In 2012, the Regional Committee passed a resolution endorsing a proposed roadmap on strengthening health systems as a strategic priority, as well as necessary steps towards boosting universal coverage with quality health services at both the population and individual levels. The resolution was based on an in-depth analysis, conducted by the Regional Office in 2012, of the challenges facing health development in the Region and a review of WHO’s work in supporting Member States in addressing these challenges.

Health systems in the Region face many challenges that are generally cross-cutting in nature and apply to most countries irrespective of socioeconomic and health development. Addressing these challenges is critical to the achievement of universal health coverage. Countries have been categorized into three groups based on population health outcomes, health system performance and level of health expenditure (see Table 1)¹. Countries in groups 2 and 3 face inadequate financing and a high share of out-of pocket expenditures for health. In some low-income countries, such payments are as high as 75% of the total health expenditure. High levels of out-of-pocket payment are a major impediment to the move towards universal health coverage (Figure 1). Other challenges relating to the lack of comprehensive, people-centred, and quality health care services, ensuring adequate health workforce, improving access to essential medicines and technologies and bridging the gaps that currently exist in health information systems will also have to be addressed in the journey to universal health coverage. The need for high-level political will and commitment to move towards universal health coverage with quality population and individual health services is the predominant challenge for many countries.

Table 1. Trends in key health outcomes in the Eastern Mediterranean Region, 1990–2010

* Values are medians
– Information not available
Source: Health systems strengthening in countries of the Eastern Mediterranean Region: challenges, priorities and options for future action. Technical paper presented to the WHO Regional Committee for the Eastern Mediterranean, Fifty-ninth session, 2012 (available at www.emro.who.int/about-who/rc59/).

Figure 1. Share of out-of-pocket in total health expenditure by country group, 2011 (%)

Health financing and governance

WHO’s work in health financing was rejuvenated following the publication of the World Health Report 2010, which focused on reforming health financing systems to move towards universal health coverage. In 2012, requests were received from countries in all the three groups for support in this area. WHO has also focused on building the national capacities to generate the evidence needed to inform equitable, efficient and sustainable health financing policies. This included a capacity-building workshop in the new system of health accounts (SHA 2011) provided to health financing experts from 11 countries and a capacity-building exercise on the use of the new WHO tool OASIS (Organizational assessment for improving and strengthening health financing), aimed at assessing the bottlenecks undermining health financing systems performance. The Regional Office prioritized the assessment of progress towards universal health coverage in the Region. An assessment framework was developed and implementation is planned in 2013. This is intended to support Member States and WHO in monitoring equity in health financing and progress towards social health protection.

Two events provided opportunity for Member States to share experiences in reforming health financing systems to move towards universal health coverage: a policy dialogue between ministers of finance and health on “Value for money, sustainability and accountability in the health sector”, held in Tunisia for African Member States in collaboration with the African Development Bank and other development agencies; and a side session on health financing and universal health coverage, held during the 59th session of the Regional Committee. The two events have engaged countries in the current global debates around health care financing and its vital role in promoting the agenda of universal health coverage. The events were followed by a high-level seminar on health financing organized in Cairo in January 2013.

The purpose of employing the various health financing analytical tools is to generate results that can be used in national policy dialogues around the future of health financing in the specific local contexts. The Regional Office has facilitated such dialogues and focused discussions around health financing in Libya, Oman and Tunisia and provided technical support to other countries. The work to map health financing and assess where countries stand in terms of their health financing system goals and the move towards universal health coverage is progressing and has attracted the attention of a range of policy-makers.

The capacity of ministries of health in formulating and evaluating evidence-based policies and plans and in regulating the health sector is often inadequate and varies between countries. The engagement of key non-health sectors, which is essential in developing and implementing health policies as an integral part of national development plans, needs to be strengthened in almost all countries. Effective mechanisms need to be put in place for facilitating multisectoral action, based on international experience and lessons learned. The potential contribution of the private health sector to public health remains untapped. At the same time, the sector is not sufficiently regulated to ensure quality and prevent inappropriate practices. The private sector rivals the public sector in provision of primary health care services in several group 2 and 3 countries. However, its role is not well defined, its capacities poorly understood, and its practices not well monitored. Information is commonly lacking or insufficient about many of its functions, about the range of services it provides in different countries and about the financial burden to the users of these services. Based on resolution EM/RC59/R.3, a focus on the private sector has been included in the programme of work of the Regional Office in 2013.

