PROGRAMME BUDGET MID-TERM REVIEW REPORT WHO/PRP/15.1 ENGLISH ONLY

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1 PROGRAMME BUDGET MID-TERM REVIEW REPORT WHO/PRP/15.1 ENGLISH ONLY

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3 PROGRAMME BUDGET MID-TERM REVIEW REPORT WHO/PRP/15.1 ENGLISH ONLY

4 Rounding convention: Due to the presentation of the financial figures in US$ 000 or US$ millions there may be a slight discrepancy between the total shown, and the total when calculated by adding the figures as printed. WHO/PRP/15.1 World Health Organization 2015 The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Printed by the WHO Document Production Services, Geneva, Switzerland.

5 CONTENTS INTRODUCTION 4 MID-TERM REVIEW BY CATEGORY AND PROGRAMME AREA Category 1 Communicable diseases HIV/AIDS 1.2 Tuberculosis 1.3 Malaria 1.4 Neglected tropical diseases Vaccine-preventable diseases Category 2 Noncommunicable diseases Noncommunicable diseases 2.2 Mental health and substance abuse 2.3 Violence and injuries 2.4 Disabilities and rehabilitation 2.5 Nutrition Category 3 Promoting health through the life-course Reproductive, maternal, newborn, child and adolescent health Ageing and health 3.3 Gender, equity and human rights mainstreaming 3.4 Social determinants of health 3.5 Health and the environment Category 4 Health systems National health policies, strategies and plans 4.2 Integrated people-centred health services 4.3 Access to medicines and health technologies and strengthening regulatory capacity 4.4 Health systems, information and evidence Category 5 Preparedness, surveillance and response Alert and response capacities 5.2 Epidemic-prone and pandemic-prone diseases 5.3 Emergency risk and crisis management 5.4 Food safety 5.5 Polio eradication 5.6 Outbreak and crisis response Category 6 Corporate services / Enabling functions 87 ANNEXES 6.1 Leadership and governance 6.2 Transparency, accountability and risk management 6.3 Strategic planning, resource coordination and reporting 6.4 Management and administration 6.5 Strategic communications 1. Overview of budget implementation by the end of Financial implementation by programme area and major office Including the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases 2 Including the the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction

6 INTRODUCTION The mid-term review is the first monitoring exercise to be undertaken under the Twelfth General Programme of Work, and the Programme budget The two documents are key products of the programmatic reforms led by Member States and constitute the two main frameworks for Organizational transparency and accountability. The present report is the first annual report based on the new results chain. The Organization-wide exercise serves internal managerial needs by tracking progress and facilitating external communication and reporting. The Programme budget : Mid-term review highlights and analyses major progress and implementation issues in the category and programme areas, setting the scene for the end of biennium assessment. It includes key information which links the programmatic aspects to financial implementation. Budget implementation is also reviewed in conjunction with the information presented to Member States through the WHO programme budget web portal and in the annual financial report and audited financial statements. 3 Lastly, the report provides an overview of the priorities for 2015, as well as any actions that programme areas will have to undertake as a result of this review during the second year of implementation. Methodology and the process This report contains a qualitative review and analysis of the rationale, relevance and purpose of WHO s contribution to the achievement of the outputs delineated in the Programme budget, and for which the Secretariat is accountable, and of the progress made. 4 Progress made in achieving outcomes for which WHO and Member States were jointly accountable will be within the scope of upcoming review and assessment exercises relating to implementation of the General Programme of Work. The outcomes of this review will be complemented by an in-depth assessment of the Organization s performance at the end of the biennium. A systematic review was undertaken of the work included in the operational plans of budget centres and the allocated financial and human resources. The views of responsible officers and senior management at all three levels of the Organization on the status of progress towards achievement of outputs was shared, discussed and validated through the programme area and category networks. An overview of the rating by output, category and major office is included in the reports of each programme area. The following components were taken into consideration during this bottom-up analysis: the status of implementation of products and services to be delivered by each organizational entity at country, regional and headquarters level as defined within the scope of the deliverables; the assumptions and risks defined internally which influence day-to-day programme delivery, and those relating to actions of partner stakeholders, including Member States, as well as strategies to mitigate these risks; consideration of gender, equity and human rights-based approaches defined during the initial planning stage and which should be followed in the course of implementation; and major financial and staffing implementation 5 issues which influence contributions to the achievement of outputs. 3 See document A68/38 (Financial report and audited financial statement for the year ended 31 December 2014), and document A68/41 (Report of the External Auditor). provided. 4 In cases where technical or epidemiological data are reported, the latest available data following standard reporting cycles are 5 Implementation includes expenditures for goods and services that were delivered by the end of the first year of implementation. Encumbrances are commitments made for goods and services that were not delivered as at 31 December 2014 and therefore are not recognized as expenditure for accounting purposes. Encumbrances are provided for information only. 4

