WHO collaborating centres in the WHO European Region - Where we are and what's next
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WHO collaborating centres
in the WHO European Region
Where we are and what’s next
OCTOBER 2021
WHO collaborating centres
in the WHO European Region
Where we are and what’s next
OCTOBER 2021
Abstract This report presents an analysis based on feedback from responsible officers working at the WHO Regional Office for Europe and WHO headquarters regarding their experiences working with WHO collaborating centres (CCs). It identifies challenges and provides solutions to improve the efficiency and effectiveness of CCs. Furthermore, it highlights the opportunities that exist with CCs to enhance their capacities and maximize their contributions towards the implementation of the WHO Global Programme of Work and the European Programme of Work. The report overall highlights the high-quality strategic and operational work that CCs deliver and how it is beneficial in achieving WHO’s priorities and mandates. Document number: WHO/EURO:2021-3909-43668-61410 © World Health Organization 2021 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: Evaluation of WHO’s work with collaborating centres: WHO European Region summary. Copenhagen: WHO Regional Office for Europe; 2021”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. (http://www.wipo.int/amc/en/mediation/rules/). Suggested citation. WHO collaborating centres in the WHO European Region. Where we are and what’s next. Copenhagen: WHO Regional Office for Europe; 2021. 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. Designed by: Pellegrini
Contents
Executive summary.................................................................................. iv
Aim of the report....................................................................................... vi
Summary of key findings......................................................................... vii
Recommendations.................................................................................... ix
Background.................................................................................................1
Role and rationale of CCs............................................................................... 1
Management and evaluation..........................................................................2
WHO’s mandate and priorities....................................................................... 3
Methodology................................................................................................... 3
Findings.....................................................................................................4
Contribution to GPW/EPW............................................................................. 4
CC activities.....................................................................................................6
Training, education and capacity-building activities...................................7
Emergency related activities........................................................................10
Financial contributions..................................................................................10
Quality of CC work........................................................................................ 11
Engagement with CCs..................................................................................13
Networks of CCs...........................................................................................14
ROs in the WHO European Region...............................................................14
ToR and workplan..........................................................................................15
Working with Member State institutions not recognized as CCs.............15
ROs working with other CCs........................................................................16
Reporting and monitoring progress of CC..................................................16
Supporting work of CCs...............................................................................16
Key challenges...............................................................................................18
Conclusions.............................................................................................20
References............................................................................................... 21
Annex 1. Survey questionnaire................................................................22
iiiExecutive summary
The WHO collaborating centres (CCs) are key Member State institutions with expertise that
is relevant to WHO’s work and can benefit all countries. Distributed globally, CCs represent a
tremendous asset for WHO and, if selected and nurtured properly, are a wealth of human resources,
information, knowledge and activities that can contribute to and supplement WHO’s mandated work.
They play a crucial role in supporting the implementation of WHO’s Thirteenth General Programme
of Work (GPW) 2019–2023 and the European Programme of Work, 2020–2025 – “United Action for
Better Health in Europe” (EPW).
The overall objective of the report is to identify opportunities to improve the efficiency and
effectiveness of CCs in relation to implementation of WHO’s mandated work and the strengthening
of institutional capacity in Member States. The WHO Regional Office for Europe conducted an
analysis to seek feedback from responsible officers (ROs) working at the WHO Regional Office for
Europe and WHO headquarters about their experiences working with CCs.
The analysis used a mixed-methods approach to integrate both quantitative and qualitative data.
It included disseminating a survey and conducting individual interviews with ROs. This report,
prepared by the Resource Mobilization and Alliance Unit of the WHO Regional Office for Europe,
presents findings and recommendations from that analysis.
Key findings included that all ROs agreed that the work CCs deliver is of high quality and is beneficial
to delivering WHO’s mandated work. Overall, the workplans and TORs for the CCs are aligned with
GPW/EPW with the highest contribution to universal health coverage (UHC), although there are
gaps in the representation of some technical outcomes. It is estimated that the in-kind contribution
by CCs in the European Region is USD14 million per annum.
Three key challenges raised by ROs that are impacting on the efficiency and effectiveness of CCs
are questions around the value that designation brings to CCs, funding constraints and bureaucratic
burdens. The following recommendations were made.
ivIdentifying opportunities to maximize the contribution to GPW/EPW, including the development
of a strategic approach to increase the connections and synergies with technical networks of
CCs and undertaking an exercise to map potential centres, look to build capacity and initiate joint
collaboration.
Strengthening internal governance through formal planning and evaluation mechanisms,
integrating CCs in WHO strategic documents, increasing the presence of executive management
engaging with CCs, rearticulating the value proposition of CCs and streamlining bureaucracy.
Building capacity by facilitating knowledge management in WHO and strengthening capacity-
building with CCs to meet the expectations set out in their terms of reference (ToRs) and workplans.
Strengthening partnerships and visibility by establishing communication and engagement
mechanisms, developing an internal/external communications strategy and increasing visibility
and reference to the work of CCs at higher platforms.
vAim of the report
Through the global network of CCs, WHO gains access to the technical expertise and knowledge
of top institutions worldwide, which can support its work and be an additional mechanism to help
to ensure the scientific validity of global health work. These global networks can also help WHO to
exercise leadership in shaping the international health agenda. This report will look towards guiding
the work of the technical units and recommend actions and ways forward in interactions with CCs.
