WHS is the first major survey program to explicitly recognize the importance of comparability in the development of the instrument in addition to the important concerns about validity and reliability.
Objectives of WHS :
1- To develop valid, reliable and comparable household survey modules for a wide range of priority topics that can be used by countries as an integral part of their health information systems in a cost-effective manner.
2- To develop a set of quality assurance protocols and reporting strategies, including visits by technical advisers, in order to ensure satisfactory survey design and implementation.
3- To develop a strategy to build national capacity and expertise to conduct surveys and develop long term sustainable platforms to share this information in public.
4- To encourage the formation of links with international and regional networks to build national and regional research capacity.
5- To provide a dynamic data collection platform that can be continuously developed with a transparent audit trail and availability of data in the public domain as an international public good.
6- To facilitate the use of information collected through the WHS in appropriate strategic planning, programme management, monitoring and evaluation. Particular emphasis is placed on policy use of the monitoring of Millennium Development Goal indicators and on the critical outcomes in the poor.
The WHS will provide data that will serve as important inputs for estimates of Health Adjusted Life Expectancy (HALE) and Burden of Disease estimates in a cross-population comparable manner. It will provide information on distribution of health and inequalities in health by income and thereby help design pro-poor policies. It will provide important estimates of distribution of risks in the population and help inter-sectoral collaboration on reducing these risks. Further, the WHS will generate data on coverage for critical interventions in order to develop strategies for access to these for the poor and inform the policy debate on human resources for health. Finally, it will provide the basis for the examination of the relationship between health, responsiveness, human security and social capital.
Realizing that this WHS will lead to the building of collaboration and partnership that will strengthen survey capacity and improve data quality in the member states, the GCC states have welcome the participation and started taking actual steps towards preparation to conduct the survey, namely:
● Development of a national technical committee in each GCC country involving Ministry of Health (owner of WHS) implementing agency and stakeholders of WHS.
● Development of plans of action, starting with project proposal document (members, budget, supplementary resources, timeline, and implementation plan). and designation of WHS National Team.
● This was discussed in the E.B (59) which issued recommendation No. 32 to be presented to the HMC (56) which in turn issued resolution #7 urging the GCC countries to adopt and finalize these requirements.
● The United Arab Emirates was the first country in the GCC to participate and finalize this survey.
An inter-country workshop was held in Muscat, Oman in 27-29 Rabi’II 1425H (15-17 June 2004) in collaboration was EMRO. The objectives of this workshop were to:
1. Strengthen national information systems with focus on decentralization.
2. Establish national mechanisms for monitoring and evaluation of health and health-related indicators including Millennium Development Goals (MDGs).
3. Discuss the role of population-based surveys in supporting national information systems including PAPCHILD-PAPFAM and the World Health Survey (WHS).
In this workshop, each country team of health system department made a presentation for about 10 minutes stating the strengths and weaknesses on Health Information Systems in their countries.
The workshop resulted in very remarkable recommendations including that:
1) The WHS for the GCC states has to be implemented through out the period 2004-2005 with a unified training, methodology and joint technical support in order to secure comparability among the participating countries.
2) Administrative procedures for the agreement of the WHS have to be finalized with each state separately.
3) The EMRO has to be provided with the names of the focal points (Executive manager) in each of the member states.
4) The member states have to review the WHS questionnaire forms. Any amendments (addition or omission) should be clearly indicated and presented to the EB where it should be sent to the EMRO before the end of Jumada’I 1425H (July 2004) as a deadline.
5) The EMRO has to prepare a draft unified questionnaire based on the remarks made by the member states, to be sent back to the member states before the end of Jumada’II 1425H (August, 2004).
6) A technical meeting is going to be held in the first half of Rajab 1425H (September, 2004) to discuss the following:
a- Finalization of the questionnaire forms to adopt the local conditions of each state.
b- Deciding on the technical matters with regard to sample size,etc.
c- Setting the executive plan required for the survey.
d- Adopting the budget required.
7) Discussing the possibility of making use of the technical facilities from regional organizations and agencies that have expertise in the field of survey and analysis of data.
8) Holding a workshop for national teams (principal investigator, focal point and the statistics officer from central statistics) who will undertake training the rest of the team in their countries. The time and place of the workshop will be discussed in the technical meeting mentioned above.
WHS questionnaires were reviewed by the member states and their remarks were sent to EMRO according to the aforementioned recommendation and other manuals were developed and the QXQ manual was translated into Arabic.
Since that first meeting, the Executive office has given great attention to the subject and the following activities were done on the road of implementation of the Gulf/ World Health Survey:
THE WORLD HEALTH ORGANIZATION (WHO)
THE EXECUTIVE BOARD,
HEALTH MINISTERS’ COUNCIL
FOR COOPERATION COUNCIL STATES
(hereinafter referred to as the Donor)
I. This Agreement relates to a financial contribution to be made by the Donor to WHO towards the implementation of the World Health Survey+ in the Gulf Cooperation Council countries, and which is hereinafter referred to as the “Project”. Annex 1 is an integral part of this agreement.
