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PROGRAMME BUDGET 2018–2019 HUMAN REPRODUCTION PROGRAMME (HRP) Department of Reproductive Health and Research including UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP)
PROGRAMME BUDGET 2018–2019 HUMAN REPRODUCTION PROGRAMME (HRP) Department of Reproductive Health and Research including UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP)
WHO/RHR/HRP/17.19 © World Health Organization 2017 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. HRP programme budget 2018–2019. Geneva: World Health Organization; 2017 (WHO/RHR/HRP/17.19). Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Printed in Switzerland
CONTENTS
ACRONYMS AND ABBREVIATIONS II
1. INTRODUCTION 1
1.1 HRP’s mandate in sexual and reproductive health and rights 1
1.2 Impact of HRP’s Work 3
1.3 HRP’s theory of change and results framework 4
1.4 Output indicators 6
1.5 HRP Portfolio review, 2016 7
1.6 HRP programme budget and operational plan, 2018–2019 8
1.7 Monitoring and accountability 11
2. HRP THEMATIC AREAS 12
2.1 Family planning and contraception 12
2.2 Maternal and perinatal health 14
2.3 Safe abortion 16
2.4 Sexually transmitted infections and cervical cancer 18
2.5 HIV–sexual and reproductive health and rights linkages 20
2.6 Fertility care 22
2.7 Sexual health 24
2.8 Violence against women and girls 26
2.9 Adolescent sexual and reproductive health and rights 28
2.10 Female genital mutilation 30
2.11 Sexual and reproductive health and rights in humanitarian settings 32
2.12 Disease outbreaks and sexual and reproductive health and rights 34
2.13 Human rights, gender equality and social determinants 36
2.14 Digital innovations 38
2.15 Measuring and monitoring indicators 40
2.16 HRP Alliance 42
2.17 General technical and programme management activities 44
3. HRP BUDGET TABLES 46
Annex 1. HO Department of Reproductive Health
W
and Research (RHR) indicative budget tables 46
REFERENCES 50
HRP PROGRAMME BUDGET, 2018-2019 i
LIST OF TABLES
Table 1. O
utput indicators and targets for 2018–2019 6
Table 2. H
RP programme budget and indicative programme development
for reproductive health (PDRH) budget (US$ thousands 9
Table 3. F
amily planning and contraception: products and milestones 13
Table 4. M
aternal and perinatal health: products and milestones 14
Table 5. S
afe abortion: products and milestones 17
Table 6. S
exually transmitted infections (STIs) and cervical cancer:
products and milestones 18
Table 7. H
IV–sexual and reproductive health and rights (SRHR) linkages:
products and milestones 21
Table 8. F
ertility care: products and milestones 23
Table 9. S
exual health: products and milestones 25
Table 10. Violence against women and girls: products and milestones 27
Table 11. A
dolescent sexual and reproductive health and rights (SRHR):
products and milestones 29
Table 12. Female genital mutilation (FGM): products and milestones 31
Table 13. S
exual and reproductive health and rights (SRHR) in humanitarian settings:
products and milestones 33
Table 14. Disease outbreaks and sexual and reproductive health and rights (SRHR):
products and milestones 35
Table 15. Human rights, gender equality and social determinants:
products and milestones 37
Table 16. D
igital innovations: products and milestones 39
Table 17. M
easuring and monitoring indicators: products and milestones 40
Table 18. HRP Alliance: products and milestones 43
Table 19. General technical activities: products and milestones 44
Table 20. P
rogramme management: products, services and milestones 45
Table 21. H
RP budget summary for 2018–2019, by budget section 46
Table 22. HRP budget summary for 2018-2019, by budget section (products only) 46
Table 23. HRP budget summary for 2018-2019, by thematic area (products only) 47
Table 24. H
RP 2018–2019 budget compared with 2016-2017 47
Table 25. R
HR consolidated 2018–2019 budget compared with 2016-2017 48
Table 26. RHR consolidated income requirements and sources of funds for 2018–2019* 49
LIST OF FIGURES
Figure 1. HRP Results framework 4
Figure 2. H
RP programme budget 2018–2019, by thematic area (product budget only) 8
Figure 3. RP budget 2016–2017 and 2018–2019,
H
by thematic area (product budget only) 10
ii HRP PROGRAMME BUDGET, 2018-2019
ACRONYMS AND ABBREVIATIONS
AMR antimicrobial resistance
DMPA depot medroxyprogesterone acetate (injectable contraceptive method)
ECHO Evidence for Contraceptive Options and HIV Outcomes Study
EMTCT elimination of mother-to-child transmission
FGM female genital mutilation
FHW front-line health worker
GRC Guidelines Review Committee
HPV human papillomavirus
HRP UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research,
Development and Research Training in Human Reproduction; also “Human
Reproduction Programme”
HSV herpes simplex virus
ICD International Classification of Diseases
ICD-11 International Classification of Diseases 11th revision
IPU Inter-Parliamentary Union
IUD intrauterine device
LGBTI lesbian, gay, bisexual, transgender and intersex
mHealth mobile health
PCC HRP Policy and Coordination Committee
PDRH programme development for reproductive health (within RHR)
RCS research capacity strengthening
RCT randomized controlled trial
RHR WHO Department of Reproductive Health and Research
RMNCAH reproductive, maternal, newborn, child and adolescent health
SDG Sustainable Development Goal
SRH sexual and reproductive health
SRHR sexual and reproductive health and rights
SRMNCAH sexual, reproductive, maternal, newborn, child and adolescent health
STAG Scientific and Technical Advisory Group
STI sexually transmitted infection
UHC universal health coverage
UN United Nations
UNDP United Nations Development Programme
UNFPA United Nations Population Fund
UNICEF United Nations Children’s Fund
WHO World Health Organization
HRP PROGRAMME BUDGET, 2018-2019 iii
iv HRP PROGRAMME BUDGET, 2018-2019
INTRODUCTION
1.1 RP’S MANDATE IN SEXUAL AND
H
REPRODUCTIVE HEALTH AND RIGHTS
Established in 1972, the UNDP-UNFPA- Agenda for Sustainable Development were
UNICEF-WHO-World Bank Special Programme formally adopted by world leaders at an historic
of Research, Development and Research UN Summit, and these officially came into
Training in Human Reproduction (also referred force on 1 January 2016. Several targets were
to as the Human Reproduction Programme established for SRHR issues, primarily within
or HRP) is the main instrument within the Goals 3 (Ensure healthy lives and promote
United Nations (UN) system for research in well-being for all at all ages) and 5 (Achieve
human reproduction, bringing together policy- gender equality and empower all women and
makers, scientists, health-care providers, girls); these targets provide countries, and HRP,
clinicians and community representatives to with clear directions for the next 15 years.
