2012-02-26-世界卫生组织-Evaluation_Report_of_Stage_1_of_Reform_Proposals_of_WHO_68页_565kb

WHO Reform Proposals Evaluation Report Summary

Core Content

This report presents the findings of the first stage evaluation of the World Health Organization (WHO) reform proposals, conducted by the Comptroller and Auditor General of India from 27 February to 30 March 2012. The evaluation aimed to assess the completeness, comprehensiveness, and relevance of the reform proposals in the areas of finance, human resources, and governance, as well as to suggest the scope for the second stage of evaluation.

Main Objectives of the Evaluation

The evaluation focused on the following key questions:

• Does the WHO reform process address financial challenges, staffing issues, and internal governance concerns adequately?
• Does the existing information provide sufficient detail to evaluate the effectiveness and efficiency of the proposed managerial reforms?
• Has the reform process considered alternatives, best practices, and lessons learned from other organizations?
• Is additional information required to fully identify the challenges facing WHO, and if so, in which areas?

Key Findings

Internal Governance

• Priority setting was identified as a critical challenge. WHO's reform process was found to be insufficiently selective and strategically focused.
• The need for strengthening governing bodies was emphasized, particularly to improve coherence and coordination between global and regional levels.
• There is a lack of a formal mechanism to align the agendas of global and regional governing bodies.

Financing Challenges

• WHO's reform proposals addressed financial constraints in a comprehensive manner, ensuring predictability and alignment with available resources.
• However, further work is required to ensure financial flexibility and to protect WHO from currency fluctuations.
• A well-designed resource mobilization strategy is needed for the next General Programme of Work, especially given the reliance on voluntary contributions.

Managerial Reforms

• Human resources policies were considered, with concrete steps proposed for results-based management linked to programmatic priorities.
• Accountability and transparency were addressed, but further detailing on organizational effectiveness and synergy between governance layers is required.
• The reform process is considered a driver for overall changes, and without addressing these issues, other reforms may not yield results.

Global Health Governance

• WHO has broad ambitions in global health governance but the final proposals presented to the Executive Board were limited in scope.
• The reform process needs to be expanded to ensure greater coherence and effective coordination among global health actors.

Recommendations

1. Linkages among Governing Bodies: Strengthen linkages between the WHO headquarters and regional offices to ensure organizational coherence and strategic focus.
2. Accountability and Responsibility Structures: Redesign accountability and responsibility structures for the three layers of governance, incorporating new programmatic approaches and resource allocation mechanisms.
3. Country Focus Strategies: Develop detailed action plans for country focus strategies, including structural and procedural support.
4. Advocacy and Change Management: Implement an advocacy plan to explain the implications of the reform strategy, identify change agents, and create a detailed change management plan.
5. Monitoring and Feedback Mechanisms: Define desired outputs, outcomes, and impact, and establish measurable performance indicators and a monitoring system.
6. Prioritization Plan: Prepare a prioritization plan to ensure a smooth and gradual implementation of the reform process.
7. Innovative HR Solutions: Consider best practices from similar organizations to address the inbuilt rigidities in WHO's human resources policies.
8. Stakeholder Communication: Maintain regular communication with stakeholders to ensure understanding and support for the reform process.
9. Interdependence Recognition: Recognize the interdependent nature of reform components and integrate this into the implementation strategy.

Scope of the Second Stage Evaluation

The second stage of evaluation will focus on informing the Secretariat's work in response to Member States' expectations regarding coherence and functioning across the three levels of WHO. This stage will be conducted after the reform proposals have been considered by the Executive Board and the World Health Assembly, ensuring that the evaluation scope is aligned with the current priorities and decisions.

Methodology

• Systems-Based Evaluation: Assessed the inter-linkages, alignment, and internal consistency of the reform proposals.
• Thematic Review: Focused on programmatic areas, financial and human resource challenges, and internal governance issues.
• Stakeholder Consultations: Evaluated the sufficiency and relevance of consultations with internal and external stakeholders.
• Information Sufficiency: Examined the sufficiency and relevance of information provided in reform proposal documents and background materials.

Limitations

• The evaluation was based on existing information and did not collect new data.
• The scope was limited to the areas outlined in the Terms of Reference.

Conclusion

The reform process of WHO is ongoing and dynamic, addressing challenges in governance, financing, and human resources. While the reform proposals have been well formulated in some areas, further work is needed to ensure coherence, flexibility, and effective implementation. The evaluation highlights the importance of stakeholder engagement, clear communication, and a structured approach to the reform process.