UN Health and Nutrition for Iraq Concept Paper on the 2006 2007 Strategic Direction and Funding Needs A. Introduction and Background The purpose of this concept paper is to provide the donor community with a brief on the strategic direction that the UN Health for Iraq will pursue in 2006 and 2007, in order to effectively support the Iraqi Government, in particular the Ministry of Health and other key ministries, in addressing the priority health needs for Iraq. The UN Health consists of, UNICEF,, WFP, UNDP, UNIDO, UNEP, IOM, UNIFEM and. The UN Health Coordinator is and the Deputy Coordinator is UNICEF. The Iraqi Ministry of Health is the key partner of the, but the also has strong linkages with entities such as the Ministry of Environment, Ministry of Municipalities and Public Works, the Iraqi Health Sector Working Group 1 and others. B. Programmatic Thinking The programmatic and strategic support provided by the UN Agencies for health in Iraq is guided by the UN Health Results Matrix (kindly refer to Annex 1), which has six strategic outcomes, in support of the Iraqi health policies: 1. 50% reduction in Under-5 and Infant Mortality; 2. 15% reduction in Maternal Mortality; 3. Increase access to quality health care services especially for vulnerable groups and the un-reached; 4. Enhance Disease Prevention and Control including HIV/Aids; 5. Healthy living environment enhanced and healthy lifestyle promoted; 6. Emergency preparedness and response ensured. The six strategic outcomes represent the programmatic thinking and the collaborative and thematic approach the UN agencies have jointly taken for Iraq. The projects being implemented by UN Health Agencies fit into the Results Matrix, irrespective of funding source. Furthermore, these outcomes have specific outputs which look to support Iraq, in the priority health needs, including improving: the nutritional status of malnourished children U5, pregnant and lactating women, immunisation programmes, emergency obstetric care, primary health care, environmental health, communicable diseases to name just a few. The results matrix is consistent with the Iraqi Ministry of Health Vision, the National Development Strategy, and the UN Country Team Strategy. It was developed in consultation with the Ministry of Health and other key ministries, who have endorsed and support the matrix. C. Current UNDG ITF Implementation As part of the Results Matrix and under the UNDG ITF, the UN Health agencies are currently implementing 10 projects, which are show in Table 1 below. 1 Further information on the Iraq Health Sector Working Group (HSWG) and the linkages between the HSWG and the UN Health can be provided upon request UN Health and Nutrition for Iraq: Concept Paper on the 2006 2007 Strategic Direction and Funding Needs 1
Table 1: UNDG ITF Health projects currently under implementation No. Title funding D2-01 Emergency Obstetric Care, $12,603,000 D2-03 Strengthening Primary Health Care System $37,363,516 D2-04 Re-establishing National Drug Quality Control Laboratory $5,977,090 D2-05 Non-Communicable Diseases and Mental Health $11,000,000 D2-06 D2-07 D2-08 D2-09 Strengthening Immunization Services in Iraq Improving Preparedness and Response to impending Cholera outbreak (Quick Impact ) Hazardous Waste Chemicals Collection and Storage: Al Qadissiya Site (Quick Impact ) Malaria and Leishmania Control and Prevention Emergency Programme (Quick Impact ) UNICEF, $7,900,000 $857,964 UNEP MOE $905,005 $5,156,640 D2-10 Health Care Waste Management (Quick Impact ) $1,407,722 D2-11 Provision of Emergency Medical Oxygen Supply in Baghdad, Mosul and Kirkuk (Quick Impact ) $2,824,760 Totals $85,995,697 D. Future UNDG ITF Implementation As of the 31st January 2005, an amount of US$ 19.6 million 2 earmarked for the Health remained in the UNDG ITF. Table 2 below lists the projects which have been approved by the Health, for implementation using these funds. Table 2: Health projects approved for funding Title Lead Status funding Assistance to Primary School Children and Vulnerable WFP Groups School Feeding $4,999,050 Strengthening Immunization Services in Iraq, UNICEF $8,162,830 Rebuilding Food Safety and Food Processing Industry UNIDO, FAO,, Programs in Iraq (this project will remain pending, until pending the has sufficient funds) sufficient funds $7,995,950 Total Needs $20,870,536 Current Balance $19,670,000 Shortfall for Food Safety $1,487,830 2 Earmarked to the from the EC, as per the UNDG ITF Twelve Funding Framework UN Health and Nutrition for Iraq: Concept Paper on the 2006 2007 Strategic Direction and Funding Needs 2
