WHO/CCU/15.02 /Graphics O WH Cover by

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1 WHO/CCU/15.02

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3 World Health Orgaizatio 2015 All rights reserved. Publicatios of the World Health Orgaizatio are available o the WHO website ( it) or ca be purchased from WHO Press, World Health Orgaizatio, 20 Aveue Appia, 1211 Geeva 27, Switzerlad (tel.: ; fax: ; bookorders@who.it). Requests for permissio to reproduce or traslate WHO publicatios whether for sale or for o-commercial distributio should be addressed to WHO Press through the WHO website ( copyright_form/e/idex.html). The desigatios employed ad the presetatio of the material i this publicatio do ot imply the expressio of ay opiio whatsoever o the part of the World Health Orgaizatio cocerig the legal status of ay coutry, territory, city or area or of its authorities, or cocerig the delimitatio of its frotiers or boudaries. Dotted ad dashed lies o maps represet approximate border lies for which there may ot yet be full agreemet. The metio of specific compaies or of certai maufacturers products does ot imply that they are edorsed or recommeded by the World Health Orgaizatio i preferece to others of a similar ature that are ot metioed. Errors ad omissios excepted, the ames of proprietary products are distiguished by iitial capital letters. All reasoable precautios have bee take by the World Health Orgaizatio to verify the iformatio cotaied i this publicatio. However, the published material is beig distributed without warraty of ay kid, either expressed or implied. The resposibility for the iterpretatio ad use of the material lies with the reader. I o evet shall the World Health Orgaizatio be liable for damages arisig from its use. Desig ad layout by Jea-Claude Fattier Cover by WHO/Graphics Prited by the WHO Documet Productio Services, Geeva, Switzerlad

4 Cotets Acroyms v 1. What is a Coutry Cooperatio Strategy? 1 2. Purpose of the CCS 1 3. CCS Guide 2014 why a ew versio? 2 Coutry specificity 2 Groudig the CCS i a wider orgaizatioal framework 3 Likages with the WHO results framework 3 4. The CCS process 5 5. The CCS documet 10 Chapter 0 Executive summary 10 Chapter 1 Itroductio 11 Chapter 2 Health ad developmet situatio Mai health achievemets ad challeges Developmet cooperatio, parterships ad cotributios of the coutry to the global. health ageda Partership ad developmet cooperatio Collaboratio with the UN system at coutry level Cotributios of the coutry to the global health ageda 22 Chapter 3 Review of WHO s cooperatio over the past CCS cycle 22 Chapter 4 The Strategic Ageda for WHO cooperatio 22 Esurig the quality of the Strategic Ageda 24 Formulatig a CCS for coutries i fragile situatios 25 Chapter 5 Implemetig the Strategic Ageda: implicatios for the etire Secretariat 28 Chapter 6 Evaluatio of the CCS Purpose of the evaluatio Timig Type of evaluatio Evaluatio process Coclusios ad recommedatios 31

5 Aex 1a: Guidace for developig a CCS i coutries i fragile situatios 33 Aex 1b: Guidace for itegratig health emergecy risk assessmet, capacity assessmet o emergecy risk maagemet for health ad WHO readiess for emergecy respose ito CCSs 40 Aex 2: Itegratig essetial criteria of geder, health equity ad huma rights ito the CCS process ad documet 42 Aex 3: Guidace ad template for CCS brief 43 Aex 4: Basic idicators for CCS documets 47 Aex 5: Coutry example of likig CCS focus areas with GPW outcomes 48

6 Guide for the formulatio of a WHO Coutry Cooperatio Strategy Acroyms AIDS BRICS BWP CCA CCS CCU CFS CO CSU DaO ERF ERM-H FCTC Gavi GFATM GPW HDI HERA HQ HWO IASC IHP+ IHR IRIS LDC MoH MDGs MDTF acquired immuodeficiecy sydrome Brazil, Russia, Idia, Chia ad South Africa bieial workpla Commo Coutry Assessmet Coutry Cooperatio Strategy Departmet of Cooperatio with Coutries ad Collaboratio with the UN System (WHO) Coutry Focus Strategy coutry office Coutry Support Uit Deliverig as Oe Emergecy Respose Framework emergecy risk maagemet for health Framework Covetio o Tobacco Cotrol Global Alliace for Vaccies ad Immuizatios (formerly) Global Fuds to Fight AIDS, Tuberculosis ad Malaria Geeral Programme of Work Huma Developmet Idex health emergecy risk assessmet Headquarters Head of WHO Office i coutries, territories ad areas Iter-Agecy Stadig Committee Iteratioal Health Partership Iteratioal Health Regulatios Istitutioal Repository for Iformatio Sharig (WHO) least-developed coutry miistry of health Milleium Developmet Goals Multi-Door Trust Fud v

7 Guide 2014 NCDs NGO NHA NHPSP OECD OECD/DAC PB PoEs RO SDGs SIDS SMART SOP SP SSFFC UHC UN UNAIDS UNCT UNDAF UNFPA UNICEF UNWOMEN WG WHO ocommuicable disease ogovermetal orgaizatio atioal health authority atioal health policy, strategy ad pla Orgaisatio for Ecoomic Co-operatio ad Developmet Orgaisatio for Ecoomic Co-operatio ad Developmet/Developmet Cooperatio Directorate Programme Budget poits of etry regioal office Sustaiable Developmet Goals Small Islad Developig States specific, measurable, achievable, realistic, time-boud stadard operatig procedure strategic priority substadard/spurious/falsely-labelled/falsified/couterfeit (medicies) uiversal health coverage Uited Natios Joit Uited Natios Programme o HIV/AIDS Uited Natios Coutry Team Uited Natios Developmet Assistace Framework Uited Natios Populatio Fud Uited Natios Childre s Fud Uited Natios Etity for Geder Equality ad the Empowermet of Wome workig group World Health Orgaizatio vi

8 Guide for the formulatio of a WHO Coutry Cooperatio Strategy 1. What is a Coutry Cooperatio Strategy? The World Health Orgaizatio (WHO) Coutry Cooperatio Strategy (CCS) is WHO s mediumterm strategic visio to guide its work i ad with a coutry i support of the coutry s atioal health policy, strategy or pla (NHPSP). It is the strategic basis for the elaboratio of the bieial coutry workpla. It is the mai istrumet for harmoizig WHO s cooperatio i coutries with that of other Uited Natios (UN) system orgaizatios ad developmet parters. The time frame is flexible to alig with atioal plaig cycles. It is geerally 4 6 years. The key priciples guidig WHO s cooperatio i coutries ad upo which the CCS is based are: owership by the coutry of the developmet process aligmet with atioal health priorities ad stregtheig atioal health systems i support of the NHPSP harmoizatio with the work of other orgaizatios of the UN system ad other parters i the coutry towards effective developmet cooperatio; ad collaboratio with Member States i shapig the global health ageda 2. Purpose of the CCS The mai purposes of the ew CCS are: to fuctio as a iterface betwee coutry health priorities ad WHO s medium-term visio for health, as defied i the 12th Geeral Programme of Work (GPW) to provide a framework facilitatig a bottom-up plaig process to esure that both WHO s global ad regioal priorities, as well as atioal health priorities, iform the bieial workpla to guide the coutry-level programme budget ad resource allocatio to eable WHO priorities to be advocated i the coutry ad to facilitate mobilizatio of resources for the health sector to provide a sigificat opportuity to mobilize a multisectoral approach to address priorities of the NHPSP 1 Twelfth Geeral Programme of Work Geeva: World Health Orgaizatio; 2014 ( GPW_ _eg.pdf). 1

9 Guide CCS Guide 2014 why a ew versio? The revised CCS guide will address the followig issues: Various aalyses of CCSs developed i recet years have revealed the eed to improve the CCS process, especially to esure co-owership of the CCS by the govermet ad the WHO Secretariat ad improve the iclusiveess of the CCS process at the coutry level. The ew guide will allow for more targeted WHO work i coutries to support the achievemet of iteratioally agreed health outcomes, icludig WHO s cotributios to a wider global health ageda 2. The ew guide will help to produce shorter, less descriptive ad more aalytical ad strategic documets through aalysis of the coutry requiremets ad WHO s added value. The revised process will icorporate a more thorough stakeholders aalysis ad selected strategic priorities for WHO collaboratio, based o the Orgaizatio s added value ad comparative advatage. Critical to the revised CCS Framework is the establishmet of a stroger lik betwee the CCS ad other WHO plaig istrumets ad tool. The CCS is the tool to iform the bieial plaig exercise ad both should be see as part of a cotiuum that icludes the ew results chai of the GPW ad regioal strategic plas, resolutios or madates. There is a eed for greater complemetarity ad iformatio sharig betwee the CCS ad the Commo Coutry Assessmet (CCA)/Uited Natios Developmet Assistace Framework (UNDAF) process ad vice versa. The two processes should be mutually reiforcig ad the idetified priorities should be aliged. The umber of developmet parters has grow cosiderably over the past two decades ad poses ew challeges, such as esurig atioal ad local owership of the developmet process. The revised CCS guide takes ito accout the ew political, ecoomic, social ad evirometal realities ad the global developmet ageda such as the Sustaiable Developmet Goals (SDGs). Coutry specificity The scope of the CCS varies accordig to the coutry s cotext this goes beyod classificatio accordig to icome: WHO eeds to respod to all Member States. The CCS eeds to be more cotiget o Member States specificities ad circumstaces. For example, stable coutries will require cooperatio of a differet ature tha coutries with complex programmes or fragile situatios icludig emergecies, the presece of a wide-reachig UN coutry team (UNCT) ad/or a peacekeepig missio. I additio, coutries i fragile situatios may beefit from a shorter duratio of CCS that allows for review ad appropriate modificatio as required. The special eeds of the various coutries are captured i the documet, with some additioal guidace for coutries i fragile situatios (see Aex 1a). 2 Kickbusch 2006 from presetatio give at the graduate istitute Geeva 2014: Global health comprises those health issues that trasced atioal boudaries ad govermets, ad call for iteratioal actio o the global forces ad global flows that determie the health of people. 2

10 Guide for the formulatio of a WHO Coutry Cooperatio Strategy Some high-icome coutries have embraced the process of developig a CCS as a way of detailig their cooperatio with WHO ad other coutries, with WHO playig the role of a kowledge broker ad coveer i the pursuit of joit iterests. Last but ot least, depedig o the coutry s specificities, the ature of WHO s activities may vary from direct operatioal techical cooperatio to coveig, upstream policy support ad kowledge brokerage, i lie with WHO s core fuctios. Groudig the CCS i a wider orgaizatioal framework The high-level strategic visio of the Orgaizatio, the 12th GPW , establishes the six leadership priorities that defie the key areas i which WHO seeks to exert its ifluece i the world of global health, ad that drive the way that work is carried out across the orgaizatio. The GPW reflects the three mai compoets of WHO reform: programmes ad priorities, goverace ad maagemet. The WHO reform process has bee desiged to make the Orgaizatio more fit for purpose, ad emphasizes the eed for WHO to stregthe ad better alig its work to coutry eeds. As a way of traslatig the WHO reform process ito actios at coutry level, a umber of streams of work have bee udertake. I particular, a draft WHO Coutry Focus Strategy (CFS) achored i WHO reform has bee proposed, based aroud three pillars of actio: redefiig how WHO does busiess at coutry level to improve support to Member States; aligig the plaig ad resource allocatio processes with the priorities for WHO cooperatio at coutry level; ad addressig coutry-level huma resources challeges. The ew CCS guide is a strategic maagemet tool that will help to respod to these three pillars of actio. Likages with the WHO results framework Aother compoet of the reform process has icluded revisios to the results framework. I 2012, Member States agreed that WHO s work should be orgaized aroud five techical categories ad oe category coverig all corporate services. Categories are further divided ito programme areas. 4 For each of the 30 programme areas, there are specific outputs. These outputs defie what the Secretariat will be accoutable for deliverig durig each bieium (three bieiums, hece three workplas from , ad ). Outputs withi programme areas cotribute to outcomes, which i tur cotribute to impacts; these are all clearly defied by the GPW through a results chai (see Figure 1)

