Presented by Imre Hollo, Director, Division of Administration and Finance, WHO Regional Office for Europe at the 64th session of the WHO Regional Committee for Europe, on 15 September 2014.

1. Draft proposed programme
budget 2016–2017:
the European regional
perspective
Imre Hollo
Director, Division of Administration and Finance

2. Main topics
• Overall context of planning for programme
budget (PB) 2016–2017
• Process and outcomes of bottom-up
planning
• Overall observations

3. Planning and budgeting in the context
of WHO reform
• Integral part of global budget: results chain and category framework
from Twelfth General Programme of Work
• Country-level focus: bottom-up planning, country consultation and
prioritization
• Iterative process: Regional Office budget within the allocated envelope

4. Planning and budgeting in the context
of WHO reform
• Regional public goods: developed through bottom-up planning from the
technical division level, responding to agreed mandates (plans/strategies
and statutory obligations, frequently in the form of resolutions from
governing bodies) and emerging concerns
• Reliance on global technical networks: category networks, programme
area networks – matrix approach across 3 levels
• Same “box” (2014–2015 figures = 2016–2017), but different content and
process

5. Health 2020 implementation
• European health policy framework adopted September 2012 at 62nd session of the
Regional Committee (RC62) with focus on improving health for all and reducing health
inequalities; and improving leadership and participatory governance for health
• Key instruments are biennial collaborative agreements (BCAs) and country
cooperation strategies (CCSs)
• The Regional Office will support national health plans, policies and strategies aligned
with Health 2020
• Road maps exist for the next steps in strategic implementation of Health 2020 in each
country

6. Lessons learnt from 2012–2013 implementation
• Pockets of poverty persisted in 2012–2013, with uneven funding across
strategic objectives/Office-wide expected results (OWERs) (lack of funding
cited as the greatest impediment to successful implementation) – addressed
in PB 2014–2015 through the financing dialogue and “fully funded budget”
• The pilot experience with key priority outcomes/other priority outcomes
was well received, helped the Secretariat target its efforts and has been
adapted in the global results chain of the Twelfth General Programme of
Work and PB 2014–2015

7. Lessons learnt from 2012–2013 implementation
• Regional Office continues to depend heavily on locally raised, voluntarily
contributed funds – for 2014–2015, the financing dialogue and resource
mobilization policy help ensure this is done in a coordinated fashion
• National capacity was cited in some countries as an impediment to
realizing objectives – thus this continues to be a priority for PB 2014–2015
and 2016–2017
• Top-down planning sometimes resulted in mismatches between resources
and priorities at country level – this has been rectified through the
bottom-up approach

8. Development of PB 2016–2017 to date
Global level Regional level
April–May 2014
• Identification of priorities at country level
• Identification of regional and global priority work
• Costing of outputs for all priorities
May 2014
Regional consolidation and review of priority outcomes
with related outputs and costing
June 2014
Global consolidation and review of
priorities by category, programme area
network and global public good
July 2014
Development of the draft global PB 2016–
2017
July–August 2014
Development of the regional perspective on
PB 2016–2017
September 2014
RC64 reviews draft global PB 2016–2017, drafts regional perspective

9. Frequency of programme areas cited as priorities
0 5 10 15 20 25 30
2.1
2.2
4.2
4.1
4.4
3.5
1.1
2.3
3.1
1.2
4.3
5.2
3.4
5.1
1.5
5.3
2.5
5.5
3.2
5.4
3.3
2.4
1.3
5.6
1.4
Number of countries
Programme category/area
• Country consultations: 10 priority
programme areas/health
outcomes identified
• Highest demand (= count of
countries that chose specific
priorities) for categories 2 and 4
• In line with Health 2020
• Does not reflect cost in US$
• Costing of outputs done by heads
of WHO country offices in
collaboration with regional
technical staff

10. Reconciling bottom-up approach to planning
with 0% growth
• Iterative process: bottom-up planning resulted in an overall Regional Office budget
that was 18% higher than 2014–2015 level; this was subsequently reduced to
arrive at 0% growth in keeping with global agreement
• 0% reached through: (a) removal of specific, large-scale implementation projects
or initiatives still uncertain or under negotiation and (b) across-the-board
proportional reduction to respect bottom-up priorities
• Comparative advantages of WHO considered in implementing programmes
compared to other health actors
• Strategic decision: 40% of Regional Office budget allocated to country level

11. Proposed PB 2016–2017 compared to
allocated PB 2014–2015
• PB 2016–2017 = PB 2014–2015, but
its components and development
process fundamentally different
• Shifts among categories and
programme areas
• Well in line with outcomes of
bottom-up planning: emphasis on
category 2 ( budget) and category 4
(largest budget share among
technical categories despite )
60
40
20
0
-3%
-5%
-12%
+9%
+8%
Cat 1 Cat 2 Cat 3 Cat 4 Cat 5 excl.
Emerg
Cat 6
Budget, US$ million
2014-2015 allocated budget 2016-2017 proposed budget
+5%
1 2 3 4 5 excluding 6
Category emergency

12. Proposed PB 2016–2017: shifts explained
• Category 1: slight decrease to allow for emphasis on other
categories
• Category 2: increase in accordance with importance of
noncommunicable diseases (Health 2020 link) and demand from
Member States
• Category 3: small decrease, although still second largest technical
category, dealt within Health 2020
• Category 4: decrease due to some large country-specific projects
removed; still largest technical category
• Category 5: modest increase for the smallest technical category for
International Health Regulations (2005), geographically dispersed
offices
• Category 6: modest increase to enhance country presence
60
40
20
0
Cat 1 Cat 2 Cat 3 Cat 4 Cat 5
excl.
Emerg
Cat 6
Budget, US$ million
-3%
-5%
-12%
+9%
+8%
+5%
1 2 3 4 5 6
excluding
Category emergency