7 In addition, owing to the recent unprecedented emergency faced by the Organization, budget centres and programme areas were asked to highlight the impact of the Ebola outbreak on implementation of activities, especially in the African Region, as well as on regional and global priorities. The progress towards the achievement of outputs was rated as follows: [] ON TRACK An on track rating implies that the rate of progress at mid-term is unlikely to change during the rest of the biennium. [! ] AT RISK An at risk rating means that progress is affected by impediments and risks which require corrective action. [ - ] IN TROUBLE An in trouble rating means that the contribution of the major office is being seriously hampered and it is likely that it will not be achieved by the end of the biennium. In cases where a major office reported that its contribution to an output was not a regional priority or the particular output was not relevant for the regional situation, the rating is not applicable (N/A). 5

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9 Category 1 COMMUNICABLE DISEASES This category groups together the work on reducing the burden of communicable diseases, including HIV/AIDS, hepatitis, tuberculosis, malaria, neglected tropical diseases and vaccine-preventable diseases. More specifically, programme areas in this category contribute to the achievement of the following outcomes: increased access to key interventions for people living with HIV; increased number of successfully treated tuberculosis patients; increased access to first line antimalarial treatment for confirmed cases; and increased and sustained access to essential medicines for neglected diseases. The work is directed by international commitments to attain the key targets set by the United Nations, including the Millennium Development Goals. Highlights of first year of implementation The provision of antiretroviral treatment to people living with HIV (15 million) and reduction in HIVrelated deaths (25% compared to 2009): the 2015 global targets are well on track and are likely to be exceeded. Achievement of the 2015 Millennium Development Goal of halting and reversing tuberculosis incidence in all six WHO regions: the mortality rate fell by an estimated 45% between 1990 and Achievement of the 2015 Millennium Development Goal of halting and reversing the incidence of malaria, in all six WHO region: malaria mortality rates fell by 47% between 2000 and

10 Implementation of the Global Plan to Combat Neglected Tropical Diseases , including the procurement and supply of medicines to 78 countries as part of the expansion of preventive chemotherapy interventions and more than one million treatments for complex diseases, such as human African trypanosomiasis, visceral leishmaniasis, leprosy, Buruli ulcer and continued progress towards eradicating dracunculiasis. The progress made in the introduction of new and under-utilized vaccines, including haemophilus influenzae type B (Hib) vaccine, hepatitis B vaccine, pneumococcal vaccine, rotavirus vaccine, human papillomavirus vaccine and meningococcal A conjugate vaccine. The elimination of maternal and neonatal tetanus by the end of 2014 in 35 of 59 countries where maternal and neonatal tetanus persist as a public health problem. Specific illustrative examples of major achievements delivered by the Secretariat are included in the reports by the programme areas and cover: intensified and direct technical assistance to Member States for successful development of concept notes for the Global Fund to Fight AIDS, Tuberculosis and Malaria; progress in updating and complementing the normative basis for realization of ambitious targets in countries; progress in diagnosing multidrug-resistant tuberculosis through expanded access to new tests; intensive technical assistance for implementing and monitoring the Global Vaccine Action Plan ; and better quality data. The latter provides a clearer global picture of the disease situation, which informs policy decisions, solutions and implementation strategies, allowing them to respond to the health needs of disease-endemic countries and which are developed through strengthened research and training. Overall, the assumptions and risks identified during the planning process still apply. However, in some instances, humanitarian crises, unfavourable security situations and political changes in countries have overtaken the plans. This has resulted in delayed implementation of planned activities and significantly increased costs, notably in countries affected by the Ebola virus disease outbreak and in numerous Member States in the Eastern Mediterranean Region which are experiencing political turmoil and massive population movements. WHO is actively engaged in developing new targets and strategies for the post-2015 agenda in the context of the sustainable development goals and an unfolding universal health coverage agenda. The impact of the Ebola virus disease outbreak varied significantly among the major offices. The most affected was the Regional Office for Africa, where, at the height of the outbreak in West Africa, routine health services were closed in Guinea, Liberia and Sierra Leone, hampering access to services for the prevention, diagnosis and treatment of HIV/AIDS, tuberculosis and malaria. Continuing Ebola virus disease outbreaks in these countries pose an ongoing risk to achievement of HIV/AIDS, tuberculosis and malaria control objectives, especially in West Africa. In other regional offices and headquarters, the need to support technical missions helping Member States assess their preparedness and response capabilities for an Ebola virus disease outbreak using available capacities led to a prioritization exercise. Its aim was to identify the activities that could be postponed to allow a clear focus on activities connected with Ebola virus disease. In 2015, the focus will continue to be on positioning communicable diseases in the context of the sustainable development goals and an unfolding universal health coverage agenda in order to sustain the progress made through attainment of the Millenium Development Goals. WHO coordinated and contributed to the evidence and formulation of new targets and strategies through global consultative processes involving Member States and stakeholders, including organizations of the United Nations system, scientific and research groups, nongovernmental organizations and partners. 7