To inform the report, the WHO Regional Office for Europe conducted an analysis to seek feedback
from ROs working at the Regional Office and WHO headquarters about their experiences working
with CCs. The objectives of the analysis included:
• to gather input to develop the background and agenda for the first meeting of CCs in
the WHO European Region and to ensure best practice, innovated ways of working,
challenges and common issues are included in its working sessions;
• to forward key findings to executive management and propose recommendations and
concrete actions for enhanced and streamlined interactions with CCs; and
• to inform updates to the WHO European Region’s corporate strategy for CCs.
viSummary of key findings
Contribution to WHO’s mandated goals
Overall, the ToRs and workplans for the CC are aligned to the priorities of the GPW/EPW. The priority
that CCs in the WHO European Region contribute most to is working to benefit people with UHC
and almost half of their CCs work in emergency-related activities. Although all priority areas and
flagships are somewhat covered by CC, there are gaps in the representation of some technical
outcomes.
The top two most frequent activities CCs have delivered in support of WHO’s priorities and mandates
in the last four years were training, education and capacity building activities and generation and
publication of technical reports, articles and book chapters. The majority of CCs have published
between one and five publications over the last four years in support of WHO’s priorities and
mandates and over two thirds of ROs identified that most CCs deliver or plan 1–5 education, training
or lifelong learning activities annually, which are delivered face to face and/or virtually.
ROs reported there are gaps where WHO should look to build capacity and initiate joint collaboration
in areas technically and geographically where there are few or no CCs currently; they also asked
for more formal mechanisms for communications and engagement with CCs.
Some CCs require more support and capacity-building from WHO in order to meet the expectations
set out in their ToRs and workplans.
Quality of work
All ROs agreed upon the quality of CCs work and commended it. They described CCs as an asset,
and agreed that their work is beneficial and gives high value to WHO’s mandated work, including
in knowledge generation and capacity. Some ROs mentioned that their programme area in the
Regional Office is underfunded and often CCs step in to support their work and; with the budget
and time CCs provide, WHO is able to undertake work not possible alone.
viiFinancial contributions
ROs estimate that over half of the CCs provide more than $50 000 annually through in-kind
contributions. For a total of 280 CCs in the WHO European Region, this amounts to a minimum
US$ 14 million per annum.
Networks of CCs
CCs were also specifically acknowledged for their work within global and regional networks, and
the majority of ROs identified that they have a network, or are in the process of consolidating a
network, of CCs in their thematic area.
Engagement with CCs
ROs reported that they regularly and formally monitor and discuss progress of ToRs and that CCs
are mostly kept informed and involved in relevant technical work conducted by WHO, including the
development of products and events.
Supporting work of CCs
Many ROs reiterated the importance of increasing the presence of executive management engaging
with CCs, with the WHO CC Regional Meeting in November 2021 being the prime opportunity to
foster engagement.
Overall, most ROs agreed that CC focal points in the WHO Regional Office for Europe and
headquarters provide timely and efficient support when needed and that the system in place
is highly organized. Some ROs asked for online training to be developed and to increase
capacity-building on certain issues: the designation/re-designation process, logo use, copyright
issues and report writing for CCs for WHO products.
Planning and reporting work of CCs
Mostly work completed by CCs was reported or acknowledged in the WHO regular reporting period
through both formal annual reporting and informal reporting opportunities; or future planning, ROs
rely heavily on support from CCs to implement their work. However, only a third of ROs identify
that they have a programme or divisional specific practices and approaches established to working
with CCs effectively
Challenges
CCs include questions concerning the value designation brings to CCs, funding constraints and
bureaucratic burdens, specifically, the lengthy designation and re-designation processes.
viiiRecommendations
Identifying opportunities to maximize contribution to GPW/EPW
Explore ways to increase interactions and support networking opportunities across CCs in the future
to identify synergies, inform them about WHO developments and strategic priorities, exchange best
practices and find ways to improve engagement (such as through annual regional CC meetings
whether virtual or face to face).
Develop a strategic approach to increase the connections and synergies with technical networks
of CCs, regionally and globally, technically and geographically.
Develop detailed mapping that gives an overview geographically and technically to identify potential
centres, and look to build capacity and initiate joint collaboration to fill gaps in priority areas and in
countries without CCs, focusing on small countries and the Balkan Member States.
Identify institutes in Member States that fulfil WHO CC criteria but are not yet designated, including
those currently working with WHO. Quality over quantity should remain the overriding objective.
Strengthen internal governance
Introduce formal planning mechanisms between WHO and the CCs so expectations are clear,
specifically adjusting the expectation of CCs to the current needs, mandates and priorities of WHO
and negotiating how best they can support us in delivering work.
ROs to meet with executive management annually to discuss the funding, strategic direction,
mandates and desired outcomes of WHO, at the programmatic, divisional and organizational levels.
Look to repurpose/update workplans on (re)designation to reflect this.
Integrate CCs in WHO strategic documents to ensure relevance to programme budgets, country
cooperation strategies and operational plans.
ixAnnual technical and financial reporting from CCs by the ROs should be integrated into planning,
monitoring and evaluation cycles in order to produce annual summaries for governing bodies.
