Annex B
WORLD HEALTH ORGANISATION DEVELOPMENT EFFECTIVENESS
SUMMARY*
CONTEXT
Mandate
The World Health Organisation is the United
Nations specialised agency responsible for matters relating to
health. Its objective is the attainment by all peoples of the
highest possible level of health. Normative work: promoting research,
generating new knowledge and formulating of policies, strategies,
guidelines and standards, is WHO's core work. WHO has a key development
role and is committed to attaining the health targets identified
in the MDGs. WHO currently pursues 35 areas of work under five
basic headings: Improving Health Outcomes; Responding to Outbreaks
and Emergencies; Tackling Health Determinants; Strengthening Health
Systems; Focusing on Results Based Management (RBM). From 2008,
WHO's work will be organised around 13 Strategic Objectives.
Size
With headquarters in Geneva, WHO have 145 country
and 6 regional offices. Expenditure in the biennium 2004-05 was
US$ 2,944.4 million with 37.5% spent at HQ level, 27.0% at regional
level and 35.5% at country level.
Key Issues
Interpreting WHO's role, as a specialised agency,
within the wider UN reform agenda will be a challenge for the
organisation—this includes clarifying WHO's respective roles
and functions of Headquarters, Regional and Country Offices. This
will be informed and modified by how they participate in the One
UN country pilots. Improving Financial Resources management is
a priority area. There is an unhelpful resource ratio of 26%:74%
between assessed contributions and voluntary contributions—funding
which is largely earmarked for specific activities—which
severely hampers WHO's ability to carry out its core work. WHO
intend to redress the imbalance of earmarked funding, and the
restrictions this places on activities by 2013.10 However the
latest propdsed programme budget for biennium 2008-09 shows even
greater imbalance of 22.7%:77.3%.10In terms of the key issue of
health systems strengthening, WHO needs to define and play its
role vis-a-vis the roles of other agencies such as the World Bank.
With the effects of climate change becoming more apparent WHO
will have a key role to play in the response to global health
security resulting from it. WHO has appointed a new Director General,
Margaret Chan. She has confirmed her commitment to ensuring participation
in the UN reform process. We hope to see a positive response at
regional and country level. WHO needs to continue to demonstrate
leadership in helping to simplify the current complex health architecture
and proliferation of global health partnerships. WHO has seen
many successes at the global level and some success at the regional
and country levels, however lack of information makes it difficult
to counter the perception of variable country level performance.
IS WHO BUILDING
FOR THE
FUTURE?
Summary
WHO have made significant strides over the last
few years in institutional reform. Some areas such as the Results
Based Management Framework have been significantly improved. There
are other areas, such as staff development, which will take longer
to see significant changes. WHO has taken an active part in the
UN reform process as a member of the UN Development Group (UNDG).
Papers to the January and May 2007 Executive Boards outlines WHO's
Views on UN reform, and their engagement, including in the pilots,
to date. These demonstrate movement and a change of position over
the previous months. The new Director General, Margaret Chan,
has confirmed her commitment to UN Reform and we expect to see
more focus on contributing to the One UN Pilots. However it is
early days and we need to wait to see what the strongly independent
regional offices will do to support the DO. The country support
network have agreed a strategy for building capacity of country
teams and addressing the harmonisation and alignment agenda. One
important challenge is posed by the interdependence between some
of the reform elements across the organisation resulting in delay
in fully implementing reform policy.
COMMITMENT TO
CONTINUAL IMPROVEMENT
To what degree is WHO committed to UN reform?
 WHO
share the views of the international development community of
the need to improve effectiveness and impact, and the need for
the UN system to demonstrate more effective actions relevant to
the needs of the 21st century. WHO is committed to investing in
collective UN action and reform. WHO believe that diversity of
the UN system is a source of strength, and that the outcome of
the current UN reform debate should be a better articulated division
of labour.9
Does the Board require management to act on performance
results?
Results
are measured against indicators set in the programme budget. But
reports are not published before the next budget is published.
Performance Assessment Reports include lessons learnt against
each area of work along with details of how they will be applied
in the next biennium. The new Medium Term Strategic Plan10 sets
out a clear framework for results based management providing indicators,
targets and resources required for their achievement. The importance
attributed to RBM is reflected in the location of the Evaluation
Unit within the DG's office.2
BUILDING KNOWLEDGE
AND LESSON
LEARNING
Does WHO have adequate mechanisms for learning
and spreading lesson learning?
 WHO
is a knowledge-based organisation. The exchange and dissemination
of information about health conditions and the Maintenance of
health has been a central activity of the Organisation since its
founding.13 Internet and published materials are widely disseminated.
