26 th PAN AMERICAN SANITARY CONFERENCE 54 th SESSION OF THE REGIONAL COMMITTEE

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1 PAN AMERICAN HEALTH ORGANIZATION WORLD HEALTH ORGANIZATION 26 th PAN AMERICAN SANITARY CONFERENCE 54 th SESSION OF THE REGIONAL COMMITTEE Washngton, D.C., USA, September 2002 Provsonal Agenda tem July 2002 ORIGINAL: ENGLISH EVALUATION OF THE PAN AMERICAN CENTER FOR SANITARY ENGINEERING AND ENVIRONMENTAL SCIENCES (CEPIS) The Drector of the Pan Amercan Santary Bureau (PASB) requested the Offce of Analyss and Strategc Plannng, n collaboraton wth the Natonal Audt Offce of the Unted Kngdom and external consultants to conduct a broad-based relevance, effectveness, and effcency evaluaton of the Pan Amercan Center for Santary Engneerng and Envronmental Scences (CEPIS). In the context of a dscusson on the Pan Amercan Centers at the Subcommttee on Plannng and Programmng of the Executve Commttee n March 2002, the Drector proposed presentng the conclusons of the evaluaton to the Governng Bodes. The evaluaton concluded that CEPIS s a valuable source of techncal cooperaton and a broker of knowledge. It would be too much of a loss to abolsh t and take too much effort to try to recreate an nternatonal agency to fulfll ts role. However, CEPIS should adapt ts present role and functons n terms of beng more proactve, and workng more through networks of nsttutons to acheve a multpler effect on ts techncal cooperaton. CEPIS should transform tself nto a catalyst organzaton, as was recommended by a 1998 Specal Advsory Group convened by the Drector of PASB, whch produced a future-orented study on CEPIS. In tune wth ths proposed new drecton of CEPIS, a shft n the nternal allocaton of resources should be expected. CEPIS should develop an approprate resource moblzaton strategy as well as a permanent nternal capacty for resource moblzaton that would orgnate and coordnate efforts on behalf of the Center. The merger of two dfferent technologcal cultures s not easy, even n prvate ndustry. The evaluaton team beleves that the constructon of a "new" CEPIS s stll a work n progress whch deserves the support of an external advsory body. Ths background summary was dstrbuted to Members of the Executve Commttee at ts 130 th Sesson. The full evaluaton report was also made avalable to Commttee members. It s hoped that n the process of evaluatng ths partcular Center an evaluaton model wll be developed that can be appled to other Centers of the Organzaton. The Pan Amercan Santary Conference may wsh to dscuss ths ssue, consder the resoluton CE130.R15 recommended by the Executve Commttee, and ndcate future actons that the Bureau should undertake.

2 Page 2 CONTENTS Page 1. Mandate and Objectves of the Evaluaton Evaluaton Desgn Data Sources and Methods Lmtatons of the Study Is CEPIS Effectve? Is CEPIS Well Managed? Has the Merger wth the Pan Amercan Center for Human Ecology and Health (ECO) Produced the Expected Synerges? Conclusons Recommendatons On Effectveness and Relevance On Management On the CEPIS-ECO merger Acton by the Pan Amercan Santary Conference...17 Annex: Resoluton CE130.R15

3 Page 3 1. Mandate and Objectves of the Evaluaton The Drector of the Pan Amercan Santary Bureau requested the Offce of Analyss and Strategc Plannng, n collaboraton wth the Natonal Audt Offce of the Unted Kngdom and external consultants, to conduct a broad-based relevance, effectveness, and effcency evaluaton of the Pan Amercan Center for Santary Engneerng and Envronmental Scences (CEPIS). It s hoped that n the process of evaluatng the Center an evaluaton model wll be developed that can be appled to other Centers of the Organzaton. Ths document represents a summary of the evaluaton report. The full verson of the evaluaton report s contaned n Document CSP26/INF/2. The Drector had asked the evaluaton team to address four man ssues: Is the orgnal ratonale for the Pan Amercan Health Organzaton (PAHO) to operate ths Center stll vald? What s the nature of the workng relatons among CEPIS and PAHO s country offces, and do these relatons result n actual synerges? What s the fnancal outlook, or medum- and long-term vablty of CEPIS as well as suggestons on how can t be mproved? Has the merger of resources from the former Pan Amercan Center for Human Ecology and Health (ECO) nto CEPIS been effectve? What were the characterstcs of the mplementaton of the merger of resources, and what lessons could be learned? 2. Evaluaton Desgn CEPIS has undergone several revews and studes n recent years. In 1998 a Specal Advsory Group convened by the Drector of PASB made recommendatons about CEPIS future strateges and prortes. Some evaluatons have been carred out of specfc externally funded projects, or of CEPIS partcpaton n regonal PAHO projects, such as Workers Health. However, the overall relevance, effectveness, and effcency of CEPIS have not been subject to an evaluaton.

