Sunday, November 13, 2023

[DRAFT]

NOTES FOR THE 3RD CONSULTATION WITH MEMBER STATES

(MSS) FOR THE DEVELOPMENT OF FOURTEENTH GENERAL
PROGRAM OF WORK (GPW 14)

QATAR PERSPECTIVE ON GPW 14

1. SETTING THE CONTEXT......................................................................................................................................

GPW 13 Targets.....................................................................................................................................................
GPW 13 Results......................................................................................................................................................
GPW 13 Extension..................................................................................................................................................
GPW 14 Consultation Process................................................................................................................................
2. QATAR’S INPUTS FOR THE DRAFT OF 2nd CONSULTATION PAPER FOR GPW 14...............................................
3. QUESTIONS FOR MEMBER STATES FEEDBACK FOR THE 3RD CONSUTATION....................................................
4. SUMMARY OF INPUTS AND RESPONSES FOR 3rd CONSUTATIVE SESSION.......................................................

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 1. SETTING THE CONTEXT

GPW 13 Targets

1.1. Member States of WHO adopted the draft Thirteenth General Program of Work (GPW 13) during
the 71st World Health Assembly (WHA, under agenda item no. 11.1). Important discussion points
during session hinted towards the potential The 71st WHA discussions points (Box 1)
impediments in implementation, institutional role Priority Setting
of WHO and financing of the ambitious ‘Triple Algeria, Thailand, India, Sweden, Sri Lanka, and Tanzania-
Complemented the report and its “triple billion” goal.
Billion’ targets (Box 1). With some improvements Colombia, Zambia and Brazil: Mentioned the need for
of the initial draft the GPW 13 was adopted and access to medicines to become a core priority.
thus provided a framework for the WHO’s work in
the five years between 2019-2023. It claimed to Implementation
Qatar- called for a reduced number of priorities to ensure
ensure that by 2023, 1 billion more people benefit better implementation.
from Universal Health Coverage (UHC) 1 billion UK- Concerns regarding implementation of the GPW.
more people are better protected from health Impact framework does neither quantify WHO’s
contribution to strengthening health systems around the
emergencies and 01 billion more people enjoy world, nor does it account for the source of the required
better health and wellbeing. In addition, the GPW 14% budget increase.
13 affirmed to strengthen the role of WHO in
global health governance, enable the organization Collaboration
European Union- Importance of collaboration with
to address its decade long financial crisis, and partners such as GAVI (Global Alliance for Vaccine and
contribute to the realization of the Sustainable Immunization), the World Bank and other UN agencies.
Development Goals (SDGs). India - Follow up on FENSA (Framework of Engagement
with Non-State Actors)
Bolivia- Strengthening public health systems is the
GPW 13 Results responsibility of governments, and not private entities.

1.2. The results of the Triple Billion targets have
been ‘off track’. According to the WHO dashboard
tracking the data for the targets, the only billion
that may be reached by 2023 is for the “Healthier
Populations” and by virtue of impact of huge
COVID funding and concentration. The Billion Mark
for UHC will fall at least 50% below the target. It is
further off target when it comes to the covering
the financial hardship within the UHC indicators.
Institutional Role (WHO) and leadership
Iceland, Norway, UK, Australia, Denmark- Improvements,
as well as a better understanding of WHO’s role at country
level in terms of provision of resources and collaborations
with other UN agencies and programs.
Japan, Russia and USA- Stressed the cooperation with and
convening of partners, including bilateral and multilateral
institutions and private entities to strengthen WHO’s
leadership.
Funding/ Financing
Flexible funding and multisectoral collaborations

“The world is off track to achieve the triple

billion targets by 2025”
“Disruptions to health services during the pandemic have sent us backwards, and we
estimate the shortfall could reach 840 million.”1 [WHO Director General]
1
WHO Director-General's opening remarks at the Member State consultation on the Extension of the Thirteenth General Programme of Work, 2019–2025 – 11
January 2023 [www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-member-state-consultation-on-the-extension-of-
the-thirteenth-general-programme-of-work--2019--2025---11-january-2023]

