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Mid-term Results Report

The world needs WHO
Now more than ever


Programme budget
2020–2021
Dr Tedros Adhanom Ghebreyesus Director-General's foreword

When I penned the Foreword to last year’s WHO Results Report, 4 million cases of COVID-19 had been reported to WHO, and some 300 000 people had lost their lives. A year later, the number of cases has ballooned more than 40-fold, to almost 160 million, and the number of deaths has increased 11 times, to more than 3.3 million.

A year ago, vaccines were still a distant hope; now they are giving us real hope of bringing the pandemic under control. Even so, the shocking disparity in the global distribution of vaccines is another painful reminder of the inequities that blight our world and lie at the root of so many of its problems.

The past year has been the most testing in our Organization’s history. However, it has also demonstrated why, more than ever, the world needs a strong and sustainable WHO. Our transformation is continuing to take root and bear fruit: many of the changes we have made have been tested by fire during the past year, and have shown their worth. Already many lessons have been learned, more changes have been made, and new initiatives have been launched to strengthen the world’s pandemic preparedness and response capacities.

This report showcases the incredible breadth and depth of WHO’s work over the past year, in responding to the pandemic, supporting countries to minimize disruption to essential health services, and in continuing our normative work at all three levels of the Organization.

Reflecting our commitment to transparency, accountability and delivering an impact, the report presents WHO’s achievements in the past year against the Output scorecard, a unique reporting mechanism in the United Nations system that provides a detailed accounting of our achievements against each of the “triple billion” indicators agreed by Member States.

Even before the pandemic, the world was lagging behind in its efforts to achieve the “triple billion” targets and the health-related Sustainable Development Goals. There is no doubt that the pandemic has blown us even further off course. At the same time, it has reminded us why the targets are so important, and why we must pursue them with even more determination and innovation.

A crisis often helps us to see with greater clarity what really matters. COVID-19 has robbed us of people we love, deprived millions of their livelihood, plunged the world into economic turmoil, torn at the social fabric and fanned the flames of inequity. But it has also reminded us that life is fragile, and that health is not a luxury item for the rich. Rather, it is the most precious commodity on earth, and the foundation of the healthier, safer, fairer and more sustainable future we all want.

Feature stories


2020, a year like no other. A special look into the indispensable role of WHO in the COVID-19 pandemic.

PROGRESS TOWARDS

Impact on health, well-being and security


The aim of the GPW triple billion targets is to improve the health of millions of people around the world by 2023. They will provide a near-term snapshot of the world’s progress towards the Sustainable Development Goals (SDGs) for 2030. Current progress in reaching each of the three billion targets is summarized below. (The projections do not yet include the impacts of the COVID-19 pandemic.)

    ACHIEVING 1 BILLION MORE PEOPLE BENEFITING FROM UNIVERSAL HEALTH COVERAGE
    An additional 290 million people are projected to have access to high-quality health-care services without incurring financial hardship by 2023, which will nevertheless leave a significant expected shortfall of 710 million. With accelerated progress, it may be possible to close the shortfall by about 30%. Progress is expected to be greatest in low-income countries. The COVID-19 pandemic threatens progress, however, because of severe service disruptions and increasing financial hardship. Redoubled emphasis on primary health care, which also supports the other two billion targets, will be key for recovery from COVID-19.
    ACHIEVING 1 BILLION MORE PEOPLE BETTER PROTECTED FROM HEALTH EMERGENCIES
    About 920 million people are projected to be better protected from health emergencies in 2023 because of improvements in emergency preparedness, vaccination and more timely responses. COVID-19 has shown that the world was unprepared for such a pandemic; additional considerations for readiness capacity and effective response are needed. The current roll-out of COVID-19 vaccines is an opportunity to accelerate routine and emergency vaccination, with equity as a focus.
    ACHIEVING 1 BILLION MORE PEOPLE LIVING WITH BETTER HEALTH AND WELL-BEING
    Around 900 million people could be enjoying better health and well-being by 2023. Progress is uneven, with limited progress in low-income countries and over a third of countries showing negative overall trend. Focus should be directed to the indicators that lag most behind the SDG targets, including water and sanitation, air quality and tobacco use. Tackling the world-wide trend of increasing obesity will also be important.
A MORE EFFECTIVE AND EFFICIENT WHO PROVIDING BETTER SUPPORT TO COUNTRIES
COVID-19 pandemic has demanded strong global health leadership. At every twist and turn of the evolution of the pandemic, there was a demand for a strong WHO – for a lead health authority that was evidence-based, data-driven, results-focused and impact-driven. The pandemic placed many demands on WHO, severely testing the Organization. Yet WHO has responded to the pandemic at a scale and pace never seen before, helping to ensure essential supplies, coordinate the response and prepare for the delivery of vaccines, therapeutics and diagnostics for even the most vulnerable communities. COVID-19 has demonstrated the benefits of WHO’s transformation into an agile organization able to rapidly leverage global technical expertise and operate on a global scale. With every major health crisis, WHO has transformed. The Organization will continue to evolve alongside shifting disease patterns and innovations in science. But WHO will continue to remain grounded in its core values of solidarity and equity to build its vision of a healthier, safer, fairer world in the 21st century.
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Budget implementation summary