4 Page 4 The key ssues dentfed by the Drector coalesce around three evaluaton questons: Is CEPIS delverng effectve, relevant, useful, hgh-qualty techncal cooperaton whch contrbutes to mprovng envronmental health n the Amercas? Is CEPIS well managed? Has the merger of some resources from the former ECO wth CEPIS created the ntended synerges? 3. Data Sources and Methods The evaluaton questons were addressed through a detaled analyss of materal and Center data; an analyss of a sample of CEPIS project fles, and ntervews wth CEPIS staff, key stakeholders n Peru, PAHO Headquarters staff and other regonal experts, and surveys. To complement the sklls of PAHO s Offce of Strategc Analyss and Plannng team, addtonal nternal assstance was provded by PAHO s Budget Offce, and external advce from the Natonal Audt Offce of the Unted Kngdom and from a consultant on health and the envronment. 1 1 The CEPIS evaluaton team ncluded: Roberto Rvero (evaluaton coordnator), Offce of Analyss and Strategc Plannng/Deputy Drector s Offce, PAHO; Davd Goldsworthy, Natonal Audt Offce, London, Unted Kngdom; Lus U. Jáuregu, JVP Consultores, Buenos Ares, Argentna; Román Sotela, Chef, Budget Offce, PAHO; Crstna Puentes-Markdes, Offce of Analyss and Strategc Plannng, PAHO; Carlos Walter, Offce of Analyss and Strategc Plannng, PAHO. Mónca Stennng, Slva Molna, and Jenny Newhall, PAHO, provded valuable secretaral support. Danne Arnold, Erc Kwak, and Sergo Roschke, Management and Informaton Support Department, PAHO, provded mportant assstance n relaton to the survey software.

5 Page 5 Evaluaton Issues Method Data Sources Is CEPIS delverng relevant, effectve, hgh-qualty techncal cooperaton? Surveys Sem-structured ntervews Analyss of program and admnstratve data Ste vst Agreements Hstorcal documents CEPIS admnstratve and program data CEPIS project documents PAHO Governng Bodes documents Dvson of Health and Envronment (HEP) documents Is CEPIS well managed? Intervews Ste vst Analyss of program, admnstratve, fnancal data Budgetary and fnancal analyss Admnstratve records Fnancal records PAHO programmng documents CEPIS programmng and budgetary documents Dvson of Health and Envronment (HEP) documents PAHO and CEPIS staff rosters Has the merger of resources produced the expected synerges? Questonnares to CEPIS Surveys Intervews Specal Advsory Group report CEPIS and Dvson of Health and Envronment (HEP) documents

6 Page 6 Notes on Data Collecton Surveys and Intervews: 157 surveys were sent to or responded n person by key ndvduals throughout the Regon: senor staff at PAHO s Headquarters (100%); to PAHO/WHO Representatves (89%); to Peruvan government offcals, nongovernmental organzatons, and blateral and multlateral agences (80%); and to government offcals of other PAHO Member States, nongovernmental organzatons (NGOs), blateral and multlateral agences (38%). The surveys sought respondent s perceptons on such ssues as how effectvely CEPIS carred out ts work, the relevance of CEPIS work, the level of consultaton, and tmelness of responses as well as seekng concrete examples of ways CEPIS had made a dfference. Together wth the surveys the evaluaton team conducted 31 sem-structured ntervews, based on the survey, whch were carred out wth key ndvduals n Peru and Washngton to probe responses more deeply, and to trangulate responses to postal surveys. Ste Vst: A one-week ste vst was made by the four key researchers. The vst ncluded ntervews wth a cross-secton of CEPIS staff, an examnaton of project control systems for a sample of actvtes, and a revew of the use of the Techncal Cooperaton Plannng, Programmng, and Evaluaton System (AMPES). Analyss of Program and Admnstratve Data: Data from AMPES was analyzed to examne budgetary and expendture trends and to compare planned and recorded project outcomes. Document Revews: Prevous revews, future-orented studes, and evaluatons of specfc CEPIS actvtes carred out by nternal or external bodes were examned to assess acceptance of prevous recommendatons. 4. Lmtatons of the Study Possble threats to nternal valdty could be present n terms of the selecton of the survey respondents. Most of the government and some nongovernmental organzatons (NGOs) respondents belong to a regonal water and santaton professonal communty, many of whom have endurng tes to CEPIS and to PAHO s health and envronment professonals, partcularly n Peru and other South Amercan countres. In some cases, some of the surveys ntended for PAHO/WHO Representatves were answered by health and envronment advsors n the PAHO country offces. A greater response rate from government offcals and multlateral organzatons could have strengthened the sample of the evaluaton team s survey. It would also have been helpful f members of the evaluaton team could have revsted CEPIS and could have vsted a sample of other Member States of PAHO to ascertan drectly the opnon of government and NGOs offcals concernng CEPIS work whch among other thngs would have