II. The budget for the activities financed by the contribution is set out in Annex 1. Prior to effecting major changes between categories of expenditure that may be found necessary in the course of implementing the activities, WHO shall consult the Donor.
1. WHO shall be responsible for the monitoring and the implementation of the Project.
2. The Donor shall be responsible for the provision of funds to WHO for the Project, in accordance with the terms of this Agreement and its Annex 1.
IV. Financial arrangements:
1. Schedule of payments:
The total amount of the contribution is US$200,000.
a- The First instalment (US$ 100,000 ) shall be paid upon signature of this agreement.
b- The Second instalment of (US$50,000) shall be paid on July 2008.
c- The Third instalment (US$50,000) shall be paid after the completion of the project in 30th June 2009 and no later than December 2009.
2. Payment of contribution
The contribution shall be deposited according to the above schedule of payments in the WHO’s Geneva bank account:
(USD) World Health Organization
IBAN CH31 0024 0240 C016 9920 3
SWIFT CODE: UBSWCHZH80A
Case Postale 2600
CH-1211 Genève 2, Switzerland.
and clearly identified, marked WHO VFHP, and the sub-account which should be credited which is XG16.
3. Utilization of funds and accounting:
(i) The contribution shall be used for the purposes indicated in Annex 1 hereto and shall be administered in accordance with the Financial Regulations and Rules, and financial and administrative rules and practices of WHO.
(ii) Under this Agreement, 13% of expenditure will be deducted by WHO to cover administrative costs related to administering the funds, in accordance with World Health Assembly Resolution WHA 34.17.
(iii) Any interest earned on the cash balance of the contribution shall be used in accordance with WHO Financial Regulations and Rules, and financial and administrative rules and practices of WHO.
(iv) Income and expenditure recorded in respect of the contribution shall be identified and kept separately by WHO in the relevant account of its Voluntary Fund for Health Promotion.
(v) Any balance of the contribution that is outstanding at the time of completion of the project, or of termination of this Agreement, and after all obligations by WHO prior to completion or termination have been fully liquidated, shall be: reprogrammed for the same project.
1. Period of implementation
The starting date of the Project shall be 1st July 2007.
The completion date of the Project shall be 30th of June 2009.
WHO shall have no obligation to implement the Project unless all necessary and sufficient funds for the implementation have been received by WHO, as stated above for schedule of payments.
A period of up to 12 months shall be allowed after completion of the project, or any termination of the agreement, to liquidate all obligations for activities completed by WHO prior to completion or termination.
WHO shall transmit to the Donor at 3 month intervals a technical report on the progress in the activities financed by the contribution.
(i) The income and expenditure recorded in respect of the contribution shall be indicated in the WHO Financial Reports submitted to the World Health Assembly on an annual and biennial basis.
Financial management reports shall be provided to the Donor on a yearly basis.
(ii) A final certified statement of income and expenditure will be provided by WHO, after settlement of all obligations for activities started by WHO prior to completion or early termination of the Agreement.
It is understood that all contributions to WHO are subject exclusively to its internal and external auditing procedures. The External Auditors’ certification of accounts and audit report is made available to the World Health Assembly on a biennial basis. The Donor may request a copy.
WHO will make an appropriate acknowledgement of the contribution in any of its publications emanating from the Project, or in reports that are habitually made available to its 193 Member States. In the absence of the consent of the other party, neither party may otherwise refer to the contribution or to the relationship between the parties in any material of a promotional nature. Of course, donors are always entitled to make reference to their donations in their internal documents and in their annual reports.
Either party may give the other notice of termination of this Agreement. Such termination shall enter into effect six months after notice has been received, subject to the settlement of any outstanding obligations.
X. Settlement of disputes:
Any dispute relating to the interpretation or application of this Agreement shall, unless amicably settled, be subject to conciliation. In the event of failure of the latter, the dispute shall be settled by arbitration. The arbitration shall be conducted in accordance with the modalities to be agreed upon by the parties, or in the absence of agreement, with the rules of arbitration of the International Chamber of Commerce. The parties shall accept the arbitral award as final.
The WHS+ survey in the GCC countries and all its components, including a validation study as specified in a separate protocol, will be carried out in the GCC countries: Bahrain, Kuwait, Oman, Saudi Arabia, UAE and Yemen. A version of this has already been completed in Qatar. In order to ensure that the survey is implemented with adequate quality control and that it meets the highest standards, WHO will assist the GCC in this exercise as follows.