11 Guide 2014 Figure 1: Results chai of the 12th GPW Iputs Activities Outputs Outcomes Impacts Fiacial, huma ad material resources Tasks ad actios udertake Secretariat accoutability Delivery of products ad services Icreased access to health services ad/or reductio of risk factors Improvemet i the health of people Joit resposibility Secretariat, Member States, parters Each programme area withi the programme budget is associated with oe specific outcome. The achievemet of each outcome is depedet o the work of each programme but some factors are beyod the cotrol of WHO (i.e. political istability). Not every coutry will have to work towards deliverables for a particular programme area, as ot every programme that is part of WHO s broad rage of programmes is relevat to every coutry. The strategic priorities for techical cooperatio i a coutry should be based o a thorough situatioal aalysis of the health ad developmet situatio i that coutry, takig ito cosideratio the NHPSP ad the six leadership priorities. The CCS s strategic priorities will facilitate the selectio by the Secretariat ad the Member State of those GPW outcomes that are most relevat to the achievemet of the NHPSP, ad that will lead to the formulatio of WHO s bieial programme budget ad workpla for the coutry cocered. Based o the CCS, its aalysis ad clearer strategic priorities, coutry offices will be better able to iform the bieial workpla ad, i tur, to better respod to the coutry s eeds ad priorities. 4

12 Guide for the formulatio of a WHO Coutry Cooperatio Strategy 4. The CCS process The formulatio of the CCS is a corporate process, ivolvig the three levels of the Orgaizatio. Coutry level: The Head of the WHO Office (HWO) leads the CCS process, with the support of the coutry office staff, as well as techical backstoppig from the regioal office ad Headquarters (HQ). Regioal ad headquarters levels: The Coutry Support Uit (CSU) at regioal level assumes a support ad oversight role durig the process. This etity esures the timely iitiatio of the CCS process, provides techical support (promotig a aalytical ad holistic approach to the process), ad facilitates backstoppig missios if ecessary. I some coutries where WHO does ot have a physical presece, the regioal office (RO) leads the developmet of the CCS. HQ provides additioal techical support, reviews drafts of the documet, facilitates iputs from the techical programmes ad participates i missios if required. There is also a role of quality cotrol at the regioal ad HQ levels, icludig the category etworks, to esure a corporate, whole-of-orgaizatio approach. UN system ad parters: The CCS process also fully ivolves all developmet parters, icludig the UN system. The process of establishig CCS strategic priorities ca be used to shape the health dimesio of the UNDAF ad other partership platforms i the coutry. The CCS provides a sigificat opportuity for usig a multisectoral approach to address the priorities of the NHPSP. The CCS process ivolves extesive cosultatios betwee WHO ad the govermet, as well as other UN system orgaizatios; bilateral ad multilateral agecies; civil society ad ogovermetal orgaizatios (NGOs); commuity groups; academic istitutios; collaboratig cetres; ad the private sector, as appropriate. Iclusive dialogues durig the CCS process should iclude cosultatio with wome ad me represetig socially excluded or disadvataged subpopulatios, as well as atioal bodies cocered with huma rights ad with wome (see Aex 2).These dialogues cotribute to esurig broad support ad to the maximizatio of complemetarity ad syergies with parters throughout the CCS process. The CCS process is flexible ad ca be applied to a variety of coutry cotexts. The geeral priciples are as follows (see Figure 2 ad Table 1). 5

13 Guide 2014 Figure 2: The process of developig a CCS 6

14 Guide for the formulatio of a WHO Coutry Cooperatio Strategy Table 1: Detailed process of buildig evaluatig a CCS Phase of CCS buildig process Whe? Who? What? Iitiate the CCS 2 moths before Coutry office Iitiatio Head of WHO Office (HWO) leads the process, with coutry office staff. Regioal office Coutry Support Uit (CSU) supports. Iitiatio Idetify the CCS workig group Moth 0 Headquarters A focal poit from Headquarters supports the process. Preparatio Coutry office The HWO leads the process, with coutry office staff, atioal couterparts, members of UN agecies ad other stakeholders. All staff participate i the process, although oly a selectio is part of the Workig Group (WG). Regioal office A focal poit from the regioal CSU supports the process. For coutries without HWOs, the workig group is orgaized by the regio. Headquarters CCU 5 resource perso supports the process. Determie whether there is a CCS or other relevat plaig tools upo which to base the future CCS. Idetify key documets to be made available to the CCS team, such as Geeral Programme of Work, NHPSP, previous CCS. Esure resources for the CCS process, request support from the regioal office ad headquarters (traiig or other). Esure a balaced team that also has broad represetatio (may ot form part of the WG but ca be called upo, e.g. from the differet techical programmes, huma rights associatios). It is recommeded to have o more tha six to eight people i the WG ad to appoit a perso to take charge of logistics. I fragile states ad /or disaster-proe coutries, esure at least oe team member has the appropriate competece for diplomacy ad a uderstadig of the political cotext, as well as expertise i the health systems of coutries with a fragile situatio, ad/or humaitaria issues. (see Aex 1a). Note: A exteral cosultat may be appoited for iformatio gatherig ad draftig but it is essetial that the critical aalysis ad elaboratio of strategic priorities is doe by the WG. Draft the roadmap Moth 1 CCS WG The roadmap lays out: timig of the CCS process roles ad resposibilities of WHO ad parters the support required from the regioal office ad headquarters costs. Preparatio Gather ad share iformatio with WG Moth 1 CCS WG WG collects ad shares: atioal developmet policies health policies, strategies ad plas aual reports, vital statistics, surveys exteral reports o the coutry, its vulerable populatios, huma rights ad geder (see Aex 2), Iteratioal Health Partership (IHP+) reports disaster risk assessmet (refer to Aex 1b) regioal ad headquarters iformatio iteratioal agreemets ad madates ratified ad/or siged by the coutry. 5 CCU, Departmet of Cooperatio with Coutries ad Collaboratio with the UN System. 7

15 Guide 2014 Critical aalysis: coutry cotext Critical aalysis: atioal developmet ad health pla Critical aalysis: WHO leadership priorities Critical aalysis: WHO cooperatio durig previous CCS Critical aalysis: parterships ad cotributio to the global health ageda Policy dialogue with atioal couterparts for joit prioritizatio Developmet of CCS Publicatio ad dissemiatio Aalysis Moths 2 3 CCS WG Moths 2 3 CCS WG Moth 2-3 CCS WG Moths 2 3 CCS WG Moths 2 3 CCS WG Developmet Moths 3 4 CCS WG, with particularly active role of HWO atioal couterparts CCS WG, plus HWO Moths 4 5 atioal couterparts regioal office headquarters Moths 5 6 CCS WG, plus HWO atioal couterparts Critical aalysis of: mai achievemets areas to be stregtheed challeges ad gaps icludig vulerable populatios socio-political situatio (states i fragile situatios) (see Aex 1a ad 1b). Aalysis of atioal developmet ad health policies, plas ad strategies to determie: coherece of strategies ad plas accordig to the health situatio aalysis iclusivity ad degree of owership i the developmet process iclusio of fiacig, implemetatio ad maagemet arragemets (icludig moitorig ad reviewig mechaisms). Selectio of the relevat questios from the CCS guide (see pages 15 19) to facilitate the team s reflectio o achievemets, progress ad challeges for each leadership priority. Assessmet of: degree of implemetatio of strategic priorities WHO s cotributio to the six leadership priorities egagemet with the UN. Aalysis of: health dimesios of Uited Natios Developmet Assistace Framework UNDAF ad other iteratioal platforms (i.e. Busa Partership for Effective Developmet Cooperatio) coutry s cotributio to the wider global health ageda. Takig ito cosideratio the critical aalysis of previous steps ad WHO s comparative advatage ad added value, the dialogue aims to: prioritize strategic priorities ad CCS focus areas esure buy-i from atioal couterparts. draftig of documet esurig the idetificatio of resources ad parterships eeded for the implemetatio of the CCS sharig draft documet with atioal authorities ad other stakeholders esurig clearace from miistry of health, regioal office ad Headquarters sigature of the CCS ad lauchig (if ecessary). wide dissemiatio at coutry level by coutry office ad atioal couterparts publicatio of documet through the Istitutioal Repository for Iformatio Sharig (IRIS) ad o the global WHO Iteret site. Developmet Aalysis 8

16 Guide for the formulatio of a WHO Coutry Cooperatio Strategy Implemetatio of CCS 4 6 years Midterm evaluatio Year 2 or 3 Fial evaluatio Year 4 or 6 Implemetatio HWO ad coutry office staff (lead) regioal office ad Headquarters (cotribute ad support) Moitorig ad evaluatio Coutry office HWO ad coutry office Regioal office Focal poit from regioal CSU Headquarters CCU focal poit Coutry office HWO ad coutry office Regioal office Focal poit from regioal CSU Headquarters CCU focal poit The CCS is a edorsemet by the etire Secretariat of the commitmet to pursue the strategic ageda i the coutry(the Regioal office ad HQ iforms the techical uits of the CCS for coutry missios) The CCS iforms the bieial programme budget ad workpla every two years. The CCS iforms the UNDAF i Deliverig as Oe (DaO) coutries ad other coutries. Assessmet of: process ad degree of implemetatio of the CCS strategic priorities WHO s egagemet with the UN system coutry s cotext Accordig to results ad cotext, cosider chages i strategic priorities ad workplas. Assessmet of: degree of implemetatio of the CCS strategic priorities WHO s cotributios to the six leadership priorities WHO s cotributios to the NHPSP WHO s egagemet with the UN system Iforms the formulatio of the ext CCS. Should be guided by the WHO evaluatio practice hadbook ad should ideally ivolve parters i the process. M&E Implemetatio 9

17 Guide The CCS documet The mai result of the process outlied above is the clear formulatio of a limited umber of strategic priorities that are to be icluded i the CCS documet. The documet should iclude: the mai documet the CCS at a glace (CCS Brief), a two-page brief that commuicates the essece of the CCS. This Brief should be updated aually as eeded durig the CCS cycle (see format i Aex 3) The mai documet is cocise ad ideally o more tha pages i legth. The outlie follows the structure elaborated below. Structure of the CCS documet Table of cotets List of abbreviatios ad acroyms 0. Executive summary 1. Itroductio 2. Health ad developmet situatio: achievemets, challeges, developmet cooperatio ad parterships ad the global health ageda 3. Review of WHO s cooperatio durig the past CCS cycle 4. Strategic ageda for WHO s cooperatio 5. Implemetig the strategic ageda: implicatios for the etire WHO Secretariat 6. Evaluatio of the CCS Aexes Chapter 0 Executive summary Suggested legth: 1 1½ pages This is a cocise summary of the etire documet that: ü highlights the coutry s mai health priorities ad achievemets; ü captures the focus areas of the CCS cosultatio process; ad ü focuses o the strategic ageda for WHO cooperatio. 10