Increase the presence of executive management engaging with CCs, for example through the CC
Regional Meeting and schedule visits to CCs on country missions or when attending events at the
country level.
Review the value of CC designation and rearticulate the so-called value proposition of CCs further.
Develop opportunities to simplify and streamline bureaucracy in the (re)designation process.
Capacity-building
Develop of training materials for strengthening technical capacity in WHO. Facilitate knowledge
management (for example, brown bag lunches, online training or workshops) on various topics
such as intellectual property rights, writing workplans or ToRs, annual reports, the (re)designation
process, funding and using the eCC platform.
Strengthen capacity-building with CCs to meet the expectations set out in their ToRs and workplans
and on specific issues: (re)designation process, funding, logo use, copyright issues and report
writing for CCs for WHO products.
Strengthening partnerships and visibility
Strengthen partnerships by establishing communication and engagement mechanisms (inviting to
meetings, using as consultants, informing on work of WHO, etc.).
Develop an internal/external communications strategy to:
• communicate (especially to Member States) the work and impact of the CCs and their
networks;
• look at ways to recognize CCs in order to acknowledge the contributions of their work;
• provide a platform for the work of CCs, including announcing new designation and
sharing best practices in implementation of the EPW; and
• inform CCs of ongoing work within WHO.
Increase visibility and reference to the work of CCs at higher platforms such as governing body
meetings, regional/national meetings, the Internet and thematic days, and by including the topic
of CCs in discussions with ministries of health, new and existing partners.
Provide more proactive updates to ROs so they can appraise their CCs of work being implemented
by the Regional Office and headquarters, especially in the area of COVID-19 and in any changes to
the (re)designation processes and rules. Updates could be circulated biannually via a newsletter.
xBackground
Role and rationale of CCs
CCs are key institutions in Member States with expertise that is relevant to WHO’s work and are
an essential and cost-effective cooperative mechanism that enables WHO to fulfil its mandated
activities and to harness resources far exceeding its own. They are designated by the WHO
Director-General to individually, and sometimes collectively, carry out activities to support WHO’s
programmes at all levels. Typically, such centres are divisions of national research institutes;
departments of universities, laboratories, hospitals or health ministries; or national institutions
such as academies. WHO designates an institution as a CC for an initial period of four years, which
can be renewed based on its continued relevance and the needs of WHO’s programme of work.
Additionally, once designated, CCs can be part of geographical and technical networks. These
networks have a range of additional benefits and help to create synergies, build capacity in
institutions and countries, provide networking and information-sharing opportunities and allow
pooling of resources to accomplish collaborative projects.
The main role of CCs is to provide strategic and operational support for WHO in meeting three
main needs:
• supporting the implementation of WHO’s mandated work and programme objectives
• enhancing the scientific validity of its global health work
• developing and strengthening institutional capacity in countries and regions.
The main functions of CCs are to support WHO in its tasks of standardization, synthesizing and
disseminating scientific and technical information; provision of services (such as epidemiological
surveillance, laboratory support); research; training and coordinating joint activities; and technical
cooperation in national health development in all Member States. The fundamental logic is to utilize
the inherent expertise in a CC for the benefit of all Member States.
1In line with WHO policy and strategy of technical cooperation, a CC also participates in strengthening
its country resources in terms of information, services, research, training and in support of national
health development. Furthermore, the designation of a national institute as a CC provides the
institution with greater visibility and recognition by national authorities and attracts more resources
and public attention for the health issues that the institution addresses in its own constituency.
Institutions also have increased opportunities: to exchange information; to develop technical
cooperation with other institutions, particularly at international level; and to mobilize additional
resources from national and international funding partners.
Globally, there are currently 842 CCs in 96 Member States. In the WHO European Region, there are
273 CCs, of which 112 have been initiated by the WHO Regional Office for Europe and 161 which
have been initiated by WHO headquarters. These are governed by technical officers based in the
regional offices (44) and headquarters (98). The countries in the Region hosting the largest numbers
of CCs are France, Germany, Italy, the Russian Federation and the United Kingdom.
The Office of the Regional Director for Europe is administratively responsible for CCs geographically
located in the WHO European Region, whether designated by headquarters or by the Region.
Technical responsibility for collaboration is between the RO and the institution.
Management and evaluation
Collaboration with a CC is primarily managed by the RO in headquarters or the region within the
technical programme that initiated the designation. If the designation is made by headquarters,
there is interaction with a technical officer in the region in which the CC is located, and vice versa.
Interaction between technical units in regions and headquarters is meant to ensure that the centre’s
possibilities for technical collaboration are available to the whole of WHO. In each WHO regional
office, as at headquarters, dedicated overall focal points are designated to manage and coordinate
statutory information and procedures on CCs.
Monitoring of technical collaboration takes place on a continuing basis. At the end of each 12-month
period, each CC must submit a formal report on the implementation of activities with the concerned
WHO programme. The purpose of the annual report is not only to monitor the progress of the
workplan but also to document the achievements which have been made and detail any difficulties
which arose during the period or areas for future improvement. A final evaluation takes place at
the end of the four-year designation period and includes an assessment of WHO’s support for, and
actual use of, collaboration with the CC.
