regional-Director for response in emergency-prone countries the Eastern Mediterranean focused on the need for WHO Recalling the Tsunami and frequent earthquakes experi- to step up its work in countries in the process of transition ences within the South-East Asian Region, Dr Poonam K. from crisis and starting recovery of their health systems. Singh, the Deputy Regional Director for South-East Asia WHO should be available in the fi eld in terms of capac- emphasized that managing and preparing for emergencies ity and people, especially when governments are not in remains an essential public health function. This is part of power. The Standard Operating Procedures (SOPs) for the core business of WHO. The WHO Regional Offi ce for emergencies should be urgently made available to improve South-East Asia (SEARO) has built on the lessons learnt WHO’s responsiveness and fl exibility. from the Tsunami by putting in place a set of 12 benchmarks for emergency preparedness which are now incorporated WHO’s mandate and accountability in the into WHO Country Offi ce work-plans under the Strategic Humanitarian Health Cluster Objective 5 (SO5) for implementation. In addition, the Region Dr Ala Alwan, Assistant Director-General, Health Action operates an Emergency Fund to facilitate operational readi- in Crises (ADG/HAC) presented the recent developments ness before Flash Appeals. Member States make a volun- and challenges in WHO’s work in countries in crisis. Based tary contribution of 1% of their regular budgets to the Fund. on WHO’s constitution and recent WHA resolutions 58.1 Regional capacity for managing emergencies is also being and 59.22, in addition to demands by the G8 and the wider built through collaboration with the WHO Regional Offi ce

Part III – Summary of proceedings 21 for the Western Pacifi c (WPRO) and the Asian Disaster Pre- cover the mental health needs of affected populations. paredness Center and the Public Health and Emergency Despite the usefulness of contracting out health services Management in Asia and the Pacifi c (PHEMAP). in emergencies, WHO’s focus must be on building govern- ment capacity at the same time. In addition, it is essential to Country realities in making WHO’s work count in strengthen partnerships with NGOs, governments and UN crisis situations agencies. It has been noted that WHO’s strength and credibility have been well demonstrated in emergencies by its ability to Moving forward the WHO Health Action in Crises provide technical guidance, health systems assessment, Agenda in countries building strong relations with ministries of health and local Deep appreciation was expressed to all HWCOs work- health authorities and mobilizing resources. However, taking ing in countries in crisis situations. The participants were the enormity of emergencies in almost all WHO Regions into reminded that HAC was elevated to a cluster level to consideration, several concrete issues raised by the partici- enable WHO to give adequate attention to emergencies pants must be considered in order to add value to WHO’s which will be occurring in 40–50 countries at any given work in emergencies. These issues include: reviving the ini- time. The existence of a crowded arena of humanitarian tiative of using Health as a Bridge for Peace (HBP) to take health actors is real in emergencies, but the challenge of advantage of its great potential and not limiting its use to coordination remains and this is where WHO must build days of tranquility as is the current practice; reviewing the its niche. WHO should enable everyone to work together current limitations on sending good candidates on HAC and avoid competition. HAC’s new status is intended to assignments due to consideration of geographical represen- enable the Organization become operational and proac- tation. It is important to realize that capable experienced staff tive; there has to be a departure from the reactive response is essential for emergency work; hence the need to allocate of the past. WHO’s target must be to have local presence the best staff from the three levels of the Organization to the in emergency situations within 24 hours of onset, and we most needy areas, and in a timely manner. need to consider how to structure the three levels of the Although WHO is now respected as the lead agency for health Organization to facilitate this. in emergencies in many affected countries, more capacity Delegation of authority is of the essence in emergency building and strengthening are still required in coordination situations, but it must be done within an accountability skills for Health Cluster work. The signifi cance of manage- framework. The conveyance of the fi rst international train- ment of the transition from crisis to recovery in post-confl ict ing course on analysing disrupted health systems in Tuni- countries where government capacity, human resources and sia and a global consultation on transition and recovery infrastructure are weak or absent was raised several times. in November 2007, as well as preparation of a training In addition, the HWCOs agreed on the signifi cance of having programme for Health Cluster Field Coordinators in health timely access to fl exible and core funding for WHO emer- coordination in crisis situations and commissioning of a gency work recognizing that Central Emergency Response study of WHO experience on using HBP all provide con- Fund (CERF) grants only act as a catalyst and often do not crete ways of moving this agenda forward.

KEY RECOMMENDATIONS

• Facilitate a pro-active preparedness and timely response by the country offices to public health emergencies and humanitarian crisis through the implementation of the Organization-wide SOPs according to the IHR and the humanitarian health cluster framework, as well as intensified work on recovery of the health sector.

22 Part III – Summary of proceedings INTERNATIONAL HEALTH REGULATIONS (2005)

The revised International Health Regulations (2005), events under the IHR pointing out WHO’s strengths and which entered into force on 15 June 2007, constitute the role of HWCOs in the overall event management. He the new formal framework of global public health reiterated that the operational principles that will drive the security. They imply new obligations for WHO, making event management process for best results in countries it pertinent for all levels of the Organization to have are Consistency, Timeliness, Technical Excellence, Trans- a clear understanding of the legal nature of IHR and parency and Accountability. of their roles and responsibilities for action. Dr David Heymann, Assistant Director-General, Health Secu- The major challenges facing IHR implementation include a rity and Environment (ADG/HSE), opened the ses- limited understanding of the operational modality despite sion by emphasizing the potential benefi ts of working awareness in countries and the need for fostering global with collaborating centres in undertaking event risk technical partnership and intersectoral collaboration for its assessments with WHO country offi ces, regional implementation and resource mobilization. Emphasizing offi ces and Headquarters. the role of the WHO country offi ces in supporting coun- tries to implement the IHR, he reminded participants that Implementing IHR (2005): the paradigm shift only 61 of the 144 country offi ces had undertaken the In his introductory remarks, Dr Shigeru Omi, Regional online training on IHR for WHO country offi ces. Director for the Western Pacifi c highlighted the three key paradigm shifts in IHR (2005) which are: moving Filling the gaps to make an impact in countries from control at borders to containment at source; focus The participants identifi ed the real issues that must be on all public health emergencies of international con- addressed to facilitate the implementation of IHR (2005) cern rather than on specifi c threats, and emphasis on and the achievement of its objectives. These include adapted response instead of use of preset measures. In the large number of countries that are currently not fully response to the key concerns of handling samples, lines equipped with the core capacities and funding to detect, of communication and sensitivities around information assess and react to public health events with a potential to sharing, he stressed the importance of building on exist- cause international concern. The huge resource require- ing national resources and strengthening national and ment to fi ll these gaps in the core capacities including regional capacities to achieve effective implementation of international involvement in response activities; the need the IHR strategic plan. to forge a system within WHO for event management; the importance of testing the rapid response plans; the Opportunities and challenges of operational need for intersectoral action; handling the diplomacy and management of IHR (2005) politics around information and communication in public Dr Guenael Rodier, Director, Epidemic and Pandemic Alert health emergencies; and handling the media in source and Response/IHR Coordination Programme (EPR/IHR), countries as well as in neighbouring countries are real reminded the participants that WHO has new obligations issues that must be addressed. under the IHR (2005), to identify, assess, assist and inform about events that may threaten international public health. Recognizing the uniqueness of each event, additional IHR offers a unique opportunity to strengthen international training and desk-top exercises can provide experience relations and diplomacy in the area of public health among to improve rapid detection, effective response and the countries and provides a framework for advocacy, coor- consistency and reliability of information, while prevent- dination and collaboration among countries, partners, UN ing overreaction of neighbouring countries. Such under- agencies, other sectors and across the three levels of the stated exercises should be held regularly at all levels of Organization. Dr Michael Ryan, Director/EPR presented the Organization and in Member States to strengthen the the operational management of acute public health capacity for IHR implementation.

Part III – Summary of proceedings 23 These are: • Complete the online IHR training. • Meet with your country national IHR focal point(s). • Explore bilateral partnerships and funding at country level. • Embrace the principles of Consistency, Timeliness, Technical Excellence and Transparency for a WHO- wide Event Management System.

KEY RECOMMENDATIONS

• Establish well-defined and sustainable mechanisms for training and guiding HWCOs in responding to Member States’ requests about International Health Regulations.

• Introduce dynamic exchange of intelligence and communication across all levels of the Organization on new developments within the Organization and emerging issues such as IHR, as well as ongoing dialogue with external partners that could have an impact on the work of the country offices.

