Draft proposed programme

budget 2016–2017:

the European regional

perspective

Imre Hollo

Director, Division of Administration and Finance

Main topics

• Overall context of planning for programme

budget (PB) 2016–2017

• Process and outcomes of bottom-up

planning

• Overall observations

Planning and budgeting in the context

of WHO reform

• Integral part of global budget: results chain and category framework

from Twelfth General Programme of Work

• Country-level focus: bottom-up planning, country consultation and

prioritization

• Iterative process: Regional Office budget within the allocated envelope

Planning and budgeting in the context

of WHO reform

• Regional public goods: developed through bottom-up planning from the technical division level, responding to agreed mandates (plans/strategies and statutory obligations, frequently in the form of resolutions from governing bodies) and emerging concerns

• Reliance on global technical networks: category networks, programme area networks – matrix approach across 3 levels

• Same “box” (2014–2015 figures = 2016–2017), but different content and process

Health 2020 implementation

• European health policy framework adopted September 2012 at 62nd session of the Regional Committee (RC62) with focus on improving health for all and reducing health inequalities; and improving leadership and participatory governance for health

• Key instruments are biennial collaborative agreements (BCAs) and country cooperation strategies (CCSs)

• The Regional Office will support national health plans, policies and strategies aligned with Health 2020

• Road maps exist for the next steps in strategic implementation of Health 2020 in each country

Lessons learnt from 2012–2013 implementation

• Pockets of poverty persisted in 2012–2013, with uneven funding across

strategic objectives/Office-wide expected results (OWERs) (lack of funding

cited as the greatest impediment to successful implementation) – addressed

in PB 2014–2015 through the financing dialogue and “fully funded budget”

• The pilot experience with key priority outcomes/other priority outcomes

was well received, helped the Secretariat target its efforts and has been

adapted in the global results chain of the Twelfth General Programme of

Work and PB 2014–2015

• Regional Office continues to depend heavily on locally raised, voluntarily

contributed funds – for 2014–2015, the financing dialogue and resource

mobilization policy help ensure this is done in a coordinated fashion

• National capacity was cited in some countries as an impediment to

realizing objectives – thus this continues to be a priority for PB 2014–2015

and 2016–2017

• Top-down planning sometimes resulted in mismatches between resources

and priorities at country level – this has been rectified through the

bottom-up approach

Lessons learnt from 2012–2013 implementation

Development of PB 2016–2017 to date

April–May 2014• Identification of priorities at country level• Identification of regional and global priority work• Costing of outputs for all priorities

May 2014Regional consolidation and review of priority outcomes with related outputs and costing

June 2014

Global consolidation and review of priorities by category, programme area network and global public good

July 2014

Development of the draft global PB 2016–2017

July–August 2014Development of the regional perspective on PB 2016–2017

September 2014RC64 reviews draft global PB 2016–2017, drafts regional perspective

Global level Regional level

Frequency of programme areas cited as priorities

0 5 10 15 20 25 30

2.12.24.24.14.43.51.12.33.11.24.35.23.45.11.55.32.55.53.25.43.32.41.35.61.4

Number of countries

Pro

gram

me

cate

gory

/are

a

• Country consultations: 10 priority programme areas/health outcomes identified

• Highest demand (= count of countries that chose specific priorities) for categories 2 and 4

• In line with Health 2020

• Does not reflect cost in US$

• Costing of outputs done by heads of WHO country offices in collaboration with regional technical staff

Reconciling bottom-up approach to planning

with 0% growth• Iterative process: bottom-up planning resulted in an overall Regional Office budget

that was 18% higher than 2014–2015 level; this was subsequently reduced to

arrive at 0% growth in keeping with global agreement

• 0% reached through: (a) removal of specific, large-scale implementation projects

or initiatives still uncertain or under negotiation and (b) across-the-board

proportional reduction to respect bottom-up priorities

• Comparative advantages of WHO considered in implementing programmes

compared to other health actors

• Strategic decision: 40% of Regional Office budget allocated to country level

Proposed PB 2016–2017 compared to

allocated PB 2014–2015

• PB 2016–2017 = PB 2014–2015, but

its components and development

process fundamentally different

• Shifts among categories and

programme areas

• Well in line with outcomes of

bottom-up planning: emphasis on

category 2 ( budget) and category 4

(largest budget share among

technical categories despite )

0

20

40

60

Cat 1 Cat 2 Cat 3 Cat 4 Cat 5 excl.Emerg

Cat 6

Bu

dge

t, U

S$ m

illio

n

2014-2015 allocated budget 2016-2017 proposed budget

-3%

-5%-12%

+9%

+8%

+5%

1 2 3 4 5 excluding 6Category emergency

Proposed PB 2016–2017: shifts explained

• Category 1: slight decrease to allow for emphasis on other categories

• Category 2: increase in accordance with importance of noncommunicable diseases (Health 2020 link) and demand from Member States

• Category 3: small decrease, although still second largest technical category, dealt within Health 2020

• Category 4: decrease due to some large country-specific projects removed; still largest technical category

• Category 5: modest increase for the smallest technical category for International Health Regulations (2005), geographically dispersed offices

• Category 6: modest increase to enhance country presence

0

20

40

60

Cat 1 Cat 2 Cat 3 Cat 4 Cat 5excl.