identify and address priorities for research
to improve sexual and reproductive health. At the same time, the UN Secretary-General
HRP is a cosponsored Special Programme launched an ambitious Global Strategy for
executed by the World Health Organization Women’s, Children’s and Adolescents’ Health
(WHO) in the Family, Women’s and Children’s (2016–2030) (4) to further the achievement
Health (FWC) Cluster. Since 1998, HRP has of the SDGs. This is a roadmap for achieving
been embedded within WHO’s Department of the right to the highest attainable standard of
Reproductive Health and Research (RHR) to health for all women, children and adolescents,
ensure strong linkages between the evidence- which will transform the future and ensure every
based outputs of HRP and the normative newborn, mother and child not only survives,
guidance and programme development roles but thrives. In May 2016, at the World Health
of WHO. Indicative budget levels for RHR’s work Assembly, delegates made a firm commitment
in programme development for reproductive to take forward implementation of the Global
health (PDRH) are shown in Annex 1. Strategy, based on a robust accountability
framework including all relevant SDG indicators
The overall mandate for the work of HRP in together with several other indicators to
sexual and reproductive health and rights ensure countries focus on all aspects of SRHR.
(SRHR) is guided by the global Reproductive Member States also endorsed the Global
health strategy (1), adopted by WHO Member plan of action to strengthen the role of the
States at the World Health Assembly in 2004 (2). health system within a national multisectoral
The critical role of this strategy in support of the response to address interpersonal violence, in
efforts to achieve the Millennium Development particular against women and girls, and against
Goals was subsequently reaffirmed by the children (5), as well as the Global health sector
World Health Assembly in 2005 (3). strategy on sexually transmitted infections,
2016–2021 (6), thus providing clear guidance
The period 2015–2016 marked a watershed for HRP’s future work on these issues.
for SRHR, with the adoption of several far-
reaching international agreements in support These coordinated international agreements,
of universal access to sexual and reproductive taken together, form a bold new roadmap
health. In September 2015, the Sustainable for SRHR as they aim to keep women,
Development Goals (SDGs) of the 2030 children and adolescents at the heart of the
HRP PROGRAMME BUDGET, 2018-2019 1
sustainable development agenda, unlocking their vast potential for transformative change. These
agreements provide a strong global mandate for rigorous research that can produce the empirical
evidence needed by countries to both implement the Global Strategy and achieve the SDGs.
In May 2017, the Member States of WHO elected Dr Tedros Adhanom Ghebreyesus as the new
Director-General of WHO, beginning in July 2017. Previously, Dr Tedros has served as Minister
of Foreign Affairs and as Minister of Health in Ethiopia; as chair of the Board of the Global Fund
to Fight AIDS, Tuberculosis and Malaria (the Global Fund); and as co-chair of the Board of the
Partnership for Maternal, Newborn and Child Health (PMNCH). Throughout, Dr Tedros has stressed
the importance of improved sexual and reproductive health and family planning services:
“Simply put, we cannot achieve the ambitious health and development targets in the SDGs
unless we improve the health, dignity and rights of women, children and adolescents. In too
many places, gender gaps, harmful cultural and social practices and gender-based violence
are negatively impacting women, children and adolescents. They are unable to reach their
full potential due to lack of access to maternal health, sexual and reproductive health
and family planning services; adolescent mental health, early education and responsive
parenting; malnutrition; sanitation issues, including menstrual hygiene management; and
harmful traditional practices, such as child marriage and female genital mutilation” (7).
Dr Tedros has been a strong advocate for gender equality and the empowerment of
women, children and adolescents throughout his public health and political careers, and
has pledged to make gender equality a priority of his tenure as Director-General.
2 HRP PROGRAMME BUDGET, 2018-20191.2 IMPACT OF HRP’S WORK
In 2015, UN Member States adopted the “2030 Agenda for Sustainable Development” and its
17 sustainable development goals (SDGs). This is a universal set of goals, targets and indicators
that Member States will use to frame their agendas and political policies over the next 15 years.
Since its inception, HRP has led ground-breaking work underpinning many of the SDG targets.
Through this programme of work, HRP aims to impact the SDG targets shown in Box 1.
