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Implementing WHO management reforms PDF Print

Programmes and priority-setting

The final phases of development of the Programme Budget 2018–2019 were completed through bottom-up planning in close coordination with Member States, and the 2017 operational planning exercise was conducted based on the priorities identified. The joint planning exercise concluded with face-to-face meetings in Cairo to ensure more harmonized plans, clearer roles and responsibilities for the two levels of WHO and the incorporation of a risk management approach.

Operational planning for the 2018–2019 biennium was also guided by the Roadmap of WHO’s Work in the Eastern Mediterranean Region 2017–2021 as a five-year strategic plan for WHO in the Region. The roadmap translates global and regional commitments, including the 2030 Agenda for Sustainable Development and the WHO reform agenda, into a set of strategic actions to guide WHO’s work with Member States in the Region. In the context of the Sustainable Development Agenda, the Regional Office launched an initiative to strengthen cross-cutting work at the regional level by encouraging new avenues for technical collaboration. Lessons learned from the regional approach will be incorporated at country level during the next planning cycle to encourage the intersectoral collaboration needed to achieve the health-related targets of the SDGs.

In 2017, more authority was given to heads of budget centres for the management of corporate flexible funding for priority activities in order to allow for the timely utilization of such funds, particularly in country offices. Review at the end of the biennium showed that 77% of expected outputs had been fully achieved, and the Region’s contributions were incorporated in the Organization-wide results reported to Member States. In keeping with corporate commitments to focus on countries and increase overall organizational transparency, key information on country achievements and on budgetary and financial matters was made available online through the WHO programme budget portal. Tools to support monitoring and decision-making included the addition of new dashboards aimed at monitoring budget and fund utilization, technical progress and a number of key compliance indicators.

The Region actively contributed to the development of the Thirteenth General Programme of Work and its planning and budgeting framework, including major contributions to improve related prioritization and planning processes.

Governance

High-level meetings of 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 provide 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 the World Health Assembly provided additional opportunities for Member States from the Region to interact and agree on common positions that affect the Region.

At its 64th session, held in Islamabad in October 2017, the Regional Committee endorsed five resolutions in relation to the regional strategic priorities. Immediately prior to the session, a day of technical meetings was held to discuss current issues of interest.

Management

The Regional Office continued to develop essential instruments to enhance the WHO reform process with a special emphasis on managerial reform, working closely with the other levels of the Organization to achieve the goals listed in the Twelfth 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.

Managerial actions associated with the reform process taken by the Regional Director with respect to staff mobility and rotation, performance management and human resource planning and management continued. Accountability and controls remained at the heart of improvement efforts, focusing on the compliance areas that were mentioned repeatedly 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 2017, all audits resulted in satisfactory or partially satisfactory ratings, showing continued improvement in controls and a deep commitment to zero tolerance of 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 continuing improvement in accountability and control, as embedded in the regulatory frameworks.

 
Young people and tobacco use PDF Print

A growing epidemic of tobacco use among young people

Many of today’s children are tomorrow’s victims of tobacco. Tobacco use, which generally starts during adolescence, is rising among young people. Addiction to nicotine ensures that many continue to use tobacco into adulthood.

The Global Youth Tobacco Survey (1999–2008) shows that tobacco use among young people age 13–15 around the world is increasing. In the Eastern Mediterranean Region, 7% of boys and 2% of girls currently smoke cigarettes, while 14% of boys and 9% of girls currently use tobacco products other than cigarettes, including waterpipe and smokeless tobacco. As in the rest of the world, the gap between girls’ and boys’ rates of tobacco use is getting smaller in some countries in the Region.

Why do young people begin using tobacco?

Tobacco use tends to start in adolescence and addiction can set in quickly. Teenagers who begin smoking at a younger age are more likely to become regular smokers and less likely to quit than those who start later. Young people may use tobacco to bolster low self-esteem, manage stress, control body weight and as a buffer against negative feelings.

Tobacco use has become more socially acceptable at home and in public. Its use by parents, family members and friends influences young peoples’ tobacco use. Teachers are role models for students, but only around half of all schools in the Region have a ban on the use of tobacco products in schools by teachers. Additionally, only 16% of teachers in the Region have been trained to prevent youth tobacco use, while less than half have access to materials on how to do so.