7 Page 7 enlarged the sample sze. A vst to Mexco would have been partcularly mportant, n order to analyze how resources that were once a part of ECO are currently addressng the needs of Mexco and potentally the needs of other PAHO Member States. In addton, members of the evaluaton team vsted CEPIS n July and September 2001, a perod of transton n Peru, the host government of CEPIS, and thus were not able to ascertan long-term host government fnancal polcy toward the Center. In terms of external valdty how or whether to generalze the fndngs of the study to other PAHO Centers some fndngs, e.g., regardng Center mergers and the need to dversfy and expand nonregular budget sources, could potentally be generalzed, but attenton should be gven to the fact that each PAHO Center s a unque nsttuton n ts own rght. 5. Is CEPIS Effectve? CEPIS s seen as a postve and effectve force n the Regon that responds quckly to requests for assstance. Over 85% of all respondents to the four surveys consdered that the techncal cooperaton actvtes and servces provded by CEPIS are relevant. CEPIS s perceved as an agency that has the ablty to convene other nsttutons, to address specfc ssues of common concern and arrve at practcal solutons. There s frequent prase of the Pan Amercan Network of Informaton and Documentaton n Santary Engneerng and Envronmental Scences (REPIDISCA), the CEPIS documentaton servce, and ts rapd response n emergency and dsaster stuatons; CEPIS role durng the cholera epdemc was repeatedly hghlghted. Respondents also noted that CEPIS prestge was the product of more than 30 years of good servce to the host country and to the rest of Latn Amerca. The Center s perceved as beng accessble and user-frendly, partcularly ts laboratory. Its current and past leadershp teams are deemed to be a major source of strength. CEPIS addtonal strengths nclude ts publcatons and ts Vrtual Lbrary for Health and Envronment. Over the past decade CEPIS has been ncluded n futureorented studes (1996 and 1998), and several evaluatons have been carred out of some of ts projects and actvtes, partcularly of those funded by extrabudgetary resources. CEPIS has receved good revews from nternal and external audtors. In 2001 CEPIS receved the PAHO Drector s Award as an Outstandng Team. CEPIS has successfully adapted to the changng needs of the Regon and ths fact has also contrbuted to the postve revews. Local/nternatonal NGOs that have been workng closely wth CEPIS were equally enthusastc about the Center. These bodes perceve CEPIS as a good partner and stated that the nternatonal donor communty s more supportve when local NGOs are supported by, or have entered nto an allance wth CEPIS.

