《卫生经济学》课程参考文献（WHO年度报告）：World Health Report 1999 Making a Difference.pdf_P16-P20

The World Health Report 1999 We work for countries in two ways. We work in countries by establishing a direct pres ence to respond to national developmental needs. In this regard, it is essential that our in- country presence is adequate for the tasks we need to undertake. We also work with the entire community of countries, collectively or in groups, helping them to mobilize their collective wisdom, knowledge and efforts in the production of norms and standards, sound evidence and surveillance data. These are all international public goods which benefit all In allocating our resources to country-specific work, concentrating technical assistance on countries with a shared strategic vision will enhance impact. We have a clear man adopted by our Member States -and the World Health Assembly regularly votes recom- mendations and policies which we are pursuing- so we should support related projects and policies to which governments are committed, rather than attempting to impose an outsiders perspective oncentrating resources on poor countries or vulnerable groups without alternative sources of finance will also amplify our impact. A recent World Bank review of what works in development assistance-and of what fails-found strong support for these conclusions When development assistance was used to support governments with sound policies it contributed significantly to economic growth and poverty reduction, particularly in poorer countries. But when external actors pushed against the grain of weak national policies they failed. The review further concluded that far too much development assistance has indeed been wasted for just this reason. If WHO is to make a difference the implication is clear: concentrate country-speci technical assistance for health on countries whose policies reflect a shared vision of reach- iency in health systems development. But as a technical agency committed toimprove the health of the poor, we alsoneed to focus on vulnerable populations and do what we can to help to improve their health status. The second modality for focusing our country efforts involves working with the entire ommunity of countries. The international community should avoid using its resources for what individual countries can do for themselves. International resources should, instead concentrate on functions that require international collective action. These tasks include catalyzing effective global disease surveillance(as is currently done with influenza, to targeting specific global or regional health problems where the concerted action of coun tries is required (for example, eradication of poliomyelitis); helping to provide a voice for those whose health is neglected within their own country or who are stateless, ensuring that critical research and development for the poor receives finance Each of these tasks involves working with the community of nations I wish to see a shift in the way WHO thinks and acts in its work with countries. Let us reflect for a moment on what it will take for our Organization to enhance its contribution WHO needs to be seen by governments and other agencies to have a sound under- standing of sectoral needs and the political and institutional contexts in which they have to be addressed WHO needs to be a reliable source of high quality advice, and to act as a facilitator with

xvi The World Health Report 1999 We work for countries in two ways. We work in countries by establishing a direct presence to respond to national developmental needs. In this regard, it is essential that our incountry presence is adequate for the tasks we need to undertake. We also work with the entire community of countries, collectively or in groups, helping them to mobilize their collective wisdom, knowledge and efforts in the production of norms and standards, sound evidence and surveillance data. These are all international public goods which benefit all. In allocating our resources to country-specific work, concentrating technical assistance on countries with a shared strategic vision will enhance impact. We have a clear mandate adopted by our Member States – and the World Health Assembly regularly votes recommendations and policies which we are pursuing – so we should support related projects and policies to which governments are committed, rather than attempting to impose an outsider’s perspective. Concentrating resources on poor countries or vulnerable groups without alternative sources of finance will also amplify our impact. A recent World Bank review of what works in development assistance – and of what fails – found strong support for these conclusions. When development assistance was used to support governments with sound policies it contributed significantly to economic growth and poverty reduction, particularly in poorer countries. But when external actors pushed against the grain of weak national policies they failed. The review further concluded that far too much development assistance has indeed been wasted for just this reason. If WHO is to make a difference the implication is clear: concentrate country-specific technical assistance for health on countries whose policies reflect a shared vision of reaching the poor and of efficiency in health systems development. But as a technical agency committed to improve the health of the poor, we also need to focus on vulnerable populations and do what we can to help to improve their health status. The second modality for focusing our country efforts involves working with the entire community of countries. The international community should avoid using its resources for what individual countries can do for themselves. International resources should, instead, concentrate on functions that require international collective action. These tasks include: • global leadership and advocacy for health; • generating and disseminating an evidence and information base for all countries to use; • catalyzing effective global disease surveillance (as is currently done with influenza, to take one important example); • setting norms and standards; • targeting specific global or regional health problems where the concerted action of countries is required (for example, eradication of poliomyelitis); • helping to provide a voice for those whose health is neglected within their own country or who are stateless; • ensuring that critical research and development for the poor receives finance. Each of these tasks involves working with the community of nations. I wish to see a shift in the way WHO thinks and acts in its work with countries. Let us reflect for a moment on what it will take for our Organization to enhance its contribution. • WHO needs to be seen by governments and other agencies to have a sound understanding of sectoral needs and the political and institutional contexts in which they have to be addressed. • WHO needs to be a reliable source of high quality advice, and to act as a facilitator with

