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WORLD HEALTH ORGANIZATION

ORGANISATION MONDIALE DE LA SANTE

REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL

REGIONAL COMMITTEE

Forty-ninth session Manila 14---18 September 1998

Provisional agenda item 12.5

WPRlRC49111

14 July 1998

ORIGINAL: ENGLISH

REVIEW OF THE WHO CONSTITUTION,

INCLUDING REGIONAL ARRANGEMENTS

(Report of the Sub-Committee of the Regional Committee on

Programmes and Technical Cooperation, Part IV)

The Sub-Committee of the Regional Committee on Programmes and Technical

Cooperation was required to review on behalf of the Regional Committee the following two

issues referred to the Regional Committee by the Executive Board.

1. Functions of WHO (Article 2 of the Constitution).

2. Criteria and selection procedures for the Regional Director.

The Sub-Committee also noted the proposed set of objective criteria to determine the

nature and ell.ient of WHO representation at country level.

WPRlRC49111 page 2

1. INTRODUCTION

The Sub-Committee was asked to review several issues that had been referred to the Regional

Committee by the Executive Board.

I. Decision EIOI(3) indicated that Article 2 of the Constitution and revIsions proposed by the

Executive Board should be reviewed at all levels of the Organization during 1998.

2. During the 10 I st session of the Executive Board a recommendation was made that the regions

themselves should consider whether the criteria and selection procedures employed for the Director­

General and the Regional Director for Europe were useful and applicable to them.

Decision E I 0 I (6) endorsed the principle of utilizing a common set of objective criteria to determine the

nature and extent of WHO representation at country level. This issue was presented to the Sub­

Committee for information only.

2. FUNCTIONS OF WHO (ARTICLE 2 OF THE WHO CONSTITUTION)

The Sub-Committee reviewed the proposed revision to the text of Article 2 of the Constitution

as prepared by the special group of the Executive Board revie\\ing the Constitution (Annex I).

Generally, the Sub-Committee expressed approval of the proposed change to Article 2. The

proposed article presented the mission of WHO clearly and concisely. The grouping of functions under

headings was considered to be more illustrative of WHO's current activities than the single list of

functions in the current article.

The Sub-Committee made two specific proposals for changes to the proposed article:

• Section 2. The Sub-Committee felt that there should be a specific reference to health promotion

and protection in this section.

• Sub-section 5 (d). There appeared to be an error in the wording of this sub-section. The word

"prevention" should be replaced by "protection".

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WPRlRC49111 page 3

3. CRITERIA AND SELECTION PROCEDURES FOR THE REGIONAL DIRECTOR

Criteria for Candidates for the Post of Regional Director in the European Region (Annex 2)

and Relevant Provisions of Resolution EB97.RIO Coacerning Qualifications for the Post of Director­

General (Annex 3) were examined by the Sub-Committee.

Although the Sub-Committee found no fault with the criteria for the two posts, it did not feel

that listing criteria for candidates for the post of Regional Director in the Western Pacific Region would

be helpful.

The Sub-Committee also noted that the criterion that candidates for the post of Regional

Director in the European Region should be fluent in more than one of the working languages of the

Regional Committee was not necessary in the Western Pacific Region.

With regard to the selection procedures for the Regional Director, the Sub-Committee was in

favour of retaining the present system and saw no need for a search committee at this stage.

4. WHO COUNTRY OFFICES: CRITERIA FOR CLASSIFYING COUNTRIES ON

THE BASIS OF NEED

The Sub-Committee was presented with Document EB I 0212 (Annex 4) and decision EB I 0 1(6)

(Annex 5) for information only.

The Sub-Committee noted that, according to the classification presented, all WHO offices in

the Western Pacific Region complied with the criteria except for that in Singapore. According to the

classification, the appropriate level of representation in Singapore was a national focal point. However,

the Sub-Committee noted that the office in Singapore is part of the shared country office for

Brunei Darussalam, Malaysia and Singapore (the WHO Representative is based in Kuala Lumpur.

Malaysia) and also carries out an extensive procurement function for the Organization as a whole.