8 Page 8 CEPIS prortes are seen as approprate though more could be done to work wth regonal health and envronment polcy- makers. Respondents were generally supportve of CEPIS prortes but thought that more could be done to work wth regonal health and envronment polcy-makers. Some respondents, however, consdered that envronmental epdemology and toxcology were areas n whch CEPIS stll has much work to do to better attend to regonal needs. Some PAHO country offce respondents ndcated that by placng greater emphass on techncal cooperaton for strategc plannng and nsttutonal strengthenng (or reform), CEPIS would be strengthened and have a better chance of carvng out for tself a more secure nche for the future n the feld of health and envronment. In addton, CEPIS does not adequately reach every country that t should partcularly n the Englsh-speakng Carbbean. CEPIS s an overwhelmngly Spanshlanguage nsttuton, wth few documents n Englsh and fewer n French. Whle there s nteracton wth envronmental nsttutons n the Carbbean, ths s not done at a level that a number of respondents found satsfactory. Some respondents, partcularly those from small countres and from PAHO offces remote from CEPIS, ndcated that they wanted to know more about, and have more drect contact wth CEPIS. These respondents felt that the Webste and the Vrtual Lbrary for Health and Envronment dd not offer the knd of dalogue they wanted. In partcular, t was suggested that the Carbbean States, the PAHO country offces n that area, and CEPIS would beneft from a monthly or quarterly CEPIS newsletter n Englsh, focusng on the Carbbean, that would nclude hghlghts of CEPIS actvtes n ths subregon, as well as the servces that the Center offers. CEPIS s perceved as strugglng to balance a lmted budget wth potentally large demands for servces. There s a general percepton that the Center s excessvely dependent on someone else s funds nsde and outsde PAHO to be able to do muchneeded work. Ether for lack of suffcent funds, or because of a 33-year-old organzatonal culture drven toward fxng specfc, compartmentalzed water and santaton problems (or both), CEPIS s perceved as more reactve than proactve, notwthstandng the fact that, partcularly n the area of nformaton, product development, and the laboratory, CEPIS has taken sgnfcant proactve steps. Respondents consder that CEPIS should gravtate more toward technology assessment, to becomng an audtor of avalable technologes, as opposed to tryng to develop new technologes wth very scarce resources. A perceved lack of regular funds for sustaned consultaton or a proactve approach frequently parallels the vew that CEPIS could also beneft from havng an organzed, professonal resource moblzaton capablty. Some respondents felt that

9 Page 9 CEPIS could beneft from a unt or specalzed group wthn the Center whch focused on resource moblzaton, publc relatons, marketng, and nternatonal relatons. Such a unt could play an advocacy role for health and envronment by promotng the envronmental agenda n the Amercas. It was suggested, n addton to an external relatons and fundrasng offce, every senor CEPIS staff member and techncal offcer should have fundrasng as part of ther job descrptons and be provded wth opportuntes for developng ths skll. Respondents overwhelmngly (88%) beleve that there s stll a need for a regonal envronmental health center and that CEPIS should provde ths servce (79%) wthout thwartng the evoluton of local consultancy servces. The majorty of respondents dd not dentfy a clear alternatve to CEPIS and consdered that CEPIS flls a vtal nche, partcularly when t engages n strategc techncal cooperaton wth governments, helpng them to develop publc polces and tran ther staffs. The countres deem t vtal to have an nsttuton wth a Pan-Amercan mandate to act as a catalytc agent of multple natonal and nternatonal actors. Overall, the relatonshp between CEPIS and the PAHO country offces s good. Overall, the relatonshp between CEPIS and the PAHO country offces s very postve, wth about 90% of the PAHO/WHO Representatves statng that t s good or very good. Nevertheless, PAHO/WHO Representatves felt that CEPIS lacked both specfc cooperaton polces relatng to each country, and mechansms for dalogue wth the countres to establsh prortes and cooperaton plans. The responses revealed that a number of PAHO country offces would lke to see a more formal, regular process for developng partnershp programs wth CEPIS dovetalng wth and gong beyond PAHO s Bennal Program Budget (BPB) plannng process. CEPIS s seen as demand drven, n a way that some respondents see dangerously close to reactng to almost ad hoc demands from ther own offces. The evaluaton team beleves that the orgnal ratonale for PAHO operatng a center such as CEPIS s stll vald. The team beleves that CEPIS cooperaton should be adjusted to ft the changed crcumstances and a wder feld of operatons. There s a real demand for techncal cooperaton from the countres and CEPIS has the capacty to respond to these demands. As the areas of nterventon evolve and redefne themselves, CEPIS must contnue adjustng ts programs and prortes.