Another key reason is tobacco advertising and promotion. The tobacco industry promotes its products to potential smokers, including young people, to ensure the market for tobacco continues to increase and that dying smokers and those who quit smoking are replaced. As tobacco rates decrease in many countries in the developed world, the industry is increasingly targeting young people in the developing world.

Tobacco marketing to young people

The tobacco industry targets young people through misleading messages that help shape attitudes to tobacco use. Tobacco promotion associates tobacco use with appealing images to lure young people into a lifetime of tobacco addiction. These encourage children to adopt a behaviour that is harmful to their physical, mental and social development.

This is done by advertising in youth magazines and designing brands, packaging and promotional items to appeal to young people. Advertisements target young people through their use of images of vitality, sports, sophistication, friendship, independence and beauty.

Tobacco marketing to young people includes both direct marketing through advertising of tobacco products and indirect marketing through promotions and sponsorship. The Global Youth Tobacco Survey has found high levels of exposure in the Region to advertising on billboards and in newspapers and magazines. It also found that 15% of 13–15 year olds in the Region own an object with a tobacco company logo or other cigarette branding, while 9% have been offered free cigarettes.

Health impact of tobacco use on young people

Tobacco use affects young people’s physical fitness. Young people who use tobacco have reduced lung function and are more likely to suffer from respiratory problems. Smoking at an early age increases the risk of lung cancer and as young people continue smoking into adulthood the risk of other cancers, heart disease and stroke increases.

Children are especially vulnerable to the harm of second-hand smoke. They have smaller lungs and absorb more tobacco smoke toxins. This makes them susceptible to many conditions, such as respiratory infections, asthma and ear infections. They are also less able to complain or remove themselves from exposure, especially at home.

Many young people are exposed to second-hand smoke in their homes and public places, including educational facilities. In the Region, 38% of 13–15 year olds live in a home where others smoke, and 46% are exposed to second-hand smoke in public places. This poses great risks for young peoples’ health and for their future well-being.

Further harms to young people from tobacco

Tobacco use by adults means that many households have reduced resources to spend on the food, health care, clothing and educational needs of their children. This can have a serious impact on their health, physical development and future employment opportunities.

Many young people from poor families are employed in the tobacco industry exposing them to the harms associated with nicotine poisoning and exposure to highly dangerous agrochemicals used in tobacco cultivation. It is hazardous work that impedes their rights to health, social development and education.

Best practices and the way forward

The UN Convention on the Rights of the Child was adopted by the UN General Assembly in 1989. Tobacco has since been identified by the Committee on the Rights of the Child as a human rights issue and States are legally bound to protect children from tobacco. Furthermore, implementation of the WHO Framework Convention on Tobacco Control (FCTC) requires Parties to take measures to protect youth against the harms of tobacco use. Article 16 specifically addresses the prohibition of the sale of tobacco products to legal minors.

Young people need to be provided with information about the harms of tobacco use and tobacco industry marketing tactics. They have a right to protection from tobacco marketing and second-hand smoke. To achieve this:

Young people need to be empowered with information about the harmful effects of tobacco use and their right to live in a smoke-free environment. They should also be provided with tobacco cessation services.

The sale and marketing of tobacco to young people must be stopped. A full ban on tobacco advertising, promotion and sponsorship is needed, in accordance with Article 13 of the WHO FCTC.

Young people are especially sensitive to rises in the price of tobacco. Taxing tobacco products effectively will prevent many young people from a lifetime of tobacco addiction.

Adults should restrain from tobacco use around young people, including in the home.

Schools must become smoke-free environments. Teachers must be supported in preventing tobacco use among young people.

