The Economic and Social Council this morning held a thematic panel discussion on strengthening the United Nations country team’s coherent support to public health.

Carmen Maria Gallardo Hernandez, Vice-President of the Council, introducing the thematic panel on strengthening the United Nations country team’s coherent support to public health, said the scope for countries to make decisions in the area of health was limited because a substantial proportion of aid was channelled through multi-country projects or technical cooperation. It was essential that the United Nations set the path, and placed its work in the area of health firmly under national ownership and leadership.

Khushnood Akhtar Lashari, Secretary of Health of Pakistan, said the public health sector in Pakistan suffered from chronic low funding. Allocations for health had always been less than 0.6 per cent of the gross domestic product. The other major challenge in the health sector had been fragmentation of actions to respond to the needs of public health. This had been evident not only at the national and sub-national levels within the country, but also among various United Nations agencies as well as international donors. Pakistan was also affected by the epidemiology of double burden of disease – communicable diseases were still rampant, while urbanization and changing lifestyles had increased the prevalence of non-communicable diseases. All this, inter alia, had made the attainment of the Millennium Development Goals concerning health rather difficult.

Khalif Bile Mohamud, Representative of World Health Organization in Pakistan, said the One UN programme was signed in February 2009, culminating in a very strong commitment by the two sides to ensure that the aspirations of the Delivery as One process were put into action. There were two ministries for health in Pakistan - the Ministry of Health, and of the Population, and they had been made to work collectively. Delivery as One had combined all United Nations agencies, bringing them together and improving their coordination, putting advantages into place and ensuring complementarity of action. The joint health programme had received incremental support from donor programmes. The United Nations staff was important, as it had to drive the change, but if it ignored the local culture, then there would be problems from within.

Adani Illo, Permanent Representative of Niger to the United Nations Office at Geneva, said Niger took up the challenges of tackling the weakness of social indicators, particularly in the health sector - with a high child mortality rate, maternal mortality rate and fertility rate with seven children per woman. Thanks to multilateral and bilateral support from partners, Niger was able to carry out an analysis which led to the strengthening of the health system; without it, the human and financial investments made could have been undermined. A complete change in the mindset of health workers and administrators was vital in order to achieve real progress in the health sector. Improving the effectiveness of the health sector fragmentation, duplication and or volatility in international aid received by Niger was a priority.

Khardiata Lo N’Diaye, Resident Coordinator in Niger, said Niger was a least developed country. Given this situation, the United Nations system was seeking, in accordance with its mandate, to provide the necessary support in agreement with national priorities and needs. There were three instruments in this regard, including the Framework Plan, which was totally in line with the national strategy to reduce poverty and accelerate development, including the Health Development Plan. There were also major efforts to strengthen joint programming within the national system, including on gender, HIV/AIDS, nutrition and food security. Joint programming in the field was also being strengthened, with an exercise aimed at decentralising efforts aimed at achieving the Millennium Development Goals. In the area of health, United Nations action had supported the development of sectoral health programmes.

Juan Manuel Sotelo, Pan American Health Organization Area Manager of External Relations, Resource Mobilization and Partnerships, representing Latin American Regional Director Team of Panama, said the region was facing a paradoxical situation at the beginning of the twenty-first century. On the one hand, it had an extraordinary wealth of human and natural resources and had been experiencing, for the past few years, a positive economic upturn. On the other hand, the region remained the most unequal on the planet. A majority of the countries were middle income countries and 34 per cent of their population lived in poverty. The United Nations needed to support the effective development of comprehensive cooperation policies in order to ensure that achievements made to date were sustained.

In the interactive discussion, following the presentations, speakers spoke about, among other things, the complexity of all of these arrangements both for donors and beneficiary countries, giving rise to a situation where field activities brought together many actors from not just the United Nations system but also the private sector and non-governmental organizations, showing that close cooperation and coordination was absolutely vital. However, this was still not enough - there were other actors who were becoming more and more involved in these activities. The concept of Delivering as One was not easy to incorporate at the institutional level and delegations were finding it difficult to involve it in their negotiations, and yet the country teams reported it as very positive, which was confusing.

Representatives who took the floor during the interactive discussion were France and Belgium.