Message from the Director-General a technically authoritative voice WHO needs to possess up-to-date and relevant evidence, set relevant norms and stand rds, and be responsive to the needs of Member States WHO should be able to serve as a broker and negotiator for better health -helping to reconcile concerns and needs of Member States and extenal agencies that support the health sector. WHO should be able to help to shape the rules of engagement between governments and external agencies, as well as being able to use its own limited financial resources as strategically as possible. WHO should be instrumental not only in raising international resources for health, but also in placing health at the heart of the development agenda. This is a tall order. But it is a clear and consistent message, one that comes from all our international partners, and is a sound reminder for the renewal process FORGING MORE INFLUENTIAL PARTNERSHIPS In approaching partnerships, we need to shift our strategic direction substantially. We eed to move from our traditional approach -which too often has favoured our own small scale projects-to one which gives more emphasis to strategic alliances. Alliances will allow us both to learn from and to influence the thinking and spending of other international actors; and they will allow us to shape what we do into a broader picture WHO is the lead agency in health. But we can lead more effectively when we link up with others and agree on a division of labour and on ground rules for conducting our relationships. In this way we can create real partnerships for the attainment of tangible health outcomes WHO is in an ideal position to play a pivotal role in sector-wide approaches- and in everal countries it is already doing so. Agencies, development banks and Member States are coming to realize the disadvantages of traditional development projects. They recog- nize, as we do, that sectoral approaches offer a way of supporting health development that strengthens national ownership and helps to build sustainable national systems Our thinking on sector-wide approaches is at an early stage. There are no blueprints to show how they should be organized. But we will actively promote cooperation and joi efforts with a number of our partners -in the United Nations family, civil society and the private sector. We will do so among agencies and in our country work. Here are some of the partnerships we have been working to strengthen: We have worked energetically during our year as chair of the cosponsors of UNAIDS, supporting the work of achieving more common programme and budget planning We have initiated a closer working relationship with the World Bank- not only on the Roll Back Malaria project and the Tobacco Free Initiative, but also by engaging in a deeper dialogue on policy issues, including in the follow-up of the Comprehensive Develop ment Framework put forward by the President of the Bank. We are likewise beginnin to intensify our efforts with the regional development banks We have initiated common analyses with the International Monetary Fund. We will share with the IMf our knowledge of the health sector, working with them in seeking to avoid the harm that can occur to the social sectors during economic adjustments to We have developed working relations with the World Trade Organization. In addition to contacts between our experts, I will be meeting the Director-General of WTo twice a

Message from the Director-General xvii a technically authoritative voice. • WHO needs to possess up-to-date and relevant evidence, set relevant norms and standards, and be responsive to the needs of Member States. • WHO should be able to serve as a broker and negotiator for better health – helping to reconcile concerns and needs of Member States and external agencies that support the health sector. • WHO should be able to help to shape the rules of engagement between governments and external agencies, as well as being able to use its own limited financial resources as strategically as possible. • WHO should be instrumental not only in raising international resources for health, but also in placing health at the heart of the development agenda. This is a tall order. But it is a clear and consistent message, one that comes from all our international partners, and is a sound reminder for the renewal process. FORGING MORE INFLUENTIAL PARTNERSHIPS In approaching partnerships, we need to shift our strategic direction substantially. We need to move from our traditional approach – which too often has favoured our own smallscale projects – to one which gives more emphasis to strategic alliances. Alliances will allow us both to learn from and to influence the thinking and spending of other international actors; and they will allow us to shape what we do into a broader picture. WHO is the lead agency in health. But we can lead more effectively when we link up with others and agree on a division of labour and on ground rules for conducting our relationships. In this way we can create real partnerships for the attainment of tangible health outcomes. WHO is in an ideal position to play a pivotal role in sector-wide approaches – and in several countries it is already doing so. Agencies, development banks and Member States are coming to realize the disadvantages of traditional development projects. They recognize, as we do, that sectoral approaches offer a way of supporting health development that strengthens national ownership and helps to build sustainable national systems. Our thinking on sector-wide approaches is at an early stage. There are no blueprints to show how they should be organized. But we will actively promote cooperation and joint efforts with a number of our partners – in the United Nations family, civil society and the private sector. We will do so among agencies and in our country work. Here are some of the partnerships we have been working to strengthen: • We have worked energetically during our year as chair of the cosponsors of UNAIDS, supporting the work of achieving more common programme and budget planning. • We have initiated a closer working relationship with the World Bank – not only on the Roll Back Malaria project and the Tobacco Free Initiative, but also by engaging in a deeper dialogue on policy issues, including in the follow-up of the Comprehensive Development Framework put forward by the President of the Bank. We are likewise beginning to intensify our efforts with the regional development banks. • We have initiated common analyses with the International Monetary Fund. We will share with the IMF our knowledge of the health sector, working with them in seeking to avoid the harm that can occur to the social sectors during economic adjustments to financial crises. • We have developed working relations with the World Trade Organization. In addition to contacts between our experts, I will be meeting the Director-General of WTO twice a