24 Part III – Summary of proceedings PUBLIC HEALTH INNOVATION, INTELLECTUAL PROPERTY, TRADE AND HEALTH

Dr Nico Drager, Acting Director/Ethics, Equity, Trade promote, shape and manage the trade policy environment and Human Rights (ETH) chairing, presented the for health in accordance with WHA 59.26. session plan which focused on the implications of international trade, trade agreements and intellectual Trade in Health Services: promoting policy property (IP) for public health and access to phar- coherence between trade and health interests maceutical products. An important theme running The presentation on liberalizing trade in health services through the session was the need for strengthening by Dr Sameen Siddiqi, the Regional Adviser/Programme capacity in countries to conduct systematic and com- Health Partnerships (PHP) at the WHO Regional Offi ce for prehensive assessments to inform policy decisions the Eastern Mediterranean focused on WHO’s global work and actions designed to make trade and trade agree- on trade in health services with particular reference to the ments work for public health. Eastern Mediterranean Regional Initiative in 10 countries. Using the framework for analysis developed at WHO, a Impact of multilateral trade agreements on public regional methodological approach to assess trade in health health outcomes services has been adopted and country assessments are In his introductory remarks, Dr Shigeru Omi, Regional Direc- being undertaken. Optimizing the effects of trade liberaliza- tor for the Western Pacifi c, highlighted the direct impact of tion on health services will include establishing trade units in trade on health in terms of cross-border transmission of ministries of health and promoting mechanisms for coordi- diseases through traded goods, increased affordability of nation between stakeholders. medical equipment and supplies through reduced trade tariffs and increased access to essential medicines, diag- Ms Mireille Cossy, the representative of the WTO Secretariat nostic devices and transfer of technology through chang- presented an overview of the General Agreement on Trade ing international rules concerning patent protection. in Services (GATS) and current negotiating issues related to GATS and trade in health services. Giving the GATS defi - Work in this area is a major part of WHO’s response to nition of health services, she emphasized that liberalizing the World Health Assembly Resolution WHA 59.26 on health services is not an end in itself, neither is it equivalent International Trade and Health. WHO works to achieve to deregulation. Health remains the only major sector where greater policy coherence between trade and health policy no proposal or any collective request has been made by so that international trade and trade rules maximize health Member States. She highlighted the key questions policy benefi ts and minimize health risks, especially for poor and makers must answer: What health policy do we want ? Can vulnerable populations. commitments under the GATS contribute to this policy ? What are the risks and opportunities of undertaking GATS Listing the four multilateral trade agreements of the World commitments ? Answering these questions requires the Trade Organization (WTO) that may affect public health involvement of trade and health policy makers. and are of importance to the work of WHO, he pointed out a few countries that are initiating a more comprehen- An overview of recent development in liberalization of health sive analysis of overall trade and health issues using the services currently under way in Malaysia was presented by diagnostic tool and companion workbook on trade and Dr Han Tieru, the WHO Representative in Malaysia. He gave health developed by WHO in collaboration with WTO, highlights of the two joint WHO/WTO missions to Malaysia World Bank and international experts. He emphasized the that supported the government in stakeholder analysis, and need for WHO to fulfi l its role in strengthening capacities by using the WHO diagnostic tool kit for assessing trade and building the knowledge base in the ministries of health and health issues and suggesting action points in selected area WHO country offi ces. This is to enable them to work effec- of trade in health services. He reiterated the need to build tively with the ministries of trade, commerce and fi nance to capacity within the MoH in trade and health issues and to

Part III – Summary of proceedings 25 initiate and maintain a dialogue on these issues among all Moving from policy to practice on international trade, stakeholders. intellectual property and health in countries

Trade-Related Aspects of Intellectual Property The participating HWCOs were able to increase their under- Rights (TRIPS), Public Health Innovation and access standing of the linkages between trade, trade agreements, to medicines: need for HWCOs to advocate for IP, and public health. In addition, they learnt about the policy intersectoral dialogue concerns and actions at country and global levels that have Ms Karin Timmermans, the Technical Offi cer/Trade and been taken in addressing these linkages to improve public Health of the WHO Regional Offi ce for South-East Asia health. However, some key issues associated with this very discussed the current policy issues relating to intellectual important evolving public health concern include: the need property rights, TRIPS and access to medicines in particu- for information and legislation by countries to protect the poor lar in relation to countries within the South-East Asia Region in relation to medical tourism and illegal trade of organs and and the Western Pacifi c Region. She urged HWCOs to: the need to make a distinction between organs and tissue. increase their awareness especially on TRIPS fl exibilities, Concerns regarding bilateral free trade agreements with large data exclusivity and ‘linkage’; advocate for intersectoral countries; migration of health professionals; WHO’s position dialogue and coordination; assist with studies, reviews and on Good Manufacturing Practice certifi cates and medicines; country-specifi c assessments and support training of MoH e-commerce on trade and health; ambiguity on current offi cials, including legal advisers, on the public health impli- issues related to compulsory licensing; and tobacco must be cations of intellectual property rights as well as promote addressed. There is limited information on the latest devel- active participation in preparation for the Intergovernmental opments on traditional knowledge concerns and intellectual Working Group (IGWG) process. property rights including protection of traditional knowledge in trade agreements. There is a need to build capacity at the Dr Elil Renganathan, the Executive Secretary/Secretariat regional and national levels including provision of the neces- on Public Health, Innovation and Intellectual Property (PHI) sary information, tools and strategies to support countries in gave a report on the second session of the IGWG on Public managing the health-related free trade agreements that are Health, Innovation and Intellectual Property which took signed at the regional and international levels. place in Geneva from 5 to10 November 2007. The task of In addition, there is a need to expedite the adaptation of the the IGWG is to draw up a draft global strategy and plan of trade and health diagnostic tools to regional and national action for submission to the 61st WHA in May 2008. Exten- realities. Development of mechanisms for effective sensitiza- sive discussion took place regarding the context, aim, focus tion of ministries of health including short and sharp critical and principles guiding the elements of the global strategy. messages about health-related WTO and GATS issues, Substantial progress was made in negotiations and con- TRIPS and TRIPS fl exibilities must be developed and widely sensus reached in a number of diffi cult areas in the eight disseminated to countries. Dissemination of information on elements of the draft plan of action. The resumption of the WTO and health issues and building the capacity of WHO second session of the IGWG has been tentatively set for 28 country offi ces and countries (training of trainers) particularly April to 3 May 2008 to fi nalize the strategy and action plan in developing countries should be prioritized.

KEY RECOMMENDATIONS

• Develop and communicate, with the involvement of the Heads of WHO Country Offices, policy directions for the country offices on WHO’s vision, orientation and approach to international trade and health.

26 Part III – Summary of proceedings CONCLUDING SESSION

Orientation by the Director-General institutionalization of the global HWCO meeting with the and Regional Directors Director-General and the Regional Directors to take place Dr A. Asamoa-Baah, Deputy Director-General led the every two years with the next one planned to take place in discussion through the key issues and actions points Geneva and a possibility of future rotation – implementing proposed by the meeting as presented by the two gen- the guidelines on working with countries to curtail uncoor- eral rapporteurs Dr Kathleen Israel, PWR/Guyana and dinated technical support to countries and review delega- Dr Mubashar R. Sheik, WR/Islamic Republic of Iran. tion of authority for improved human resource, fi nancial and programmatic management. Chair: Dr Hussein A. Gezairy, Regional Director EMRO. Remarks on behalf of HWCOs by Dr Helene In his opening remarks, Dr Gezairy informed the meeting Mambu-Ma-Disu, WHO Representative, Cameroon5 about the deliberations of the Director-General and the Dr Helene Mambu-Disu expressed appreciation on behalf Regional Directors on the action points proposed by the of all HWCOs to the Director-General for allowing the HWCOs. He affi rmed that the recommendations were HWCOs to enter into a dialogue with her and the Regional found to be logical and quite practical making it feasi- Directors about the work in the fi eld and highly praised ble for the Director-General and the Regional Directors the collegial spirit shown by the Director-General and to reach consensus on ways of moving forward on the the six Regional Directors. Having participated in all four action points. He called on the Director-General to share global meetings of HWCOs, Dr Mambu-Disu used her the consensus reached during their deliberations. recollections to highlight very clearly - with life experiences from the African Region – the progress WHO has made The Director-General acknowledged the hard work and to date in improving its responsiveness to emergencies openness that had been put into the 3-day policy dialogue and in leading the health cluster in humanitarian action. meeting by all participants and in addition expressed her In conclusion, she expressed her appreciation to Dr Chan satisfaction and that of the Regional Directors with the and the Regional Directors for the confi dence they had conduct and outcomes of the meeting. shown in the HWCOs and declared that all her colleagues were committed to translating the recommendations and In sharing the result of their deliberations, the Director- conclusions of this meeting into concrete actions in their General said: “I want to let you know that we hear you respective countries. very well. I also want to remind you: never for a moment to forget that you are a very important part of the Organiza- Director-General’s Closing Remarks6 tion. We need your input and we also need your guidance The Director-General, in a short but emotional speech fol- on how the Organization can move forward as one.” lowing the intervention of Dr H. Mambu-Disu, WR/Cam- eroon and the solace singing of Dr S. Anyangwe, WR/ The most important ways in which the Director-General South Africa, expressed great joy, deep admiration and and the Regional Directors planned to take forward the appreciation to everyone for making her fi rst meeting with recommendations put to them by the HWCOs include: a the HWCOs such a touching one. She highly commended retreat for the WHO senior executive offi cers on 15 Novem- the rich interventions and honest sharing. ber 2007 to identify the implications of the recommenda- tions for the regions and their resources and to organize Recounting the lessons learnt from the wealth of work the recommendations into an appropriate timeframe and experiences, diversity of culture, frustrations, good sto- work out an Organization-wide follow-up plan; agreement ries and bad stories during the 3-day policy dialogue, at the senior level to capture the inputs of HWCOs before 5 Refer to Annex 3. making policy decisions on major issues – hence the 6 Refer to Annex 3.

Part III – Summary of proceedings 27 Dr Chan reaffi rmed that diversity remains the strength of our Organization and urged all the participants not to forget for a moment that WHO is strongest when our country offi ces are strong. She later called on all col- leagues to take this opportunity to join her in thanking colleagues who will be retiring in 2008 for their outstand- ing contribution to WHO and for making WHO a strong Organization.

In conclusion, the Director-General said, “...on that, I would like to bring a close to this historical meeting and I assure you that we will take on board the recommen- dations. We will move forward in a way that will involve you all and will make you proud of our implementation. As I said, we cannot promise everything, but we will do what- ever is possible within our authority to make you proud of us. I thank you all”.