WHO’s biennial Programme budget is based on the principles of transparency, accountability and providing value for money

  • The World Health Assembly approved a total budget of US$ 5.84 billion for the 2020–2021 biennium.
  • The Programme budget for this biennium was presented in four distinct segments: the Base programmes, Polio eradication, Special programmes and Emergency operations and appeals.
  • As of 31 December 2020, budget utilization in all major offices is in line with that of previous biennia, and by the end of 2020 it had reached 60%.
  • The Programme budget is fully funded at the segment level, despite the impacts of the COVID-19 crisis on the world’s economy .

    Approved Programme budget
    US$ 5840.00 MILLION
    Available funds
    US$ 8260.00 MILLION
    Utilization
    US$ 3505.90 MILLION
The budget segment for Base programmes represents WHO’s core mandate and constitutes the largest part of the Programme budget in terms of strategic priority setting, detailing of deliverables and budget figures. The overall Base programme segment of US$ 3.8 billion is 106% funded and has a utilization of 39%. Despite the COVID-19 pandemic, the Secretariat is committed to deliver on the promises of the Base programmes in the Programme budget and will continue striving for a high level of utilization.

 

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Health outcomes


Health outcomes we achieve together with Member States and partners to contribute to the triple billion targets.

1.1 Improved access to quality essential health services
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Increased access to high-quality essential services is vital: at least half the world’s population still lacks coverage of essential health services.

World leaders reconfirmed commitment to universal health coverage in a landmark political declaration in 2019. But, just months later, the COVID-19 pandemic arrived and threatened to undo decades of progress. A WHO survey of the continuity of essential services during COVID-19 indicated that the pandemic is testing all national health systems. Between March and June 2020, health services were disrupted in almost all the 105 countries that responded in the five regions surveyed, with routine and elective services suspended in most countries.

The pandemic also exacerbated systemic deficiencies, such as lack of investment in essential public health functions and surveillance and shortages of health workers.


WHO

In response, WHO rapidly developed operational guidance on maintaining essential health services during an outbreak, recommending practical actions to maintain access, community-based health care, online courses and disease- and condition-specific guidance during different life-course stages, immunization, long-term care, health workforce, supply chains and blood supply.

A dynamic new web platform, the WHO COVID-19 Health Services Learning Hub, supports countries in implementing operational guidance and in innovation by rapidly collecting, synthesizing, curating and sharing the experiences and knowledge of front-line workers.

To help countries advance towards universal health coverage, WHO’s UHC Compendium of Health Interventions offers new tools for decision-makers to develop service packages. The Compendium’s database of 3500 health actions is supported by evidence, guidance, resource inputs and cost analyses.

To maximize the impact and health outcomes in countries, WHO has intensified support for implementation of guidance and tools and worked globally to harness political will and coordinate action among agencies.


By June, many countries had started to implement WHO-recommended strategies to mitigate disruptions to services, such as triaging according to priorities, use of online patient consultations, changes to prescribing practices and supply-chain strategies and refocusing public health communications.

Huge efforts to sustain essential services at all three levels of WHO and by national governments helped to mitigate the impact of COVID-19 and to avoid health system collapse in 2020.