The World Health Report 1999 year on a prepared agenda. We need to interact better with WTO to make sure that the health dimension of trade and globalization is considered before and during-and not We are strengthening our work with the Organization of African Unity by upgrading We are updating and expanding our working relations with the European Union, an increasingly important partner in health, not only in Europe but beyond We need to work with our United Nations partners to help refine the purpose of the UN Development Assistance Framework process, and develop a clear vision of how closer oordination will be expressed in individual countries. Ideally, this will mean movin towards the development of common policy positions on key sectoral issues, and dray s ing other development partners into the process In addition to governmental and intergovernmental partners, we are making progress in building partnerships with nongovernmental organizations and the private sector. We have had a number of round table meetings with industry. We are working closely with the Global Forum on Health Research in their efforts to catalyze greater public and private sector involvement in developing new products of relevance to the poor. The initial focus is on a public/private partnership to produce a new generation of anti malarial drug REPOSITIONING WHO FOR THE 2IST CENTURY Helping to meet the health challenges facing the world through effectively implement ing our strategic themes requires changes in WHO. Much of my work in the past ten months, and that of my colleagues, has attempted to reposition WHO internally to respond better to external needs and demands. The key objectives we identified for structural change at headquarters have either been reached or we are very close to reaching them. The structure is flatter, and staff report to a competent and clearly mandated senior management with clear priorities. There is more transparency through more open deci sion-making in a new Cabinet form of govemance, where heads of the nine clusters of departments meet on a weekly basis. We are moving with determination towards gender parity. We have initiated a process of staff rotation and mobility. There is a new dialogue Some reforms need time. We wish to see the number of senior positions come down and they will. But in getting there we are fully respecting contracts and previous commit- ments. We have reduced administrative costs. And we will go further. It is my ambition to ee to it that our administrative and programme reviews identify further scope for redirec tion of funds from administrative to technical activities Having spent ten months at WHO I feel I can say this: staff serving the United Nations are hard-working people, often accepting workloads that many national civil servants would turn down. These staff constitute our ultimate resource. Providing them with the tools, skills and mandates to work effectively is the objective of our personnel policies, and I believe we are beginning to see results Our work in this initial phase is about renewal, and I wish to see this penetrate everything we do: safeguarding what works, drawing on experience and knowledge, but looking ahead to serve a world in dramatic change. The challenge now is to work better and focus our efforts on where the return in health gains is greatest. In this we intend to draw more heavily on the wisdom and experience of the WHO Executive Board and to create a

xviii The World Health Report 1999 year on a prepared agenda. We need to interact better with WTO to make sure that the health dimension of trade and globalization is considered before and during – and not only after – complex negotiations. • We are strengthening our work with the Organization of African Unity by upgrading our presence in Addis Ababa. • We are updating and expanding our working relations with the European Union, an increasingly important partner in health, not only in Europe but beyond. • We need to work with our United Nations partners to help refine the purpose of the UN Development Assistance Framework process, and develop a clear vision of how closer coordination will be expressed in individual countries. Ideally, this will mean moving towards the development of common policy positions on key sectoral issues, and drawing other development partners into the process. • In addition to governmental and intergovernmental partners, we are making progress in building partnerships with nongovernmental organizations and the private sector. We have had a number of round table meetings with industry. We are working closely with the Global Forum on Health Research in their efforts to catalyze greater public and private sector involvement in developing new products of relevance to the poor. The initial focus is on a public/private partnership to produce a new generation of antimalarial drugs. REPOSITIONING WHO FOR THE 21ST CENTURY Helping to meet the health challenges facing the world through effectively implementing our strategic themes requires changes in WHO. Much of my work in the past ten months, and that of my colleagues, has attempted to reposition WHO internally to respond better to external needs and demands. The key objectives we identified for structural change at headquarters have either been reached or we are very close to reaching them. The structure is flatter, and staff report to a competent and clearly mandated senior management with clear priorities. There is more transparency through more open decision-making in a new Cabinet form of governance, where heads of the nine clusters of departments meet on a weekly basis. We are moving with determination towards gender parity. We have initiated a process of staff rotation and mobility. There is a new dialogue with staff. Some reforms need time. We wish to see the number of senior positions come down – and they will. But in getting there we are fully respecting contracts and previous commitments. We have reduced administrative costs. And we will go further. It is my ambition to see to it that our administrative and programme reviews identify further scope for redirection of funds from administrative to technical activities. Having spent ten months at WHO I feel I can say this: staff serving the United Nations are hard-working people, often accepting workloads that many national civil servants would turn down. These staff constitute our ultimate resource. Providing them with the tools, skills and mandates to work effectively is the objective of our personnel policies, and I believe we are beginning to see results. Our work in this initial phase is about WHO renewal, and I wish to see this penetrate everything we do: safeguarding what works, drawing on experience and knowledge, but looking ahead to serve a world in dramatic change. The challenge now is to work better and focus our efforts on where the return in health gains is greatest. In this we intend to draw more heavily on the wisdom and experience of the WHO Executive Board and to create a