contents · 3 director-general’s foreword i am pleased to present the staff health insurance...

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Contents Director-General’s Foreword .................................................................................................................................. 3

Global Oversight Committee (GOC) Chairman’s Report ......................................................................................... 4

Certification of the Financial Statements for the year ended 31 December 2017 ............................................... 17

Letter of Transmittal ............................................................................................................................................. 18

Opinion of the External Auditor ........................................................................................................................... 19

Statement I: Statement of Financial Position ....................................................................................................... 22

Statement II: Statement of Financial Performance .............................................................................................. 23

Statement III: Statement of Changes in Net Assets/Equity .................................................................................. 24

Statement IV: Statement of Cash Flow ................................................................................................................. 25

Statement V: Comparison of Budget and Actual Amounts .................................................................................. 26

Notes to the financial statements ........................................................................................................................ 27

1 General information .................................................................................................................................. 27

2 Basis of preparation and presentation ...................................................................................................... 28

3 Significant accounting policies ................................................................................................................... 29

4 Supporting information to the Statement of Financial Position................................................................ 32

5 Supporting information to the Statement of Financial Performance ........................................................ 45

6 Supporting information to the Comparison of Budget and Actual Amounts ............................................ 48

7 Related party and other senior management disclosures ......................................................................... 49

8 Events after the Reporting Date ................................................................................................................ 49

9 Annex ........................................................................................................................................................ 50

Membership ........................................................................................................................................ 50 9.1

Fund Balance Reconciliation ............................................................................................................... 53 9.2

Claims Processing ................................................................................................................................ 54 9.3

Analysis of claims by category ............................................................................................................. 56 9.4

Major cases >US$ 50,000 .................................................................................................................... 56 9.5

Organization's Contributions .............................................................................................................. 57 9.6

Statement of First Tier and Second Tier Contributions ...................................................................... 58 9.7

Contributions Received and Claims Paid ............................................................................................. 59 9.8

Insured Persons ................................................................................................................................... 63 9.9

Composition of Global Oversight Committee (GOC) ........................................................................... 66 9.10

Composition of Global Standing Committee (GSC) and Interim GSC .................................................. 67 9.11

Composition of PAHO Sub-Committee of the GSC.............................................................................. 68 9.12

Surveillance meetings & Briefing/Visits .............................................................................................. 68 9.13

Composition of Medical Review Committee ....................................................................................... 68 9.14

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Director-General’s Foreword

I am pleased to present the Staff Health Insurance Annual Report for the year 2017, which includes financial statements, accounting policies and notes, and has been prepared in compliance with International Public Sector Accounting Standards (IPSAS) and WHO’s Financial Regulations and Rules. Financial reporting is a critical element of both governance and sound management, the improvement of which is an important aspect of the WHO reform process.

A sound Staff Health Insurance (SHI) is not only about having good financial results and a strong governance, it is also about providing participants with a high level of service, easy access to treatment as well as providing benefits that are appropriate and up-to-date with current medical practices. In this regard, WHO SHI is in a unique position compared to other UN Organizations and external insurance plans as we have world class health experts on hand to advise.

2017 was an exceptional year for SHI for many reasons:

• Investments gave a return of over 12%, which is a very good performance.

• SHI-Online was successfully launched in every region. Field staff and former staff living and working in remote locations can now with a click of a mouse, submit their claims electronically, knowing that they will be dealt with promptly.

• A pilot on Case Management began with a view to providing a better level of treatment whilst at the same time containing costs.

• PAHO full integration is progressing well, whereby the SHI Secretariat worked together with colleagues in PAHO to identify a new Third Party Administrator (TPA) for the processing of claims in the United States of America, and to harmonize IT systems for SHI.

• Financial stability and sustainability is of the upmost importance for a fund the size of the SHI. I have approved the formation of a working group to look at ways to ensure greater financial stability, as well as reducing costs for the SHI, its participants as well as Member States. I look forward to hearing the proposals of this working group.

We can be proud that SHI has served staff and former staff and their family members for almost 60 years. In today’s world of ever-increasing costs, instability in financial markets and evolving IT applications, SHI is a good example of the initiative and innovation required to respond to these challenges. Together with the Organization’s senior management, SHI is contributing towards the transformation of WHO and I look forward to future improvements that SHI has in store for us for 2018.

Dr Tedros Adhanom Ghebreyesus Director-General Geneva, 1 July 2018

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Global Oversight Committee (GOC) Chairman’s Report In application of SHI Rule G.1.15, the Annual Report of the Staff Health Insurance Fund (SHI) has been prepared, and it includes the financial statements which are reported separately from the rest of WHO’s financial statements. The SHI Fund financial statements identify separately the following SHI accounting entities (referred to in this report as “participating entities”): • World Health Organization (WHO) • Trust Fund for the Joint United Nations programme on HIV/AIDS (UNAIDS) • International Drug Purchase Facility (UNITAID) • International Agency for Research on Cancer (IARC) • International Computing Centre (ICC) • Pan American Health Organization (PAHO) Highlights of revenue, expenses, statistics, operations, administration and governance are included in order to provide a complete picture of the SHI Fund as at 31 December 2017. The statutory components of the financial report have been audited by the Organization’s External Auditor, the Republic of the Philippines Commission of Audit, whose opinion is included in the financial report.

Overall Results for 2017

I am pleased to report that 2017 was an exceptional year for SHI, both in terms of investments and achievements. Contributions totalled US$ 137.1 million (US$ 190.5 million in 2016), with operational contributions of US$ 114.4 million (US$ 106.7 million in 2016), and claims of US$ 90.5 million (US$ 83.8 million in 2016). This resulted in a net operational surplus of US$ 23.9 million (US$ 22.9 million in 2016), despite the operational deficit for former staff of almost US$ 9.4 million. Furthermore, PAHO transferred supplementary contributions (currently levied at 4% on staff payroll) to the SHI Fund worth US$ 2.1 million (US$ 64.6 million in 2016). This is shown in both Table 1 and Note 5.1.

In accordance with SHI Rule F.8.4, a fixed percentage of active staff contributions (both staff and Organization shares) is set aside each year as a provision for future former staff. The current percentage is 25%, and represents US$ 24.6 million, which is included within other contributions.

In US$'000 CONTRIBUTIONS CLAIMS PAIDSURPLUS /

DEFICIT

Activ e Staff and Eligible Family Members (ex c. App C) 73,726 40,610 33,117

Former Staff/Surv iv ors and Eligible Family Members 40,505 49,861 (9,356)

Temporary Staff (Appendix C) 196 11 185

114,427 90,482 23,945

Earmarking 25% of Activ e Staff Contributions for Former Staff 24,575 Surplus/(Deficit) on Organization Share for Former Staff carried ov er (5,790) Second-Tier Contributions 1,814 Prior Year adjustments (22) (625) Current Year adjustments 32

135,004 89,889 PAHO-administered asset transfer 2,136 Total 137,140 89,889

Table 1

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The US$ 5.8 million deficit on Organization Share for Retirees carried over relates to all entities excluding PAHO.

Claims increased in 2017 compared to 2016, due to higher hospitalization and medication costs paid (particularly in the Americas). Despite a decrease in the number of major claims (>US$ 50,000) in 2017, these were higher in value (as mentioned in Note 9.5).

After other income items (including investment earnings of US$ 90.3 million), and administrative costs of US$ 5.9 million (which represents 2.6% and remains significantly lower than the 6% provision allowed for under SHI Rule F.6.5), the overall result was US$ 130.3 million. This extremely positive result can be explained by both exceptionally good investment income, and the increase in contributions (including the PAHO-administered assets). This balance has been booked to the participating entities to reduce their unfunded liabilities, as shown in both Statement II: Statement of Financial Performance, and Note 5.7.

The latest contributions, claims, and headcount are all factored into the latest SHI actuarial liability, and AON Hewitt have informed the SHI that there was a favourable variance in 2017, compared to the previous actuarial valuation.

Active Staff (except Appendix C) After deduction of the 25% provision for future former staff, the remaining 75% of contributions was sufficient to cover claims of active staff in all offices except in the Americas region1. The Americas region’s deficit (US$ 2.6 million), largely due to the higher cost of health care in the United States of America, was largely offset by a second tier contribution payable by staff and the Administration of Americas region on a one-third/two-third basis under the provisions of the SHI Rule F.3. This compares with a deficit of US$ 1.0 million in 2016 and US$ 1.1 million in 2015. The contributions/claims relationship is shown in Figure 1.

1 The Americas region was reported as AMRO/PAHO in previous SHI annual reports.

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20.0

25.0

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Figure 1: Active Staff (except App C) Contributions and Claims by Office for 2017

Contributions Claims Second Tier ContributionsUS$ millions

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For all other offices (excluding the Americas region) combined, there was a net overall surplus of US$ 35.7 million for active staff (i.e. contributions exceeded claims) after a deduction of 25% of contributions as earmarked for former staff. This compares with a figure of US$ 33.2 million in 2016 and US$ 28.7 million in 2015.

The statement of first and second tier contributions is presented in Note 9.7 of this report, and the surplus/deficit history is shown in Figure 2.

Figure 2: Surplus/deficit of fixed-term active staff (excl. App C) in all offices

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16.0

2009 2010 2011 2012 2013 2014 2015 2016 2017

HQ/UNAIDS/UNITAID/ICC/ IARC SURPLUSin US$ millions

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2009 2010 2011 2012 2013 2014 2015 2016 2017

AFRO SURPLUSin US$ millions

(4.0)

(3.0)

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AMERICAS DEFICITin US$ millions

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2009 2010 2011 2012 2013 2014 2015 2016 2017

EURO SURPLUSin US$ millions

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2009 2010 2011 2012 2013 2014 2015 2016 2017

EMRO SURPLUSin US$ millions

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SEARO SURPLUSin US$ millions

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WPRO SURPLUSin US$ millions

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Former Staff

Claims paid in respect of former staff exceeded contributions received by US$ 9.4 million (compared with US$ 9.5 million in 2016 and US$ 7.4 million in 2015). This category has been consistently in deficit for several years, and Americas region former staff alone account for a deficit of US$ 9.1 million in 2017. The contributions/claims relationship is shown in Figure 3.

