WHO and Results-based Management

1. WHO and Results-based Management This presentation was used during a workshop run by UPU. It was accompanied by a speaker and explanations, and is not a “stand-alone” presentation.

2. Competitive co-operation with Non-Governmental Organizations Member States Contributors with high levels of expectations Competitive co-operation with Inter-Governmental Organizations Momentum for results-based management

3. Assess Evaluate Plan Monitor Implement Normal Planning Process Results & Indicators

4. Analysing problems Formulating objectives Identifying indicators Strategic Planning Specifying expected results Performance management Monitoring results Reporting and reviewing results Integrated evaluation Results-Based Management Using performance information for decisions Phases of Results-Based Management Operations & Implementation

5. Process Instrument Elements Strategic directions Core functions WHO priorities Corporate Strategy formulation General Programme of Work Core Functions: 1. Policy and advocacy 2. Managing information 3. Technical and policy support 4. Partnerships 5. Norms and standards 6. Technologies, tools & guidelines Strategic Directions: 1.  morbidity, mortality, disability 2.  healthy lifestyles 3. Health systems & equity 4. Health in development WHO managerial framework

6. Process Instrument Elements Cycle Strategic directions Core functions WHO priorities Corporate Strategy formulation General Programme of Work 6 years Areas of Work Goal Objectives Expected Results Strategic Planning Programme Budget 2 years Products, Services Resources Operational Planning Workplans 2+ years Activities and Expenditure Operations Reports Annual, etc WHO managerial framework

7. 2000 2001 2002 2003 … 2004 2006 2005 WHO’s Planning Tools Planning Process

8. 2000 2001 2002 2003 … 2004 2006 2005 WHO’s Planning Tools Planning Prog. Budget GPW Process

9. 2000 2001 2002 2003 … 2004 2006 2005 WHO’s Planning Tools Planning Prog. Budget Workplan GPW Process

10. The pyramid may be wider or narrower depending on the extent or complexity of the work. Goal Objectives Planning is an iterative process Expected Results Products and Services Activities WHO’s planning framework

11. Higher order goals that WHO and partners are committed to assist achieving Goal Objectives Planning is an iterative process Expected Results Within the responsibility and control for WHO to achieve Products and Services Activities WHO’s planning framework

12. Planning pyramid Situation analysis Goal Objectives . Programme strategy Expected Results Planning is an iterative process Indicators Products & Services Time-scale and resources Milestones Activities Key planning steps: Overview

13. Planning pyramid Goal Objectives . Key planning steps: Expected Results Situation analysis Expected Results • Key points: Several Expected Results per objective • What can the organisation realistically achieve in this planning period? • How can this be quantified? • Are the Expected Results SMART? • Will the Expected Results significantly contribute to meeting the objective?

14. S Specific M Measurable A Achievable / Appropriate R Relevant T Time-frame specified Defining Smart Expected Results Good statements of Expected Results meet several criteria:

15. Example from WHO 2002-03 Programme Budget Area of Work: Vaccines and Biologicals Goal:.To protect all people at risk against vaccine-preventable diseases Objectives: • To achieve substantial progress towards ensuring availability of new vaccines and biologicals ... • To strengthen the impact of immunisation services as a component of health delivery systems, and to control, eliminate and eradicate priority diseases.

16. Example : Expected Results Objective: To strengthen the impact of immunisation services as a component of health delivery systems, and to control, eliminate and eradicate priority diseases Expected Results: • Effective co-ordination and support provided for eradication of poliomyelitis and certification of all WHO regions as free of poliomyelitis. • Adequate support provided for building capacity in priority countries to implement strategies for controlling and eliminating major vaccine- preventable diseases.

17. Example : Indicators Expected Results: Adequate support provided for building capacity in priority countries to implement strategies for controlling and eliminating major vaccine- preventable diseases. Indicators: • Percentage of countries implementing the high-risk approach to accelerating elimination of maternal and neonatal tetanus. • Percentage of countries implementing strategies for accelerated measles control. • Percentage of countries where vitamin A deficiency is a public health problem that have integrated vitamin A supplementation with immunisation services.

18. Planning pyramid Situation analysis Goal Objectives . Programme strategy Products & Services Key planning steps: Indicators Expected Results Indicators • Key points: 1 to 3 indicators for each element • What can be measured to demonstrate results? • Specific and valid? • Sensitive to change? Reliable? • Resources available to collect the data?

19. Indicators • Valid - actually measures what it is intended to measure • Reliable - measurement is consistent and comparable accross time and place • Sensitive - can measure the extent and direction of change in a suitable timeframe • Need to know where, how & when to get relevant data, and who is responsible for doing so • Need to set baselines and targets

20. Clarifying meaning of indicators • Percentage of countries implementing the high-risk approach to accelerating elimination of maternal and neonatal tetanus. What will be accepted as “implementing”? • Percentage of countries implementing strategies for accelerated measles control. What will be accepted as “implementing”? • Percentage of countries where vitamin A deficiency is a public health problem that have integrated vitamin A supplementation with immunisation services. What will be accepted as “have integrated ... …….with immunisation services”?

21. Commitment Performance Measurement of indicator at the end of the period Indicator Baseline Indicator Target Measuring performance

22. Indicator Issues • Process or impact indicators, or both? • How many indicators? • What effort for gathering data? • Institutional change • Training and staff development • Agreed language used consistently • Not too many different changes too quickly

23. Impact Goal is measured as Goal Expected results are measured as Objectives Outcomes Expected Results Products and services are measured as Products and Services Outputs Activities Process and impact indicators

24. What level of indicators? Expected Results: Adequate support provided for building capacity in priority countries to implement strategies for controlling and eliminating major vaccine- preventable diseases. Indicators: • Percentage of countries implementing the high-risk approach to accelerating elimination of maternal and neonatal tetanus. • Percentage of countries implementing strategies for accelerated measles control. • Percentage of countries where vitamin A deficiency is a public health problem that have integrated vitamin A supplementation with immunisation services.