Also speaking at the end of the panel discussion were Tarande Constant Manzila, Resident Representative of World Health Organization in Niger; and Souley Rabi Maitournam, Director of Statistics, Monitoring and Epidemics Readiness, Niger.

This afternoon the Council will meet at 3 p.m. to hold a joint segment meeting under the operational activities and humanitarian assistance segment, and a panel discussion on “coordination in the transition phase between emergency relief and sustainable recovery”.

Dialogue with UN Country Teams on Strengthening UN Country Team’s Coherent Support to Public Health

Opening Statement

CARMEN MARIA GALLARDO HERNANDEZ, Vice-President of the Economic and Social Council, introducing the dialogue with UN Country Teams on strengthening the United Nations country teams' coherent support to public health, said all were aware that a major effort was required for developing countries and least developed countries in particular to achieve the health-related Millennium Development Goals such as child mortality, maternal mortality, HIV/AIDS, nutrition, and malaria. This was all the more difficult as the current economic crisis was threatening to impact on public health spending and the health situation. The crisis however could also open up a new avenue for reforming the way health services were financed and organised and for accelerating progress towards universal primary healthcare and community-based approaches.

The United Nations funds, programmes, specialised agencies and other organizations such as the regional commissions were actively engaged at the national and regional levels in joint efforts to help countries to achieve internationally-agreed development goals, including the Millennium Development Goals, in the health sector. National health plans had to form the backbone for the United Nations system's support at the country level. Overall, the scope for countries to make decisions in the area of health was limited because a substantial proportion of aid was channelled through multi-country projects or technical cooperation. Global, regional and country priorities had an important influence on shaping up the aid architecture. It was essential that the United Nations set the path, and placed its work in the area of health firmly under national ownership and leadership.


Statements by Panellists

KHUSHNOOD AKHTAR LASHARI, Secretary of Health of Pakistan, said the public health sector in Pakistan suffered from chronic low funding. Having limited financial resources, allocations for health had always been less than 0.6 per cent of the gross domestic product. The other major challenge in the health sector had been fragmentation of actions to respond to the needs of public health. This had been evident not only at the national and sub-national levels within the country, but also among various United Nations agencies as well as international donors. Pakistan was also affected by the epidemiology of double burden of disease – communicable diseases were still rampant, while urbanization and changing lifestyles had increased the prevalence of non-communicable diseases. Added to this was the demographic transition taking place in the country. There was an increase in the number of elderly people, with an increase in chronic illnesses among them. All this, inter alia, had made the attainment of the Millennium Development Goals concerning health rather difficult.

It was against this backdrop that Pakistan had agreed to be a member of the high-level panel on United Nations system-wide coherence constituted by the Secretary-General in 2005. The report of the panel affirmed that the United Nations needed to overcome its fragmentation and ‘deliver as one’ through a stronger commitment to work together on the implementation of one strategy, in the pursuit of a uniform set of clearly articulated national goals. Pakistan opted to be part of the ‘delivering as one’ initiative, alongside other Member States, with a firm belief that this was their United Nations and any effort that led to better efficiency, better utilisation of resources and achievement of objectives ultimately benefited them all. “Delivering as one” meant “delivering better”. The One UN Programme in Pakistan comprised of five Joint Programmes developed to compliment, support and catalyze five major priority sectors identified by the Government for which the United Nations technical capacities were readily available. The development process of each of these Joint Programmes was preceded by a Government, United Nations and civil society participatory exercise that duly incorporated the situation analysis of current development status of the sector. Mr. Lashari noted with caution that the ‘delivering as one’ pilot was a commitment by the international community with Pakistan. Unless support was sustained, it would not achieve the desired results.

KHALIF BILE MOHAMUD, Representative of the World Health Organization in Pakistan, said there were 19 United Nations agencies working in Pakistan, and the One UN programme was signed in February 2009, culminating in a very strong commitment by the two sides to ensure that the aspirations of the Delivery as One process were put into action. There were five joint programmes indicated in the process, of which health was one. There were two ministries for health in Pakistan - the Ministry of Health, and the Ministry of the Population, and they had been made to work collectively. The joint programme emanated from Pakistan's national priorities, and was from the start a nationally-driven initiative, where the Government had streamlined its operations and capacities with these aspirations. The main process was to provide essential services to the nation, in which context the Government, jointly with the United Nations, had examined policies and streamlined them into the framework of primary healthcare. The harmonisation of efforts had been one of the major objectives of the exercise.