18 Guide for the formulatio of a WHO Coutry Cooperatio Strategy Chapter 1 Itroductio Suggested legth: 1 1½ pages This sectio sets out the policies uderlyig the role of the CCS i the wider health developmet ladscape. It icludes: ü a overview of the WHO policy framework: the GPW, as well as regioal ad subregioal orietatios ad priorities ü the coutry cotext, which explais the choices made ad the timig of the CCS formulatio, relevat features of the CCS process, icludig compositio of the team, people met ad key actios udertake Chapter 2 Health ad developmet situatio Suggested legth: 6 8 pages (The weight of each subsectio will deped o the coutry s specificity.) This chapter deals with the curret situatio i the coutry ad comprises two subsectios, detailig 2.1. the coutry s mai health achievemets ad challeges 2.2 the coutry s ladscape of developmet cooperatio, parterships ad collaboratio with the UN ad obligatios uder regioal resolutios, agreemets ad commitmets 2.1 Mai health achievemets ad challeges This sectio aalyses ad summarizes the coutry s mai health ad developmet issues based o a comprehesive review of key atioal referece documets ad coutry itelligece. 1. The first paragraph should describe the political, social ad macroecoomic cotext of the coutry ad metio membership or participatio i ay relevat regioal or subregioal political bodies (i.e. BRICS, LDC or SIDS). 6 The sectio should highlight ay risk factors, for example if the coutry is i the midst of a coflict, is i proximity to a coflict zoe, or is proe to atural disasters (see Aexes 1a ad 1b for coutries i fragile situatios ad other hazards with a potetial health impact) ad take ito accout a framework for geder, equity ad huma rights (see Aex 2). 2. The health situatio aalysis should take place withi a broader developmet framework, such as the existece of a atioal developmet pla, a poverty reductio strategy, the coutry s commitmet to achievig the Milleium Developmet Goals (MDGs), its preparedess for crises ad emergecies ad withi the cotext of the aticipatio of the post-2015 SDGs. 3. The ext paragraphs should aalyse the health status of the populatio ad provide a brief descriptio of the health system icludig private for-profit ad ot-for-profit istitutios that have a impact o access to health care ad health outcomes. Maps, graphs ad boxes may be used to summarize iformatio as appropriate. A list of essetial idicators should be icluded usig statistics from the Global Health Observatory (See template i Aex 4). Sigificat differeces (if ay) betwee the data from the Global Health Observatory ad other sources (i.e. atioal data), should be oted 6 BRICS, Brazil, Russia, Idia, Chia ad South Africa; LDC, least-developed coutry; SIDS, Small Islad Developig States. 11

19 Guide 2014 ad sources of iformatio ackowledged. Other idicators should be added accordig to the coutry s specificity. Tred aalysis of burde of disease is ecouraged to show progress ad the remaiig challeges (e.g. to track progress over time of prevalece of a specific disease). Disaggregatio by sex ad other variables should be used to highlight health-related huma rights ad geder issues, as well as uderlyig root causes. 4. The aalysis of the coutry s respose to health issues should iclude a referece to the NHPSP, a documet or set of documets that lays out the cotext, visio, objectives, spedig priorities ad key itervetios for health developmet i a coutry. NHPSPs may differ cosiderably i scope ad ature. I some coutries, the aforemetioed elemets may be eumerated i several laws, orms ad policy papers. The followig attributes of the NHPSP may be cosidered: ü the coherece of strategies ad plas accordig to the health situatio aalysis; ü the iclusiveess ad degree of owership of its developmet process; ad ü the iclusio of fiacig, implemetatio ad maagemet arragemets, icludig moitorig ad review mechaisms. 5. The health situatio aalysis should be further facilitated by cosiderig the coutry s progress i the six WHO leadership priorities. The set of followig questios is proposed to facilitate reflectio o the achievemets, progress, ad challeges a coutry has experieced for each leadership priority, ad to elicit the priority area where WHO offers a comparative advatage ad added value. Each coutry ca choose the questios that are most relevat to its cotext ad specific attributes. 12

20 Guide for the formulatio of a WHO Coutry Cooperatio Strategy Questios for a health situatio aalysis Uiversal health coverage (UHC) More about uiversal health coverage Is there ay explicit coutry strategy for implemetig or advacig UHC at the coutry level? Does the UHC strategy iclude, at least: o a explicit defiitio of what UHC meas i terms of populatios covered, services provided ad fiacial protectio guarateed? o fidigs of situatio aalysis, mai issues, challeges ad obstacles? o a roadmap for movig towards UHC by addressig the mai issues ad obstacles? o ivolvemet of differet stakeholders that play a role i its realizatio? o a clear ad feasible moitorig system to assess progress? Who iitiated this strategy ad has it bee edorsed at the highest level withi the coutry? Is UHC part of broader efforts to deal with (extreme) poverty, social exclusio ad geder iequity? Does UHC take ito accout possible hazards that could iterrupt the CCS review process? Has the UHC strategy bee backed by appropriate coutry legislatio? Does the UHC strategy take (or i the absece of a explicit strategy, has the atioal health authority (NHA) take) steps to improve access to comprehesive, perso-cetred, itegrated health services based o primary health care, quality ad cotiuity of care, ad closer liks betwee medical, social ad log-term care services? Does the UHC strategy (or i the absece of a explicit strategy, does the NHA) take ito accout all relevat sources of health fiacig i the coutry ad is it aimed at icreasigly poolig reveues ad substatially reducig out-of-pocket expediture o health? Is the coutry takig measures to improve efficiecy? Does the UHC strategy take (or i the absece of a explicit strategy, has the coutry take) steps to effectively meet the health eeds of vulerable members of the populatio such as wome of reproductive age, childre ad older people at the coutry level? Is the UHC strategy cosistet with the huma, techological, ad orgaizatioal resources available (curret ad future) i the coutry? Is the UHC strategy debated at the public level? Does the UHC strategy take (or i the absece of a explicit strategy, has the coutry take) steps to improve the coutry s health iformatio system, with a focus o vital registratio? If the coutry has a protracted emergecy where access to health services is low or disrupted, does the coutry have a strategy for icreasig health service coverage ad/or delivery? Does the humaitaria coutry team have such a strategy? 13

21 Guide 2014 Iteratioal Health Regulatios (2005) (IHR 2005) More about Iteratioal Health Regulatios 14 Have the capacity requiremets for IHR bee met by the coutry? If so, whe? If ot, has a extesio util 15 Jue 2016 bee formally requested? Is there a atioal coordiatig mechaism to implemet IHR? (List stakeholders ad parters.) Is there a atioal actio pla to implemet ad meet IHR requiremets? Are aual updates o the status of IHR implemetatio coducted? Are there aual updates ivolvig stakeholders across all relevat sectors? Has the surveillace system bee stregtheed at atioal ad local levels ad does it iclude surveillace withi high-risk groups ad of uexplaied illesses i health workers? Does the coutry have a disease early warig system? Is the coutry prepared, ad does it have the capacity, to respod i a timely ad coordiated fashio to a major epidemic or pademic? Are eeds assessmets coducted to idetify gaps i huma resources ad traiig eeded to meet IHR requiremets? Has progress bee made i meetig targets for workforce umbers ad skills cosistet with IHR requiremets? Are there specific programmes with allocated budgets, to trai workforces to deal with IHR-relevat hazards? Have all diagostic laboratories bee certified or accredited to iteratioal stadards or to atioal stadards adapted from iteratioal stadards? Is bio-risk assessmet coducted i laboratories to guide ad update biosafety regulatios, procedures ad practice, icludig for decotamiatio ad maagemet of ifectious waste? Are there, or does the coutry have access to, biosafety levels 3 ad 4 laboratory facilities? Are atioal risk assessmets to idetify potetial urget public health evets, ad the most likely sources of these evets, properly coducted? Have atioal resources bee mapped for IHR-relevat hazards ad priority risks? Are stockpiles (critical stock levels) accessible for respodig to priority biological, chemical ad radiological evets ad other emergecies? Is there a risk commuicatio pla? If so, has it bee implemeted or tested i a actual emergecy or i a simulatio exercise ad updated i the past 12 moths? Is evaluatio of public health commuicatios coducted after emergecies, for timeliess, trasparecy ad appropriateess of the commuicatios? Poits of etry (PoEs) Have desigated PoEs bee idetified ad properly assessed? Are there public health emergecy cotigecy plas at the desigated PoEs? Are they tested ad updated as eeded? Are relevat legislatio, regulatios, admiistrative acts, protocols, procedures ad other govermet istrumets to facilitate IHR implemetatio at desigated PoEs updated as eeded? Are stadard operatig procedures (SOPs) for respose at desigated PoEs available?

22 Guide for the formulatio of a WHO Coutry Cooperatio Strategy Icreasig access to essetial, high-quality, effective ad affordable medical products More about essetial medicies Is icreasig the access to essetial, high-quality, effective ad affordable medical products (medicies, vaccies, diagostics ad other procedures ad systems) a major compoet of health policies at the coutry level? Have mechaisms for coordiatio with stakeholders bee established to icrease access to essetial, high-quality, effective ad affordable medical products? Is there up-to-date legislatio o how to produce, register ad commercialize medicies, vaccies ad other biological products for huma ad veteriary health at coutry level? Is the legislatio implemeted ad eforced? Are the regulatory authorities well equipped to fulfil their duties at coutry level (this icludes the existece of specific regulatory bodies or agecies)? Is the quality of medical products periodically tested usig validated iteratioal orms ad stadards? Is the cotrol of substadard/spurious/falsely-labelled/falsified/couterfeit (SSFFC) medical products a relevat issue at coutry level? Is multidrug resistace or atimicrobial resistace a issue i the coutry? Is a atioal list of essetial medicies curretly i use? Is ratioal prescriptio of medicies a specific priority at coutry level? Is there a specific policy that favours greater use of geeric over origiator brads at coutry level? Are the procuremet ad supply maagemet processes ad procedures for medical products ad techologies curretly workig efficietly at coutry level? I protracted emergecy situatios, are the supply ad distributio of essetial medicies ad other health techologies adequately guarateed? Is cost-effectiveess take ito cosideratio i public fiacig of medical products? Is the evaluatio of other health techologies, equipmet ad procedures a priority at the coutry level? Is the global strategy ad pla of actio o public health, iovatio ad itellectual property beig implemeted i the coutry? Is research ad iovatio o medical products promoted at coutry level, icludig etworkig with the regioal level? 15

23 Guide 2014 Social, ecoomic ad evirometal determiats More about social determiats of health How is the coutry placed, ad how is it evolvig, i terms of the Huma Developmet Idex (HDI)? Are social ad ecoomic determiats of health placed i the maistream of the public policy ageda at the coutry level? Are social ad ecoomic determiats of health, icludig geder equality ad wome s empowermet, periodically moitored ad the results widely commuicated ad discussed at the coutry level? Has the coutry effectively itegrated geder, equity ad huma rights ito public policies, strategies ad operatioal plaig? Are climate chage ad evirometal health o the public policy ageda of the coutry? Is the coutry stregtheig its capacity to assess ad maage the health impacts of evirometal risks ad to develop policies ad plas o evirometal health ad sustaiable developmet? Is the coutry stregtheig its capacity for preparedess ad respose to evirometal emergecies related to climate, water, housig, saitatio, chemicals, air pollutio, ad radiatio ad for coveig parters ad coductig policy dialogue o these matters? Have itersectoral mechaisms bee established to address social determiats of health? (Health i All Policies, UN ad other coordiatio platforms.) Geder, equity ad huma rights i the CCS Maistreamig geder, health equity ad huma right issues ito the CCS is critical (see Aex 2). Two key questios to be asked to esure that the issues of geder, health equity ad huma rights are maistreamed ito the health situatio aalysis i the CCS as well as the agreed CCS strategic ageda are: Who are the socially excluded or disadvataged subpopulatios that might experiece differetial exposure, vulerability, access or treatmet outcomes/cosequeces, because of characteristics such as place of residece, race or ethicity, occupatio, geder/sex, religio, educatio or socioecoomic status? How does the coutry esure that health-care services are available, accessible, acceptable ad of adequate quality, to socially excluded or disadvataged subpopulatios? 16