To facilitate management, cooperation and networking, a global information system on all CCs has
been developed that is intended to be accessible worldwide to WHO staff, CCs and, eventually, to
Member States and the public health community at large.
2WHO’s mandate and priorities
The 13th GPW is WHO’s five-year strategic plan for 2019–2023. It aims to contribute to the
achievement of the Sustainable Development Goals and to drive public health impact at country
level. Through the GPW, WHO aims to become more focused and effective in its country-based
operations by working closely with partners, engaging in policy dialogue, providing strategic
support and technical assistance, and coordinating service delivery. Additionally, for the WHO
European Region, in 2020 the EPW was endorsed by 53 Member States at the Seventieth session
of the WHO Regional Committee for Europe. The EPW also calls for scaling up existing intersectoral
work with diverse actors to achieve regional and national health and well-being goals and targets
and to meet today’s complex health challenges. CCs can play an important role in supporting the
implementation of the GPW and EPW.
Methodology
The analysis used a mixed-methods approach integrating both quantitative and qualitative data
collection and analysis. Information was collected and analysed through creating and disseminating
an online survey to all staff at the WHO Regional Office for Europe and headquarters serving as a
RO for one or more CCs, with some also serving as technical counterparts (see survey questions
in Annex 1). The online survey was open for eight weeks and closed on 1 September 2021.
The survey included closed and open-ended questions. As an alternative to the survey format,
some semistructured face-to-face and virtual interviews were undertaken with ROs using the same
survey questions to further gather and clarify information about their experiences working with CCs.
For the quantitative analysis, Excel was used to tally the results. Thematic analysis was used for
the qualitative data. The survey questions allowed for an interpretative framework to be applied
when identifying and grouping common topics, ideas and themes.
ROs raised their concerns over the survey design and its limitations. Specifically, most ROs manage
more than one CC. This made accurately answering a question difficult at times if ROs were unable
to consider multiple CCs as an option in their response.
3Findings
A total of 55 ROs participated in the online survey, 27 from the WHO Regional Office for Europe and
28 from headquarters; eight survey responses were incomplete and so only 47 responses were
included in the analysis. There are 44 ROs working for the WHO Regional Office for Europe and
98 ROs working for headquarters; therefore, the overall response rate was 39%.
Contribution to GPW/EPW
The priority that CCs in the WHO European Region contribute most to is working towards UHC
(Fig. 1).
Fig. 1. GPW/EPW priority CCs contribute to in the WHO European Region
0 5 10 15 20 25 30
One billion more people benefiting from 92 27
universal health coverage
One billion more people better protected from 19
health emergencies
One billion more people enjoying better health 23
and well-being
More effective and efficient WHO providing 7
better support to countries
4Under priority 1, working towards UHC, most CCs contribute towards outcome 1.1 (improved access
to quality essential health services lists (n = 13)).
Under priority 2, protecting against health emergencies, the majority of CCs contribute towards
outcome 2.1, countries prepared for health emergencies lists (n = 6).
Under priority 3, promoting health and well-being, the majority of CCs contribute towards outcome
3.1 determinants of health addressed lists (n = 10).
CCs also contribute towards the WHO Regional Office for Europe’s EPW flagship initiatives (Fig. 2).
They contribute mostly towards healthier behaviours: incorporating behavioural and cultural insights
and empowerment through digital health.
Fig. 2. EPW flagship initiatives CCs contribute towards
0 1 2 3 4 5
Healthier behaviours: incorporating
behavioural and cultural insights 92 5
incorporating behavioural and cultural
insights
The European Immunization Agenda 2030 1
Empowerment through Digital Health 84 5
The Mental Health Coalition 4
5CC activities
ROs were asked to reflect on the most frequent activities that their CCs have delivered in the last
four years; 46 ROs answered this question with respondents able to select the two most frequent
types of activity. A breakdown of these types is summarized in Fig. 3.
Fig. 3. The activities that CCs delivered in support of WHO’s priorities and mandates
in the last four years
Generation and publication Providing technical advice
of technical reports, articles, to WHO
book chapters, etc., including
translations
43%
57%
Training, education and
capacity building activities
Provision of reference,
83% substances, standardization
of terminology and
Collection, organization Research projects nomenclature and other
and dissemination of laboratory activities
information through
15%
11%
web-based products (such
as websites, toolkits, etc.)
20% Responding to outbreaks
and emergencies
7%
The top two most frequent activities CCs have delivered in support of WHO’s priorities and mandates
in the last four years were:
• training, education and capacity-building activities (n = 38; 83%)
• generation and publication of technical reports, articles, book chapters, etc.
(n = 26; 57%).
Other activities mentioned that support the work of WHO centred around thematic areas, including
those related to:
• the circular economy
• social enterprises
• health and well-being within regional development context
• mental health and COVID-19.
Fig. 4 summarizes some examples of the type of deliverables CCs have produced in the last
four years or are currently working on.
6Fig. 4. Examples of outputs delivered by CCs in the last four years
Research
Framework on
Refugee & Migrant
Health
Training in NCDs,
emergency Translating
management and protocols &
environment & standards into
health Russian
Regional action Regional action
plan on HIV & TB plan on HIV & TB
Systematic reviews
on climate change Country
& environmental assessment on HIS
health inequality purchasing
Childhood obesity
report
Note: HIS : health information systems; NCDs: noncommunicable diseases; TB : tuberculosis.
