Day 3 highlights: Resolution on accelerating primary health care adopted

WHO’s strengthened collaboration with the European Commission, the invaluable work of WHO country offices, and a resolution on 10 evidence-based policy accelerators for strengthening primary health care were in focus on Day 3 of the 69th session of the WHO Regional Committee for Europe (RC69).

Keynote speech by Ms Anne Bucher, European Commission

Ms Bucher, Director-General of the European Commission’s Directorate-General for Health and Food Safety, opened her speech on the third day of RC69 by praising the strong collaboration of the organizations over the past 10 years. She listed 5 strategic areas in particular: crisis preparedness, antimicrobial resistance, cancer, inequalities and pricing.

Stating, “We can never be prepared enough,” Ms Bucher mentioned improvements to the European Union (EU) early alert system, and coordination between WHO/Europe, Member States and the EU Health Security Committee. Member States have cooperated on pandemic influenza vaccination procurement, and 14 Member States have signed an agreement for coordinated action on influenza vaccination.

Ms Bucher noted that the European Commission will continue to collaborate with WHO to support national planning on cancer, building on the great progress made in national screening plans.

She then welcomed WHO/Europe’s work on inequalities and health, acknowledged the success of the migration and health programme, and outlined the importance of WHO–EU collaboration on fair pricing, affordability and access to medicines. Ms Bucher concluded by expressing her excitement for future developments: “We know that progress is impossible without change, and we look forward to continued partnership.”

WHO transformation and its implications for the WHO European Region

Dr Zsuzsanna Jakab, WHO Regional Director for Europe, presented the status of the transformation, which seeks to break down silos, remodel the structure of the Organization and align it with the 3 strategic priorities of WHO’s 13th General Programme of Work (GPW 13). She underlined the bottom-up approach taken by WHO/Europe, stating, “Several of the organizational and operating models tested in this Region are now contributing to the transformation process at the global level, and are considered by other regions as examples of good practice.”

Dr Jakab announced that Dr Bente Mikkelsen, Director of the Division of Noncommunicable Diseases and Promoting Health through the Life-course at WHO/Europe, leads the regional transformation process.

Reflections from Member States highlighted:

  • the need for more information about the challenges encountered during the transformation process so far;
  • the desire for a better understanding of how the centralization of normative work will impact work at the country level;
  • the fact that Member States have an important role to play in the reform process;
  • the need to tie the process to health system needs and to ensure increased transparency;
  • the importance of involving and consulting staff throughout the process;
  • the need for clear timeframes, clear goals and progress measurement; and
  • the need to recognize the role of youth.

In her response, Dr Jakab reminded the Regional Committee that the transformation process package was only announced in March, and that it could be a long process.

Putting countries at the centre in the WHO European Region

This agenda item began with a short film focused on WHO/Europe’s advances in country-focused work through training and capacity-building, sharing best practices, building networks and investing in staff. The film places these advances within the wider context of the European health policy framework Health 2020, the 2030 Agenda for Sustainable Development and the GPW 13.

Dr Lucianne Licari, Director of Country Support and Communications at WHO/Europe, explained that since the beginning of Dr Jakab’s mandate, working with, in and for Member States has been a priority. She noted that key determinants have included investing in staff, including WHO representatives; building networks of national counterparts; and facilitating visits to country offices so that members of WHO’s governance bodies see first-hand how WHO operates at the country level.

Panellists including members of the Standing Committee of the Regional Committee, a United Nations resident coordinator, a WHO representative and national focal points then shared the following thoughts, experiences and findings.

  • Country offices must understand and adjust to local circumstances to navigate the system, but also have a role in guiding other health partners through this system.
  • WHO representatives require multiple skills: they must be technically competent in public health, strong managers, articulate communicators and skilled economists.
  • Thanks to United Nations reform, United Nations teams are collaborating more and more by sharing information, working in tandem and deploying capacity together to support national counterparts.
  • Continuous investment in staff through trainings and regular information-sharing across the different levels of WHO is vital.
  • Networks of national counterparts offer opportunities to collaborate more closely with WHO, but also with other countries.
  • When working together, there is no substitute for face-to-face interaction where “smile meets smile”.
  • There is great diversity among countries and country offices in terms of contexts, needs, capacities and ways of working.
  • Visits to country offices have illustrated how flexible, innovative, highly motivated and professional their staff are.
  • The concept of multicountry duty stations has been tested for emergencies, and facilitates working across several countries using fewer resources.

Representatives of several Member States then took the floor to acknowledge the essential contribution of WHO country offices.

Report on the work of the geographically dispersed offices (GDOs) in the WHO European Region

Dr Jakab thanked the host countries of the 5 current GDOs for their contributions while emphasizing the crucial role and added value of these offices. GDOs function as technical centres of excellence in terms of products as well as human and financial resources. She also noted that other regions are emulating the European Region’s model of GDOs.

The 5 heads of the GDOs highlighted concrete examples of the work done by their respective offices. Dr Jakab explained that a new GDO in Turkey is in the final stages of being established, but no further GDOs will be established without further consultation with the Regional Committee.