 
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Technical guidance

Avian influenza: guidelines. recommendations, descriptions and training

 
Emergency preparedness and response PDF Print

The Eastern Mediterranean Region has a high risk for natural hazards such as earthquakes (Islamic Republic of Iran), floods (Pakistan) and drought (which has resulted in famine in Djibouti, Somalia and South Sudan since 2011 and is expected to re-emerge in 2013). Political instability and civil conflict in countries such as South Sudan, Sudan, Syrian Arab Republic and Yemen have resulted in millions of people in need of emergency and basic health services, especially the most vulnerable populations, such as women, children and the elderly. More than 50% of the world’s refugees originate from the Eastern Mediterranean Region. In light of the increasing number and magnitude of emergencies in the Region, in March 2012 the Regional Director identified the area of emergency preparedness and response as one of five priority areas with the goal of increasing the resilience of countries to emergencies, disasters and other crises, and subsequently ensuring effective public health response to risks and threats. A new set of strategic priorities was defined to outline the way forward, including offering support to countries in developing clear policies and legislation based on an all hazard and ‘whole health’ approach, and paying special attention to safeguarding health facilities and the health workforce in times of emergency.

In all countries facing emergencies, there was a highlighted need in 2012 to ensure that health services for vulnerable populations, especially women and children in the most affected areas, were made available. Priorities included the provision of obstetric and gynaecological health services, as well as vaccinations for children below the age of 5 years. In countries with on-going conflict and violence, mental health services were largely unavailable due to a lack of qualified health staff. Increasing numbers of refugees and internally displaced persons in countries such as South Sudan, Syrian Arab Republic and neighbouring countries, Sudan and Yemen highlighted the need for effective disease monitoring and response systems for the prompt control of communicable disease outbreaks. In both acute crises and protracted emergencies, the burden of noncommunicable disease also came to the fore as patients lost access to essential drugs and life-saving treatment.

Reform in WHO’s work in emergencies, specifically the Emergency Response Framework, stressed the need for strengthening country office capacity to prepare for and respond to crises. To ensure a more rapid response, an emergency surge roster was developed with identified expertise on standby. Additionally, the process of establishing a regional WHO hub for medicines and medical supplies and equipment was initiated. On a regional level, medicines, medical supplies, logistics, and office and laboratory equipment worth almost US$ 120 million were provided to six countries facing emergency (Afghanistan, Libya, Pakistan, Somalia, Sudan and Syrian Arab Republic), amounting to almost 40% of WHO procurement on a global level.

Despite an increase in the funding of health activities in emergencies, only 38% of the Region’s health funding requirements was met in 2012. The health sector continues to be severely underfunded, emphasizing the need for a more coordinated approach by traditional and non-traditional partners to address the health needs of affected populations in the Region.

An evolving leadership role in health emergencies

In all countries experiencing emergencies, WHO supported health authorities to lead a coordinated and effective health sector response together with the national and international community, in order to save lives and minimize adverse health effects, with specific attention to vulnerable populations. One of the main challenges was lack of accessibility and humanitarian space. The delivery of health services to affected populations in Palestine, South Sudan and Syrian Arab Republic was impeded by the limited access by health humanitarian partners and by health care workers to their place of work due to insecurity. Twenty-three months into the crisis in the Syrian Arab Republic, for example, 70% of health workers in heavily affected areas reported difficulties in accessing their workplace. Similar challenges associated with inaccessibility and insecurity that impeded the delivery of emergency and basic health services were faced in Afghanistan, Somalia, South Sudan and Yemen.

The delivery of basic and emergency health care services was also impeded as an indirect result of economic sanctions on countries such as Islamic Republic of Iran, Libya and Syrian Arab Republic. For example, pharmaceutical plants in the Syrian Arab Republic that had previously produced almost 90% of the country’s medicines were forced to halt production due to the combined effects of economic sanctions, fuel shortages and damage to infrastructure. Consequently, health facilities received insufficient supplies from the central authorities due to critical shortages in life-saving essential medicines.

To ensure that urgently needed medicines and medical supplies were available, WHO worked with governments and partners to broker the procurement and provision of supplies. Examples of these partnerships included those with the League of Arab States for the provision of medicines and medical supplies to Syrian Arab Republic and Yemen, and with local authorities and the Organization of Islamic Cooperation to coordinate access of the population to health services in Somalia.

In countries such as Afghanistan, Libya, Pakistan and Syrian Arab Republic, where health care workers and health facilities were intentionally targeted or indirectly affected, WHO condemned the attacks in the regional and international media and through advocacy campaigns, referring to World Health Assembly resolutions and human rights laws prohibiting the targeting of health staff in times of conflict.