ROs mentioned during their interviews that the number of publications (technical reports, articles
and book chapters) produced by CCs in support of WHO’s priorities and mandates varied from CC to
CC. Out of 45 ROs, the majority reported that each CC published between one and five publications
over the last four years (n = 29; 64%) (Fig. 5). Overall, CCs spend a considerable amount of time and
resources developing technical reports and articles and contributing to book chapters in support
of WHO’s priorities and mandates.
Training, education and capacity-building activities
As reflected on CC’s agreed workplan, over two-thirds of ROs (n = 33; 70%) identified that most
CCs deliver or plan one to five education, training or lifelong learning activities annually (Fig. 6).
The main topics addressed in these activities are summarized in Fig. 7.
7Fig. 5. Number of technical reports/articles/book chapters published by CC in support
of WHO’s priorities and mandates in the last four years
Responses (%)
0 20 40 60 80
None
13%
1-5 64%
6-10 7%
More than 10 16%
Fig. 6. The number of education, training or lifelong learning activities delivered or
planned by CCs
Responses (%)
0 20 40 60 80
None
9%
1 5
1-5 70%
6 10
6-10 13%
10 +
More than 10 9%
8Fig. 7. Topics addressed in CC activities
Health poli
cy monitor
ing
Air quality
c ontrol
Tobacco Occupatio
nal health
Health d and safety
ata colle
ction an
d analys
is
n e
TB and HIV nand h
ygie
Climate change and health san itatio
r,
Wate
Food an
d environm Tripartite Childhood obesity
ental he
alth Strengthen
ing commu
nity-based
care
ent Beha
ntion an d managem viour
al an
NCD preve d cul
tural
Emergenc insig
y prep aredness,
re
hts
sponse an
Migrant health d IHR
Multis
ector
ol consu mption al co
ordin
Monito ring alcoh ation
Sexual and reproduct Violence against women and children
ive health and rights
text
tional con
to the na
Tra nslating e
vidence in Mental health AMR
hts
Human rig PHC
Note: AMR: antimicrobial resistance; IHR: International Health Regulations (2005); NCDs:
noncommunicable diseases; PHC: primary health care; TB : tuberculosis.
9Prior to the COVID-19 pandemic, ROs described that most education, training and capacity-building
activities were conducted face to face; however, currently they are largely delivered virtually. Out of
43 ROs, the majority (53%; n = 23) indicated that hybrid learning modalities are utilized to conduct
training.
ROs highlighted that they anticipate that online modalities will continue, and face-to-face
engagement opportunities will be reintroduced once COVID-19 restrictions reduce at the country
level.
Emergency related activities
From the 46 ROs, almost half (n = 20; 43%) identified that they work with CCs in emergency-related
activities, including those pertaining to COVID-19.
The types of activity include:
• response efforts for occupational health and safety and how to protect workers against
COVID-19;
• CCs utilizing existing country and regional networks to assist with COVID-19 activities.
This includes collecting and monitoring data and information about COVID-19 in the
country and sharing with the WHO Regional Office for Europe;
• assessing COVID-19 impacts on key health and well-being services, including mental
health, HIV and hepatitis assessment and treatment services in Member States in the
Region; and
• assessing COVID-19 impacts on obesity and noncommunicable diseases.
One RO described that the ToRs for their CC included emergency activities that covered the
COVID-19 response. Another RO identified that through their strong relationship with the CCs they
manage, it allowed for CCs to provide further support in COVID-19 response efforts; however, this
was not reflected on the CCs’ ToRs.
Financial contributions
Out of 40 ROs, over half (53%; n = 21) estimated that their CC provided more than US$ 50 000
annually through in-kind contributions (Fig. 8).
Some ROs mentioned that their programme area in the Regional Office is underfunded and often
CCs step in to support their work, with the budget and time CCs provide to WHO exceeding what
was possible by WHO alone. In some programmes, 80% of the technical work comes from CC
support. These ROs mentioned that if they had more funding, from either side, then the Regional
Office would be able to utilize CCs’ expertise to a greater degree.
10Fig. 8. The estimated in-kind financial contribution (including staff time) of CCs annually
Responses (%)
0 20 40 60 80
$20,000 Less than $20,000
13%
$20,000-$50,000
$20,000-$50,000 35%
$50,000-$100,000
$50,000-$100,000 33%
$100,000 +
More than $100,000 16%
ROs also stated in interviews that it was often difficult to estimate the cost of CCs’ contributions
to work of the WHO Regional Office for Europe. Most ROs agreed that CCs provide a lot of time,
financial and human resources towards supporting the Regional Office without funding. For many
deliverables, the Regional Office benefits from CCs’ work, and the development of deliverables
usually involves all CC staff to some extent. It was reiterated that the budget and time CCs provide
to WHO to deliver work, exceeded what was possible by WHO alone.
Out of 47 ROs, a third identified that WHO has financially supported their CC or its staff outside
of the agreed ToRs and workplans; for example through consultancy contracts with staff, travel
and general expenses when a CC visits the Regional Office in Copenhagen and through COVID-19
response activities that fall outside the CC’s ToR and workplan.