Table 2 shows that the proportion of claims covered by contributions, as can also be derived from Table 13 in Note 9.8. The surplus/deficit history is shown in Figure 4.

However, the 25% provision which was set aside (in accordance with SHI Rule F.8.4) adequately covered the former staff operational deficit in 2017, as can be seen in Figure 13 under Note 9.1.

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25.0

Figure 3: Former Staff Contributions and Claims by Office for 2017

Contributions ClaimsUS$ millions

Former Staff PercentageAll : 81.2%All ex cluding Americas region 99.1%Americas region 56.4%

Table 2

(20.0)

(16.0)

(12.0)

(8.0)

(4.0)

0.02009 2010 2011 2012 2013 2014 2015 2016 2017

Figure 4: FORMER STAFF and DEPENDANT DEFICIT in US$ millions

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Investment performance

The SHI Fund investments yielded 12.2% in 2017 (3.1% in 2016), which represented a net return of US$ 90.3 million (compared to a return of US$ 23.7 million in 2016).

2017 was a very positive year for the fixed income and equities markets in which the SHI Fund’s assets are invested. Markets were buoyed by synchronised growth across all major economies, benign inflation, accommodative monetary policies and an absence of volatility. These factors combined to generate strong corporate earnings, which caused equities values in particular to rise strongly.

The majority of the SHI Fund investments are in fixed income dollar denominated bonds. Both US and non-US fixed income markets posted positive returns in 2017, particularly longer dated bonds and investment grade corporate bonds, which make up a significant proportion of the SHI Fund fixed income investment portfolios. The longer dated bonds benefited from decreases in interest rates on the long end of the US yield curve, and the corporate bond values rose due to the strength in corporate earnings growth.

As the SHI Fund size grew during the year, and with the receipt of funds from PAHO, the investment in the passive global index fixed income fund was increased during 2017: by US$ 110.0 million in May, and by US$ 30.0 million in October. In July, US$ 25.0 million was reallocated from the emerging market equities investment to the passive global index fixed income fund.

The SHI investment portfolio is structured with a long term time horizon to match the long term nature of its future expenditure, and so some years of lower performance are to be expected. The 2017 investment return figure of 12.2% was exceptionally good and should be viewed in the context of the returns in recent years (as provided in Figure 5).

The equity and fixed income investments are managed by external fund managers, whose appointment and performance is closely managed by the WHO Treasury unit and monitored by the independent expert advisors in the Advisory Investment Committee. The total funds invested in the three asset classes has increased by US$ 192.3 million, with the relative allocations among the asset classes as follows: fixed income securities 71%; equities 27%; and cash 2%.

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Figure 5 - SHI Fund Investment performance

TARGET

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Table 3 provides a summary of the SHI investments at 31 December 2017, and the investment returns during 2017 (based on the average balances throughout the year).

Table 3

Fund Balance and Liability

The SHI engaged Aon Hewitt Corporation to conduct an After Service Health Insurance (ASHI) actuarial valuation, in accordance with generally accepted actuarial principles and practices. In addition, the accounting valuation results are based on the actuary’s understanding of the requirements of IPSAS 39.

The 31 December 2017 valuation results and the IPSAS 39 disclosures are split by regional office and entity. The defined benefit obligation and service cost are allocated to the regional offices and entities.

Figure 6 provides an overview of the Fund balance and long-term liability. The Fund balance as at 31 December 2017 is US$ 979.2 million (an increase of 15.3% over 2016), whereas the liability is now estimated to be US$ 2,910.4 million as at 31 December 2017 (an increase of 23.2% over 2016). This leaves an unfunded deficit representing 67% of the total liability, and is shown in the accounts of participating entities.

The liability for current retirees (under SHI Rule F.8.2) had been steadily growing until 2012 when the liability for future retirees (SHI Rule F.8.3) was added in application of IPSAS.

Figure 6: Fund Balance and Long-Term Liability (in US$ millions)

It is also worth noting that the current Fund balance is insufficient to cover the liability for current retirees (SHI Rule F.8.2), which is estimated as US$ 1,274.7 million.

The increase in the liability can be explained by a decrease in both the discount rates and contribution growth rates, and an increase in life expectancies (as advised by the UN). This is partly offset by net decreases to assumed future medical/administrative costs. Further information on the actuarial valuation (including assumptions used) is contained in Note 4.10.

US$ millions % Return WeightGOC-recommended weighting,

effective since 2013

Co-mingled cash 16.4 1.5% 2% 0% to 10%Fix ed Income 692.4 6.5% 71% 55% to 75%

Equities 265.2 27.5% 27% 25% to 35%

Total Investments 974.0 12.2% 100% 100%

Other Net Assets (eg Receiv ables) 5.2 0.0% 0% -

Total Fund Balance 979.2 12.2% 100% 100%

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FUND BALANCE

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LONG-TERM LIABILITY DEFINED BENEFIT OBLIGATION (F.8.2

and F.8.3)

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(1,500.0)

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(500.0)

0.02009 2010 2011 2012 2013 2014 2015 2016 2017

UNFUNDED LIABILITY

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ASHI Liability and Funding Level – 30-Year Projection

To address the liability, both the Organization and participating entities continue to pursue two strategies:

• cost containment; and • increased contributions (as presented in Table 4).

Figure 7 shows Aon Hewitt Corporation’s recent 30-year projection, from which it is important to note that the ASHI liability is in any case expected to reach nearly US$ 10,000.0 million by 2047. As a result of the above strategies, it is now estimated that full funding will be reached only in 2049.

Figure 7

Years31 December 2017

Valuation2016-2019 4%

2020-2040 2%

2041-2049 2%

2050+ 0%

Table 4 - Proposed Contribution Rate Increase

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Governance

It is pleasing to report that the SHI Governance is working effectively.

The Global Oversight Committee

The Global Oversight Committee’s (GOC) role is to oversee the SHI and advise the Director-General on SHI operations and management, finance and investments, audit and control, benefits and best practices, rules and governance. The GOC met twice in Geneva during 2017.

The Global Standing Committee and the Interim Global Standing Committee

The Global Standing Committee (GSC) met 10 times during 2017 and reviewed a total of 47 cases from all regions (excluding the Americas). The Committee also discussed the SHI rules and made a number of proposals for rule changes to the GOC.

The Interim Global Standing Committee’s role is to transact emergency business when the Global Standing Committee itself is not in session. This Committee met twice during 2017.

The PAHO-Sub-Committee met 4 times during 2017 and handled 14 cases.

Highlights of SHI Operations

Staffing and operational budget The SHI at Headquarters is under the responsibility of the Head SHI, who reports to the Coordinator, Insurance and Pension Services (IPS) and the Comptroller respectively.

Staffing did remain stable during 2017: two G.06 staff retired at the end of the year in HQ and succession planning started in September when a G.02 and G.04 short term staff were recruited. In addition a G.03 fixed term data entry clerk was recruited for HQ as per the audit recommendations to segregate duties by ensuring that only one person enters the details of health care providers into the HIIS database. The ninth GOC approved a review of all posts in the regional offices with a view of harmonizing job descriptions, recruitment and the number of staff together with the supervision being performed by HQ SHI Officer at the first level and second level by BFO in the respective regional office. The review began in 2017 and will be discussed at the tenth meeting of the GOC. In 2017, the administrative expenses represented US$ 5.9 million and are split as per Table 5.

Total staff costs reflect salary costs of HQ and Regional staff processing claims. There was a 16% increase in 2017, albeit well below the biennium budget. This increase primarily reflects the late recognition of the biennium staff cost for the IT Product Specialist.

in US$'000 2017 2016 % Change

Staff costs 5,152 4,430 16%

Travel 137 148 (8%)

Other operating costs (including actuarial valuation costs) 639 431 48%

TOTAL 5,928 5,010 18%

Table 5

https://sharepoint.who.int/sites/shi/SHI%20Document%20Library/JM7_0_4_PRES_opening.ppt#307,2,Slide%202

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Travel costs decreased by 7% in 2017, but consist mainly of missions to all regions to promote SHI-Online and to brief staff, discuss administrative matters and enhance or establish agreements with major medical networks.

Other operating costs have increased in 2017, mainly due to additional overtime costs to cover claims processing vacancies and extra consultant fees for the IT project, offset by administration cost savings. However, overall costs were contained within the biennium budget allocated.

The comparison of budget and actual expenses for the period ended 31 December 2017 is shown in both Statement V and Note 6.

SHI Rule F.6.5 states that any administrative expenses are charged, up to a maximum of 6% of total premiums collected and other sources of income. From Table 6, it can be seen that the current administrative expenses fall well below this percentage, despite the additional staff costs. As stated before, these figures cover not only HQ but also Regional Office staff costs for claims processing.

SHI cards and emergency number The SHI Secretariat is happy to report that the emergency number on the SHI cards is rarely used. This is however, an essential service which we will continue to provide.

Access to treatment SHI continues to sign conventions with health care providers and update existing conventions on a yearly basis. 2017 was no exception and more conventions were added to the list. This will be given an even greater priority during 2018 where we hope to collaborate with other international Organizations in order to broaden our list of conventions, and hence provide greater access to treatment to all of our participants. The fact that the SHI Emergency number is rarely used is an indication that having more conventions with health care providers is paying off. A SHI Guide to Hospitalization was launched in 2017 which should facilitate participants understanding and responsibility in gaining access to health care providers.

