WORLD HEALTH ORGANISATION MONDIALE

Transcription

1 WORLD HEALTH ORGANISATION MONDIALE ORGANIZATION DE LA SANTÉ EXECUTIVE BOARD Thirty-fifth Session Provisional agenda item EB35/wp/l Corr.l 12 January 1965 ORIGINAL: ENGLISH ORGANIZATIONAL STUDY ON METHODS OF PLANNING AND EXECUTION OF PROJECTS Report by the Director-General Corrigendum 1. Top table on page J>6, paragraph ; last figure in last two columns: The figures 122 and 58 should be changed to Jl and 52 respectively. In the caption against these figures, the expression "receipt of clearалее in regional office" should be changed to "receipt of clearance in recruiting office". 2. Table on page 37, paragraph ; last figures in first columnj should be instead of Table in paragraph on page 47: show against first figure in second column footnote reference number "l", i.e. the figure should read "38 and not "38".

2 WORLD HEALTH ORGANIZATION EXECUTIVE BOARD Thirty-fifth Session Provisional agenda item i ORGANISATION MONDIALE DE LA SANTÉ EB35/WP/1. 27 November 1964 Ч ORIGINAL: ENG1ISH ORGANIZAITONAL STODY ON MEIHODS OP PLANNING AND EXECUTION QP PROJECTS Report by the Director-General In accordance with the decision of the Executive Board in resolutions EB32.R10 1 and the Director-General has proceeded with the Organizational Study on Methods of Planning and Execution of Projects and submits herewith as a, working document a further report on this study. 1 Handbook of Resolutions and Decisions, 7th ed #, p.) 斗 6, 2 Off. Rec, Wld Hlth Org 22.

3 7 789о121 1EB35/WP/I page ii % CONTENTS Page 1 # INTRODUCTION 争..,. e 1. Origin of the Study 2. Methodology General Summary and Suggestions 3 3 II. METHODS OF PLANNING AND EXECUTION OP PROJECTS Factors Determining Methods of Planning and Execution 111 Nature and type of WHO assistance 1National character of projects 1 Trends in WHO 1 s field operations Regionalization and decentralization 42. Methods of Planning and Execution Division of responsibilities between headquarters and regional offices Origin and life cycle of projects Appropriateness of requests Plans of operations UNICEP/ШО projects Projects financed by the United Nations Special Fund Project operations Supervision and evaluation Action schedule, III, ROLE OP WHO IN THE PLANNING OF PROJECTS 1 The Planning Process 2. Methodology of Planning 5. Analysis of the Result of the Study of WHO 1 s Role in the Planning of Projects 3Project origin 2Relationship of requests to national health programme 5Further planning of projects 4Conclusion

4 EB55/WP/1 page iii Page ' IV. MAJOR- CAUSES OP DELAYS IN STARTING PROJECTS AND MEASURES FOR. REDUCING THE DELAYS Factors which Influence the Starting of the Project 24 Timing the Start of Projects.. 25, Analysis of the Results of the Study cf Over-all Delays in Starting Pro ifintñ I-66289ооо General Criteria for "delayed projects" Number of projects delayed and reasons for the delays 2Signature of plans of operations *5 Conclusions on over-all delays 23Recruitment of Project Staff 34.1 General 斗 Recruitment sources 4.3 Recruitment and appointment of-staff Selection of staff 33Recruitment of action Briefing 5. Provision of Supplies and Equipment, 4l e 4.4 Analysis of the results of the study of delays in provision of staffing affecting the setting in motion of projects Number of filled posts and selected candidates Time intervals in the recruitment process 3 斗 3Stage one - Finding the candidates Stage two - Getting the selected candidate to the 3project Total time* needed 4Л.З Delays in filling posts ;57 34 ;5.1 Length of delays «4.4.3,2 Reason for delays. * Influence of delays in starting projects 4 # 5 Conclusions 5.1 General.... WHO supplies..., *... 斗 Supplies provided by other sources 斗 Analysis of the results of the study of delays in provision of supplies and equipment affecting the setting in motion of projects 6253

5 EB35/WP/1 page iv Number of projects with supplies and equipment Delays in provision of supplies and equipment 5«3 Conclusion,,, * 6. Award of Fellowships 6.1 General 6.2 Analysis of the results of the study- of delays in provision of fellowships affecting the setting in motion of projects or. their, pi aimed continuation Number of fellowships Delays in arrival at first place of study Return of fellow to home country 6.5 Conclusions Page б468sЯ-4Я.49 V, RELATIONSHIP BETWEEN THE EFFECTIVENESS OF WHO ASSISTANCE AND IHE ADEQUACY OF THE PROJECT SUPPORTING STAFF AND WORK FACILITIES 49., 1 Obligations of Project Participants Government Personnel 5 〇 Analysis of the Results of the Study of the' Relationship between the. Effectiveness of WHO Assistance and the Adequacy of the Project Supporting Staff and Work Facilities * Areas covered by the study Results of the study 51 ^.2.1 Assessment of adequacy of non-who staff, equipment, transportation and other facilities 51 ;%2.2 Time spent on non-technical operations by WHO professional 'technical staff Relationship between effectiveness of assistance and adequacy of project support 53 D Conclus i'ons 5 斗 * -.. Annex 1. Past.Organizational Studies by the Executive Board relevant to the Subject of the Present Study 56 Annex 2 Distribution of the Sample of Projects studied 57/58 Annex 3 Action Schedule.. % Annex 4 Scheme of the Planning'process for WHO assisted Health Projects 63