Quality of CC work
All ROs agreed on the quality of CC work and commended it; they described them as assets and
our expertise champions and acknowledged that their work is beneficial and gives high value to
WHO’s mandated work, including for knowledge generation and capacity.
CCs contain public health experts, and so it is in WHO’s best interest to work with them. The ROs
acknowledged that changes introduced in 2004 to the designation and re-designation process
has led to rule tightening and a reduction in the number of CCs in the Region. This has led to the
remaining CCs’ work being of higher quality than the standard expected. ROs appreciated that the
more stringent policy aimed to improve the quality of deliverables had, therefore, strengthened
the WHO brand.
11ROs highlighted that the formal recognition of institutions by WHO is an asset which supports CC
work and gave added value within global and regional networks and platforms.
There was some mention of the quality of CCs work varying across Member States in the Region.
Some ROs identified that the WHO designation is more important for some CCs than others
as it highlights nationally the importance of the CC’s work and provides resource mobilization
opportunities. However, this does not necessarily mean that the quality of work that the CC
produces is of a high standard.
It was further reiterated that some CCs require more support and capacity-building from the
Regional Office in order to meet the expectations set out in their ToRs and workplans and in WHO’s
policies and standards. Specifically, writing a product for WHO differs from writing an academic
publication, and some CCs need coaching to adjust how they write specific documents under the
designation umbrella.
Proposals to improve the quality of CCs’ work and support them to meet the expectations of the
WHO Regional Office for Europe were proposed by ROs, as summarized in Fig. 9.
Fig. 9. Proposals to improve the quality of CCs’ work and support them to meet the
expectation of the Regional Office for Europe
Capacity and Establish clear
capability building expectations of
in CCs WHO and from CCs
Introduce
formal planning
mechanisms
between the
Region and the
Strengthen CCs
knowledge of CCs
better through
increasing networking
and rapport-building
activities
12Engagement with CCs
Interactions
ROs proposed that interactions across CCs should increase in the future to explore and ensure
synergies, inform them about WHO developments and strategic priorities, and exchange best
practices and ways to improve engagement. The CCs’ Regional Meeting scheduled for November
2021 was raised by ROs as a good starting point for an initiative to strengthen communication and
engagement opportunities among CCs as it will provide an opportunity to explore the added value
of CCs interacting together and identify how this will impact on the work and inputs of WHO.
Out of 46 ROs, most (96%; n = 44) commented that they keep CCs informed and involved in relevant
technical WHO work, including in the development of products and events.
Out of 46 ROs, close to two thirds (61%; n = 28) highlighted that they invite CCs to more than three
relevant technical meetings of the Regional Office annually, including inviting them to policy forums,
the Regional Committee, and its side events.
Communications
ROs asked for more formal mechanisms for communications and engagement with CCs such as a
newsletter detailing updates in CC processes and information regarding mandated work by WHO.
All ROs identified that they communicate and work with their CCs through informal and formal
engagement opportunities, with engagement ranging from a few times a week to monthly.
The majority, of ROs contact their CC at least four times per year (85%; n = 40).
Some ROs explained that there are times of intense engagement, especially when working towards
a deliverable, event or publication, when coordinating outputs from the workplan, or when planning
for re-designation or designation. Some ROs commented that it can be time consuming to respond
to and work with CCs especially those that require capacity-building or when working through the
designation and re-designation process.
Out of 46 ROs, most mentioned (87%; n = 40) that they regularly and formally monitor and discuss
progress of ToRs and workplan activities with the CC through organizing engagement opportunities.
At minimum, this is discussed through an annual planning meeting for the workplan.
Engagement generally happens organically and is most often initiated both ways from the Regional
Office and the CCs (81%; n = 38), for both technical and strategic discussions.
With types of communication modality used by ROs when communicating with CCs, 42 (89%)
communicate with CCs through both virtual meetings (via Zoom, Microsoft teams or Webex) and
by e-mail; 27 (57%) communicate via face-to-face meetings and the use of traditional letters was
not mentioned.
Some ROs mentioned that face-to-face communication modalities were reduced by the travel
restrictions imposed by the COVID-19 pandemic. Other communication modalities mentioned
included WhatsApp and telephone.
13Capacity building
Some institutions would benefit from capacity-building, advocacy and support from WHO before
commencing the designation process and it was proposed that a process of supporting Member
State institutions towards eventual designation be established, especially in countries where there
are few or no CCs currently.
Some ROs stated that the past culture of collaboration between the WHO Regional Office for Europe
and some CCs that was established under different conditions remains pervasive; specifically, past
understandings have been inherited where procedures were not always followed, and it is difficult
to change this culture.
Only 12 of 44 ROs (27%) identified that they have a programme or divisional specific practices and
approaches established to working with CCs effectively. For example, one RO explained that the
ToRs and workplans describe how they will work with CCs. Another RO highlighted that they are
the only person in their programme area responsible for working with CCs, and, therefore, they
had developed their own approaches to working with the CCs they are responsible for, for example
through convening a meeting of their CCs and other key partners every six months.