WPRlRC49/11 page 4

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ARTICLE 2. FUNCTIONS OF WHO

(current version)

In order to achieve its objective, the functions of the Organization shall be:

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ANNEX 1

(a) to act as the directing and co-ordinating authority on international health work;

(b) to establish and maintain effective collaboration with the United Nations, specialized

agencies, governmental health administrations, professional groups and such other

organizations as may be deemed appropriate;

(c) to assist Governments, upon request in strengthening health services:

(d) to furnish appropriate technical assistance and, in emergencies, necessary aid upon the

request or acceptance of Governments;

(e) to provide or assist in providing, upon the request of the United Nations, health services

and facilities to special groups, such as the peoples of trust territories;

(f) to establish and maintain such administrative and technical services as may be required,

including epidemiological and statistical services;

(g) to stimulate and advance work to eradicate epidemic, endemic and other diseases;

(h) to promote, in co-operation with other specialized agencies where necessary, the

prevention of accidental injuries;

(i) to promote, in co-operation with other specialized agencies where necessary, the

improvement of nutrition, housing, sanitation, recreation, economic or working

conditions and other aspects of environmental hygiene;

(j) to promote co-operation among scientific and professional groups which contribute to

the advancement of health;

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Annex 1

(k) to propose conventions, agreements and regulations, and make recommendations with

respect to international health matters and to perform such duties as may be assigned

thereby by the Organization and are wnsistent WIth its objective;

(I) to promote maternal and child health and welfare and to foster the ability to live

harmoniously in a changing total environment:

(m) to foster activities in the field of mental health. especially those affecting the harmony of

human relations:

(n) to promote and conduct research in the field of health;

(0) to promote improved standards of teaching and training in the health. medical and

related professions:

(p) to study and report on. in co-operation with other specialized agencies where necessary.

administrative and social techniques affecting public health and medical care from

preventive and curative points of view. including hospital services and social security:

(q) to provide information, counsel and assistance in the field of health:

(r) to assist in developing an informed public opinion among all peoples on matters of

health;

(s) to establish and revise as necessary international nomenclatures of diseases, of causes of

death and of public health practices:

(t) to standardize diagnostic procedures as necessary;

(u) to develop, establish and promote international standards with respect to food,

biological, pharmaceutical and similar products:

(v) generally to take all necessary action to attain the objective of the Organization.

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ARTICLE 2. FUNCTIONS OF WHO

(proposed revision)

In order to achieve its objectives the functions of the Organization shall be:

WPRlRC49111 page 7

Annex I

TO ACT AS THE DIRECTING AND COORDINATING AUTHORlTY ON INTERNATIONAL HEALTH AND,

IN SO DOING,

(a) to provide leadership in health:

(b) to develop an effective partnership with Member States in pursuit of global health:

(c) to support Member States in formulating, implementing and evaluating their health

policies;

(d) to establish and maintain effecti\'e collaboration with the United Nations, the

specialized agencies. and other intergovernmental bodies:

(e) to work with, and promote cooperation between, professional groups and

nongovernmental organizations active in the field of health, and "here necessary to

mobilize them for international health action.

2. TO LEAD INTERNATIONAL HEALTH POLICY DEVELOPMENT BY

(a) providing global surveillance and early "'arning systems for transnational threats to

health;

(b) collating and disseminatmg data and assessments of disease treatments:

(c) identifying and testing strategies to eradicate or control communicable diseases;

(d) identifying determinants of health status as a basis for health programmes and resource

allocations;

(e) designing preventive programmes to combat other threats to health, including lifestyle

diseases, mental illness and substance abuse;

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Annex 1

(f) designing programmes for the prcvention and management, including rehabilitative

aspects, of noncommunicable diselses:

(g) advancing health research through stimulation and, where necessary, coordination of

research actiVItIes:

(h) collating and disseminating data on desirable and appropriate methods of teaching and

training in the health professions.

3. TO SERVE AS THE INTERNATIONAL AGENCY FOR SETTING AND MONITORING NORMS AND

STANDARDS IN HEALTH BY

(a) proposing com·cntions. agreements and regulations and making recommendations with

respect to international health matters, and to perform such duties as may be assigned

thereby to the Organization and are consistent with its objectives;

(b) establishing and rc\'ising as necessary international nomenclatures for diseases, of

causes of death. and of public health practIces:

(c) developing, establishing and promoting international standards with respect to food,

biological, pharmaceutical and similar products and for health devices and health

technologies:

(d) developing, establishmg and promoting international ethical standards in all aspects of

health practIce and research.