13. Historic programme budgets, income and
expenditures in Regional Office
• 2012–2013: good alignment between
PB, funds and expenditure
• 2014–2015: if projections are
realized, funding is OK overall, but
pockets of poverty and budget-space
issues in some programme areas
• 2016–2017: still very early to assess
but the proposed PB seems realistic
250
200
150
100
50
0
Projected
2012-2013 2014-2015 2016-2017
Approved / proposed programme budget
Funds available (+ projected)
Expenditure (for 2014-2015 to date)
Projected + to be
mobilized

14. Next steps in the development of PB 2016–2017
Global level Regional level
September 2014
RC64 reviews draft global PB 2016–2017, drafts regional perspective
January 2015
Executive Board reviews revised PB
2016–2017 incorporating input from
all regional committees
October–December 2014
Region contributes to revision of the global PB
2016–2017 based on feedback from regional
committees
July–September 2015
Regional implementation plan for PB 2016–
2017 (the new “contract”) prepared and
presented to RC65
May 2015
World Health Assembly considers
draft PB 2016–2017

15. Overall observations
• Although overall Regional Office budget is equal to 2014–2015, composition is
different – based on solid foundation of bottom-up planning/costing
• Proposed ceiling of US$ 228 million presents some challenges for the Regional
Office, but with some flexibility could be accommodated
• Proposed budget is based on the priority demands of countries, not funding
driven, and relies on the “fully funded budget” concept and financing dialogue
• There is time to further refine/adjust budgets and priorities for the Region based
on input from the Regional Committee

16. Annex: category highlights

17. Category 1
• Prevent, diagnose and treat HIV infection in at-risk populations. Promote equal access to
antiretroviral therapy, prevent mother-to-child transmission of HIV and provide measures to
better manage co-infections, such as tuberculosis (TB) and hepatitis.
• Achieve universal access to diagnosis and treatment for multidrug- and extensively drug-resistant
TB (M/XDR-TB) , strengthen mechanisms for cross-border TB control and care, and
improve the drug supply. Support Member States to further reduce TB mortality, increase
early detection and improve treatment success rates.
• Eliminate malaria, providing certification and preventing reintroduction.
• Assist Member States in updating and modifying policies and strategies on vaccine-preventable
diseases and immunization. Advocate for broadening the stakeholder base
supporting immunization.

18. Category 2
• Develop and strengthen multisectoral plans on NCDs. Implement the European action plan to
reduce the harmful use of alcohol 2012–2020, the European Food and Nutrition Action Plan
2015–2020 and the forthcoming European strategy for physical activity and health. Provide
technical support to countries for full implementation of the WHO Framework Convention on
Tobacco Control in strong cross-sectoral partnerships. Strengthen the capacity to control
NCDs at primary care level.
• Implement the European Mental Health Action Plan.
• Build health systems capacity, improve surveillance, and develop evidence-informed policy
and programmes in the areas of road safety, child injury prevention and interpersonal
violence prevention, in particular child maltreatment prevention.
• Provide policy briefs and technical advice to achieve targets in childhood obesity,
breastfeeding and maternal nutrition.

19. Category 3
• Support Member States in using Investing in children: the European child and adolescent
health strategy 2015–2020 to draft and/or revise national policies.
• Design or review national ageing strategies, policies and action plans, based on the strategy
and action plan for healthy ageing in Europe, 2012–2020.
• Apply the gender, equity and rights component of the Health 2020 implementation package
in health policies, in Health 2020 roadmaps and throughout the work of the Regional Office.
• Improve implementation and monitoring of common actions on social determinants of
health and equity.
• Conduct assessments, devise tools and strengthen capacity to monitor and address air
pollution, climate change, water and sanitation, chemical safety, noise pollution, housing,
health in transportation, population exposure in contaminated areas and environment and
health in emergencies.

20. Category 4
• Implement intersectoral national health policies, strategies and plans, which are aligned with
Health 2020.
• Develop a regional framework for action towards coordinated, integrated health services delivery
to operationalize the WHO Global Strategy on People-centred and Integrated Health Services,
revitalize the primary health care approach to extend interventions for universal health coverage
and address challenges in the provision of health services that impede better outcomes of NCDs
and M/XDR-TB.
• Advocate, network and give technical guidance to improve access to essential, high-quality
medicines moving towards universal health care.
• Enhance and harmonize the systematic collation, analysis and dissemination of evidence for use in
policy-making in the context of Health 2020, by fully integrating health information systems.
• Extend the regional knowledge translation network – the Evidence-informed Policy Network –
resulting in integrated mechanisms at national level.

21. Category 5
• Strengthen laboratory capacities and enhance outbreak response capacities. Support Member
States in preventing and controlling influenza.
• Develop national preparedness plans and strengthen their emergency- and risk management
capacities.
• Fully implement the European strategic action plan on antibiotic resistance 2011–2016 and the
new global action plan on antimicrobial resistance.
• Promote the work of the Codex Alimentarius Commission and collaboration between the
agriculture, animal health and human health sectors.
• Ensure that the objectives of the global Polio Eradication and Endgame Strategic Plan 2013–
2018 are met.
• Help Member States to respond in an effective, timely manner to acute and protracted
emergencies with public health consequences.

22. Category 6
• Implement WHO reform through respective regional policies, processes and
initiatives. Strengthen country offices in non-European-Union countries by
appointing new WHO representatives.
• Foster partnerships at regional and country levels.
• Support Member States in preparing for effective participation and engagement in
the work of the WHO governing bodies at regional and global levels.
• Enhance multilingualism at the Regional Office.
• Implement the global internal control framework, increase compliance measures
and improve audit response. The Regional Office foresees full application of a
comprehensive risk management framework.