6 E655/wp/l page 1 I., INTRODUCTION.., 1. Origin of the Study At its thirty-second session the Executive Board adopted resolution EB)2.R10, authorizing the Director-General to proceed with an organizational study on methods of planning and execution of projects, with particular emphasis on the following points: (a) (b) the delays; (c) role of WHO in the planning of projects; major causes of delays in starting projects and measures for reducing relationship between the effectiveness of WHO assistance and the adequacy of the project supporting staff and work facilities» This resolution constitutes the terms of reference of the present study. *. 1.2 The origin of resolution EB)2*R10 was a resolution of the Fifteenth World health 2 " Assembly (WHA15.58), which in its operative paragraph 1 expressed the view "that there is a continuing need for detailed study of methods and planning and of the effectiveness of the measures taken by the Organization in the field". WHA In its subsequent resolution the Fifteenth World Health Assembly decided that the subject of the next organizational study by the Executive Board should be "Methods of planning and execution of projects", - Following its consideration of the Health Assembly 1 s decision, the Executive Board at its thirtieth session adopted resolution EB30.R19,^ requesting the Director- General to prepare a preliminary report on the subject for the consideration of the Executive Board at its thirty-first session; inviting comments and suggestions from members of the Executive Board for inclusion in the Director-General 1 s report; and recommending that the Executive Board at its thirty-first session consider the desirability of establishing an ad hoc committee to continue the study in the light of_ the Board! s discussion, 1 Handbook of Resolutions and Decisions, 7th ed,, p # 2. Handbook of Resolutions and Decisions^ 7th ed 9, p. Handbook of Resolutions and Decisions, 7th ed., p.

7 EB35/Wp/l page 2 1Л In response to the Board! s request, the Director-General presented to the Board at its thirty-first session a report outlining some basic requirements that have to be met and the main problems that have to be solved in developing methods of planning and execution of field projects, and summarizing the existing rules and procedures relating to planning and execution. Its aim was also to give the Board a factual account of the situation at the time and to indicate some areas which might usefully be examined. Relevant parts of that document are reproduced in the present report. 1.5 The Executive Board considered the report prepared by the Director-General at its thirty-first session. The Board discussed a number of concepts and methods related to planning and operation of WHO-assisted health projects. The concepts of economy and efficiency were mentioned as basic elements in carrying out projects. It was felt that there was no need to revise all the methods of work of the Organization, but a survey was suggested to review the methodology of project planning and present procedures for recruitment of international staff, procurement of supplies and award of fellowships. There was a debate on the best ways and means to continue the study, the predominant opinion being that the Director-General should collect information byanalysing the experience of a number of projects. It was considered that these should be projects initiated in recent years and chosen from different regions and from various fields of activity. Nevertheless, no final decision was reached at this stage, and the Director-General was requested "to proceed with the preparation of the studyalong the lines set forth in his preliminary report, taking into account the views expressed in the Board at its thirty-first session" (resolution EB)1,R 斗 1.6 Since the inception of the Organization, the Executive Board has undertaken several organizational studies in its endeavour to find ways and means for WHO to do a better job at less expense. These studies, some of which are listed in Annex 1, have profoundly influenced the development of the Organization and are very relevant to the subject of the present study. The continuing interest shown in making studies which will help to guide the Organization is further confirmed by the selection for the next organizational study of the subject: "Co-ordination at the national level in relation to the technical co-operation field programme of the organization". 1.7 Finally, the Board is aware that the Director-General keeps all subjects having implications for administration and efficiency in field work under constant review. ~J ' Handbook of Resolutions and Decisions, _7th ed., p