BOX 1. THE IMPACT OF HRP’S WORK
1. By 2030, reduce the global maternal mortality ratio to
less than 70 per 100,000 live births (SDG target 3.1)
2. By 2030, ensure universal access to sexual and reproductive
health-care services, including for family planning, information
and education, and the integration of reproductive health
into national strategies and programmes (3.7)
3. End all forms of discrimination against all
women and girls everywhere (5.1)
4. Eliminate all forms of violence against all women and girls
in the public and private spheres, including trafficking
and sexual and other types of exploitation (5.2)
5. Eliminate all harmful practices, such as child, early and
forced marriage and female genital mutilation (5.3)
6. Ensure universal access to sexual and reproductive health and
reproductive rights as agreed in accordance with the Programme
of Action of the International Conference on Population and
Development and the Beijing Platform for Action and the
outcome documents of their review conferences (5.6)
7. Enhance scientific research, upgrade the technological capabilities of
industrial sectors in all countries, in particular developing countries,
including, by 2030, encouraging innovation and substantially increasing
the number of research and development workers per 1 million people
and public and private research and development spending (9.5)
8. End abuse, exploitation, trafficking and all forms of
violence against and torture of children (16.2)
HRP PROGRAMME BUDGET, 2018-2019 31.3 HRP’S THEORY OF CHANGE AND RESULTS FRAMEWORK
HRP’s work is guided by a theory of change, which are produced through various processes
which is expressed through a results framework. and with a range of interrelated inputs. For
Through this HRP results framework, which each of the five outputs, specific products and
was developed in 2014 (see Fig. 1) and is milestones have been developed. HRP plans,
periodically revised, HRP aims to improve sexual prioritizes and produces outputs by taking into
and reproductive health, in particular among consideration their potential outcome and likely
women and young people. This impact is to impact. The link between outcome and impact
be achieved through fostering and facilitating is made on the assumption that if policies and
sustainable change in national and international programmes reflect the evidence base and
policy and public health programmes that there is enough technical capacity on a national
deliver sexual, reproductive, maternal and and international basis to implement them, then
perinatal health services. This outcome will sexual and reproductive health will improve.
be achieved by producing five broad outputs,
FIGURE 1. HRP RESULTS FRAMEWORK
Improved sexual and reproductive health and rights, in particular among
IMPACT young women and young people
Sustainable change in national and international policy and public health
OUTCOME programmes
1. Creation of new knowledge 5. Development of evidence-
2. Synthesis of research evidence based normative guidelines,
3. Strengthening of research and implementation tools and policy
OUTPUTS
technical capacity statements
4. Strengthening of research/
policy dialogue
• Undertake and support • Cordination of research
research institutions
• Research reviews and synthesis • Research capacity strengthening
PROCESSES • Scientific consensus generation • Leadership in developing and
• Policy dialogue monitoring global goals and targets
• Partnerships • Advocacy and communications
• Funds • HRP/WHO infrastructure
INPUTS • Human resources • HRP global reputation
A fuller description of how HRP produces each its five main outputs follows.
4 HRP PROGRAMME BUDGET, 2018-2019OUTPUT 1: CREATION OF NEW KNOWLEDGE OUTPUT 3: STRENGTHENING OF
RESEARCH AND TECHNICAL CAPACITY
This will be achieved through HRP’s capacity
to support a wide variety of primary research, A significant portion of HRP’s research budget
including biomedical, clinical, behavioural, social, is dedicated to strengthening research and
epidemiological and implementation studies. technical capacity in low- and middle-income
The creation of new knowledge about the countries. Increasing technical capacity will
frequency and distribution of health problems, result in a greater body of professionals who
the determinants of health status, and the are able to conduct research and work with
effectiveness of various innovations, and health evidence to make the appropriate policy
system and service-delivery implementation decisions and programmatic interventions
models, will directly inform improvements in to improve sexual and reproductive health
policies in individual countries and add to the outcomes. HRP has created a global network
global evidence base for predicting improvement of expertise and centres of excellence in sexual
in outcomes for specific populations. For and reproductive health research, known as
example, an external evaluation of HRP’s work on the HRP Alliance. See Chapter 2, section 2.16
medical abortion during 2003–2007 found that for more information about the HRP Alliance.
the high-quality research from HRP, coupled with
its collaboration with medication manufacturers, OUTPUT 4: DEVELOPMENT OF
enabled the registration and distribution of EVIDENCE-BASED NORMATIVE
affordable commodities to the public sector in GUIDELINES, IMPLEMENTATION
low- and middle-income countries, facilitating TOOLS AND POLICY STATEMENTS
the translation of the results of clinical research
to changes in policy, and thus contributing HRP supports the production of WHO-endorsed
to the reduction in maternal mortality (8). guidelines and standards. These documents
facilitate the use of evidence to inform and
OUTPUT 2: SYNTHESIS OF shape policy and practice through compiling and
RESEARCH EVIDENCE synthesizing multiple sources of information,
recommending evidence-based approaches
The synthesis of existing evidence results to achieve desired health outcomes, and using
in a robust body of knowledge regarding WHO’s endorsement for global credibility.
the effectiveness of interventions and their
implementation methods, and it also assists OUTPUT 5: STRENGTHENING OF
with identifying high-priority populations or RESEARCH/POLICY DIALOGUE
countries for action. This evidence can then
inform policies and programmes and result HRP has a strong role in facilitating and
in the expected improvements in sexual and strengthening research and policy dialogues
reproductive health. For example, HRP has with and among key decision-makers. Through
published global and regional estimates of this role, HRP provides influential leadership and
unsafe abortions, indicating a rise between ensures that sexual and reproductive health
2003 and 2008, which led to the development research is highly visible and that the most up-
of UN global estimates on maternal mortality. to-date evidence is considered during policy
This information helps to inform global policy and programme development, and that these
and funding decisions, including decisions efforts are coordinated among concerned
about which populations or countries to target departments at WHO headquarters and with
with specific interventions and resources. WHO regional and country offices. HRP actively
A synthesis of evidence from six countries engages with key political stakeholders and
identified a number of strategies that have platforms, including the Inter-Parliamentary
proved effective in reducing maternal deaths Union (IPU) and the G7, facilitating dialogue
(9). A number of systematic reviews have been between research and policy, and promoting
produced, which have directly informed guideline an evidence-based approach to legislation
development, including information supporting development in relation to SRHR.
recommendations on postpartum haemorrhage
and labour induction and on the types of
progesterones in combined oral contraceptives.
HRP PROGRAMME BUDGET, 2018-2019 51.4 OUTPUT INDICATORS
The HRP cosponsors (including WHO) and 1), is shown in Table 1. The HRP annual
donors have varying reporting requirements, technical report 2015 (11) reported that the
some of which require establishment of programme reached or exceeded its targets
measurable output indicators and targets. for the 2014–2015 biennium, and the interim
In order to efficiently respond to these report prepared at the end of 2016 showed
requirements, one harmonized list of output high achievement values. Therefore, more
indicators is used, which was initially developed ambitious targets have been proposed for
in 2013–2014 (10). The list of indicators, 2018–2019, as also shown in Table 1.
linked to the HRP results framework (Fig.