11 1.1 HIV/AIDS In the biennium , the Secretariat has focused its efforts on supporting countries to implement and monitor the global health sector strategy on HIV/AIDS , preparing a post-2015 strategy and strengthening capacity for HIV policy and programme implementation. Moreover, it is consolidating and updating policy guidance on the prevention and treatment of HIV infection for all age groups and key populations, with a focus on integrating HIV and other health programmes. Hepatitis was added as a new area of work and the Secretariat s response to hepatitis was fast tracked. The Secretariat is building its work on technological advances and new opportunities, including promotion of the use of antiretroviral medicines more strategically with the aim of maximizing their benefits for the prevention of HIV transmission; accelerating technological innovation in medicines and diagnostics to allow for simpler, safer, more affordable therapeutic regimens and decentralized service delivery; ensuring quality and reinforcing patient retention across the continuum of diagnosis, care and treatment; linking and integrating HIV services with those for tuberculosis, hepatitis, maternal and child health, drug dependence and other programmes; and monitoring the impact of expansion of treatment on HIV incidence and drug resistance. Progress to date During 2014, the Secretariat contributed to expanding access to key interventions for people living with HIV and to addressing viral hepatitis, including: provision of technical support and capacity building to more than 50 countries to develop concept notes for continued co-funding of the national HIV response by the Global Fund to Fight AIDS, Tuberculosis and Malaria, in the context of cohesive national HIV plans which are in line with the global health sector strategy on HIV/AIDS ; an agreement with multiple partners on a reduced core set of 10 global indicators, which forms an essential part of the 2015 consolidated strategic information guidelines for HIV in the health sector; work with partners to strengthen supply systems in order to ensure uninterrupted antiretroviral treatment for patients; provision of technical support to countries in all regions for planning and scaling up the health sector response, reviewing national HIV programmes, and increasing coverage of life-saving antiretroviral therapies; the launch of new publications: The global health sector strategy on HIV/AIDS an interim review of progress; HIV, universal health coverage and the post 2015 In 2014, WHO supported more than 50 countries to develop concept notes for continued co-funding of the national HIV response by the Global Fund to Fight AIDS, Tuberculosis and Malaria. development agenda; and The availability and use of diagnostics for HIV: a 2012/2013 WHO survey of low- and middle-income countries; the launch and implementation of the WHO consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations in 2014; the formulation of optimized priorities for adult and paediatric treatment and a roadmap and research agenda for the future; development of the global health sector strategies for HIV and the global hepatitis targets towards a vision of eliminating hepatitis was initiated, as well as a programmatic note on how the 2013 guidelines on antiretrovirals treatments support the emerging post-2015 sustainable development targets, including the targets proposed by UNAIDS ; intensifying technical support on hepatitis to countries across all regions and increasing engagement of Member States and partners in the hepatitis response through a Health Assembly resolution, the establishment of strategic and community advisory bodies, and the initiation of a global strategy and targets; 8

12 publication of guidelines for the screening, care and treatment of persons with hepatitis C infection were issued and provide key recommendations for hepatitis C programmes in low- and middleincome countries. This was complemented by the 2015 guidance on hepatitis B and hepatitis surveillance; and systematically addressing equity and gender concerns in all guidance, placing them at the centre of the 2014 consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. Work on gender-related violence in the context of HIV made a specific contribution to reducing inequities. Challenges and impediments The contribution of the Secretariat to the outputs, depends on the continued recognition of HIV/AIDS as a priority on national and international health agendas, and increased attention being paid to hepatitis as a global concern. Progress in both areas hinges on further significant scaling up, supported by continued commitment and investment. The upcoming new WHO HIV and hepatitis strategies for will have to predict and respond to changing needs and targets in a broader health and development context. Despite efforts to address them in WHO s work, inequities and imbalances persist in the global response to HIV and hepatitis. The challenge, which will be faced with partners, is how best to deal with this uneven landscape. Priority should be given to children, adolescents and key populations in optimizing access to, and the quality of, HIV, HIV-associated tuberculosis and hepatitis related prevention, diagnostics, treatment and care. The increasing focus and awareness should be coupled with sufficient capacities and financial resources to allow a response that is commensurate with the significant burden posed by the diseases. Overview of progress towards achievement of the outputs by major office () On track (!) At risk (-) In trouble Output Implementation and monitoring of the global health sector strategy on HIV/AIDS through policy dialogue and technical support at global, regional and national level Adaptation and implementation of most up-to-date norms and standards in preventing and treating paediatric and adult HIV infection, integrating HIV and other health programmes, and reducing inequities (US$ 000) 50,000 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 - WHA Approved Budget Funds Available (as at 31 Dec 2014) Total Expenditure Total Encumbrances The contributions of the regions and headquarters to the achievement of all outputs were judged to be on track. The funds available as a percentage of the approved budget amounted to 91%. Expenditure was 45% compared to the approved budget and 49% of funds available. 9