Saving lives and meeting health needs

Incapacitated health systems in countries experiencing emergencies often result in vulnerable populations having little or no access to health care services. In the Syrian Arab Republic, more than 50% of public hospitals had been damaged or destroyed as a result of the conflict as of December 2012. To ensure the continuity of health care services, WHO partnered with 13 local nongovernmental organizations to ensure the provision of treatment, medicines and medical supplies. By the end of 2012, WHO had provided medicines and medical supplies for 1.2 million treatments, and more than 195 000 blood safety kits to the national blood bank, trauma surgery and emergency care supplies, intravenous nutrition fluid and intravenous supply sets to hospitals in affected areas.

Vulnerable populations in Afghanistan and Somalia, especially women and children, were reached through field hospitals and mobile clinics. In Somalia, children and women of childbearing age in remote communities and underserved areas were reached thorough health interventions on Child Health Days, in partnership with the national authorities and UNICEF. Nationwide emergency vaccination campaigns were conducted with health partners in Afghanistan, South Sudan and Sudan, as well as in Syrian Arab Republic where WHO and UNICEF supported the Ministry of Health in measles and polio vaccination campaigns for 2 million and 2.5 million children under 5 years of age, respectively. WHO provided vaccines, paracetamol and multivitamin syrups, as well as ensured capacity-building for national staff to implement the campaign effectively and efficiently.

In order to detect, and provide a timely and effective response to confirmed outbreaks, ministries of health strengthened the Early Warning Alert and Response (EWAR) systems in six countries (Afghanistan, Iraq, Jordan, Pakistan, Somalia and Sudan). These systems allowed WHO and partners to detect and manage outbreaks of cholera in southern and central Somalia, yellow fever in Sudan, acute watery diarrhoea in South Sudan, cholera in Iraq and tuberculosis among Syrian refugees in Jordan. As a result of the deteriorating heath situation in the Syrian Arab Republic, WHO established an early warning and response system and provided training to national surveillance focal points from around the country. Data collection began in September 2012 and enabled WHO and national authorities to monitor and control reported cases of hepatitis A, typhoid and leishmaniasis.

Incapacitated health systems and shortages in medicines also increase the burden of noncommunicable diseases as populations are no longer able to get regular treatment or access to essential, life-saving medicines. This has highlighted the need to update national lists of urgently required essential medicines in emergency countries based on disease profiles, current gaps and critical needs, with the Syrian Arab Republic identified as a priority country in early 2013.

Ensuring the collection and dissemination of health information in emergencies

One of the biggest challenges faced during emergencies is obtaining timely information on the health system so that health risks, needs and gaps can be accurately assessed. This challenge can be further aggravated during complex emergencies where access to this information is hindered. To ensure an efficient approach in managing health information, WHO worked with national authorities and health partners to establish emergency health information management systems and coordinated the collection, analysis and dissemination of essential information.

In the Syrian Arab Republic, WHO participated in two interagency assessment missions and conducted rapid assessments of public health facilities in all governorates to determine accessibility and functionality. In the neighbouring countries of Iraq, Jordan and Lebanon, nutrition assessments were conducted among Syrian refugees living in both the refugee camps and within the host communities. Nutrition assessments were also conducted in Afghanistan, Pakistan and Yemen to ensure capacity-building for response to severe and acute malnutrition.

In Pakistan, the Health Resources Availability Mapping System (HeRAMs) was integrated into the national health system to ensure good practice in the mapping of health resources and services availability in emergencies and to strengthen informed based decision-making by the Health Cluster. Inter-agency partnerships were also strengthened through WHO support of the assessment of 65 UNHCR-administered health facilities.

Strengthening country office capacity

Natural disasters and political unrest can occur at any time and are often difficult to predict. In order for WHO’s country offices to efficiently support country response operations, the deployment of health experts and procurement of medicines during emergencies must be as rapid and streamlined as possible. Challenges encountered at the onset of emergencies include the need to be able to identify and deploy qualified expertise rapidly and the lengthy procurement procedures within WHO for medicines and medical supplies.