TABLE 1. O
UTPUT INDICATORS AND TARGETS FOR 2018–2019
OUTPUT OUTPUT INDICATOR TARGET FOR 2018–2019
1. REATION OF NEW
C 1.1 Implementation research and clinical trials on 320 Scientific publications issued
KNOWLEDGE sexual and reproductive health published reporting new and improved
tools, solutions and strategies in
sexual and reproductive health
1.2 G
lobal and regional estimates of reproductive, 6 Global/regional estimates published
maternal and perinatal conditions
1.3 I nterventions developed, tested and 3 New interventions developed,
implemented to address unmet needs tested and disseminated
in sexual reproductive health
1.4 New or ongoing research funded 24 Research projects approved
(by WHO and HRP institutional
review boards) and initiated
1.5 Gender balance among principal 50% Proportion of women among PIs of new
investigators (PIs) of new and and ongoing HRP research projects
ongoing HRP research projects*
2. SYNTHESIS OF 2.1 Systematic reviews of key questions 80 Systematic reviews published
RESEARCH EVIDENCE in sexual and reproductive health
3. STRENGTHENING 3.1 National research capacity strengthened 20 Research centres strengthened
OF RESEARCH through HRP grants
AND TECHNICAL
CAPACITY
3.2 Individual research capacity strengthened* 200 Individuals trained through grants
and activities of the HRP Alliance
3.3 Gender balance in individual capacity 50% Proportion of women among
of individuals strengthened* individuals trained
4. DEVELOPMENT 4.1 Technical, clinical and policy guidelines 20 New or updated guidelines issued
OF EVIDENCE- issued on sexual and reproductive health
BASED NORMATIVE
GUIDELINES,
IMPLEMENTATION
TOOLS AND POLICY
STATEMENTS 4.2 Gender, rights and equity considerations 100% Proportion of technical, clinical and
mainstreamed into guideline development* policy guidelines issued on sexual and
reproductive health in which gender
and rights are explicitly elaborated
5. STRENGTHENING 5.1 Policy options analysed and synthesized, 20 Evidence briefs and other
OF RESEARCH– derived from technical and clinical guidelines guideline derivatives issued
POLICY DIALOGUE
5.2 National capacity to support and develop 9 National or regional consultations
evidence-based policies strengthened* convened explicitly for the
systematic introduction or revision
of policy and programming options
based on HRP research
* New or revised indicator for 2018-2019
6 HRP PROGRAMME BUDGET, 2018-20191.5 HRP PORTFOLIO REVIEW, 2016 In 2016, the Scientific and Technical Advisory (NGOs) and national partners, civil society, Group (STAG) and the HRP Policy and WHO regional and country offices, research Coordination Committee (PCC) recommended partners at the global level, donors, HRP that the RHR Department review and cosponsors, and the members of the PCC, prioritize its outputs and key areas of work, STAG and Gender and Rights Advisory Panel taking into account emerging issues and (GAP). The results of the review, which were the capacity of the Department to respond compiled by thematic area (see Box 2), were within the limits of the available human presented to and endorsed by the STAG at the and financial resources. To respond to this annual meeting in February 2017, and then recommendation, the Department initiated a used to develop this programme budget and broadly consultative portfolio review process operational plan, which is also organized by in July 2016, involving over 600 stakeholders, thematic area (see Chapter 2) and which will including nongovernmental organization guide HRP’s work for 2018–2019 and beyond. BOX 2. HRP THEMATIC AREAS 1. Family planning and contraception 2. Maternal and perinatal health 3. Safe abortion 4. Sexually transmitted infections and cervical cancer 5. HIV-sexual and reproductive health and rights (SRHR) linkages 6. Fertility care 7. Sexual health 8. Violence against women and girls 9. Adolescent SRHR 10. Female genital mutilation 11. SRHR in humanitarian settings 12. Disease outbreaks and SRHR 13. Human rights, gender equality and social determinants 14. Digital innovations 15. Measuring and monitoring indicators 16. HRP Alliance HRP PROGRAMME BUDGET, 2018-2019 7
1.6 RP PROGRAMME BUDGET AND
H
OPERATIONAL PLAN, 2018–2019
The HRP programme budget 2018–2019 approved by the PCC in June 2017. Following
includes a list of technical products, milestones the structure of the portfolio review process,
for achievement during the biennium, and the budget is organized by thematic area
planned contributions to the output indicators. (see Box 1), which represents a more detailed
As in the past, each product has been assigned breakdown than in previous years, as shown in
a priority level, which will determine the order Figure 2. The data are also presented by budget
of funding and implementation over the course section in the budget tables in Chapter 3 of
of the biennium. This budget was endorsed by this document, in order to enable clear linkages
STAG in February 2017, and the HRP Standing with organizational and managerial structure.
Committee of Cosponsors in May 2017, and was
FIGURE 2. HRP PROGRAMME BUDGET 2018–2019, BY THEMATIC AREA (PRODUCT BUDGET ONLY)
HRP PROGRAMME
BUDGET 2018–2019
8 HRP PROGRAMME BUDGET, 2018-2019The workplan and budget of HRP is fully Furthermore, the operational plans for HRP and
integrated within WHO’s programme budget PDRH are shown in this document, although
2018–2019 (12). Specifically, HRP’s outcomes funding remains separate. The source of funding
and outputs contribute to the results of for each product is indicated in the product
WHO’s Category 3, “Promoting health through and milestone tables presented for each
the life course”, in particular Programme thematic area in Chapter 2 of this document.