10 Page Is CEPIS Well Managed? Management structures and processes need to be more clearly defned. CEPIS does not have a clear senor staff management structure wth detaled mnutes of senor staff meetngs and recorded decsons. It also lacks a medum-term strategc plan whch dentfes CEPIS man prortes and broadly states what t beleves t can acheve from ts own resources plus, where known, the resources of other thrd partes. Such a plan would need to be developed n conjuncton wth key stakeholders and outlne changes whch would be ntroduced to CEPIS current range of actvtes. The process and the product of a strategc plannng exercse would make t easer for CEPIS to defne ts goals vs-a-vs other key stakeholders, ncludng nternatonal donors and partner health and envronment authortes. It would also be a useful nternal management tool for assessng whether the expected results and actvtes proposed for ncluson n the BPB can demonstrate ther contrbuton to CEPIS overall strategc drectons. External donors were generally satsfed wth the way CEPIS manages grants. They felt that they were kept adequately nformed of progress and that CEPIS delvered on agreed tasks. CEPIS has developed gudance on project desgn but more consderaton needs to be gven to methods of achevng objectves, communcatng results, managng rsks and evaluatng mpacts. CEPIS has developed ts own good practce gudance on project desgn and most of those ntervewed carred out elements of sound project management. However, practces vared wdely. Project fles and documents were not n a consstent form and new staff were not beng systematcally traned n project management sklls. The more detaled project documents were assocated wth external bds for fundng and t was not always evdent how these projects ft wthn CEPIS, and more generally PAHO s polcy drectons. In the absence of proper project documents, t was not clear f rsks to a project s success had been consdered. The evaluaton team found no evdence that CEPIS staff were systematcally dentfyng potental rsks and ways to manage them. There was lttle evdence at the project development stage that consderaton had been gven to how a project would be evaluated or the results communcated to key audences. The team also found over-centralzaton n certan routne admnstratve procedures. CEPIS has no formal and systematc qualty control system to ensure that all products and servces are systematcally revewed pror to release. However, most of those ntervewed had developed ther own revew arrangements. In some cases ths

11 Page 11 nvolved the creaton of nternal ad hoc groups, occasonally cross-dscplne, and n others the use of external reference partners. Staff development requres a hgher profle. Staff are CEPIS major resource and the level of enthusasm and dedcaton that staff exhbted were evdent durng the evaluaton team s ste vst. However, CEPIS does not seem to have a human resource strategy to dentfy staff profles and needs for the future, nor how exstng staff throughout the Center can best be developed. There s an annual tranng program whch lsts the staff development courses planned for a year ncludng external and nternal courses. Yet, there are no formal records of what addtonal tranng ndvdual staff members need to receve over tme, followng a development plan for the Center and for the ndvdual. The one area whch has prortzed staff tranng, as part of ts accredtaton process, s the laboratory. But even there staff are strugglng to fnd tme to meet the oblgatory requrement of tranng each year. Whle fundng for CEPIS s tght, tranng s never a luxury for the publc sector n these technologcally fast-paced tmes. Attendng courses externally may not always be feasble but through the use of Web-based courses and through usng n-house staff to delver tranng, staff development n CEPIS could be gven a substantal boost. CEPIS overall expendture grew steadly durng the 1990s but declned slghtly n The merger nto CEPIS of some of the resources of the former ECO Center gave CEPIS three addtonal professonal posts (an Epdemologst, a Toxcologst, and an Envronmental Polluton Advsor), along wth US$ 727,000 of nonpost funds. The nonpost funds ncluded funds from the abolshment of a vacant P4 post. Gven the nflux of funds, there has been much nterest n how the Center has carred out ts busness effectvely. One of the man ssues that the evaluaton team analyzed s whether or not ths level of fundng s adequate, and f t s beng used n the most effectve manner gven the Center s transformaton wth the merger, and ts redrecton toward a catalyst organzaton as a result of the Drector s 1998 Specal Advsory Group study. The BPB attempts to defne the Center s functons more effectvely and the number of CEPIS projects has expanded from fve n ts BPB to nne newly defned projects n the BPB. There was consensus among those staff members ntervewed that CEPIS needed to become more proactve. However, we feel that as each advsor s only allocated $10,000 per bennum for proactve management of ther respectve programs, n realty there s lttle they can ntate or acheve.