In the area of governance, a number of advisory missions were undertaken. A multi-partner mission to Pakistan made recommendations to the Government following the decision to abolish the Ministry of Health and devolve the health sector to the provinces. An in-depth review of the health system in Morocco was undertaken following the recent constitutional amendment that recognized health as a human right, and a series of missions to Libya included an in-depth review of the health system and assessment of primary health care facilities and hospitals.

The work on health policy and governance also focused on capacity-building and country support in more than half of the countries of the Region. The health system profiles of four countries were updated and profiles of another four countries are in the process of publication.

Health information systems

The health information systems are generally weak in many countries and need to be improved, especially in quality and timeliness of reporting. There are important gaps in all countries of the Region. Data collection is fragmented and often duplicated and key areas related to monitoring of health status, health outcomes and health system performance are either missing or poorly integrated into the national health information system. More specifically, there are major gaps in reporting of cause-specific mortality and health facility records, in conducting regular health surveys, in routine and other data collection activities and in the availability of information disaggregated by age, gender, location and/or socioeconomic status; all coupled with a scarcity of human resources trained in epidemiology and health information systems. Important variations in regional and country estimates are also observed. In discussions with Member States, coordination and strengthening collaboration in the development and reporting of estimates emerged as key priorities and will receive focus in 2013.

The strengthening of capacity in health information is also important, for decision-making and developing and evaluating policies and plans. This was emphasized by the Regional Committee in resolution EM/RC59/R.3. Civil registration and vital statistics (CRVS) received special attention in 2012. Registration of births and deaths needs strengthening in almost all countries. A rapid assessment of CRVS systems was conducted to establish a baseline of the current situation and identify gaps and priorities for improvement. The results show that almost 40% of countries have either inadequate or weak systems, and only 25% have satisfactory systems. However, overall, these systems serve only 5.3% of the population in the Region. A satisfactory level of CRVS system reflects its ability to produce data of sufficient quality to adequately cover the needs for policy- and decision-making and for monitoring the impact of interventions and development programmes. These results have paved the way for conducting a comprehensive assessment, in collaboration with relevant partners and stakeholder, as a first step in the development of country action plans for CRVS.

The Regional Office launched a Regional Health Observatory, which is directly accessible through the regional web site, to support the dissemination and use of health information. This is now the main source for country health-related information, drawing on more than 40 databases and 800 indicators collected since 1990.

WHO’s work in 2013 will aim to develop technical guidance on the essential elements of health information systems, including consensus on a core list of indicators covering health risks and determinants, health outcomes (morbidity and mortality) and health system performance.

Health workforce development

Most countries need to develop a balanced, motivated, well-distributed and well-managed health workforce with the appropriate skills mix. The overall workforce density in the Region is below the global average of 4 skilled health workers per 1000 population. Eight countries (Afghanistan, Djibouti, Iraq, Morocco, Pakistan, Somalia, Sudan and Yemen) are classified as facing a crisis in human resources for health, largely due to insufficient measures to facilitate market entry, such as lack of preparation of the workforce through strategic investment in education and effective and ethical recruitment practices. Another challenge is inadequate workforce performance due to lack of adequate continuing education and training, as well as poor management practices in the public and private sectors. Policies for retention of health workers and for managing migration and attrition to reduce wasteful loss of human resources are also lacking, despite the magnitude of the problem.

There are serious challenges to ensuring access to quality nursing education in the Region, in particular inadequate investment and the low priority given to nursing education; lack of capacity in nursing schools in terms of the availability of trainers as well as infrastructure; the need to further update nursing curricula in order to bridge the service–education gap; the limited institutional capacity to offer post-basic training programmes; and inadequate emphasis on continuous professional development programmes.