13 The Ebola virus disease outbreak slowed down the implementation of HIV/AIDS programmes in the African Region, especially in the countries affected by the disease; however, all priority activities have been maintained through re-scheduling and/or the increased engagement of partners. In the Regional Offices for Europe, the Eastern Mediterranean and the Western Pacific, implementation was affected by a reduction in staffing and limited resources for key activities, including, work related to vulnerability, structural barriers, including gender, accessing services, strengthening community systems and promoting health rights, evidencebased policy guidance, and technical assistance to address vulnerability. Actions for 2015 The main priorities for the programme area in 2015 include: finalization of the global health sector strategies for HIV and hepatitis on the basis of extensive consultations throughout the year, followed by regional strategies and/or action plans to be initiated in 2016; continued tracking and reporting of progress in the global HIV and hepatitis response, notably through a 2015 update of the report on the global health sector response to HIV, including information on HIV drug resistance and forecasts for HIV and hepatitis treatment needs; the consolidation and updating of normative guidance, including on strategic information for the HIV health sector response, and HIV testing and counselling; continued technical support for the development of grant proposals to the Global Fund to Fight AIDS, Malaria and Tuberculosis and their implementation; and comprehensive action in the regions to address the high disease burden posed by chronic hepatitis. 1.2 TUBERCULOSIS During the biennium , the Secretariat has focused its work on further building capacity to implement the Stop TB Strategy at national and regional level in order to reach vulnerable populations and ensure adequate access to new tools and guidelines for prevention and treatment of all forms of tuberculosis, as well as access to first- and second-line treatment, and to strengthen surveillance systems and use of data. Furthermore, it continued to update and consolidate policy and technical guidance on rapid diagnostic tools and laboratory practices, delivery of care for patients with multidrug-resistant tuberculosis, HIVassociated tuberculosis and integrated community-based management of tuberculosis. The Secretariat also worked with countries to adapt policies and guidance to national and regional contexts. Particular attention was paid to detecting and treating drug-resistant tuberculosis, including multidrug-resistant tuberculosis, at global and national level. Progress to date Progress in diagnosing multidrug-resistant tuberculosis through the EXPAND-TB project, an initiative to expand access to new tests in 27 countries, which has tripled the number of multi-drug resistant cases diagnosed. During 2014, Secretariat activities contributing to increasing the number of successfully treated tuberculosis patients, included: a new strategy to end the global tuberculosis epidemic between 2015 and 2035 was finalized and approved by World Health Assembly in May 2014; implementation of the EXPAND-TB project financed by the International Drug Purchase Facility (UNITAID) and other donors, helped to triple the number of cases of multidrug-resistant tuberculosis 10