12 Page 12 Although CEPIS regular budget fundng s expected to reman farly stable, fundng from other sources s lkely to be less predctable and CEPIS wll need to do even more to dversfy fundng sources. CEPIS regular budget s expected to reman farly stable, although as fundng from other sources becomes less predctable, CEPIS wll need to do even more to dversfy ts fundng base. PAHO s regular budget for CEPIS s some 62% of the total budget, down from about 75% n Ths s not due to a decrease n absolute fundng; rather t s a result of an ncrease n share of the total budget from both extrabudgetary sources and cost-recovery work. Although the regular budget element has grown n recent years, the share of fundng contrbuted by the other two sources doubled durng ths perod, ncreasng n absolute terms by 112% and 350% respectvely. The CEPIS laboratory s success story s promsng. The laboratory has evolved from functons lmted to research of water treatment n 1970, to a full-blown accredted reference laboratory n Income generaton has grown sgnfcantly durng ths perod. In , actvty from laboratory servces totaled $170,000. In the laboratory generated over $750,000 n ncome, manly from Peru and a few other countres. A key drver of ths growth has been CEPIS ablty to expand the qualty and range of servces provded by the laboratory, towards areas of techncal cooperaton and away from the more retal sde of processng envronmental samples. The laboratory currently generates most of ts ncome from accredtaton and advsory servces as a reference laboratory. And havng recently been accredted by the Canadan Assocaton of Envronmental Accredted Laboratores (CAEAL), the current trend n ncome generaton s expected to contnue. CEPIS has many of the elements n place of a well-managed organzaton and has proved effectve n seekng funds from a varety of sources. Over the medum term, core fundng for CEPIS from PAHO funds s unlkely to grow. Yet the demand and need for CEPIS servces contnues to expand. CEPIS has worked hard to seek extrabudgetary funds and has been by and large successful n ths endeavor. Grants from other governments and nternatonal organzatons accounted for 19% of the budgeted expendture n , and the laboratory has proved partcularly effectve n recevng grants and sellng ts servces. In the medum term these sources should keep CEPIS fnancally vable though there s a need to seek grants from a wder range of donors, and to market CEPIS work more aggressvely, especally the work wth the ndgenous rural poor and those lvng on the frnges of the urban centers. To ths end, CEPIS needs to buld up ts marketng/grant-seekng capabltes.

13 Page Has the Merger wth the Pan Amercan Center for Human Ecology and Health (ECO) Produced the Expected Synerges? Opnons are dvded on whether the merger wth ECO was well mplemented. Opnons are dvded among respondents on whether the merger of CEPIS wth some fnancal, human, and post resources from the former ECO Center n Mexco was well mplemented wth large numbers of respondents uncertan. In open-ended responses many respondents ndcated that they felt that somethng had been lost through the merger whch has yet to be fully restored. Several Washngton-based PAHO managers, n partcular, consdered that CEPIS had yet to fully grasp the complexty of the work that ECO used to carry out n relaton to the envronmental mpacts on human health, and had not taken enough steps to close the knowledge, sklls, and program gaps resultng from the merger. At the same tme there s evdence n the work of CEPIS and the response of CEPIS staff that some progress s beng made and that staff are developng new ways of workng whch could result n future synerges and advances. Several respondents felt that the merger was done too quckly, wth too many questons unanswered and the mandate unclear. One respondent suggested that when the merger decson was taken, PAHO's Dvson of Health and Envronment (HEP) lacked a comprehensve vson of ts long-term future outsde the tradtonal water, santaton, and sold waste areas. In the future, before abolshng or creatng a Center, or mergng Centers, there s a need for exercses n futures/scenaros/strategc plannng, nvolvng as many stakeholders as possble. A few respondents saw the merger prmarly as a costcuttng exercse durng whch adjustment problems would lnger on for several years, and eventually the reshufflng would result n changes to the characterstcs of both former components. More needs to be done to work wth governments to montor envronmental health rsks and to keep the publc nformed about such rsks. Assocated wth a new catalytc role, there s an expectaton that CEPIS should do more to advse and motvate natonal authortes, the academc communty, NGOs and communtes on the processes of assessng, prortzng and controllng envronmental rsks n the Amercas. In partcular, CEPIS has a role to play n addressng the growng gap that separates the scentfc descrpton of rsks and the publc understandng of those rsks. To do ths nvolves CEPIS staff movng beyond the tradtonal scentfc and techncal focus of the two envronmental health Centers and developng new ways of communcatng about rsk through the mass meda to the communty, although a strong base n scence and technology must be mantaned to underpn these broader actvtes. Whle CEPIS provdes wde-rangng tranng programs across the Regon on