PAHO A Request for Proposal was issued during 2017 to identify the future Third Party Administrators (TPAs), for processing medical and pharmaceutical claims and processing medicines in the United States of America. This was a massive undertaking due to the complexity of the business of the SHI Fund and also due to the complex health care system in the United States of America. The new TPAs should be in place by mid 2018. The full integration of PAHO into the same systems as the rest of the SHI also began which will result in a harmonized approach, stronger controls, less risk to the fund and hopefully provide a faster, more transparent service to participants. It is hoped that PAHO will go-live with SHI-Online by September 2018 for its country offices.

Briefings and trainings Regular monthly briefings were provided to new staff, as well as monthly video conferences with regional offices and their SHI teams and BFOs. A pre-retirement briefing was provided to future

2009 2010 2011 2012 2013 2014 2015 2016 2017

Total Income (in US$'000) 146,842 123,376 113,801 154,267 145,738 133,325 107,071 214,132 227,399

Administrative expenses (in US$'000) 1,938 2,532 3,415 3,989 4,271 4,519 5,111 5,010 5,928

Adm. Exp. / Income (in % ) 1.3% 2.1% 3.0% 2.6% 2.9% 3.4% 4.8% 2.3% 2.6%

Limit put in place in 2005 as per para F.6.5 (in %) 6% 6% 6% 6% 6% 6% 6% 6% 6%

Table 6

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retirees and a presentation was given at the HQ/AFSM meeting. All regional offices were visited together with the GSC in Malaysia in order to brief staff on SHI-Online and to provide briefings and confidential clinics on SHI matters. In addition to this, many country offices were visited in order to establish conventions with major health care providers. For the first time in the history of the SHI, two representatives from each regional office SHI team came to Geneva for a 3-day briefing and training in April with several objectives, namely, harmonizing all work and practices and application of SHI rules, learning more about the SHI-Online tool and sharing best practices. As a consequence of the above mentioned workshop, the SharePoint created in 2014 for regional SHI teams and HQ was updated to make it more user-friendly. Audit SHI continued to work on the internal audit recommendations made at the end of 2016. The GOC endorsed the recommendations at its eighth and ninth meetings and as a result, as previously mentioned, additional professional posts were approved to strengthen the Secretariat together with the recruitment of a G.03 data entry clerk. All SHI/HQ posts were reviewed to ensure segregation of duties and necessary changes were implemented. The review of the regional posts also began. The SHI put in place several new reports to control claims and with the help of the SHI-Online managed to identify several cases of suspected fraud. There were 19 suspected fraud cases still under investigation as at 31 December 2017. Once the new P.02 Compliance Officer is in place it is believed that more cases will be identified.

SHI newsletter The fourth SHI newsletter was issued for 2017 in English, French and Spanish and distributed to all participants. As last year, it included an executive summary of the SHI report. The 2017 newsletter focused on: the launch of the SHI-Online; new rule amendments; Prevention Corner – “Eat better and move more!” and launched the new SHI Guide to Hospitilization.

Computer systems – HIIS and self-service portal (SHI-Online) The project to upgrade the HIIS continued in 2017. The major enhancements that were delivered included: (i) an improved facility to select a Health Care Provider during data entry; (ii) the introduction of more system logic to strengthen the automated checks for duplicates; (iii) increased integration with SHI-Online; and (iv) enhancements to the claims entry module to improve user experience for SHI Claim Specialists.

Phase 1 of the SHI-Online was launched on 2 February 2017 in HQ, and by the end of April 2017 it had been launched in all regional offices with great success. It is considered one of WHO’s best IT success stories. The tool was created in-house using Nintex and Sharepoint and was developed in partnership with colleagues in the IMT department and Global Service Centre. The tool allows staff and former staff around the world to submit their claims electronically on-line and dramatically reduces the time for reimbursement for participants living in remote places. It is possible to see the status of claims being processed and claims history, as well as the remaining credits, for all members of a family. SHI-Online is also a library of SHI information and includes the SHI rules, Information Notes, FAQs and important SHI announcements. Work began on Phase 2 of the SHI-Online also in 2017. This should be available during the third quarter of 2018 and will allow participants to produce attestations, whilst having many other features.

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Risks and Challenges

Every Health Insurance scheme has its risks and challenges, the WHO SHI is no different. The SHI Secretariat is working on solutions to mitigate the main risks and challenges to the scheme, as highlighted in Table 7.

Challenge Risk On-going solutionsSHI cards were made available during 2015 which contain an emergency number (available 24/7 in 3 languages). This service will continue, despite being l ittle used as it is considered to be essential.The establishment of conventions with hospitals is an on-going process. Many more conventions were signed during 2017 and a stronger plan is being put in place for 2018. BFOs are assisting in as many countries as possible and joint missions are constantly being organized between SHI/SHW/RSPs and BFOs. SHI is also working with other UN Organizations to see how we can join agreements that they may have at country level and vice versa. A P.03 administrative officer position will be created which will allow more time to focus on this area in 2018.A Guide to Hospitalization was prepared at the end of 2017 and communicated to all participants and is available on SHI-Online and on the SHI intranet pages.The Rules were modified to ensure that participants request a letter of guarantee 2 weeks in advance (except for emergencies) of hospitalization in order to allow for the SHI to negotiate both access and cost with health care providers.

The rules are revised every year and sent to staff electronically and by mail if necessary.Pamphlets summarizing benefits have been updated.The SHI Intranet site is regularly updated.The Extranet site for former staff is regularly updated.Information Notes are sent out to participants when needed.The annual SHI Newsletter is issued to participants.The SHI-Online was launched early 2017 and is a one-stop-shop for all SHI information. It wil l contain regular updates on important SHI information.Regular briefings, country visits, regional office visits, briefing packages (videos) and sharepoint sites have been created for use by the regions.

Table 7

Lack of information on how SHI works can lead to many problems (i.e. the participant embarking on expensive treatment that is not reimbursable; submitting claims out of date; and not being reimbursed etc).

Access to information

Access to treatment

This is one of the biggest challenges facing the SHI today. It is a global plan, active in over 190 countries. The risk of a participant not having access to treatment could have serious implications for their health.

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Challenge Risk On-going solutions

The SHI Secretariat visited all regional offices during 2017 to ensure harmonization of processes and consistency of practices.Monthly video-conferences with the regional offices are held to discuss issues.The first ever SHI workshop was held in April 2017 which brought together 2 staff from each region to work on harmonization.Work is currently underway to ensure that there is harmonization in job descriptions, standard office procedures and recruitment and the role and terms of reference of SHI Officers is also under discussion.

SHI-Online is a one stop shop for all rules, procedures, FAQs. It facil itates participants having immediate access to latest information instead of referring to old rules.

IT systems

The IT system needs to be robust andsustainable and able to protect allinformation, particularly due to itsconfidential nature. An IT system that is notfit for purpose poses one of the greatest risksto the SHI. Incorrect financial reporting, lossof data and breach of confidentiality wouldbe catastrophic and would mean the end ofthe SHI being internally managed.

The SHI HIIS database continued to be updated and even more controls will be put in place for cross-checking and flagging potential errors or areas of concern and more reports will be available. The SHI-Online was launched and has reduced the number of errors for both staff and claims staff due to the fact that only one currency will be allowed per claims submission with a maximum of 5 invoices per claim. The payment process has been reviewed and improvements were made and will continue to be made. A new P.02 post was agreed upon to assist in all of this area, and a G.03 was recruited to ensure that the health care providers are only entered into the HIIS by one person. Phase 2 of the SHI-Online began work in 2017 and will be completed in 2018 and SHI is also working on an additional tool which will upload the claims directly into the HIIS which will be discussed at the GOC in June 2018.A dedicated Finance Officer and Finance Assistant are in place to ensure that the SHI accounts are in compliance with International Public Sector Accounting Standards (IPSAS).Regular actuarial reviews are made, as well as both internal and external financial audits.The SHI Secretariat will continue to make various financing proposals (including cost containment initiatives) to be considered by the GOC for the long-term sustainabil ity of the SHI Fund.

Overuse of benefitsFrom a cost containment perspective, the financial risk of overuse of benefits must also be considered.

Indicators for overuse of benefits are being explored by the SHI Secretariat, in order to control this risk.

Table 7 continued

Harmonization of processes Inconsistencies of processes leads to confusion, lack of trust and inefficiencies.

FinancingInproper financial controls and planning will most definitely lead to the demise of the SHI Fund.

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On behalf of the GOC, I am very pleased with the progress made to improve the service level, communication, and sustainability of the SHI Fund. The GOC will continue to monitor the performance and the long term financing of SHI very closely, and will make any recommendation to the Director-General, as appropriate.

Stewart Simonson Assistant Director-General – GMG Geneva, 1 July 2018

Challenge Risk On-going solutionsCurrently the SHI Secretariat has a staff member who spends 50% of his time auditing and controll ing claims. Rigorous controls and checks are made at every stage of claims processing. The GOC approved the recruitment of a P.02 Compliance officer who will put in place automatic and systematic controls.The SHI now produces more reports at the time of payment and as a consequence is investigating many more "suspect" claims.The SHI reviewed all functions in HQ to ensure segregation of functions, including who could enter bank details. This is now limited to few staff who cannot process claims.The GOC approved the recruitment of a P.02 IT officer who will work with the new P.02 compliance officer to put in more controls in the IT systems.The GOC approved the recruitment of a G.03 data entry clerk to ensure segregation of duties and ensure that only this person can enter the details of the health care providers in the HIIS data base. This person took up these functions in September 2017.The claims team are given regular briefings and trainings on fraud control and during 2017 ILO engaged an independent consultancy firm to brief on Fraud detection which WHO/SHI staff participated in. SHI will engage the same company in 2018 to continue their briefing.Visits to regional offices are made to audit SHI claims.

