Leveraging funds and power for public health – WHO in Thailand
Dr Maureen Birmingham is on her mobile phone in the back of her car. Her driver navigates the vehicle through heavy, early evening traffic in Bangkok as she answers questions from Geneva on how she tested a new way of working for health in Thailand. The line is bad but Maureen’s model for partnership is both exciting and promising, so the conversation continues. She has a story to tell on how the World Health Organization is changing itself to be able to meet the health challenges of the new century.
When Maureen started work in Thailand four years ago as Head of WHO Country office, the Organization was focused on a large number of small health projects and initiatives. Spreading what little resources we had – human and financial – thin, we were kept busy, but the impact was small or not very tangible, says Maureen. That’s when, with the advice and encouragement of the Regional Director and the leadership in the Ministry of Public Health, she decided to try a novel approach.
Leveraging people, expertise and resources
“Thailand is a country with great people, expertise and resources. We wanted to leverage these for greater public health impact,” says Maureen. Together with the Ministry of Public Health, WHO in Thailand joined forces with the CEOs of Thailand’s public health agencies. They all had a lot of individual power, capacity, influence and resources, but these were not optimally synergized, she explains. With a little relationship building, they felt comfortable enough to ask WHO to join as an equal partner, and soon after that to help drive the process of working together using the Organization’s historic role as a neutral broker.
“We all mapped the different powers we had. In Thailand, WHO is viewed as having the power of knowledge as well as social power (i.e. high credibility). The other public health agencies had powers as well, such as financial, political, social and technical power.” The idea was to select 3-5 priority public health areas and learn how to synergize our powers for greater public health impact. All agencies, as equal partners, were invited to submit two-page concept papers and criteria for prioritization were agreed. In all 22 proposals were then ranked and 5 major public health priority areas were selected: road safety, noncommunicable disease control, community health system strengthening, knowledge and capacity development in international trade and health, and strengthening of disaster risk management.
Investing in health priorities
Then it was time for the partners to put their money into the health priorities. WHO Thailand invested almost half of its predictable activity funds (assessed contributions) in the process. These five areas now constitute WHO’s direct technical cooperation with Thailand.
Other areas of WHO’s work in Thailand include: health beyond national borders; emerging challenges and unfinished agendas (including MDGs, migrant health, etc); and “normative functions” such as knowledge management, capacity building and work related to WHO’s governing body resolutions as well as the Framework Convention on Tobacco Control and the International Health Regulations.
A new approach with partners
The Country Cooperation Strategy (CCS) is WHO’s instrument to identify health priorities in countries. The new approach with partners started in 2010 and a year later, Maureen took a deep breath and started the transition by reprogramming funds to the five agreed priorities, even though the new CCS would not start until 2012.
A steering committee made up of the key stakeholders and co-chaired by the Permanent Secretary of the Ministry of public health and Maureen, as head of WHO Country office, was established to oversee the initiative. The collaboration is transparent and accountable and has a strong governance system.
This initiative in Thailand has succeeded in leveraging WHO’s comparatively small funds to attract bigger funds within the country. In 2012 alone, WHO-Thailand leveraged USD 427 000 for 1 462 000, an increase of 243%. The same people, the same WHO financial investment, but an altogether different result.
How significant is this?
“I feel we started real and meaningful change. It is not perfect. We have teething problems and it needs to be nurtured. But the change has started and has great potential for improving people’s health in this country. It is fantastic we got this far,” she says.
Addressing major public health challenges
“Today WHO Thailand is more strategic. We can articulate clearly what we are doing. Big government agencies are working together to address five major public health challenges which put at risk the health and lives of people. Last but not least, we have leveraged big money aimed at big improvements in people’s health.“
This is not Maureen’s first assignment with WHO. She previously worked on polio eradication and as a team coordinator in the department of immunization, vaccines and biologicals in HQ and then as a team leader of a regional unit in Bangkok (attached to SEARO) on emerging diseases and building core capacities related to the International Health Regulations. Her current assignment in Thailand is coming to an end. Maureen will take up another Head of Country office role in a few weeks, this time on the other side of the world in Mexico.