24 Guide for the formulatio of a WHO Coutry Cooperatio Strategy Nocommuicable diseases (NCDs) More about ocommuicable diseases To what extet has the prevetio ad cotrol of NCDs bee give high priority at the coutry level? Is there a multisectoral atioal pla for the prevetio ad cotrol of NCDs (amely, cardiovascular diseases, diabetes, cacer, chroic respiratory diseases, ad metal health problems) cotaiig priorities, targets that take ito accout the volutary global targets, strategies ad idicators, based o evidece geerated at the iteratioal ad coutry level? Is the coutry stregtheig atioal capacities, leadership, goverace, multisectoral actio ad partership to accelerate atioal efforts towards NCDs prevetio ad cotrol? Is the coutry makig efforts to reduce the major modifiable risk factors for NCDs, amely, tobacco use, the harmful use of alcohol, uhealthy diet ad physical iactivity? Are there risk-factor-specific atioal plas ad programmes, such as a atioal tobacco cotrol programme? If so, how are these programmes aliged to the NCDs actio pla? What steps is the coutry takig towards implemetig effective tobacco cotrol measures at coutry level, as required by the WHO Framework Covetio o Tobacco Cotrol (FCTC)? Is the coutry stregtheig ad (re)orietig health systems to address the prevetio ad cotrol of NCDs, icludig metal health disorders, ad the uderlyig social determiats through people-cetred primary health care ad UHC? Is the coutry makig efforts to stregthe huma resources ad istitutioal capacities to address the prevetio ad cotrol of NCDs icludig metal health? Is the coutry makig efforts to moitor the determiats ad treds of NCDs ad evaluate progress i their prevetio ad cotrol, icludig developig baselies, atioal targets ad idicators, establishig or stregtheig comprehesive surveillace systems ad itegratig them with atioal health iformatio systems? Do these surveillace systems iclude data disaggregated by sex ad other variables? Are violece ad ijuries a sigificat health problem i the coutry ad has the coutry take steps towards evidece gatherig, prevetio ad cotrol? Is the coutry supportig atioal capacity for high-quality research for the prevetio ad cotrol of NCDs? Is the coutry reportig o progress made towards fulfillig the commitmets made i the Political Declaratio of the High-Level Meetig of the Geeral Assembly o the Prevetio ad Cotrol of NCDs ad the Global Actio Pla, icludig the ie volutary targets? Is the coutry reportig o progress made with NCD regioal or subregioal plas ad/or strategies? Is the coutry itroducig iovative approaches to fiace NCDs prevetio ad cotrol plas? 17

25 Guide 2014 Ufiished health-related Milleium Developmet Goals (MDGs) ad Sustaiable Developmet Goals (SDGs) More about the Sustaiable Developmet Goals The UN will adopt a ew post-2015 developmet ageda i September 2015, referred to as the Sustaiable Developmet Goals (SDGs), to esure follow-up o the implemetatio of the MDGs. The suggested draft set of 17 SDGs is already ifluecig the work of the UN system i support of the Member States developmet priorities. It is essetial to esure cotiued relevace of health-related goals ad targets i settig up atioal actios o implemetig the SDGs, icludig relevat idicators. The proposed SDGs cotai oe health-specific goal: Esure healthy lives ad promote well-beig for all at all ages, but there are a umber of health-related targets across other SDGs. The followig questios should be cosidered. Have the MDGs had a high priority i the political ageda, i.e. ifluecig the public policies of the coutry? Have specific strategies to achieve MDGs bee put i place? Have the MDGs bee moitored ad evaluated, ad the evaluatio results publicized? Did the coutry develop the MDG Acceleratio Framework (MAF) ad MAF Actio Pla? What were the mai successes ad challeges i achievig the MDGs? Are there established mechaisms for collaboratio o the achievemet of the MDGs (improvig materal health, icludig sexual ad reproductive health, as well as ewbor ad child health)? What itervetios are idetified as priorities (e.g. providig free access to health care to pregat wome, mothers ad childre, emergecy obstetrics, immuizatio, utritioal supplemets)? Is there a focus o equitable immuizatio coverage ad the itroductio of ew vaccies? Do the HIV/AIDS, tuberculosis ad malaria programmes adopt a itegrated approach ad do they iclude a health systems stregtheig compoet? Did the coutry orgaize atioal cosultatio i preparatio for the post-2015 ageda? What were the health priorities idetified at atioal level? Are ay of the proposed SDG targets (other tha MDGs) cosidered a priority: premature mortality from NCDs? Metal health? Road safety? Prevetio of substace abuse? UHC? Is the support of the UN system i the implemetatio of the SDGs at the atioal level discussed i the Uited Natios Coutry Team? Is WHO leadig the work o idetifyig health targets ad idicators relevat for the coutry? 18

26 Guide for the formulatio of a WHO Coutry Cooperatio Strategy 2.2 Developmet cooperatio, parterships ad cotributios of the coutry to the global health ageda Partership ad developmet cooperatio Over the years, health has become ever more promiet, icludig i the post-2015 developmet ageda ad the proposed SDGs ad targets. The growig umber of developmet parters i health provides a potetial for icreased resources. However, this poses challeges for coordiatio ad aligmet with coutry eeds ad priorities ad icreases trasactio costs for the Orgaizatio. Both the Paris Declaratio followed by the Busa Partership provided key priciples for effective developmet cooperatio. They are i tur reiforced by the Iteratioal Health Partership (IHP+) behaviours. The Busa priciples to achieve commo goals are: ü Owership of developmet priorities by couties: Coutries should defie the developmet model that they wat to implemet. ü A focus o results: Havig a sustaiable impact should be the drivig force behid ivestmets ad efforts i developmet policy makig ü Parterships for developmet: Developmet depeds o the participatio of all actors, ad recogises the diversity ad complemetarity of their fuctios. ü Trasparecy ad shared resposibility: Developmet co-operatio must be trasparet ad accoutable to all citizes WHO s role is to support the govermet i effectively coordiatig parters ad exteral resources so as to ehace effectiveess ad esure that all exteral resources respod to coutry eeds ad priorities. This role was reiterated i the 12th GPW ad draft Coutry Focus Strategy (CFS). The CCS team therefore eeds to aalyse the roles fulfilled by key developmet parters, the allocatio of resources by these parters i the health sector, ad major areas of support. The CCS workig group should collect ad aalyse iformatio o bilateral ad multilateral agecies, global health parterships ad iitiatives, developmet baks ad iteratioal fiacial istitutios, civil society ad NGOs, commuity groups, academic istitutios, collaboratig cetres, the private sector, ad others as appropriate. The stakeholder mappig should be captured ad details should be icluded i the aexes. 19

27 Guide 2014 Itegratig priciples of developmet cooperatio effectiveess The workig group (WG) should cosider: existig partership platforms for health sector ad related aspects such as coordiatio ad divisio of labour (if available), icludig: the extet to which these platforms ad mechaisms help to avoid duplicatio ad foster coherece ad cooperatio, fillig critical gaps; the extet to which techical cooperatio ad health-sector aid flows are aliged with atioal policies, strategies, plas ad plaig cycles; existig mechaisms for the moitorig ad assessmet of partership ad developmet cooperatio e.g. Busa partership ad IHP+ results, ad progress made over the years o aligmet ad harmoizatio; WHO s role i supportig the govermet i effective coordiatio ad moitorig of developmet cooperatio (e.g. does WHO chair or co-chair local developmet parter coordiatio parterships or groups?); ad WHO s relatioship with the above cooperatio platforms ad withi the developmet cooperatio effectiveess framework (as outlied i the Paris ad Busa priciples), as well as based o WHO s added value ad comparative advatage, icludig the demads placed o WHO by the govermet ad developmet parters Collaboratio with the UN system at coutry level The CCS process provides a opportuity to iitiate a strategic dialogue with the UN agecies o challeges ad opportuities for cooperatio i the coutry. The UNCT is the platform through which WHO ca stregthe dialogue amog UN agecies, foster a multisectoral respose to health challeges, ad mobilize additioal resources to achieve atioal health goals. The UNDAF is the strategic programme framework that describes the collective respose of the UN system to atioal developmet priorities. The UNDAF provides a opportuity to highlight the role of health i the broader developmet ageda by reiforcig a multisectoral respose to health challeges ad addressig key socioecoomic ad evirometal determiats. The CCS ad the health dimesio of the UNDAF should be harmoized ad mutually reiforcig for better health results i the coutry. 20

28 Guide for the formulatio of a WHO Coutry Cooperatio Strategy There are two mai issues to be cosidered i the aalysis of WHO collaboratio with the UN system: A. WHO eeds to leverage the expertise of other UN agecies i the coutry Uderstadig the available expertise available i other UN agecies at coutry level is part of the WHO coordiatig role amog health parters ad facilitates the coveig role ad support provided to miistry of health (MoH) i aligig the work of health parters aroud atioal priorities. I additio, other UN orgaizatios have direct commuicatio chaels with differet lie miistries ad ca facilitate the ivolvemet of o-health sectors i a whole-of-govermet approach i addressig health challeges. 1. Which UN system orgaizatios are part of the UNCT (both residet ad o-residet)? 2. What is the scope of activities ad available expertise i health of other UN system orgaizatios i the coutry? (Check the aalysis of the comparative advatages of the UN system orgaizatios i the coutry, which could have bee doe as part of the UNDAF preparatio process.) 3. If the coutry adopted the Deliverig as Oe approach (DaO), which DaO pillars are implemeted? 4. What is the miistry of health s role i the Joit Natioal/UN Steerig Committee? 5. What is WHO s role i the Steerig Committee? 6. Are there joit programmes dedicated to health? What is WHO s role i the joit programmes? 7. Is itersectoral actio beig cosidered to address health i all policies issues? 8. Has the UNCT established a joit mechaism to mobilize resources for health? Is there a Multi- Door Trust Fud (MDTF) i the coutry (Oe Fud i the DaO cotext)? 9. Are there ay other UN-wide iitiatives or processes active i the coutry? (For example, MDG Acceleratio Framework, IHP+ or H4+ 7.) B. CCS ad Commo Coutry Aalysis (CCA) ad UNDAF The health situatio aalysis of the CCS should iform the CCA ad the UNDAF ad vice versa. The aalysis should be shared ad harmoized. WHO should cotribute to the health-related outputs ad outcomes of the UNDAF ad the UNDAF should be iformed by the CCS strategic priorities. 1. Are there ay health-related outcomes i the curret UNDAF (utritio, social protectio, water ad saitatio, specific vulerable groups or others)? 2. What are the mai health-related challeges idetified i the coutry aalysis of the UNDAF or DaO programme? 3. Are there health thematic groups (these might be called sectoral groups or results groups i the DaO cotext) i.e. is there a UN iteragecy task force o NCDs? 4. What are the specific outputs agreed upo by health thematic groups? 5. What is WHO s role i these groups? 7 WHO ad parters programmes UNAIDS, UNFPA, UNICEF, UN WOMEN, ad the World Bak work together as the H4+ i a joit effort to improve the health of wome ad childre ad accelerate progress towards achievig Milleium Developmet Goals (MDGs) 4 (reducig child mortality) ad 5 (improvig materal health). 21

29 Guide Cotributios of the coutry to the global health ageda Takig ito accout the coutry s cotext, this subsectio of the CCS should highlight: ü the experieces, kowledge ad research existig i the coutry, ad cocrete lessos leart that ca be shared to ehace resiliece ad cotribute positively to health developmet i other coutries ad globally; ü the coutry s cocrete fiacial ad techical support to other coutries for health developmet through bilateral or multilateral cooperatio; the latter icludig logistics, huma resources, trasfer of techologies ad research skills; ü sharig of experiece ad cooperatio amog coutries, through triagular ad south-south cooperatio; ad ü the coutry s level of participatio ad leadership role (if ay) i subregioal or other itercoutry political itegratio groupigs that have health agedas, ad the extet to which it participates i WHO ad regioal office goverig bodies meetigs. Chapter 3 Review of WHO s cooperatio over the past CCS cycle Suggested legth: 2 2½ pages This chapter reflects o WHO s cooperatio with the coutry durig the past CCS cycle. It should take ito cosideratio the results of existig midterm ad fial CCS evaluatios. If such evaluatios have take place recetly, they ca be used for this purpose ad a additioal review is uecessary. See Chapter 6. Chapter 4 The Strategic Ageda for WHO cooperatio Suggested legth: 8 10 pages The Strategic Ageda is the core of the CCS process, ad cosists of a set of strategic priorities ad CCS focus areas for WHO s cooperatio with the coutry. These are joitly agreed to with atioal authorities to support the NHPSP. The CCS strategic priorities (3 5 maximum) costitute the medium-term priorities for WHO s cooperatio with the coutry, o which WHO will cocetrate the majority of its resources over the CCS cycle. Each strategic priority makes a specific cotributio towards achievig at least oe coutry health priority ad should covey a message about the objective of the techical cooperatio. The achievemet of each strategic priority is the joit resposibility of the govermet ad WHO. The CCS focus areas (maximum 1 3 per strategic priority) are the what uder each strategic priority to which WHO will specifically cotribute. They reflect the expected achievemet(s) required for reachig the strategic priority ad they are cosistet with ad cotribute to the atioal health priorities ad the global level outcomes i the GPW (see Figure 5). Each focus area will lik directly with a specific GPW outcome. The same GPW outcome ca be used more tha oce if ecessary. CCS focus areas should adopt the SMART format (specific, measurable, achievable, realistic ad time-boud). 22