As Table 2 shows, there is a current shortfall of $1,200,536 for the Food Safety. This project will move forward to obtain the available funding. Priority activities will be implemented first and the remaining activities will be put on hold, until the remaining funds are secured. As well as the projects listed in Table 2, there are more needs and priorities in the health sector in the coming two years. The projects listed in Table 3 below, represent the priority programmatic areas identified by the Ministry of Health, other key ministries and the UN Health for 2006-2007. Table 3: Health cluster projects for 2006 2007 requiring funding Title Water Purification and Filter Units for Health Care Facilities in Marshland Regions of Iraq Depleted Uranium Assessment and Capacity Building in Iraq Strengthening the medical equipment repair and maintenance system across Iraq Strengthening Primary Health Care System (Phase 2) Physical Rehabilitation of the Primary Health Care rural network in Iraq Physical Expansion of the Primary Health Care rural network in Iraq Lead UNEP MoEN,, Emergency Obstetric Care (Phase 2) Control and Prevention of Communicable Diseases Support to the control and prevention of Avian Influenza Prevention of HIV/AIDS among young people Rehabilitation of Health Care Waste Management Facilities in Iraq (Phase 2) Strengthening Regional Blood Bank Services (Erbil and the Southern Governorates), MOA, FAO, UNICEF,, UNICEF, MOEN, MOMPW Status Official Endorsement Approval Presentation Presentation funding $989,750 $3,687,066 $1,600,000 $17,000,000 $7,000,000 $12,300,000 $2,000,000 $4,000,000 $5,000,000 $ 2,000,000 $10,000,000 $5,000,000 Shortfall carried over from Table 2 (for the Food Safety ) $1,487,830 Total Health Needs for 2006-2007 $72,064,646 As shown in Table 3, the total UN Health needs, for effective support to the health sector and Iraqi Government in 2006 is $72.1 million. E. Conclusion The Iraqi Ministry of Health, other relevant ministries and the UN Health appreciate the strategic, consistent and concerted support that the EC has provided for the health sector in Iraq. In 2006 and into 2007, as the political environment of Iraq settles and the new Minister of Health takes leadership of health in Iraq, the UN Health will continue to provide the needed support to the Iraqi Government. UN Health and Nutrition for Iraq: Concept Paper on the 2006 2007 Strategic Direction and Funding Needs 3
Annex 1: UN Health for Iraq Results Matrix Kindly find below an adapted version of the current UN Health for Iraq Results Matrix. National goal / priority The aim of the UN Health in Iraq is to support the Ministry of Health s (MoH) National Health Strategy in meeting basic health needs. The fundamental objectives of this strategy is to shift from a hospital-oriented healthcare delivery system, to one based on primary healthcare delivery, including emergency preparedness and response addressing the needs of the Iraqis, especially the vulnerable population while promoting a healthy living environment. The Health coordinates its activities with the Ministry of Health and all stakeholders working in the health sector to ensure they complement the MoH Strategy in health reform process. High-level / cluster outcome by the end of the programme cycle Substantially reduced maternal and child mortality and morbidity through the transitional period by addressing underlying causes, improving access to, and providing quality health care services. Programme Outcomes Programme Outputs by End 2008 Role of Partners 1. 50% reduction in Under-5 and Infant Mortality 3 2. 15% reduction in Maternal Mortality 3 3. Increase access to quality health care services especially for vulnerable groups and the un-reached 1. Routine / accelerated immunization programs for women and children strengthened (measles, polio, MNT) 2. Diarrhoeal Diseases & Acute Respiratory Infections control programme enhanced and integrated into IMCI program 3. Micronutrient deficiencies addressed (Iodine, Vit A, Iron and folic acid etc ) 4. Infant and Young Child Feeding strategy implemented 5. Strategies and Policies for RH/MCH in place 6. Quality antenatal, peri-natal and postnatal care provided 1. Strategies and policies for RH in place including safe motherhood 2. Access to quality reproductive health services provided, including emergency obstetric care family planning and gender issues 3. Micronutrient deficiencies addressed (Iron, folic acid and Vit A etc ) and Provide support to the in food fortification policy/strategy and Improve awareness on nutrition and food utilization among the beneficiaries 4. Supplementary Feeding programs for pregnant and lactating women strengthened 5. Unmet need for family planning reduced 1. Developed consolidated and streamlined health policies and strategies that are gender sensitive & based on human right approach. 2. Provide technical logistical support for the referral system 3. Technical and logistical support provided for improved quality of health care including community outreach programmes. 4. Improve physical access of population to quality services through strengthening the PHC network 5. Technical and logistical support provided to key laboratories and institutions at the National and Regional levels. This will include the institutionalising of a food safety regime covering health, agrosector, and industry. 