I am pleased to welcome you to this RPM, the second since I assumed office as Regional Director.
I would like to extend a special welcome to the recently appointed WRs – Dr Olusegun Olu - Rwanda, Dr Deo Nshimirimana – Senegal and Dr Mohamed Belhocine - Guinea.
I am confident our new WRs will make a difference in the health development of the new countries of assignment and ensure WHOs leadership. I would kindly request all of you to provide them with the necessary support.
During the last RPM held in April this year, I presented to you my Strategic Priorities and launched the Transformation Agenda (TA).
As part of the Transformation Agenda, we committed ourselves to being Change Agents. I would like to thank all of you for consulting your staff and providing important inputs into the TA document. I am aware that several of you have started implementing various aspects of the TA. I look forward to hearing from you about the concrete achievements that you have made so far in your offices.
On my part, I have issued a report of the first 100 days of our work –“Leading Change for Enhanced Performance”. This report was published on the AFRO website on 1st October. I hope you have all had time to read the report and have shared the contents with your staff and health partners. We are sending printed copies to your offices for dissemination. I am informed that you will receive them before the Regional Committee.
At the end of the last RPM, we came up with 23 recommendations. From the feedback I am getting, only 33/47 country offices have reported back on the status of implementation of these recommendations.
There is need for all of us to develop a culture of regularly monitoring the implementation of all agreed actions from such meetings and providing feedback when requested. We may have to adopt a policy of “name and shame” as a way of improving compliance, if necessary.
A lot has happened since the last RPM. I will just highlight some of the key developments:
a) Polio
Let me start with an historic achievement that we have made in the Region. On 25 September 2015, the Director-General announced the removal of Nigeria, the then only remaining endemic country in the African Region, from the list of polio endemic countries.
The announcement was made after I had updated the Polio Oversight Board (POB) Meeting in New York, USA, on the current status and challenges of the polio eradication programme in the African Region. The POB comprises Heads of Agencies of the Global Polio Eradication Initiative partners.
The POB congratulated Nigeria and the African Region on the historical milestone in polio eradication and global health. The Board advised the African Region to do more to sustain the hard-earned gains and to ensure that the Region is certified polio-free by 2017.
Among the priorities we should be addressing in this regard are intensified surveillance, improved routine immunization to rapidly raise population immunity, the switch to inactivated polio vaccine, and timely response to any poliovirus outbreaks.
On the 26th of October, I was received in audience by His Excellency the President of Nigeria to formally inform him that Nigeria has been removed from the list of polio-endemic countries. I handed over to the President a letter from the Director General on this pronouncement. On his part, the President assured us that his Government will continue to be vigilant, enhance efforts to sustain the gains, and contribute the needed funding for polio operations and vaccine procurement for the programme
May I take this opportunity to congratulate all those who have worked over the years to achieve this major milestone, including previous WRs and EPI Team Leaders. This historic milestone came under the watch of Rui Vaz.
Let us all give Rui and his Team, and all others, past and present, who have contributed to this achievement, a rousing round of applause. We salute them for their dedication, commitment and hard work.
I must however add that we cannot at this stage rest on our laurels. The entire region needs to ensure that no case of wild poliovirus occurs by intensifying AFP surveillance and ensuring the highest level of polio vaccination coverage for the next 2 years.
The importance of polio legacy planning and transitioning at this stage cannot be over-emphasized. We need to ensure that the GPEI human resources and assets are properly used to strengthen health systems and to benefit other public health interventions, now and in the future. We will be talking about this on Day 2 of our meeting.
b) Ebola and Global Health Security
Significant progress has been made in getting to zero Ebola cases and to improve health security the region.
Liberia was declared Ebola-free on 3 September. Sierra Leone has not reported any new case for the past 6 weeks and is well on its way to being declared Ebola Free tomorrow Saturday 7 November, if no case is reported between today and tomorrow.
Sporadic cases of Ebola are still being detected in Guinea, although the overall situation has improved with cases being confined to limited locations. This is justification for the HQ Ebola Operations to continue till January 2016.
I am confident that with the efforts that all of us are making we will attain Zero Ebola cases sooner rather than later.
We will be discussing Global Health Security after lunch. There is ongoing work on reform of WHO’s Work on Outbreaks and Emergencies. The key elements in the roadmap for the reform are:
A unified WHO platform for outbreaks and emergencies with health and humanitarian consequences.
A global health emergency workforce.
Priority IHR core capacities developed as an integral part of resilient health systems.
Improved functioning, transparency, effectiveness and efficiency of the International Health Regulations (2005).