28 Part III – Summary of proceedings AFGHANISTAN ALBANIA ALGERIA ANDORRA ANGOL A ANTIGUA AND BARBUDA ARGENTINA ARMENIA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BRAZIL BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA COLOMBIA COMOROS CONGO PART IV COOK ISLANDS COSTA RICA CÔTE D’IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLICSTRATEGIC DEMOCRATIC AND MANAGERIAL PEOPLE’S REPUBLIC ACTIONS OF RECOMMENDED KOREA DEMOCRATIC REPUBLIC OF THE CONGO DENMARKBY THE MEETING DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FIJI FINLAND FRANCE GABON GAMBIA GEORGIA GERMANY GHANA GREECE GRENADA GUATEMALA GUINEA GUINEA- BISSAU GUYANA HAITI HONDURAS HUNGARY ICELAND INDIA INDONESIA IRAN (ISLAMIC REPUBLIC OF) IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KUWAIT KYRGYZSTAN LAO PEOPLE’S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LITHUANIA LUXEMBOURG MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MAURITANIA MAURITIUS MEXICO MICRONESIA (FEDERATED STATES OF) MONACO MONGOLIA MONTENEGRO MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL QATAR REPUBLIC OF KOREA REPUBLIC OF MOLDOVA ROMANIA RUSSIAN FEDERATION RWANDA SAINT KITTS AND NEVIS SAINT LUCIA SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAJIKISTAN THAILAND THE FORMER YUGOSLAV REPUBLIC OF MACEDONIA TIMOR-LESTE TOGO TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED REPUBLIC OF TANZANIA UNITED STATES OF AMERICA URUGUAY UZBEKISTAN VANUATU VENEZUELA (BOLIVARIAN REPUBLIC OF) VIET NAM YEMEN ZAMBIA ZIMBABWE AFGHANISTAN ALBANIA ALGERIA ANDORRA ANGOL A ANTIGUA AND BARBUDA ARGENTINA ARMENIA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BRAZIL BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA COLOMBIA COMOROS CONGO COOK ISL ANDS COSTA RICA CÔTE D’IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DEMOCRATIC PEOPLE’S REPUBLIC OF KOREA DEMOCRATIC REPUBLIC OF THE CONGO DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FIJI FINLAND FRANCE GABON GAMBIA GEORGIA GERMANY GHANA GREECE GRENADA GUATEMALA GUINEA GUINEA- BISSAU GUYANA HAITI HONDURAS HUNGARY ICELAND INDIA INDONESIA IRAN (ISLAMIC REPUBLIC OF) IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KUWAIT KYRGYZSTAN LAO PEOPLE’S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LITHUANIA LUXEMBOURG MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MAURITANIA MAURITIUS MEXICO MICRONESIA (FEDERATED STATES OF) MONACO MONGOLIA MONTENEGRO MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL QATAR REPUBLIC OF KOREA REPUBLIC OF MOLDOVA ROMANIA RUSSIAN FEDERATION RWANDA SAINT KITTS AND NEVIS SAINT LUCIA SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAJIKISTAN THAILAND THE FORMER YUGOSLAV REPUBLIC OF MACEDONIA TIMOR-LESTE TOGO TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED REPUBLIC OF TANZANIA UNITED STATES OF AMERICAPart IV – Strategic URUGUAY and managerial actions UZBEKISTAN29 VANUATU VENEZUELA (BOLIVARIAN REPUBLIC OF) VIET NAM YEMEN ZAMBIA ZIMBABWE STRATEGIC AND MANAGERIAL ACTIONS RECOMMENDED BY THE MEETING

1. Institutionalize the policy dialogue process between policy as well as a human resource plan for each DG, RDs and the Heads of WHO Country Offi ces by country offi ce consistent with the CCS. scheduling it once per biennium and if possible rotat- ing the venue between headquarters and the regional 6. Establish well-defi ned and sustainable mechanisms offi ces. The agenda of the meeting should be pre- for need-based staff development in the country pared in conjunction with the heads of WHO Country offi ces including : Offi ces and include, among other things, a report • Induction course for heads of country offices, as well on the follow up actions of the previous meeting as as refresher training at regular intervals, particularly well as discussion on collective decision-making and on new initiatives. policy options for ensuring ownership and account- • Developing a tool kit and conducting mandatory ability across the organization. briefing sessions for both general and professional staff on WHO mandate, values and strategic orien- 2. Develop and communicate, with the involvement of tations. the heads of WHO Country Offi ces, policy directions • Training on health systems, IHR, emergency prepar- for the country offi ces on WHO vision, orientations, edness and response developing project proposals; and approach on the following : negotiation, communication, and networking skills. • Building partnerships in the context of the GHP • Providing opportunities and simplifying procedures • Linkages between various instruments such as for staff development to enhance competencies GPW, MTSP, CCS and WHO country plans and and career development. their alignment with national development agendas and harmonization with the UNDAF 7. Guarantee the existing guidelines for working with • International Trade and Health countries are fully implemented so as to avoid the problem “parachuting” as well as direct communi- 3. Develop and communicate policy directions on UN cation with national authorities. Further conduct an Reform. Keeping the HWCOs well briefed about analysis to determine why these phenomena persist, new development in the Reform initiative from the and undertake appropriate measure to prevent their high level shapers of the UN Reform initiative, and occurrence in the future. follow-up actions that need to take place at country level. 8. Introduce dynamic exchange of intelligence and com- munication across all levels of the organization on 4. Institute measures, including back-stopping from the new developments within the organization, emerg- Regional Offi ce and HQ, to strengthen country offi ce ing issues such as UN Reform and IHR as well as capacity for the effective performance of the core on-going dialogue with external partners that could functions of the Organization using the CCS and the impact the work of the country offi ces. MTSP as a basis for the WHO country plan. 9. Use of a fair, honest, transparent, and robust appraisal 5. Fill the human resource gaps in the country offi ces system for all categories of staff at all levels of the to ensure the appropriate mix of competencies by Secretariat and develop global performance appraisal restructuring the available human resources along indicators for WHO work in countries. with recruiting new international staff based on the specifi c needs of each country. This will require an 10. Strengthen WHO leadership at country level and analyse of the obstacles to rotation and mobility and technical capacity at country level on health systems the development of a well-defi ned Organization-wide development based on Primary Health Care as the

30 Part IV – Strategic and managerial actions framework for achieving the Millennium Develop- to enhance performance and ensure compliance with ment Goals, in collaboration with the countries and organizational rules and procedures. partners. This requires the strengthening of health information systems and the development of guide- 13. Revise administrative, fi nancial, human resource- lines and tools to support the country offi ces to related procedures, and legal requirements to make advocate and brand the critical nature and scope of them more simplifi ed, fl exible and responsive to dif- this approach for resource mobilization and improved ferent and changing contexts of countries particularly health outcomes. with respect to MOUs and emergency situations.

11. Facilitate a pro-active preparedness and timely 14. Ensure a smooth and phased introduction of GSM by response by the country offi ces to public health emer- developing an organization-wide plan to address the gencies and humanitarian crisis through the imple- human, technical and fi nancial requirements that is mentation of the Organization -wide SOPs according required for its implementation. to the IHR and the humanitarian health cluster frame- work, as well as intensifi ed work on recovery of the 15. Target resource mobilization taking into consideration health sector. the different country realities to address priority health needs within the MTSP framework and in line with the 12. Undertake a review of the existing level of delegation CCS. This would require capacity building, tools, and of authority to the regional and country offi ces with the support. objective of enhancing and making it more decentral- ized and uniform across the entire organization. This 16. Review and determine the level of use and distribution process should also be accompanied by an evalua- of PSC with a view to making it more fl exible to refl ect tion system as part of the accountability framework present day operational reality.

Part IV – Strategic and managerial actions 31 32 MARKET PLACE

The colourful market place event comprised country and headquarters exhibits in the cafeteria winter garden, the library and in front of the main building meeting rooms. In total there were 21 country exhibits, with all WHO regions represented and 24 exhibits from headquarters departments and units.

The country exhibits showcased a wide range of themes from WHO’s emergency work, to examples of partnerships and joint work, and specifi c programmes such as: polio eradication, tobacco control and HIV/AIDS. Headquarters exhibits were mainly focussed on Family and Community Health; Information, Evidence and Research and Health Security and Environment.

The country exhibits were well patronized over the lunch breaks, but there was free time during the 3-day programme to visit the headquarters exhibits.

Market place 33 THE FOURTH GLOBAL MEETING IN PICTURES

34 The fourth global meeting in pictures The fourth global meeting in pictures 35 LUNCH-TIME EVENTS

36 Lunch-time events AFGHANISTAN ALBANIA ALGERIA ANDORRA ANGOL A ANTIGUA AND BARBUDA ARGENTINA ARMENIA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BRAZIL BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA COLOMBIA COMOROS CONGO COOK ISLANDS COSTA RICA CÔTE D’IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC PART DEMOCRATIC V PEOPLE’S REPUBLIC OF KOREA DEMOCRATIC REPUBLIC OF THE CONGO DENMARKANNEXES DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FIJI FINLAND FRANCE GABON GAMBIA GEORGIA GERMANY GHANA GREECE GRENADA GUATEMALA GUINEA GUINEA- BISSAU GUYANA HAITI HONDURAS HUNGARY ICELAND INDIA INDONESIA IRAN (ISLAMIC REPUBLIC OF) IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KUWAIT KYRGYZSTAN LAO PEOPLE’S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LITHUANIA LUXEMBOURG MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MAURITANIA MAURITIUS MEXICO MICRONESIA (FEDERATED STATES OF) MONACO MONGOLIA MONTENEGRO MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL QATAR REPUBLIC OF KOREA REPUBLIC OF MOLDOVA ROMANIA RUSSIAN FEDERATION RWANDA SAINT KITTS AND NEVIS SAINT LUCIA SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAJIKISTAN THAILAND THE FORMER YUGOSLAV REPUBLIC OF MACEDONIA TIMOR-LESTE TOGO TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED REPUBLIC OF TANZANIA UNITED STATES OF AMERICA URUGUAY UZBEKISTAN VANUATU VENEZUELA (BOLIVARIAN REPUBLIC OF) VIET NAM YEMEN ZAMBIA ZIMBABWE AFGHANISTAN ALBANIA ALGERIA ANDORRA ANGOL A ANTIGUA AND BARBUDA ARGENTINA ARMENIA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BRAZIL BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA COLOMBIA COMOROS CONGO COOK ISL ANDS COSTA RICA CÔTE D’IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DEMOCRATIC PEOPLE’S REPUBLIC OF KOREA DEMOCRATIC REPUBLIC OF THE CONGO DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FIJI FINLAND FRANCE GABON GAMBIA GEORGIA GERMANY GHANA GREECE GRENADA GUATEMALA GUINEA GUINEA- BISSAU GUYANA HAITI HONDURAS HUNGARY ICELAND INDIA INDONESIA IRAN (ISLAMIC REPUBLIC OF) IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KUWAIT KYRGYZSTAN LAO PEOPLE’S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LITHUANIA LUXEMBOURG MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MAURITANIA MAURITIUS MEXICO MICRONESIA (FEDERATED STATES OF) MONACO MONGOLIA MONTENEGRO MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL QATAR REPUBLIC OF KOREA REPUBLIC OF MOLDOVA ROMANIA RUSSIAN FEDERATION RWANDA SAINT KITTS AND NEVIS SAINT LUCIA SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAJIKISTAN THAILAND THE FORMER YUGOSLAV REPUBLIC OF MACEDONIA TIMOR-LESTE TOGO TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED REPUBLIC OF TANZANIA UNITED STATES OF AMERICA URUGUAYPart V – Annexes UZBEKISTAN37 VANUATU VENEZUELA (BOLIVARIAN REPUBLIC OF) VIET NAM YEMEN ZAMBIA ZIMBABWE ANNEX 1 AGENDA

