I have been greatly looking forward to this week.

This is the first time ever that all WRs and Liaison Officers have been gathered here at Headquarters in Geneva. It is not one day too early, and let me tell you why:

• Nobody in WHO is more exposed to the health realities among the populations we are meant to serve.
• Nobody in WHO is better placed to see if our joint efforts really make a difference for those who need it most.
• Nobody in WHO is better placed to pick up failures and successes - to observe bottlenecks and discover new opportunities.

For most national governments, and many of our partners in the international community, you are the public face of WHO. And yet - strange as it may seem - it seems at times that nobody is as far away from Headquarters than you. You are rarely involved in strategic planning, and your daily experiences - exciting or hard - just occasionally reach us here in Geneva.

This was one of the first observations I made when I studied the work of the Organization before taking up my responsibilities as Director-General. And one of my first decisions was that this had to change.

I discovered that people frequently talked about three levels of the Organization. People spoke about the global level - dealing with global issues; the regional level - dealing with regional efforts and coordinating country activities; and finally the country level - dealing directly with the national Ministries of Health.

I am committed to the concept of One WHO. Not seven - meaning Geneva and the six Regional Offices. And let me add on this occasion - not three - one at the global level, one at the regional level and one at the country level.

One WHO; setting its priorities as one, performing as one, making a difference as one. A WHO where all of us feel like being part of the same team - regardless of where we go to work every morning.

This is what we wish to achieve. We are getting closer, but there is still quite a way to go. The purpose of this week, with your help, is to take a solid step forward.

We wish to learn from you - from your experiences - from your knowledge and from your suggestions. We wish to present to you a new structure at Headquarters and explore with you how we, together with the Regional Offices and our collaborating centres, can be of better help to you in your daily work. We wish to explore the implication of changing relationships on the international health scene, and in particular how they influence work at country level.

Conversely - we recognize that your work in countries is of great value for our strategic planning and that it can influence our relationships in the international health community.

This morning, I would like to focus on four main themes:

• First, I would like to look ahead and to share with you some thoughts about a new approach to working in and with countries.
• Second, I would like to talk about the organizational changes we have made so far - where they are leading, and how the process of renewal is designed to underpin WHO's country support.
• Third, I would like to share with you our current thinking on WHO's corporate strategy. In particular, I would like to reflect on how different elements of the strategy will affect the way we think about our work in countries.
• And last, I would like to highlight some of the challenges that we need to address if we are to make the vision of a new approach to working with countries a reality.

These thoughts are based on my visits to the Regions, my interactions with Member States, inputs from Regional Directors and not least my meetings with many of you. In addition, a great deal of thoughtful work has taken place since July - spearheaded by the Working Group on Partnerships with Countries on which all parts of WHO have been represented.

My point of departure is simple: it is the populations of our Member States that we are here to serve. A

All parts of the Organization have contributions to make. This is, as I see it, the raison d'être of WHO as a whole.

I say working for, in and with countries.

In all our activities we work for countries, and we do so in two ways. We work in countries by establishing a direct presence in order to respond to their specific development needs. In this work you are key. You promote the policies, strategies and programmes of the Organization and you cooperate with national authorities in the formulation of their health policies and priorities.

We also work with the entire community of countries, collectively and in groups, helping them to mobilize their collective wisdom, knowledge and experience in the production of norms and standards, sound evidence and surveillance data. These are international public goods that benefit all.

Let me give you some examples:

• We work in countries when we collaborate with Ministries of Health as they coordinate key actors in the health sector.

• We work in countries when we cooperate with local authorities as they design a DOTS programme to combat TB.
• We work in countries when we collaborate with national governments in advocating active ageing policies.
• We work in countries when we cooperate with national policy-makers as they review options for health care reform.
• But we also work with countries when we set standards for blood safety.
• We work with countries when we organize disease surveillance networks that protect populations from events occurring beyond their national borders.
• And we work with countries to synthesize experiences with health reform on which our advice to specific countries is based.

For WHO to make a difference in the world, it must make a difference in countries. Therefore we have to ask: how can the whole of the Organization, working together, best support you doing your job? What can we do better, or at least differently, to support you in your work?

For example - how can the whole of WHO best support you:

• in responding to the needs of the Ministry of Health?
• in working with the other Ministries, such as finance and planning, whose work directly impacts on the health sector and health?
• in supporting governments in their negotiations with the World Bank, regional development banks, bilateral agencies or other development partners?
• In finding more effective ways of working beyond government ministries - with local NGOs, professional associations and other partners active in the health sector?

If you are to be effective, WHO as a whole must be effective. Let us therefore reflect for a moment what it will take for our Organization to regain its position as a more significant actor.

• WHO must be seen by governments and other agencies to have a sound understanding of sectoral needs and the political and institutional context in which they have to be addressed.