Service level

Failure to reimburse participants in a timely manner leads to frustration, unhappiness and can lead to financial hardship. This is particularly important when reimbursing claims for former staff, who normally l ive on a reduced income.

The SHI Secretariat has strived to reimburse all participants within 15 days. 2017 was a difficult year due to the launch of the SHI-Online and also to many long term absences. The Secretariat resolved the SHI-Online issues and will be presenting solutions to the GOC in June 2018 for the staffing issues.

Table 7 continued

The financial risk of fraud cannot be under-estimated, and all SHI staff must remain vigilant.

Detection of fraud

17

Certification of the Financial Statements for the year ended 31 December 2017

The accounts for the SHI have been established and maintained in accordance with International Public Sector Accounting Standards (IPSAS). The financial statements for the year ended 31 December 2017, together with the notes to the financial statements and supporting schedules, have been reviewed and approved. Nicholas R Jeffreys Claude Hennetier Rossier Comptroller Coordinator, Insurance and Pension Services 1 April 2018

18

Letter of Transmittal

19

Opinion of the External Auditor

22

Statement I: Statement of Financial Position As at 31 December 2017

(In thousands of United States dollars)

The section on significant accounting policies and the accompanying notes form part of the financial statements.

Notes 31 December 2017 31 December 2016

ASSETSCurrent assets

Cash and cash equiv alents 4.1 39,357 41,273 Short-term inv estments 4.2 58,311 49,205 Accounts receiv able - current 4.3 5,643 76,754 Receiv able from participants - net 4.4 370 180 Inter-entity receiv able 4.5 16,390 53,954

Total current assets 120,071 221,367

Non-current assetsAccounts receiv able - non-current 4.6 1,963,292 1,534,157 Long-term inv estments 4.2 960,148 726,240

Total non-current assets 2,923,440 2,260,397

TOTAL ASSETS 3,043,511 2,481,764

LIABILITIESCurrent liabilities

Financial liabilities 4.2 100,227 88,943 Other current liabilities 4.7 678 1,270 Deferred rev enue 4.8 88 71 Prov ision for outstanding claims 4.9 32,135 29,619

Total current liabilities 133,128 119,903

Non-current liabilitiesLong-term liabilities 4.10 2,910,384 2,361,861

TOTAL LIABILITIES 3,043,511 2,481,764

NET ASSETS/EQUITYReserv es - -

TOTAL NET ASSETS/EQUITY - - TOTAL LIABILITIES AND NET ASSETS/EQUITY 3,043,511 2,481,764

23

Statement II: Statement of Financial Performance For the year ended 31 December 2017



Notes 2017 2016

REVENUEContributions - regular 5.1 135,004 125,877 Contributions - PAHO-administered asset transfer 5.1 2,136 64,590

TOTAL REVENUE 137,140 190,467

EXPENSESClaims paid 5.1 89,889 82,919 Amounts w ritten-off 5.2 - 3 Staff costs 5.3 5,152 4,430 Trav el 5.4 137 148 Other operating costs 5.5 639 431

TOTAL EXPENSES 95,817 87,932

Finance rev enue/(ex pense) 5.6 89,016 22,486 Amounts booked to participating entities 5.7 130,339 125,021

NET SURPLUS/(DEFICIT) FOR THE YEAR - -

24

Statement III: Statement of Changes in Net Assets/Equity For the year ended 31 December 2017


There is no reported change in net assets/equity, due to the policy of booking any surplus back to the participating entities to reduce their unfunded liabilities. This policy will continue whilst there is an overall unfunded liability for the SHI.


25

Statement IV: Statement of Cash Flow For the year ended 31 December 2017



2017 2016

CASH FLOWS FROM OPERATING ACTIVITIES Surplus/(Deficit) for the year - - Non-cash movements

(Increase)/decrease in accounts receiv able - current 71,112 (64,237) (Increase)/decrease in receiv able from participants - net (190) (5) (Increase)/decrease in Inter-entity receiv able 37,563 6,388 (Increase)/decrease in accounts receiv able - non-current (429,135) (26,632)

Increase/(decrease) in prov ision for outstanding claims 2,516 (312)

Increase/(decrease) in other current liabilities (592) 874

Increase/(decrease) in deferred rev enue 17 37 Increase/(decrease) in long-term liabilities 548,522 150,660

Net cash flows from operating activities 229,813 66,771

CASH FLOWS FROM INVESTING ACTIVITIES (Increase)/decrease in short-term inv estments (9,105) (28,671) (Increase)/decrease in long-term inv estments (233,908) (93,428) Increase/(decrease) in financial liabilities 11,284 34,585

Net cash flows from investing activities (231,729) (87,514)

Net increase/(decrease) in cash and cash equivalents (1,915) (20,742)

Cash and cash equivalents at beginning of year 41,273 62,015

Cash and cash equivalents at end of year 39,357 41,273

26

EXPE

NSES

Orig

inal

Bi

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27

Notes to the financial statements

1 General information The SHI is a trust fund of WHO. It is treated as a multi-employer plan for various participating entities. WHO has had its own independent SHI scheme since 1 January 1960.

Since that date it has evolved, but it still remains true to its basic principle: to provide for the reimbursement of a major portion of the expenses for medically recognized health care incurred by staff and other participants to the SHI. SHI therefore recognizes expenses related to the reimbursements of claims submitted by its participants (both active and former staff, and their recognized family members).

The Global Oversight Committee (GOC) of the WHO SHI was established to oversee the SHI and advise the WHO Director-General on SHI operations and management, finance and investments, audit and control, benefits and best practices, rules and Governance.

The SHI Secretariat is based in WHO Headquarters at Avenue Appia 20, 1211 Geneva 27, Switzerland.

28

2 Basis of preparation and presentation The financial statements of the SHI have been prepared on the accrual basis of accounting in accordance with International Public Sector Accounting Standards (IPSAS). Where IPSAS do not address a particular issue, the appropriate International Financial Reporting Standard (IFRS) has been applied.

These Financial Statements were prepared under the assumption that the SHI is a going concern and will continue in operation and will meet its mandate for the foreseeable future (IPSAS 1).

These financial statements are presented in United States dollars and all values are rounded to the nearest thousands ($’000).

Functional currency and translation of foreign currencies The functional and reporting currency of the SHI is the US$. Foreign currency transactions are translated into US$ at the prevailing United Nations Operational Rates of Exchange (UNORE). The UNORE are set once a month, and revised mid-month if there are significant exchange rate fluctuations relating to individual currencies. Assets and liabilities in currencies other than US$ are translated into US$ at the prevailing UNORE month-end closing rate. Resulting gains or losses are accounted for in the Statement of Financial Performance. The non US$ denominated assets and liabilities in the investment portfolios are translated into US$ at the month-end closing rate used by the custodian.

Materiality and the use of judgments and estimates Materiality 2 is central to SHI’s financial statements. The SHI process for reviewing accounting materiality provides a systematic approach to the identification, analysis, evaluation, endorsement and periodic review of decisions taken involving the materiality of information, spanning a number of accounting areas. The financial statements include amounts based on judgments, estimates and assumptions by management. Changes in estimates are reflected in the period in which they become known.

Financial Statements3

In accordance with IPSAS 1, a complete set of financial statements has been prepared as follows:

• Statement of Financial Position • Statement of Financial Performance • Statement of Changes in Net Assets/Equity • Statement of Cash Flow • Comparison of Budget and Actual Amounts • Notes, comprising a summary of significant accounting policies and other relevant information.

2 Omissions or misstatements of items are material if they could, individually or collectively, influence the decisions or assessments of users made on the basis of the financial statements. 3 The financial statements are rounded to the thousands of US dollars. Comparative figures have been adjusted, as a result rounding differences may occur.

29

3 Significant accounting policies SHI applies the World Health Organization accounting rules and has adopted the IPSAS since January 2012.

A financial accounting valuation of the WHO After Service Health Insurance plan is performed annually in application of International Public Sector Accounting Standards 39.

Cash and Cash Equivalents 3.1

Cash and cash equivalents are held at nominal value and comprise cash at banks, collateral deposits, commercial papers, money market funds and short-term bills and notes. All investments that have a maturity of three months or less from the date of acquisition are included as cash and cash equivalents. This includes cash and cash equivalents held in the portfolios managed by external investment managers.

Investments and financial instruments 3.2

Financial assets or financial liabilities at fair value through surplus or deficit are financial instruments that meet either of the following conditions: 1) they are held for trading; or 2) they are designated by the entity upon initial recognition as at fair value through surplus or deficit. Financial instruments in this category are measured at fair value and any gains and losses arising from changes in the fair value are accounted for through surplus or deficit and included within the Statement of Financial Performance in the period in which they arise. All derivative instruments, such as interest rate swaps, currency forward contracts, futures or options are classified as held for trading.

Bank deposits and other receivables are non-derivative financial assets with fixed or determinable payments that are not quoted in an active market. Accrued income related to interest, dividends and pending cash to receive from investments are included here. Bank deposits and other receivables are stated at amortized cost calculated using the effective interest rate method, less any impairment. Interest income is recognized on the effective interest rate basis, other than for short-term receivables where the recognition of interest would be immaterial.

Other financial liabilities include accrued expenses and payables relating to investments and are recognized initially at fair value, and subsequently measured at amortized cost using the effective interest method other than for short-term liabilities where the recognition of interest would be immaterial.

Financial instruments are allocated between current and non-current. This is based on the investment time horizons of each of the investments and is shown in the Statement of Financial Position. All of the financial instruments in the investment portfolios other than those classified in the categories detailed above are classified as non-current due to the long-term investment horizon of the portfolios.

Accounts receivable 3.3Accounts receivable are recorded at their estimated realizable value. Accounts receivable is classified as non-current if the receivable is due after one year from the reporting date.

