The role of WHO in Global health Universiteit Hasselt, Belgium 12 March 2013 Dr Mike Mbizvo, ex-Director Department of Reproductive Health and Research (RHR), WHO

2 WHO Governance and Structure

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Source: WHO’s Constitution WHO's definition of health

“The mission of WHO is the attainment by all peoples of the highest possible level of health” WHO’s mission is global and permanent Source: WHO’s Constitution

The Core Functions of WHO  providing leadership on matters critical to health and engaging in partnerships where joint action is needed  shaping the research agenda, and stimulating the generation, dissemination and application of valuable knowledge  setting norms and standards, and promoting and monitoring their implementation  articulating ethical and evidence-based policy options  providing technical support, catalysing change and building sustainable institutional capacity  monitoring the health situation and assessing health trends.

 World Health Assembly (WHA) appoints the Director-General upon the recommendation of the Executive Board  Reviews and approves the proposed Programme Budget  Considers reports of the Executive Board (EB) on technical and health matters, in addition to programme budgetary matters  Comprises delegates from all 193 Member States. Many Ministers of Health attend. The World Health Assembly is WHO's supreme decision-making body

 Headquarters – Global Service Centre – Director General = "DG"  Regional Offices –Regional Director = "RD"  Country Offices –WHO Country Representatives = "WR" ONE WHO - three levels of action

WHO's Global Presence ♦ ♦ Global Service Centre Last but not least, WHO is people. Over 7000 public health experts including doctors, epidemiologists, scientists, managers, administrators and other professionals from all over the world work for WHO in 150 country offices, six regional offices and at the headquarters in Geneva, Switzerland.

 Headquarters Office (HQ) –Cluster –Department –Team (some exceptions in GMG)  Regional Offices (RO) –Division –Team  Country Offices Hierarchy levels

 Regional Committee governs the work of each region  "RD" Regional Director WHO's Regional Offices (RO)

 150 Country offices  “WR” = WHO Representative is responsible for WHO’s activities in the countries by supporting the government in the planning and management of national health programmes  HWCO = Heads of WHO Country Offices WHO is present in many countries

HQ Headquarters Seven "Clusters" in HQ HQ/ODG Office of the Director-General HQ/ General Management Cluster HQ/FWC Family, Women's and Children's Health HQ/HIS Health Systems and Innovation HQ/HSE Health Security and Environment HQ/HTM HIV/AIDS, TB Malaria and Neglected Tropical Diseases HQ/NMH Noncommunicable Diseases and Mental Health HQ/IER Information, Evidence and Research HQ/PEC Polio, Emergencies and Country Collaboration

HQ/FWC HQ/FWC Family, Women's and Children's Health HQ/ALC Ageing and Life Course HQ/MCA Maternal, newborn, child and adolescent health HQ/IVB Immunization, Vaccines and Biologicals HQ/RHR Reproductive Health and Research HRP IVR HQ/FWC Family, Women's and Children's Health PMNCH

14 “REQUESTS the Director-General to develop further the programme proposed: (a)in the fields of reference services, studies on medical aspects of sterility and fertility control methods and health aspects of population dynamics; …” (WHA Resolution 18.49; 1965) How it began … World Health Assembly

:Human Reproduction Unit within existing Division of Family Health (WHA Resolution 18.49; 1965) :WHO (Expanded) Special Programme of Research, Development and Research Training in Human Reproduction :UNDP/UNFPA/WHO/World Bank cosponsored Special Programme (WHA Resolution 41.9; 1988) 2012-presentUNDP/UNFPA/UNICEF/WHO/World Bank cosponsored Special Programme UNAIDS becomes PCC permanent member How it has evolved

16 HRP’s governance members ex-officio members (GAP, RAPs, RP2 and PCC Chairs) Temporary advisers PCC Scientific and Technical Advisory Group STAG Standing Committee

STAG mandate 17  Review, from a scientific and technical standpoint, the content, scope and dimensions of the Special Programme, including the research areas covered and approaches to be adopted  Recommend priorities within the Special Programme, including the establishment and disestablishment of task forces, and all scientific and technical activities related to the Special Programme cont'd…

STAG mandate 18  Provide PCC and the Standing Committee with a continuous and independent evaluation of the scientific and technical aspects of all activities of the Special Programme  Review the plans of action and the budget for financial periods prepared by the Executing Agency and make proposals to the Standing Committee for possible reallocation of resources within the scientific and technical component of the Special Programme during each financial period …cont'd

19 STAG 18+ experts Gender and Rights Advisory Panel (GAP) Scientific and Ethical Review Group (SERG) + Specialist Panels Research Proposal Review Panel (RP2) Toxicology Panel HRP’s scientific and technical advisory bodies Regional Advisory Panels: - African and Eastern Mediterranean Regions - Americas - Eastern Europe and Central Asian Republics - Asia and Western Pacific

Scope of STAG mandate and membership 20  In 1999, PCC endorsed the recommendation of STAG to expand its mandate to review the activities of RHR as a whole, rather than just HRP (provided no financial implications to HRP)  Membership:  Temporary advisor status  3 years if approved by SC and PCC  3 final years if approved by SC and PCC  Regional, expertise and gender balance

21 "Because of the good credibility of the Programme and WHO in general, HRP's research results have a greater influence on reproductive health policies and standards than the research of any other organization." (External Evaluation of HRP, Final Report, 2008)