WHO HQ technical assistance:
1. HQ will provide Questionnaires in other languages if already available in HQ.
2. HQ will finalize the layout of the final version of the Arabic Questionnaires before end of September 2007.
3. HQ will provide unique IDs for each country with rotation codes for the individual interviews and the Kish tables. These IDs will be used in the data entry program. Should these IDs be different from those provided in the final allocation table, a key correspondence table must be provided to HQ such that each individual can be assigned to a selection unit in the allocation table.
4. Independent quality assurance visits will be organized by HQ in consultation with country partners and UNFPA CST team.
5. HQ will develop in co-ordination with each country a set of templates for field monitoring.
6. HQ will develop a secondary data cleaning programs in both CSPro and STATA for the secondary cleaning of the data after entry has taken place during July-December 2007.
7. Upon receipt of the final clean data set from each country, HQ will produce the final cleaned, weighted data sets for analysis. Data sets will be produced in STATA and SPSS with backups of the master data files.
8. A template for the national report and the dummy tables will be prepared by HQ to be discussed in the first coordinators a month after final cleaned data is produced for each country.
9. HQ will make available to countries all analysis codes to generate these tables in STATA when the final report is completed.
10.HQ will provide technical training in the use of STATA and advanced data analysis training course in STATA using the countries WHS data.
11.HQ will provide effective technical assistance for production of the preliminary and final reports. WHO will review the reports prepared by the countries to ensure technical accuracy and consistency. In addition, WHO will assist effectively in the interpretation of the findings and their implications for policy.
12.HQ will support any in-depth or comparative analysis with final products to publications in the form of monographs, working papers or papers in peer-reviewed journals.
Tasks to be undertaken by each participating country
1. Each country will submit its final timelines and schedules for the different phases of the activities such that technical support from WHO-HQ can be planned in terms of presence at interviewer training, supervision of field work, etc. It is expected that by the end of July 2008 all countries will have completed data collection and by April 2009 all data sets will be finalized.
2. Each country should name a survey focal point, a senior Data Manager and a senior Statistician. Also it was recommended that, assistant data managers and assistant statisticians should be recruited as backups.
3. Countries should decide which other languages they want to use, in addition to Arabic and English depending on the non-national population that will be included in the sample.
4. Each country sample design must be discussed and cleared with WHO-HQ before the survey goes to the field. In order for the HQ to clear the design, a detailed document describing the design of the sample and the selection procedures must be submitted to WHO-HQ.
5. Each country must provide a final allocation table with the list of strata and clusters, the total number of clusters from which the sampled clusters have been selected, the selection procedure, the number of households in each cluster and the number of households selected in each cluster.
6. Each country will carry out the validation study for chronic illnesses as per the circulated protocol either simultaneously or after the main field work is completed.
7. WHO will provide the core data entry program in CSPro-PAPI, and help countries identify consultants to assist in the data management training. Countries should take the responsibility of adapting the program according to their specific needs (if any).
8. Log files of the data entry errors, validations and inconsistencies should be kept locally in each centre and also sent to WHO-HQ on a regular basis (every week or two weeks).
9. Progress reports on the field work and the data entry should be produced and sent periodically (every two weeks) to WHO-HQ.
10.The final cleaned data sets should be submitted to WHO-HQ within a week of the completion of the data cleaning.
11.Countries should acquire the most recent version of the statistical package STATA/SE.
12.A final report from each survey will be produced by each country.
Personnel costs $150,000
Travel, communication, miscellaneous $026,991
Programme support costs $023,009
The situation so far is as follows :
1- Qatar and Saudi Arabia have finished the survey.
2- Oman finished the field work data analysis and in the stage of puportion of the final report.
3- Kuwait and the UAE both have completed the field work and started data cleaning and the analysis report waiting is underway.
4- Kingdom of Bahrain will start field work soon.
Lately, the subject was discussed in the 73rd meeting of the Executive Body (Riyadh, 28/30 Dhul Hejja, 1431 H/ 4-6/12/2010 which issued recommendation # 9), which included the following:
1- The Executive Body expresses its thanks and its appreciation to WHO/ EMRO for the readiness shown to extent the donor agreement with the Executive Office for implementation of the Gulf WHS. The Executive Body also expresses its gratitude to WHO/ EMRO experts in providing technical assistance and their efforts to over come all difficulties and constraints forced in implementation of this vitally important project.
2- Formal request from WHO/ EMRO to extend the donor agreement referred to above to allow completion of provision of technical assistance to the Cooperation Council States to finish the Gulf WHS project by the end of 2011.
3- Holding the advanced STATA training in Kuwait or UAE, during the second quarter of 2011.
4- Holding a Gulf workshop in Riyadh in the first half of 2011 to discuss the results of the Gulf WHS in the Cooperation Council States and the lessons learnt, as well as making comparison among the members States.
5- The Republic of Yemen has to decide whether to add a WHS component to the DHS or not.
6- The member states which finished the survey have to exchange the final reports with the rest of the Cooperation Council States to maximize benefits and make use of these reports in preparation of theirs.
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