This includes an inter-entity receivable due to the SHI from the World Health Organization, representing excess cash invested within co-mingled short-term investments.

30

Any write-off of SHI receivables will be in accordance with World Health Organization accounting rules, and will be properly escalated to the appropriate Management level.

Other current liabilities 3.4Other current liabilities includes accrued liabilities which are financial liabilities in respect of goods or services that have been received by the SHI during the reporting period and which have not yet been invoiced.

Provisions and contingent liabilities 3.5Provisions are recognized for future liabilities and charges where the SHI has a present legal or constructive obligation as a result of past events and it is probable that the SHI will be required to settle the obligation.

Other commitments, which do not meet the recognition criteria for liabilities, are disclosed in the notes to the financial statements as contingent liabilities when their existence will be confirmed only by the occurrence or non-occurrence of one or more uncertain future events which are not wholly within the control of the SHI.

Revenue 3.6The main sources of revenue for the SHI include but are not limited to: Non-exchange revenue • Contributions. Revenue is from contributions collected from both active and former staff. Where payment terms are in the current accounting year, revenue is recognized in the current period. Where payment terms specify payment after the year end (as in the case of both Leave Without Pay and Extension periods concluding after the year end), the amount is reported as deferred revenue. • Finance revenues. Revenue is from income on externally managed investments, and interest on excess cash invested by the World Health Organization within co-mingled short-term investments. Where SHI does not control the resource, the revenue and amount receivable is not recorded until the cash is received.

Expenses 3.7Expenses are decreases in economic benefits or service potential during the reporting period in the form of outflows or consumption of assets or incurrences of liabilities that result in decreases in net assets/equity. Expenses are recognized when claims are due (delivery principle) and not when cash or its equivalent is paid.

31

Provision for outstanding claims 3.8The Provision for outstanding claims is estimated for the settlement of four months of combined in-service and after-service claims and administrative expenses for the SHI.

In accounting for the Provision for outstanding claims:

- an actuarial valuation is generally needed; and - an entity recognizes the undiscounted cost of benefits as they are earned.

The portion of the SHI covering active staff is a short-term benefit for which SHI should record an annual expense equal to the cost of medical benefits for active staff and their dependents, reduced by all contributions made by active staff.

Long-term liabilities 3.9Long-term liabilities are post-employment health care benefits paid after separation for service rendered.

In accounting for Long-term liabilities:

- an actuarial valuation is generally needed to determine a discounted liability; and - an entity accrues a liability and an expense as employees render service.

The portion of the SHI covering former staff is a defined benefit, post-employment benefit subject to all requirements for defined benefit plans contained in IPSAS 39, “Employee Benefits”.

Statement of Cash Flow 3.10The Statement of Cash Flow (Statement IV) is prepared using the indirect method.

Budget comparison 3.11SHI’s budget and accounting bases differ. Budgets within the SHI are approved on a modified cash basis rather than the full accrual basis of IPSAS. In addition, budgets are prepared on a biennial basis.

Amounts booked to participating entities 3.12Any surplus is booked back to the participating entities to reduce their unfunded liabilities, thus there is no reported change in net assets/equity (Statement III). This policy will continue whilst there is an overall unfunded liability for the SHI.

32

4 Supporting information to the Statement of Financial Position

Cash and cash equivalents 4.1Cash and cash equivalents are held by investment portfolios on behalf of the SHI. They include cash and other financial assets with original maturity dates of three months or less from the date of acquisition. A, B and C are different Fund managers.

Investments and financial instruments 4.2The overall investment portfolio for SHI is periodically reviewed by the World Health Organization Advisory Investment Committee to ensure that the level of returns, as well as the level of investment risk, is appropriate for the Fund. The long-term funds are managed by external fund managers who invest primarily in government and corporate bonds, and in equities. The fixed income portfolio of investments is hedged 50% US$, 30% CHF, 20% EUR to match the currencies of the Fund’s liabilities. The three existing managed fixed income mandates (A, B, and C) and the passive global index fund were maintained throughout the year. As the SHI Fund size grew during the year, and with the receipt of funds from PAHO, the investment in the passive global index fixed income fund was increased during 2017: by US$ 110.0 million in May, and by US$ 30.0 million in October. In July, US$ 25.0 million was reallocated from the emerging market equities investment to the passive global index fixed income fund.

In US$'000Long-term

fixed income portfolio A

Long-term fixed income portfolio B

Long-term fixed income portfolio C

Long-term global bond index fund

Equity portfolio

Externally managed

Staff Health Insurance portfolios

CASH AND CASH EQUIVALENTS 11,171 19,135 9,049 2 - 39,357

In US$'000Long-term





Equity portfolio

Externally managed


INVESTMENTS UNDER CURRENT ASSETSCash and cash equiv alents 11,171 19,135 9,049 2 - 39,357 Short-term inv estments

Financial assets at fair v alue through surplus or deficit -- held for trading 2,838 708 1,503 - - 5,049 Bank deposits and receiv ables 49,900 1,792 1,570 - - 53,262

Total inv estments under current assets 63,909 21,635 12,122 2 - 97,668

INVESTMENTS UNDER NON-CURRENT ASSETSLong-term inv estments

Financial assets at fair v alue through surplus or deficit -- upon initial recognition 189,542 138,315 157,737 209,381 265,173 960,148 Total inv estments under non-current assets 189,542 138,315 157,737 209,381 265,173 960,148

FINANCIAL LIABILITIES UNDER CURRENT LIABILITIESFinancial liabilities

Financial liabilities at fair v alue through surplus or deficit for trading (2,928) (650) (1,015) - - (4,593) Pay ables and accruals (86,364) (351) (8,919) - - (95,634)

Total financial liabilities under current liabilities (89,292) (1,001) (9,934) - - (100,227) TOTAL INVESTMENTS - NET 164,159 158,949 159,925 209,383 265,173 957,589

33

Short-term investments

Short-term investments are held by investment portfolios on behalf of the SHI. These include financial assets at fair value through surplus or deficit held for trading, and bank deposits and receivables. “Financial assets at fair value through surplus or deficit – held for trading” include fixed income securities and derivatives instruments held to cover projected liabilities and any unexpected cash requirements. Receivables include accrued income on investments and receivables from trade sales to settle.

Long-term investments

Long-term investments are placed in accordance with the approved World Health Organization Investment Policy, and are invested in high-quality, medium-dated and long-dated, government, agency and corporate bonds, and global equities. As the investment horizon and objective of the externally managed portfolios are more than one year, the financial assets at fair value through surplus or deficit upon initial recognition in the portfolios are classified as long-term investments.

Financial liabilities

Financial liabilities disclosed under “Financial liabilities at fair value through surplus or deficit for trading” include derivative transactions such as foreign exchange forward contracts and interest rate swaps. Financial liabilities disclosed under “Payables and accruals” relate to other financial liabilities from investments including the trade purchases made before 31 December 2017 and settled after that date.

In US$'000Long-term





Equity portfolio

Externally managed


SHORT-TERM INVESTMENTS

Financial assets at fair v alue through surplus or deficit -- held for trading 2,838 708 1,503 - - 5,049

Bank deposits and receiv ables 49,900 1,792 1,570 - - 53,262

Total 52,738 2,500 3,073 - - 58,311

In US$'000Long-term





Equity portfolio

Externally managed


LONG-TERM INVESTMENTS

Financial assets at fair v alue through surplus or deficit -- upon initial recognition 189,542 138,315 157,737 209,381 265,173 960,148

In US$'000Long-term





Equity portfolio

Externally managed


FINANCIAL LIABILITIES

Financial liabilities at fair v alue through surplus or deficit for trading 2,928 650 1,015 - - 4,593

Pay ables and accruals 86,364 351 8,919 - - 95,634

Total 89,292 1,001 9,934 - - 100,227

34

Fair value hierarchy

The fair value hierarchy is the categorization of market pricing indicating the ease of realizing the value of investments held as shown below.

Most of the financial instruments held have quoted prices (unadjusted) in active markets and are classified as Level 1 valuations. Derivative instruments that are “over the counter” are classified as Level 2 because their fair value is observable either directly (i.e. as a price) or indirectly (i.e. derived from prices). The instruments shown under the Level 2 fair value measurement category consist of the derivative contracts in the externally managed portfolios. There were no instruments held at 31 December 2017 which would be classified as Level 3 valuation, for which the fair value is not based on observable market data.

Risk management

The SHI investments are exposed to financial risks including credit risk, interest rate risk, foreign exchange risk and investment price risk. In accordance with the Financial Regulations, funds not required for immediate use may be invested. All investments are carried out within the framework of investment policies approved by the Director General. All portfolios are managed by external managers who manage funds in accordance with a defined mandate. The Advisory Investment Committee reviews regularly the investment policies, and the investment performance and risk for each investment portfolio. This Committee is comprised of external investment specialists and can make recommendations to the Director General.

Nature of financial instruments

Investments are categorised as follows:

- Long-term fixed income – comprising funds managed by external investment managers as defined in the approved Investment Policy – these are invested in high-quality medium-dated and long-dated, government, agency, and corporate bonds.

- Equities – Comprising either funds or pooled funds invested in global equities managed by external investment managers as defined in the approved Investment Policy.