Human resources observatories in Afghanistan and Palestine were set up to support health workforce development. The Regional Office has promoted several regional tools to strengthen the capacity for workforce governance and planning, such as a guide for accreditation of health professions programmes, and tools to optimize staff workload in health facilities and to make workforce projections.

Initiatives to strengthen nursing and midwifery training included support to several countries in developing their national strategic plans. The leadership and management training programme, developed by the International Council of Nurses with WHO support, continued in several countries.

All countries are currently facing some gaps in health workforce development, mainly in the areas of production, distribution, training and continuing education, and retention, although the type and magnitude varies between countries. Addressing these gaps and developing effective and feasible strategies in these areas will require an in-depth review and analysis of existing regional and international experience and lessons learned. Health workforce development is an areas that will require greater attention in the next two years.

Integrated service delivery

Many countries are making efforts to establish effective family practice programmes as the principal vehicle for delivering primary health care and increasing access and coverage of population to health care services. Family practice is an overarching model of care delivery that contributes to moving toward universal health coverage. The challenges include the lack of adequately trained family physicians, nurses and other practitioners, maldistribution of the health workforce and insufficient engagement with hospitals to provide the necessary back-up and support.

There is a need to review international and regional experience and lessons learned based on workable models of family practice and develop guidance on feasible strategies to strengthen family practice in the Region and these areas will be the focus of attention in the coming period.

Patient safety and health system strengthening component of the global health initiatives

Support for patient safety continued with the expansion of the Patient Safety Friendly Hospital Initiative to more countries. The patient safety assessment manual was translated into Arabic and the second edition is being finalized. The patient safety multi-professional curriculum guide developed by WHO was launched; several medical schools have started to integrate it in the training curricula. Work is under way to develop a patient safety improvement toolkit that includes practical steps and needed actions for building a comprehensive patient safety improvement programme.

System-wide barriers, relating to accessibility, availability and affordability of health care, are a substantial challenge to the implementation of public health programmes, affecting the provision of services and reducing programme performance. Poor health system performance is also a constraint. In the area of health system management, a study on decentralization in 10 countries and another study on hospital management and performance assessment in 12 countries were conducted and the results shared.

Several Member States have benefited from the health system strengthening component of the global health initiatives, e.g. GAVI Alliance, Global Fund to Fight AIDS, Tuberculosis and Malaria and International Health Partnerships Plus (IHP+). Over a five-year period, funds provided by the GAVI Alliance for strengthening health systems totalled US$ 160 million and by the Global Fund US$120 million. In most countries these funds are largely channelled through national governments, with technical support provided by WHO in the development of proposals for new rounds of funding, implementation monitoring and capacity-building. Countries that have used these funds well have demonstrated good progress towards health system strengthening. However, performance varies across countries and use of the funds is sometimes caught up in extensive government procedures. Three countries have also signed the IHP+ compact. This is not a funding initiative but encourages countries and partners to agree on one national health plan. There is variation in the extent to which the countries have shown commitment to IHP+.

Many countries in the Region face complex emergencies and most health systems are not well prepared to respond to these situations and are not resilient in extended emergencies. These countries need to be supported to enhance their collaboration, coordination, planning, communications and information exchange capacities.

Essential medicines and technologies

There is insufficient access to essential technologies (medicines, vaccines, biological and medical devices) in most countries in groups 2 and 3 and irrational use is common. While almost all countries have national regulatory authorities, performance needs to be improved. Most authorities focus on the regulation of medicines and not on the regulation of biological products, medical devices and clinical technologies including laboratories. Quality management, monitoring the private sector, and protecting public goods from commercial interests are weak and require attention.

In the area of essential technologies, six pharmaceutical country profiles were developed, national medicine policy documents were updated for two countries and five additional countries joined the good governance for medicines programme. National transparency assessment reports on vulnerability to corruption in the pharmaceutical sector were drafted for three countries and support was provided to more than 10 national regulatory authorities on good manufacturing practice inspections.