• WHO must be seen as a reliable source of high quality advice, and act as a facilitator with a technically authoritative voice.

• WHO must possess up-to-date evidence, set relevant and realistic norms and standards which are responsive to the needs of Member States.

• WHO must be able to serve as a broker and negotiator for better health - helping to reconcile the concerns of Member States with those of the external agencies that support health and economic development.

• WHO must be able to help shape the rules of engagement between governments and external agencies, as well as being able to use its own limited funds as strategically as possible.

• WHO must be instrumental not only in raising resources for health, but also in placing health at the heart of the development agenda.

This is a tall order. But it is a clear and consistent message, and one that comes from all our international partners. If we are serious about our ambition to earn a leadership role either at global or national level, these are the skills and capacities that we need to possess: at Headquarters, in our Regional Offices - and perhaps more important than anywhere else - in our Country Offices.

We need to get our own house in order. My first concern was to make sure that WHO's structure at Headquarters more accurately reflected the business we are in. This we have done. Fifty-two separate programmes have been grouped into nine clusters and thirty-two departments.

Two Cabinet Projects - Roll Back Malaria and the Tobacco Free Initiative - are well underway and I hope you are getting acquainted with them. A Cabinet Project is a concentrated effort aimed at mobilizing our work - sharpening our focus, bringing together the efforts and triggering the contribution of our Member States and partners.

The Projects will act as pathfinders, exploring new ways of working together across the Organization. They cut across departments and clusters, and we all have a stake in making them succeed.

A third project, Partnerships for Health Sector Development has just been launched, and I will be saying more about this in a minute.

Change was necessary. Drawing on all the knowledge and experience assembled in WHO - but looking ahead - not looking back. The change process has placed a real burden on staff, not least here at Headquarters, and I pay tribute to the way they have responded.

I wish to report on a complete process of structural change to the World Health Assembly in May. It needed to be fast. Dragging on would not be wise - not for WHO, not for staff and not for our technical work.

What we are after is a better team. A WHO working, acting and making a difference as one. The clusters will help us get there. We have more coherence between our activities - and that will serve you too. Our programmatic work no longer operates in isolation. It is part of a broader context, and that will - we hope - give you broader support.

To take just one example: we have combined the two previous medicines programmes - one normative, concerned with global standards, and one operational, concerned with essential drugs - into one department of Essential Drugs and Other Medicines. This will bring greater unity of purpose.

We have a decision-making process which puts single decisions and issues into a larger picture. The Cabinet - where I bring together the Executive Directors on a weekly basis - has a four month work plan mapped out, and you will receive a copy of this plan during this week. On all strategic issues the Regional Offices will be given time to comment and improve on the recommendations. I also wish to include WRs with special experience - so do not be surprised if a draft Cabinet paper lands on your desk for comments.

Another issue which has demanded a real effort has been the budget. You know the challenge. We had very few weeks to totally renew the budget structure to fit with the cluster structure, and to shift and reallocate resources to match new priorities. We presented to the Executive Board a shorter document - shorter, but sharper. The budget was well received. We are now working hard to improve and further sharpen the objectives and expected results.

In addition, the regional budgets will be presented according to the clusters. It does not mean that we will ask the Regional Offices to adopt the same structure as at Headquarters. But the signals from the Board told us that it would be more transparent to have the same structure in the budget.

What then about the country budgets, representing nearly 40% of our regular budget?

You will notice that the country budget is distinct from the budget of the Regional Office. This sends a signal of the direct allocation under the control of the Country Office. But the real expenditure on country activities - of course - is broader and larger.

This budget structure signals our desire to see a better fit between the responsibility of the WR and his or her managerial autonomy. With every right comes a responsibility. These are WHO allocations to support country work - and we have to spend it wisely.

We have now shown this spending more clearly in a separate part of the 2000-2001 proposals. The Executive Board last month had a discussion about what country budgets should be used for and how allocations were made within a Region. I undertook to come back to the Board next January with proposals in these areas, and we will be seeking input to this review from all those directly involved.

The strategy behind all change is to be better placed to do our work and to pursue our priorities. The major changes will soon be behind us. But like all effective organizations we are going to have to live with change as a permanent feature.

One such ongoing change process is the policy of rotation and mobility. For too long there has been too little mobility between Geneva, the Regional Offices and the countries. We need more interchange - enabling the whole of the Organization to learn from different experiences. This policy has started, and we are gradually seeing the first results. In a few days the initial rotation following the reorganization of departments draws to an end. It will then be followed by a general policy of mobility.

Being the lead agency in health we need to understand and define our own role. Let us agree; the broad development agenda is too big and too complex for any single agency. You feel that in your everyday work. Even the global health agenda is too big for WHO alone. We must develop a clear sense of how we, as a UN technical agency, can use our resources to the greatest effect.