Level 1 Level 2 Level 3 Total

Cash and cash equiv alents 10,308 - - 10,308

Short-term inv estmentsFinancial assets at fair v alue through surplus or deficit -- held for trading 12 4,172 - 4,184

Long-term inv estmentsFinancial assets at fair v alue through surplus or deficit -- upon initial recognition 960,148 - - 960,148

Financial liabilitiesFinancial liabilities at fair v alue through surplus or deficit for trading - (4,511) - (4,511)

Total 970,468 (339) - 970,128

35

Credit risk

The SHI investments are widely diversified to limit credit risk to any individual investment counterparty. Investments are placed with a wide range of counterparties using minimum credit quality limits and maximum exposure limits by counterparty (and by groups of related counterparties) established in investment mandates. These limits are applied both to the portfolios managed internally by the World Health Organization Treasury unit, and also to the portfolios managed by external investment managers. The Treasury unit monitors the total exposure to counterparties across all internally and externally managed portfolios to ensure that total counterparty exposures across portfolios are tracked and managed.

The credit risk and liquidity risk for cash and cash equivalents are minimized by investing only in major financial institutions which have strong investment grade credit ratings from primary credit rating agencies. The Treasury unit regularly reviews the credit ratings of the approved financial counterparties and takes prompt action in the event of any credit rating downgrade. The credit risk of the investments under externally managed portfolios are monitored by the managers and they are summarised as follows.

Interest rate risk

The SHI fixed income investments are exposed to interest rate risk. Investment duration is a measure of sensitivity to changes in market interest rates, and the effective average duration of the investments of the SHI at 31 December 2017 was 6.6 years for the long-term investments.

Fixed income derivative instruments may be used by external investment managers to manage interest rate risk under strict investment guidelines. These interest rate instruments are used for portfolio duration management and for strategic interest rate positioning.

Average rating of the top 2 ratings Asset value

AAA 181,148

AA+ 11,138

AA 31,576

AA- 28,689

A+ 30,885

A 71,989

A- 37,658

BBB+ 31,839

BBB 38,177

BBB- 10,079

Total 473,178

Not rated 481,239

Grand total 954,417

36

The interest rate swaps held in the SHI portfolios as at 31 December 2017 are summarised below.

Currency Local currency '000 US$'000 equivalent Pay/Receive Maturity

CAD 14,200 11,333 Pay Floating / Receiv e Fix ed Sep 2019

CAD 3,300 2,634 Pay Fix ed / Receiv e Floating Jun 2026

CAD 3,100 2,474 Pay Fix ed / Receiv e Floating Sep 2027

EUR 2,000 2,402 Pay Floating / Receiv e Fix ed Jun 2020

EUR 13,300 15,971 Pay Floating / Receiv e Fix ed Mar 2023

EUR 1,400 1,681 Pay Floating / Receiv e Fix ed Mar 2028

EUR 3,400 4,083 Pay Fix ed / Receiv e Floating Sep 2039

GBP 8,200 11,093 Pay Floating / Receiv e Fix ed Sep 2019

GBP 17,400 23,538 Pay Fix ed / Receiv e Floating Sep 2019

GBP 6,300 8,522 Pay Fix ed / Receiv e Floating Mar 2020

GBP 8,200 11,093 Pay Fix ed / Receiv e Floating Sep 2020


GBP 200 271 Pay Fix ed / Receiv e Floating Mar 2028


GBP 400 541 Pay Fix ed / Receiv e Floating Mar 2040

JPY 2,550,000 22,636 Pay Floating / Receiv e Fix ed Mar 2018

JPY 320,000 2,841 Pay Fix ed / Receiv e Floating Jun 2035

KRW 1,159,600 1,083 Pay Fix ed / Receiv e Floating Jul 2027

KRW 2,276,900 2,127 Pay Fix ed / Receiv e Floating Jul 2027

MXN 4,300 220 Pay Floating / Receiv e Fix ed Mar 2026

MXN 1,500 77 Pay Floating / Receiv e Fix ed Feb 2027

NZD 22,700 16,144 Pay Floating / Receiv e Fix ed Jul 2019

USD 87,800 87,800 Pay Floating / Receiv e Fix ed Apr 2019

USD 20,500 20,500 Pay Fix ed / Receiv e Floating Jun 2019

USD 87,800 87,800 Pay Fix ed / Receiv e Floating Apr 2020


USD 1,900 1,900 Pay Floating / Receiv e Fix ed Jun 2022



USD 1,600 1,600 Pay Fix ed / Receiv e Floating Aug 2022

USD 2,750 2,750 Pay Fix ed / Receiv e Floating Aug 2022

USD 1,500 1,500 Pay Fix ed / Receiv e Floating Dec 2022

USD 3,900 3,900 Pay Fix ed / Receiv e Floating Jan 2023


USD 3,000 3,000 Pay Floating / Receiv e Fix ed Dec 2027


USD 6,000 6,000 Pay Fix ed / Receiv e Floating Jul 2041

USD 5,200 5,200 Pay Fix ed / Receiv e Floating Dec 2042

37

Forward foreign exchange contracts and other derivative financial instruments held within the externally managed investment portfolios

In accordance with the investment guidelines set up for each externally managed portfolio, the external investment managers use forward foreign exchange contracts, futures contracts and interest rate swap contracts to manage the currency and interest rate risk of groups of securities within each portfolio.

The forward foreign exchange contracts within the externally managed investment portfolios are summarised below.

A 1% appreciation (or a 1% depreciation) in the relative value of the U.S. Dollar against the above forward foreign exchange contracts would result in an increase (or decrease) in the unrealized loss on these contracts by less than US$ 0.2 million.

Local currency '000 US$'000 equivalent Local currency '000 US$'000 equivalent

AUD 7,138 5,583 CHF 142,272 146,205

CAD 18,745 14,965 EUR 9,585 11,491

DKK 40,488 6,568 IDR 10,771,410 794

GBP 18,717 25,337 INR 79,014 1,230

JPY 7,816,478 69,495 MXN 3,469 177

KRW 5,099,656 4,773 PEN 576 177

NOK 2,640 323

PLN 19,348 5,568

SEK 85,930 10,576

SGD 2,136 1,599

Total 144,787 Total 160,074

Net sold amounts Net purchased amounts

38

Futures contracts

The futures contracts held within the externally managed portfolios are summarised below.

Long position

Products Exchange No. of contracts

Eurodollar 3 month Futures MAR 2018 CME 158

Eurodollar 3 month Futures SEP 2018 CME 131

US 2 y ear T-Note Futures MAR 2018 CBOT 20



US Ultra T-Bond Futures MAR 2018 CBOT 49

Sterling 3 month Futures MAR 2018 ICE 40

Sterling 3 month Futures JUN 2018 ICE 127

Sterling 3 month Futures SEP 2018 ICE 40

Sterling 3 month Futures DEC 2018 ICE 179

Sterling 3 month Futures MAR 2019 ICE 40

Australian 3 y r Gov ernment Bond Futures MAR 2018 ASX 3


German 5 y ear Gov ernment Note (BOBL) Futures MAR 2018 EUREX 5

German 10 y ear Gov ernment Note (BUND) Futures MAR 2018 EUREX 7

German 30 y ear Gov ernment Note (BUXL) Futures MAR 2018 EUREX 24

Italian 10 y ear Gov ernment Bond (BTP) Futures Mar 2018 EUREX 4

Japanese 10 y ear Bond Futures MAR 2018 OSAKA EX 12

Put option Eurodollar 3 month Futures MAR 2018 9825 CME 89

39

Short position

Products Exchange No. of contracts

Eurodollar 3 month Futures SEP 2019 CME 131

Eurodollar 3 month Futures DEC 2019 CME 158


US Ultra 10 y ear T-Note Futures MAR 2018 CBOT 26

US T-Bond Futures MAR 2018 CBOT 25

US Ultra T-Bond Futures MAR 2018 CBOT 3

Sterling 3 month Futures DEC 2019 ICE 179

UK Long Gilt Futures MAR 2018 ICE 19

German 2 y ear T-Bill (Schatz) Futures MAR 2018 EUREX 109

German 5 y ear Gov ernment Note (BOBL) Futures MAR 2018 EUREX 40

German 10 y ear Gov ernment Note (BUND) Futures MAR 2018 EUREX 60

Italian 10 y ear Gov ernment Bond (BTP) Futures Mar 2018 EUREX 1

French 10 y ear Gov ernment Bond (OAT) Futures MAR 2018 EUREX 9


Call option Eurodollar 3 month Futures MAR 2018 9875 CME 89

Put Option German 10 y ear Gov ernment Bond (BUND) MAR 2018 1605 EUREX 14

Call Option German 10 y ear Gov ernment Bond (BUND) MAR 2018 1650 EUREX 14

Note 1 : ASX refers to Australian Securities Ex change. CBOT refers to Chicago Board of Trade.

CBOT is a part of Chicago Mercantile Ex change Group (CME).

EUREX refers to the Eurex Ex change. ICE refers to Interncontinental Ex change.

Note 2: Some products are show n on both long and short positions because they are held

in tw o different ex ternally managed portfolios.

40

Accounts receivable – current 4.3Total current accounts receivable amounted to US$ 5,643 thousand as at 31 December 2017, primarily due from both the Pan American Health Organization (PAHO) and United Nations Joint Staff Pension Fund (UNJSPF).

Receivable from participants - net 4.4The total balance of receivables amounted to US$ 370 thousand at 31 December 2017, and is related to 20% of medical expenses to be recovered from participants following direct payments.

For active staff members and their participating family members, direct payment may be made to a health care provider for the full amount of an individual medical bill, where the full amount of the medical bill equals at least 15% of a staff member's net monthly salary (plus post adjustment for staff in the P&D categories). The staff member’s share of expenses (normally 20% + non-reimbursable expenses) is recovered from the next month salary/3 months’ salaries.

This balance has increased in 2017 due to a recently approved change in the SHI Rules whereby 100% (instead of 80%) direct payments may also be made on behalf of former staff, with subsequent recovery within 3 months. Despite this change, no amount has been written-off in 2017, as disclosed in Note 4.2.