A Framework for research and development (R&D) preparedness and for enabling R&D during epidemics or health emergencies.
An international system for financing the response to pandemics and other health emergencies, including the WHO Contingency Fund for Emergencies
The reform will have major implications for our work in this area, especially at country level.
c) SDGs
As you know, the Sustainable Development Goals (SDGs) were adopted last September at the 70th United Nations General Assembly. I hope you have all familiarized yourselves with the SDGs document – Transforming our world: the 2030 Agenda for Sustainable Development.
Building on the Millennium Development Goals (MDGs), the 17 SDGs cover a broad range of economic, social and environmental objectives, as well as the promise of more peaceful and inclusive societies and countries. Health is covered under SDG-3: “Ensure healthy lives and promote well-being for all at all age”.
While health is portrayed as a desirable outcome in its own right, it is important to note that it is also presented as an input to other goals, and a reliable measure of how well sustainable development is progressing in general.
The SDG agenda will of course have implications on the focus of our work.
- For example, Universal health Coverage and Health Systems Strengthening will drive the work, with more focus on integration and measurement of results.
- We will need to support countries to scale-up interventions addressing the unfinished agenda of the MDGs
- We will have to support countries in their multi-sectoral work to address the social determinants of health
We will have the opportunity to further discuss, during this meeting and the meeting of Heads of WHO Country Offices, the work we, as WHO, need to do as we collaborate with our Member States and partners to meet the SDG targets.
d) Impending closure of APOC and the establishment of ESPEN
As you may be aware, the African Programme for Onchocerciasis Control (APOC) is expected to close in December 2015, as was planned and in accordance with the confirmation by its governing body, the Joint Action Forum during its twentieth session held in Addis Ababa in December 2014.
APOC, established in 1995 in response to the devastating impact of river blindness in the African region, has been one of the most successful public private partnerships involving countries, pharmaceutical companies, non-governmental development organizations and donors.
The Programme initiated and established river blindness control activities in 20 countries and successfully treated about 106 million people. River blindness is now close to elimination in selected areas in Burundi, Chad, Malawi, Mali, Niger, and Senegal.
I wish to commend the contributions made by past and present APOC staff, countries, donors, non-government development organizations and communities in the long fight against river blindness. Without these contributions, this progress would not have been made.
After 3 years of very challenging and sometimes difficult discussions and negotiations with partners, we are in the final stages of establishing a new NTD entity. The new NTD entity is called the Expanded Special Project for Elimination of NTDs (ESPEN). The new entity will be hosted at the Regional Office under the CDS Cluster and become operational in January 2016.
ESPEN will focus on providing technical support to endemic countries in their efforts to control and eliminate Preventive Chemotherapy Neglected Tropical Diseases (PC-NTDs). The 5 PC-NTDS are Lymphatic Filariasis, Onchocerciasis, Schistosomiasis, Soil-Transmitted Helminthiasis and Trachoma within the framework of the Regional Strategic Plan for NTDs; 2014-2020.
The establishment of ESPEN will have implications for WHO’s work on PC-NTDs. ESPEN is going to be lean and we are expecting that national programmes, working with NGDO partners, will assume more responsibility for building capacity for implementation. There will thus be more involvement of WHO Country Offices in organizing technical support and in monitoring. There is also the need to sustain focus on integration into NCD plans. This will be challenging though.
e) Meetings with Key Partners and Official Country Visits
Since the last RPM, I have undertaken official visits to Zambia and Nigeria. These visits have focused on advocating with national governments on the need for greater investment in their health systems. I would like to thank the WRs for facilitating these official visits.
I have also visited key partners such as the BMGF, the United Kingdom Department for International Development, the US CDC to enhance our collaboration. I participated in the DG’s meeting with the US Government. The key messages from these visits are as follows:
- Partners are ready to expand partnerships with WHO and some are keen to work directly with AFRO within the framework of a global WHO partnership
- Partners welcome our focus on results and are keen to see change
- Partners see WCO work as one of the most important WHO roles
We thus need to move speedily on the Transformation Agenda so that WHO in our region retains its leadership in health. I have asked the cluster directors to follow up on all agreed actions. We will need to inform WRs about these.
I also participated in the Ministerial meeting of SIDS countries in Mauritius at which the need for WHO to increase support in the areas of NCD, Climate Change and health financing was highlighted by these countries.
Since August, we have been working on two main areas to enhance our performance, as part of the Transformation Agenda.
The first area is how we conduct our operations in 4 areas. These are human resources, finance, procurement and buildings and assets management. The purpose of this is to propose new and efficient methods to facilitate our work and enhance our performance.