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GPW 13 Extension

1.3. In the wake of the shortfall of the objectives and targets set in the GPW 13, the GPW 13
extension was proposed for 2024–2025 and adopted in the EXECUTIVE BOARD EB152/28 152nd
session aiming “Prioritization and scaling up of High-Impact Interventions”2 with the focus on:
- Investing in the health workforce, particularly using primary health care as the vehicle for
integrated health service delivery
- Maximum alignment with respective country situations and priorities, and overall, with
regional and global priorities. This implies a bottom-up and consultative process.
- Supporting Member States in using a delivery for impact approach

GPW 14 Consultation Process

1.4. In the meantime, when GPW 13 is concluding, the GPW14 is in the process of development
and consultations with MSs are underway. In this process two consultation sessions have been
conducted with the MSs.
1.5. The consultation sessions suggest that GPW 14 should improve on the earlier program
through adding SDGs key ‘accelerator’ interventions, strengthening the WHO’s country and regional
presence, capacities and capabilities, improving and including a comprehensive theory of change and
engaging all players. The consultations so far have set the following strategic objectives:

i. Promoting health and preventing disease

ii. Providing health
iii. Protecting health
iv. Powering for health
v. Performing for health3

1.6. Financial envelope for GPW 14 has also been identified for the investment round of
consultation schedule to start after the 3 rd consultation. Following is the indicative financial outlay for
the program duration of 2025-2028:
GPW 14 indicative envelope (US$ million) 2025 2026 2027 2028 TOTAL
Base segment (based on the Program budget 2 484 2 484 2 484 2 484 9 936
2024–2025)
Emerging priorities 244 476 501 1 221
Total 11 157
GPW 14: Fourteenth General Programme of Work, 2025–2028.

1.7. WHO requires about USD 12 Billion spread over 4 years between 2025 and 2028. It has
identified to MSs a ‘sustainable’ financing model that would ensure a long-term funding, that is
predictable and without limitations on the program selection and geography.
1.8. The investment case is made for the MSs to preferably choose the ‘Core Voluntary
Contribution (CVC)’ model of financing the GPW 14 without many ‘strings’ attached.

2
Thirteenth General Programme of Work, 2019–2025 Report on the outcomes of the Member States consultation process Report by the Director-General
https://apps.who.int/gb/ebwha/pdf_files/EB152/B152_28-en.pdf

3
Fourteenth GPW Regional Committee for the Eastern Mediterranean Seventieth session EM/RC70/11 August 2023
https://applications.emro.who.int/docs/Towards-WHOs-14th-GPW-accelerating-health4all-eng.pdf

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 1.9. Qatar Financial contribution has been mostly in the form of CVC and remained one of the top
contributors to the GPW 13 program that has been to the tune of 10 million USD every year and
above. These funds have been flexibly assorted for WHO Headquarter Geneva (17%) and WHO
Eastern Mediterranean Regional Organization (EMRO) (83%). About 40% of the total EMRO budget is
allocated to the programs of GPW4.
1.10. The draft paper of the 2nd consultation with the MSs is in the development. Based on its
experience with the GPW 13 and the consultations so far, Qatar submits the inputs for the paper

2. QATAR’S INPUTS FOR THE DRAFT OF 2nd CONSULTATION PAPER FOR

GPW 14
2.1. Proposed changes in the outcomes for each Strategic Objective

[2.1.1.] Climate Change: Qatar National Vision 2030 dedicates vital significance to the challenges of
environment as one of the four pillars and identifies as key to the future planning. Climate change
and the looming challenges are embedded in the vision approach. The climate change effects are
imminent for the nation and the region and pose immediate challenge to the health system and
healthy living. It is pertinent to add an urgency to the climate change outcome within the current
consultation for the development of GPW 14. It may be embedded in the Adaptation outcome
theme, but it is proposed that a minimum result or outcome for the Preparedness of the health
systems and healthy living environment may be clearly identified. It is also proposed that a climate
marker/ lens may be applied in all the strategic priorities as a Cross Cutting Priority. Common
Regional approaches and priorities: Qatar envisions a regional integrated approach towards certain
common regional challenges. The climate change hazards and risks are common in the region and
therefore require a regional integration for climate research and analysis. Value-Based Financing
Model for Climate Change Priorities: WHO funding models allow ‘voluntary specific’ allocation for
specific interventions and locations. The climate change strategic priority requires specific funding
allocation and consistent with the Result Based Management model of WHO.
Country Proposal:
- Climate Change Preparedness: Clearly identify climate change preparedness of Health Systems
and all work and living environments as a result/ outcome.
- A cross cutting strategic priority: It is also proposed that a climate marker/ lens may be identified
in all the strategic priorities
- Promote and incentivize low-carbon living and work environments.
Proposal for WHO Regional and Global approaches:
- Promoting research and development on climate change effect on Health
- Common regional approaches and priorities to common regional challenges
- The value-based financing model may be aligned and in line with the Result Based Management