Delivery as One had combined all United Nations agencies, bringing them together and improving their coordination, putting advantages into place and ensuring complementarity of action. A great opportunity had come to the health sector through this, as health was not limited to the delivery of health-care services, but was about what other sectors that impinged on health were doing. Without progress in these areas, health and the health-related Millennium Development Goals attainment was far away. The United Nations system had enabled the World Health Organization to work with all five joint programmes. Change had also been catalysed within the Government and with the Organization's partners. The joint health programme had received incremental support from donor programmes. The United Nations staff was important, as it had to drive the change, but if it ignored the local culture, then there would be problems from within. It had taken a long time to educate the staff to understand the process. For the United Nations to survive, it had to ensure that this process was brought forward. This was not just a United Nations paradigm - it was an international initiative, a collective paradigm which was necessary to ensure better results for tomorrow.

ADANI ILLO, Permanent Representative of Niger to the United Nations Office at Geneva, said the convening of this panel discussion gave Niger an opportunity to review its policies and strategies in the area of health, as well as financing mechanisms which financed these strategies in the country. Niger took up the challenges of tackling the weakness of social indicators, particularly in the health sector, as it was a country with a high child mortality rate, maternal mortality rate and a high fertility rate with 7 children per woman. In addition malaria, tuberculosis, and HIV/AIDS, among others, were additional challenges. However, despite the fact that the gross domestic product was $ 280 per year, they were able to achieve good results in the area of health. This was made possible as a result of the strong leadership, setting priorities and effective policies, and partnerships; in addition to the key role played by the United Nations system. Thanks to the unflagging multilateral and bilateral support from partners the health programme implemented in Niger was able to carry out an analysis which led to the strengthening of the health system; without it, human and financial investments made could have been undermined. The health programme focused on results and focus based management.

In 2010 Niger planned to implement a programme, supported by Niger’s partners, focused on achieving Millennium Development Goals 1 (ending poverty and hunger), 4 (improving child health), 5 (reducing maternal mortality), 6 (combating HIV/AIDS), and 8 (global partnerships). In order to the achieve performance based management, it was necessary to focus on contractalization, motivation of human resources and evaluation. A complete change in mindset of health workers and administrators was also vital in order to achieve real progress in the health sector. Though funding for health initiatives would come from donors and the Government, half of the health expenditure would have to be taken on by households, as it was still one of the least developed countries. The United Nations initiative to accelerate the achievement of the Millennium Development Goals was thus welcomed in this regard. Furthermore, improving the effectiveness of the health sector fragmentation, duplication and or volatility in international aid received by Niger was also a priority. In addition Niger was looking to innovative financing mechanisms, in order to reduce the impact of the reduction of official development assistance as a result of the financial crisis. Niger reiterated its commitment and determination to live up to its obligation to its people.

KHARDIATA LO N'DIAYE, UN Resident Coordinator in Niger, said Niger was not a pilot country in the Delivery as One initiative, but there was a common commitment by the Government and the development partners to implement the principles and mechanisms of the United Nations reform even so, and it was striving to be part of this greater efficiency in all areas, including health. Niger faced constraints in the health sector, due to the high vulnerability of the country for reasons including its geographical situation. The maternal and child mortality figures were very poor, and one child in five died before the age of five. It was a least developed country. Major development challenges included the achievement of the Millennium Development Goals. Population growth was not under control, and there was much poverty, with equal pressure on the social services of the country, which required major investment if they were to improve access to these services by the people.

Given this situation, the United Nations system was seeking, in accordance with its mandate, to provide the necessary support in agreement with national priorities and needs. There were three instruments in this regard, including the Framework Plan, which was totally in line with the national strategy to reduce poverty and accelerate development, including the Health Development Plan. There were also major efforts to strengthen joint programming within the national system, including on gender, HIV/AIDS, nutrition and food security. Joint programming in the field was also being strengthened, with an exercise aimed at decentralising efforts aimed at achieving the Millennium Development Goals. The third instrument was linked to humanitarian response - the United Nations system was strengthening its coordination in order to meet needs and was aligning itself to meet these. In the area of health, United Nations action had supported the development of sectoral health programmes. The United Nations system had also revised its programming and follow-up cycles so that it had aligned itself with the cycles adopted by the Government and its partners for programming and follow-up, and was optimising its role and modalities, taking into account comparative advantages.