Networks of CCs
For the next question, ROs were able to select more than one answer; 44 ROs identified that they
have a network or are in the process of consolidating a network of CCs in their thematic area, at
the global (39%; n = 17), regional (41%; n = 18) and/or geographical level (7%; n = 3) (Fig. 10) (3).
ROs cited benefits of having annual meetings to explore engagement opportunities between
different CCs based on thematic areas, geographical locations or similar mandates and interests,
thus exploring the added value of CCs interacting together regularly.
Fig. 10. ROs who identified if they have a network of CCs in their thematic area
Responses (%)
0 20 40 60 80
Global
13% 39%
Regional 41%
Geographical 7%
None 27%
14ROs in the WHO European Region
Of the 47 ROs who completed the survey, 29 (62%) are responsible for managing one to three CCs.
ToRs and workplan
The majority of ROs identified that the ToR and workplan for the CC they are responsible for are
relevant to their technical workplan and align to the priorities of the GPW/EPW. With the introduction
of the EPW, and the unforeseen health and well-being issues arising from the COVID-19 pandemic,
some ROs identified that they were unaware that they could repurpose the activities on the workplan
and reflect these changes in the annual report.
Two thirds (66%; n = 31) of CCs’ ToRs and workplan were initiated by the current RO. For the
remainder of responses, this was either a joint effort between CCs and the RO or created by a
previous programme manager or another technical officer.
Some ROs highlighted that with organizational reforms they had inherited a CC that they had not
previously worked with. They would work with the CC on updating their workplan to align to the
programme area’s technical workplan and the GPW/EPW.
Due to WHO undergoing organizational change approximately every five years, some ROs identified
that it can be difficult to plan in advance. Therefore, some explained that they develop a workplan
with the CCs that is as broad as possible, allowing the flexibility for change in the future. Alternatively,
other ROs identified that they try to design with the CC concrete objectives in the CC’s ToR, so the
expectations of WHO and the CC are clear, where concrete outputs and outcomes are required.
Working with Member State institutions not recognized as CCs
Out of 45 ROs, over 75% identified that they work in some capacity with Member State institutions
that are not a CC but fulfil the criteria.
Some ROs further described that they had discussed with Member State institutions about becoming
a CC, but not all are interested due to the lengthy and bureaucratic process for designation and
the financial and human resources required to fulfil designation expectations. They explained that
there is an expectation of CCs to support other countries and other institutions, which goes beyond
their national role and mandate, and that some countries do not have the resources or finances to
build capacity and capability and provide support elsewhere. Overall, the Member State institution
would benefit from CC designation but not the people working inside.
Some ROs recognized that designation brings little value to some Member State institutions,
especially in countries where prestige and resourcing is already well established.
Some ROs also highlighted that they continue to work with Member State institutions that were
previously CCs but had not chosen to undertake the re-designation process. It was proposed
that the WHO Regional Office for Europe should explore different options for how Member State
institutions are recognized.
15ROs working with other CCs
Out of 46 ROs, almost half (46%; n = 22;) identified that they work with CCs where they are not
the designated RO. They explained that they work with these other CCs in order to network, or
when some thematic areas they work on overlap, for example in areas of viral hepatitis, HIV and
tuberculosis.
Reporting and monitoring progress of CCs
Almost all ROs (42 out of 46; 91%) responded that they have reported/acknowledged work
completed by CCs in the WHO regular reporting period through formal annual reporting and informal
reporting opportunities. Furthermore, they discussed that they engage frequently with CCs to
discuss activities and efforts.
Two ROs identified that they had not had the opportunities to report on or acknowledge the work
of the CCs they were managing as it had only recently been designated. Two ROs identified that
time is often a constraint to the quality of work produced. Stronger incorporation of work with CCs
into WHO planning and reporting cycles was deemed vital and would help to align WHO priorities
with the work delivered by CCs.
The majority of ROs (91%; n = 43) identified that they include the activities undertaken by CCs
into their 2022–2023 workplans. For future planning, ROs acknowledged that they rely heavily on
support from CCs to implement their work.
Reasons for why ROs do not explicitly list the activities of CCs on their technical workplan included
time restraints (ROs do not have the time to determine how CCs’ work fits into the technical
workplan) and that the technical workplan does not include detailed outputs and, therefore, the
work conducted with CCs cannot be reflected.
Nearly two thirds (61%; n = 28) of 46 ROs identified that they reflected their interactions with CCs
in their performance management and development system (PMDS).
Two ROs identified that these interactions were not included in PMDS due to the limitations of the
system and not enough smart objectives being allowed. They further explained that it would be
helpful if work with CCs is included in staff job descriptions and added to PMDS.
Supporting work of CCs
Support from executive management
Many ROs reiterated the importance of increasing the presence of executive management engaging
with CCs, with the WHO CC Regional Meeting in November 2021 being the prime opportunity to
foster engagement. Other proposals included executive management scheduling visits to CCs
during country missions or when attending events and engaging with heads of CCs to acknowledge
their work with WHO.
16Many ROs would like to see increased acknowledgement and recognition of CCs’ work by executive
management and WHO generally.
Many ROs would like to see support from executive management to initiate changes in areas where
there are challenges and opportunities to streamline, such as reducing bureaucracy; simplifying
the designation/redesignation process; improving the relationship between CCs and FENSA; issues
affecting certification of training courses; and the use of WHO logo when designated.
