Strengthening support to Member States: when one size does not fit all
Supporting WHO’s smallest Member States is just as important as supporting our larger Member States, but the way we go about that support is different.
A major focus of reform is to ensure that countries remain at the centre of our work, through strengthened technical and policy support. A new model for supporting small countries in the Pacific is showing how that can be accomplished.
The Republic of Nauru is a 21 km2 rock island located in the Pacific, just south of the equator. Nauru is home to about 10 000 people. A single health facility, a 55-bed hospital, provides all medical services for the local population. Noncommunicable diseases (NCDs) are the greatest public health threat. The rate of adult-onset diabetes is among the highest in the world, and the prevalence of obesity and use of tobacco are extremely high.
With a country as small as Nauru, a fully operational WHO country office is not feasible. This is where WPRO’s Division of Pacific Technical Support (DPS) comes in. Established in 2010, DPS is designed to provide Pacific-specific solutions, close to the source, for the 21 countries and areas under its purview. In an effort to provide targeted and tailored support to countries, aligned with WHO reforms, ongoing technical support for Nauru is provided through a focal point in DPS.
The focal point system is the region’s innovation for small island nations without a WHO presence. It is adapted to country needs and allows for focused and harmonized technical support, aligned with the principles of aid effectiveness. Dr Ezekiel Nukuro, in addition to his usual responsibilities as team leader for health systems, is responsible for overseeing technical support to Nauru, ensuring that support is timely and relevant for the country.
In early June 2014, DPS organized an integrated mission of several technical staff from different countries in the region to Nauru, to make the best use of the Ministry staff’s time and efforts. When several technical staff go to a country at the same time, the impact of their work can be maximized by encouraging a systems approach. This also avoids the duplication of meetings and appointments when individual missions take place, thus saving time for local staff. This efficiency is essential because ministries of small island nations have only a few senior officials.
The June mission brought together colleagues from surveillance and response, sexually transmitted infections/HIV, NCDs, and health systems. Each had a specific area of work. For example, one colleague led a consultation on sexually transmitted infections and HIV, and another mapped out an NCD strategy for the country. The team also provided support for the mid-term review of the health strategic plan, which was an opening to tie the work together into a coherent whole.
Besides joint missions, the focal point system is designed to review national health polices strategies and plans both for adaptation to the country context and for consolidation where appropriate. This multidisciplinary approach has been in place since April 2014 and is now being applied in several other countries in the Pacific that do not have a WHO country office.