Accelerating primary health care in the WHO European Region

The resolution on 10 evidence-based policy accelerators for strengthening primary health care in the Region was adopted by Member States and welcomed by civil society bodies, professional associations and international organizations. These policy accelerators, based on the best available research and practice, are high-impact entry points for rapidly advancing progress in primary health care.

Several Member States spoke about national efforts and challenges in building quality primary health care systems, and stressed that primary health care is a cornerstone of sustainable development, universal health coverage, equity, and strong and efficient health systems.

The session included the screening of a short film featuring Ms Nagima Plokhikh, who, having survived cancer, went on to establish the Centre of Palliative Care for Children in the Almaty region, Kazakhstan. The multiprofile team at the Centre has helped more than 350 children with oncological diseases.

Implementation of the programme budget 2018–2019 and planning for 2020–2021 (from Tuesday)

Dr Sussan Bassiri, Director of Administration and Finance at WHO/Europe, presented the progress report on the implementation of the programme budget (PB) 2018–2019 and European perspectives on the PB 2020–2021.

The implementation of the PB 2018–2019 was on track as of the end of June 2019 with the World Health Assembly-approved budget funded at 89%, but below the global average of 97%. If projected voluntary contributions materialize, the funding level would increase to 96%. To date, the utilization of available funding is strong at 75%. The European Region raises 73% of its voluntary contributions – the highest across regional offices. WHO/Europe sees strong support from regional donors.

Moving to PB 2020–2021, of the US$ 368.4 million increase in the global budget, the Region received the smallest budget increase at US$ 21.5 million; this brings the regional budget for 2020–2021 to US$ 277.9 million, or 7.4% of the global budget for the base segment. Operational planning is the next major step in the budget process, including the finalization of regional public health goods.

In response to the presentations, Member States welcomed the continued consultation on the PBs. They recognized the good overall financing level for PB 2018–2019. However, they expressed concerns about future shortfalls given the reliance on a relatively small number of donors. They noted that the Region raises most of its own voluntary funding, and that global voluntary fund flows still seem to favour WHO headquarters.

Member States stressed the importance of continued efforts in the area of resource mobilization, and that WHO/Europe needs to be well aligned with the new resource mobilization strategy of headquarters.

Dr Jakab informed the Regional Committee that the Region’s budget is small given the number of countries it covers. She apprised the Committee of current changes being introduced at headquarters to redirect funding streams to regional offices and countries. These include efforts to review current agreements to determine their flexibility, and to ensure that new agreements allow for vertical and horizontal resource distribution. Dr Jakab emphasized that the global donations/grants received by headquarters are for the whole Organization.

Breakfast briefing: Update on the work of the WHO collaborating centres

WHO collaborating centres are tremendous assets that enable WHO to implement its mandated work. In her introduction to the session, Dr Anne Marie Worning, Acting Director of Programme Management at WHO/Europe, highlighted links with the Sustainable Development Goals (SDGs) and the PB, and thanked Member States for their support to these centres, noting that this is a very large in-kind contribution to WHO.

Technical briefing: Regional collaboration for health with parliaments in the WHO European Region

Panellists Ms Elisa Scolaro, External Relations Officer for Parliamentary Engagement at WHO headquarters, and Dr Lucianne Licari presented an overview of WHO/Europe’s process of engaging with parliaments across the Region on a bilateral or subregional basis.

WHO/Europe has examined options for setting up a network for collaboration at the regional level with European parliaments, taking into account the needs of parliamentarians and the support they would need from WHO. It aims to develop parliamentary capacity to better respond to health challenges and ensure universal health coverage – and to increase political will beyond party lines to promote health and well-being.

Several comments from the floor and from Member States in the consultative group underlined that dialogue with parliaments also means dialogue with the opposition, and that there is a need to tread carefully in order to avoid a misstep.

Dr Licari responded to the delegates by pointing out that there will be another consultative meeting, and that the launch will not happen before there is governing body clearance.

Side event: Guide to resources to implement the SDGs

During a side event, Dr Bettina Menne, Coordinator for Sustainable Development and Health at WHO/Europe, introduced a draft guide to resources to implement the SDGs. Developed by WHO/Europe and partners, it proposes the E4As approach – engage, assess, align, accelerate and account – to promote health and well-being for all at all ages.

Panellists pointed out that the guide covers the different resources needed to plan and implement policies and interventions to achieve the SDGs in a user-friendly manner; that the United Nations system is equipping itself to support countries in this endeavour; and that civil society actors such as the European Public Health Association can support Member States to use the E4As approach to accelerate achievement of the SDGs.

The guide is expected to be launched in early 2020.

Memorandum of understanding between IFRC and WHO/Europe

On Tuesday, a memorandum of understanding was signed by Mr Jagan Chapagain, Under Secretary General of the International Federation of Red Cross and Red Crescent Societies (IFRC) and Dr Jakab, WHO Regional Director for Europe, to reaffirm and consolidate cooperation between the organizations.

Through the memorandum, the organizations will increase and mainstream collaboration in the following areas: universal health coverage with a focus on community health; health emergencies; the promotion of healthy lifestyles and noncommunicable disease prevention through the life course; and voluntary blood donor recruitment.

Highlights for Day 4

  • Health literacy in the WHO European Region
  • Technical briefing on children’s and adolescents’ health
  • Accreditation of non-State actors