30 Guide for the formulatio of a WHO Coutry Cooperatio Strategy The CCS WG should udertake the prioritizatio exercise with the govermet at the highest level possible, as well as with parters, especially other UN agecies. The followig list highlights the mai elemets to be cosidered i the selectio of the strategic priorities. 1. the NHPSP 2. the health ad developmet achievemets ad challeges idetified i the strategic aalysis of Chapter 2. (Note: ot every challege eeds to be traslated ito a strategic priority) 3. the outcomes of cosultatios with key stakeholders 4. the outcomes idetified i the UNDAF or DaO programme, if applicable 5. the lessos leart from the review of the ogoig or past CCS cycle 6. the lessos leart from the coutry s experieces ad the potetial for cotributio to health developmet i other coutries ad globally 7. GPW ad WHO s comparative advatage, added value ad core fuctios 8. WHO s fiacial ad huma resources (preset ad future forecasts) 9. the coutry s specificity: depedig o the cotext, strategic priorities may be idetified for emergecy respose, addressig the global health ageda, or other priority issues that are ot reflected i the six leadership priorities, but which are reflected i the strategic plas or other frameworks for techical cooperatio of the respective regioal office. Oe example of how this is reflected i the CCS is show i Figure 3. It illustrates how the atioal health pla feeds ito the CCS ad how differet steps i the assessmet refie the approach further. Figure 4 shows the full process of CCS formulatio idicatig the processes that eed to be take ito cosideratio ad the parties resposible for each stage. 23

31 Guide 2014 Figure 3: Elemets to be cosidered i the prioritizatio of the CCS strategic priorities Priorities idetified i the atioal health policy, strategy or pla - Goals that the Govermet would like to achieve - Key health ad developmet challeges cofrotig the coutry as aalized by WHO Lessos from the review of WHO s past cooperatio WHO s comparative advatage Cotributio to health developmet by other developmet parters WHO s plaig framework WHO CCS Strategic Ageda Objectives ad outputs to which WHO would like to cotribute i achievig atioal health goals Source: Coutry Support Uit, WHO Wester Pacific Regio. Esurig the quality of the Strategic Ageda All strategic priorities ad CCS focus areas must be submitted to the checklist i Table 2 to esure relevace. Table 2: Quality checklist for the Strategic Ageda Item CCS strategic priority CCS focus area Checklist for quality assurace Q1. Is the strategic priority clearly liked to a NHPSP objective? Q2. Is the strategic priority backed by the aalysis? Q3. Is the strategic priority cosistet with the GPW ad oe or more of the leadership priorities? Q4. Does the statemet idicate or describe a cotributio of WHO that is relevat 8 ad achievable 9 withi the CCS period (4 6 years)? Q5. Is the whole set of strategic priorities comprehesive i that they reflect the full rage of objectives for the etire CCS period (4 6 years)? Q6. Are the CCS focus areas liked to the atioal health priorities ad results? Q7. Are the CCS focus areas liked to GPW outcomes? (See Aex 5 for a coutry example of likig CCS focus areas with GPW outcomes.) Q8. Are the CCS focus areas backed by the aalysis? Q9. Do the CCS focus areas reflect a chage or accomplishmet for which WHO is willig to be held accoutable? Q10. Will the completio of the CCS focus areas cotribute to achievig the objective stated i the strategic priority? Q11. Is the scope of the work specific, 10 measurable, relevat, achievable ad time-boud? 11 8 Relevat: it respods to the coutry priorities ad eeds or challeges idetified i the atioal policies, strategies ad plas, ad is withi the madate of the orgaizatio, the GPW, ad the regioal priorities. 9 Achievable: it is realistic give the resources likely to be available. 10 Specific: it idetifies the ature of the expected achievemets or chages, ad the target should be as detailed as possible without beig wordy. 11 Time-boud: it ca be achieved withi the CCS period (4 5 years). 24

32 Guide for the formulatio of a WHO Coutry Cooperatio Strategy There eeds to be a explicit lik betwee the CCS focus areas ad the GPW outcomes (see Figure 4). Each CCS focus area should be liked to oe GPW outcome oly. This should be mapped, guided by Figure 4 ad usig Aex 5 as a format, ad added to the fial documet. The CCS strategic ageda should iform the elaboratio of the bieial workpla. However, if a bieial workpla is already i place, efforts should be made to make programme chages to esure cosistecy betwee the two. It is also ecessary to keep track of curret challeges to iform plaig of the ext bieial workpla. Formulatig a CCS for coutries i fragile situatios I emergecy cotexts, the Strategic Ageda will address immediate priority health ad health developmet eeds of the coutry, based o vulerability ad risk assessmets ad WHO s fuctios i emergecy situatios. It is recommeded that CCSs i coutries i fragile situatios iclude strategic priorities to cover uforesee evets that may require emergecy actio, icludig disease outbreaks ad atural or ma-made disasters (see Aexes 1 ad 1b). Preparatio of the fial versio of the Strategic Ageda Oce the draft Strategic Ageda has bee validated with the NHPSP, the six leadership priorities ad UN- DAF outputs ad outcomes, the CCS team should prepare the fial versio of the Strategic Ageda to be icluded i the mai CCS documet. 25

33 Figure 4: Global model of CCS ad results chai likages Sustaiable Developmet Goals ad other global commitmets ad agreemets WHO Global Programme of Work Leadership Priorities Used for strategic aalysis Natioal developmet pla UNDAF Health compoet of the UNDAF Natioal health policy, strategy or pla Selected joitly by the Member State ad CCS Workig Group Coutry Cooperatio Strategy CCS Strategic Priority CCS Strategic Priority CCS Strategic Priority CCS focus area CCS focus area CCS focus area CCS focus area CCS focus area CCS focus area CCS focus area CCS focus area CCS focus area CCS focus areas must lik to oe GPW/PB outcome

34 WHO Global Programme of Work Results chai GPW/PB Outcomes Icreased access to key itervetios for people livig with HIV Icreased umber of successfuly treated tuberculosis patiets Icreased access to first-lie atimalarial treatmet for cofirmed malaria cases Icreased ad sustaied access to essetial medicies for eglected tropical diseases Icreased vacciatio coverage for hard-to-reach populatios ad commuities Icreased access to itervetios to prevet ad maage ocommuicable diseases ad their risk factors Icreased access to services for metal health ad substace use disorders Reduced risk factors for violece ad ijuries with a focus o road safety, child ijuries ad violece agaist childre, wome ad youth Icreased access to services for people with disabilities Reduced utritioal risk factors Icreased access to itervetios for improvig health of wome, ewbors, childre ad adolescets Icreased proportio of older people who ca maitai a idepedet life Geder, equity ad huma rights itegrated ito the Secretariat s ad coutries policies ad programmes Icreased itersectorial policy coordiatio to address the social determiats of health Reduced evirometal risk factors All coutries have comprehesive atioal health policies, strategies ad plas updated withi the last five years Policies, fiacig ad huma resources are i place to icrease access to people-cetred, itegrated health services Improved access to, ad ratioal use of safe, efficacious ad quality medicies ad health techologies All coutries have properly fuctioig civil registratio ad vital statistics systems All coutries have the miimum core capacities required by the Iteratioal Health Regulatios (2005) for all-hazard alert ad respose Icreased capacity of coutries to build resiliece ad adequate preparedess to mout a rapid, predictable ad effective respose to major epidemics ad pademics Coutries have the capacity to maage public health risks associated with emergecies All coutries are adequately prepared to prevet ad mitigate risks to food safety No cases of paralysis due to wild or type-2 vaccie-related poliovirus globally All coutries adequately respod to threats ad emergecies with public health cosequeces Category 1 Category 2 Category 3 Category 4 Category 5 Selected joitly by the Member State ad WHO Office GPW/PB Outcomes Idicators Number of ew paediatric HIV ifectios (ages 0-5) Number of people livig with HIV o atiretroviral treatmet Percetage of HIV + pregat wome provided with atiretroviral treatmet (ARV prophylaxis or ART) to reduce mother-to-child trasmissio durig pregacy Cumulative umber of volotary medical male circumcisios performed i 14 priority coutries Cumulative umber ot TB patiets successfully treated i programmes that have adopted the WHO-recommeded strategy sice 1995 Aual umber of TB patiets with cofirmed or presumptive multidrug-resistat TB (icludig rifampici-resistat cases) placed o multidrug-resistat TB treatmet worldwide Percetage of cofirmed malaria cases i the public sector receivig first-lie atimalarial treatmet accordig to atioal policy Number of Member States certified for eradicatio of dracuculiasis Number of Member States havig achieved the recommeded target coverage of populatio-at-risk of lymphatic filariasis, schistosomiasis ad soil-trasmitted helmithiasis through regular athelmithic prevetative chemiotherapy Global average coverage with three doses of diphtheria, tetaus ad pertussis vaccies WHO regios that have achieved measles elimiatio Proportios of the 75 coutdow coutries that have itroduced peumococcal, rotavirus or huma papilloma virus (HPV) vaccies ad cocurretly scaled up itervetios to cotrol peumoia, diarrhoea or cervical cacer At least a 10% relative reductio i the harmful use of alcohol, as appropriate, withi the atioal cotext A 30% relative reductio i prevalece of curret tobacco use i persos aged 15+ years A 10% relative reductio i prevalece of isufficiet physical activity A 25% relative reductio i the prevalece of raised blood pressure or cotai the prevalece of raised blood pressure accordig to atioal circumstaces Halt the rise of diabetes At least 50% of eligible people receivig drug therapy ad cousellig (icludig glycaemic cotrol) to prevet heart attacks ad strokes A 30% relative reductio i mea populatio itake of salt/sodium as measured by: age-stadartized mea populatio itake of salt (sodium chloride) per day i grams i persos aged 18+ years A 80% availability of the affordable basic techologies ad essetial medicies, icludig geerics, required to treat major NCDs i both public ad private facilities Proportio of persos with a severe metal disorder (psychosis; bipolar affective disorder, moderate-severe depressio) who are usig services Suicide rate per year per populatio Global idicator (s) o reductio of risk factors o road safety to be developed as part of the Decade of Actio for Road Safety ( ) Global idicator (s) o icreased access to services for people with disabilities to be developed as part of the global disability actio pla Number of stuted childre below five years of age Proportio of wome of reproductive age (15-49 years) with aaeria Number of wome usig cotraceptio for family plaig i the 69 poorest coutries Skilled attedat at birth (percetage of the births atteded by skilled health persoel) Postatal care for mothers ad babies (percetage of mothers ad babies who received postatal care visit withi two days of childbirth) Exclusive breastfeedig for six moths (percetage of childre aged 0-5 moths who are exclusively breastled) Atibiotic treatmet for peumoia (percetage of childre aged 0-59 moths with suspected peumoia receivig atibiotics) Adolescet birth rates (per girls aged years) Global idicator (s) will be developed as part of a global framework o moitorig ageig ad health to be developed by December 2014 Evaluatio processes are i place to esure geder, equity ad huma rights are measured i Secretariat programmes Net primary educatio erolmet rate (MDG target 2A) Number of slum dwellers with sigificat improvemets i their livig coditios (MDG target 7D) Proportio of the populatio without access to improved drikig-water sources Proportio of the populatio without access to improved saitatio Proportio of the populatio relyig primarity o solid fuels for cookig Number of coutries that have a comprehesive atioal health sector strategy with goals ad targets updated i the last five years Number of coutries that are implemetig itegrated service strategies Proportio of coutries facig critical health workforce shortages Availability of tracer medicies i the public ad private sectors Number of coutries that report cause of death iformatio usig the Iteratioal Classificatio of Diseases, 10th revisio Number of coutries meetig ad sustaiig Iteratioal Health Regulatios (2005) core capacities Percetage of coutries with a atioal strategy i place that covers resiliece ad preparedess for major epidemics ad pademics Number of coutries with a atioal atimicrobial resistaces (AMR) actio pla Percetage of coutries with miimum capacities to maage public health risks associated with emergecies Number of coutries that have adequate mechaisms i place for prevetig or mitigatig risks to food safety Number of coutries reportig cases of paralysis due to ay wild poliovirus or type-2 vaccie-related poliovirus i the precedig 12 moths Percetage of coutries that demostrated adequate respose to a emergecy from ay hazard with a coordiated iitial assessmet ad a health sector resposes pla withi five days of oset Category 1 Category 2 Category 3 Category 4 Category 5 Selected by the Member State ad WHO Office