Area 3.1 “Reproductive, maternal, newborn,
child and adolescent health” (RMNCAH), The budget levels for HRP are shown in Table
alongside WHO’s work in programme 2, alongside indicative budget levels for
development for reproductive health WHO’s work in PDRH, which are included for
(PDRH), which is also administered through completeness. In view of the 8.8% budget
the RHR Department. Beginning in 2016, growth the previous biennium, as well as the
in order to provide enhanced transparency, uncertain financial landscape in 2017, the
HRP has been budgeted under a distinct Standing Committee proposed a “no growth”
output, which includes all of HRP’s research budget for 2018–2019, and this budget has
outputs, to distinguish it from RHR’s work on been prepared on that basis. Detailed figures
PDRH. This arrangement highlights HRP’s are shown in the budget tables in Chapter
instrumental contribution to the outcomes 3 of this report. The changes in product
and outputs of WHO’s Category 3 work. (activity) budgets are shown in Figure 3.
TABLE 2. RP PROGRAMME BUDGET AND INDICATIVE PROGRAMME DEVELOPMENT
H
FOR REPRODUCTIVE HEALTH (PDRH) BUDGET (US$ THOUSANDS)
2016-2017 2018-2019
PERCENT CHANGE
Budget US$ Percent of total Budget US$ Percent of total
UNDP/UNFPA/UNICEF/WHO/World Bank Special
Programme of Research, Development and
Research Training in Human Reproduction (HRP)
Products 41,040 60.0% 41,040 60.0% +0.0%
Staff positions 27,360 40.0% 27,360 40.0% +0.0%
Subtotal HRP 68,400 100.0% 68,400 100.0% +0.0%
WHO Programme Development in Reproductive
Health HQ (PDRH) (Indicative, for information)
Products 8,605 53.4% 8,105 50.3% -5.8%
Staff positions 7,500 46.6% 8,000 49.7% +6.7%
Subtotal PDRH 16,105 100.0% 16,105 100.0% +0.0%
Grand total Department of Reproductive Health
and Research (RHR) (Indicative, for information)
Products 49,645 58.7% 49,145 58.2% -1.0%
Staff positions 34,860 41.3% 35,360 41.8% +1.4%
Grand total RHR 84,505 100.0% 84,505 100.0% +0.0%
HRP PROGRAMME BUDGET, 2018-2019 9FIGURE 3. HRP BUDGET 2016–2017 AND 2018–2019,
BY THEMATIC AREA (PRODUCT BUDGET ONLY)
2016 — 17
2018 — 19 US$ Millions
10 HRP PROGRAMME BUDGET, 2018-20191.7 MONITORING AND ACCOUNTABILITY
The success of HRP’s work in sexual and research proposal funded by HRP; it meets
reproductive health depends on its scientific and annually to assess the review process.
ethical rigour, its sensitivity and commitment
to human rights and gender equality, and its The work of the HRP Alliance is monitored
capacity to address global priorities that are and evaluated at annual meetings of the HRP
also important for countries, particularly low- Alliance Steering Committee. At these meetings,
and middle-income countries. This implies progress is reviewed and evaluated, and plans for
continual monitoring of the programme the coming year are developed. HRP research
outcomes and output indicators. Monitoring capacity strengthening projects are reviewed
is carried out by a number of complementary by the HRP Alliance Steering Committee.
advisory and governing bodies.
HRP is evaluated at the annual meetings
The Scientific and Technical Advisory Group of the Policy and Coordination Committee
(STAG) meets annually to review progress in (PCC), at biannual meetings of the
scientific studies, to recommend priorities Standing Committee, and through periodic
and to advise on the allocation of resources. independent external evaluations. The next
external evaluation will be carried out in
The Gender and Rights Advisory 2018, covering the period 2013–2017.
Panel (GAP) reviews the work from the
perspective of gender and rights. Each of these bodies is in a position to
assess, from different points of view,
The Research Project Review Panel (RP2) the achievement of the programme
provides an independent scientific and processes, outputs and outcomes.
ethical review and approval for every
HRP PROGRAMME BUDGET, 2018-2019 11HRP THEMATIC AREAS
2.1 FAMILY PLANNING AND CONTRACEPTION
Contraception is one of the most effective and product development process through pre-
cost-effective public health interventions. Its qualification and introduction by convening,
use is increasing worldwide but remains very guiding and supporting key stakeholders.
uneven across regions; it is estimated that
some 220 million women living in developing To meet the increasing demand for services
countries do not want to become pregnant but in the context of an existing health workforce
do not use effective contraceptive methods that is limited in size/numbers, and in particular
for a variety of reasons. Moreover, improving to reach underserved populations, efforts
access to contraception could decrease must continue to ensure the provision of
maternal mortality by a third worldwide. services by the most appropriate cadre of
providers, at different levels of the health
Ensuring high standards of quality of care system and through integration with other
across the wide variety of service-delivery services. This task sharing/task shifting must
settings remains a challenge. WHO’s range of be achieved while maintaining a high level
guidelines relating to family planning, which of quality of care and full respect for human
are developed with significant support of rights. HRP’s contribution will be to synthesize
HRP, are widely recognized as authoritative in existing evidence from programmatic
the field. To facilitate their use, HRP and the research, coordinate the generation of new
RHR Department will continue to develop evidence and convene key stakeholders for
consolidated guidelines and derivative tools periodic review and dissemination of the
that are easier to adapt and use by intended evidence on task sharing and integration.
audiences, and that improve service delivery.
From the perspective of health system
This guidance needs to be kept up to date as strengthening, HRP will coordinate the
new scientific evidence becomes available evidence base for cost-effective service
and potential safety concerns emerge. delivery and financing innovations through
HRP will contribute to the global evidence multi-site operations research, and
base on safety, efficacy and utilization of develop guidance for their implementation
contraception through synthesizing existing at scale through coordinating multi-
evidence, coordinating generation of new site implementation research.
evidence and convening key stakeholders.