4. TO COOPERATE WITH MEMBER STATES, PRIMARILY TI1ROUGH NATIONAL HEALTH

ADMINISTRATIONS, AND UPON REQUEST, BY PROVIDING ADVICE AND TECHNICAL

COOPERATION

(a) on ways to strengthen and improve sustainable health systems and resources;

(b) on enhancing policy-making, management capability and accountability within their

health systems;

(c) on disease eradication and prevention strategies;

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(d) in explicit health emergencies, on a short-term basis;

(e) on other arcas of the Organization's functIOns.

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Annex I

5. TO ACT AS THE INTERNATIONAL ADVOCATE FOR ilEAL Til FOR ALL BY PROMOTING

PARTICULARL Y

(a) the pursuit of equity in health outcomes, and the equitable international mobilization

and management of health resources:

(b) the centrality of primary health care within health systems;

(c) intersectoral responses to health challenges:

(d) health promotion and prevention, with particular reference to environmental,

occupational and nutritional health. and combating of violence and substance abuse:

(e) attention to the most vulnerable health stages of the life cycle (childhood, maternity,

old age);

(f) development of an informed public opinion on health among all peoples:

(g) resource mobilization for health.

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Annex 1

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CRITERIA FOR CANDIDATES FOR THE POST OF REGIONAL DIRECTOR IN THE EUROPEAN REGION 1

WPRlRC49/11 page 11

ANNEX 2

The following criteria were approved as guidelines by the Regional Comminee at its fortieth session (resolution EURiRC40!R3).

The candidate must have a true commitment to \\'HO's mission. The candidate should be truly commined to the values. roles and policies of WHO and notably the goal of health for all. There should be clear evidence of hislher personal involvement in furthering that commitment.

The candidate must have proven leadership qualities and integrity. The candidate must have demonstrated long-term and consistent leadership qualities. A commitment to outcomes and effective results -as opposed to merely a concern about processes - is essential. and the person must be dynamic. Ability to communicate in a clear and inspiring way is an important requirement. Such communication skills need to be effective with widely different target groups. including the mass media. and involve direct personal contact with political and other leaders in the public health field. health personnel. a wide range of academic and other professional groups outside the health sector. and WHO staff. etc. In view of the high goals of WHO and its impartial international character. the personal integrity of the candidate and the ability to withstand pressures from official or private sources contrary to the interests of the Organization are essential.

The candidate must have pro\'en managerial abili~·. The person should have demonstrated clear ability to manage a complex organization in the health field. Hislher performance in that role should have demonstrated a determination to make a thorough analysis of the problems and possibilities for solving them: the sening of clear goals and objectives: the design of appropriate programmes for optimal use of the total resources: the efficient use of those resources: and a careful process for monitoring and evaluation. Importance should be anached to the candidate' s skills in fostering teamwork - with appropriate delegation of responsibility - and in creating a harmonious working environment. In view of the need for the work of the Region to interact with and actively support the efforts of other regions and headquarters. the candidate's ability to work effectively with leaders. at both national and international levels. in health and other sectors. is an important element.

The candidate should be a person professionally qualified in the field of health and ha"ing a sound knowledge of public health and of its epidemiological basis. This type of qualification and background would greatly assist the candidate in the performance of hislher duties. and in contacts with national health administrations.

The candidate must have a broad understanding of the health problems and political. cultural, ethnic and other sensitivities in the Region. In view of the above. it follows that the candidate would normally be a national of one of the Member States of the Region. The candidate should be fluent in more than one of the working languages of the Regional Comminee. and knowledge of others would be an asset.

1 The Standing Comminee of the Regional Comminee has proposed that these criteria be amended 10 take into account the CrIteria contained In resolution EB97.R 1 0

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Annex 2

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EBIConstitutionl414

RELEVANT PROVISIONS OF RESOLUTION EB97.R10 CONCERNING QUALIFICATIONS FOR THE POST

OF DIRECTOR-GENERAL

The Executive Board.

ANNEX 3

I . RESOL YES that the candidate nominated by the Executive Board for the post of Director-General should fulfil the following criteria: he or she should have:

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(I) a strong technical and public health background and extensive experience in international health:

(2) competency in organizational management:

(3) proven historical evidence for public health leadership:

(4) sensitiveness to cultural. social and political differences:

(5) a strong commitment to the work of WHO;

(6) the good physical condition required of all staff members of the Organization: and

(7) sufficient skill in at least one of the official and working languages of the Executive Board and Health Assembly.

