WHO and the Millennium Development Goals

1
WHO and the Millennium Development
Goals Interregional Meeting
San Jose, Costa Rica, 11-13 November 2004
WHO and the Millennium Development Goals Current
Situation, Policy Issues and Challenges
WHO Regional Office for South-East Asia New Delhi
2
Regional Policy and Strategies for the MDGs in
the Region

• 55th Session of WHO Regional Committee for
  South-East Asia, September 2002. MDGs brought to
  the attention of this Regional Committee. In her
  address, the Director General of WHO described
  some key elements of WHO agenda. She stated that
  two year ago, world leaders agreed on a set of
  development goals for the millennium. Many of
  them are concerned with health. The Millennium
  Development Goals show us the benefits of having
  a limited list of objectives, a careful
  definition of indicators and a rigorous analysis
  of costs. I strongly believe that the MDGs can
  become a key rallying point for action, not just
  internationally, but at country level, too.

3
Regional Policy and Strategies for the MDGs in
the Region (Contd)

• 8th Meeting of Health Secretaries of the
  Countries of WHO South-East Asia Region, April
  2003 Agenda Item WHOs Contribution to
  Achievement of the Development Goals of the
  United Nations Millennium Declaration. Brought to
  the attention commitments of the countries,
  process of monitoring, reporting, emphasizing
  political support, appropriate investment,
  selecting cost-effective interventions,
  implementation main responsibilities remain
  with countries.

4
Regional Policy and Strategies for the MDGs in
the Region (Contd)

• WHO Regional Committee for South-East Asia,
  September 2003 noted that there was a need
  to offer technical, financial and managerial
  support to meet the Millennium Development Goals

5
Regional Policy and Strategies for the MDGs in
the Region (Contd)

• Twenty-second Meeting of Ministers of
  Health of SEAR Countries, September 2004. Report
  on Progress Towards Achieving Millennium
  Development Goals in WHO South-East Asia Region.
  Based on the Report prepared by WHO SEARO
  Secretariat, it recommended that based upon the
  assessment of the progress towards achieving
  MDGs, Member States should identify specific
  challenges and develop appropriate intervention
  programmes with the support of all partners in
  health, focusing on the health needs of the
  underprivileged and the poorest segments of the
  population. It also recommended that WHO
  should continue to assist countries in their work
  in MDGs, with particular emphasis on (i)
  technical support (in planning, identification
  and scaling up of cost-effective interventions,
  reviewing the implication of globalization and
  providing advice (ii) monitoring and reporting
  (by linking interventions with indicators,
  facilitating collection of baseline data,
  addressing equity and (iii) resource
  mobilization (through follow-up on the work of
  the national commissions on macroeconomics,
  development of joint proposals with partners, and
  facilitating use of existing resources
  effectively, as part of national poverty
  reduction strategies.

6
Regional Policy and Strategies for the MDGs in
the Region (Contd)

• SEARO Regional Working Group on Millennium
  
• Development Goals (established in early
  2003)
• Terms of Reference
• Assist Dept. of Health System Development in
  collecting and producing MDGs and core health
  indicators by ensuring consistency across all UN
  agencies with WHO programmes at all levels
• to work with HQ counterparts for ensuring the
  accountability on sources, methods of estimation,
  and full development of figures keeping in view
  the five quality criteria and
• to provide technical support in country level
  consultation process wherein consultation with
  MoH on preliminary country estimates proposed by
  WHO.

7
Regional Policy and Strategies for the MDGs in
the Region (Contd)

• A Seminar of all technical programmes within
  SEARO on MDGs / targets / indicators in their
  respective areas and their role at regional level
  (November 2003)
• SEARO Staff Retreat on MDGs, December 2003.
  Objectives (1) Clarify the role of professional
  staff whose technical programmes have direct
  involvement towards the achievement of the MDGs,
  and (2) clarify the issues related to linking the
  MDGs to the work plans for 2004-2005, and to
  understand the process of preparation of the
  Programme Budget 2006-2007 and the Eleventh
  General Programme of Work (GPW). Outcomes from
  the Retreat were (1) A better understanding of
  the implications on WHOs role regarding the MDGs
  the rationale, level of involvement, and use of
  indicators, as well as assisting countries in
  monitoring the achievement of MDGs, and (2) a
  better understanding of the relationship between
  the work plans for 2004-2005 and the process of
  preparing the Programme Budget for 2006-2007
  towards achievement of the MDGs, and the role of
  professional staff / concerned technical units in
  assisting countries and the WHO country offices.