Capacity-building was supported in order to strengthen coordination between policy-makers and regulators on the proper use and evaluation of vaccines, such as diphtheria-tetanus-pertussis (DTP) and DTP-combo vaccines, as well as vaccine safety systems. Afghanistan, Sudan and Yemen received support to enhance their vaccine pharmacovigilance systems.

In the area of health technology and medical devices, missions to assess health technology infrastructure and management were conducted in several countries. In collaboration with WHO headquarters, a second wave of the global survey on medical devices was launched. Over 70% of Member States participated in this round compared to 40% in the first one. Results indicated that only 5% of the Member States of the Region have established policies and coordination units for medical devices, 29% have regulation and inventory systems and 16% have developed national procurement and maintenance guidelines. An intercountry consultation in this area of work will be organized in 2013.

¹. Group 1: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates; Group 2: Egypt, Islamic Republic of Iran, Iraq, Jordan, Lebanon, Libya, Morocco, Palestine, Syrian Arab Republic, Tunisia; Group 3: Afghanistan, Djibouti, Pakistan, Somalia, South Sudan, Sudan, Yemen

Universal health coverage

In 2014 WHO focused on providing Member States with technical support in implementing the commitments made in Regional Committee resolutions EM/RC59/R.3 (2012) and EM/RC60/R.2 (2013). A framework for action for progressing towards universal health coverage, and linking the various commitments, was endorsed by the Regional Committee in its 61st session in October 2014.

Health financing

Health financing strategies that are evidence-based and context-specific are essential to pursuing the goal of universal health coverage. The lack of information about the institutional and organizational arrangements of the health financing systems and the flow of funds in several countries of the Region hampers efforts to develop evidence-based health financing strategies. In addition, the limited national expertise in health financing in general, and in specific health financing arrangements such as social health insurance, in particular, is critical to moving ahead.

WHO support in developing health financing strategies involved building national capacity in generating quantitative and qualitative information by following national health accounts and the OASIS (organizational assessment for improving and strengthening health financing) approach, respectively. The focus of technical support shifted from advocacy for health financing to skills development in areas such as establishment of social health insurance programmes, strategic purchasing and multisectorality and universal health coverage, by organizing regional consultations and developing policy papers. The capacity of a pool of experts and researchers is being developed in the areas of measurement of financial risk protection, as part of monitoring progress towards universal health coverage, and in undertaking economic evaluation studies.

Country-level technical support was provided to several countries to formulate a national vision, strategy and roadmap to move towards universal health coverage. This was preceded by several diagnostic studies as related to the various health financing functions.

The work in 2015 will continue to focus on key interventions for action towards universal health coverage, including a national vision, strategy and roadmap for universal health coverage that is fully integrated within the national policy framework, expansion of social health insurance schemes, extending financial protection to the informal and vulnerable segments of the population and reduction of out-of-pocket payments.

Health governance and human rights

Evidence-informed policies, strategies and plans are a cornerstone for progressing towards universal health coverage. Most countries do not have adequate capacity in ministries of health to formulate evidence-informed policies and strategic plans, and have limited access to, and use of, quality data for informing policy and strategy development. The current political instability and social crisis seen across much of the Region, and the limited alignment and harmonization among development partners to support one national health plan, are some of the additional challenges faced by several countries in groups 2 and 3 ¹ .

Ongoing efforts to assess the status of national health planning has provided a better picture of the overall strengths, weaknesses and challenges facing health policy and planning in ministries of health. In an effort to build the capacity of WHO country offices to support countries in their national health policy formulation and planning processes, senior WHO staff attended workshops on strategic health planning, conducted in collaboration with the Nuffield School of Public Health and Centre for International Development, University of Leeds, United Kingdom. It is planned to build national capacities in strategic health planning and health sector regulation, and to review, in selected countries, the status of coordination among development partners and the effectiveness of external assistance.

The Region has longstanding challenges in relation to gender equality, equity and human rights in health. Extended conflicts, rising levels of poverty, varying degrees of inequity and the existence of vulnerable and marginalized groups are important underlying factors. The lack of disaggregated data and vulnerability assessment to inform public health policies and guide actions through a “human rights lens” continues.