14 Page 14 envronmental health rsks, t has not developed a strategc plan to show what t ntends dong n ths feld nor a strategy for gettng clear messages to the general publc. A new CEPIS should focus not only on exstng envronmental health problems of the Regon, but also play a role n scannng for future threats, as suggested by the 1998 Specal Advsory Group. In partcular, that Group recommended that CEPIS should provde gudance to Member States on how to ensure that all major development projects ncorporate an element of envronmental health assessment nto ther plannng. To mplement ths recommendaton, CEPIS has made resources avalable by translatng documents of the World Health Organzaton (WHO) nto Spansh, has made a tutoral program avalable on the Webste and has revsed a tranng course developed by ECO. CEPIS, however, could do more to montor major development projects n the Regon, to alert Member States to the need to carry out envronmental health assessments and to dssemnate good practces n ths area. The apparent over-relance on the Vrtual Lbrary for Health and Envronment n the progresson to the new CEPIS deserves some attenton, snce t would seem hard to buld up the nontradtonal areas at CEPIS, n ts progress toward a new Center, wth such heavy relance upon one major approach. The pcture that emerges from the analyss of the CEPIS-ECO merger s one of a Center workng to become the new CEPIS suggested by the 1998 Specal Advsory Group. Serous efforts are beng done n ths drecton, wth renewed emphass n the BPB. However, when lookng at the totalty of the process nvolvng the closng of ECO, the renforcng of CEPIS wth ECO resources, and the four-year evoluton toward a new CEPIS, many respondents from the PAHO country offces and Headquarters communcated a sense of loss for PAHO and the Regon, partcularly n answers to open-ended questons. It would seem from ther responses that ths loss has yet to be remeded, ether by CEPIS or by another entty nsde or outsde PAHO. 8. Conclusons CEPIS s perceved as a valuable source of techncal cooperaton and a broker of knowledge. It would be too much of a loss to abolsh t and too much effort to try to recreate an nternatonal agency to fulfll ts role. However, CEPIS should adapt ts present role and functons n terms of beng more proactve, and workng more through networks of nsttutons havng a multpler effect on ts techncal cooperaton. CEPIS must drect tself toward a transformaton nto a catalyst organzaton, as was recommended by the 1998 Specal Advsory group. In tune wth ths new drecton of CEPIS, a shft n the nternal allocaton of resources should be expected. To the extent

15 Page 15 that ths process contnues, CEPIS plannng, programmng, and budgetng process must fnd a better way to dstrbute avalable Regular Budget resources. CEPIS should develop an approprate resource moblzaton strategy as well as a permanent nternal capacty for resource moblzaton that would orgnate and coordnate efforts on behalf of CEPIS wth the support of the HEP Dvson and Offce of External Relatons. Developng ths capacty would requre addtonal fundng. Ths could be acheved by ether a redrecton of CEPIS resources or addtonal fundng approved by the Drector of PAHO. The merger of two dfferent technologcal cultures s not easy, even n prvate ndustry. We feel that the constructon of a "new" CEPIS s stll a work n progress whch deserves the support of an external advsory body. 9. Recommendatons 9.1 On effectveness and relevance CEPIS should engage n a strategc plannng/futures exercse n the context of the HEP Dvson. CEPIS should create a unt to promote and market the center and to moblze addtonal fnancal resources. CEPIS should contnue to reorent ts work to place a greater emphass on workng wth governments on envronmental polcy and put less effort nto solvng techncal problems and provdng local-level techncal advce and support. CEPIS needs to evolve progressvely from a reactve to a proactve mode by establshng consultaton processes and nternal mechansms for a pror consultaton wth PAHO country offces. The Center needs to keep the Carbbean more nformed of ts actvtes and address ts partcular ssues so that the Carbbean can beneft more from CEPIS servces, partcularly laboratory tranng. 9.2 On management CEPIS should adopt a more formalzed management structure wth regular meetngs, formal revews of progress, and records of decsons.

16 Page 16 CEPIS should develop a medum-term strategc plan showng key drectons t wshes to pursue and supported by a detaled busness plan and a rskmanagement strategy. CEPIS should regularly produce excepton reports whch show whch projects have been delayed or are runnng over budget and notng any remedal actons. CEPIS has developed gudance on project desgn but more consderaton needs to be gven to methods of achevng objectves, managng rsks, and communcatng results. CEPIS should establsh a more formal system for revewng the qualty of ts products and actvtes, evaluatng major projects, and consderng the results of such revews. Staff development needs to be gven a hgher profle, wth all staff beng set annual professonal-development targets. CEPIS needs to seek vgorously to dversfy ts sources of extrabudgetary funds, partcularly by makng potental fundng bodes more aware of the mpacts CEPIS work has on allevatng poverty, for example, among ndgenous populatons and people lvng n rural or urban-margnalzed areas. CEPIS laboratory should contnue emphaszng a wder marketng for ts accredtaton servces beyond the current range of countres. There should be a shft n the nternal allocaton of resources so that professonal staff have ncreased resources for proactve work. 9.3 On the CEPIS-ECO merger The strengthenng of the process toward the creaton of a new, more catalytc CEPIS recommended by the 1998 Specal Advsory Group, should be fostered by the establshment of an Advsory Commttee reportng to the HEP Dvson Drector and through hm/her to the Drector, PAHO. Ths Advsory Commttee would advse the HEP Dvson on techncal and polcy aspects concernng the contnung buldng of a new CEPIS reflectng the antcpated evoluton of the health and envronment feld n the Amercas. The Commttee should meet at least once a year under a rotatng charmanshp. The Drector of PAHO would appont ts members upon the recommendaton of the HEP Dvson, for lmted, staggered, but potentally renewable terms. Care should be taken that at all tmes ts membershp should be balanced between veteran nternatonal professonals