JUAN MANUEL SOTELO, Pan American Health Organization Area Manager of External Relations, Resource Mobilization and Partnerships, representing Latin American Regional Director Team of Panama, said the region was facing a paradoxical situation at the beginning of the twenty-first century. On the one hand, it had an extraordinary wealth of human and natural resources and had been experiencing, for the past few years, a positive economic upturn. On the other hand, the region remained the most unequal on the planet. Indeed, while a majority of their countries were middle income countries and had mostly high or medium human development levels, the sad truth was that a large (34 per cent) proportion of their population lived in poverty. For the United Nations system, the middle income countries represented a special challenge. The 2007 Triennial Comprehensive Policy Review acknowledged that middle-income developing countries still faced significant challenges in the area of poverty eradication and that efforts to address those challenges should be supported. In particular, the United Nations needed to support the effective development of comprehensive cooperation policies in order to ensure that achievements made to date were sustained.

An important achievement of the United Nations Latin American Regional Director Team had been the establishment of the Panama Regional Centre, noted Mr. Sotelo. The regional “hub” made possible the collocation of regional entities in Panama’s “City of Knowledge” (in the former United States base). This had made possible increased inter-agency dialogue, collaboration, and efficiency as requested by the General Assembly’s Triennial Comprehensive Policy Review. The United Nations Country Team’s in Latin America and the Caribbean with regard to the provision of coherent support to public health, established the Pan American Alliance for Nutrition and Development to achieve the Millennium Development Goals; the participation in vaccination week in the Americas, which sought to revitalize high level political commitment to vaccination and promote a culture of prevention; developed and launched the health Millennium Development Goals interagency report; and established the regional directors group in Latin America and the Caribbean on HIV/AIDS, which was an innovative structure set up in June 2003, and brought together the regional directors of the 10 cosponsors of the Joint United Nations Programme on HIV/AIDS programme and its secretariat.

Discussion

Speaking in the general discussion following the presentations, speakers raised, among other things, the complexity of all of these arrangements both for donors and beneficiary countries, giving rise to a situation where field activities brought together many actors from not just the United Nations system but also the private sector and non-governmental organizations, showing that close cooperation and coordination was absolutely vital. However, this was still not enough - there were other actors who were becoming more and more involved in these activities. The World Health Organization should have a key role to play in coordination, although there were other mechanisms that could be used. The concept of Delivering as One was not easy to incorporate at the institutional level and delegations were finding it difficult to involve it in their negotiations, and yet the country teams reported it as very positive, which was confusing.

Concluding Remarks

KHUSHNOOD AKHTAR LASHARI, Secretary of Health of Pakistan, said there was a role for the World Health Organization and resident coordinator within the United Nations system and within the country. In Pakistan the resident coordinator was the overall coordinator for all joint programmes. As for the health and population, the World Health Organization representative was the focal person. Another issue raised by France was with regard to coordination between the Government and non-United Nations partners, which was of concern to them, more and more bilateral aid came from organizations that were not in the United Nations and there was a need to develop coordination in that regard. With regard to the questions raised by Belgium, he said the ‘delivery as one’ programme was only one year in, and there would of course be, and there was need for a further assessment of the programme. Pakistan was also in the process of re-aligning their own delivery system to ‘deliver as one’, which not only cut costs, but improved transparency and brought value for money.

KHALIF BILE MOHAMUD, Representative of the World Health Organization in Pakistan, said in the current difficult situation in Pakistan, the Government and organizations had focused on coordination. Within the United Nations system, five thematic working groups had been established, with co-Chairs. The World Health Organization representative was a permanent co-Chair- the other rotated between the partners. This ensured that World Health Organisation initiatives on health were not lost. At the same time, when talking about Delivery as One, it should be realised that everybody had a place at the table, and there was a unity of purpose. No organization should be eliminated, no matter its size, and there should be an opportunity for partnership from all. A large number of displaced in Pakistan were returning to their homes, and the United Nations response to this was to be addressed through Delivery as One to ensure unity of response to their needs. A programme team had been established composed of the different agencies working in the process, ensuring collective reaction.