2.1.1.[2.1.2.] Health Determinants: The social, economic and environmental determinants in the
individual and community lives incentivize or dis-incentivize particular lifestyle. Public health parks
4
https://open.who.int/2020-21/contributors/contributor?name=Qatar

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provide healthy environment for physical activity, likewise, the restricted zones inhibit smoking and
promote healthy living. The spaces for healthy youth engagement or raising the taxes on unhealthy
food and environment are a few life examples. Therefore, the integration of risk factor for NCDs in all
the determinants have augmented impact. The loop of ownership of the health promotion and risk
reduction is complete when it becomes accountable to the community involved. The outcome
themes of 2.1, 2.2 and 2.3 are the natural continuum of the health promotion and therefore should
be not only combined but complemented with each other.

Country Proposal:
- Integrated approach to the health determinant strategic priority.
- Empowering population through involving communities in accountability and decision making

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2.1.2.[2.1.3.] Service Coverage and Financial Protection: Universal Health Coverage combines the service
coverage with the financial hardship to cover the services in the 3.8.1. and 3.8.2 indicators. The two indicators
are framed to complement each other and therefore always monitored jointly. The service coverage clubs
range of health services and index it into one. The aggregate index is not reflective of the individual country
health priorities. Therefore, it is proposed that major service package outcome may be kept and measured
separately.

Country Proposal:
- Combined service coverage and financial protection reporting to evolve a value-based UHC
-

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2.1.3.[2.1.4.] Essential health system capacities: The health system capacities to Promote, Provide
and Protect would require specialized and specific health system capacities and thus require a fine
distinction to measure the same. It is proposed that the outcome for the key health system capacities
be kept separate.

2.2. Overview of WHO cross-cutting Core Technical & Management Functions

The need for strengthening the WHO country office and close work of the regional offices have been
highlighted as pivotal to achieving the intended outcome of GPW in the 13 th round and now in the
14th one. Apart from the structural capacity, the emphasis on the result-based management within
the WHO offices is also important for the service delivery in the MSs and thus is crucial to the success
of the GPW 14. However, RBM will only be actively implemented if it is backed by the Result Based
Financing.
Therefore, the country contributions may be directed as Specific Voluntary Contribution (i.e.
segment-wise) towards the specific objectives and outcome

3. QUESTIONS FOR MEMBER STATES FEEDBACK FOR THE 3RD

CONSUTATION
3.1. Do Member States agree to complement ‘health outcomes’ with ‘health systems’ outcomes
as proposed?
Qatar agrees to not only complement the health outcome with the health system outcome but also
intertwine the same at the policy, program, service delivery and monitoring levels. This will make the
GPW 14 “everyone’s responsibility” and evolve a responsive and a robust accountability for
achievement of the results. Health systems outcome in tandem with the health outcomes will add
sustainability to the program and provide firm grounds for the MSs for the horizontal integration of
the same.

Country Response:
- Combined service coverage and financial protection reporting to evolve a value-based UHC
-

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3.2. Do the major directions of the proposed outcomes resonate with Members States and how
they organize their health services?

Qatar National Development Strategy-3 (QNDS-3) underscores the national strategic objectives for
health and clearly identifies the outcomes with more precision (Box 2). The draft Strategic Priorities
set in the GPW identifies with Qatar, however, the outcome may require further refinement. TQatar
National Health Strategy-III (NHS-III) identifies with the major outcome of the GPW 14. However, the
precision of the outcome and interventions initiatives in the NHSQNDS-III 3 is targeted towards
national health goals of a modern, quality and responsive health system with the focus on NCDs and
on the resilience to the impacts of the disasters and hazards of climate.

Qatar National Development Strategy-3 (QNDS-3) Outcome

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Qatar National Development Strategy-3 (QNDS-3) Outcome

- Improved Population Health

- A strengthened integrated model of care
- Service and clinical excellence and effectiveness
- An effective andlean system of governance
- Enhances financial sustainability and efficiency of healthcare
- Elevated workforce planning and security
- Enhanced public and private collaboration in healthcare
- Strengthen research and innovation to serve the national health agenda

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 Qatar National Vision 2030 clearly identifies the future of health sustainability, resilience
modernization through total sector / total market approaches and therefore signifies the private
sector involvement.