35 Guide 2014 Chapter 5 Implemetig the Strategic Ageda: implicatios for the etire Secretariat Suggested legth: 2 3 pages Oce the draft Strategic Ageda is validated, the team should cosider its implicatios ad the appropriate clearace processes. I determiig the implicatios, the team should address the followig questios: ü Is the core capacity (i terms of huma ad fiacial resources, ifrastructure (icludig iformatio ad commuicatio techology) ad other resources) eeded to implemet the CCS Strategic Ageda available i the WHO coutry office? ü If ot, what are the implicatios for the etire Secretariat of fillig the gaps idetified i terms of priority-settig, programmig ad resposibility? Therefore, i additio to aalysig coutry office resources, the team should aalyse resources available through, or from, the subregioal, regioal ad global levels of WHO, as well as from other coutries, to take advatage of south south ad triagular cooperatio opportuities, if feasible. Table 4: Clearace process ad use of the CCS documet Actio CO RO HQ Fial review by regioal office (RO) ad Headquarters (HQ) X X Clearace by miistry of health (MoH), RO ad HQ X X Agree o the process for the publicatio of the CCS documet with the RO, esurig the proper use of the WHO logo ad publishig stadards X X Sigature ad lauch of the CCS documet by MoH ad HWO a X Widely dissemiate the CCS documet to all staff of the coutry office, to the govermet ad other parters workig i ad with the coutry, as well as publishig o the coutry X office Iteret site Upload the fialized CCS to the regioal database of IRIS (Istitutioal Repository for Iformatio Sharig) X Use CCS priorities to revise existig workplas, to iform the elaboratio of the Bieial Workpla ad budget, to defie ad shape the health compoet of the UNDAF ad other X partership platforms Use the CCS for advocacy ad resource mobilizatio for health X X X Widely dissemiate the CCS documet ad the Brief to all WHO departmets ad divisios, ad to other relevat parters ad stakeholders X X Esure that techical iteractios with the coutry offices ad govermets are cosistet ad based o the CCS priorities X X Esure that CCS priorities are used as the basis for the preparatio of strategic ad operatioal plas icludig budgets ad resource allocatio X X X Esure CCS evaluatio with support from HQ X X Back the approved priorities with relevat resources X X X a This could iclude the Regioal Director or eve HQ depedig o the circumstaces. 28

36 Guide for the formulatio of a WHO Coutry Cooperatio Strategy Chapter 6 Evaluatio of the CCS 6.1 Purpose of the evaluatio The coutry office, uder the leadership of the HWO, with the support of the regio ad HQ, ad i full coordiatio with the MoH ad other parters, should esure the evaluatio of the CCS to assess WHO s cotributio to the atioal health priorities. The proper evaluatio of the CCS is the first step towards assessig WHO s performace i coutries. 6.2 Timig The CCS is reviewed halfway ito, ad agai ear the ed of, the CCS cycle, coicidig with other atioal review processes i the coutry (as relevat). This exercise eeds to be liked with the bieial workpla moitorig ad assessmet of the UNDAF, if feasible. 6.3 Type of evaluatio The midterm review should be more process-orieted ad will be used to correct the implemetatio process of the CCS. (Is the implemetatio of the CCS goig as plaed? Is the coutry facig a particular situatio or crisis, which warrats a chage i priorities?) The ed evaluatio will focus o determiig whether the achievemets of the strategic priorities have cotributed to the NHPSP. The fidigs of the evaluatio will iform the formulatio of the ext CCS. If both reviews are doe at the appropriate time, the iformatio gathered ca readily be itegrated i the ext CCS process. 6.4 Evaluatio process 12 The evaluatio process, led by the HWO, icludes the desigatio of a CCS evaluatio WG (which may iclude a exteral elemet especially for the fial evaluatio), the elaboratio of a roadmap ad the selectio of evaluatio questios Midterm review The midterm review should cosider the followig compoets ad questios: ü the relevace of the strategic priorities i the preset cotext ad progress ü the ivolvemet of the coutry staff i the CCS process ü the support received from the regioal office ad HQ for the CCS developmet ü the hirig of a exteral cosultat ü the cosultatio ad or ivolvemet of other stakeholders ü the dissemiatio of the CCS documet ü usage of the CCS strategic ageda by coutry office staff for the elaboratio of the bieial workpla (BWP) ad by atioal authorities ad other stakeholders 12 Guided by the WHO Evaluatio practice hadbook. Geeva: World Health Orgaizatio; 2013 ( am/10665/96311/1/ _eg.pdf). 29

37 Guide Fial evaluatio The ed evaluatio criteria are relevace, effectiveess, efficiecy ad impact. These criteria are applied alog the lies of the Orgaisatio for Ecoomic Co-operatio ad Developmet/Developmet Cooperatio Directorate (OECD/DAC) criteria for developmet aid. 13 The relevat iformatio will come through review of documets ad from the midterm ad programme budget assessmet report, as well as from meetigs with coutry staff ad exteral stakeholders. 1. The review of the relevace ad achievemet of the strategic priorities Relevace: Are the CCS strategic priorities aliged to the atioal developmet pla ad/or NHPSP? Is each strategic priority liked to oe or more leadership priority? Is each CCS focus area liked to a GPW outcome? Are CCS strategic priorities liked to the regioal strategic pla? Effectiveess: Were the strategic priorities achieved? If ot, which parts were ot achieved ad why? Efficiecy: Did the CCS iform the bieial workpla ad budget i a appropriate way? Impact: Have the strategic priorities of the CCS bee achieved? What was the extet of achievemets i relatio to the GPW outcome idicators, the atioal health priorities ad regioal strategic focus areas? 2. The iput of the aalytical elemet of the CCS to other plaig tools (desk review ad meetigs with WHO coutry staff) Were workplas iformed by the CCS priorities? Note that the coutry s cotext may sigal the impedig ecessity for a shift i workplas if a crisis situatio emerges. Was WHO s comparative advatage ad added value take ito cosideratio durig the plaig process? Are the tools ad resources provided aliged with Member States eeds ad with the eeds of other relevat coutry parter orgaizatios? Did budget allocatios reflect the priorities idetified i the CCS? Were budget allocatios liked to the outcomes of the workplas? Has the CCS bee used for advocacy ad mobilizatio of resources for implemetig the CCS strategic ageda? Has the CCS bee used for adjustig the mix of competecies ad skills i the coutry office? Is the huma resources pla cosistet with the competecies ad skills required to implemet the CCS priorities? Was the techical, maagerial ad admiistrative support from the regioal office ad HQ timely ad adequate? 13 OECD DAC criteria for evaluatio i developmet cooperatio, 30

38 Guide for the formulatio of a WHO Coutry Cooperatio Strategy Did the iformatio techology ad commuicatio ifrastructure provide required support for CCS implemetatio? 3. The cosistecy betwee the CCS strategic priorities ad the UNDAF Have the CCS strategic priorities bee used to iform the health priorities of the UNDAF? The extet to which the CCS cotributed to icreased collaboratio with a wider array of parters at coutry level should also be cosidered. 4. The aalysis of WHO cooperatio with parters The meetig with stakeholders aims to capture the parters perceptios of: WHO s cotributio to ehacig atioal owership WHO s aligmet to atioal health priorities WHO s cotributios to the achievemet of MDGs ad the developmet of the post-2015 Sustaiable Developmet Ageda Areas where WHO s cotributio was required, but was isufficiet to achieve the stated objectives WHO as a member of the UNCT WHO as a broker for health amog parters ad across sectors Areas i which WHO has a comparative advatage ad added value, ad o which it should focus, as well as areas from which it should shift its focus, durig the ext CCS cycle. 6.5 Coclusios ad recommedatios I this cocludig sectio, describe the mai achievemets, gaps ad challeges ad make appropriate recommedatios. The documet should be shared for commets with the regioal office ad HQ. The mai areas to be summarized here are the strategic priorities to iform the BWP, WHO s cotributio to atioal health priorities ad outcomes, WHO s cotributio to UNDAF ad the Oe UN programme ad the differet stakeholders perceptio of WHO s performace. Lessos leart from the moitorig ad evaluatio of CCSs should be shared with other coutries, particularly withi similar coutry groupigs, withi the Secretariat ad with govermet ad parters. 31

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40 Guide for the formulatio of a WHO Coutry Cooperatio Strategy Aex 1a: Guidace for developig a CCS i coutries i fragile situatios The purpose of this documet is to provide guidace to WHO CCS teams to develop more resposive ad effective CCSs with coutries i fragile situatios. The overall CCS process i coutries i fragile situatios will be i accordace with the process set out i the curret CCS guide 2014 ad this documet has bee desiged to complemet that guide. 1. Guidig priciples for articulatig the CCS with coutries i fragile situatios I additio to the priciples of owership, aligmet, harmoizatio ad collaboratio as a two-way process that guides the developmet of all CCSs, the CCS process i coutries i fragile situatios will eed the followig additioal guidig priciples. These are: Soud aalysis of the fragility characteristics: This is a critical startig poit for developig effective resposes i situatios of fragility. Istitutioal developmet: A key objective of the CCS process i coutries i fragile situatios is capacity-buildig of the atioal health authorities ad restoratio of the fuctioality ad steerig role of the miistry of health, icludig at subatioal levels, as a compoet of state buildig. Focus o service delivery: I parallel to the istitutioal developmet, the CCS eeds to focus o esurig that people have access to health services, icludig i areas where the public health service delivery has bee disrupted. Aligmet ad strategic parterships: The CCS should take ito accout the Priciples for good iteratioal egagemet i fragile states ad situatios as defied by the Orgaisatio for Ecoomic Co-operatio ad Developmet (OECD) i These priciples provide a set of guidelies for actors ivolved i developmet cooperatio, peace buildig, state buildig ad security i fragile ad coflictaffected states as well as the decisio of the UN Secretary-Geeral o UN support of the New Deal for Egagemet i Fragile States dated 12 July Defiig ad aalysig fragility There are several defiitios of fragility ad/or fragile states, ofte used to idetify ad group coutries. The Orgaisatio for Ecoomic Co-operatio ad Developmet/Developmet Co-operatio Directorate (OECD/ DAC) has defied a state as beig fragile whe state structures lack the political will ad/or capacity to provide the basic fuctios eeded for poverty reductio, developmet ad to safeguard the security ad huma rights of their populatio. 14 The New Deal outlies a ageda for more effective aid to fragile states, based o five peace-buildig ad state-buildig goals (legitimate politics, security, justice, ecoomic foudatios, ad reveues ad services), stroger aligmet ad mutual accoutability, ad more trasparecy ad ivestmets i coutry systems based o a shared approach to risk maagemet. The five peace- ad state-buildig goals are at the core of UN egagemet i most coutries affected by coflict ad crisis. See also 33