A review of the existing evidence and gaps and continued advocacy have helped to better integrate gender, equity and human rights across the work of the Organization. A course on health and human rights was developed and piloted in Egypt in collaboration with the American University in Cairo. The course has been externally evaluated and is being conducted in Pakistan and offered to other countries in 2015.

Public health law and legislation need updating, and the capacities of ministries of health in formulating, implementing and monitoring legislation need strengthening. A review of the status and capacities for regulating the private health sector was completed in four countries and a manual is currently being developed in collaboration with WHO headquarters. During 2015, the focus will be to build ministry of health capacities in strategic planning through training of national staff and through provision of user-friendly guidance for developing effective strategic plans. Attention will be given to capacity-building in health legislation, regulation, standard-setting and enforcement, with focus on the private sector. The effectiveness of external assistance and the status of aid flow in countries, particularly those facing conflict situations, will be assessed.

Further to the request of Member States, WHO launched a regional initiative in 2013 to assess public health capacity in countries, through identification of essential public health functions relevant to the context of the Region. In 2014, two country assessments were conducted, in Qatar and Morocco, with the support of WHO and a team of international public health experts. Through this assessment, countries led by their ministries of health, are able to identify the strengths in their public health systems as well as areas that require reinforcement. In May 2015 WHO brought together a small group of international public health experts and representatives from the two countries that conducted the assessment to discuss the experience, review the tool and refine the assessment and follow-up process. Currently, the assessment tools are being revised to make them more user friendly, following which the initiative will be offered to other countries.

Health workforce development

The health workforce situation continues to reflect global trends with regard to numerical shortages, inequitable distribution, retention and performance. Overall health workforce density is suboptimal and maldistribution, retention, migration and over-dependence on expatriate health workforce are daunting challenges that impede progress towards universal health coverage in several countries. Lack of institutional capacity for national health workforce planning is another impediment and information sources are inadequate.

While the gaps in the development of the health workforce are clear, solutions to address these gaps are not always clear. To respond to this challenge, a regional strategic framework for health workforce was developed, following a critical review by a group of international experts and a regional consultation to help move the health workforce agenda forward. The framework will be aligned with the global workforce strategy that is currently being developed by WHO headquarters and the Global Health Workforce Alliance.

After a gap of almost two decades, the area of medical education was revisited and a comprehensive online survey undertaken targeting over 300 medical schools. Among other things, the survey confirmed a move towards the privatization of medical education, while also showing inadequate regulation, lack of accreditation systems, teacher-centered curricula, and use of traditional assessment methods unlinked to learning outcomes and competencies. The results were presented at a meeting of regional and international leaders in medical education. A road map was developed to guide medical schools in becoming more socially accountable, community-oriented and accredited, in support of universal health coverage. The subject of medical education will be discussed by the Regional Committee at its 62nd session, following which countries will be expected to adapt the regional action framework based on national priorities.

Plans are under way to carry out a comprehensive review of the status of nursing and midwifery in the countries of the Region. The review is aimed at providing clear strategic directions based on practical and feasible actions that are evidence-based and guided by reliable information and good practices.

Technical support was provided to the Arab Administrative Development Organization of the League of Arab States for the conference on migration of health workers. The Regional Office participated in the ninth annual meeting of the International Association of National Public Health Institutes, which was held for the first time in the Eastern Mediterranean Region. A side-meeting of regional public health institutes was organized to encourage networking and development of collaborative programmes to strengthen public health in the Region.

The fellowships programme continued to support countries in building national capacities in the five regional priority areas, with 74 fellows benefiting from across the Region. The programme was closely involved in organizing the Leadership for Health programme in collaboration with the Harvard School of Public Health. This was launched in early 2015 with the aim of developing future public health leaders who can address, in a proactive way, national and local health problems that have direct impact on population health, and play active roles in the global public health sphere. The programme was conducted in two parts, in Geneva and Muscat, and both components were highly rated by the participants and facilitators. Based on initial success and high demand, the second round of the programme will commence in November 2015.