8
Regional Policy and Strategies for the MDGs in
the Region (Contd)

• Bi-regional Collaboration on Monitoring and
  Reporting MDGs SEARO/WPRO
• Bi-regional Consultation on Strengthening
  Health Information System, December 2004
• Bi-regional brochure on MDGs including core
  health indicators by March 2005
• Report on Progress Towards Achieving MDGs in
  Asia and the Pacific for the MDGs Health
  Poverty Meeting, June 2005, Japan
• Bi-regional publication Health in Asia
  the Pacific, Edition 2007, highlighting progress
  in MDGs

9
Status and Measurements of the MDGs in the
Region

• Regional Consultation on Reporting UN MDGs
  and WHO Core Health Indicators, June 2003.
  Identified role of member states and WHO in
  monitoring reporting of MDG data set and
  recommended
• For Member States
• Continued political commitment should be
  provided to planning and monitoring MDGs, and
  adequate financial, logistics, technical and
  human resources, in coordination with other
  sectors, development partners, stakeholders, UN
  Agencies and NGOs.
• National consultative meetings should be
  conducted to review and follow-up the MDG health
  indicators. National focal points responsible for
  reporting MDG should be designated. Ideally, the
  national HIS focal points should act as
  coordinators and facilitate capacity building in
  data collection, analysis, dissemination,
  periodic surveys and reporting related to MDG
  indicators.

10
Status and Measurements of the MDGs in the
Region (Contd)

• For Member States (Contd)
• An inter-sector working group or taskforce
  should be established for coordination with other
  agencies and UN Country team, in sensitization of
  political leaders and provision of financial,
  technical, human resource development support and
  advocacy for MDG activities.
• The national MDG reporting agency should
  ensure that the MDG reporting periodicity should
  be comparable with all other national information
  reporting periodicity.
• Periodicity surveys on health and
  health-related MDG indicators should be carried
  out to complement national routine data
  collection, with support of national governments
  and development partners.

11
Status and Measurements of the MDGs in the
Region (Contd)

• For WHO
• Guidelines on standards for recording and
  reporting on the MDGs health indicators should be
  finalized as soon as possible which could be used
  as a tool for monitoring and evaluation.
• National workshops, seminars and orientation
  courses should be organized in collaboration
  with the ministries of health and national
  statistical institutions, to advocate and
  disseminate information related to MDG health
  indicators such as basic rationale, definitions,
  methods of collection, compilation, analysis and
  estimation, results of trend analysis and
  limitation of data reporting, etc.
• Collaborative activities in strengthening
  national health information systems, especially
  in its capacity foe collection, analysis and
  reporting should be enhanced. Resource
  mobilization for enhancing HIS activities should
  be facilitated.

12
Status and Measurements of the MDGs in the
Region (Contd)

• For WHO (Contd)
• WHO should work closely with the national
  focal institutions in order to reconcile data
  contained in national MDG-health reports with
  those published by it. WHO as a member of UN
  country Team at each country, should ensure
  appropriate interaction with other UN agencies
  and development partners, and also with national
  statistical agencies for planning, implementation
  and monitoring of UN MDGs, especially for health
  and health related MDG indicators.
• WHO should work closely with its partners
  especially those responsible for generating and
  using of MDG indicators in getting consensus of
  on the definition and their measurement tools and
  methods. WHO should also work with other agencies
  and national authorities who are responsible for
  conducting health and health related surveys by
  trying to incorporate the modules contained in
  World Health Survey and trying to avoid
  duplication and conflict and also to reduce cost.

13
Status and Measurements of the MDGs in the
Region (Contd)
2004 Basic Indicators Health Situation in
South-East Asia includes MDGs health related
targets and indicators (latest available data)
provided by the official national reports
14
Status and Measurements of the MDGs in the
Region (Contd)

• 6 national MDG progress reports (out of
  eleven SEAR member states) submitted
• Inequities captured ? Indonesia MDG Report
  National averages are misleading, especially in
  a country as vast and diverse as Indonesia. At
  the very least, data should be examined by
  province and ideally by district. Susenas data
  yield reasonably precise estimates for provincial
  levels and the yearly core component of the
  Susenas also provides district-level data with a
  fairly acceptable level of precision. Thailand
  most of the targets already achieved. MDG plus
  target of reducing proportion of poor people to
  below 4 percent by 2009 set up. Persistent
  disparities among regions and groups within the
  country, including marginalized and vulnerable
  groups need to be addressed. Policies and
  resources are needed to tackle poverty and
  below-average health conditions in the
  North-East, the remote highland areas of the
  North, and the three predominantly Muslim
  southernmost provinces, areas that are lagging
  behind the rest of the country. Nepal the
  distribution of educational, health-related and
  other opportunities and attainments remains
  highly unequal along regional, urban/rural,
  gender and socio-economic dimensions. Bhutan
  inequities captured in each indicator.