FOURTH GLOBAL MEETING OF HEADS OF WHO COUNTRY OFFICES WITH THE DIRECTOR-GENERAL AND REGIONAL DIRECTORS 3-DAY POLICY DIALOGUE

World Health Organization Headquarters, Geneva – 12-14 November 2007

 
       

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38 Part V – Annex 1 ANNEX 1 PROGRAMME OF WORK

FOURTH GLOBAL MEETING OF HEADS OF WHO COUNTRY OFFICES WITH THE DIRECTOR-GENERAL AND REGIONAL DIRECTORS 3-DAY POLICY DIALOGUE

World Health Organization Headquarters, Geneva – 12-14 November 2007

SUNDAY, 11 NOVEMBER 2007

14:00 - 17:00 Early Registration

MONDAY, 12 NOVEMBER 2007

08:00 - 09:00 Registration

WHO’S SIX-POINT AGENDA, PARTNERSHIPS AND UN REFORM

09:00 - 10:30 Opening Session - Opening address – Dr Margaret Chan, Director-General - Plenary exchanges with Participants - Administrative announcement - Group Photograph

10:30 - 11:00 Tea/Coffee break

11:00 - 12:00 WHO and Global Health Partnerships Lead: AMRO/PUN – Chair: RD/AFRO - Introductory remarks – Dr Mirta Roses, RD/AMRO 10 mins - Country experiences with Global Partnerships for Health Dr Michael O’Leary WR/Cambodia 10 mins Dr Socorro Gross PWR/Nicaragua 10 mins - Plenary Exchanges 25 mins - Wrap Up and introduction to Group Work 05 mins

12:00 - 13:00 Panel Discussion on WHO and UN Reform Lead: AFRO/PUN – Chair: RD/AMRO - Introductory remarks - Dr Luis G. Sambo, RD/AFRO 10 mins - Experiences and lessons learned so far Dr Khalif B. Mohamud, WR/Pakistan 10 mins Dr Mohammed Belhocine, WR/United Republic of Tanzania 10 mins - Plenary Exchanges 25 mins - Wrap Up and introduction to Group Work 05 mins

13:00 - 14:30 Lunch-time Market Place

14:30 - 16:00 Group work on Global Health Partnerships and UN Reform: Practice, Implications & Perspectives - Groups 1 to 6

16:00 - 16:30 Tea/Coffee break

16:30 - 18:00 Report back on Global Health Partnerships and United Nations Reform Co-chairs: RD/AFRO and RD/AMRO - Report back from 3 partnerships working groups 30 mins - Report back from 3 UN Reform working groups 30 mins - Discussion and Wrap-up 30 mins

18:00 - 19:30 Cocktail

Part V – Annex 1 39 TUESDAY, 13 NOVEMBER 2007

HEALTH SYSTEMS STRENGTHENING AND EFFECTIVE FUNCTIONING OF WHO COUNTRY OFFICES

09:00 - 10:30 Health Systems Strengthening: Implications for WHO’s work at country level Lead: EURO/HSS – Chair: RD/EURO - Introductory remarks – Dr Marc Danzon, RD/EURO 05 mins - Global health systems strategy and its application at country level – Dr A. Nordstrom, ADG/HSS 15 mins - Remarks on EURO Health Systems’ work Dr Nata Menabde, DRD/EURO 05 mins - EURO/Country presentation on Health systems Dr P. Ursu, Republic of Moldova and Dr E. Danielyan, Armenia 20 mins - Reaction of 2 WRs Dr T. M. Manzila, Burundi and Dr M. O’Leary, Cambodia 10 mins - Plenary Exchanges 30 mins - Wrap-up 05 mins

10:30 - 11:00 Tea/Coffee

11:00 - 12:30 Effective Functioning of WHO Country Offi ces Lead: SEARO/GMG Co-chairs: ADG/GMG and DPM/SEARO - Introductory remarks Dr Samlee Plianbangchang, RD/SEARO 05 mins - Changing role of the Country Offi ces by Dr Duangvadee Sungkhobol, WR Bangladesh 05 mins - Plenary Exchanges 20 mins - Improving Management of Country Offi ces Dr Kan Tun, WR Nepal 05 mins - Plenary Exchanges 15 mins - Improving the effi ciency of Country Offi ce Operations through the Global Management System Dr Salim Habayeb, WR India 05 mins - Plenary Exchanges 20 mins - Wrap-up – ADG/GMG 05 mins - Introduction to Group Work – co-Chair DPM/SEARO 10 mins

12:30 - 14:00 Three Parallel Lunch-time Seminars on a) Managing WHO’s work in Small Island Countries Chair: Dr Bernadette Theodore Gandhi b) Global New Vaccine Priorities: WHO and GAVI Alliance Chair: Dr J. Olive, WR/ Viet Nam c) Briefi ng on World Health Report 2008 Chair: Dr Tim Evans, ADG/IER

14:00 - 16:00 Group work on Effective Functioning of WHO Country Offi ces - Groups 1 to 6

16:00 - 16:30 Tea/Coffee

16:30 - 18:00 Report back on Effective Functioning of WHO Country Offi ces Co-chairs: ADG/GMG and DPM/SEARO - Opening 05 mins - Presentation by Groups 50 mins - Discussion 30 mins - Wrap-up 05 mins

40 Part V – Annex 1 WEDNESDAY, 14 NOVEMBER 2007

HEALTH ACTION IN CRISES AND EMERGING STRATEGIC HEALTH ISSUES

09:00 - 10:30 WHO’s work in countries in crises situations Lead: EMRO/HAC – Chair: RD/EMRO - Introductory remarks – Dr H.A. Gezairy, RD/EMRO 10 mins - Recent developments and challenges in WHO’s work in crises Dr Ala Alwan, ADG/HAC 15 mins - Plenary exchanges 15 mins - Implications for WHO country offi ces: Feedback from 1st Annual Workshop on WHO’s work in health action in crises – Dr M. George, WR/Uganda 10 mins - Regional Perspective 10 mins - Plenary exchanges 25 mins - Concluding remarks – Dr Gezairy, RD/EMRO 05 mins

10:30 - 11:00 Tea/Coffee

11:00 - 12:30 Public Health Innovation, Intellectual Property, Trade, Health and International Health Regulations(2005)

International Health regulations(2005) Lead: WPRO/HSE – Chair: ADG/HSE - Introductory remarks – Dr Omi, RD/WPRO 05 mins - General introduction to IHR and status of implementation Dr G. Rodier, Dir/EPR/IHR 10 mins - WHO-wide Standard Operating – Procedures for IHR – Dr M. Ryan, Dir/EPR 10 mins - Plenary exchanges 20 mins

Public Health Innovation, Intellectual Property, Trade and Health Lead: WPRO/IER/HTP – Moderator: Director a.i., ETH - Introductory remarks – Dr S. Omi, RD/WPRO 05 mins - Panel speakers on trade in health services • Frameworks for assessment and policy issues – Dr S. Siddiqi RA/EMRO 10 mins • GATS and current negotiation issues – Ms Mirelle Cossy, WTO Secretariat 10 mins • Liberalizing health services in Malaysia – Dr Han Tieru, WR/Malaysia 05 mins - TRIPS and access to drugs • Current policy issues: Karen Timmermans, TO/IP SEARO 05 mins - Public health, Innovation and Intellectual Property - IGWG report - Dr Elil Renganthan, Executive Secretary PHI 05 mins - Wrap up by Moderator 05 mins - Questions & answers on this session will be taken on Thursday during the training session.

12:30 - 14:00 Lunch-time Seminars on a) Commission on Social Determinants of Health Chair: Dr Tim Evans ADG/IER b) Pandemic Infl uenza Chair: Dr Hande Harmanci c) Report on WHO Global Stakeholders Perception Survey Chair: Ms Jane Wallace

14:00 - 16:00 Presentation of key issues and proposed action points Discussion Chair: Dr A. Asamoa-Baah, Deputy Director-General

16:00 - 16:30 Tea/Coffee

17:30 - 18:30 Concluding Session with Senior Executive Offi cers Chair: Dr H.A. Gezairy, Regional Director, EMRO - Orientation from the Global Policy Group - Remarks by a representative of HWCOs - Closing address – Dr Margaret Chan, Director-General

Part V – Annex 1 41 ANNEX 2 DIRECTOR-GENERAL’S OPENING REMARKS

Dr Margaret Chan Director-General

Regional Directors, senior managers, heads of WHO gets done at the country level is the best measure of our country offi ces, colleagues, ladies and gentlemen, performance.