WHO have made some progress in sharing knowledge and good practice
with member states through its Knowledge management and information
cluster. A new partnership is hosted by WHO—The Health Metrics
Network. It seeks to increase the availability and use of timely,
reliable health information by catalysing the funding and development
of core health information systems in developing countries.2 National
offices in priority countries need to improve their communication
strategy and proactively disseminate regular updates that inform
key stakeholders in simple terms of the interpretation of the
WHO mandate in emergencies in the local context.
RESULTS BASED
MANAGEMENT
WHO
is committed to results based management and has a well defined
framework starting with the General Programme of Work providing
the long term strategic direction to set priorities that will
be outlined in the Medium Term Strategic Plan. Performance is
assessed biennially with additional thematic, programmatic and
country evaluations to critically assess outcomes.2
STAFF DEVELOPMENT
What is the level of staff satisfaction? Not reported
in the public domain
Not reported in the public domain.
HOW WELL
IS WHO MANAGING
ITS RESOURCES?
Summary
WHO's ability to prioritise and fund its work
is significantly restricted by the high level of earmarking by
donors against voluntary contributions. These contributions account
for 74% of funding to WHO in comparison to 26% assessed contributions.
This results in an imbalance of attention and resources going
to issues important to member states while other pertinent areas
are neglected. WHO recognises that it needs to improve the predictability
of its financing if it is to more effectively manage its resources
as set out in the MTSP.10 The role of WHO as a normative and standards
setting agency points to less not more decentralisation. However
WHO is moving towards greater decentralisation at regional and
country levels. The regional layer has an important technical
support and performance monitoring role but in the case of WHO,
the regions have a unique semi-autonomous status, making any reform-minded
changes to the regional level very difficult. WHO take the opposite
view to this.
CORPORATE GOVERNANCE
AND STRATEGY
Is WHO's corporate strategy based on a clear definition
of mandate and comparative advantage?
WHO
has identified its strengths as its neutral status and nearly
universal membership, its impartiality and its strong convening
power. WHO has a large repertoire of global normative work and
many countries rely on WHO standards and assurances in medicine.
Based on evidence of where WHO could make the biggest difference
to health outcomes, 35 areas of work were identified within four
strategic priorities directly linked to the mandate. From 2008-13,
WHO's work is clearly described through 13 Strategic Objectives
of the Medium Term Strategic Plan.
RESOURCE MANAGEMENT
What proportion of the budget is spent against
the period to which it was allocated?
The
latest financial report states that there was an average under-spend
of 3.6% across work areas; therefore 96.4% was spent.6
What percentage of total expenditure is spent
on administration?
x This is not clear from financial
report, but appears to be 18.2% calculated from figures in the
2004-05 Financial Performance report. Direct Costs are recovered
directly from the projects, Programme Support Costs are set at
13% and are recovered from extra budgetary projects and finally
Fixed Indirect Costs are financed from regular/core income.6
Is the agency committed to robust efficiency targets?
x WHO have not published any efficiency
targets but have identified areas where savings could be achieved
through implementation of the Global Management System beginning
2008 and through the natural decline of some programmes eg Polio.10
How well is WHO's resource allocation criteria
aligned with its corporate strategy and comparative advantage?
The
latest report shows a much tighter distribution of budget variance
illustrated by the small under-spend. More areas of work were
closer to their budget targets.4
STAFF MANAGEMENT
To what extent is staff recruitment, postings
and promotions meritocratic and transparent?
x WHO have started to implement contract
reform to provide an easier, transparent recruitment and postings
process. They have implemented a global competency framework which
has been integrated into major human resource functions.2
Is there an agreed human resources strategy in
support of WHO's strategic plan?
WHO
recognize that good planning of human resources based on actual
and projected needs is essential to effective programme implementation
at country level and have improved staff mobility and rotation
to address this issue.2 Inductions and ongoing training for WHO
staff in interpreting and delivering the HAC (Health Action in
Crisis) emergency mandate need to be enhanced and delivered at
the national level whenever possible and additional focus and
resources need to be identified to support these activities. Training
packages for staff at national level need to be further developed
and delivered to improve capacity to create quality proposals
to donors.11
OPERATIONAL MANAGEMENT
Is WHO sufficiently decentralised to enable it
to respond flexibly to country demand?