8 eb35/wp/i page Methodology 2.1 In line with views expressed during the discussions at the thirty-first and ; ' r t thirty-second sessions of the Board, it was decided to base the study on a group of projecits recently begun and representing a broad spectrum as to type of project. - In order to give the result of the study the highest possible degree of general validity, it was decided to ;exclude from the sample projects of types which, owing to special features or procedures, did not lend themselves to a study of this general nature. The types of projects so excluded were malaria eradication projects; inter~country and headquarters projects; inter-regional, projects consisting orily of fellowships; and projects consisting only of single visits by short-term consultants. Subject to these exceptions only, and in order to have a group of sufficient size, it was decided to study all projects initiated in the years 1^60 and "1'9бХ;.; :.Iffefèâûl.tiXlg: sample of 86 projects in ^VJ countries is listed in Annex 2. ' -'. '.... 2«2 Questionnaires were designed to elicit detailed information directly related to.. *.... л..... ' the subjects of the study selected by the Board for particular emphasis; they were to be filled in by regional staff, which was also asked tó provide supporting narrative material, :In addition, the regional offices were requested to submit the plans of operations for the projects studied and all subsequent agreements delating to them. The data in the completed questionnaires were supplemented by additional olarification in subsequent correspondence with the regional offices, where necessary. Altogether 680 questionnaires totalling 950 pages were returned together with narrative statements. Many of the data received were punched од cards, and the time differences between related operations were calculated by punched card equipment. 2.3 Towards the end of the study, a corisliltarit (a senior public health official with a wide experience of national and international health work) was appointed iо collaborate in reviewing the data collected and in the preparation of the final report " - d 一一,,. 一. 一 _. 一....; ^.. * " - " -...._._.».. ^ - 3 General Summary and Suggestions.To r facilitate the task of the reader in the analysis of this complex study, the following paragraphs highlight some salient facts brought out by the study and contain a summary of the more important suggestions made. found in the reference made under each heading. Details of each subject can be

9 EB35/wp/l page 4 ^ 1 General It was found, as had been expected and as was clearly stated by the Director- General at the thirty-first session of the Executive Board, that there is always room for improvement of the administrative methodology. The study has shown that a basic machinery and administrative procedures are in operation which are suited to the requirements of effective management of field activities, but that this machinery and these procedures cannot modify certain local habits of work, and that they cannot interfere with the legal and administrative patterns which derive from the structure of national governments Nevertheless, WHO'S administrative methodology is kept under constant review, 3.2 Role of WHO in the planning of projects 3.2 # 1 WHO provided at one stage or another direct technical consultation in project planning on the spot in 93 per cent* of the cases studied. In 56 per cent, these consultations took place before the governments submitted their requests (IU, Ц p. 2>) It was noted that 29 countries out of 斗 7 concerned were reported to have some form of plan relating to their health services. This is an important fact, since it is considered that projects should be a concrete short-term phase of a long-term programme (ill, p. 25) It is suggested that as full discussions as possible should precede the inclusion of the project in the regional programme to allow for studying with the government the priority of the project, its cost, the resources available, and the ability of the country to finance its implementation and to carry on after WHO 1 s withdrawal A full appreciation of these elements is essential before going ahead with the project (IV, 3.5,p, 29 and 2.2, p. 25). D З.З.1 Major causes of delays in starting projects and measures for reducing the delays Over-all delays Out of 86 projects studied, JO were delayed by six months or more (IV,,.5.1, p. 26).

10 EB35/WP/I page 5 3. T h e major causes of over-all delays were: (a) governments 1 state of unreadiness to put. the. project in operation (b) prolonged negotiations; (b) 1 recruitment of project staff (IV/W,p. 27).. In l6 out of the delayed projects the government! s unreadiness to P.ut, the project into operation was the sole or a contributory cause of the delay. This is a finding from the study that should invite careful thinking about the responsibility that the government takes on when a request for assistance is submitted to WHO (IV, 3.5.1, P. 29)....,.. Lengihy negotiations; are. probably unavoidable,and they, like the state of unreadiness referred to in above., may to a- certain- extent pesult- -from insufficiently full preliminary discussions of the kind mentioned in above. Sometimes they are lengthened by the need for consultations with provincial or local authorities (IV, 5.5.3, p. 29) Recruitment of project staff 5.5*2*1 Out of 135 posts, 53 had not been filled three months after the latest planned target date (IV, , p, 37). The main reason for the delays was difficulty in finding suitable candidates. It took 5.6 months, on an average, to find the finally appointed candidate, and a further 6.5 months before he arrived on the project (IV, 4.4.P. 38 and , p # 37) Measures are suggested for reducing recruitment delays; these include building up a larger number of suitable candidacies, simplification of clearance and other administrative procedures, and beginning the process of recruitment earlier (IV, 4,5.), P. 39) Supplies a.nd equipment 3.5.This is practically never a cause of delay, and the conclusion is that present procedures are adequate and need no change (IV, P«斗 5).