Shortly after taking offi ce, I set out to improve the way This meeting is a policy dialogue engaging all three levels WHO uses the strategic value of its decentralized struc- of the Organization. Nonetheless, I want to address my ture. I was asked specifi cally by Member States to make comments most specifi cally to the heads of country this structure perform better. offi ces.

It makes sense to do so. We all know that health problems, You are the representatives of the Director-General and and the capacity to address them, vary considerably from the Regional Directors. You and your staff are the people region to region. Each country has its own unique set of on the frontline. You know the country and its culture. You threats to health. see the health problems. You follow the national news. You are the closest to the Ministry of Health. You know Health is affected by cultural beliefs, such as those that the politics. infl uence the status of women or stigmatize people with certain diseases. Health is infl uenced by political systems You are our health intelligence within countries, and you and the quality of governance. Health systems are them- are also the public face and voice of WHO – at the frontline, selves highly context-specifi c, shaped by history, and by where people actually live and die, sometimes as a result the social, cultural, and political environment. of our policies. You are the link between those frequently used phrases, “at the country level” or “in the fi eld”, and These observations lead us to an obvious conclusion: this the reality on the ground. You, your staff, your facilities, Organization’s decentralized structure is an asset. It fol- your connections are the operational base for the interna- lows a time-honoured principle: delegation of responsibil- tional response to emergencies. Much depends on your ity to the level of greatest operational effi ciency. competence and operational effi ciency.

Since taking offi ce, I have worked to engage Regional Ladies and gentlemen, Directors more directly in the formulation of international health policies and in decisions about the day-to-day Much depends on all of us. I believe we have arrived, functioning of this Organization. in less than a decade, at a uniquely exciting, and yet a uniquely challenging point in the history of public health. This is the fourth meeting of its kind, but we want to Health has become an attractive area of engagement for view this event as somewhat different than in the past. a multitude of different agencies and actors. Through this meeting, we are extending participation in the policy dialogue to country offi ces. In addition, one In just the past seven years, more than 100 partnerships, of the objectives of this meeting is to fi nd ways to make focused on individual diseases, have formed. External your participation more routine, so that WHO experience funding for health in developing countries increased within countries operates as formal guidance when policy from $7 billion in 2000 to $10.7 billion in 2003, and is still decisions are made. climbing. The number of innovative funding mechanisms continues to grow, as does the size of resources they As I have said, what gets measured gets done. And what command.

42 Part V – Annex 2 Health has never before received such attention or The health-related Goals have at least two major policy enjoyed such wealth. But attention means close scrutiny, implications. First, if we want better health to work as and resources come with an expectation of results. a poverty-reduction strategy, we must reach the poor. Second, if we want health to reduce poverty, we cannot We are at the midpoint in the countdown to 2015, the allow the costs of health care to drive impoverished year given so much signifi cance by the Millennium Dec- households even deeper into poverty. We are failing on laration and its Goals. These Goals represent the most both counts. ambitious commitment ever made by the international community. They attack the causes of poverty at their Ladies and gentlemen, roots, and they acknowledge that these causes interact. In short, they acknowledge the importance of multisecto- For all of these reasons, I want to speak to you at the ral collaboration. policy level, using the WHO agenda as a framework. This agenda offers a simplifi ed way of looking at some very The Goals champion health as a key driver of economic complex challenges. It has six items. progress. In so doing, they elevate the status of health. Health is no longer merely a consumer of resources. It is The fi rst two concern fundamental needs: for health devel- also a producer of economic gains. opment and for health security. The second two items are strategic: strengthening health systems and making the Despite these welcome trends, we have to face the real- best use of evidence through research and information ity. Of all the Goals, those directly related to health are the management. The remaining two items are operational: least likely to be met. managing partnerships to get the best results in coun- tries, and improving the performance of WHO, also to get These are the Goals that aim to reduce high levels of pre- the best results in countries. mature death from diseases and health conditions that disproportionately affect the poor. These are the Goals Let us look at each of these items in more detail. that can make the greatest life-and-death difference for millions of people. These are the Goals that have powerful Health development has been the bread-and-butter tools – drugs, vaccines and other interventions – to sup- work of this Organization since its inception. Some of port their attainment. this work has received a sharper focus with the Millen- nium Development Goals. This focus is most welcome. Something is wrong. Public health has political commit- Our strong programmes in this area include those for ment, effective tools, good strategies for implementation, HIV/AIDS, tuberculosis, and malaria, for child health, and resources from new sources. Finally, with so much immunization, making pregnancy safer, and improving working in our favour, we can see what is holding us back. gender equality. It is this. The power of interventions is not matched by the power of health systems to deliver them to those in But health development has a broader meaning at WHO. greatest need, on an adequate scale, in time. We must also address the rise of chronic diseases. These diseases now impose their greatest burden on low- and All around the world, governments have failed for decades middle-income countries. Many chronic diseases require to invest adequately in basic health systems. It has taken lifelong care, vastly increasing the burden on health sys- a strong international commitment, like the Goals, to make tems. These diseases also increase costs – for house- the consequences of this failure painfully apparent. holds, health systems, and government budgets.

Part V – Annex 2 43 In many developing countries, the speed of moderniza- At the strategic level, the strengthening of health sys- tion has outpaced the ability of governments to provide tems is perhaps our most critical and urgent task, both the necessary supporting infrastructures. This is true in for governments and the international community. For- urban shantytowns, and this is true on the roads. Devel- tunately, we are seeing some encouraging trends at the oping countries, already saddled with the double burden international level. This past September, several heads of infectious and chronic diseases, do not need a third of state launched a new International Health Partnership burden of injuries, disabilities and deaths from violence, in response to stalled progress in reaching the health- accidents, suicide, and traffi c crashes. related Millennium Development Goals. It acknowledges the explicit need to invest in health systems. To make Under health development, we also include the neglected aid more effective, it introduces a framework of mutual tropical diseases. These diseases affect the poorest of the accountability that recognizes the need for health initia- poor in huge numbers. The sheer scale of those affected tives to be country-owned and country-led. – more than one billion people – makes control of these diseases a signifi cant poverty-reduction strategy. Fortu- In another welcome trend, both the GAVI Alliance and nately, progress on many fronts is making it possible, for the Global Fund have recognized the need to improve the fi rst time in history, to set goals for eliminating many of health systems. In short: interventions and money are not these ancient diseases of poverty. enough. If we intend to meet our international commit- ments, we must have better delivery systems. Health security is concerned, in part, with acute shocks to the health of populations. These may come during out- As you know, I have called for a return to primary health breaks of emerging or epidemic-prone diseases, following care as an approach to strengthening health systems. natural disasters. or in confl ict situations. Natural disasters Fortunately, a number of initiatives, both regional and and confl icts are localized events. But conditions in the 21st international, are under way to pave the way forward. century – our high mobility and the interconnected nature I am glad to see that the strengthening of health systems of our businesses and economies – have made emerging will be discussed during this meeting. As health systems and epidemic-prone diseases a much greater international are so context-specifi c, ways to strengthen them must be threat. Any country with an international airport is at risk. worked out at the country level.

Again, we have strong programmes for health action in Evidence is also strategic. Evidence is the foundation for crises, and for implementation of the revised International setting priorities, crafting policies, and measuring results. Health Regulations. We will need these programmes all Evidence can have great persuasive power at the policy the more as the health consequences of climate change level. As one example, the strategy for the Integrated Man- are increasingly felt. agement of Childhood Illness has had a strong evaluation component since 2000. Evidence from this evaluation has A second dimension of health security concerns assur- helped overcome one of the greatest barriers in public ance that households and communities have access to health: moving from pilot projects to national scale. the fundamental prerequisites for health. This means ade- quate and safe food, water, sanitation, and shelter, and Evidence can also bring attention to neglected health access to essential health care. It also means that health problems. As one recent example, WHO worked closely care must be appropriate and affordable. As you will with The Lancet to generate evidence and formulate a call know, these are needs addressed in the primary health for action to increase coverage of mental health services care approach. Once again, we see the importance of in low- and middle-income countries. The data, published multisectoral collaboration. in September, generated broad media coverage. This is

44 Part V – Annex 2 an important step towards correcting a bleak situation: channels. Single-disease initiatives can draw staff away mental health services are being starved of both human from the provision of essential care. I am aware of the and fi nancial resources. added burden partnerships place on country offi ces and their staff. But we are not yet realizing the full strategic power of evidence within countries, where basic health data and Country offi ces are also on the frontline in that second statistics are usually weak or poorly used. The Health operational area: the performance of WHO. WHO is Metrics Network, hosted by WHO, was established to constantly working to align its fi nancial and administra- address the lack of reliable health information in devel- tive instruments with a rapidly changing environment. We oping countries. Most recently, this Network has drawn have a results-based budget and the Eleventh General attention to the consequences of inadequate systems Programme of Work. We have guidance from the priori- for civil registration – that is, counting births and deaths ties and organization-wide strategic objectives set out in and recording the cause of death. For example, WHO the Medium-term Strategic Plan. receives reliable cause-of-death statistics from only 31 of its Member States. You will be hearing about implementation of the Global Management System and its implications for your daily Without these fundamental health data, we are working in work. Some of you are directly engaged in pilot projects the dark. We may also be shooting in the dark. Without for UN reform, delivering as one. I know you will have a these data, we have no reliable way of knowing whether panel discussion on UN reform this afternoon, followed by interventions are working, and whether development aid group work on partnerships and UN reform. WHO is com- is producing the desired health outcomes. This is part of mitted to UN reform, and we are fully engaged in each of our job: to be accountable. the eight pilot projects.