Health for All identified equity as a core value for our work. We now need to take this one step further and define more clearly a corporate message for WHO into a new century - a message that we all can refer to - a message that can guide us in our work and be the glue in our efforts to make One WHO.

This is work in progress. I presented the four following strategic themes to the Executive Board last month:

• We need to be more strategic in our work in and with countries.
• We need to be more focused in helping to obtain better and more equitable health outcomes.
• We need to be more effective in supporting health sector development.
• And we need to be more innovative in creating influential partnerships.

Each one of these themes brings its own special challenge to you as WHO Representatives and Liaison Officers. I have already spoken in general terms about our work with countries. But there are some points that I would like to add about what it means to be more strategic.

In too many countries, the regular budget is divided between a large number of disparate activities and programmes, with insufficient attention being paid to where that input can make the most difference.

To take just one example that one of you brought to my attention: In the Executive Summary of the Annual Report, a WR explained that 4.9 million US dollars from WHO's regular budget had been allocated to cover the cost of 428 priority activities in 44 different national health programmes. Priority setting is indeed complex - but this seems really to atomize our efforts.

Too often we are concerned with accounting for inputs. If we are to be truly strategic, we need to think more about what effect our resources are having - and how they complement and add value to the efforts of others.

Being strategic means thinking not just about what we spend, but what we do. We are an Organization whose prime resource is knowledge and people. We are not a major donor. Examining budget allocations in the country programme does not give a true picture of how we influence health and development.

Being strategic does not just refer to making detailed plans once every few years. It is a state of mind, it means looking for opportunities - within an agreed framework - to advance the cause of health in the national agenda. It means being skilled at presenting our case, when it matters, to the people that matter. As representatives of WHO, this is your challenge.

If we are to use our resources wisely, we must be able to show that our support is based on well-documented country strategies which clearly explain the thinking that underpins WHO's role in a particular country - setting decisions in the context of a concise analysis of sector development issues.

I believe the goal for us should be to end up with one country programme for what the whole of WHO can contribute. This programme would of course have to be the result of very close collaboration and exchange with the national government. And in the next stage, this WHO programme would be our input when looking at what all contributors can do together.

I am particularly concerned that we focus on health interventions that will help lead populations out of poverty. Let me highlight some key priorities as they are defined in the Budget.

• We are committed to reducing the burden of sickness and suffering resulting from communicable diseases. Roll Back Malaria is central to this approach. But we will also contribute as effectively as possible to combating the global epidemics of HIV/AIDS and TB, and to completing the eradication of poliomyelitis.
• We need to step up our ability to deal with the rising toll of noncommunicable diseases. Special attention will be given to cancer and cardiovascular diseases. The Tobacco Free Initiative is supporting and leading this approach.
• We will pay more attention to the delivery of high quality health care for children, adolescents and women.
• We will put the spotlight back on immunization as one of the most cost-effective health interventions.
• We need to intensify our efforts to reduce the enormous burden of malnutrition, especially in children.
• We will continue to support countries in their quest for access to affordable and quality essential drugs.
• We will work to see that mental health - and particularly the neglected scourge of depression - be given the attention it deserves.
• We need to be better at responding to increasingly diverse kinds of emergencies and humanitarian crises.
• We will develop our capacity in WHO - and in collaboration with others - to give advice on the crucial issue of health care financing issues.
• And we need to be able to deal more effectively with intersectoral issues - particularly the threats to health that result from environmental causes.

This is a long list. But your challenge, drawing on help from the rest of WHO, is to ensure a better match between the health needs of specific countries, global health priorities and WHO's response. At the same time being ready to play your part in alerting us to changing and emerging threats to human health.

WHO has always been strong at responding to specific requests. We are good at fielding highly qualified technical experts. But often individual experts tend to see the world through their own expert lenses. We are less good at helping senior decision-makers deal with the big picture.

You know very well that your senior colleagues in Ministries of Health do not have the luxury of focusing on single issues. Health is one of the most politically and institutionally difficult sectors in any country. If WHO is to earn a leadership role in health, we cannot deny the responsibility of helping our colleagues deal with complexity.

In too many countries, national governments have tended to look to other agencies for advice on issues that affect the sector as a whole. WHO needs to become a more reliable and effective supporter of countries as they reform and restructure their health sectors. We also have to be clear that reform is not an end in itself. It is a way of making sure that people - particularly poor people - get a better deal from their health system.

Regaining our place at the centre of the health sector development agenda is a challenge for the whole of WHO - but especially for our Country Offices and Representatives. And it is one reason why I have launched the project under the title of Partnerships for Health Sector Development.

As you will hear during the week, the Project will be working to advance our strategic agenda on several fronts. It will work throughout the Organization to establish a health sector development perspective in all aspects of our work. It will also be involved in helping you develop a more strategic approach to work with countries.