11 EB35/WP/I page б 3 Л 2 It should, moreover, be kept in mind that IA/HO'S policy is to avoid becoming, a sort of supply agency (IV,5Д.2.1, p. 42). W Fellowships Fellowships are not an important factor in delaying projects. (IV, 6.5.1,p. 49) The time element for project-related fellowships is not always referred to in plans of operations. Although it is suggested that this should be kept in mind when projects are being planned, it is also noted that in practice the timing of nearly all awards was satisfactorily related to the presence of international staff (IV, 6.3.2, p. 49). 3 斗 Relationship between the effectiveness of WHO assistance and the adequacy of the project supporting staff and work facilities. Л- The provision of national project staff, and of counterparts in particular, was assessed, on an average, as less than reasonably adequate (V, 3-5 攀 1, p. 54). This deficiency must necessarily constitute a very serious obstacle' to efficient project implementation and to the achievement of a fundamental project aim The provision of some other supporting facilities was on an average assessed as less than "reasonably adequate" However, it cannot normally be expected that the standard of some of these facilities should be above the national standards for other national undertakings, unless the technical objectives of a project cannot be achieved without special or exceptional provisions (V, p. and W 7 p. 55) The difficulties covered under this heading do not necessarily impair th^ ultimate effectiveness of WHO assistance, though the period needed for it to become fully so must often be prolonged (V, ).2.).2,p. 55). v. 3ДInadequate national financing of the project is another frequent drawback. In many instances this results from the economic situation at the national level, but it may also result from failure to make the necessary budgetary provisions owing to lack of appropriate information at the executive levels (V, p»

12 EB)5/wp/l page 7 II. METHODS OP PLA2INING AND EXECUTION OF PROJECTS general *programme of vjork covering a specific period, and the annual programme and budget 1 Factors Determining Methods of Planning and Execution An illustrative rathei 5 than exhaustive description of the factors on which the planning and execution of projects depend is given in the following paragraphs. 1.1 Nature and tyi^e of WHO ass Istancо 1сД 1 The methods of planning and execution of projects derive from the nature and type of the assistance provided by WHO Tb.e assistance is based on the Constitution (which defines the ultimate objectives and functions of the Organization and sets forth the principles on which arrangements and methods of work used by it are developed), the It i3 the Health Acsembly which lays down intermediate and immediate objectives, introduces the element of time, and determines the financial means within the framework of which individual projocts are undertaken. Thus the Organization y s policies, the dcfjnition of its programmes, the nature and type of its assistance, and the provision of means to carry on its work are the responsibility of governments 0 l.lc2 WHO assistance to national health projects normally consists of (a) advisory services; rendered mainly by advisers and consultants, (b) some supplies and equipment, and (c) feilovrshipc. The ratio between international staff, fellowships and supplies and equipment has been under constant consideration by the World Health Assembly; policy in the mattor is guided by the consideration that the services of WHO are principally of an advisory and demonstration nature r 1.1,3 Tho projects assisted Ъу WKO fall within the following broad fieldsi (i) asgi3tance to govermients in the assessment of a situation: surveys, studies, research aimed at laying down baselines for actionj (ii) helping national authorities in their planning: elaboration of plans for action either on a specific matter or covering the whole field of health services development; (iii) technical aid to ministries of health in the control or eradication of cominunicable diseases;

13 eb35/wp/i page 8 (iv) advice and support to governments in their organization of services: basic health services, maternal and child health services, etc; (v) assistance to governments in training professional and auxiliary health staff for general duties or for specialized work; (vi) helping national authorities in their evaluation of programmes to serve for further planning and action; (vii) exceptionally, operational assistance may be given under the terms of resolution 1 2 National character of projects The World Health Organization, like other international organizations, works In a world of national sovereignties and domestic jurisdictions. The health of a country is the responsibility of its government, and WHO has no authority to take over any part of thai:; responsibility or to intervene in any way except at the government 1 s request, Th8 policy of the Organization is to foster the greatest possible selfreliance and initiative in national and community health services So-called WHO projects are in fact national health activities for the planning or implementation of which the goverment has requested the technical assistance or advice of thp Organization In other words, a project is a national enterprise, and from the time of its planning to the winding-up of its international phase, it is its national aspect that very largely determines its planning, execution and eventual { outcome. 1,2 :> T3ne adoption of the necessary national legislation, the provision of adequate local administrative machinery and physical facilities, the allocation of financial means, and the appointment of counterpart and other national personnel are the national measures on which the success of the project largely depends» Likewise, the continuation of the project on the withdrawal of international assistance is also exclusively within the government 1 s jurisdiction e In fact, the result of the project ultimately depends 1 Handbook of Resolutions and Decision, 7th ed. 9 p. 6,

14 EB35/WP/1 page 9 on what continues to exist and grow once WHO assistance is completed. Before any work is undertaken in a country there should be reasonable assurance that the country is ready and willing to give it moral and material support and is able to carry it through once it has been started with help from WHO. However, there can be no assurance against changes in policies or sudden financial and other difficulties of the government. 1.3 Trends in WHO r s field operations The following paragraphs discuss some of the developments which have taken place over the recent years and executing projects, They illustrate the increasing complexity of planning 1 O v e r the years changing national health needs have brought significant changes in the very nature of the average assisted project. Pew are now of the short-term or single-purpose kind except Where some urgent critical need is still to be met. Most projects are now conceived on a long-term basis and the assistance requested of the Organization is in keeping with that conception. - The approach is multi-disciplinary and the work of the various professions concerned (public health administrators, public health nurses, sanitary engineers, health educators, etc.) assists governments in fitting their projects into their health programmes All projects have some demonstration aspects and training of national staff is almost invariably involved, A distinctive trend in WHO j s field operations is the increasing number of co-ordinated programmes in which several international and national agencies co-operate. This derives from the concept of interdependence of economic, social and health factors in the process of development which is clearly implied in the definition of health given by the WHO Constitution, The decision taken by the World Health Assembly at its fifteenth session with regard to WHO's participation in the United Nations Development Decade (resolution WHA15.57) 1 is a recent indication of the recognition of the need for fully co-ordinating health planning and health operations with the work undertaken in other social and economic fields. 1 Handbook of Resolutions and Decisions, 7th ed., p. 363.