WHO
is already significantly decentralised with six regional and 147
country offices. Emergency response activities require standard
operating procedures to be finalised that are tailored to maximising
speed and efficiency of internal resource flow and minimise bureaucracy
and unnecessary delay. Training programmes in the understanding
of standard operating procedures should be further developed and
finalised and implemented as widely as possible at National, Regional
and HQ levels of WHO. A system for monitoring the implementation
of and compliance with standard operating procedures needs to
be put in place at all levels of the organisation.11
Does WHO's Management Information System provide
accurate, useful and timely information for programmatic decision-making?
WHO
have developed a draft information and communication technology
strategy. 85 locations have access to WHO intranet but the use
of IT across country offices is patchy.2 WHO plan to update their
MIS system to an Oracle based system in mid 2007, which will link
resources more closely to programme outcomes.
How clear and effective are WHO's financial management
procedures?
The
Programme, Budget and Administration Committee (PBAC) are responsible
for monitoring WHO's financial management procedures. They are
in the process of implementing new policies on a range of financial
management issues to clarify and improve procedures.14
HOW WELL
IS WHO MANAGING
ITS PARTNERSHIPS?
Summary
There is a perception that WHO is being stretched
in too many directions by the growing number of Global Health
Partnerships (GHPs). A positive development is a report on Partnerships
to be presented to the January 2008 executive board, which will
look at this whole area. With the introduction of a Health Systems
Cluster and greater clarity on strategies of GHPs we should encourage
WHO towards greater harmonisation. Although the Country Cooperation
Strategy (CCS) encourages dialogue beyond the Ministries of Health
there is sometimes a tendency to restrict partnerships, to health
ministries and exclude wider constituencies at country level.
This close relationship with health ministries can, on occasion
make WHO representatives reluctant to challenge government policy
on difficult issues. The MOPAN survey will review donor perceptions
of WHO in 2007. Country governments turn to WHO for assistance
in preparing proposals and monitoring reports and WHO cooperate
well in this. However lack of resources and lack of the right
people on the ground mean that they are not always able to respond
in a timely manner.
VOICE
What mechanisms exist for developing countries
to influence the strategy of WHO?
WHO
has global membership: developing countries are on the Executive
Board and they participate in the World Health Assembly.5
How actively is WHO promoting the participation
of civil society?
WHO
operate a Civil Society initiative which enables informal and
official relations with NGOs at the HQ level. There is no evidence
that WHO is unresponsive and it seeks to engage with civil society
where possible particularly at global level and within key partnerships
such as stop TB or Roll Back Malaria.1 NGOs in official relations
can attend governance body meetings and make statements although
they cannot participate in debates.5
PARTNERSHIP BEHAVIOUR
What mechanisms are in place to seek feedback
from partners and what do the results show?
No
global partners survey. Outside of World Health Assembly, not
known if any formal and regularised mechanisms exist and are active.
How willing is WHO to challenge and assist governments
on difficult/controversial issues?
WHO
engage with governments on difficult and controversial issues
that have a high profile at the regional and global level. Recent
examples include implementing travel restrictions during the SARS
outbreak and introduction of the new International Health Regulations.
There is less evidence of challenging at the country level.
ALIGNMENT
To what extent does this organisation foster government
ownership through the project/programme cycle?
The
WHO Country Cooperation Strategy represents a balance between
country priorities and WHO priorities. It is a vehicle for WHO
alignment with national health and development plans and strategies
such as PRSPs and SWAPs.4
What % aid flows to government sector is reported
on national partner budgets?
Information not available in the public domain.
What % of TC flows are provided through coordinated
programmes consistent with partners' national strategies?
Information not available in the public domain.
Does WHO use countries' own public financial management
and procurement systems?
x No. WHO has set up its own electronic
procurement system, operating on the basis of reducing costs by
bulk buying, etc.3
Is the number of Project Implementation Units
decreasing or non-existent?
Information not available in the public domain.
In what ways has WHO been aligning its strategy/programme/projects
with national strategies?
WHO
has a Country Cooperation Strategy framework which clearly identifies
consultation with all stakeholders as being essential to developing
country plans.4 90% of country offices use these to deliver WHO
core functions.
HARMONISATION
To what extent does WHO participate in local donor
coordination activities such as sector working groups/thematic
groups?
WHO
participates extensively in sector working and thematic groups
although the quality of participation can be personality dependant
and relies on the relative strengths of both the WHO representative
and the UN Resident Coordinator.1 WHO will build more effective
alliances within the UN and broader development community, to
harmonise the health architecture at country level, and engage
in reform process towards an effective country team under a common
UN lead.5
To what extent does WHO share information with
other donors?
WHO
publishes and disseminates information widely and readily answers
queries.5
What evidence is there of harmonising procurement
and consulting services procedures, disbursement policies and
evaluation practices?