25. Impact Goal Objectives Outcomes Expected Results Products & Services Outputs Activities Examples : Process and impact indicators Incidence of maternal tetanus. Incidence of neonatal tetanus. Percentage of countries implementing the high-risk approach to accelerating elimination of maternal and neonatal tetanus. Framework and guidelines for implementing the high-risk approach to accelerating elimination of maternal and neonatal tetanus completed and translated into official languages.

26. Indicator Issues • Not too many indicators • Reliable signals that inform about real changes • Objectively verifiable and not just subjective • Measurable with reasonable cost and effort - or already available in other database systems • Assisting managers to monitor progress and focus efforts and resources

27. Aspects of organisational change Culture Management Immaterial Structure Flows Material Immobile Mobile

28. Change Issues • Institutional change -agreed at high level of the organisation; both useful and required as part of normal activities • Training and staff development - need comprehensive roll out of training with follow-up and reinforcement • Agreed language used consistently - this needs careful thought • Not too many different changes too quickly - staff become disillusioned if it appears that every time they just get used to something it changes again. Consolidation of learning requires some stability of expectations. However, iterative adjustments are always required.

29. WHO Experience • Major debates about process or impact indicators  differentiating between the responsibilities of WHO and those of the member states  The WHO RBM focuses on WHO’s manageable concerns.

30. WHO Experience • Indicators focus WHO on WHO’s manageable concerns. • The Regional Office structure of WHO adds complexity.

31. WHO Experience • Indicators focus WHO on WHO’s manageable concerns. • The Regional Office structure of WHO adds complexity. • Changed the design of the 2002-03 Programme Budget to meet requirements for transparency and accountability, also to reflect the concept of “One WHO”.

32. Culture Management Immaterial Structure Flows Material Immobile Mobile WHO Experience • Indicators focus WHO on WHO’s manageable concerns. • The Regional Office structure of WHO adds complexity. • Changed the design of the 2002-03 programme budget • Some management changes required compromises for different parts of the organisation. e.g. The 35 “Areas of Work” in the 2002-03 programme do not fit easily with the structure in HQ or the Regional Offices, but form a matrix across structures.

33. Culture Management Immaterial Structure Flows Material Immobile Mobile WHO Experience • Indicators focus WHO on WHO’s manageable concerns. • The Regional Office structure of WHO adds complexity. • Changed the design of the programme budget • Management changes from a matrix across structures • Management changes were ahead of communication flows needed to fully explain or build the new concepts into the organisational culture, e.g. to use Results Based Management to enhance organisational learning.

34. Culture Management Immaterial Structure Flows Material Immobile Mobile WHO Experience • Indicators focus WHO on WHO’s manageable concerns. • The Regional Office structure of WHO adds complexity. • Changed the design of the programme budget • Management changes form a matrix across structures • Intensive communication needed • Some training over a long period - but still not sufficiently rolled out, and not enough direct coaching - assisting people to formulate the Expected Results and Indicators.

35. Culture Management Immaterial Structure Flows Material Immobile Mobile WHO Experience • Indicators focus WHO on WHO’s manageable concerns. • The Regional Office structure of WHO adds complexity. • Changed the design of the programme budget • Management changes form a matrix across structures • Intensive communication needed • More direct coaching - assisting people to do it. • Planning two years ahead of implementation poses challenges, e.g. some parts of the managerial process are related to 3 different biennia in any one biennium.

36. Culture Management Immaterial Structure Flows Material Immobile Mobile WHO Experience • Indicators focus WHO on WHO’s manageable concerns. • The Regional Office structure of WHO adds complexity. • Changed the design of the programme budget • Management changes form a matrix across structures • Intensive communication needed • More direct coaching - assisting people to do it. • Planning two years ahead of implementation poses challenges. • Gradual improvement in expression of Expected Results and indicators: 2000-01 budget started with Expected Results but no indicators; both ERs and indicators in the 2002-03 budget, and improved wording in the 2004-05 budget.

37. Culture Management Immaterial Structure Flows Material Immobile Mobile WHO Experience • Indicators focus WHO on WHO’s manageable concerns. • The Regional Office structure of WHO adds complexity. • Changed the design of the programme budget • Management changes form a matrix across structures • Intensive communication needed • More direct coaching - assisting people to do it. • Planning two years ahead of implementation poses challenges. • Expression of results and indicators improving over 6 years. • Many senior managers are not used to having their work monitored and measured.

38. Culture Management Immaterial Structure Flows Material Immobile Mobile WHO Experience • Indicators focus WHO on WHO’s manageable concerns. • The Regional Office structure of WHO adds complexity. • Changed the design of the programme budget • Management changes form a matrix across structures • Intensive communication needed • More direct coaching - assisting people to do it. • Planning two years ahead of implementation poses challenges. • Expression of results and indicators improving over 6 years. • Managers often not used to having their work measured. • Average recruitment age at WHO is 43 years, and 1 in 3 staff leave after 2 years - such staff profiles have training, management and organisational change implications.

39. Thank you

40. The Team Dynamic • Teamwork • Ownership • Responsibility • Leadership

41. Links between Expected Results and products Activity Product Activity Expected Result Activity Product Objective Expected Result Product