Inter-entity receivable 4.5This is a net receivable due to the SHI from the World Health Organization, representing excess cash invested within co-mingled short-term investments. The inter-entity receivable decreased in 2017 because SHI funds previously held in co-mingled WHO short-term investments were mainly invested in externally managed equity funds.

In US$'000 31 December 2017 31 December 2016ACCOUNTS RECEIVABLE - CURRENT

Accumulated ASHI assets duePan American Health Organization (PAHO) - 64,590

Unfunded ASHI long-term liability duePan American Health Organization (PAHO) - 8,435

Former staff (Organization Share) Staff Health Insurance contributions duePan American Health Organization (PAHO) 4,283 3,303

Former staff (Former staff Share) Staff Health Insurance contributions dueUnited Nations Joint Staff Pension Fund (UNJSPF) 1,248 117

CVS Caremark rebate duePan American Health Organization (PAHO) - 135

Contribution to cover administrative expensesInternational Computing Centre (ICC) 47 58

General operating costs - regions paid in advance 65 117 Total 5,643 76,754

In US$'000 31 December 2017 31 December 2016

RECEIVABLE FROM PARTICIPANTS - NETWorld Health Organization (WHO) 331 131 International Computing Centre (ICC) 8 3 International Drug Purchase Facility (UNITAID) 1 7 Trust Fund for the Joint United Nations Programme on HIV/AIDS (UNAIDS) 29 39

Total 370 180

41

Accounts receivable – non-current 4.6

Total non-current accounts receivable amounted to US$ 1,963,292 thousand as at 31 December 2017, representing the entity share of the unfunded long-term liability for future healthcare costs, as determined by Aon Hewitt Corporation, professional actuaries.

Other current liabilities 4.7Total balance for other current liabilities as at 31 December 2017 is US$ 678 thousand. This consists mainly of accruals made for investment management fees.

Deferred revenue 4.8Unrealized contributions (related to both Extensions and Leave Without Pay) worth US$ 88 thousand were received in 2017.

Provision for outstanding claims 4.9As at 31 December 2017, an amount of US$ 32,135 thousand has been estimated by Aon Hewitt Corporation, professional actuaries, for settlement of four months of combined in-service and after-service claims and administrative expenses for the SHI.


ACCOUNTS RECEIVABLE - NON-CURRENTWorld Health Organization (WHO) 1,500,479 1,185,511 International Agency for Research on Cancer (IARC) 71,397 52,162 International Computing Centre (ICC) 61,136 47,062 International Drug Purchase Facility (UNITAID) 12,354 9,368 Pan American Health Organization (PAHO) 240,894 187,913 Trust Fund for the Joint United Nations Programme on HIV/AIDS (UNAIDS) 77,032 52,140

Total 1,963,292 1,534,157


OTHER CURRENT LIABILITIESVoided claim pay ments (pending repay ment) 59 38 Inv estment management fees 429 302 IT project fees 86 - Actuarial fees - 140 Other consultant fees 17 - General operating costs - regions 87 790

Total 678 1,270


PROVISION FOR OUTSTANDING CLAIMSWorld Health Organization (WHO) 22,912 20,516 International Agency for Research on Cancer (IARC) 352 344 International Computing Centre (ICC) 626 635 International Drug Purchase Facility (UNITAID) 216 172 Pan American Health Organization (PAHO) 6,608 6,499 Trust Fund for the Joint United Nations Programme on HIV/AIDS (UNAIDS) 1,421 1,453

Total 32,135 29,619

42

Long-term liabilities 4.10The Defined Benefit Obligations as of 31 December 2017 were determined by Aon Hewitt Corporation, professional actuaries, based on personnel data and past payment experience provided by SHI. At 31 December 2017, the Defined Benefit Liabilities amounted to US$ 2,910,384 thousand for After Service Health Insurance.

In 2013, the SHI Governance approved that a full actuarial study should only be undertaken every 3 years, with lighter studies in interim years. It must be noted that the actuarial valuation as of 31 December 2017 is a light study, whereby all assumptions have been updated excluding census data.

Below are the disclosures required for After Service Health Insurance as at 31 December 2017 under IPSAS 39.


LONG-TERM STAFF LIABILITIESWorld Health Organization (WHO) 2,278,639 1,855,896 International Agency for Research on Cancer (IARC) 101,103 77,857 International Computing Centre (ICC) 70,747 54,839 International Drug Purchase Facility (UNITAID) 16,585 12,435 Pan American Health Organization (PAHO) 299,597 252,128 Trust Fund for the Joint United Nations Programme on HIV/AIDS (UNAIDS) 143,713 108,705

Total 2,910,384 2,361,861

US$'000

Reconciliation of Defined Benefit ObligationDefined Benefit Obligation at 31 December 2016 2,361,861

Serv ice Cost for 2017 109,707 Interest On Defined Benefit Obligation for 2017 64,288 (Actual After Serv ice Gross Benefit Pay ments in 2017) (49,861) (Actual After Serv ice Admin Ex penses in 2017) (3,161) Actual Contributions by After Serv ice Participants in 2017 13,502 (Gain)/Loss on Defined Benefit Obligation Due to Financial Assumption Changes 170,425 (Gain)/Loss on Defined Benefit Obligation Due to Other Assumption Changes 243,622

Defined Benefit Obligation at 31 December 2017 2,910,384

Reconciliation of AssetsAssets at 31 December 2016, Net of F.8.1 Reserv e 819,269

Rev ersal of F.8.1 Reserv e at 31 December 2016 29,619 Assets at 31 December 2016, Gross of F.8.1 Reserv e 848,888

(Actual Total SHI Gross Benefit Pay ments for 2017) (90,482) (Actual Total SHI Administrativ e Ex penses for 2017) (5,928) Actual Total SHI Participant Contributions during 2017 47,884 Actual Total SHI Organization Contributions during 2017, ex cluding 4% of Pay Contributions for the Americas 92,934 4% of Pay Contributions for the Americas during 2017 2,136 Interest on Gross SHI Assets for 2017 23,952 Gain/(Loss) on Plan Assets during 2017 59,844

Assets at 31 December 2017 979,226

43

US$'000

Reconciliation of F.8.1 ReserveF.8.1 Reserv e at 31 December 2016 29,619

Interest on F.8.1 Reserv e for 2017 797 (Gain)/Loss on F.8.1 Reserv e during 2017 1,719

F.8.1 Reserve at 31 December 2017 32,135 Assets at 31 December 2017, Net of F.8.1 Reserve 947,091

Reconciliation of Funded StatusDefined Benefit Obligation (DBO)

Inactiv e 1,274,703 Activ e 1,635,680

Total DBO 2,910,384

ASHI Plan Assets(Gross SHI Plan Assets Administered by WHO) (979,226) Offset for WHO F.8.1 Reserv e 32,135

Net ASHI Plan Assets Administered by WHO (947,091)

Net (Surplus)/Deficit 1,963,292 Current (Asset)/Liability - Noncurrent (Asset)/Liability 1,963,292

Annual Expense for Calendar Year 2017Serv ice Cost 109,707 Interest on (Surplus)/Deficit 41,133 Past Serv ice (Credit)/Cost -

Total Expense Recognized in Statement of Financial Performance 150,841

Medical Sensitivity Analysis

31 December 2017 Defined Benefit ObligationCurrent Medical Inflation Assumption Minus 1% 2,358,646 Current Medical Inflation Assumption 2,910,384 Current Medical Inflation Assumption Plus 1% 3,646,623

Current Discount Rate Assumption Minus 1% 3,706,075 Current Discount Rate Assumption 2,910,384 Current Discount Rate Assumption Plus 1% 2,332,870

Approx imate Duration of Defined Benefit Obligation (y ears) 26

Expected Accounting Contributions during 2018Contributions by /for Activ e Staff, Net of Claims/Admin Costs 65,691 Contributions by WHO for Inactiv es 31,108

Total 96,799

44

Key assumptions and methods

Measurement date-

Discount rate----

Medical Cost Increases by Nationality Region of Staff Member

-

-

-

-

Annual general inflation----

SHI bases its discount rates on the yields on high-grade corporate bonds. SHI uses a yield curve approach, which reflects the expected cash flows and assumed currency exposure (specific to the ASHI) for each grouping of offices.

The l iabil ity is assumed to be incurred in CHF, EUR, and US$, based on the approximate l iabil ity mix for each grouping of offices and the following yield curves:

- Switzerland - SIX Swiss Exchange curve- Euro Zone - iBoxx Euro Zone curve- United States - Aon Hewitt AA Above Median curve

The discount rates for the 31 December 2017 valuation are based on the geographic locations of the offices. In all regions, the resulting rate is rounded to the nearest 0.1%.

31 December 2017

Europe - Non-UNAIDS - 1.1% (also 1.1% in prior valuation)

The Americas - 3.8% (decrease from 4.3% in prior valuation)Other Countries - 4.0% (decrease from 4.6% in prior valuation)

Europe - UNAIDS - 2.3% (decrease from 2.5% in prior valuation)

Europe - Initial Increase 3.25%, Long-term Increase 3.25%, Year Long-term Increase Reached 2018.

Other Countries - Initial Increase 6.0%, Long-term Increase 4.0%, Year Long-term Increase Reached 2040.

USA - Initial Increase 5.0%, Long-term Increase 3.85%, Year Long-term Increase Reached 2033.

The Americas (excluding USA) - Initial Increase 6.4%, Long-term Increase 3.85%, Year Long-term Increase Reached 2040.

Europe - Non-UNAIDS - 1.5%

The Americas - 2.2%Other Countries - 2.2%

Inflation rates are based on the U.N. common assumptions (for long-duration plans) of 1.3% Switzerland, 1.8% Euro Zone, and 2.2% for the United States as directed by the U.N. System Task Force on Accounting Standards.