6. Capacity development programs for all cadre at all level developed and implemented 7. Updated / developed plans for strengthening of the National Health Information System (HIS) 8. Services for victims of gender and sexual- based violence provided 9. Enhanced national capacity to deal with mental health issue 10. Establish School Feeding Program including de-worming 11. Enhance the DOTS program through supplementary feeding to 1. / UNICEF / 2. / UNICEF / 3. / / UNICEF / WFP 4. / / UNICEF / WFP 5. / / UNICEF / 6. / UNICEF / / 1. / / / UNICEF 2. / / / UNICEF 3. / UNICEF / / WFP / 4. / UNICEF / WFP / 5. / / / UNICEF 1. / / 2. / / / UNICEF 3. / / / UNICEF 4. / / / UNICEF / 5. / / UNICEF / / UNIDO 6. / / UNICEF / / UNIDO 7. / / / UNICEF 8. / / / UNICEF 9. / / 10. / UNICEF / WFP / / 11. / UNICEF / WFP / / 12. / UNIDO 13. / UNICEF / WFP / / / UNIDO 14. / UNICEF / / WFP 3 Based on 1999 statistics UN Health and Nutrition for Iraq: Concept Paper on the 2006 2007 Strategic Direction and Funding Needs 4
TB patients. 12. Rehabilitated and developed health sector products (SOE and private sector) manufacturing such as: 1) pharmaceutical (medicines, intravenous fluids), 2) medical accessories (blood bags, syringes) and 3) medical use oxygen. This includes training of manufacturing firms in policies, procedures and TQM. 13. Update and review of health law and legislation and finance (in collaboration with WB) 14. Provision of food aid to most vulnerable people and health institution residence (tuberculosis patients) 4. Enhance Disease Prevention and Control including HIV/Aids 1. Disease control / prevention strategies, policies and programs (communicable and non communicable/ mental health) strengthened and enhanced 2. Capacity development programs for all cadre developed and implemented 3. Public health laboratories network strengthened 4. Strengthened programme for prevention and early detection for HIV AIDS and other STI s (Primary prevention, VCCT, PMTCT etc.) 5. Comprehensive approach to HIV-AIDS treatment and care developed and mainstreamed into existing services 1. / / UNICEF / 2. / / UNICEF / / WFP 3. / / UNICEF 4. / / / UNICEF 5. / / / UNICEF 5. Healthy living environment enhanced and healthy lifestyle promoted 1. Medical and psychological services for victims of violence, including gender based violence provided 2. Environmental health issues identified, assessed and addressed 3. Life-skills and healthy life styles enhanced, developed and supported 4. Developing and implementing the waste disposal capacities at hospitals, health clinics, manufacturing firms and relevant institutions including policies and procedures, training and equipment and tools 1. / / 2. / / / UNEP 3. / / / UNICEF 4. / UNIDO / / UNEP 6. Emergency preparedness and response ensured 1. Enhanced national capacity and capability to deal with health sector aspect of emergencies (including in the fields of food and vulnerability analysis) 1. / / UNICEF / / WFP Coordination Mechanisms and Programme Modalities Health coordination is undertaken on behalf of UN agencies operating, or planning to operate, in Iraq by ( Programme Support Team ) in Amman. The current Task Manager is Dr. Naeema Al Gasseer / WR, with the deputy being Dr. Alexander Malyavin of UNICEF. Active UN agencies in Health include, UNICEF,, WFP, UNDP, UNIDO, UNEP, IOM, UNIFEM and. The is a large number of UN national technical staff active in Health in Iraq, including personnel associated with disease surveillance activities (with additional support staff in terms of security guards and others). Regular contact is maintained between the UN agencies and with the World Bank, Ministries of Health, Environment, and Planning and with other health partners. The Health is working closely with the and has an active role in the on-going national health planning process. Donor coordination of the Health is an issue of importance of the and it is something the Health supports the to do. Opportunities for local-level contacts are severely constrained by current UN Phase IV restrictions on in-country movement by national staff. National and International NGOs (although with very limited expatriate presence in the country, due to security constraints) are currently engaged in activities in Iraq and through our biweekly coordination meetings health cluster members exchange information with these counterparts. Any re-entry by international staff is likely to be under the auspices of the Integrated Sectoral Approach which foresees a single point of entry into the UN system. The UN is actively engaged in the following coordination mechanisms: 1. Weekly UN Health and Nutrition meeting between the main partners of the ; 2. Bi-weekly UN Health and Nutrition with NGOs and all other partners meeting; 3. participate in aforementioned meetings and ad-hoc meetings through video-conferencing on a relatively regular basis; 4. Donor meetings 5. Regular virtual communication between members; 6. representatives travel to key sites in Iraq on a regular basis; 7. The Health Sector Working Group. UN Health and Nutrition for Iraq: Concept Paper on the 2006 2007 Strategic Direction and Funding Needs 5