15 EB35/WP/I page 斗 There has been a significant trend in educational and teaching programmes : the earlier practice of requesting fellowships singly or individually is now usuallyelaborated into a comprehensive system to ensure that fellowships fit logically into national education and training programmes and that they are designed to help meet the staffing needs of health programmes. 1 # 3 # 5 The extension of field activities is illustrated by the fact that approved operational programme posts increased by J22 per cent, between 1952 and 1964, while all other posts increased by 6l per cent. (The total over all increase was 164 per cent,) 1.4 Regionalization and decentralization One of the most distinctive features of WHO's structure and methods of work is its regionalization, established by the Constitution, which has led to an unusual degree of administrative and technical decentralization. With the progressive establishment of regional offices, a number of important functions relating to the development of programmes in each region and the planning and execution of projects were delegated to them. At the same time, procedures were developed to ensure uniformity of interpretation of the Organization^ policies and technical requirements and the attainment in all regions of the standards laid down by. the Health Assembly and the Executive Board 2. Methods of Planning and Execution Project planning and execution consist of a series of operations performed at different levels according to rules and procedures that have been developed and are continually being adjusted according to the following principles: (a) (b) There should be appropriate delegation of authority and responsibilities; Planning should be careful, detailed and realistic; (c) There should be flexibility in adjusting projects to scientific, social and economic changes and in meeting unforeseen situations and developments; (d) A mechanism for follow-up, control and evaluation should be built up so that adjustments which-become necessary in the. course, of operations can be promptly made

16 eb35/wp/i page 11 The paragraphs below contain a summary of the existing rules and procedures relating to the planning and execution of projects, with some explanations considered appropriate for the purpose of this study.. Some basic considerations concerning planning as a whole are set out in Chapter 工工 I n Role of WHO in the Planning of Projects (PP 斗 ) 2.1 Division of responsibilities between headquarters and regional offices IJie.. Director-General, as chief technical and administrative officer of the' Organization, is responsible for preparing a long-term world-wide plan of work for consideration by the Board and submission to the Health Assembly for approval; 1 deciding, after considering the general programme of work and the discussions in the Executive Board and the Health Assembly, on the total amount of the effective working budget which he intends to propose; for for developing general technical methods for all Ш0 programmes; for co-ordination of research; and for analysing regional surveys of the health needs of countries in order to gain information on which the long-term programme and general technical conclusions may be based. Direo tor-general: (a) For these purposes, the circulates at headquarters and to regional offices a statement of the policy considerations, based on the decisions of the Health Assembly and the Executive Boards that are to be taken into account in planning the annual programme, together with a tentative estimate of the amounts that will be requested under the regular budget and that may be expected to become available under existing procedures from the Expanded Programme of Technical Assistance; (b) examines regional programmes and budgets in the light of the.organi-.. * zation*s long-range plans; To secure technical information and guidance in formulating programme policy and for preparing WHO programmes, the Organization relies to a great extent on a complex system of expert advice which includes expert advisory panels, technical meetings such as expert committees, study groups, scientific groups, conferences (including regional and inter-regional symposia and other meetings), etc., the Advisory Committee on Medical Research, the WHO international centres and many hundreds of collaborating laboratories; all these contribute to give authoritative technical guidance to the policies and programmes of the Organization.

17 EB35/wP/l page 12 (c) provides technical consultation to regional directors before he approves new types of projects, unusually large projects^ or projects involving subjects for which there are no regional advisers; (d) informs regions on technical matters and developments relevant to regional programmes. у ,1.2 Beginning with the Director-General s policy considerations, and within the budgetary allocations indicated by him, regional directors are responsible for the development, implementation and evaluation of annual regional health programmes based on requests submitted by the governments. The sum of health projects to be assisted by WHO within a region constitutes the regional programme. In this connexion regional directors: (a) (b) (c) (d) consult with governments; prepare annual regional programmes and budget estimates; negotiate with governments and execute WHO basic agreements; negotiate with governments for the signing of project agreements for all projects assisted by WHO; on joint projects, undertake preliminary negotiations with governments and, after concurrence of the other organizations has been obtained, 1 negotiate with governments for the signing of project agreements; (e) (f) implement approved plans of operations; evaluate progress and results. 2.2 Origin and life cycle of projects A written request from the government concerned is the firm basis for planning and implementing a project. The origin of such country requests should normally be found in government consultations, initiated by national health departments, with WHO representatives or regional advisers As a result of such exchanges of views, certain preliminary programme ideas usually develop to a point of mutual agreement in principle about technical soundness and project priority. Eventually, a first draft of an annual programme, consisting of various projects to be assisted by WHO for each country, is 1 For UNICEP-assisted projects, concurrence is obtained by the regional director; for other co-operating organizations this is done through WHO headquarters