14 diagnosed in 27 countries. Such an increase was facilitated by the 97 new or refurbished reference laboratories established in 27 low- and middle-income countries. improved data presented in the Global tuberculosis report 2014 gives a clearer global picture of the burden of tuberculosis and highlight the need for an acceleration in current rates of decline in order to meet all targets; in collaboration with the European Respiratory Society, production of a new framework towards tuberculosis elimination in countries with a low burden of the disease; release of guidance materials, including a policy update and an implementation manual entitled, Xpert MTB/RIF, Technical and operational how-to : practical considerations, an assay for the detection of tuberculosis and rifampicin-resistant tuberculosis in less than two hours; interim guidance on the use of two new drugs for the treatment of multi-drug resistant tuberculosis; new guidelines on testing, treating and managing latent tuberculosis infection; a training manual on integrating community-based tuberculosis activities into the work of nongovernmental and other civil society organizations (ENGAGE-TB approach); facilitation of a consensus on the minimal and optimal specifications of four different types of tuberculosis diagnostic tests which were identified by multiple stakeholders to be of high priority; continued work on rational introduction of new tuberculosis drugs and regimens in countries; technical assistance provided to 43 countries which submitted tuberculosis or TB/HIV concept notes to the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2014; 74% of the applications were approved to receive a grant; and continued work on gender, equity and human rights, including vulnerable populations, which will be addressed in the new strategy to end the global tuberculosis epidemic, as well as other deliverables, such as operational guidance on tuberculosis screening, prevention and treatment in maternal and child health settings. Challenges and impediments Progress and successful implementation of the outputs depends on strong political commitment to tuberculosis control globally and in the regions, in particular, to scaling-up the availability of second-line drugs for patients with multidrug-resistant tuberculosis. In the African Region, the Ebola virus disease outbreak hampered technical support for tuberculosis as regional and intercountry support teams and country staff joined the response. In the Regional Office for the Eastern Mediterranean, the main challenges were a reduction in the number of staff during 2014 and the security situation, which affected timely implementation. In the Regional office for South-East Asia, the small number of experts providing technical assistance to countries and limited capacity for managing multidrug-resistant tuberculosis, infection control, childhood tuberculosis and laboratory services, such as culture and drugsusceptibility testing, was reported as a main challenge. In headquarters, in order to mitigate the risks related to increased staff costs, consultants were recruited to understake specific work and to collaborate with partners providing in-kind and in-service support to complement technical expertise. Overview of progress towards achievement of the outputs by major office () On track (!) At risk (-) In trouble Output Intensified implementation of Stop TB Strategy to scale up care and control, with focus on reaching vulnerable populations, strengthening surveillance, and alignment with health sector plans facilitated Updated policy guidance and technical guidelines on HIV-related tuberculosis, delivery of care for patients with multidrug-resistant tuberculosis, tuberculosis diagnostic approaches, tuberculosis screening in risk groups and integrated community-based management of tuberculosis 11

15 (US$ 000) 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 - WHA Approved Budget Funds Available (as at 31 Dec 2014) Total Expenditure Total Encumbrances The contributions of the regions and headquarters to the achievement of all outputs were judged to be on track. The percentage of funds available for the programme area compared to the approved budget was 80%. Expenditure was 42% compared to the approved budget, and 52% of the funds available. In some regional offices low implementation was due to reduced financing during the first year of the biennium, as well as the security situation in some countries, especially in the Eastern Mediterranean Region. Actions for 2015 Development of operational guidance and support for the adaptation, roll-out and promotion of the WHO End TB Strategy. Delivery of the main normative products including: consolidated guidelines on tuberculosis diagnostics, including evaluation of new tests; consolidated guidelines on tuberculosis treatment and updated handbook for programmatic management of drug-resistant tuberculosis; updated policy guidance on tuberculosis infection control; operational guidance on tuberculosis screening, prevention and treatment in maternal and child health settings; guidance on adaptation of the WHO End TB Strategy targets; guidance on e/m-health applications in tuberculosis and multidrug-resistant tuberculosis prevention, care and control; updated guidance on the monitoring and evaluation of collaborative tuberculosis/hiv activities. Updated framework for the implementation of pharmacovigilance activities in multidrug-resistant tuberculosis care. Monitoring and evaluation framework for latent tuberculosis infection in countries with low tuberculosis incidence. Continued support to countries, including for capacity building for the roll-out of the WHO End TB Strategy and scaling-up childhood tuberculosis training. Expanded access to diagnosis and treatment for drug resistant tuberculosis; expansion of the Tuberculosis Supranational Reference Laboratory network to accelerate technology transfer and laboratory strengthening; and updating of guidelines and first nationally representative data on resistance to drugs being tested as part of new tuberculosis treatment regimens. 1.3 MALARIA During the biennium , the Secretariat has focused its work on developing and updating normative guidance on all core malaria interventions (vector control, preventive therapies, diagnostic testing, and treatment), and on providing technical support to countries in which malaria is endemic, including for the development of concept notes for the Global Fund to Fight AIDS, Tuberculosis and Malaria, and providing support to countries affected by Ebola virus disease. Furthermore, it continued to track global progress in the adoption and implementation of policies recommended by WHO globally, and regularly reported on progress 12