Particular emphasis will be given in 2015 to helping countries develop national health workforce strategies and action plans, and to implement the strategies to strengthen medical education and nursing and midwifery. New initiatives will include assessment of continuous professional development for physicians and improved reporting by countries on the implementation of the WHO Code of Practice for the International Recruitment of Health Personnel.

Essential medicines and technologies

Pharmaceutical sector country profiles developed during 2014 highlighted gaps in key areas related to regulatory authorities for medicines, including: organizational structure and technical capacity; national medicines policies; transparency and accountability in regulation and supply of medical products; mechanisms to contain antimicrobial resistance; promotion/advertising of medical products; and access to controlled medicines, including medicines for pain management.

Approaches to strengthening regulatory capacity for medicines and medical devices were discussed during the Eastern Mediterranean Drug Regulatory Authorities Conference held in May 2014. Prior to the conference, a survey of 17 national regulatory authorities revealed that the majority (80%) of authorities have core regulatory functions in place and all are responsible for the registration of medical products. Only 40% of national regulatory authorities undertake fast-track registration of WHO prequalified medicines whereas 80% undertake fast-track vaccine registration.

Work progressed in good governance for medicines in 16 countries. In a regional meeting focus was placed on conflict of interest management as a priority issue in governance policies. The good governance for medicines programme in the Region is the most developed among all WHO regions, with 6 countries in phase I; 7 in phase II and 3 in phase III. The updated pharmaceutical sector profiles for all countries revealed that access to controlled medicines for pain management and mental disorders remains very limited and patients are therefore suffering when they should not have to. Progress was made in the area of health technology assessment, regulation and management with the creation of the Eastern Mediterranean Regional Health Technology Assessment Network for information exchange and knowledge sharing. This was an outcome of the second intercountry meeting on development of national health technology assessment. A regional survey was conducted to map health technology assessment resources. The survey, which targeted health technology-related officials and champions in 15 countries, showed that 52% of regional entities perform assessment-like actives that are mainly related to measurement of clinical effectiveness and economic evaluation of medical devices and medicines. The survey indicated the need to re-organize and/or initiate assessment activities in the Region in order to make rational investments to health technologies that are accessible for the majority of the population.

In 2014, the first two medical products produced by a local pharmaceutical company in Egypt and the first medicine quality control laboratory in the private sector in Pakistan were prequalified by WHO. National medicine quality control laboratories in two other countries are in the process of becoming prequalified by WHO.

In 2015, focus will be placed on the implementation of Health Assembly resolutions on strengthening regulatory systems for medical products, including strengthening pharmacovigilance. Reporting on counterfeit medical products will be strengthened. In line with the global action plan on antimicrobial resistance, support will be provided for development of national plans to strengthen surveillance of antimicrobial resistance and the responsible use of antimicrobial medicines.

Integrated service delivery

Most countries in the Region are committed to strengthening family practice. However, implementation is uneven and inconsistent. An assessment of the status of family practice revealed significant gaps in terms of political commitment, patient registration, packages of essential health services, essential medicines lists, referral systems and staff. Another big challenge is the insufficiency of trained family physicians and the inability of current training programmes to meet the enormous needs.

A lack of quality care at primary health care level and the unregulated expansion of the private health sector in most group 2 and 3 countries pose additional challenges. Public sector hospitals consume a significant proportion of health budgets, do not meet standards of quality and safety in many countries and in others are increasingly dependent on user fees. Hospitals are generally not integrated within the health system and do not provide referral support.

Family practice has been promoted as the principal approach to achieving people-centred integrated services. A situation analysis of the current status of family practice programmes and training for family physicians was presented at a regional consultation organized in collaboration with the World Organization of Family Doctors. The results of a 2014 situation analysis revealed that most countries have developed, and just over half are implementing, an essential package of services, a system of patient registration and family/individual folders is practised in half the countries, and the referral system is partially or fully functional in five countries. However, more than 90% of physicians working in primary care facilities are not trained in family medicine. Family medicine departments are available in 13 countries and the annual output of family physicians is 700, the majority of whom are from group 1 countries.