Partnerships at national level are going to become increasingly important. And this means that we need to make a shift. We need to move away from our traditional approach which too often has favoured our own small-scale projects - to one which gives more emphasis to strategic alliances in which we influence both the thinking and spending of other international actors.

You know a lot about partnerships on the ground - with other UN agencies, bilateral development agencies, NGOs and the private sector. Just think about the alliance behind the national immunization days - and the excellent relationship we have developed with Rotary International in our fight against Polio.

There are many examples. The Manas Programme developed by the Government of Kyrgyzstan with help from EURO has been influential in providing a solid foundation for health development in that country and continues to influence the activities of all other donors in the country. In Vietnam, Cambodia and Laos the European Commission has made substantial resources available for malaria control, and WHO is made responsible for preparation, planning and technical follow up for the entire duration of the programme.

Elsewhere in the world there are similar opportunities for us to pursue and many of you have experience of doing just that.

The World Bank and bilateral development agencies are the largest providers of funds. We need to work with them and to make our voice and advice heard loud and clear. For example, in Indonesia, in the face of the economic crises, WHO has been working closely with the World Bank, the Asian Development Bank and the Indonesian Central Planning Bureau to build a "health link" into the multimillion dollar safety net loans to the country.

For me this is the message: We can lead more effectively when we link up with others, agree on a clear division of labour, and ground rules for conducting our relationships. Your challenge, working in countries, is to play a part in helping to forge real partnerships that help our Member States achieve tangible health outcomes.

I am pleased that our closest partners in the UN family have responded to our invitation and sent their senior representatives to this meeting. We want them to speak out. What works well and what does not? How can we improve our collaboration in countries?

I believe we can do a lot more by working more closely together. During my years as Prime Minister of Norway we spent time and effort to see how we could contribute to improve the UN performance in countries. I was then - and I am now - a strong supporter of a much closer collaboration between UN agencies working in countries. Where possible we should strive for joint approaches, responding as well as we can to the national and local needs.

I know this is how many of you already work. I also know that there are issues making such pooling of efforts difficult. Let us be specific and address those issues. I also know that the specialized agencies have not yet formally become part of all UN reform proposals.

To me, however, these formalities are secondary. We need to work with our UN partners to help refine the purpose of the UNDAF process and develop a clear vision of how closer coordination will be expressed in individual countries. That may include moving all the way towards common policy positions on key sectoral issues.

Eighteen of you have been actively involved in strategic planning exercises during the UNDAF pilot phase. I look forward to learning about your experiences. This will help me tailor my input when I discuss the follow up with UNDP and the Secretary-General on WHO's further role.

We need to be very pragmatic and look for what works and what does not. I recall what Kofi Annan said when we launched Roll Back Malaria last October: This is UN reform in practice.

WHO is in an ideal position to play a pivotal role in sector-wide approaches - and in several countries it is already doing so. The exciting work that is going on in Uganda and Cambodia comes to mind and I know that many of you have similar experiences to share. Agencies, development banks and Member States are coming to realize the disadvantages of traditional development projects. They recognize, as we do, that sectoral approaches offer a way of supporting health development that strengthens national ownership and helps to build sustainable national systems.

Our thinking on sector-wide approaches is at an early stage. There are no blueprints to show how they should be organized. The experience you gain has the potential to influence the international agenda in ways that will have a lasting effect on how we conduct our business.

In our discussions this week, I would encourage you to think about the changes that are needed at Headquarters and in the Regions as well to make our efforts more consistent where it matters most. What would you like to see change in Geneva and in the Regional Offices to better serve you in your work?

Coordination of our inputs to countries is critically important. I would encourage you to think about coordination mechanisms that will help to draw together all our resources. Some of you have already raised with me the wish to see an improved capacity here in Geneva to respond to country needs. If that is a widespread wish - let us hear how you see this.

Dear colleagues,

We need to envisage a situation in which we enable WHO Representatives to be far more effective in managing our relationships with countries. A situation in which Country Offices draw upon people, skills and experience from other parts of WHO. A situation in which the WHO country programme is not driven by the needs of different programmes, but by the needs of our national partners. A situation where WHO delegations do not meet each other in an airport of a Member State, heading on to separate missions and not knowing what the other colleagues are up to.

Let me encourage you to think carefully about what will be necessary for this to happen. What will be needed in terms of greater managerial autonomy, new systems and procedures, flows of information, planning tools, and skills development?

Lastly, if more effective country work lies at the heart of our corporate strategy, I would encourage you to think about how we should assess our performance. This is a particular challenge as we move from implementing our own activities towards working in partnership with others. We must still be able to show how we have made a difference.

A week of hard work and exchange of views lies ahead of us. This is above all your week. I hope you will leave Geneva with a stronger feeling of belonging to One Organization - with a motivation of going back to make a difference with support and contributions from the whole of WHO.