41 Guide 2014 Cautio is required whe classifyig or groupig such states, as coutries labelled as fragile are heterogeeous ad the modalities for itervetios eed to be adapted to the cotext-specific priorities ad uderlyig political settlemets. 15 Furthermore, fragility is dyamic, ad chages over time. Some coutries with fragile situatios could be i post-coflict, early recovery, trasitio, or developmet phases, or faced with recurret disasters ad humaitaria crises, while i other coutries all these differet cotexts of fragility might exist simultaeously. To allow for flexibility ad cotext specificity, it is importat to idetify factors that either cotribute to fragility or that result from it. This way, we ca see which of these factors apply at a particular time to a particular coutry ad what their ifluece is o the health sector ad the CCS process ad cotet. It is therefore importat for all HWOs ad CCS developmet teams to assess ad aalyse fragility i their host coutries ad see how this guidace ote could accompay the CCS process. There are various tools for aalysig fragility. 16 The CCS team eeds to idetify reports i which such aalyses have bee doe, ad the determie how these may affect the health sector 3. Characteristics of fragile situatios ad justificatio for developig cotext-specific CCSs with coutries i fragile situatios Coutries i fragile situatios are ofte characterized by severe developmet challeges such as isecurity, weak capacity or uwilligess to deliver basic state fuctios, chroic or recurrig humaitaria crises, persistet social tesios, ecoomic ad political istability, lack of accoutability, poorly fuctioig istitutios ad sigificat costraits o achievig the MDGs. There are several socio-political ad security factors oted i coutries i fragile situatios that impact the health sector ad should be take ito cosideratio whe developig the CCS. These iclude: ü Pervasive security problems with violece caused by armed coflict, drug or huma traffickig, leadig to restrictios o UN staffig or their movemet i coutry, which could result i remote cotrolled programme maagemet. ü Widespread huma rights violatios icludig effects o the right to health ad possible exacerbatio of pre-existig iequities. The impact o the health sector may be reduced access of the affected populatio to services, deliberately excluded or margialized groups, ad risk of violatios of the priciples of medical eutrality, whereby the health sector may become a target, or where health-care providers may participate i the huma rights violatios. ü Oppositio groups cotrollig sigificat parts of the coutry, ad differet parts of the coutry differetly affected by fragile situatios. The impact for the health sector may be that there is a eed to egage i areas that are ot uder govermet cotrol, ad to have approaches that are adapted to the differeces that may exist i the various regios i the coutry. 15 Bertoli S, Ticci E. A fragile guidelie to developmet assistace. Dev Policy Rev. 2012;30(2): Departmet of Iteratioal Developmet. Workig effectively i coflict affected ad fragile situatios. Summary ote. ( uk/govermet/uploads/system/uploads/attachmet_data/file/67696/summary-ote-briefig-papers.pdf). ad Departmet of Iteratioal Developmet. Briefig paper A: Aalysig coflict ad fragility. Lodo: DFID; 2010 ( attachmet_data/file/67693/buildig-peaceful-states-a.pdf). 34

42 Guide for the formulatio of a WHO Coutry Cooperatio Strategy 4. Adapted CCS process with coutries i fragile situatios Although aliged with the 2014 CCS Guide, some of the approaches withi each elemet will eed to be adapted i coutries with fragile situatios. a. Preparatio Compositio of the CCS team It is importat that at least oe of the team-members has the appropriate competecies for diplomacy ad a uderstadig of the political cotext, as well as expertise o health systems i coutries with fragile situatios ad/or humaitaria cotexts. Choosig appropriate timig ad timeframe for the CCS The timig of the CCS should take ito accout specific plaig cycles liked to fragility to esure syergies ad reduce trasactio costs. The CCS cycle could be shorter to brig it ito aligmet with the cycles of atioal plas or strategies such as the atioal recostructio, recovery ad developmet pla. Where applicable, the CCS should articulate with humaitaria strategies ad the Commo Humaitaria Actio Pla of the Cosolidated Appeal Processes. However, where the CCS cycle has to be as log as 5 years, it will be essetial to have a aual or bieial review of the CCS. Security briefig This is ecessary to obtai adequate iformatio o the coflict dyamics ad possible movemet restrictios, as well as to esure the safety of the CCS team. Iclusiveess of the CCS process ad dialogues It is critical to udertake a wide stakeholder cosultatio. There may be a eed to idetify a mixture of alterative approaches to esure iclusive dialogues for the health ad developmet situatio aalysis as well as the strategic ageda formulatio (e.g. iterviews usig Skype or makig use of the atioal staff to cosult with stakeholders that are ot accessible to iteratioal staff who may be costraied by security cocers or restrictios o movemet). Sesitivity to coflict dyamics Stakeholder aalysis ad mappig should be sesitive to coflict dyamics, esurig represetatio of views of various parties to the coflict. Sceario, situatio ad fragility aalysis There is a eed to uderstad the uderlyig causes of fragility, idetify immediate risks of istability, to cosider i greater depth the political cotext, coutry capacity ad resiliece, ad possible scearios. Specialized iformatio sources Key iformatio o cotext ad coflict aalyses ca be foud i coutry-specific publicatios, such as: l the Iteratioal Crisis Group l the Ecoomist Itelligece Uit l the Cetre for Research o the Epidemiology of Disasters l the ew deal for peace iitiative at For further readig see the WHO maual for Aalysig disrupted health sectors ( hac/techguidace/tools/disrupted_sectors/e/idex.html). 35

43 Guide 2014 b. Developmet Strategic Ageda udertake a cotext-specific prioritizatio process with all the relevat stakeholders to esure the agreed strategic priorities are relevat, aliged with atioal recostructio ad developmet priorities ad have the potetial to be effectively implemeted. Recovery may take up to 15 years or more, therefore, it is ecessary to develop a strategy that takes a log-term view, while aimig for short-term, realistic, icremetal steps. c. Implemetatio The timig of the CCS lauchig should be carefully selected, preferably to be i lie with the statead peace-buildig ageda or other atioal multisectoral policy ad plaig processes, to geerate maximum effect. Furthermore, the implemetatio of the CCS strategic ageda may be affected by chages i the fragility situatio i the coutry. Emergig from fragility is ofte ot a liear process ad implemetatio of ay pla or strategy ca therefore face uexpected costraits or setbacks. d. Moitorig ad evaluatio of the CCS The possible shorter implemetatio cycle of the CCS i coutries i fragile situatios, ad the fact that there are ofte sigificat chages i the cotext ad characteristics of fragility, also call for a shorter period for reviews ad the ecessary revisios after such reviews. For example, aual reviews of the CCS udertake at the same time as reviews of other atioal recovery processes ca be cosidered. 5. Outlie of the CCS documet for coutries i fragile situatios 17 Chapter 1: Itroductio Chapter 2: Health ad developmet situatio 2.1 Mai health achievemets ad challeges This chapter should start with a summary of the cotext, coflict ad/or fragility aalyses, scearios 18 ad evolutio, icludig health emergecy risk assessmet ad the presece of disparities, as differet parts of the coutry are ofte differetly affected by fragile situatios ad this may chage over time. The ext step is a critical aalysis of the health system with particular focus o the effects of fragility o: ü Service delivery damaged ad/or destroyed health ifrastructure; uequal access to health services. 17 Iclude examples of characteristics of fragility that will eed to be take ito accout i relatio to the respective chapters. 18 To icrease the flexibility of the sceario aalysis, the aalyses should cover the three classic scearios of: improvemet, status quo, ad deterioratio. 36

44 Guide for the formulatio of a WHO Coutry Cooperatio Strategy ü Goverace iterruptio of policy process ad sector coordiatio with weak steerig role of the atioal ad subatioal health authorities ad ieffective emergecy preparedess ad respose. There may be a ew iterim govermet ad possible revisio of the NHPSP, which ca be see as a opportuity to restore a policy dialogue that gives promiece to health. The multiplicity of actors with diverse agedas, udermies the goverace role of the atioal health authorities ad leads to fragmetatio or duplicatio of health service delivery ü Health iformatio system fragmeted ad may challeges i validatig existig data sets. ü Huma resources for health loss of staff, uequal distributio of huma resources, utraied staff or ucertified traiig by various NGOs, task shiftig, loss of huma resources for health to aid agecies or diaspora returig. ü Health fiacig weak fiacial maagemet capacity of the miistry of health ad high depedece o exteral assistace. Humaitaria fudig may ivolve Multi-Door Trust Fuds ad/ or pooled fudig mechaisms for humaitaria aid, icludig cosolidated appeal ad/or cetral emergecy respose fud for uderfuded emergecies. ü Pharmaceutical products atioal productio ad distributio may be iterrupted. There is absece of regulatio of import ad quality ü Health status of the populatio icludig treds, disparities ad disaggregatio of data: Poor materal ad child health, excessive burde of commuicable diseases, or disruptios of access to diagosis ad treatmet for chroic ad ocommuicable diseases. ü Health determiats icludig iequity ad geder-based violece 2.2 Collaboratio with the UN ad other parters Review the specific coordiatio arragemets with the UN ad iteratioal parters that may or may ot support atioal coordiatio, the presece of a humaitaria coordiator or humaitaria coordiatio team (health cluster coordiatio). Take ito cosideratio the existece of recovery/trasitio coordiatio ad plaig mechaisms, for example liked with post-coflict eeds assessmet ad recovery plaig supported by the World Bak Europea Commissio Uited Natios (WB-EC-UN) ad coordiatio mechaisms outside the coutry, icludig coordiatio for multiple coutries affected by the same hazard. 2.3 Cotributios of the coutry to the global ageda Role of the coutry i regioal, ad global activities (if ay) o health maagemet i fragile situatios (for example beig a member of the Busa ew deal ). Global health iitiatives such as Gavi, or the Global Fud to Fight AIDS, Tuberculosis ad Malaria (GFATM), may have adapted programmes, coordiatio structures ad implemetatio chaels to take ito accout the fragility i that cotext. Global eradicatio or elimiatio programmes ofte face difficulties i achievig effective implemetatio ad coverage i coutries with fragile situatios. 37

45 Guide 2014 Chapter 3: Review of WHO cooperatio Critical aalysis of what WHO ad other actors ad stakeholders have doe to address cosequeces of fragility for the health sector ad how priciples of egagemet with coutries i fragile situatios were take ito accout: idetifyig gaps, ad what has worked ad why. Chapter 4: A Strategic Ageda for WHO cooperatio The Strategic Ageda must be resposive to the characteristics of fragility idetified i the coutry, based o iclusive dialogue with stakeholders, strategic aalysis ad prioritizatio. The team must cosider the potetial role of the health sector ad social services i state- ad peace-buildig ad focus o service delivery, seekig multiple chaels for implemetatio adapted to the cotext. A useful referece is Priciples for egagemet i coutries i fragile situatios ad the Busa New deal : Chapter 5: Implemetig the Strategic Ageda implicatios for the etire Secretariat The implicatios for the WHO Secretariat ivolve capacity, poolig of resources, ad applicatio of stadard operatig procedures (SOPs) for emergecies. See also the WHO Emergecy Respose Framework (ERF) documet that provides guidace o WHO coutry office structures durig emergecies. 19 Priciples for good iteratioal egagemet i states i fragile situatios 20 as applicable to CCS developmet with such coutries ü Take cotext as the startig poit Esure that the strategic ageda is adequately rooted i a uderstadig of the coutry cotext. The coutry cotext covers issues of political ecoomy aalysis, coflict aalysis ad the assessmet of state-buildig challeges. ü Do o harm CCS developmet ad the agreed strategic ageda should ot lead to the weakeig of state capacity ad/or legitimacy, either should the ueve distributio of techical support lead to a uitetioal wideig of social disparities. ü Focus o state-buildig as the cetral objective techical focus or ivestmets i istitutioal developmet/capacity-buildig i the Strategic Ageda should ot be limited to the goverace level. ü Prioritize prevetio aalyse risks i a systematic ad sustaied maer ad esure that itervetios are ot patchy but are plaed withi the overall strategy for crisis prevetio ad health system rebuildig with a special focus o capacity-buildig for sustaiability. ü Recogize the liks betwee political, security ad developmet objectives aim for itegrated whole-of-govermet approaches ad seek the required buy-i across the various relevat sectors through iclusive dialogue ad cosultatios Priciples for fragile states ad situatios. Paris: Orgaisatio for Ecoomic Co-operatio ad Developmet; 2007 ( dacfragilestates/). 38