To address these challenges, a regional emergency roster of public health experts was developed to enable WHO to respond in a more timely and effective manner to emergencies in the Region, with a number of public health experts identified and on standby. Negotiations were initiated in December 2012 with the United Arab Emirates Government to establish a dedicated hub for WHO in Dubai’s Humanitarian City. This hub will ensure that standard medical kits and supplies are stockpiled for more rapid deployment as needed in emergencies, and streamline the procurement process for WHO’s health relief operations in the Region and around the world. The standard operating procedures, developed in 2010 to streamline WHO’s work in emergencies, continued to be adhered to in addressing these challenges.

Emergency risk management

The growing number of large-scale emergencies enhanced the momentum of engaging Member States in multisectoral emergency risk management in the Region. It also highlighted the need to strengthen the emergency preparedness and response capacity of health systems, including the coordination among national and private sector partners.

Advocacy continued throughout 2012 in order to ensure that health is one of the priorities addressed in the global, regional and national development and disaster risk management agendas, in partnership with UNISDR, League of Arab States and UNDP. As a result, health has been underscored as one of the priority areas in the policy guidance for disaster risk reduction for Arab, African and Asian Member States, developed by all key partners. WHO was invited to participate in the First Arab Conference on Disaster Risk Reduction in 2013, where the regional disaster risk reduction platform was planned to be launched. A side meeting on multisectoral health is planned to be held during the conference for representatives/delegates of participating Member States.

Recognizing that incapacitated health systems impede national ability to respond to emergencies in a timely and efficient manner, emergency risk management was one of the areas highlighted for action within the context of the regional strategic priorities endorsed by the Regional Committee. This has spearheaded the impetus towards building national capacity with an all-hazard risk management approach incorporating the International Health Regulations (2005). As a result, the regulations have been included in national and regional training curricula for public health emergency management. To meet the challenges, even countries with protracted emergencies (Afghanistan, Pakistan and Sudan) are developing capacity in managing crises in a more institutional manner. This has also become evident in Islamic Republic of Iran, Oman and Pakistan, which are managing acute emergencies at the national level with minimal external support.

So far, seven countries (Afghanistan, Bahrain, Islamic Republic of Iran, Oman, Pakistan, Qatar and Sudan) are on track to institutionalize emergency risk management within the health sector. In light of this, preparation was undertaken to launch comprehensive risk assessment in Qatar and Sudan in the coming year. While establishing emergency risk management programmes remains a priority, simultaneous training in the areas of hospital preparedness, public health emergency management and disaster risk reduction also remain in focus in many countries. Recognizing that the safety of health facilities and health workforce is of utmost importance in the response to any public health emergency, several countries, including Bahrain, Islamic Republic of Iran, Lebanon, Oman and Sudan, are continuing to implement the hospital safety programme. WHO also worked with partners to develop a training programme on hospital preparedness in conflict situations.

To harmonize the national capacity-building activities from an all hazard approach at WHO, preparedness activities for emergencies, including epidemic and pandemic preparedness and core capacities for implementation of the International Health Regulations, were merged into one technical body ensuring optimum use of resources within the framework of health security and regulations under the auspices of of the Department of Communicable Disease Control. This was done in alignment of 2014–2015 biennium planning priorities.

Scaling up emergency response in the Region

With the deterioration of the situation inside the Syrian Arab Republic and the increasing scale and complexity of health issues and response in the neighbouring countries, the emergency was designated Grade 3 by WHO in December 2012 – the first time a Grade 3 was announced in the history of the Organization. As outlined in WHO’s Emergency Response Framework, a Grade 3 emergency called for the establishment of an emergency support team (EmST) to provide a consolidated, dedicated response to the crisis at the regional level by reinforcing WHO’s four critical functions: 1) coordination; 2) information; 3) technical expertise; and 4) core services. Plans for the immediate establishment of the EmST were finalized in December 2012 in a meeting in Beirut attended by senior representatives from all three levels of the Organization.

In addition to consolidating WHO’s response on a regional level to the Syrian crisis, the establishing of the EmST also reinforced the one-WHO model as other regions expressed their support. Despite its own financial limitations, the Regional Office for Africa donated US$ 100 000 to support EmST operations while WHO headquarters and the Regional Office for Europe deployed technical expertise as part of the emergency team.

 


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