A roadmap was developed to strengthen service delivery through the family practice approach and is aligned with the framework for action for progressing towards universal health coverage. During 2015, the work on scaling up family practice as the principal approach to people-centred integrated health care will continue to be promoted. A particular task will be to share evidence on how to scale up the production of family physicians in the short and medium term.

Several studies were also undertaken to better understand the private health sector, including assessment of the quality and cost of care in the private health sector in six countries and of the status of private sector regulation in four countries, as well as a review of the lessons in public–private partnership. These studies were presented at a regional consultation which resulted in identification of a number of priorities in regard to work with the private sector.

A regional consultation on addressing the quality and safety of care was organized in collaboration with the Central Board for Accreditation of Healthcare Institutions, Saudi Arabia. The Patient safety assessment manual, published in 2011, was updated and field tested in two countries and a tool kit for patient safety was developed. A framework for assessing and improving quality at the primary care level is currently being piloted. Capacity building will be intensified in the areas of patient safety and quality, assessment, regulation and partnership with the private health sector and hospital care and management.

Hospital care and management is a new area of work that is being given increasing attention. The focus has been to develop a comprehensive analysis of the status of public sector hospitals in the Region. A course on hospital management was offered in collaboration with the Aga Khan University, Karachi, for countries in conflict. The course is being updated and will then be rolled out to the Region.

Technical support was also provided to eligible countries for new applications for support from the Gavi, The Vaccine Alliance for health system strengthening worth US$ 85 million. Concurrently, health system capacity development workshops were conducted in order to build capacity of programme managers from these countries.

Health information systems

Intensive work took place in reviewing health information systems in the Region through expert consultations, intercountry meetings and rapid and comprehensive assessments. Gaps and challenges were identified and an approach was developed to strengthen the national health information systems. The resultant framework for health information systems and core indicators, which were endorsed by the Regional Committee (EM/RC61/R.1), will provide clear guidance for countries. The regional health information framework and its core indicators cover three areas: health risks and determinants, health status and health system performance.

The emphasis placed on strengthening cause-specific mortality statistics, as recommended in the regional strategy to strengthen civil registration and vital statistics systems endorsed by the Regional Committee in 2013, resulted in an increase in the number of countries reporting mortality statistics, from 7 countries (Bahrain, Egypt, Jordan, Kuwait, Morocco, Oman and Qatar) to 12 countries (with the addition of Islamic Republic of Iran, Palestine, Saudi Arabia, Tunisia and United Arab Emirates). The quality of information reported improved somewhat but there is still work to be done to obtain optimal quality. A WHO collaborating centre was established in Kuwait to support further improvement in mortality statistics and better use of the WHO family of international classification.

In the next two years, WHO is committed to supporting Member States in their endeavours to strengthen their health information systems, based on the new framework, and provide reliable information that will enable them to monitor health determinants and risks and health status and assess health system response, which, in turn, will inform policy and decision-making for better health care delivery. WHO will also continue to support Member States in addressing the gaps in their civil registration and vital statistics systems, which were demonstrated by the rapid and comprehensive assessments conducted over the past two years.

Research development and innovation

A regional meeting was held for members of the Eastern Mediterranean Advisory Committee on Health Research and research experts to discuss integrating research in shaping the future of health in the Region. The meeting focused on the identification of research priorities related to the five regional strategic priorities. This exercise is expected to conclude in January 2016 and the results will guide research activities for 2016–2017. The call for proposals for the special grant for research in priority areas of public health for 2104 was also focused on the strategic priorities. Twelve awards ranging from US$ 10 000 to US$ 20 000 were granted in early 2015.

¹ Three groups of countries are defined in the Region, based on population health outcomes, health system performance and level of health expenditure are: group 1: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates; group 2: Egypt, Islamic Republic of Iran, Iraq, Jordan, Lebanon, Libya, Morocco, Palestine, Syrian Arab Republic and Tunisia; group 3: Afghanistan, Djibouti, Pakistan, Somalia, Sudan and Yemen.