We cannot be fully accountable without research. And I know that your responsibilities have changed dramati- public health cannot move forward without innovation. cally within less than a decade. This is in line with some These are additional challenges facing this Organization. of the changes in the health landscape that I outlined earlier. Ladies and gentlemen, Recent trends have brought specifi c obligations, such as Let us turn to the remaining two items, as these have par- those arising from the revised International Health Regu- ticular relevance to your daily work. Both aim to get the lations. These trends also include the consequences of best results in countries. trade agreements, especially those infl uencing trade in health services and access to affordable medicines. I At the operational level, the management of partnerships know you will be addressing this issue as well. is a comparatively new challenge. And it is a big one. Increasingly, health development within countries is being More funds are available. But someone must help coun- pursued by multiple agencies, often with little coordina- tries put together convincing proposals. More partners tion. Efforts overlap and may not align with country priori- are now working in health than in any other sector. But ties and capacities. someone must help align their activities with country pri- orities and capacities. Otherwise, all this fl urry of activity In addition, national capacities in recipient countries may and fl ow of new funds may end up doing more harm be strained by high transaction costs, multiple report- than good. ing requirements, and multiple distribution and delivery

Part V – Annex 2 45 Ladies and gentlemen, The rise of chronic diseases makes this negotiating power all the more critical. The causes of these diseases Let us take a look at one more hard reality. What is the – inappropriate diet, lack of exercise, tobacco use, and comparative advantage of WHO ? What is our added excessive alcohol consumption – lie outside the direct value ? Do we perform essential functions ? Is our work responsibility of the health sector. Prevention depends relevant or redundant ? absolutely on multisectoral action, with health given pride of place. If an agency is the only one working in a particular fi eld, it can claim leadership as a given. This is not the case with The need for coordination is equally absolute. If a country health. Health leadership must be earned. gets one set of recommendations from UNICEF, another from the World Bank, and yet another from WHO, confi - As I have said, the fi eld is crowded. Attention brings scru- dence in the authority of international agencies is dimin- tiny and resources come with an expectation of results. ished. If a country gets confl icting recommendations from Progress in meeting the health-related Millennium Devel- WHO headquarters and regional offi ces, confi dence is opment Goals has stalled. Where are the results ? demolished.

We earn the right to lead by demonstrating results within Leadership and authority are not guaranteed by our Con- countries. I know very well: we can design programmes stitution. We have to earn this role in a highly competi- and strategies, but WHO has neither the mandate nor tive and rapidly changing environment. We need to move the means to directly implement them within countries. down from lofty phrases about our technical excellence There are exceptions, of course, such as the response to and concentrate on our performance, on the ground, in emergencies of international concern as mandated by the the countries we serve. International Health Regulations. If WHO cannot deliver, a country can turn to many other Country offi ces exist to advise ministries of health, to providers and sources of advice. Again, are we relevant ? translate international guidelines, norms and standards Is the money being given us by Member States and into country-relevant approaches. You are the bridge donors bringing measurable results ? between what a country needs and what headquarters and regional offi ces have to offer. You are also the bridge Let me make one fi nal point. As I said, these are exciting between multiple implementing agencies and the wishes but challenging times for public health. All the good will we and priorities of the ministry of health. are seeing – the good intentions, the new funding mecha- nisms, the multiple partnerships – actually operate under Traditionally, ministries of health are among those govern- the real conditions in the countries where you serve. ment departments with the lowest status. Country offi ces need to help ministries of health negotiate with other sec- We must aim for the best results in countries. You are the tors. Evidence can increase this negotiating power, espe- frontline troops. We eagerly seek your guidance. cially when evidence shows the economic consequences of failing to address health problems.

46 Part V – Annex 2 ANNEX 3 CONCLUDING SESSION, SPEECHES AND REMARKS

Dr Hussein A. Gezairy, to let you know that we hear you very well. I also want to Regional Director for the Eastern Mediterranean remind you: never for a moment forget that you are a very Thank you very much. As it has been agreed this after- important part of the Organization. noon we’ve had about half an hour-forty minutes meeting together with the Director-General, and we had discussed You are managers like us. We sit in different offi ces what could be done regarding your recommendations. – country offi ces, regional offi ces and head offi ce – but I think in spirit almost all the recommendations were agreed all of us are managers. And we have a duty to manage upon because simply they are very logical recommenda- the work of this Organization and the performance of this tions and also practical ones. But I think I will leave it to the Organization in times that are extremely challenging for Director-General to say exactly how it is going to be done. global public health.

Dr Margaret Chan, Today’s environment for public health is complex and Director-General highly competitive. Our collective performance in deliv- Thank you, Dr Gezairy, for chairing this very important ering good health within countries is fundamental to our session. very existence. It is fundamental for us to keep up the fl ag of WHO for the good track record of this Organization. I would like to share with you what we have been doing in the last 45 minutes following the reporting back of discus- In order to do that, we need commitment and dedica- sions and recommendations. This is the fi rst time I have tion. I have no doubt, we have plenty of that in all of our attended a global meeting with Heads of WHO Country colleagues. I have already mentioned the passion in your Offi ces in my capacity as DG. I will make a few observa- discussions. We also need a spirit of collaboration. We tions that help explain how we will take forward the rec- must work in a collegial manner, and we must understand ommendations that you have put to us. there are situations where we need to give and take. There are situations we need to agree to disagree. There are First and foremost, I feel that we – all of us, your good situations where people at the level of Regional Director selves, the Regional Directors, the DDG, myself and my and the DG can say “yes” to you and there are situations colleagues who have been participating in the presenta- where they will have to say “no” to you. When we say tions, lunch hour seminars and working groups – we have “yes” to you, of course you are happy. When we say “no” all worked very hard in the past few days. We are doing to you, do not be unhappy. There are always reasons. this with one very clear objective: to have a good policy dialogue involving managers at the three levels, that is, At the senior level, we agree that we need to listen to country offi ce, regional offi ce and head offi ce. And of you before we make policy decisions on major issues. But course, specifi cally in the last two and a half days, we at the end of the day, after I have heard inputs, advice are listening to you. As I said on Monday in my opening and guidance from all the Regional Directors, I am left to address, we need your input and we also need your guid- make very diffi cult decisions. These decisions are easier ance on how the Organization can move forward as one. when the Regional Directors agree. Once a decision is taken by the DG, Regional Directors will toe the line as an In our discussions, the Regional Directors, the DDG organization-wide policy. I would like all the managers in and myself have similar observations. We are extremely this Organization, at all three levels, to work in this spirit. impressed with the frank and also passionate discussion we have had and the exchange of experiences from differ- In the last few days, you have raised many very impor- ent offi ces. You have exchanged not just experiences, but tant issues and asked some pointed questions, some of also some frustration and some specifi c diffi culties. I want which concern urgent needs. Some of these questions,

Part V – Annex 3 47 comments, and even complaints are very legitimate. I hear reality: our ability to mobilize resources, and what we can and I know how much it hurts when you tell me you do do with existing resources. not like people parachuting into your offi ce. This is one of those issues we need to take on board and address right What are some corporate projects that we need to push away. As you put it, the guidelines are there. We need to forward ? You have identifi ed some. Number one: health get them implemented as a matter of urgency. This is one systems are the backbone of the work of ministries of of the things we need to get a good handle on. health, and this deserves special attention. Unfortunately, we cannot give such a fi rm response for matters that have But I need your help. As suggested by colleagues from implications across the United Nations common system. Botswana and elsewhere, we need you to provide us with UN reform is extremely important. We will keep you some information as a basis for analysis. The analysis is not posted. We will not shy away from speaking to New York. with the objective of witch-hunting. We do not do this here As we have heard, discussions and decisions in New York in WHO. The analysis of why people do not observe the can have an impact on the effi ciency of our work within guidelines is for us to learn lessons and move forward. countries. One clear example came from the offi ce in Iraq. Do we need 21 days for security clearance ? Another area of passionate discussion concerns the del- egation of authority. You feel a need for more authority, not For discussions with New York, one channel is through only in human resource terms but also in fi nancial man- our New York offi ce and our Assistant Director-General agement and in programmatic management. You need a stationed in New York. As a diplomat, he can give techni- speedy response to some legal issues. We will take this cal issues the advantage of diplomacy. He knows how to on board as a matter of urgency and come back to you, move around in New York, to represent WHO issues, and as soon as possible, with a global view on how we move get his voice heard there. forward. As I said, we can take immediate action on some of your Some other recommendations coming from you may recommendations. Tomorrow we have a retreat involving need more time for a response. One obvious example is DPMs, DRDs from the regions, Regional Directors, myself, recommendations having resource implications. You have the DDG and all the ADGs. We will use this opportunity to expressed your need for more resources at the country look at recommendations coming from you and work out level. This request cannot be addressed in isolation. We what I call a plan of follow up. As I said, Regional Direc- need to look at country offi ce, regional offi ces and head tors are present and will also consider the follow-up plan. offi ce. How do we realign the way we do business in They have expressed commitment to take forward some order to back-stop you ? We cannot give an empty prom- of your recommendations. Other recommendations need ise today, or give you a blanket promise that we increase to be taken forward jointly by regional offi ces and the head your budget by 10%, 5% or whatever percent. Different offi ce. country offi ces have different needs. This is how we plan to move forward. We will do some We have some big country offi ces, others are smaller. editorial work on some of the recommendations and try When I say small, it doesn’t mean you are not important. to bring related ones together in the interest of greater Sometimes small is beautiful. AB and I are quite small. But coherence. For example, many recommendations men- we are beautiful. For proposals with resource implications tion the CCS. We will try to bring these related recom- for the Organization, we need to take a very pragmatic mendations together for a more workable and coherent approach. We need to see how we can realign and read- plan. Would the RDs like to supplement these comments ? just the work of the Organization while also looking at the Dr Omi ?