HRP has a key role to play in the process
A wide variety of contraceptive methods are of developing and reporting on sexual and
available. In practice, however, many individuals reproductive health and rights (SRHR)-
have a limited choice and there is a need to related indicators under the Sustainable
continue to develop methods that are better Development Goals (SDGs) and the Global
suited to a wider range of health needs and living Strategy for Women’s, Children’s and
conditions. As new or adapted contraceptive Adolescents’ Health. It will take decisive action
technologies become available (e.g. to ensure that global agreement is reached
subcutaneous depot medroxyprogesterone on operational definitions and indicators for
acetate [DMPA] self-injection, pericoital measuring and monitoring contraceptive-use
contraception, multipurpose prevention dynamics, particularly when it comes to the
technologies), HRP will ensure that there is a estimation of unmet need for contraception
clear and coordinated pathway to complete the called for under SDG indicator 3.7.1.
12 HRP PROGRAMME BUDGET, 2018-2019TABLE 3. AMILY PLANNING AND CONTRACEPTION: PRODUCTS AND MILESTONES
F
ID PRODUCT MILESTONES CLASSIFICATIONS
HRP PRODUCTS
A01 Evidence for Contraceptive Options and HIV 1. Follow-up and analysis completed for a multicentre, Priority A
Outcomes (ECHO) Study –evidence of HIV incidence open-label, randomized controlled trial (RCT) HRP/FP
and contraceptive benefits for women using DMPA, 2. Results disseminated
LNG Implant, and copper intrauterine devices (IUDs)
3. New guidance developed, as indicated
A02 Evidence of impact of an intervention 1. Expert consultation and study initiation Priority A
promoting community monitoring and social 2. Study conducted HRP/FP
accountability of contraceptive programmes
3. Results disseminated
4. New guidance and manuals developed
A03 Evidence of safety of combined versus progestogen- 1. Double-blind RCT implemented; follow-up completed Priority A
only hormonal contraceptives for women who are 2. Analysis completed HRP/FP
exclusively breastfeeding and for infant weight gain
3. Results disseminated
4. New guidance developed, if indicated
A04 Acceptability, safety and effectiveness of pericoital 1. Consultation to define key research and development and Priority B
contraception at varying levels of the health system pre-qualification pathways for pericoital contraception HRP/FP
2. Protocol finalized and research initiated
3. Study conducted
4. Results disseminated
A05 Health system strengthening for 1. Expert consultation on status of implementation, Priority B
implementation and scale-up of subcutaneous challenges and research gaps HRP/FP
DMPA documented and shared 2. Development of implementation research protocol
3. Research conducted, with feedback loops in the countries
4. Results disseminated
RELATED PRODUCTS OF WHO/RHR IN PROGRAMME DEVELOPMENT FOR REPRODUCTIVE HEALTH (PDRH)
A06 Implementation at scale of WHO guidelines and 1. Knowledge Gateway and website updated; evaluation Priority A
high-impact interventions through Implementing plan and baseline survey implemented PDRH/FP
Best Practice (IBP) initiative partners 2. Support provided to International Family Planning
Conference implementation tracks
3. Regional workshops held with key stakeholders
(UNFPA, Family Planning 2020 [FP2020]) to support
implementation and scale-up of tools and guidelines
4. Case studies finalized documenting implementation of
high-impact interventions and use of WHO tools
A07 Normative WHO guidelines and derivative 1. Guidance on duration of use of implants and IUDs if indicated Priority A
products for family planning services 2. Guidance based on the ECHO Study and postpartum PDRH/FP
family planning (PPFP) study results if indicated
3. Guideline disseminated, guideline implementation supported
4. Expert consultation to initiate the scheduled review of Medical
eligibility criteria for contraceptive use (MEC) and Selected practice
recommendations for contraceptive use (SPR) guidelines convened
A08 Increased access to family planning services 1. Training resource package modules revised Priority A
and information through workforce 2. Training resource package adopted for in- PDRH/FP
interventions including task sharing service and pre-service training
3. Various cadres of health workers trained to implement task sharing
4. Training impact documented
A09 Evidence generated on innovative 1. Implementation plan developed and priority activities identified Priority A
financing mechanisms 2. Regional workshops to support country plan development PDRH/FP
3. Review evidence generation including evaluation of
implementation process and lessons learnt
4. Results and lessons learnt disseminated
A10 Information to monitor the status of 1. Data collection conducted and completed Priority A
national reproductive health policies 2. Results disseminated PDRH/FP
DMPA: depot medroxyprogesterone acetate; FP: family planning, contraception and fertility; LNG: levonorgestrel; PDRH: programme development for reproductive health
*In the product and milestone tables throughout this document, each product is classified according to: (i) priority, as discussed in Chapter 1, section
1.5, (ii) budget segment (HRP or WHO programme development for reproductive health) and (iii) budget section (see Chapter 3).
HRP PROGRAMME BUDGET, 2018-2019 132.2 MATERNAL AND PERINATAL HEALTH
HRP strives to be an agent of transformation for antenatal care and intrapartum care at
for maternal and newborn health. Its core scale, including as part of WHO’s “Quality,
mission is to perform research and support Equity, Dignity” (QED) initiative to improve
the development of WHO guidance and the quality of maternal and newborn health
implementation tools that not only ensure care. This guidance will be informed by multi-
that pregnant women and newborn infants site implementation research for health
survive but which also enable the mother systems strengthening, and, for antenatal
and child to thrive. HRP’s work is guided by care, by developing, testing and validating
strategic priorities for achieving the SDGs, indicators of quality antenatal care.