  • An estimated 6017 facilities were providing early essential newborn care in nine countries in the Western Pacific Region, an increase of 79% from 2017.
  • Consideration of benefit–risk ratios minimized the disruption of essential services for sexual and reproductive health, as did measures such as increased use of digital and telehealth and task-shifting to community health workers.
  • Initial estimates suggest that a third of the 119 immunization campaigns that had been postponed were reinstated by the end of 2020.
  • The numbers of cases of both human African trypanosomiasis and dracunculiasis were reduced by 50%.
  • The number of cases of animal infection with Guinea worm was reduced by 20%.
  • Myanmar eliminated trachoma, Malawi eliminated lymphatic filariasis, and Togo eliminated human African trypanosomiasis.
  • Home care with adequate drug stocks and expanded use of digital technologies for remote advice and support have helped to mitigate the potential increase in the number of deaths from tuberculosis.
  • The prevalence of hepatitis B virus in children < 5 years is < 1.0%, achieving the first indicator of SDG target 3.3.
  • 26 million people living with HIV received
  • 3 million people in 18 countries were on protocol-based management of hypertension, with increasing use of WHO HEARTS.
  • 31 countries have integrated mental health into primary health care, a 34% increase since 2017 and a 100% increase since 2014.

 

There were, however, some significant setbacks during 2020, such as suspension of routine immunization campaigns. Surveys on COVID-19-related disruption of essential health services indicate that they threaten years of progress in reducing mortality from causes such as HIV, hepatitis, sexually transmitted infections, tuberculosis, malaria, neglected tropical diseases, noncommunicable diseases and mental health conditions. Programmes for reproductive, maternal, newborn, child and adolescent health and ageing were also disrupted.

WHO used its technical expertise and leadership to optimize responses, to help strengthen health systems and to continue to drive progress in achieving universal health coverage. In some countries, innovative adaptations and reorganization strengthened service delivery, and, in others, a comprehensive COVID-19 response helped to advance universal health coverage. Progress was also seen in terms of quality and safety, particularly in infection prevention and control and the safety of care and of health workers.

How Ethiopia prepared its health workforce for the COVID-19 response

Ethiopia invested in emergency care systems by nationwide training with the WHO/ICRC Basic Emergency Care course, after initial training of trainers from several countries in Addis Ababa. By the end of 2019, over 2500 health workers in more than 700 health centres had been trained and certified in basic emergency care, and 100 health care facilities had introduced the extended WHO Emergency Care toolkit, which includes triage, checklists and designation of resuscitation areas.

WHO operational guidance on maintaining essential health services during an outbreak emphasizes maintenance of emergency care as priority for population health in countries that are forced to make strategic shifts in the context of the pandemic. Standardized triage and staff competence in basic emergency care strengthened the capacity for early recognition of serious illness and allowed provision of life-saving treatment for people with COVID-19 and other acute conditions, such as injury, heart attacks, mental health crises, pregnancy-related bleeding and serious childhood infections.

Even after onset of the COVID-19 pandemic, local trainers ensured certification of many additional providers, even as borders closed and international travel was limited. Nearly 300 more providers have been trained and certified in basic emergency care this year, and 100 more health centres are implementing key emergency care by using the WHO toolkit.

Health workers at the Gambella isolation and treatment center set up in the Gambella University premises ©WHO/Loza Tesfaye.WHO/Loza Tesfaye

Health for all is Somalia’s answer to COVID-19 and to future threats to health

Guided by a pilot version of the WHO UHC Compendium of Health Interventions, Somalia revised its national package of essential health services in early 2020, after a high-level WHO mission. The new package includes integrated, first-contact primary and emergency care services, which are often lacking from service packages but which are fundamental to meeting population health needs and maintaining essential health services during a crisis.

After systematic prioritization, Somalia was able to identify and engage in targeted strengthening of key health areas relevant to the COVID-19 response and in maintaining the continuity of essential health services.

WHO continued to provide support at all three levels of the Organization through remote consultations to implement the package, targeted training and applying WHO operational guidance on maintaining essential health services during an outbreak and guidance on case management for COVID-19.  Training focused on emergency and critical care, infection prevention and control and mass casualty management.  In several rounds of training, over 100 health workers were trained and certified in WHO/ICRC Basic Emergency Care; 16 became certified facilitators recognized by the International Federation for Emergency Medicine, who will conduct training both nationally and regionally in association with the African Federation for Emergency Medicine.

WHO, Blink Media/Mustafa Saeed

To find progress on health outcome indicators, visit the World health statistics

 

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How the WHO secretariat contributes to health outcomes


To demonstrate greater accountability, the WHO Secretariat measures the delivery of its outputs through the Output Scorecard.

Choose output
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Scale: 1-Emergent 2-Developing 3-Satisfactory 4-Strong
These are the narratives
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Stories of WHO’s impact in countries


Selection of stories that exemplify how WHO is achieving impacts where it matters most