15
Challenges, Strategies Development Perspective

• Challenges of interventions (i) combating
  extreme poverty and hunger (ii) reducing
  mortality (iii) combating infectious diseases
  (iv) sustaining environment (v) scaling-up
  interventions (vi) challenges for the health
  system
• Partnership. Strengthening linkages between
  numerous strategies or initiatives (incl. MDG) at
  the country level would be an important challenge
  to achieve progress in poverty reduction. In
  SEAR, UN system works on MDGs, UNDAF, and the
  Common Country Assessment. The WB/IMF initiatives
  consist, among others, of Poverty Reduction
  Strategy Programmes and the Medium Term
  Expenditure Framework. In some countries
  Sector-Wide Approaches have been adopted. WHO
  the National Commissions on Macroeconomic and
  Health, National Health Accounts Framework and
  the WHO CCS.

16
Challenges, Strategies Development
Perspective (Contd)

• All these focus on poverty reduction and
  health poverty reduction as the main challenge
  the MDGs should be the focus of these joint
  actions.
• The multidimensional nature of the MDGs, the
  linkages among them and their multi-sector
  determinants imply that the policy agenda for
  achieving the goals is broad
• 6 out of 11 SEAR countries have implemented
  various activities under their national
  commissions on macroeconomic and health
• In some SEAR countries, preparation of a
  plan that links the PRSP and the MDGs has been
  initiated
• Governments should use these plans as
  long-term action plans for poverty reduction and
  human development, by setting sectoral targets
  and linking them to policy actions and resource
  allocations

17
Challenges, Strategies Development
Perspective (Contd)

• SEAROs involvement in the Regional
  activities - attended Regional Workshops on MDGs
  for Asia and the Pacific (organized by UNDGO and
  UNDP) Dec 2003 (Kuala Lumpur), Manila (August
  2004) and Siem Reap (October 2004).
• Collaboration with UN ESCAP in exchange of
  information/data and progress reports.
• SEARO participated in the Expert Group
  Meeting on Training Design for Upgrading
  Statistical Capabilities on MDGs, Bangkok,
  September 2004 (UN Statistical Institute for Asia
  and the Pacific).

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The Process of MDGs at the Country Level

• Regional policies, Reports on MDG
  achievements from SEAR member countries,
  experiences from the country visits indicate that
  MDGs are considered under responsibility of the
  countries and are expressed in the national
  policy agendas.
• Bhutan The MDGs are of great relevance and
  fully compatible with Bhutans development vision
  and aspirations. The various MDGs relating to
  poverty, educational attainments, maternal and
  child health and environmental sustainability are
  high priority development themes for Bhutan
  National Development targets as reflected in the
  Ninth Plan and the Bhutan Vision 2020 often
  exceed or closely match MDG targets.

19
The Process of MDGs at the Country Level
(Contd)

• India Existing National Plans are in harmony
  with MDGs. The National Plans aim to achieve MDGs
  before 2015. Poverty should be reduced to 7 by
  2012. Overall plans and strategy papers by
  programmes exist. UN support needed for advocacy,
  sector specific analytical work, work on gender
  issues, poverty, knowledge management. (from the
  Regional Workshop on MDG for Asia and the
  Pacific, Manila, August 2004).
• Indonesia The MDGs are an important input
  for Indonesias national development planning.

20
The Process of MDGs at the Country Level
(Contd)

• Nepal Progress along the MDGs are
  crucially contingent on further democratization
  of state, politics and government policies
  including the following (i) realignment and
  harmonization of macroeconomic and sectoral
  policies with constitutional mandate (ii)
  reprioritization of development interventions
  along targets encapsulated under the MDGs (iii)
  drawing of the required financial and other
  political, institutional, and administrative
  resources away from security organs and towards
  the attainment of the MDGs (iv) local
  involvement (i.e. participation, empowerment),
  commitment and ownership (v) prioritization of
  MDGs, as well as contextualization of MDG
  attainment strategies, in a locally sensitive
  manner.

21
The Process of MDGs at the Country Level
(Contd)

• Thailand The MDG Plus framework is a tribute
  to Thailands can-do and result-based approach to
  human development. Most of the MDG Plus targets
  are taken from already agreed national plans and
  strategies. (e.g. The 9th National Economic and
  Development Plan by 2006).
• Timor-Leste The National Development Plan
  formulated prior to independence successfully
  internalized the MDGs, which is indeed a unique
  achievement. As a result, the National
  Development Plan objectives and targets
  substantially overlap with the MDGs.