22 Department of Reproductive Health and Research (RHR)  Created in November 1998  Composed of two pre-existing entities  UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP)  WHO Division of Reproductive Health (Technical Support) (RHT) RHR = HRP+RHT (PDRH)

23 To help people lead healthy sexual and reproductive lives Mission of HRP The attainment by all peoples of the highest possible level of sexual and reproductive health Vision statement

24 The WHO global reproductive health strategy adopted by WHO's 192 Member States in May 2004 (Resolution WHA 57.12)

UN Secretary General's Global Strategy for Women's and Children's Health Components  Country-led health plans  Comprehensive, integrated package of essential interventions and services  Integrated care  Health systems strengthening  Health workforce capacity building  Coordinated research and innovation Role of UN agencies  Define norms, regulations and guidance to underpin efforts  Help countries align their national practices  Work together and with others to strengthen technical assistance to scale-up  Encourage links between sectors and integration with other international efforts  Support systems that track progress and identify funding gaps  Generate and synthesize research-derived evidence and provide a platform for sharing best practices, evidence on cost-effective interventions and research findings Opportunity

RHR/HRP core functions  Identifying gaps and priorities and shaping the global SRH research agenda  Providing leadership on matters critical to improving SRH through knowledge generation, synthesis and management  Supporting national research, research and technical capacity strengthening and engaging in relevant partnerships  Development of clinical standards, norms and related policy and technical guidance documents  Articulating ethical and evidence-based options for policy formulation and programme development to improve SRH, in collaboration with regional and country offices  Monitoring and evaluation of SRH situations and trends, advocacy, catalysing change and supporting intervention delivery

HRP Objectives  Generating new knowledge in SRH  Synthesizing research evidence  Strengthening research capacity  Developing evidence-based guidelines  Strengthening research policy dialogue

RHR/HRP functions within thematic areas of the WHO Global Reproductive Health Strategy

29 Improving quality of and access to Family planning  Document needs and preferences of users and potential users  Develop new and improved methods  Assess safety and efficacy of existing methods  Develop, keep up-to-date and promote evidence-based practice guides for family planning including infertility

30 Improving maternal and perinatal health  Improve knowledge on magnitude/burden of leading causes of mortality and morbidity  Identify, develop, adapt and evaluate best practices in maternal and perinatal health  Conduct research to improve quality of maternal and newborn care and promote utilization of findings  Develop, keep up-to-date and promote evidence-based clinical practice guides for maternal and perinatal health

31 Eliminating unsafe abortion and improving postabortion care  Generate and synthesize scientifically sound evidence on the prevalence of, and mortality related to, unsafe abortion to assist programmes/policies  Support research to identify interventions for the prevention of unsafe abortion and for postabortion care  Undertake research to improve methods of safe abortion and promote quality of care  Develop, keep up-to-date and promote guidelines for provision of safe abortion, management of abortion complications and provision of postabortion care

32 Combating STIs / RTIs  Establish and disseminate evidence for new and improved STI and RTI prevention and control strategies  Facilitate microbicide testing, registration (and introduction)  Conduct research on prevention of MTCT of HIV and other STIs, on cervical cancer screening and on introduction of HPV vaccines  Develop, keep up-to-date and promote implementation of guidelines and tools for STI and RTI policy, programmes, care and surveillance  Ensure linkages with HIV prevention (e.g. STI control, male circumcision, prevention of MTCT of HIV and syphilis)

33 Promoting adolescent sexual and reproductive health  Support research on factors that affect sexual and reproductive health outcomes, including operations research on the optimal provision of information and services to adolescents  Strengthen research capacity and attention to implementation of findings  Ensure that technical and managerial tools and advocacy materials produced by the Department also address the unique sexual and reproductive health needs of adolescents (“mainstreaming”)

34 Addressing gender issues and reproductive rights  Assess laws, policies, practices  rights-based approach to maternal and newborn health  assist countries to improve the legal, policy and regulatory environment for sexual and reproductive health  Coordinate multinational research aimed at abandonment of female genital mutilation and vaginal practices  Continue analyses of data from multicountry study on violence against women  Mainstream gender and reproductive rights issues in the Department’s work  Develop guidance for health sector on response to violence against women  Contribute to understanding of relationship between human rights and sexuality and sexual health

35 Research capacity strengthening  Strengthen the research capacity of investigators and infrastructure in developing countries  Support researchers to conduct studies based on national priorities in SRH and facilitating their participation in regional and global research  Promote dissemination and utilization of research results and evidence-based guidelines in SRH programmes and services  Develop strategies to plan, implement, monitor and evaluate programmes to advance SRH

36 Strengthening national research and technical capacity: an ongoing HRP commitment Long-term Institutional Development grant Long-term Institutional Development grant Service Guidance Centre grant Service Guidance Centre grant RCS Research Training grant Research Training grant Long-term Institutional Development grant (LID) Long-term Institutional Development grant (LID) Service Guidance Centre grant Service Guidance Centre grant RCS Research Training Grant (RTG) Research Training Grant (RTG) Courses, Workshops, Seminars grant Courses, Workshops, Seminars grant

37 Thank you "Societies and the political leaders who govern them must first decide that the health of women matters. Public health can do something of course. We can promote better access to sexual and reproductive health services … we can map out technical strategies for reducing maternal deaths" Margaret Chan, Director-General, WHO