17 Page 17 from the santary engneerng feld, and from the envronmental epdemology, toxcology, and human-health rsk assessment felds. The CEPIS Drector would be an ex offco member of the Commttee. CEPIS staff should provde the Commttee's secretarat support. CEPIS should seek nnovatve ways of helpng the people of the Regon develop a better understandng of envronmental health rsks. As a frst step n the process, CEPIS should develop a strategc plan to show what t ntends to do and nurture lnks wth key regonal prnt and televson journalsts to ensure that envronmental ssues obtan a hgher meda profle. CEPIS should montor major development projects n the Regon, alert Member States to the need to carry out envronmental health assessments, and dssemnate good practce gudelnes. CEPIS should produce more gudes and teachng materals to assst countres n developng sustanable development plans and make these materals wdely accessble n the PAHO offcal languages. CEPIS should fll any vacances n areas related to envronmental epdemology, toxcology, and human-health rsk assessment as soon as feasble. 10. Acton by the Pan Amercan Santary Conference The 130 th Sesson of the Executve Commttee dscussed the summary and the full evaluaton report, fndng t a very nformatve, helpful document, and a very useful exercse for the Pan Amercan Santary Bureau, and requested a wrtten management response to the recommendatons of the evaluaton of CEPIS. The Pan Amercan Santary Conference s nvted to dscuss ths summary and the full evaluaton report, consder the annexed Resoluton CE130.R15 recommended by the Executve Commttee, and ndcate to the Bureau future steps n relaton to these ssues. Annex

18 PAN AMERICAN HEALTH ORGANIZATION WORLD HEALTH ORGANIZATION 130 th SESSION OF THE EXECUTIVE COMMITTEE Washngton, D.C., USA, June 2002 RESOLUTION CE130.R15 Annex EVALUATION OF THE PAN AMERICAN CENTER FOR SANITARY ENGINEERING AND ENVIRONMENTAL SCIENCES (CEPIS) THE 130 th SESSION OF THE EXECUTIVE COMMITTEE, Havng seen Document CE130/19, Evaluaton of the Pan Amercan Center for Santary Engneerng and Envronmental Scences (CEPIS), RESOLVES: To recommend to the Pan Amercan Santary Conference the adopton of a resoluton along the followng lnes: THE 26 th PAN AMERICAN SANITARY CONFERENCE, Havng seen Document CSP26/17, Evaluaton of the Pan Amercan Center for Santary Engneerng and Envronmental Scences (CEPIS); Aware of the full nternal evaluaton report submtted by the evaluaton team to the Drector contaned n Techncal Report OPS/DAP/ ; Bearng n mnd Resoluton CSP20.R31 of the 20 th Pan Amercan Santary Conference, requestng the Drector to carry out a regular evaluaton of each of the Pan Amercan Centers; Notng wth satsfacton that ths process has entered a new and expanded stage wth the evaluaton of CEPIS;

19 CE130.R17 (Eng.) Page 2 Aware of the recommendatons that the nternal evaluaton team has presented to the Drector; Recallng the dscussons on the topc of the Centers at recent sessons of the Subcommttee on Plannng and Programmng and of the Executve Commttee; and Notng the need to strengthen program evaluaton throughout the Bureau, RESOLVES: 1. To commend the Drector for havng carred out ths comprehensve evaluaton and for havng reenergzed the process of evaluaton n general, and that of the Pan Amercan Centers requested by the Conference n To request the Drector to: (a) (b) (c) (d) (e) mplement the pertnent recommendatons of the evaluaton team to ensure the evoluton of a strengthened CEPIS, able to serve better the current and emergng needs of Member States n the feld of health and envronment; conduct a perodc comprehensve evaluaton of one of the Pan Amercan Centers each year; strengthen the Bureau s capacty for program evaluaton; promote the development of cooperaton networks among CEPIS, the Collaboratng Centers, and other nsttutons lnked wth health and the envronment n the countres; present a wrtten management response to the recommendatons of the evaluaton of CEPIS and of other other Pan Amercan Centers as they are evaluated.