in particular primary targets 3.1 and 3.2,
and by the Global Strategy for Women’s, Of the 303 000 maternal deaths that occur
Children’s and Adolescents’ Health. annually, it is estimated that over 10% are
due to sepsis. Sepsis is also the cause of 15%
Three areas of work related to maternal health of newborn deaths. HRP will provide global
have been prioritized by HRP: antenatal care, leadership in preventing and managing maternal
intrapartum care and maternal sepsis. HRP and neonatal sepsis through coordinating
will develop guidance tools to assist countries multi-site research to develop and test clinical
in implementing WHO recommendations innovations, and multi-site implementation
TABLE 4. MATERNAL AND PERINATAL HEALTH: PRODUCTS AND MILESTONES
ID PRODUCT MILESTONES CLASSIFICATION
HRP PRODUCTS
B01 Standards developed for fetal growth and development 1. Fetal growth study secondary analyses conducted Priority A
2. Guideline development meeting conducted HRP/MPH
3. Tool for customizing fetal growth curves developed
B02 Interventions for stillbirth reduction based 1. Research protocol on the use of continuous Priority A
on Doppler screening developed wave Doppler screening developed HRP/MPH
2. Data collection initiated in 2 countries
3. Systematic reviews of other key interventions conducted/updated
B03 Guidance for implementation of the 2016 1. Research protocol finalized, decision-support tools developed Priority A
WHO Antenatal Care Model developed 2. Formative research conducted HRP/MPH
through implementation research
3. Intervention designed and implementation initiated
B04 Implementation toolkit for the "Born Healthy" 1. Current antenatal care recommendations adapted Priority C
intervention finalized and disseminated for the group antenatal care format HRP/MPH
2. Toolkit finalized and disseminated
B05 Effectiveness of a novel magnesium sulfate regimen 1. Intervention designed and study design agreed Priority C
for eclampsia prevention and treatment evaluated 2. Research protocol finalized HRP/MPH
3. Trial data collection initiated
B06 Effectiveness of digital and wearable technologies for 1. Research protocol developed Priority C
prediction of pregnancy complications demonstrated 2. Data collection initiated HRP/MPH
B07 Quality of care around the time of childbirth 1. WHO recommendations on non-clinical interventions for Priority A
in high caesarean section settings improved reducing unnecessary caesarean sections developed HRP/MPH
through testing interventions in multiple sites 2. Formative research protocol approved, implemented
3. Intervention designed and implementation
initiated in at least two countries
B08 Global roadmap for improving experience of care in 1. WHO recommendations on intrapartum care for Priority A
pregnancy and childbirth developed and tested a positive childbirth experience developed HRP/MPH
2. Roadmap developed through evidence syntheses
3. Human rights integrated into study design and analysis of outcomes
B09 Guidance for implementing the WHO intrapartum care 1. Protocol for implementation research developed Priority A
model developed through implementation research 2. Formative research conducted HRP/MPH
3. Intervention phase design finalized and protocol approved
4. Implementation initiated in at least 1 country
continued on next page
14 HRP PROGRAMME BUDGET, 2018-2019research to support adaptation of WHO recommendations on interventions to reduce
recommendations on maternal sepsis. unnecessary caesarean sections and by
conducting multi-site implementation research
New technologies have the potential to for evaluating the effectiveness of interventions,
improve pregnancy and childbirth experience implementation frameworks and processes.
and health outcomes. HRP will coordinate
the development of digital and technological Over the years, HRP has developed a
innovations, including wearable technologies series of WHO clinical and programmatic
artificial intelligence and machine-learning tools. guidelines for maternal and perinatal care.
It will ensure continuous review of these
HRP has long advocated for rational use of guidelines, undertaking revisions as required
caesarean section, performed exclusively for by new evidence, and developing consolidated
medically indicated reasons. It will pursue this guidelines and derivative tools that are easier
work and provide global leadership in optimizing to adapt and use by intended audiences.
the use of caesarean section by developing
ID PRODUCT MILESTONES CLASSIFICATION
B10 Evidence of the effectiveness of an intrapartum 1. SELMA prototype integrated into a tablet platform Priority A
decision-support tool - SELMA – Simplified, 2. Research protocol for randomized controlled trial (RCT) finalized HRP/MPH
Effective, Labour Monitoring-to-Action – to support
front-line health workers in labour management 3. Formative research conducted
4. Intervention designed and implementation initiated
B11 Evidence of the safety and effectiveness of a device 1. Research protocol for the RCT developed Priority C
for assisted vaginal delivery ("Odon" Device) HRP/MPH
B12 Evidence of the effectiveness of room temperature 1. Analysis completed Priority A
stable carbetocin for the prevention of postpartum 2. Results published and disseminated HRP/MPH
haemorrhage during the third stage of labour in
women delivering vaginally (the "Champion Trial") 3. Secondary analysis initiated
B13 Evidence of the effectiveness of room 1. Research protocol finalized Priority C
temperature stable carbetocin for the HRP/MPH
treatment of postpartum haemorrhage
B14 Evidence of the quality of medicines used 1. Medicines identified Priority B
during pregnancy and childbirth in field 2. Research protocol finalized HRP/MPH
settings (e.g. oxytocin, misoprostol)
3. Quality of two medicines assessed
B15 Evidence of the safety and effectiveness of 1. RCT data collection initiated Priority A
corticosteroids for women at risk for preterm birth 2. Technical advisory committee and data safety HRP/MPH
monitoring committee meetings held
3. Recruitment completed in at least 1 of 5 countries
B16 Evidence of the global burden of maternal sepsis 1. Analysis of the Global Maternal Sepsis Study completed Priority A
generated and guidance for an intervention for 2. Formative research conducted for the active prevention HRP/MPH
active prevention and treatment developed and treatment of maternal sepsis trial
through implementation research
3. Secondary analysis of the cohort study conducted
4. Implementation research initiated
B17 Digital platform for guideline derivatives on maternal 1. Guideline communication tools developed Priority A
and perinatal health (e.g. managing complications of 2. Guideline implementation tools developed HRP/MPH
pregnancy and childbirth, essential routine care)
B18 Maternal and perinatal health recommendations 1. 40 existing recommendations prioritized for updating Priority A
prioritized and continuously updated 2. Planning proposal approved HRP/MPH
3. Guideline development meetings conducted
4. 40 updated recommendations approved,
published and disseminated
B19 WHO Recommendations on duration of 1. Final guideline approved and published Priority A
bladder catheterization after surgical 2. Guideline disseminated HRP/MPH
repair of simple obstetric fistula
RELATED PRODUCTS OF WHO/RHR IN PROGRAMME DEVELOPMENT FOR REPRODUCTIVE HEALTH (PDRH)
B20 Maternal and perinatal health recommendations 1. Policy briefs developed with partners Priority A
disseminated through derivatives, including 2. Regional meetings convened PDRH/MPH
policy briefs and meetings with partners
MPH: maternal and perinatal health; PDRH: programme development for reproductive health
HRP PROGRAMME BUDGET, 2018-2019 152.3 SAFE ABORTION
Globally, an estimated 56.3 million abortions data to measure trends in the magnitude
take place each year. Over the past 25 years, of unsafe abortion and its consequences.