16 towards regional and global targets. Two additional major priorities for the biennium are the development of a new global technical strategy for malaria for the period, and the coordination of an emergency response to drug-resistant malaria in the Greater Mekong subregion. Progress to date During 2014, the Secretariat contributed towards expanding access to first-line antimalarial treatment for confirmed malaria cases including through: development of the draft global technical strategy for malaria , with seven regional consultations and an online public consultation; the draft strategy was endorsed by the Executive Board in January 2015 and will be submitted to the World Health Assembly for consideration in May 2015; coordination of an emergency response to artemisinin resistance in the Greater Mekong subregion, through a regional hub based in Cambodia, which was established to spearhead a multi-stakeholder effort to contain the spread of drug-resistant malaria; a feasibility assessment of malaria elimination in the sub-region by 2030 was also conducted; continued support to endemic countries to update their national strategic plans, and successful provision of support for the development of concept notes for the Global Fund to Fight AIDS, Tuberculosis and Malaria. In the Regional Office for Africa, support efforts resulted in the submission of 41 malaria concept notes, with a 92% success rate; continued normative and policy-setting work, by convening the Malaria Policy Advisory Committee and by issuing and disseminating new policy recommendations and guidance documents; among key documents in 2014 was an interim recommendation on temporary malaria control measures for countries affected by the Ebola virus disease outbreak; continued capacity building work through international malaria training courses for managers and health professionals working in malaria control and elimination programmes, regional workshops on conducting therapeutic efficacy studies; Between March and June 2014, seven regional consultations were convened to review a draft version of the global technical strategy for malaria More than 70 Member states were represented and more than 400 technical experts provided input. continued assessement of regional and global progress in implementing policies recommended by WHO, and reporting of results in the World Malaria Report 2014, which was launched at the Houses of Parliament in London in December 2014; and technical support to countries to strengthen malaria surveillance programmes (including drug efficacy and insecticide resistance monitoring), and monitoring and evaluation, and a global assessment of progress in the implementation of the global plan for insecticide resistance management in malaria vectors. Challenges and impediments The work under this programme area is being conducted against the backdrop of major global gaps in access to prevention measures, diagnostic testing and treatment, the double threat of emerging drug and insecticide resistance and major challenges in funding. There is a risk of malaria resurgence in all areas where prevention measures are scaled back prematurely, demanding sustained strategic investment from both donors and the countries in which malaria is endemic. Strengthened surveillance systems are also needed to target limited resources appropriately, to detect outbreaks and to evaluate the progress and impact of control measures. 13

17 Therefore, progress and successful implementation of the outputs depends on high political commitment to malaria control globally and in the regions. At the regional level, sustaining financial support for national malaria efforts remained a challenge, and political instability is also complicating efforts in many countries. Close coordination between development partners, United Nations agencies, research bodies and acadaemia, and non governmental organization is also essential. A major challenge for the Secretariat in 2014 was to sustain high quality and sufficient human resources at the regional, inter-country and country levels, including WHO national professional officers, to provide the needed technical support to national programmes. The Regional Office for Africa and the Regional Office for South- East Asia, the two regions with the highest malaria burden, are particularly understaffed and under-resourced. In the latter, the dependence of WHO on Principal Recipient Global Fund to Fight AIDS, Tuberculosis and Malaria grants in four countries to support technical staff for country level work is also a challenge. Once the new strategy for is endorsed, WHO will be required to increase its capacity at the three levels of the organization to support Member States to fully implement the strategy. Overview of progress towards achievement of the outputs by major office () On track (!) At risk (-) In trouble Output Countries enabled to implement malaria strategic plans, with focus on improved diagnostic testing and treatment, therapeutic efficacy monitoring and surveillance through capacity strengthening Updated policy recommendations, strategic and technical guidelines on vector control, diagnostic testing, antimalarial treatment, integrated management of febrile illness, surveillance, epidemic detection and response (US$ 000) 35,000 30,000 25,000 20,000 15,000 10,000 5,000 - WHA Approved Budget Funds Available (as at 31 Dec 2014) Total Expenditure Total Encumbrances The contributions of the regions and headquarters to the achievement of all outputs were judged to be on track. The funds available as a percentage of the approved budget were 107% at the end of Expenditure was 45% compared to the approved budget, and 42% of the funds available. Challenges reported included, the availability of stable financing for WHO staff in countries in which malaria is endemic for providing support to national programmes. The deterioration of the security situation in countries in the Eastern Mediterranean Region was also reported as one of the major obstacles to the implementation of available resources. Some meetings and training courses were delayed because of the Ebola virus disease response in 2014, but no major activities will be delayed in