46 Guide for the formulatio of a WHO Coutry Cooperatio Strategy ü Promote o-discrimiatio as a basis for iclusive ad stable societies As far as possible, esure that collated data ad the related aalyses are disaggregated to demostrate disparities ad treds. The agreed Strategic Ageda, i tur, should be as iclusive ad o-discrimiatory as possible ad based o a aalysis of the disaggregated data. ü Alig with local priorities i differet ways i differet cotexts Esure aligmet of the CCS Strategic Ageda with atioal health priorities ad deepe aligmet i Strategic Ageda implemetatio through the use of coutry systems for example i moitorig ad evaluatio. ü Agree o practical coordiatio mechaisms Esure that the Strategic Ageda prioritizatio process ad the implemetatio of the agreed Strategic Ageda do ot foster fragmetatio but rather seek to promote coordiatio of parter support for govermet plas ad programmes. ü Act fast but stay egaged log eough to give success a chace. Esure a mixture of strategic priorities that ca meet immediate eeds as well as those that assure the coutry of medium-term predictability of techical support based o joitly agreed bechmarks. ü Avoid pockets of exclusio Esure a eve distributio of techical support. 39

47 Guide 2014 Aex 1b: Guidace for itegratig health emergecy risk assessmet, capacity assessmet o emergecy risk maagemet for health ad WHO readiess for emergecy respose ito CCSs 1. Itroductio All coutries from commuity to atioal levels are at risk of emergecies or disasters arisig from a rage of hazards, which ca affect public health, health ifrastructure, services ad progress o health developmet as well as WHO s programme of techical cooperatio with Member States. Hece the eed durig the developmet of all WHO CCSs to assess the potetial risks i the coutry that could lead to emergecies with health cosequeces, the capacity of the coutry to maage such risks ad WHO s readiess to respod to emergecies. This sectio has bee developed to provide brief guidace to WHO CCS teams o how to itegrate the outcomes of these three assessmets ito all ew CCSs. 2. Defiitios A all-hazards atioal health emergecy risk assessmet A all-hazards atioal health emergecy risk assessmet (HERA) describes the ature ad extet of risks from all potetial hazards ad existig vulerabilities that could cause harm to exposed people or cause damage or disruptio to health ifrastructure ad services. HERA cosists of four compoets amely: cotext aalysis, risk idetificatio (hazard ad vulerability aalyses), risk aalysis ad risk evaluatio. Capacity assessmet o emergecy risk maagemet for health Capacity assessmet o emergecy risk maagemet for health (ERM-H) provides iformatio o the stregths of, ad gaps i, the coutry s multisectoral ad health systems to maage the risks of emergecies, implemet the Iteratioal Health Regulatios (2005) ad stregthe commuity ad atioal resiliece. Assessmet of WHO readiess for emergecy respose This assessmet determies WHO`s readiess to provide a timely ad effective respose to emergecies ad disasters i support of Member States ad to be a effective parter with the UN ad bilateral agecies at coutry level. This icludes WHO s ability to fulfil its resposibilities uder the Iteratioal Health Regulatios (IHR), the Iter Agecy Stadig Committee (IASC) Trasformative Ageda ad as Global Health Cluster Lead. 40

48 Guide for the formulatio of a WHO Coutry Cooperatio Strategy 3. How to itegrate the three assessmets ito the CCS process ad documet a. The CCS process The followig key steps should be take by the CCS team to achieve itegratio ito the CCS process: Iclusiveess of the CCS process ad dialogues iclude the key stakeholders resposible for multisectoral ad health emergecy risk assessmet, emergecy risk maagemet for health, Iteratioal Health Regulatios ad WHO readiess for emergecy respose i the CCS cosultatios. Health ad developmet situatio aalysis Note to solicit aswers for the HERA, capacity assessmet o ERM-H ad WHO readiess for respose. b. The CCS documet The framework i Table 1b1 shows how ad where to briefly itegrate the outcomes of the HERA, capacity assessmet o ERM-H ad assessmet of WHO readiess for emergecy respose ito the CCS documet. Table 1b1 Itegratig outcomes of assessmets ito CCS documet Sectios i the CCS documet Key elemets to iclude Chapter 1: Itroductio Chapter 2: Health ad developmet situatio Macroecoomic, political ad social cotext o The risk of political istability (civil war, adverse regime chages, ethic coflict) icludig history of emergecies i the coutry Other major determiats of health o Outcome of all-hazard aalysis ad the potetial cosequeces for the health status of the people, health ifrastructures, health systems ad services Health status of the populatio o Outcome of vulerability aalysis: differetial effects ad vulerabilities to emergecies across the populatio ad subpopulatios Natioal resposes to overcomig health challeges o Outcomes of capacity assessmets of atioal multisectoral capacities, stregths ad gaps i maagig risks to health o Outcome of assessmet of coutry capacities for IHR Health systems ad services, ad the respose of other sectors o Outcomes of assessmet of health systems capacities, challeges, gaps at coutry level for ERM-H icludig for prevetio, preparedess, respose ad recovery Natioal cotributio to ad role i global health o Role of the coutry i regioal ad global activities i ERM-H, IHR, cross-border, regioal ad iteratioal agreemets ad arragemets o Good practices i ERM-H, icludig risk assessmet which could be shared with other coutries Chapter 3: Evaluatio of WHO cooperatio durig the past CCS cycle o Outcomes of iteral ad exteral review of WHO cooperatio i stregtheig atioal ERM-H ad WHO readiess for respose ad recovery Chapter 4: Strategic ageda for WHO s cooperatio Defiitio of strategic priorities o Based o the outcomes of the three assessmets ad if required, iclude a strategic priority for stregtheig WHO readiess for emergecy respose i coutry, ad developig atioal capacities o ERM-H, icludig the IHR Chapter 5: Implemetig the strategic ageda: implicatios for the Secretariat o State briefly, the related implicatios i the case that a strategic priority related to HERA has bee selected as part of the strategic ageda 41

49 Guide 2014 Aex 2: Itegratig essetial criteria of geder, health equity ad huma rights ito the CCS process ad documet Geder, equity ad huma rights criteria Iclusive dialogue Iclusive dialogues durig the CCS process, iclude cosultatio with wome ad me from subpopulatios experiecig differetial exposure, vulerability, access, ad treatmet outcomes or cosequeces, as a result of characteristics that may cotribute to social exclusio or disadvatage, such as place of residece, race or ethicity, occupatio, geder or sex, religio, educatio or socioecoomic status. Iclusive dialogues durig the CCS process iclude cosultatio with atioal bodies o huma rights ad atioal bodies o wome. Aalysis The aalysis iformig the CCS icludes idetificatio of the differeces betwee me ad wome resultig from (i) geder orms, roles, ad relatios; (ii) differetial access to ad cotrol over resources; ad (iii) biological differeces, across the life-course, i: o ü risk factors, exposures ad disease maifestatios o ü severity ad frequecy of disease burde health-seekig behaviour o ü access to care, experieces i health-care settigs o ü outcomes ad impact i (cotext-specific) priority health areas. The aalysis iformig the CCS icludes idetificatio of socially excluded or disadvataged subpopulatios. The aalysis iformig the CCS icludes assessmet of the: i) availability, ii) accessibility, iii) acceptability ad iv) quality i the provisio of health-care services for socially excluded or disadvataged subpopulatios. The aalysis iformig the CCS health ad developmet challeges takes ito cosideratio recommedatios o the right to health made to the coutry as a result of oe of the Treaty Body moitorig mechaisms, Special Procedures (e.g. Special Rapporteurs) or Uiversal Periodic Review to which the coutry is party. Strategic priorities ad outcomes Should advocate reducig or mitigatig ways i which geder orms, roles or relatios egatively impact, or beefit from, access to ad use of health services. Should advocate reducig or mitigatig iequitable exposure, vulerability or access of socially excluded or disadvataged subpopulatios. Should advocate iclusio ad participatio of socially excluded or disadvataged subpopulatios. Report Data i the CCS report are disaggregated by sex ad the followig stratifiers where possible ad relevat: age, rural/urba, household wealth, ethic group, educatio. The CCS report icludes iformatio o geder aalysis ad equity aalysis. The CCS report icludes referece to iteratioal huma rights treaties, covetios or stadards o the right to health ratified by the coutry. 42

50 Guide for the formulatio of a WHO Coutry Cooperatio Strategy Aex 3: Guidace ad template for CCS brief The template is customized for each coutry ad set by Headquarters. The data i the curret health idicators box are automatically updated based o the most recet data available from the Global Health Observatory ( If idicators other tha the curret health idicators are used i the body of the text, the data used must be up to date ad the data sources quoted. The coutry map is automatically geerated usig the stadard WHO maps available o the website ( apps.who.it/gho/data/ode.cco). The suggested maximum word cout for the CCS brief is 1350 to Briefs may be produced i Spaish or Frech, i additio to Eglish, depedig o the laguage of the coutry. The text of the CCS brief should be succict, highly aalytical ad based o the cotet of the most recet CCS documet. Health situatio ( words) Cotet should be cocise ad highly aalytical based o the coclusios of the health situatio aalysis i the CCS documet. It should cover: ü progress i health status of the populatios, showig treds ad disparities; ü disease patters ad burdes (icludig commuicable, ocommuicable ad re-emergig diseases) ad major determiats of health; ü status of achievemet of iteratioal agreemets/commitmets (e.g. MDG targets, WHO Framework Covetio o Tobacco Cotrol (FCTC) ad Iteratioal Health Regulatios (IHR) implemetatio); ü key gaps ad challeges i a populatio s health status that justify the selectio of the agreed CCS Strategic Ageda. Health policies ad systems ( words) Cotet should highlight i a cocise ad aalytical maer the existig policy ad systems issues that could facilitate or challege the atioal priorities ad the six leadership priorities of the 12th GPW which justify the selectio of the agreed Strategic Ageda: ü key health policies (i.e. istrumets, legislatio ad frameworks) existig i the coutry, with years, ad icludig status of implemetatio; ü key health itervetios put i place as a result of policy orietatio of the coutry resultig from World Health Assembly (WHA) resolutios, iteratioal agreemets such as MDGs ad other developmets i health; ü key features of the orgaizatio of the health system ad delivery mechaism(s), icludig private forprofit ad ot-for-profit istitutios i the coutry that affect access ad health outcomes. 43

51 Guide 2014 Cooperatio for health ( words) Cotet should reflect key issues withi the cooperatio eviromet for health that justify the agreed Strategic Ageda. Idetify the key stakeholders ad key processes for cooperatio for health: ü UN systems ad delivery mechaisms Deliverig as Oe (DaO), Uited Natios Developmet Assistace Framework (UNDAF) ad joit programmig where applicable; ü bilateral agecies ad other o-state actors workig i the coutry ad with whom WHO works; ü partership framework for developmet cooperatio (e.g. Busa, Iteratioal Health Partership [IHP+] Every Woma Every Child) ad cotributio to global health where applicable. Acroyms should be spelt out i full the first time they are used ad subsequetly the acroym ca be used. Acroyms should be used sparigly to ehace readability. Coutry offices are requested to maitai the stadard fot from the template, Calibri, for both the headigs (size 12) ad the body text (size 8, miimum size 7.5). The automatically geerated text of the coutry ame ad idicators should remai i Arial, size 22 ad 6, respectively). It is importat to keep easy readability of the briefs i mid whe selectig the appropriate fot type ad size. Text i the boxes should be justified. Briefs should be well edited to maitai techical itegrity. Oce produced, coutry offices are requested to sed the Word documet to CCU for fial editig, formattig ad postig o the global website. 44

52 Guide for the formulatio of a WHO Coutry Cooperatio Strategy Figure 5: Template for CCS brief 45

53 Guide 2014 Figure 5: Template of CCS brief (cotiued) 46