The second area is to assess our human resources and organizational structure, beginning with the Regional Office and moving to the Inter-Country Support Teams.
With regards to the first area, we have engaged an external consultancy firm – Dalberg Global Development Advisors – following a competitive bidding process, to assist us in this exercise. You are all aware of the process as I have been sending you regular email updates on this.
I am aware that many of you participated in the various workshops and meetings organized by the Dalberg Consultants in order to enable them to carry out a dependable assessment and analysis of our working methods.
I would like to thank all of you who found the time to share your views and expertise with the Dalberg Consultants. The analysis work has now been completed. Dalberg and the GMC cluster are working to formulate the recommendations to be made and to define an implementation plan. My decision will be shared with you in due course, but not at this meeting.
As I said earlier, the second area is to assess our human resources and organizational structure, beginning with the Regional Office and moving to the Inter-Country Support Teams.
Our goal is to build a flexible and dynamic Organization that is capable of proposing solutions to the most urgent health issues besetting Africa, and one in which staff can attain their potential through a culture of competence, cooperation, team work and shared responsibility in the achievement of results.
You will recall that when I announced the current organogram in March this year, I did indicate that the components of the technical Clusters would be decided through a consultative process involving extensive analysis and discussion.
We were assisted by HR consultants, some of whom were retired WHO staff members, the Dalberg team and a former WHO DPM.
Some of the key findings of the analyses were:
- Duplication of roles, and inconsistent levels of administrative support in each cluster
- Over-concentration of staff in Brazzaville, with over 2/3 of all technical AFRO staff in Brazzaville
- A top-heavy organization, with the proportion of senior managers too high in most clusters – ill-defined hierarchy (P5s and P6s); and
- Inconsistencies between cluster HR plans, with staff levels poorly correlated to workload and priorities
- Some cross-cutting functions, such as such as data management, monitoring and evaluation, and communications, offering opportunities for sharing resources and common approaches for synergy.
To address these gaps, a series of models were modelled:
- The first model mapped the burden of disease and health system strength across the region, to better match the technical work and IST team composition with health priorities at the country level.
- The second model estimated workload within each technical cluster, based on the technical cluster director’s priorities.
Standardized recommendations for the structure and function of roles within each technical cluster have been made and new organograms for each technical cluster have been developed. These new organograms will help us ensure that we are providing smarter technical support.
This work is now completed and the final proposals for the Technical Clusters are as follows:
- The Communicable Diseases (CDS) Cluster will comprise 5 programmes – the HIV, Tuberculosis and Hepatitis Programme (HTH); the Malaria Programme (MAL); the Neglected Tropical Diseases Programme (NTD); the Expanded Special Programme for Elimination of NTDS (ESPEN); and the Public Health and Environment Programme (PHE).
- The Family and Reproductive Health (FRH) Cluster will comprise 3 programmes – the Child and Adolescent Health and Nutrition Programme (CAN); the Reproductive and Women’s Health Programme (RWH); and the Immunization and Vaccine Development Programme (IVD).
- The Health Security and Emergencies (HSE) Cluster will comprise 3 programmes – the Strategic Information and Management Programme; the International Health Regulations and Integrated Disease Surveillance Programme; and the Epidemics and Emergencies Preparedness and Response Programme.
- The Health Systems and Services (HSS) Cluster will comprise 4 programmes – the Health Policies, Strategies and Governance Programme (HSG); the Health Information and Knowledge Management Programme (HIK); the Service Delivery Systems Programme (SDS); and the Health Technologies and Innovations Programme (HTI).
- And finally the Non-Communicable Diseases (NCD) Cluster will comprise 3 programmes – the NCD Primary Prevention Programme (NPP); the NCD Integrated Management Programme (NIM); and the Mental Health and Substance Abuse Programme (MSA). Further work is being done on the NCD Cluster.
The Cluster Directors are here in this meeting and will respond to questions related to their Clusters.
I would also like to add that the Compliance Team has been restructured and has adopted a new and more integrated way of working to enable prevention as well as alignment with IOS, facilitating the imposition of sanctions where necessary.
Work on RDO and DPM Groups and GMC is in progress.
Following the reorganization of the programmes within the technical Clusters, we are in the final stages of completing our Human Resource Plans for the Technical Clusters. All Post Descriptions are being reviewed and classified by external HR experts. This review will also determine the degree to which the functions have changed. Appropriate HR actions will be taken after that, according to WHO rules.
We expect this process to be completed by the end of the 1st Quarter of 2016.