It was proposed that executive management meet with ROs annually to discuss the strategic
direction, funding and desired outcomes of working with CCs at the programmatic, divisional and
organizational levels, and to foster information sharing between ROs. This will support the ROs to
better adapt ToRs and workplans to align to the priorities and mandates of WHO.
Some ROs mentioned the importance of ensuring that Member State institutions’ criteria are fulfilled
before any indications are given that a designation process will be initiated.
Support from CC focal points in the WHO European Region and headquarters
Overall, most ROs agreed that CC focal points in the Regional Office and headquarters provide
timely and efficient support when needed and that the system in place is highly organized.
ROs raised the importance of the role that CC focal points at regional and headquarters levels have
in providing individual advice and support through the designation and re-designation process, and
in providing information about the requirements of those processes as needed. They commended
those involved.
Some ROs asked for online training to be developed and to increase capacity-building on certain
issues CCs find complex such as the designation/redesignation process, logo use, copyright issues
and report writing for WHO products.
Some ROs identified that they would appreciate more proactive updates from CC focal points in the
Regional Office and headquarters so they could share with their CCs the work being implemented
by WHO, especially in areas of COVID-19 and any changes to the designation and re-designation
processes and rules. This communication does not have to be constant; they proposed that regular
communication from the Regional Office could be circulated to CCs through a newsletter, and that
communication was at least twice annually.
Some ROs suggested that organizing regular meetings between the CC focal points and the ROs
would be beneficial to share best practices, discuss progress and challenges in the work, and to
understand what common activities and deliverables CCs are delivering across the Region in order
to identify any networking opportunities.
17Key challenges
The three key challenges raised by ROs in their work with CCs are summarized in Fig. 11.
Fig. 11. Key challenges raised by ROs
Value proposition: what Funding constraints
value does designation
bring to CCs?
Bureaucratic designation
and re-designation
process burdens
Value proposition – what value does designation bring in 2021?
There was some disagreement between ROs over the value that designation brings to CCs. Some
expressed that WHO designation brings prestige and funding opportunities for CCs, especially
in countries of the Commonwealth of Independent States, and that CCs benefit more from the
collaboration than does the WHO Regional Office for Europe. However, other ROs stated that WHO
relies on expert knowledge and support from CCs to carry out its work; that WHO designation may
not assist all CCs to get funding; and that CCs do not rely on WHO designation for prestige. These
ROs believe that WHO benefits more from the collaboration as CCs spend a lot of time, human and
financial resources supporting WHO’s mandate and in some cases they do not benefit. Overall, there
is a perceived disconnect between what WHO expects of CCs and what is provided in return, and
18expectations should be clarified on both sides.
Funding
Lack of funding was another challenge raised by many ROs. The work the Regional Office asks
CCs to do largely requires CCs to utilize their own time and funding sources. Some ROs mentioned
that their programme area in the Regional Office is underfunded and often CCs step in to support
their work, with the budget and time CCs provide WHO exceeding that possible by WHO alone.
They mentioned that if they had more funding, from either side, then the Regional Office would be
better able to utilize CCs’ expertise.
There is an assumption that WHO designation elevates institutions at the national level and highlights
the national importance of the work they deliver, providing resource mobilization opportunities;
however, this is not always the case.
The designation process validates the quality of work delivered by CCs. Therefore, there needs
to be a way to recognize CCs, outside of the CC ToRs and workplans, in order to acknowledge the
contributions of CCs’ work.
Bureaucratic process burdens
The re-designation and designation process is very demanding, time-consuming and has many
clearance steps and interactions with CCs in the process, which can take many months.
Some ROs raised the concern that working around the legal requirements for (re)designation can
be difficult as legal clearance is detailed and focused. Specifically, there is a disconnect between
technical work being implemented and the legal modality and requirements that are being enforced.
For example, ROs described how they had to reword sentences to comply with legal requirements
which in their opinion have no link to the work programme areas WHO performs with their CC. It
can, therefore, make amending or changing activities on a workplan difficult if the workplan is too
detail oriented. They commented that we should put more emphasis on quality of designation as
opposed to legal definitions.
The WHO system for CC (re)designation needs to be revised to simplify the process. It was raised
by ROs that there is a lot of back-and-forth communication between various focal points and, for
each comment, the (re)designation process is reset. Consequently, it is not uncommon for a focal
point or divisional director to see the (re)designation form multiple times. Overall, improvements
to the design of consolidating requests to the CC is needed.
19Conclusions
WHO has access to the most prestigious institutions worldwide, and, consequently, the institutional
and technical capacity to support its work and ensure the scientific validity of global health work.
Some of these institutes are formally designated as CCs and are potentially a very cost-effective
mechanism for implementing WHO goals, especially given scarce resources. The WHO European
Region has a significant number of these centres, which are an important source of information
and expertise and a highly valued mechanism of cooperation to support the implementation and
achievement of WHO’s mandated goals. CCs can also be invaluable in developing and strengthening
institutional capacity in countries. It is hoped that the specific recommendations and proposed
actions in this report will contribute to the above by ensuring that the relationship with CCs remains
strong and that the activities agreed with CCs fit the strategic directions of WHO and are in line
with WHO policies.
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