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Progress in reducing neonatal mortality in the Eastern Mediterranean Region has been slower than progress in reducing under-5 mortality and maternal mortality. Between 1990 and 2015, neonatal mortality was reduced by 37%, as compared to a 48% and 54% reduction in under-5 and maternal mortality, respectively.

Between 1990 and 2020, neonatal mortality was reduced by 46%, as compared to 58% reduction in under-5 mortality. Neonatal deaths constituted 56% of under-5 deaths in the Region in 2020. The leading causes of neonatal mortality are:

prematurity

intra-partum complications

neonatal sepsis

congenital anomalies.

The burden of neonatal deaths in the Region is mainly in 9 countries that contribute to more than 97% of the overall number of neonatal deaths.

ENAP

Every Newborn Action Plan

Prematurity

Essential newborn care

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About UHC

Universal health coverage (UHC) means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship. For countries to achieve UHC they require a strong, efficient, well-run health system that meets priority health needs through people-centred integrated care and a system for financing health services so people do not suffer financial hardship when using them.

Universal health coverage has a direct impact on a population’s health. Access to health services enables people to be more productive and active contributors to their families and communities. It also ensures that children can go to school and learn. At the same time, financial risk protection prevents people from being pushed into poverty when they have to pay for health services out of their own pockets. Universal health coverage is thus a critical component of sustainable development and poverty reduction, and a key element of any effort to reduce social inequities. Universal coverage is the hallmark of a government’s commitment to improve the well-being of all its citizens.

UHC is firmly based on the WHO Constitution of 1948 declaring health a fundamental human right and on the Health for All agenda set by the Alma-Ata declaration in 1978.

WHO identifies UHC as a strategic priority, with the goal of 1 billion more people benefiting from universal health coverage by 2023.

UHC does not mean free access to every possible health service for every person. Every country has a different path to achieving UHC and deciding what to cover based on the needs of their people and the resources at hand. It does, however, emphasize the importance of access to health services and information as a basic human right.

UHC service coverage index

UHC is the overarching platform for achieving the health-related SDGs and one of the key objectives of WHO’s 13th General Programme of Work (2019–2023). The ministers of health of the Region signed the UHC2030 Global Compact collectively at the Ministerial Meeting on the Road to Universal Health Coverage in Salalah, Oman, in September 2018. The ministers confirmed their commitment to achieving UHC through a whole-of-government and whole-of-society approach, and endorsed the Salalah Declaration to “Recognise the key role of Universal Health Coverage in realizing the right to health care and the right to health of all people in the Eastern Mediterranean Region”.

Sixteen tracer indicators that include reproductive, maternal, newborn and child health, infectious diseases, noncommunicable diseases, and service capacity and access, have been selected to measure the breadth of essential health services for UHC (SDG target 3.8). The UHC service coverage index combines the 16 tracer indicators of service coverage into a single summary measure. According to the UHC index, essential health services are less widely available in the Eastern Mediterranean Region than in most regions of the world. In 2015, the UHC service coverage index had a global value of 64 (out of 100), based on data from the WHO/World Bank 2017 global monitoring report.

Ten countries in the Region stand at 64 or less on the UHC service coverage index. This translates to about 347 million people, or a weighted average of 53% of the Region’s population, having access to basic UHC services. Therefore, almost half of the Region’s population do not have access to 16 essential health services.

The 2019 global monitoring report shows that between 2000 and 2017, the UHC global index value increased from 45 to 66 (out of 100); however, the value remained at less than 60 for the Eastern Mediterranean Region.

uhc-service-coverage-index

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Implementing WHO management reforms

Programmes and priority-setting

Supporting Member States continues to be at the centre of WHO’s work. The initial phases of the development of 2018–2019 programme budget were undertaken in close consultation with Member States through bottom-up planning approach. A preliminary human resources planning exercise was conducted in the Region to inform the development of a programme budget based on realistic needs. The category and programme area networks proactively supported the planning exercise by providing guidance and feedback to country offices, and by stimulating cross-cutting programme planning aligned with the SDGs. As a result nearly two thirds of the Region’s budget for base programmes was allocated to country offices, one of the highest proportions among all regions.

The outcome of the mid-term review exercise showed that 76% of the expected outputs were on track to be achieved by the end of the biennium, despite the financial challenges and conflicts in several countries. As with the programme budget planning, the category and programme area networks played a vital role in ensuring achievements and challenges at the country level were captured in the regional progress reports and in informing adjustments to the programme directions.

In December 2016, a regional standing group on evaluation was established with the aim of facilitating implementation of the global evaluation policies and building a culture of evaluation and organizational learning in the Region. Following its first retreat, the group’s vision, mission and scope were outlined and a plan of action was drafted.

Human resources remain the Organization’s core investment to support Member States. Capacity-building activities for staff on results-based management, programme management and related areas were reinstated in 2016. In close collaboration with the human resources team, an overview of WHO’s results-based management cycle was integrated into the Region’s induction programme for new staff. More such capacity-building activities are planned in the future with a focus on the staff in country offices.

As part of enhancing support to country offices, a regional network of programme management focal points was established to improve the coordination of programme management and related exercises across the Region. The network played a key role in the improvement of statutory monitoring and reporting during the mid-term review exercises. A new Business Intelligence tool was also launched which generates a wide range of information to inform decision-making, including several dashboards aimed at improving the monitoring of programme implementation.

Governance

High-level meetings for ministers and representatives of Member States and permanent missions in Geneva continued to be held prior to the World Health Assembly and Executive Board. These meetings provided an excellent opportunity to review with ministers of health and senior government officials the progress in addressing key priorities since the previous meetings. They have also had a positive impact in strengthening the engagement of Member States in global discussions on health and WHO reform. Daily briefings during the Executive Board meeting and Health Assembly provided additional opportunities for Member States from the Region to interact and agree on common positions that affect the Region.

At its 63rd Session in October, the Regional Committee adopted several amendments to its rules of procedure that concern: a code of conduct for the nomination of the Regional Director; election of officers; establishment of a programme subcommittee; and identification of a process for the nomination of Executive Board members and the nomination of a country of the Region as President and other elected officials of the World Health Assembly. These amendments are in line with global governance reform and reflect efforts to harmonize procedures across the Organization.

Management

The Regional Office continued to develop essential instruments for the enhancement of the WHO reform process with special emphasis on managerial reform, working closely with all other levels of the Organization to achieve the goals listed in the 12th General Programme of Work. It also continued to improve its planning, forecasting, implementation, monitoring and evaluation capacity aimed at more efficient use and distribution of limited resources.

The managerial actions associated with the reform process taken by the Regional Director with respect to staff mobility and rotation, performance management and human resources planning and management continued. Accountability and controls remained at the heart of improvement efforts with focus on the compliance areas, which were repeatedly mentioned in preceding years’ internal and external audit observations: direct financial cooperation, direct implementation, imprest purchase orders, asset inventories and non-staff contractual arrangements. The use of monthly compliance dashboards throughout the year has increased the awareness and capacity of staff across the Region with regard to key administrative issues. Activities aimed at managing financial and administrative risks effectively, improving the internal control framework, reducing audit observations to a minimum and closing outstanding audit observations in a timely manner. In 2016 all audits resulted in satisfactory or partially satisfactory ratings, showing continued improvement in controls and a deep commitment to zero tolerance to non-compliance across the Region.

WHO will continue to address key challenges including the need for: capacity building to help Member States remain aligned with evolving requirements; strengthening country level perspectives in responding to acute and protracted emergencies; consideration to deploy and deliver on a no-regrets basis; and continual improvement in accountability and control, as embedded in the regulatory frameworks.

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