22
WHO Role on MDGs at the Regional Country
Levels
I) General Role of WHO II) Specific Role of
WHO - Technical Support - Monitoring and
Reporting - Resource Mobilization - Advocacy
23
WHO Role on MDGs at the Regional Country
Levels (Contd)

• General Role of WHO
• (1) Participatory facilitation
• (2) Strengthening coordination at national and
• regional global levels

24
WHO Role on MDGs at the Regional Country
Levels (Contd)

• Specific Role of WHO

• Technical Support
• Preparation of common work plan with strategic
  partners
• All work plans need to strategize how to link
  with MDG indicators and targets (maternal health,
  CDS, HIV/AIDS, W/S, CAH, environmental health,
  etc.)
• Identification of cost-effective interventions -
  common aspects including specific steps to reach
  the poor (link with PRSP, CMH, FHA)
• Strengthening bottom-up planning capacities at
  country levels
• Promoting health education at all levels
• Strengthening national health information systems
• Training staff in data collection analysis, and
  interpretation
• at sub-national level
• Strategizing each goal

25
WHO Role on MDGs at the Regional Country
Levels (Contd)

• Specific Role of WHO (Contd)

(2) Monitoring and Reporting

• Facilitate collection of baseline data
• Identify and coordinate with national
  MDG focal
• institutions and all stakeholders
• Work with national authorities and other
  agencies to
• incorporate MDG in surveys
• Link interventions with indicators
• Address equity (gender, geographical,
  sub-national,
• ethnic groups etc.) in monitoring,
  reporting and
• interventions
• Ensure qualitative criteria for monitoring and
  reporting
• of achievements

26
WHO Role on MDGs at the Regional Country
Levels (Contd)

• Specific Role of WHO (Contd)

• Follow-up of CMH report in countries
• Advocacy to reach globally-agreed development
  targets
• Development of joint proposal with partners
  and the
• regional and country levels including
  short- and long-
• term costing
• Recruitment of skilful staff and posting in
  countries
• Facilitate the use of existing
  financial resources
• effectively
• Advocacy to generate additional funds

(3) Resource Mobilization
27
WHO Role on MDGs at the Regional Country
Levels (Contd)

• Specific Role of WHO (Contd)

(4) Advocacy

• Creating public awareness jointly with UN
  agencies and
• stakeholders at country level
• For ownership of MDG
• For sustaining political commitment
• Demonstrate examples success stories

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Involvement of WHO Country Offices

• National Workshops with participation of all
  stakeholders
• WHO supported ( awareness, identification
  of roles of all
• partners) during 2003/2004.
• UN Country Teams for MDGs (UNCT) established
  in all 11
• SEAR countries. WRs are members of the UNCT

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Summary of Issues and Challenges Related to
Monitoring MDGs and Development

• Baselines not always available
• Quality of data (i) routine vs.
  surveys (ii) collaboration
• between MoH and NSOs
• Monitoring/reporting vs. specific
  interventions fetish of
• reporting in some countries specific
  interventions should be
• as a primary, reporting as a secondary
• Data availability for some indicators level
  of development of
• HIS
• Data interpretation has to be made taking
  into account the
• country-specific context and the
  views of various
• stakeholders in preparing country level
  reports

30
Summary of Issues and Challenges Related to
Monitoring MDGs and Development (Contd)

• The MDGs give a high prominence to health,
  but do not
• cover all priority areas of health
  development. They are
• mainly a set of outputs and outcomes
  that need to be
• associated with inequality measures to allow
  for a poverty
• analysis and for sub-national analysis.
  The challenge is to
• tailor MDGs to a poorest / vulnerable
  availability of
• indicators at the sub-national level (good
  examples already
• available Sri Lanka, Indonesia,) for
  targeting specific
• interventions in the context of
  poverty reduction and
• development.
• Harmonization of all existing initiatives in
  development and
• poverty reduction at the country level
• Pro-activity of WHO Country Offices versus
  their passivity
• other UN agencies may take a lead

31
Summary of Issues and Challenges Related to
Monitoring MDGs and Development (Contd)

• Both ways information / communication
  between WHO
• ROs and COs crucial for work on MDGs
• WHO roles and responsibilities in MDGs must be
  clear for
• all staff
• Planning of WHO Collaborative Programme in the
  context
• of MDGs
• Country ownership should be emphasized
  however all
• stakeholders are also committed and should
  assist the
• countries
• How to get the MDGs into the community
  leveltargeting
• specific interventions

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Thank you