18 EB55/WP/I page 15 drawn up at the regional office, due account being taken of the general programme of work, the Director-General 1 s guidance, tentative estimates of funds expected to be available, and the programmes of other agencies working in the region. This draft... is then discussed with the individual governments by WHO representatives, or byregional advisers visiting each country; these discussions help towards the selection of those projects which are most likely to contribute to the development of strong, well-balanced and integrated health services, to the control and eradication of communicable diseases, and to other priority health needs. As a result, formal written requests are presented by governments to the regional director, who satisfies himself that they are appropriate before he includes them in the proposed regional programme to be submitted to the regional committee at its annual meeting in that year. Governments are consulted in determining priorities for the selection of projects in case it proves impossible to include all requests within the regional budget figure (it is understood that continuing projects have first priority) The recommendations of the regional committees are in turn submitted to the Director-General, who, after they have been analysed by his technical and administrative staff, may include them in his annual programme and budget proposals which he submits to the Executive Board and Assembly. The programme is reviewed early in the following year by the Executive Board and submitted for approval to the World Health Assembly; it is carried out in the year after that (see also Annex 5) Once the World Health Assembly has examined and approved the programme and budget for a given year, it becomes the programme of the Organization for that year, and its execution is the responsibility of the Secretariat in conjunction with the requesting governments # The projects under the Expanded Programme of Technical, Assistance follow a somewhat different time-table. In spite of this and of a more complicated procedure which EPTA follows, including consultations with the Resident Representative of the Technical Assistance Board and the approval of the gоver riment T s co-ordinating authority, the Organization has, since th-э beginning of this programme,,.endeavoured to integrate fully the health projects under EPTA with its normal work and to minimize differences in their planning, implementation and evaluation.

19 EB35/WP/I page 14 2, Appropriateness of requests The appropriateness of requests is determined on the basis of the guiding principles.which the Health Assembly and the Executive Board have laid down in a number of resolutions (EB2,Rl/ WHA3.116, 2 EB7 雜, 2 EB9.R21 2 and EB11.R57 2 ). In the light of the responsibilities, programmes and technical policy of the Organization as well as of the decisions, plans and programmes of the United Nations and specialized agencies, the following considerations are relevant in judging the appropriateness of requests :. (a) the probability of achieving successful, useful and permanent results; (b) the relative importance of the problem in the whole health programme of the requesting country; (c) the ability of the country to provide the services required as measured by the availability of trained personnel and of means for training personnel; (d) the financial and administrative ability of the country to absorb the requested assistance, taking into, account all the health projects planned and in operation as well as assistance in other forms, including bilateral, which might overload the country r s operating capacity;. (e) reasonable assurance of satisfactory working relationships with the government throughout the programme; (f) reasonable assurance that the projects will be continued, and particularly that the government will provide adequate personnel and financial support for their continuation; ^. (g) (h) balanced expenditure among the various health sectors; equitable distribution of funds among countries in the region; (i) the strengthening of basic health serviced needed to assist economic and social development 1 Q Handbook of Resolutions and Decisions, Tth ed" p. Handbook of Resolutions and Decisions, 7th ed., pp. 1бЗ, l64, 165, 171.

20 EB35.A/r/l page 15 2Л Plans of operations 2Л.1 A plan of operations is an agreement between WHO and the government concerned, concluded within the framework of the WHO Basic Agreement or of the Basic Technical Assistance Agreement. In projects jointly assisted by other United Nations organizations, all participants are parties to the agreement. The plan of operations provides a formal basis for WHO action and is at the same time a guide according to which a project is developed and carried out For each project, the plan of operations: (a) defines the short-term and long-term objectives of the project and the methods to be used in its execution; (b) outlines the plan of action^ with the principal steps to be taken by the. government and WHO; (c) fixes the sequence and time schedule for the various steps involved; (d) establishes the precise commitments of WHO and the government; (e) provides for evaluating and reporting on the project and for accounting for WHO Supplies; and (f) provides for the continuation of the project after the assistance from WHO has ended. Usually the phasing set out in the plan of operations is adhered to, but if the need for revision arises, the plan can be modified by agreement among the contracting parties Similarly, the assistance offered by WHO can be prolonged after the period initially agreed upon if the government concerned so requests The plan of operations must take into account numerous technical, administrative and other factors such as local conditions, the health problems involved, the existence of adequate techniques to be applied for their solution, etc. Its completion requires detailed negotiations with various government departments; these negotiations are often unavoidably prolonged owing to the time required for inter-departmental consultations and legal or constitutional formalities While in principle no financial obligations can be incurred before the plan of operations is signed by the government, the Director-General approves exceptions to this rule if a regional director assures him that delay in government signature results from questions of- formality and that in effect agreement based on a draft plan exists Plans of operations are approved and signed for WHO by regional directors.