48 Part V – Annex 3 Dr Shigeru Omi, your uncertainty about whether this process will be insti- Regional Director for the Western Pacifi c tutionalized. Yes, it will. We have agreed that there will be Thank you Margaret. Now, obviously we received more a meeting every two years. At this point in time we have than ten recommendations that we discussed very deeply. decided that the next meeting will be in Geneva. We have Obviously some recommendations are more closer to also taken on board your suggestions about rotation of your heart than others. I understand that one of the things the venue. We will leave this issue open for future discus- that you are very much passionate is about delegation of sion. I ask you for that understanding. So basically, that’s authority. DG and we all understand the frustration that all I have to say. Would Dr Samlee or Dr Marc Danzon you have over the several years because in the past we have any points to make ? talked a lot about this issue of the delegation of authority and DPMs and colleagues spent a lot of time to come Dr Samlee Pliangbangchang, up with a draft proposal. But somehow because of one Regional Director for South-East Asia reason or another, this was not fi nalized. Finally listening to I just would like to repeat what DG said. Many things can you very carefully the DG has agreed to take the following be done at the regional level. And we would take initiative action: by the end of November, the draft paper on del- starting from the week and the next week, we will have a egation of authority will be reviewed by the GMG. There is meeting with all WRs in South-East Asia region where we already a draft so we are building on the existing one. By spend time together to check out the strategy for follow the end of November this paper will be shared with all the up action. And I am sure that working closely between the regions and we immediately share the draft with all of you. regional offi ce and country offi ces we can do a lot in follow Then accommodating some of the good suggestions, we up of these recommendations from this meeting. Regional Directors and DG will meet again next January, immediately before or after the Executive Board, and will Dr Marc Danzon, fi nalize it. The fi nal version will be circulated to all of you by Regional Director for Europe the end of February. But the DG assures you that you will Margaret, you will be surprised but I have nothing to say, be fully involved during the process. I totally agree on everything.

Dr Margaret Chan, Dr Luis G. Sambo, Director-General Regional Director for Africa Thank you. Thank you Madam Director-General. I would also like to say that as far as the African Region is concerned, we We will give information on the granularities and details have taken note of all the recommendations made by the of examples we will take forward. Some recommenda- meeting, and we fully endorse all of them. We will make tions will be discussed in tomorrow’s retreat. The regional sure that they are followed up at the regional WR meet- offi ces will be responsible for getting inputs from the ings. Some of these recommendations as a matter of fact country offi ces. This is how we plan to take your views are being implemented right now. So you may rely on the on board. As I said earlier, we value your views and want full support of the African Region for follow up. to hear them. If we say “no” to your recommendations, it does not mean we do not respect you. It means other Dr Hussein A. Gezairy, considerations come into play. This is important, and I Regional Director for the Eastern Mediterranean hope you understand. Thank you very much.

Let me refer again to your number one recommendation. I think it goes without saying but I think it is important On Thursday, some of you gently complained, expressing to say it. We are very grateful to Marie-Andrée. She has

Part V – Annex 3 49 done extremely good work, I know she has a big team Andrée Romisch-Diouf and her team for their excellent with her. So our thanks goes to everyone of the team. organization of the meeting. By the quality of the meeting, we I would like also to say that we had excellent interpreta- can tell that she and her team have spent months, weeks, tion and everybody here at Headquarters have assisted, days and sleepless nights preparing for this meeting. one way or another to have a very successful meeting. We had excellent presentations and all of us had enjoyed Yes, Dr Asamoa-Baah, you do not need to be blamed them. Especially with Anders Nordström we had a very because the work has been well done. good presentation, it is why everybody is speaking now about health systems. I asked him actually to give me a As we all know, this series of meetings started in 1999 to: copy of his presentation. One of the things that we, the – strengthen the esprit des corps of WRs and Heads of Regional Directors have noticed, is that now whenever WHO Country Offi ces as a group; there is an important issue, all the regional offi ces have – encourage the sharing of WRs and Heads of WHO been involved. The WHO strategy “Health Systems is eve- Country Offi ces experiences at country level and rybody’s business” resulted from the consultation with all encourage common problem solving; the regional offi ces as well as Headquarters. This is what – facilitate interregional cooperation and an exchange we call ‘One WHO’. I think you all had an opportunity to of information on common issues; say what you wanted to say but now it is time to listen – update and inform WRs and Heads of WHO Country to one of our senior WRs who has been with us for quite Offi ces on new initiatives and corporate programmes sometime and has been WR to three countries. We were to encourage proactive leadership at country level. talking about rotation, so you can see rotation has been done and I would like to give her a chance to make some During these past three days, we have learned a lot and remarks about the meeting in general, maybe also about have noted that though we are all from one WHO family, recommendations and about this new trend on how we each Region has its specifi cities; countries that we are are trying to be “One WHO”. The fl oor is yours. serving differ one from the other: – from inland countries to small islands – from small to large countries REMARKS ON BEHALF OF HWCOs BY – from developed to developing countries DR HELENE MAMBU-MA-DISU, – from low- to middle-income countries WHO REPRESENTATIVE, CAMEROON – from peaceful countries to countries in crisis – from donor attractive to donor “orphan” countries, Dr Margaret Chan, our Director General, and so on. Dr Asamoa-Baah, the Deputy Director-General, Our six Regional Directors, These diversities show that WRs and Heads of WHO The Assistant Directors-General, Country Offi ces are constantly adapting strategies and Directors of Programme Management (DPMs), guidelines developed at headquarters and the regional Directors, offi ces to make them coherent and useful to the countries Ladies and Gentlemen, we are working in.

On behalf of my colleagues, WRs and Heads of WHO Yes, Dr Chan, things have changed in WHO and we are all Country Offi ces, I would like to thank Dr Chan for keeping proud to be members of this family. From what we have her promises in allowing us to come and talk to her about been hearing over the past three days, and especially our work in the fi eld. about progress that has been made on how we deal with We also would like to thank and congratulate Dr Marie- crises, I just have two examples which illustrate that just a

50 Part V – Annex 3 decade ago, WHO had diffi culty in being accepted as the the recommendations and conclusions of this meeting. leader of health cluster in humanitarian action. Dr Chan, I come from a country that is in a situation of In the United Republic of Tanzania there was a refugee crisis or post crisis, which is known for its singing. Unfor- camp called NGARA with about 350 000 people who had tunately, I don’t know how to sing but I have asked one of settled there since April 1994. The fi rst WHO humanitarian my sisters to sing before we give back the fl oor. team arrived there in June of that year. A song rendition by Dr Stella Anyangwe, Dr Bassani and myself were almost kicked out of the camp WR/South Africa entitled “We Thank Thee” by the actors who had been there since the fi rst settle- Yes in the names of those of us who will be leaving the ment. Goma, a small town of 150 000 people in eastern organization before the next meeting, we would like the Democratic Republic of the Congo (DRC) became a to thank you Dr Chan, all RDs, all the other colleagues big city of more than 1 000 000 inhabitants in less than 48 and we do apologize for anybody that we have offended hours in April–May 1994. People were dying from exhaus- during our work. I think we all have given the best of our- tion, hunger, cholera and dysentery. The fi rst WHO mis- selves. Whatever we did not do we were not able to do it sion led by Dr Kadri Tankari, WR Togo, arrived in Goma in or we did not know how to do it. But whatever we knew mid-July. Dr Kadri Tankari and his team managed to take we did it with all the love for the work of WHO. I thank you the leadership of the health cluster, but he can tell you that very much. it was not easy. From the experiences we heard, WHO is now one of the fi rst, if not the fi rst, to be at the site. DIRECTOR-GENERAL’S CLOSING REMARKS On the other hand, in Africa we have a saying that goes “when elephants fi ght, it is the grass that suffers.” Seeing Thank you Dr Gezairy. After Helène’s intervention and Dr Margaret Chan laughing, singing and joking with our solace singing what else can I say ? All I can tell you, for RDs, we feel very happy, that is a sign that times when the those who are sitting far away and could not observe DG and RDs were fi ghting in front of their WRs are over. closely, that what was said brought tears to my eyes. I am saying what my colleagues felt and what I felt myself. I am very touched. I cry easily – yes, that’s true. That’s Dr Chan and your whole team including RDs, I think this not a secret. But today, well AB is saying that “you are the is a new beginning for WHO and we need to continue like crying DG.” But the tears I shed today are tears of happi- this because our countries and our Member States are ness. Are tears of great joy. And deep appreciation. looking upon us to help them improve the health of the people. Now I think about all that I have said. I don’t know All of you, your wealth of experience, as Helène stated, the how many times I have said “Dr Chan” but I have not said diversity of culture, work experiences, frustrations, good it as often as Dr Chan talked about her RDs and me, RDs stories, bad stories offer lessons for all of us. And that and me, I wish I could have said the same thing. I think we diversity is also the strength of this Organization and we really need to applaud Dr Chan for all that she has been should never forget for a moment. And WHO is strongest doing and to encourage her to continue to lead WHO. when our country offi ces are strong. I think she deserves it. Tonight I would like to thank you all for making the special Dr Chan and RDs, thank you for your confi dence in effort to come here and for your rich interventions and your WRs and Heads of WHO Country Offi ces. You can honest sharing. I also would like to thank the RDs, DPMs always count on us and we will not deceive you. We and the DRDs and their directors for their contribution to make the commitments to translate in concrete actions this important meeting. And of course, my DDG. Without

Part V – Annex 3 51 him, I don’t know what to do. And of course the ADGs us and may become constant reminders for us and the here and the directors in the head offi ce plus their teams RDs to refl ect on how we move this Organization from in supporting this work in terms of their presentation and strength to strength. I thank you for that. preparations. And I would like to close by making one last comment. The interpreters who worked so hard for us, our support Some WR colleagues will not be able to participate in the staff who are the unsung heroes, the men and women next meeting because they will be retiring. Helène you are behind the scene and, of course, CCO led by Marie- one of them. We are going to miss you. Andrée. The list can go on. Those whom I forgot to men- tion do excuse me and you have my deepest admiration. I want all colleagues to take this opportunity to join me Thank you for making this – my fi rst meeting with this to thank colleagues who will be retiring in 2008, for their group – such a touching meeting. outstanding contribution to WHO and for making WHO a strong Organization. We appreciate your commitment, I would like to take this opportunity to explain to you that your dedication and your contribution. Let us give them a Dr Mirta Roses, for personal reasons, could not be here in big hand of appreciation. person. She is with us in spirit and is well represented by WRs from the Region. On that, I would like to bring a close to this historical meet- ing and please rest assure that we will take on board the Again, I cannot fi nd appropriate words to thank you. I don’t recommendations. We will move forward in a way that will know how to say it. Other than to say: hopefully my tears, involve you all and will make you proud of our implementa- the tears of joy and appreciation, express my gratitude. tion. As I said, we cannot promise everything, but we will do whatever is possible within our authority to make you Helène, you attended all four global meetings. The stories, proud of us. the anecdotes that you have shared with us will stay with I thank you all.

