Working in the international
context with WHO and
others
Hernan Montenegro, MD, MPH
Health Systems Adviser
HIS/PSP
WHO, Geneva
What is WHO?
 UN specialized agency for health (1948)
 194 countries (Ministries of Health)
collectively decide together with WHO
Secretariat on global health priorities and
action to save lives and improve health.
 Headquarters in Geneva, 6 regional
offices, 151 country offices
 Secretariat is staffed by some 7500
health and other experts and support
staff
 Director-General: Dr Margaret Chan
2 | WHO: Who we are and What we do |
1 July 2013
Objective of WHO
The objective of the World Health Organization shall
be the attainment by all people of the highest
possible level of health
(Article 1, Chapter I, WHO Constitution)
3 | WHO: Who we are and What we do |
1 July 2013
WHO Headquarters and Regions
• Copenhagen, Denmark
 Geneva, Switzerland
• Washington DC, USA
• Cairo, Egypt • New Delhi, India
• Manila, Philippines
• Brazzaville, Congo
Staff
4 | WHO: Who we are and What we do |
1 July 2013
Headquarters:
26.3%
Regional Offices: 23.6%
Country Offices: 50.1%
Our approach – WHO core functions
 Providing leadership on matters critical to health and
engaging in partnerships
 Setting norms and standards and promoting and
monitoring their implementation
 Use evidence and research to frame ethical policy
options for countries to improve people's health
5 | WHO: Who we are and What we do |
1 July 2013
Enhancing partnerships
 WHO works with the support
and collaboration of many
partners including other UN
agencies, donors, NGOs and
the private sector.
 Finding new ways of working
with our partners is key to
achieving our goals.
6 | WHO: Who we are and What we do |
1 July 2013
Need for PHC reforms
Source: WHO, Primary Health Care- Now More than Ever, World Health Report, 2008
Three dimensions (policy choices) of
Universal Coverage as portrayed in WHR

10 |
UHC for FGPH, Paris
18-19 June 2012
WHO Strategy on High Quality, Integrated
People-centred Services to Achieve UHC
 Forward-looking
 Evidence-informed, based
 Action-oriented (how to of health care delivery reform)
 Develop policy options, strategies and interventions
 Adaptable to various country settings, contexts
 Build on WHO's past and current work
 Build on lessons learnt from Member States and others
 Participatory and consensus-building approach:
– Patients, users, communities, CSOs, NGOs
– Professional associations, etc.
11 |
TITLE from VIEW and SLIDE MASTER | July 1, 2013
Universal Health
Coverage
(UHC)
People-Centred Care
(PCC)
Integrated Service Delivery
(ISD)
"Ensuring that all people
have access to needed
promotive, preventive,
curative and rehabilitative
health services, of sufficient
quality to be effective, while
also ensuring that the use
of these services does not
expose the user to financial
hardship."
"Care that is focused and
organized around the health
needs and expectations of
people and communities rather
than on diseases."
"The management and
delivery of health services
such that people receive a
continuum of health
promotion, disease
prevention, diagnosis,
treatment, diseasemanagement, rehabilitation
and palliative care services,
through the different levels
and sites of care within the
health system, and according
to their needs throughout the
life course."
(WHO, 2010)
(WHO Glossary)
(adapted by PAHO from WHO 2008)
The Attributes of Family Practice
(General Practice)
• Person-centred
• General
• Continuous
• Comprehensive
• Coordinated
• Collaborative
• Family-oriented
• Community-oriented services
Policy options and intervention
levels
Information &
Exhortation
Society
Legal &
Regulation
Community
Building
Capacity of
others
Family
Person
UHC with High Quality,
Integrated People-centred
Services
National
Context
Direct
Provider(s)
Bureaucratic
Reforms
Health
Facility
Taxes &
Subsidies
Provider Network
Service
Provision
System
Financing &
Contracting
Global &
Regional
Context
Country Settings
Post-conflict:
Low HD:
- Special needs of refugees & displaced people
- Specific health needs resulting from conflict
- Increase in CDs due to disruption of services & destroyed infrastructure
- Security issues
- Unstable governance & weak institutional capacity
- Damaged infrastructure
- Shortages of HRH and other essential supplies
Non-functioning functioning delivery system
- High dependency from external assistance & financing
- Low Life Expectancy, high burden of CDs & malnutrition
- High reliance on O-O-P contributions & regressive public health spending
- Low public health expenditure as % of GDP
- Poor governance & weak institutional capacity
- Shortages of infrastructure, HRH and other essential supplies
- Poorly developed delivery system & predominance of vertical programs
- Majority of existing services provided by NGOs & informal providers
- Poor information systems and lack of performance assessment
- High dependency from external assistance & financing
- Inequities that affect the most vulnerable
population groups
- Quality of care issues, including medicines
- Fragmented care
-Inefficient use of existing resources
- Insufficient participation
Very High & High HD:
Medium HD:
- High Life Expectancy, predominance of NCDs & mental health problems
- Medium Life Expectancy, double burden of disease: NCDs & CDs
- Aged population
- Need for chronic care
- High reliance on O-O-P contributions & regressive public health spending
- Low public health expenditure as % of GDP
- High levels of public health spending & low levels of O-O-P contributions
- High levels of public service provision
- Poorly organized delivery system with overreliance on vertical programs
- Poor information systems and lack of performance assessment
Road Map
July 2012:
Concept note
shared with
Regional HSS
Directors
17 |
End of
September
2013: First
draft of WHO
Strategy
produced
August 2012:
Terms of
Reference
developed for
studies
End May
2012:
Concept note
drafted
End of
December
2013:
March 2013:
Central
Repository of
Information
functioning
TITLE from VIEW and SLIDE MASTER | July 1, 2013
Second draft
of WHO
Strategy
produced
November
2013:
Background
Studies
completed
June 2014:
Global/ Regional
consultations
finalized
Strategy development and Background studies
Type of work
Objective
Progress so
far
Strategy
writing
Write WHO Strategy on high quality people-centred and integrated
care to achieve UHC
Ongoing
Study 1
Exploit existing databases according to key service delivery variables
to assist situation analysis and developing country clusters that have
similar service delivery issues
Ongoing
Field study 1
Develop case studies on achieving UHC with people-centred and
integrated care
Contracting
out
Field study 2
Document people's stories while seeking, obtaining or providing
care, both positive and negative
Drafting ToR
Systematic
review 1
Gather evidence on the impact of UHC, PCC and ISD
Ongoing
Systematic
review 2
Identify evidence-based policies, strategies and interventions
conducive to UHC with people-centred and integrated care
Ongoing
Study 2
Identify strategies for managing change and overcoming
institutional resistance when introducing service delivery reforms
Ongoing