21 EB35/wp/l page l6 2.5 UNICEP/WHO projects Some supplementary provisions are necessary to regulate WHO T s participation inthe planning and implementation of projects jointly assisted by UNICEF and WHO.. f By virtue of the established responsibilities of UNICEF and WHO, every government request to UNICEF for assistance to national health projects becomes a matter for tripartite agreement involving the government which requests aid, UNICEF which provides material assistance, and WHO which is responsible for giving technical approval and for providing advisory services. All requests addressed by governments to UNICEF for assistance to health projects must therefore be referred by UNICEF to the WHO regional office concerned for technical appraisal and approval. The government request and related formal project proposal consists of: (a) (b) a tripartite plan of operations; additional background data if appropriate; 2.5 斗 (c) a detailed list of the supplies and equipment required.. i. - The WHO regional director considers the formal project proposal and, if he decides that it is acceptable, gives it technical approval on behalf of the Director- General and notifies the UNICEF regional office concerned and WHO headquarters of his action This procedure is repeated if any modifications are subsequently proposed. ^^. 2,5-5 Requests for assistance from UNICEF 1 are submitted to the UNICEF Executive Board for approval. The UNICEF Executive Board approves assistance to cover the total cost of the project but allocates funds to meet the expected expenditure either for the whole of the project or for a limited period. In the latter event, further ; * - allocations are normally made at subsequent meetings of the Executive Board to cover the further expenditure necessary. 2.6 Projects financed, by the Uni ted Nations Special Fund 2,6,1 WHO staff give governments full assistance in planning and preparing requests for health projects to be submitted to the United Nations Special Fund; they also co-operate with Resident Representatives of TAB (who are also appointed as Directors of

22 EB35/WP/I page 17 the Special Fund Programme) by advising on the. health aspects of project requests received by the Special Fund from governments Negotiations on Special Fund projects involve not only the ministry of health or other technical ministries, but also the national authority (e.g. foreign ministry) with which the Special Fund normally deals WHO regional offices are responsible for preparing in consultation with headquarters a detailed plan of operations for each Special Fund project for which WHO is to act as executing agency. Negotiations with the government concerned may under no circumstances be considered final, nor may the plan of operations be signed, until the latter has been reviewed and agreed to by both the Special Fund and WHO headquarters, 2.7 Project operations Implementation of projects begins when agreement has been reached by the contracting parties on the plan of operations. Governments are kept fully informed about the selection of the staff and the delivery of supplies. National authorities on their part undertake to make available the necessary premises and facilities for the execution of the project, and are responsible for the appointment of counterpart staff and the designation of fellows for study abroad, as appropriate and agreed upon. 2.7*2 The operation of the project is the responsibility of the national health authorities concerned, with the advice and assistance of the WHO staff. It requires day-to-day co-operation between the WHO advisers and the national counterparts who are the executants. The quarterly reports referred to in paragraph 2.8,5 (p. l8) are prepared jointly by them and submitted both to the minister of health and WHO and other participating organizations, if any. Periodic visits are made to the project byregional technical staff. 2.8 Supervision and evaluation 2.8,1 The experience from projects all over the world is fed back to WHO for assessment, principally by the means described in the following paragraphs. On the basis of this experience, the Organization adjusts its methods to achieve its objectives and to meet the needs of its Members more effectively.

23 EB35/wp/l page l The role of WHO representatives is of increasing importance in providing to regional offices information about local conditions and developments in the field and in following up the servicing of projects. WHO representatives and regional office staff are also expected to advise governments on various measures which may appear necessary to the execution of projects At the same time, regional offices keep headquarters informed of the field work To ensure adequate co-ordination and an orderly development towards achieving the objectives laid down in agreements between governments and WHO, regular as well as ad hoc programme meetings of regional staff have proved valuable. During these meetings the responsible technical and administrative staff, competent to deal with various aspects of each problem, have an opportunity to review the status óf WHO 1 s assistance to individual projects as well as the development of the regional programme as a whole. It is also to a large extent during these meetings that important decisions are made about action to be taken Day-to-day contacts between projects and regional offices are kept primarily through ad hoc correspondence on various questions relating to the conduct of a project There exists a comprehensive reporting system during the period of operation of the project; it consists of monthly, quarterly and final project reports, and also individual reports from field staff at the end of their assignment to the project Parallel wi-th supervision and control, the evaluation of projects is undertaken as an inherent part of their execution» Every plan of operations contains provision for the joint assessment of the progress of the project by the government and WHO during and after the period of WHO assistance. The government is committed to continuing the evaluation after the period of international assistance. 2.9 Action schedule The various operations involved in project planning and execution, described above, are performed according to an "action schedule". The present action schedule for projects under the regular budget and for those financed under EPTA or jointly assisted with UNICEF is described in Annex It should be noted that: (a) the action schedule has to fit the existing framework of organizational meetings which set the timing pattern of programme planning;