3.3. Do MSs have perspectives on whether to aggregate or breakout the

3.1.1 major elements of service packages (e.g. NCDs, CDs, MH, MCAH)

Qatar National Health Strategy identifies and addresses the country health needs and health status of
its population. NCDs with the distinct risk factors and targeted approaches have been prioritized in the
national plans. The UHC Service Coverage Index has multiple analytic implications and impacts that
may skew the data and hence country specific interventions to address the national or even regional
priorities.

Country Response: 3.1.2

- Disaggregate / separate outcomes for major package. The same aligned with the national
e
priorities
-

ssential health system capacities (e.g. workforce, finance, digital) as separate outcomes?

If each of the health outcome is complemented by the health system outcome, the essential health
capacities would differentiate at certain level and therefore the resultant outcome. It is therefore
imperative to have essential health system capacities as separate outcome.

Country Response:
- Separate outcome for key system capacities
-

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Page 11 of 13
 4. SUMMARY OF INPUTS AND RESPONSES FOR 3rd CONSUTATIVE SESSION
Strategic Outcome Working proposal Country Proposals Proposal for Regional and
Priority Theme Global Approaches
PROMOTE
1. Climate change 1.1. Adaptation Deliver climate resilient health Proposal Proposal
system to address health risks and - Climate Change Preparedness: Clearly - Promoting research and
impacts of climate change that affect identify climate change preparedness of development on climate change
populations. Health Systems and all work and living effect on Health
environments as a result/ outcome. - Common regional approaches and
- A cross cutting strategic priority: It is priorities to common regional
also proposed that a climate marker/ challenges
lens may be identified in all the strategic - The value-based financing model
priorities may be aligned and in line with the
Result Based Management of WHO.
1.2. Mitigation Build low-carbon health systems & Proposal
healthy, low carbon societies. - Promote and incentivize low-carbon
living and work environments.

2.Health 2.1. Health Improve healthy life expectancy & Proposal

determinants determinants reduce inequities by acting on social,
economic, environmental &
commercial determinants, and
investing in public goods for health.
Should 2.1 & 2.2 be combined?
2.2. Health risk address risk factors for NCDs,
factors communicable diseases, violence
and injuries and mental health to
improve health outcomes.
2.3. Health empower populations to increase
promotion control over their health through
policies & programmes that create
healthy living environments and
involve communities in decision-
making.
PROVIDE
3.Service coverage 3.1. Comprehensive Increase equitable access to
& financial package of services comprehensive packages of health
- Integrated approach to the health
determinant strategic priority.
- The Outcome themes 2.1, 2.2 and 2.3
may be combined and complemented
with each other.
Proposal
- Empowering population through
involving communities in accountability
and decision making
Proposal
- Disaggregate / separate outcomes for
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protection services(focus on NCD, mental major package. The same aligned with
health, communicable disease the national priorities
coverage, RMNCAAH gaps)
Should major package elements be
separate outcomes?
3.2. Financial Reduce financial barriers and Proposal
protection catastrophic spending due to out-of- - Combined service coverage and financial
pocket payments on health protection reporting to evolve a value-
Combine 3.2 with 4.1? based UHC
- Separate 3.2. from 4.1.

4.Essential Health 4.1. Essential strengthen essential capacities to Proposal

System Capacities capacities deliver on Promote, Provide & Separate outcome for key system
Protect (focus on workforce, capacities
financing & digitalization gaps)
Should key system capacities
separate outcomes?
4.2. Reorienting enhance PHC approach to
to PHC strengthen service delivery &
accelerate progress on UHC/Health
Security and address inequity
emerging challenges
PROTECT
5.Prevent & 5.1. Risk reduction Reduced risk & mitigate impact of AddresedAddressed as National Priority
prepare health emergencies for all hazards
5.2. Preparedness Enhanced preparedness & readiness
& resilience for health emergencies

6.Detect & respond 6.1. Detection Timely & effective detection &
& response response to acute public health
threats
6.2. Essential Equitable, sustained access to
service essential health services during
delivery emergencies

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