A large proportion of the resources that were channelled to countries did not go through the United Nations system, and efforts to widen the scope of coordination in an Informal Forum where coordination and streamlining were discussed with such other bodies as the World Bank had been established. Coordination per se was a national responsibility, not a donor, nor a United Nations responsibility. Coordination was probably one of the weakest segments in the development sector, and Delivering as One, if it were to provide a new advantage, had to provide coordination, and this was a milestone to address.

ADANI ILLO, Permanent Representative of Niger to the United Nations Office at Geneva, said France was a key health partner for them. He agreed with the comments made by France and Belgium. He was also surprised to see how divergent the agencies were in Geneva, the principles of ‘One UN’, were more effective in the field. Belgium was planning a vital role in the coordinating process in Niger.

KHARDIATA LO N'DIAYE, Resident Coordinator in Niger, said some relevant questions and contributions had been made. Niger was not a pilot country in the Delivering as One initiative, but at a time when resources were getting rarer and rarer, pragmatism required greater consistency in the use of resources. In a country as large as Niger, there were not enough human resources to be physically present throughout the country, so joint action by all organizations working in food, health and security gave greater value to the activities of the United Nations, rather than each working in isolation. A single United Nations office was present in each region, moving away from the proliferation of offices, providing a single structure for all United Nations system staff. This reduced costs and improved coordination and interaction between staff on the ground, with a greater vision of the United Nations system and simplifying the relationship between the different partners. There was a distribution of tasks, taking into account the different capacities and skills of the agencies. Coordination was an on-going process, but there was a need for Government leadership as a capstone, and the willingness of development partners to share in this coordination as well.

TARANDE CONSTANT MANZILA, Resident Representative of World Health Organization in Niger, responding to questions raised, said the historical context had resulted in the current situation in the country. The lead role played by Belgium in Niger was a rotating role between the lead country and the lead agency. This allowed the partners of the country to become really involved. They were involved in advocacy, mobilization of resources and partnerships. It was the lead in the United Nations system for coordinating health efforts in Niger. Niger had signed the international health partnerships initiatives. As soon as the health ministry assumed her role, she said that the health partnership in Niger would be reviewed and encouraged partners to support the international health partners’ initiative, allowing for the health partnerships to be reconsidered. There was a campaign launched by the World Health Organization in Niger in response to the meningitis outbreak in the country. Thanks to the coordination efforts led by the Ministry of Health and the World Health Organization, to combat the outbreak, partners welcomed the reduced rate of less than 4 per cent of the outbreak for this year. There was also an initiative to control entry into and out of the country with regard to the H1N1 flu. The World Health Organization had already put a warning out on potential cholera outbreaks this year. The World Health Organization also played a leadership role in the development of a national health plan in the country. The World Health Organization was playing its leadership role in the United Nations system and in partnership with the Government of Niger through the Ministry of Health.

SOULEY RABI MAITOURNAM, Director of Statistics, Monitoring and Epidemics Readiness, Niger, said the system was very complex, but there was a very active system in health, with bilateral and international cooperation. There was a monthly meeting for planning, evaluation, monitoring and revision of health plans. The coordination process was being built up, and everybody was very keen to improve coordination. There were focal points to coordinate with partners at the regional level, with decentralisation of these at regional focal points. Coordination was there, and was being extended through the regions, as Niger worked with its development partners.

JUAN MANUEL SOTELO, Pan American Health Organization Area Manager of External Relations, Resource Mobilization and Partnerships, representing Latin American Regional Director Team of Panama, said it was very interesting and useful for him to hear the panellists and Member States responses. In the Americas there was a health agenda which was the framework for activities in the area of health for the Americas based on the next 10 years. The country team aimed to address unfinished agendas, the diseases that had been rampant for years and where the fight had not been successful, for instance with malaria and tuberculosis. He said he agreed with what France said, coordination and cooperation was extremely significant. The reference to the fact that health was important for everyone and encouraging the involvement of civil society was necessary. At the level of institutions at the World Health Organization and the Pan American Health Organization, they used a rights-based approach to show what had been achieved for a ‘delivery as one’.


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