52 Part V – Annex 3 ANNEX 4 FINAL LIST OF PARTICIPANTS

COUNTRY OFFICES AND REPRESENTATIONS

AFRICA REGION

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Part V – Annex 4 53  
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Part V – Annex 4 55    , %6 D#  !" &! ""!   , %6 D$ )#&'')  %< *  ;  % A B6 D#  !" &! "!# ;  % 0 /< A B6 D$ $#!"$'         % E/F        E F/F 

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56 Part V – Annex 4  
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58 Part V – Annex 4  4F I  > A4 ; F 9% > ,7  F    > 3 ; :F  9%> 4,;  F / > : ; F  > 3  F    >  ; F F
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Part V – Annex 4 59 ANNEX 5 EVALUATION

INTRODUCTION

This report is a summary of the evaluation given by • The four most preferred sessions (in order of preference) participants of the Fourth Global Meeting of the Heads were: Health Systems Strengthening, Partnerships and of WHO Country Offi ces (HWCOs) with the Director- UN reform, Managing WHO’s work in countries in crisis General and Regional Directors. situations and International Health Regulations. A total of 305 daily evaluation forms were collected • The Director-General’s continued presence throughout throughout the three-day meeting. The overall evalua- the meeting was highly appreciated. tion form was fi lled out by 84 participants. • One-quarter of the participants suggested that the duration of the meeting should have been extended by Key fi ndings and general comments at least an additional day. Respondents expressed con- • One-third of the respondents made reference to the cerns regarding the tight agenda which was felt to be transparent and positive discussions, to the very too compressed and compact. There were suggestions good atmosphere of the meeting, the frank and sup- for limiting the number of topics that can realistically be portive environment and the excellent organization of covered in three days, to allow more time for discussions the meeting. and for sharing the wealth of country experiences. • An overwhelming majority (99%) of respondents con- sidered the meeting was a genuine policy dialogue.

SUMMARY OF RESULTS ! !F&  F& " #F& * > $845 / /%        9  %% T #F) , /  B  /   B      T #F# / /%     9  %%  <       T #F$ / /%      %    9  9  T #F$

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$ 6@ )= $5 %6%<58?< > $845 8 %     #F!  9   %      B     #F"  9    /0     B     #F

$ 6@ :%A > $845 8 %     #F  9   %      B     #F!  9    /0     B     #F

8 %    0  %  F)

60 Part V – Annex 5 DAY 2 ! !F&  F& " #F& * $5 <<A< <%6456864 > $845 8 %     #F&  9   %      B     #F!

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Part V – Annex 5 61 SUGGESTED IMPROVEMENTS

Time management Other issues/comments The time management of the plenary sessions could be • Two respondents commented that some topics criti- further improved in order to allow more views from the fl oor cal to the country offi ce were not suffi ciently raised to be heard. There was a suggestion that the Chair should or discussed during the meeting, e.g. issues around restrict interventions to a maximum of three minutes and to the role of UNDP and the Resident Coordinator at discourage speakers of the fl oor from repeating previously country level. raised points and issues. A practical suggestion from one • One respondent suggested that the GSM presenta- respondent was to set clear rules to allocate more time tion given during the GSM group work should have for interventions, for example, “every representative has been conducted in plenary to allow participants to two times and two minutes per day or similar to make have a better understanding of what is coming and interventions”. Another suggestion was for participants to what is required. submit questions and comments beforehand and these • Given the extremely packed agenda, some respond- could be addressed by the speakers/panellists during a ents felt that they had insuffi cient time to interact with summary session. HQ technical units, visit the Market Place exhibits and attend the lunchtime seminars. Three respond- Format ents requested more time for personal administrative Respondents generally felt that the presentations during issues. plenary were too lengthy. One respondent suggested setting a limit to the number of maximum slides allowed per presentation (e.g. 6 slides for a 10-minute presen- REMARKS tation). Nearly half of the respondents commented that there was insuffi cient time allocated for discussions Most respondents indicated that subsequent global meet- and that it was important to reduce the time allocated ings of HWCOs with the Director-General and Regional to speakers and increase the time set aside for discus- Directors should be held biennially and that the true meas- sions. There were suggestions to decrease the number of ure of success for such a meeting would depend on the presentations given and to allow more time for sharing of follow up and implementation of recommendations arising country experiences. from the meeting.

With regard to the working groups, respondents raised the need to have more time for discussion. There were suggestions to have a facilitator to better manage the time and allow ample time and space for discussions.

62 Part V – Annex 5 63 ANNEX 6 CD-ROM CONTENTS

1. General documents

2. WHO 6-point agenda

3. Partnerships and UN reform

4. Health systems strengthening

5. Effective functioning of WHO country offi ces

6. WHO work in countries in crisis situations

7. International Health Regulations (2005)

8. Public health innovation, intellectual property, trade and health

9. Lunchtime seminars 9.1 Commission on Social Determinants of Health 9.2 WHO Categorization of vaccines by public health priority 9.3 Pandemic Infl uenza 9.4 WHO work in small island states 9.5 Global Stakeholder Perception Survey results 9.6 World Health Report 2008

10. Training sessions

11. Photographs and slideshow

64 Part V – Annex 6

AFGHANISTAN ALBANIA ALGERIA ANDORRA ANGOL A ANTIGUA AND BARBUDA ARGENTINA ARMENIA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BRAZIL BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA COLOMBIA COMOROS CONGO COOK ISLANDS COSTA RICA CÔTE D’IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DEMOCRATIC PEOPLE’S REPUBLIC OF KOREA DEMOCRATIC REPUBLIC OF THE CONGO DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FIJI FINLAND FRANCE GABON GAMBIA GEORGIA GERMANY GHANA GREECE GRENADA GUATEMALA GUINEA GUINEA- BISSAU GUYANA HAITI HONDURAS HUNGARY ICELAND INDIA INDONESIA IRAN (ISLAMIC REPUBLIC OF) IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KUWAIT KYRGYZSTAN LAO PEOPLE’S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LITHUANIA LUXEMBOURG MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MAURITANIA MAURITIUS MEXICO MICRONESIA (FEDERATED STATES OF) MONACO MONGOLIA MONTENEGRO MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL QATAR REPUBLIC OF KOREA REPUBLIC OF MOLDOVA ROMANIA RUSSIAN FEDERATION RWANDA SAINT KITTS AND NEVIS SAINT LUCIA SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAJIKISTAN THAILAND THE FORMER YUGOSLAV REPUBLIC OF MACEDONIA TIMOR-LESTE TOGO TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED REPUBLIC OF TANZANIA UNITED STATES OF AMERICA URUGUAY UZBEKISTAN VANUATU VENEZUELA (BOLIVARIAN REPUBLIC OF) VIET NAM YEMEN ZAMBIA ZIMBABWE AFGHANISTAN ALBANIA ALGERIA ANDORRA ANGOL A ANTIGUA AND BARBUDA ARGENTINA ARMENIA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BRAZIL BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA COLOMBIA COMOROS CONGO COOK ISL ANDS COSTA RICA CÔTE D’IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DEMOCRATIC PEOPLE’S REPUBLIC OF KOREA DEMOCRATIC REPUBLIC OF THE CONGO DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FIJI FINLAND FRANCE GABON GAMBIA GEORGIA GERMANY GHANA GREECE GRENADA GUATEMALA GUINEA GUINEA- BISSAU GUYANA HAITI HONDURAS HUNGARY ICELAND INDIA INDONESIA IRAN (ISLAMIC REPUBLIC OF) IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KUWAIT KYRGYZSTAN LAO PEOPLE’S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LITHUANIA LUXEMBOURG MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MAURITANIA MAURITIUS MEXICO MICRONESIA (FEDERATED STATES OF) MONACO MONGOLIA MONTENEGRO MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL QATAR REPUBLIC OF KOREA REPUBLIC OF MOLDOVAWorld ROMANIA Health Organization RUSSIAN FEDERATION RWANDA SAINT KITTS AND NEVIS SAINT LUCIA SAINT VINCENT20, avenue AND Appia THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI 1211 Geneva 27 ARABIA SENEGALSwitzerland SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA SUDAN SURINAME SWAZILAND Tel.: +41 22 791 21 11 SWEDEN SWITZERLANDFax: +41 22 791 31 11 SYRIAN ARAB REPUBLIC TAJIKISTAN THAILAND THE FORMER YUGOSLAV REPUBLIC OF MACEDONIA TIMOR-LESTE TOGO TONGA TRINIDAD AND TOBAGO TUNISIA TURKEYwww.who.int TURKMENISTAN TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED REPUBLIC OF TANZANIA UNITED STATES OF AMERICA URUGUAY UZBEKISTAN VANUATU VENEZUELA (BOLIVARIAN REPUBLIC OF) VIET NAM YEMEN ZAMBIA ZIMBABWE