24 eb35/wp/i page 19 (b) any given calendar year is simultaneously a planning^ approving, and operating year in respect of successive programmes; thus the year 1965 is the operating year for the 1965 programme, the approving year for the 1966 programme, and the planning year for the 1967 programme; (c) the Expanded Programme of Technical Assistance is planned and approved on a biennial basis; thus, 196 斗 was both the planning and approving year for the 1965/66 programme as well as the second operating year for the 19б)/б 斗 biennium. I 工工 ROLE OF WHO IN THE PLANNING OF PROJECTS 1. The Planning Process 1.1 Although national health planning was already the subject of a previous organizational study, it should be re-stated that project planning cannot be analysed without referring to national health planriing (where it exists) of which WHO-assisted projects are only one operative part, 1.2 In the whole planning process there are preliminary steps which are essential. The first of these steps is the diagnosis of the health situation, as a basis for a clear definition of objectives. Then come collection of basic demographic and epidemiological information; assessment of available resources; determination of the feasibility of the objectives in the light of the relationship between needs and resources; and establishment of priorities according to the estimated impact of each individual project on the improvement of community health» 1.3 If a country has some form of national health plan, it is easier for the national health authorities to define desirable projects and also to decide how well anysuggested health project fits into the general long-term scheme, whether available resources are adequate for its immediate execution, and what impact it will have on the health of the people. In other words^ a project should not be an isolated enterprise^ but on the contrary should be a partial expression of a national longterm health programme

25 EB35.A/r/l page Methodology of Planning 2.1 It сал be said that the planning, execution and evaluation of a programme is a continuous process subject to wéll-defined cycles, with a sequence of activities that should lead to the achievement of the proposed goal. Relationships between effect and cost are of the utmost importance> since needs are always greater than financial resources and therefore the maximum effect should be;sought at the minimum cost. A quantification of needs and resources is thus essential 2.2 National Health Planning is an integral part of broader national plans intended to raise the standard of living and welfare of the people by means of economic development and social progress. No health project, whether exclusively national or internationally assisted, can be set into motion unless the national budget makes provision for it. This is why the national health administrator has to think of projects in financial terms This is especially important when it is considered that the priority of health projects will be compared with that of projects of an industrial or agricultural nature The resources invested in these latter fields are more easily seen to increase wealth in a short period of time. Projects in the health field, on the other hand, are aimed at improving services and health conditions, reducing morbidity and prolonging life expectancy, and the achievement of such less tangible objectives is usually difficult to demonstrate, 2.3 It is always advisable to have a comprehensive national health plan developed horizontally to cover all sectoral health needs, with a criterion of maximum performance, It may also be necessary to draw up a minimum plan to tackle only some health problems proportionately to resources available. Sometimes too, an exceptional vertical plan with central command is advisable to bring under control, or to eradicate, certain diseases that overshadow the health picture and that require complex instrumentalization or specialized skills 2.4 A diagram is presented in Annex 4 to show the scheme and sequence of the process of planning and implementing health projects assisted by WHO and other agencies. In this scheme, three clearly defined stages can be distinguished.

26 EB35/WP/1 page In the first stage, which is mostly a government responsibility, the formulation of a national health policy and the design of plans and programmes should be done on the basis of an accurate diagnosis of health problems and available resources In the second stage discussions should be held between the government and WHO and other international agencies concerned in order to enable the national health authorities to make a decision taking into consideration the expected impact of the project on community health, the feasibility.of its impl emen t a.t i on, the possibility of financing it and the availability of human and physical resources In the third stage, the operative part consists of the signature of a plan of operations; the recruitment and placement of international staff and appointment of national counterparts., the award of fellowships, and the procurement of physical facilities and supplies - in other words the execution of the project by the government with assistance from WHO, It should be stressed that every step in this process is a link in a continuous sequence, and that the omission or faulty execution of any of these steps may delay or lead to the failure of the project as a whole 2.5 Governments are progressively realizing that WHO can be of great assistance in establishing health priorities' and. helping to implement selected health projects oriented to the achievement of a definite final goal. Analysis of the Result of the Study of WHO T s Role in the Planning of Projects Project origin * It appears that in 22 out of 86 projects studied, Ш0 staff were involved in originating the idea behind the request itself and that 21 others were a continuation of previous WHO-assisted field projects. The idea behind the requests for the remaining 斗 5 projects appears to have been generated completely within the government concerned* All the requests examined conformed to the policies adopted by the Assembly and the Board WHO's participation in developing national requests comes about naturally through the increasing occasions for contact and discussion between national health authorities and WHO personnel in regional committees, meetings, seminars, and other technical gatherings, through visits by specialized teams д consultants, headquarters and regional staff, and through the increasing number of WHO representatives and public health advisers stationed in countries.