18 Actions for 2015 Main priorities for 2015 include: development of an updated programme area strategy aligned at all three levels of the Organization to ensure that WHO is able to fully support Member States in implementing the draft global technical strategy for malaria and achieving its ambitious goals. Upon endorsement of the strategy by the World Health Assembly at its Sixty-eighth session in May 2015, the work will also focus on developing regional frameworks and action plans for implementation of the strategy and on supporting countries to collect baseline data for 2015; the Regional Offices for South-East Asia and the Western Pacific, and headquarters, will support the goal of elimination in the Greater Mekong subregion by 2030 and prevention of the emergence of artemisinin resistance in neighbouring countries; the Regional Office for Africa will support malaria interventions through the development and deployment of operational manuals and training materials on use of local surveillance and entomological data defining high risk areas for the appropriate targeting of case management, vector control interventions in districts, and subregional malaria data management workshops; the Regional Office for Europe, will provide strategic guidance and technical assistance to eligible Member States for achieving malaria elimination, preventing the re-establishment of malaria transmission, maintaining malaria-free status and certifying malaria elimination; and the Regional Office for the Eastern Mediterranean will focus on developing a regional advocacy framework for strengthening political and financial support for the final goal of malaria elimination, including establishment of a regional fund for malaria elimination. 1.4 NEGLECTED TROPICAL DISEASES 6 The road map for accelerating the work to overcome the impact of neglected tropical diseases sets out a detailed timetable for the control and, where appropriate, elimination and eradication of the 17 specific diseases. In the biennium , the Secretariat is focusing its work on increasing access to essential medicines for neglected tropical diseases, and expanding preventive chemotherapy and innovative and intensified disease management. Additionally, strengthening national capacity for disease surveillance and certification/verification of the elimination of selected neglected tropical diseases will remain a central concern. WHO continues to build partnerships with manufacturers in order to secure access to high-quality medicines. Progress to date The Secretariat s contribution to increased and sustainable access to essential medicines for neglected diseases included: coordination of the procurement and supply of some 1300 million tablets to 78 countries as part of the expansion of preventive chemotherapy interventions and more than one million treatments for complex diseases, such as human African trypanosomiasis, visceral leishmaniasis, leprosy and buruli ulcer; In combating vector-borne diseases, such as dengue and chikungunya, WHO has established the Vector Control Advisory Group to assess the public health value of new vector control innovations and develop appropriate technical recommendations. 6 Including the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases. 15

19 establishment of the Vector Control Advisory Group to assess the public health value of new vector control innovations and develop appropriate technical recommendations; creation of a network for the elimination of human African trypanosomiasis to coordinate interventions in order to reach the target in the neglected tropical diseases roadmap of eliminating human African trypanosomiasis as a public health problem by 2020; strengthening the capacity and resources of the WHO Pesticide Evaluation Scheme to strengthen its critical roles in testing and evaluating new pesticides and supporting Member States in developing policies, strategies and guidelines for the sound management of pesticides; in the African Region, 22 country data managers received training in using the tool for the integrated planning and costing of strategic and annual plans for tackling neglected tropical diseases; in the Region of the Americas, verification of onchocerciasis elimination was carried out in Ecuador, and technical assistance was provided for launching national integrated plans of action to combat neglected tropical diseases; in the Eastern Mediterranean Region, a free diagnosis and treatment programme for leishmaniasis continued in all affected countries upon request; in the European Region, a regional partnership between WHO, the European Mosquito Control Association and the European Centre for Disease Prevention and Control was set up, with the involvement of the VBORNET network of medical entomologists and public health experts. The objective was to increase awareness and understanding about the growing threat of the introduction, establishment and spread of invasive species of mosquitoes, and to assist countries in early detection and a prompt response; in the South-East Asia Region technical assistance towards elimination and control of the targeted neglected tropical diseases continued to be provided; in the Western Pacific Region, support was provided for mapping and initiation of mass drug administration for foodborne trematodes in the Greater Mekong Subregion, and capacity building and technical support in response to outbreaks of dengue and other arboviral diseases, such as chikungunya; the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases initiated new research projects addressing control programme needs, such as drug and insecticide resistance. Research projects were carried out as planned to address priorities such as: community-based management of childhood fever (six African countries); impact of environmental changes on vector-borne diseases (five African countries); visceral leishmaniasis elimination (Indian subcontinent); dengue fever surveillance and outbreak management (South-East Asia and Western Pacific Regions); and social innovation in health-care delivery (focused on sub-saharan Africa). In 2014, a regional training centre was selected in the African Region to focus on training researchers and disseminating good practice in implementation research; and gender and social equity values continued to be at the core of the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, and, in 2014, the need to remove barriers in the careers of women scientists was made explicit. Challenges and impediments Human resources capacity and financial limitations remain the key obstacles to the continuous provision of technical support to the different programmes on neglected tropical diseases in order to reach regional and global targets. The drugs for mass treatment in preventive chemotherapy of neglected tropical diseases are donated by the pharmaceutical companies and provided freely by WHO and the countries bear the operational cost. Continuation of this generous donation is essential to sustain the gains and progress further. Some delays may occur in the work of the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, which are not directly related to project management, including reviews by 16