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Annex 3

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~ . ~ World Health Organization -., ~ Organisation mondiale de la Sante

EXECUTIVE BOARD 102nd Session

Provisional agenda item 5.1

WHO reform

WPRlRC49/11 Ilage 15

ANNEX 4

EB102/2 27 April 1998

WHO country offices: criteria for classifying countries on the basis of need

Report by the Director-General

In January 1998, a report on WHO country offices, focusing on the development of criteria for establishing a WHO country office that emphasize the priority placed on countries in greatest need, was presented to the Executive Board. 1 The report proposed appropriate mechanisms for WHO representation and coordination at country level according to the economic development and health status of the Member States, and considered also how the functions could be improved while concentrating more of WHO's scarce resources in countries in greatest need.

The Executive Board decision EB101(6), inter alia, requested the Director-General to develop further the criteria for classifying countries on the basis of need, in conformity with those provided in resolution EB101.R10 on regular budget allocations to regions, and to report on the results to the Executive Board at its 102nd session.

INTRODUCTION

1. An objective of WHO at country level is inter alia to support governments, upon request, in strengthening health services to provide infonnation, counsel and assistance in the field of health and to establish and maintain effective collaboration with the United Nations, specialized agencies, governmental health administrations and professional groups. Various ways in which the Organization's activities can be coordinated at country level, from a large WHO country office (in a country in greatest need) to no actual representation (as in developed countries), were suggested in document E8101/5 together with criteria for various types of representation.

I Document EBIOI/5.

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Annex 4

2. As health and economic status improve, the need for technical cooperation should change, which also implies both a change in the WHO resources allocated at country level and in WHO representation.

3. Various mechanisms to adjust the present method of allocating WHO's resources at country level have been suggested, taking into account population size, and using the Human Development Index and immunization coverage as indicators for WHO country contributions.

4. This report reviews the usefulness of these criteria for the flexible adaptation of WHO coordination at country level.

POPULATION COMPONENT

5. The population of WHO Member States and Associate Members ranges from 1600 (Tokelau) to I 243 738 000 (China). Three categories of countries were defined according to their population size: countries __ with a population of less than 300 000 (31 countries); countries with a population between 300 000 and 50 million (146 countries); and countries with a population of more than 50 million (22 countries).

6. For countries with a population of less than 300 000, which receive a limited regular budget allocation and for which the Human Development Index is usually not available, it is suggested that less costly arrangements other than WHO country offices, such as liaison offices or shared country offices, be utilized. At present all of these countries except five are already using liaison offices or shared offices.

7. In the 17 developing countries with a population exceeding 50 million (Bangladesh, Brazil, China, Egypt, Ethiopia, India, Indonesia, Islamic Republic of Iran, Mexico, Nigeria, Pakistan, Philippines, Russian Federation, Thailand, Turkey, Ukraine and Viet Nam), owing to the magnitude of their health problems, ministries of health are usually supported by the donor community, including other organizations of the United Nations system, through an important technical field presence. In these countries the tasks of advocating WHO policies, providing high-level policy advice to the govemment and to donors, and helping the government coordinate external assistance require a strengthened WHO country office. Some of these countries also house regional offices for various organizations of the United Nations system or development banks, which require WHO presence to ensure that health aspects are given due consideration in their activities. [n some of these countries WHO country offices also administer the subregional activities in smaller surrounding countries.

8. For all other countries, representing the majority of WHO Member States, the suitability of using indicators proposed for WHO regular budget allocation was reviewed.

HUMAN DEVELOPMENT INDEX AND IMMUNIZATION CRITERIA FOR THE ESTABLISHMENT OF WHO COUNTRY OFFICES IN COUNTRIES WITH A POPULATION SIZE OF BETWEEN 300 000 AND 50 MILLION

9. The Human Development Index is a composite index strongly correlated with other health indicators such as maternal mortality rate, infant mortality rate and under-five mortality rate. However, it tends to give greater emphasis to socioeconomic development and to respond slowly to changes in health services. A rapid improvement in health services may therefore not necessarily translate into an equally rapid change in the Index.