abortion rates declined markedly in developed This will include documenting the impact of
regions but have remained static in developing inequalities in access to safe abortion care
regions. Less than half of all abortions take place as experienced by adolescents, poor women
in circumstances that would be considered safe, or women in humanitarian situations.
and over the years 2003–2009, abortion-related
deaths accounted for 7.9% of all maternal As part of its technical support to countries,
deaths. An estimated 7 million women seek HRP will continue to guide progressive
facility-based care for abortion complications. policy development and reform in order
Measurement of abortion-related events has to increase access to safe abortion care
always been methodologically challenging, through documenting the impact of diverse
but the complexity has increased manifold interpretations and applications of abortion laws
with the widespread informal use of and policies (both facilitative and restrictive)
misoprostol outside of health-care facilities. on access to and availability of services, and
on the incidence and safety of abortion.
Eliminating unsafe abortion has been a strategic
objective of HRP since its inception, placing Over the past 15 years, HRP has been
it in a unique position within the UN system recognized for its leadership in the development
to provide credible scientific information and of WHO’s technical and policy guidance
guidance to countries on understanding and on safe abortion, which integrates clinical,
interpreting abortion data. Recently, HRP health system and human rights issues.
introduced a reconceptualization of the way the Evidence-based updates and revisions to
definition of unsafe abortion is interpreted, and the guidelines will continue. Scaling up the
is developing global estimates of the distribution use of these guidelines remains a challenge
of safe and unsafe abortion along a continuum. and HRP will develop implementation
HRP will pursue this work and strengthen research to facilitate this process.
the global evidence base of population-level
16 HRP PROGRAMME BUDGET, 2018-2019TABLE 5. AFE ABORTION: PRODUCTS AND MILESTONES
S
ID PRODUCT MILESTONES CLASSIFICATION
HRP PRODUCTS
C01 Evidence of the effectiveness of decentralized 1. Research protocol finalized Priority B
models of providing medical abortion 2. Feasibility/formative research conducted HRP/SA
3. Implementation under way
C02 Evidence of effectiveness of anonymous third party 1. Research protocol for population-based study finalized Priority A
reporting as a new way to measure abortion safety 2. Study implemented in 2 sites HRP/SA
3. Results published and disseminated
C03 Evidence of abortion law and policy 1. Country case studies (at least 3 countries) completed Priority A
application in countries, based on the 2. Three subregional dissemination/capacity- HRP/SA
Global Abortion Policies Database building workshops conducted
3. Paper on impact of punitive sanctions on risk
perception and safety of abortion procedure
C04 Facility-based evidence on the burden 1. Africa and Latin America surveys implemented; other regions Priority A
of abortion complications implemented depending on the results from Africa HRP/SA
2. PAHO/WHO Network of Care for Women in Abortion
Situations (MUSA) network strengthened in terms
of data collection and research methods
3. Survey implemented in selected countries in the
WHO South-East Asian, Western Pacific, Eastern
Mediterranean and European regions
4. Secondary analyses published and disseminated
C05 Evidence of safety and effectiveness 1. Randomized controlled trial initiated and completed Priority B
of medical management of second- 2. Results published and disseminated HRP/SA
trimester intrauterine fetal death
C06 Evidence on application and scale-up of WHO 1. Research protocol finalized Priority C
safe abortion guidelines in 3–4 countries 2. Study initiated HRP/SA
C07 Facilitation of in-country adaptation of 1. Fellows identified, managed and mentored through the process Priority C
guidelines using implementation research of research question development and systematic reviews HRP/SA
through the fellowship initiative 2. Proposal developed for in-country work for post-fellowship period
C08 Safe abortion technical and policy guidance 1. Stakeholder survey and scoping completed Priority A
developed (clinical, service delivery, human 2. Evidence syntheses completed HRP/SA
rights, quality, monitoring and measurement)
3. Third addition of the guideline published
C09 Scale up availability and use of combi- 1. Strategy developed and logistics completed for Priority A
packs for medical abortion international consultation on global scale-up of HRP/SA
combination-packs for safe abortion
2. Activity launched in up to 10 countries
C10 Guideline on medical abortion 1. Print, online and interactive versions of the Priority A
developed, adapted and used medical abortion guideline launched HRP/SA
2. One regional dissemination event held
3. Implementation and adaptation supported through partnerships
SA: safe abortion
A powerful development in recent years has implementation research on task sharing and
been the increasing evidence base for moving self-management approaches for increasing
medical abortion care to the community level the availability of mifepristone and misoprostol.
and for women to self-manage all or parts of
the process. Conventional models of safety, Second-trimester abortion carries significantly
service delivery and quality of care do not apply higher risks of morbidity and mortality, yet it
in these settings and innovative interventions remains neglected in terms of service-delivery
and interventions to make accurate interventions. HRP will coordinate development
information, high-quality drugs and appropriate of a global evidence base on innovations in
back-up care available to women in these the safe and effective delivery of abortion
circumstances are needed. HRP will develop procedures during the second trimester.
models of care by coordinating multi-site
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