20 the Ethics Review Committees, and procurement processes. However, they should not affect the delivery of planned outputs at the end of the biennium. Overview of progress towards achievement of the outputs by major office () On track (!) At risk (-) In trouble Output Implementation and monitoring of the WHO road map for neglected tropical diseases facilitated n/a Implementation and monitoring of neglected tropical disease control interventions facilitated by evidence-based technical guidelines and technical support New knowledge, solutions and implementation strategies that respond to the health needs of disease-endemic countries developed through strengthened research and training n/a n/a n/a n/a n/a n/a (US$ 000) 120,000 WHA Approved Budget Funds Available (as at 31 Dec 2014) Total Expenditure Total Encumbrances 100,000 80,000 60,000 40,000 20,000 - The contributions of the regions and headquarters to the achievement of all outputs were judged to be on track. The funds available as a percentage of the approved budget amounted to 111%. Expenditure was 40% compared to the approved budget, and 36% of the funds available. The high level of funds available for the programme area can be explained by the fact that earmarked funding for the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases are included in the available resources for headquarters. Financial implementation was relatively low in 2014, reflecting the initiation phase of projects and the impact of the Ebola virus disease outbreak on activities resulting from staff time and efforts being assigned to the response. This should not, however, have a significant impact on programme delivery and the achievement of outputs during the biennium. The UNICEF/UNDP/World Bank/ WHO Special Programme will increase its financial implementation in 2015 by emphasizing the new working model, which focuses on partnerships. In the regional offices, implementation was delayed because of security issues in countries and low staff capacity at the regional and country level. Actions for 2015 In the Regional Office for Africa, priority will be given to completing the mapping of preventive chemotherapy for neglected tropical diseases in all countries, and the scaling up of mass drug administration in all endemic countries. In the Regional Office for the Americas, the work to increase capacity in surveillance, prevention, control, and elimination of neglected, tropical and zoonotic diseases will be pursued. 17

21 In the Regional Office for Europe, finalization of the training curriculum on invasive mosquitoes and reemerging vector-borne diseases in Europe, and testing in some countries will be prioritized. For the Regional Office for the Eastern Mediterranean, 2015 represents a milestone in assessing progress towards the eradication/elimination of major neglected tropical diseases, notably, Guinea worm, schistosomiasis, lymphatic filariasis and onchocerciasis, and interruption of the transmission of dracunculiasis, due to be achieved by The target date for eliminating S. haematobium schistosomiasis as a public health problem in Egypt, Islamic Republic of Iran, Libya and Saudi Arabia is also For the Regional Office for South-East Asia, 2015 is also a crucial year for achieving the lymphatic filariasis elimination target, since all endemic districts in the Region must be put on mass drug administration this year if the Region is to meet the target. In the Regional Office for the Western Pacific, one of the priorities will be reviewing the Asia-Pacific Dengue Strategic Plan, and the development of a draft new plan. In 2015, the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases will accelerate implementation of ongoing projects, delivering more in the area of research capacity strengthening (PhD, MSc, IMPACT grants, regional grant schemes, and career development fellowships) and strengthening its support for the implementation of research projects in areas such as, community-based interventions, environmental change impact on vector-borne diseases, operational research in support of national control programmes, insecticide resistance and research ethics. 1.5 VACCINE-PREVENTABLE DISEASES In the biennium , the Secretariat has focused its efforts on supporting countries to implement and monitor the Global Vaccine Action Plan , including development of national immunization plans, strengthening national capacity for monitoring immunization programmes, and ensuring adequate supplies and financing for immunization programmes. Additionally, efforts are being intensified for the elimination of measles and rubella, and control of hepatitis B. The work has been carried out in a context where several new vaccines are becoming available and routine immunization is being extended from focusing on infants and pregnant women as the sole target groups to include adolescents and adults. New vaccines are increasingly being introduced in coordination with other programmes as part of a package of interventions to control diseases, especially pneumonia, diarrhoea and cervical cancer. However, up to one fifth of children born each year are hard to reach and thus risk being excluded from immunization programmes. By scaling up the use of existing vaccines and introducing more recently licensed vaccines, nearly one million additional deaths could be averted each year. The development and licensing of additional vaccines promises to reduce mortality and morbidity. Progress to date During the year, the Secretariat contributed to increasing vaccination coverage for hard-to-reach populations and communities, including through: coordination of the work of the Strategic Advisory Group of Experts (SAGE) on immunization for providing recommendations, including on polio eradication, the immunization supply chain, human papilloma virus vaccines, pertussis vaccines, Japanese encephalitis vaccines, meningococcal conjugate vaccine, hepatitis E vaccine, and varicella and herpes zoster vaccines; revision of the WHO-UNICEF guidelines for developing a comprehensive multi-year plan in order to align it with the Global Vaccine Action Plan , and using a systems approach, with related 18