10. Immunization coverage for diphtheria, pertussis and tetanus (DPT3) is the only widely available index reflecting health service perfonnance. Having a relatively low correlation with the Human Development Index, it is attractive as a supplementary index. However, immunization coverage should be used with caution as a substitute for perfonnance of health services, as it can vary rapidly, for example, after an intensive immunization

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Annex 4

campaign. Furthermore. as countries are rapidly closing the gap between the ideally aChievable immunization coverage and their current coverage. other widely available health service performance indicators arc needed.

COUNTRY BUDGET ALLOCATION AND OTHER INDICATORS

II. As this report was written during the period in which the budget allocation model was being reviewed. it was not possible to use the likely size of WHO country allocations as a criterion for determining the level of representation at country level. However. the size of the WHO country allocation and of the extrabudgetary funds and other contributions administered by WHO at the country level are clearly a major factor in determining the size of the WHO country office and the numbers and type of staff.

12. More qualitative information on. for example. exposure to emergencies. equity. capacity to implement programmes and activities. as well as the need to effect coordination with other agencies that have large country or regional offices. existing subregional (intercountry) or interregional programmes. for example. should be used for further adjustment.

SUGGESTED GROUPING OF MEMBER STATES WITH A POPULATION SIZE OF BETWEEN 300 000 AND 50 MILLION

13. The Human Development Index (HDI) and immunization coverage already proposed as indicators for the allocation of resources at country level might be used to group Member States according to their economic and health status and to the performance of their health services. especially in the vast majority of countries where the population is between 300 000 and 50 million. Suggested ranges of indicator for the four categories of countries identified in document EB I 0 115 are shown in the table.

SUGGESTED RANGE OF INDICATORS FOR CLASSIFYING COUNTRIES WITH POPULATION 300 000 TO 50 MILLION

Human Immunization Countries Development coverage Suggested level of WHO representation

Index ("!o)

Group 1 0.000-0.699 and <60 Strengthened WHO country office

Group 2 0.000-0.699 or <60 Limited WHO country office

Group 3 0.700-0899 and 60-80 Liaison office

Group 4 >0.900 and >80 Focal point at national level supported by national authorities

14. It should be emphasized that these ranges are to be used flexibly and for guidance only when grouping countries. The indicators will help to establish a common assessment framework for all WHO regions. It will be necessary to establish a fixed schedule for reassessing the situation as well as for preparing guidelines to encourage the use of other mechanisms for coordination at country level.

15. The precise extent and composition of WHO country presence should be jointly decided by the government and WHO taking into account, in addition to the above criteria, the national health priorities and WHO priorities, the capacity of the country health system and the aims of bilateral and multilateral cooperation.

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Annex 4

ACTION BY THE EXECUTIVE BOARD

16. The Board may wish to recommend the following:

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(I) Regional Directors should determine, in consultation with countries, whether the type of WHO representation in each country is appropriate, taking into account the Human Development Index and immunization coverage as indicators, and retaining the possibility ofmodirying representation in some countries;

(2) Regional Directors should report to the Director-General on their progress in reassessing and redefining WHO representation according to specific needs and situations in countries;

(3) the Director-General should develop guidelines for Member States, according to national capacity, to assume greater responsibility for coordination with the Organization. -

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EXECUTIVE BOARD, 101 ST SESSION

EB101(6) WHO reform: WHO country offices

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ANNEX 5

The Executive Board (I) endorsed the principle of utilizing a common set of objective criteria to determine the nature and extent of WHO representation at country level: (2) requested the Director-General to develop further the criteria for classifying countries on the basis of need. in conformity with those provided in resolution EB I OI.R lOon regular budget allocations to regions. and to report the results of his refinement of the criteria to the Executive Board at its I 02nd session; (3) requested that the refined criteria should be applied in a flexible manner, in order to guide decisions on the nature and level of WHO representation at the country level. taking into account the activities of other organizations and countries; (4) requested that any changes in WHO representation at the country level resulting from application of these criteria should be phased in over the next three bienniums; (5) emphasizing the leadership role of WHO in United Nations health activities and its role as the directing and coordinating authority for international health work. requested WHO to cooperate fully with other organizations and bodies of the United Nations system at country level: (6) requested the Director-General to report to the Executive Board at its I03rd session on the outcome of the pilot phase of the United Nations Development Assistance Framework. which is being conducted in 19 countries.

(Twelfth meeting. 24 January J 998)