Towards optimal collaboration: reforming the WHO country cooperation strategy in Thailand

As the leading coordinating agency for global public health, the World Health Organization (WHO) is challenged to improve its country-level work.1,2 In May 2016, the World Health Assembly requested WHO’s senior management to use country budgets and the organization’s social and intellectual capital to leverage additional resources to implement and sustain national programmes.3 A 2017 meeting of WHO country representatives highlighted the need to transform WHO into a flexible, nimble, responsive and proactive organization at the country level.4 Here we describe how WHO and Thai health authorities (the health ministry, autonomous health agencies outside the ministry, civil society and academia), have created an innovative country cooperation strategy that responds to these recommendations. At country level, WHO defines its medium-term strategic vision in the country cooperation strategy, a narrative describing how WHO’s offices contribute to the countries’ health priorities. Since 1999, such strategies have been developed for many Member States according to detailed guidelines.5 A recent global analysis called for more focused, analytical and strategic country cooperation strategies.6 Country cooperation strategies should reflect common elements of strategic planning with a broad outlook and clear, prioritized objectives with acknowledged trade-offs, to identify and catalyse relationships and creativity.7 Therefore, a strategic WHO country cooperation strategy should: reflect a process that is managed by and for the Member State; focus on fewer priorities, selected through an evidence-based participatory process; be creative in using WHO’s social and intellectual capital to add value; and innovate to improve collaboration between WHO and the Member State. Thailand achieved universal health coverage in 2001, and has since worked with civil society, academia and other partners to shape health policies. In addition, the health ministry develops and implements policy alongside several autonomous, partner public health agencies governed by independent boards.8 Thailand is the first country to have completed its fifth country cooperation strategy.9 Table 1 shows how the strategy has evolved. National health authorities and WHO agreed to focus on fewer priorities and to reconsider the role of WHO in the country to focus on more upstream policy work. During a 9-month consultative process, over 60 stakeholders worked in groups to submit proposals for inclusion as priority areas of the strategy. Proposals were based on specific criteria: relevance to national priorities, potential impact on public health, feasibility and comparative advantage of WHO and other partners participating in implementing the country cooperation strategy. Thirtyeight proposals were considered by the country cooperation strategy Executive Committee, which includes stakeholders from all constituencies. The committee selected six priorities for the 2017–2021 strategy: noncommunicable diseases; road safety; antimicrobial resistance; migrant health; global international trade and health; and global health diplomacy. These priorities reflect Thailand’s most pressing health issues: more Thais die annually from noncommunicable diseases than from any other cause.10 Thailand has enacted legislation designed to reduce road traffic mortality, the ninth highest in the world.11 Antimicrobial resistance is both a global and national crisis. Ensuring universal health coverage for migrants and their families is a priority for Thailand, and international trade and health, and global health diplomacy reflect the country’s understanding of the need to intervene globally to improve health locally. A strategic, focused country cooperation strategy cannot address all health issues. Some areas of work, such as community health, tuberculosis and ageing were not selected as priorities. Some of these issues are addressed through collaboration with other partners or had been sufficiently advanced in previous strategies. There is no universally accepted definition of country ownership, critical for a successful country cooperation strategy, in the literature. We believe that the Thai Ministry of Public Health owns its country cooperation strategy because the country leads all aspects of the document’s development and implementation. The strategy’s executive committee, convened and chaired by the Permanent Secretary of Public Health, oversees these functions and its secretariat is assumed by the Global Health Division of the health ministry, rather than by WHO. National health authorities lead implementation of the strategy through six programme subcommittees, one for each priority area, convened and chaired by Thai officials or highly respected senior experts in health. WHO is one of many members in each subcommittee. The health ministry and its country cooperation strategy partners believe that WHO adds value through its intellectual and social capital, rather than through funding. Therefore, the health ministry capitalizes on WHO’s reputation and expertise to engage stakeholders, influence decision-makers and leverage the highest quality technical support available globally. The Thai country cooperation strategy is catalytic, stimulating both policy dialogue and investment. The programme subcommittees are a fora for multisectoral discussions on the strategy’s priorities. In addition, the Towards optimal collaboration: reforming the WHO country cooperation strategy in Thailand Sirinad Tiantong, Attaya Limwattanayingyong, Suwit Wibulpolprasert, Liviu Vedrasco & Daniel Kertesz