No evidence available in public domain
WHAT DO
WE KNOW
ABOUT WHO'S
COUNTRY/GLOBAL
RESULTS?
Summary
As a global norms and standard selling agency,
WHO have played a key role in significant achievements in health
outcomes such as tobacco control, eradication of infectious diseases
(such as Smallpox), and preparations for global health security
issues such as Avian Flu, and SARS. WHO now has a stronger planning
and results focus at the country level, though it is difficult
to assess how effective WHO are at this level based on publicly
available information. WHO need to demonstrate their effectiveness
at the country level through greater transparency and reporting
of country level performance. WHO still work in vertical health
initiatives and until recently have not sufficiently contributed
to building countries' sustainable health systems. WHO need to
build on the leadership they are now demonstrating at the global
level on strengthening health systems, by leading and coordinating
at the country level with the World Bank, GFATM and other UN agencies.
As a norms and standard setting agency their role at the country
level should be more about providing strategic health policy advice
to governments, than project implementation.
COUNTRY/GLOBAL
RESULTS
What information is available on the WHO's performance
at country level?
No
country-level performance information in public domain. Regional
offices publish information on WHO performance based on results
based management.2 WHO aggregate initially at the regional level
and then again at the global level to provide aggregate performance
against global targets.
What evidence is there of the independence, credibility
and utility of WHO's own evaluations?
External
evaluators are part of the team which carried out pilot, country
evaluations to assess the development of country specific cooperation
strategies.12
What result is WHO having at country level?
WHO's
performance assessment is focused on thematic areas rather than
countries, for example, in their "making pregnancy safer"
area of work, 29 more countries received technical and policy
support for maternal and newborn health, 37 more countries received
support to adapt and introduce standards, guidelines and tools
recommended by WHO.2
What results is WHO having at the global level?
There
have been significant successes, for example: small pox has been
eradicated; polio has almost been fully eradicated; and the "three
by five Initiative" has helped 1.3 million HIV positive people
to access anti-retroviral medicines. WHO also helped to monitor
and contain a global epidemic of SARS and contributed significantly
to the eradication of Small pox.2
PORTFOLIO QUALITY
What is the % of projects/programmes which met
their targets?
No
aggregated assessment of portfolio performance in public domain.
Performance Assessment Report outlines progress on myriad of individual
targets.2
How does this vary across sectors, regions and
countries?
Because
there is no aggregated assessment of portfolio performance it
is difficult to make comparisons across sectors, regions and countries.
This is a presentational issue rather than data not being available.
REFERENCES
1 DFID's 2004 Multilateral Effectiveness Framework
(MEFF) report
2 Programme budget 2004-05 Performance Assessment
Report
3 Programme budget 2006-07
4 11th General Programme of Work
5 WHO website.
6 Financial Performance 2004-05.
7 Human Resources Annual Report.
8 Ownership, Alignment, Harmonisation and Results—Building
partnerships with WHO donors towards an improved and simplified
management of voluntary contributions.
9 "WHO and UN reform"—consultation
document.
10 Medium Term Strategy Plan (MTSP).
11 Health Action in Crisis: mid term evaluation
of the three year programme to improve the performance of WHO
in crises.
12 Report of Office of Internal Oversight EBPBACI_3.
13 WHO Knowledge management strategy.
14 Financial Report 1 January 2004 to 31 December
2005.
15 WHO Country offices and country focus report
21 April 2005.
BACKGROUND
This fact sheet is designed to summarise information
available on the effectiveness of WHO. It collates the latest
published information in four key areas from a variety of sources
including the Multilateral Effectiveness Framework (MEFF)1 as
well as a range of WHO's own Annual Reporting2-10 and assesses
areas of strength () and weaknesses
(x) and where progress is mixed ().
* DISCLAIMER
The Effectiveness Summary is a tool designed
to simply present the latest available information on WHO's effectiveness.
It is prepared by DFID covering a range of multilaterals. The
summaries will inform policy but are only one of a range of criteria
and sources of evidence considered in recommending future DFID
funding allocations. The balanced scorecard format organises what
we believe to be the objective sources of information available
on four aspectsof each organisation's internal effectiveness.
It does not measure actual development results on the ground or
the merits of the organisation's development objectives. The text
within each summary box provides a short analysis of what we believe
this information tells us. Any unreferenced text if DFID analysis
not in the public domain. It should be noted that the amount of
information available and the quality and reliability of information
varies considerably across organisations, so there is a limit
to which the summaries will be used for comparative purposes.
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