Emerg

Cat 6

Bu

dge

t, U

S$ m

illio

n

-3%

-5%-12%

+9%

+8%

+5%

1 2 3 4 5 6excluding

Category emergency

Historic programme budgets, income and

expenditures in Regional Office• 2012–2013: good alignment between

PB, funds and expenditure

• 2014–2015: if projections are

realized, funding is OK overall, but

pockets of poverty and budget-space

issues in some programme areas

• 2016–2017: still very early to assess

but the proposed PB seems realistic

0

50

100

150

200

250

2012-2013 2014-2015 2016-2017

Approved / proposed programme budget

Funds available (+ projected)

Expenditure (for 2014-2015 to date)

Pro

ject

ed

Pro

ject

ed +

to

be

mo

bili

zed

Next steps in the development of PB 2016–2017

September 2014

RC64 reviews draft global PB 2016–2017, drafts regional perspective

January 2015

Executive Board reviews revised PB 2016–2017 incorporating input from all regional committees

October–December 2014

Region contributes to revision of the global PB 2016–2017 based on feedback from regional committees

July–September 2015

Regional implementation plan for PB 2016–2017 (the new “contract”) prepared and presented to RC65

Global level Regional level

May 2015

World Health Assembly considers draft PB 2016–2017

Overall observations

• Although overall Regional Office budget is equal to 2014–2015, composition is different – based on solid foundation of bottom-up planning/costing

• Proposed ceiling of US$ 228 million presents some challenges for the Regional Office, but with some flexibility could be accommodated

• Proposed budget is based on the priority demands of countries, not funding driven, and relies on the “fully funded budget” concept and financing dialogue

• There is time to further refine/adjust budgets and priorities for the Region based on input from the Regional Committee

Annex: category highlights

Category 1

• Prevent, diagnose and treat HIV infection in at-risk populations. Promote equal access to antiretroviral therapy, prevent mother-to-child transmission of HIV and provide measures to better manage co-infections, such as tuberculosis (TB) and hepatitis.

• Achieve universal access to diagnosis and treatment for multidrug- and extensively drug-resistant TB (M/XDR-TB) , strengthen mechanisms for cross-border TB control and care, and improve the drug supply. Support Member States to further reduce TB mortality, increase early detection and improve treatment success rates.

• Eliminate malaria, providing certification and preventing reintroduction.

• Assist Member States in updating and modifying policies and strategies on vaccine-preventable diseases and immunization. Advocate for broadening the stakeholder base supporting immunization.

Category 2• Develop and strengthen multisectoral plans on NCDs. Implement the European action plan to

reduce the harmful use of alcohol 2012–2020, the European Food and Nutrition Action Plan 2015–2020 and the forthcoming European strategy for physical activity and health. Provide technical support to countries for full implementation of the WHO Framework Convention on Tobacco Control in strong cross-sectoral partnerships. Strengthen the capacity to control NCDs at primary care level.

• Implement the European Mental Health Action Plan.

• Build health systems capacity, improve surveillance, and develop evidence-informed policy and programmes in the areas of road safety, child injury prevention and interpersonal violence prevention, in particular child maltreatment prevention.

• Provide policy briefs and technical advice to achieve targets in childhood obesity, breastfeeding and maternal nutrition.

Category 3• Support Member States in using Investing in children: the European child and adolescent

health strategy 2015–2020 to draft and/or revise national policies.

• Design or review national ageing strategies, policies and action plans, based on the strategy and action plan for healthy ageing in Europe, 2012–2020.

• Apply the gender, equity and rights component of the Health 2020 implementation package in health policies, in Health 2020 roadmaps and throughout the work of the Regional Office.

• Improve implementation and monitoring of common actions on social determinants of health and equity.

• Conduct assessments, devise tools and strengthen capacity to monitor and address air pollution, climate change, water and sanitation, chemical safety, noise pollution, housing, health in transportation, population exposure in contaminated areas and environment and health in emergencies.

Category 4• Implement intersectoral national health policies, strategies and plans, which are aligned with

Health 2020.

• Develop a regional framework for action towards coordinated, integrated health services delivery to operationalize the WHO Global Strategy on People-centred and Integrated Health Services, revitalize the primary health care approach to extend interventions for universal health coverage and address challenges in the provision of health services that impede better outcomes of NCDs and M/XDR-TB.

• Advocate, network and give technical guidance to improve access to essential, high-quality medicines moving towards universal health care.

• Enhance and harmonize the systematic collation, analysis and dissemination of evidence for use in policy-making in the context of Health 2020, by fully integrating health information systems.

• Extend the regional knowledge translation network – the Evidence-informed Policy Network –resulting in integrated mechanisms at national level.

Category 5• Strengthen laboratory capacities and enhance outbreak response capacities. Support Member

States in preventing and controlling influenza.

• Develop national preparedness plans and strengthen their emergency- and risk management capacities.

• Fully implement the European strategic action plan on antibiotic resistance 2011–2016 and the new global action plan on antimicrobial resistance.

• Promote the work of the Codex Alimentarius Commission and collaboration between the agriculture, animal health and human health sectors.

• Ensure that the objectives of the global Polio Eradication and Endgame Strategic Plan 2013–2018 are met.

• Help Member States to respond in an effective, timely manner to acute and protracted emergencies with public health consequences.

Category 6• Implement WHO reform through respective regional policies, processes and

initiatives. Strengthen country offices in non-European-Union countries by appointing new WHO representatives.

• Foster partnerships at regional and country levels.

• Support Member States in preparing for effective participation and engagement in the work of the WHO governing bodies at regional and global levels.

• Enhance multilingualism at the Regional Office.

• Implement the global internal control framework, increase compliance measures and improve audit response. The Regional Office foresees full application of a comprehensive risk management framework.