We are almost at the end of planning process for PB16-17. I am informed that all the 47 Salary Workplans for WHO Country Offices have been created in GSM. The HR Plans have been prepared in GSM based on the positions submitted by WRs. In the same vein, the 8 Salary Workplans for the Regional Office have been created. The HR plans are currently being prepared in GSM.
All the activity workplans for all the 55 Budget Centres, including ISTs, have been created in GSM, although some of these are yet to be completed. In addition, 6 Non-PB workplans have been developed for the management of In-Kind/Services, Terminal and Statutory Payments and Real-Estate Fund. The workplans will be submitted to RD for final approval.
We have had some challenges in the preparation of these workplans. I am informed that in several instances, the guidance materials for preparing the work-plans were not followed and timelines were not respected. It also appeared that WRs and Cluster Directors did not fully lead the process in some cases. Some WCOs even went into the planning workshops with no offline workplans at all. It also appeared that Programme Managers in the Region Office did not adequately guide the preparation of country plans. We will have the opportunity to discuss some of these issues during this meeting.
Dear colleagues, as you know we, WHO, are hosting the 3rd Financing Dialogue which began yesterday 5th November.
The objectives of the Financing Dialogue are:
- To review progress towards full funding of PB 2016-2017 and improved implementation of the guiding principles of the Financing Dialogue
- To highlight WHO’s role in contributing to the SDGs and examine progress made on key priority areas such as the emergency reform and coordination of resource mobilisation efforts.
The first day focused on the PB 2016- 2017, financing, resource mobilisation and the web portal. The principle here is to promote predictability, alignment, transparency and sustainability.
Some of the key points made were:
- While 75% of the base program in the PB 16-17 has been funded alignment is still an issue. We are still overly dependent on VC and this contributes to misalignment. Several member states supported increase of AC as a solution to resolving this.
- More than 50% of funding for WHO comes from 20 donors; there is the need to move away from this by widening the donor base, including engaging more with non-traditional donors and Non-State actors
- Member States need to be held more accountable to their people while the WHO Secretariat to the Member States. There is the need to have a strong link between performance indicators and performance management and Member States need to be more willing to finance Category 6.
- With regards to the SDGs, Member States suggested that WHO should take an inter-sectoral approach and go beyond the Health Sector. WHO should play its convening role by bringing partners together and coordinating them.
- There is the need for WHO to be better funded to enable it support MS to meet the SDG targets.
- There is the need to make a stronger case for funding for health with Ministers of Finance and increase domestic investments in health
This RPM gives us the opportunity to take stock of the progress made since the last meeting as well as the implementation of the AFRO Transformation Agenda and going forward in the new biennium.
During this meeting we will also address the following key areas:
- Implementation of the Transformation agenda including the accountability framework and the result based management framework
- Agree on a new format for the Quarterly country reports
- Regional expectations from the discussions of the 8th Global HWCO meeting and common understanding of AFRO region’s position on key issues to be discussed at this meeting.
As you know, the 8th Global Meeting of HWOs with the DG and RDs will provide an opportunity for in-depth policy dialogue on issues that will shape the organizations future such as: health implications of the SDGs, improving WHO’s response to emergencies and outbreaks, and organizational accountability.
In addition to these three thematic sessions, a number of departments at HQ are organizing lunchtime seminars. I am urging you to actively participate in these seminars
As a region we would like to see a coordinated contribution to these discussions and for this reason we have set time during this RPM to discuss the 8th Global meeting of HWOs.
Of course you all know that RC 65 will be held in N’Djamena, Chad from 23 to 27 November. I thank you all for facilitating the consultations on the venue and dates of the RC with your countries of assignment.
I am informed that all the preparations are on-course. Our main challenge now is getting the names of members of country delegations.
I am requesting all WRs whose countries of assignment have not yet submitted their lists to follow-up with their Ministers, even while you are here in Geneva, and to ensure that we receive the names as soon as possible.
As I come to the end of my remarks I would like to thank all the WRs, cluster directors and IST Coordinators and their Teams for the continued support and commitment you are showing to promote the image of WHO in our region and enhance our performance, especially at country level
I would like to acknowledge the work of Dr Babacar Drame, WR/Burundi, who is retiring end of this year. Dr. Drame, I hope we can continue to interact with you even as you take a well-deserved rest. I also say a big thank you to Drs. Gamatie and Gaye who have retired since we last met.
I would now like to declare open the 51st Regional Programme Meeting. I urge all of you to fully participate in the deliberations and come out with concrete recommendations for the benefit of our Region.
Thank you