Europe - UNAIDS - 1.8%

45

5 Supporting information to the Statement of Financial Performance

Contributions and Claims paid 5.1The revenue of the SHI consists of a first tier of contributions received in respect of both active and former staff (of which one third is paid by the participants and two-thirds by WHO).

A region, or any other office administered by WHO, shall be required to add a second tier of contributions to the SHI throughout the year following any calendar year in which the claims reimbursed to its active staff total more than 75% of the first tier contributions. The amount by which these claims exceed the 75% ceiling is defined as the regional deficit. It is this amount that must be recovered by the SHI through the second tier of contributions. Historically, this has been applicable to the Pan American Health Organization (PAHO), as can be seen in Note 9.7.

A decision was made in 2011 to ensure long-term sustainability and full funding of the SHI. In order to increase the funding level of the SHI liability, rates of contributions have been increased from 2012. An increase of 4% per year (compounded rate) in the rates of contributions and lump sum rates is currently being applied. The situation is monitored closely on a yearly basis by the SHI Governance, and the rates will be reviewed and revised as and when necessary.

SHI’s main purpose is to provide for the reimbursement of a major portion of the expenses for medically recognized health care incurred by staff and other participants to the SHI. SHI therefore recognizes expenses related to the reimbursements of claims submitted by its participants (both active and former staff, and their recognized family members).

Underlying contributions were higher in 2017 than in 2016 (US$ 125,877 thousand), reflecting the rate increase approved by the SHI Governance. As in 2016, PAHO transferred supplementary contributions (currently levied at 4% on staff payroll) to the SHI Fund. These are worth US$ 2,136 thousand in 2017, compared to a cumulative receipt of PAHO-administered assets worth US$ 64.6 million in 2016.

Claims increased in 2017 compared to 2016 (US$ 82,919 thousand), due to higher hospitalization and medication costs paid (particularly in the Americas).

In US$'000 CONTRIBUTIONS CLAIMS PAIDSURPLUS /

DEFICIT

Activ e Staff and Eligible Family Members (ex c. App C) 73,726 40,610 33,117

Former Staff/Surv iv ors and Eligible Family Members 40,505 49,861 (9,356)

Temporary Staff (Appendix C) 196 11 185

114,427 90,482 23,945

Earmarking 25% of Activ e Staff Contributions for Former Staff 24,575 Surplus/(Deficit) on Organization Share for Former Staff carried ov er (5,790) Second-Tier Contributions 1,814 Prior Year adjustments (22) (625) Current Year adjustments 32

135,004 89,889 PAHO-administered asset transfer 2,136 Total 137,140 89,889

46

Amounts written-off 5.2No amounts were written-off in 2017.

Staff costs 5.3Total staff costs reflect salary costs of HQ and Regional staff processing claims. There was a 16% increase in 2017, albeit well below the biennium budget. This increase primarily reflects the late recognition of the biennium staff cost for the IT Product Specialist. However, the SHI Secretariat has recently arranged the lateral transfer of the relevant staff member from the IT Group, which should avoid a recurrence of this issue going forward.

Travel 5.4Travel costs decreased by 7% in 2017, but consist mainly of missions to all regions to promote SHI-Online and to brief staff, discuss administrative matters and enhance or establish agreements with major medical networks.

Other operating costs 5.5Other operating costs have increased in 2017, mainly due to additional overtime costs to cover claims processing vacancies (US$ 158 thousand) and extra consultant fees for the IT project (US$ 144 thousand), offset by administration cost savings. However, overall costs were contained within the biennium budget allocated.

In US$'000 31 December 2017 31 December 2016STAFF COSTS

HQ 4,062 3,327 Regional Offices 1,090 1,103

Total 5,152 4,430

47

Finance revenue/(expense) 5.6SHI Fund investments yielded 12.2% in 2017, compared to 3.1% in 2016.

2017 was a very positive year for the fixed income and equities markets in which the SHI Fund’s assets are invested. Markets were buoyed by synchronised growth across all major economies, benign inflation, accommodative monetary policies and an absence of volatility. These factors combined to generate strong corporate earnings, which caused equities values in particular to rise strongly.

The majority of the SHI Fund investments are in fixed income dollar denominated bonds. Both US and non-US fixed income markets posted positive returns in 2017, particularly longer dated bonds and investment grade corporate bonds, which make up a significant proportion of the SHI Fund fixed income investment portfolios. The longer dated bonds benefitted from decreases in interest rates on the long end of the US yield curve, and the corporate bond values rose due to the strength in corporate earnings growth.

Amounts booked to participating entities 5.7Any surplus is booked back to the participating entities to reduce their unfunded liabilities. This policy will continue whilst there is an overall unfunded liability for the SHI.

In US$'000 31 December 2017 31 December 2016FINANCE REVENUE/(EXPENSE)

Income on Equity Inv estments (Ex t. Managed) 54,818 14,102 Income on Fix ed Income Inv estments (Ex t. Managed) 35,031 8,714 Interest on Ex cess Cash inv ested w ithin Co-mingled WHO Short-Term Inv estments 410 850 Inv estment Income/(Ex pense) 90,259 23,665 Ex change (Gain)/Loss 143 (17) Inv estment Management Fees (1,386) (1,162)

Total 89,016 22,486

48

6 Supporting information to the Comparison of Budget and Actual Amounts

The original 2016/17 biennium budget was approved by the Director-General on 12 December 2015 following the fifth SHI Global Oversight Committee meeting.

Staff costs 6.1The budget includes staff costs for the SHI unit in Headquarters, and for claims processing in the Regional Offices. There was an underspend against the biennium budget, due to delayed recruitment of staff for increased control and validation of claims.

Travel 6.2There is an overspend against the biennium budget, with reference to the costs disclosed in Note 5.4.

Other operating costs 6.3The original budget was subsequently amended to include the cost of the HIIS enhancement. There was an underspend against the biennium budget related to various administration cost savings.

Claims paid 6.4There is no approved budget available for claims paid in 2017. The nature of the SHI operation is such that only one very large claim is needed to distort the outcome, plus this amount is largely dependant on other variables such as headcount. Therefore, it is difficult to forecast accurately.

Amounts written-off 6.5There is no approved budget available for amounts written-off in 2017.

49

7 Related party and other senior management disclosures

The only staff member considered to be “key management personnel” is the Chairman of the SHI Global Oversight Committee (GOC). There are no other ungraded staff working for the SHI.

As the Chairman is receiving all entitlements and benefits which are funded by WHO and not SHI, these are disclosed in WHO’s financial statements and not in the SHI’s financial statements.

8 Events after the Reporting Date

SHI’s reporting date is 31 December 2017. The financial statements were authorized for issue on 12 March 2018, the date at which they were submitted to the External Auditor by the Comptroller.

On the date of the signing of these accounts, a further second tier contribution (worth US$ 759 thousand) relating to 2017 is due to the SHI from the Pan American Health Organization (PAHO), in accordance with SHI rule F.3. This amount will be recovered from PAHO, as reflected in Note 9.7.

Other than this, no material events, favourable or unfavourable, had arisen between the balance sheet date and the date when the financial statements were authorized for issue that would have had an impact on the financial statements.

50

9 Annex

Membership 9.1The insured population of active staff (excluding temporary staff App C), former staff and eligible family members totalled 39,608, which represents an increase of 1.7% compared to the previous year (38,932 insured persons at the end of 2016). The trends in membership are given in Figure 8.

As far as paying members are concerned (i.e. active staff and former staff & survivors) the ratio of active staff to former staff is 1.90 in 2017.

A breakdown of information on active staff (and their dependants) by Region is provided in Figures 9 and 10. As will be seen, Headquarters, UNAIDS, UNITAID, ICC, IARC, EURO, and the Americas region together represented 44% of insured active staff, i.e. just under half of insured active staff are in areas where the cost of health care is high. AFRO accounted for 31% and the other regional offices together represented 25%.

A breakdown of information on former staff (and their dependants) by Region is provided in Figures 11 and 12. Headquarters, UNAIDS, UNITAID, ICC, IARC, EURO, and the Americas region together represented 63% of insured former staff, i.e. well over half of insured former staff are in areas where the cost of health care is high. AFRO accounted for 18% and the other regional offices together represented 19%.

2009 2010 2011 2012 2013 2014 2015 2016 20170

5,000

10,000

15,000

20,000

25,000

30,000

35,0001 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Figure 8: Trends in Membership

Former Staff & Survivors - Paying Members Active Staff (exc App C) - Paying Members

Dependants of Former Staff & Survivors Dependants of Active Staff (exc App C)

51

Active Staff (except Appendix C)

For active staff (exc. App C), both first and second-tier contributions are include in Figure 10. The bubble size is based on the value of claims.

HQ19%

UNAIDS7%

UNITAID1%

ICC2%

IARC2%

AFRO31%

AMERICAS9%

EMRO12%

EURO4%

SEARO7%

WPRO6%

Insured Persons - 2017

Figure 9: By Office

0.0

5.0

10.0

15.0

20.0

25.0

30.0

0.0 5.0 10.0 15.0 20.0

Contributions (US$ millions)

Claims (US$ millions)

Surplus/Deficit - 2017

HQ

UNAIDS

UNITAID

ICC

IARC

AFRO

AMERICAS

EMRO

EURO

SEARO

WPRO

Figure 10: By Office

Deficit

Surplus

52

Former Staff

Figure 12 demonstrates that the deficit for former staff continues to be mainly generated by both the Americas and HQ regions. The bubble size is based on the value of claims.

HQ31%

UNAIDS1%

UNITAID0%

ICC0%

IARC2%

AFRO18%

AMERICAS27%

EMRO5%

EURO2%

SEARO8%

WPRO6%


Insured Persons - 2017

0.0

5.0

10.0

15.0

20.0

25.0

0.0 5.0 10.0 15.0 20.0 25.0

Contributions(US$ millions)

Claims (US$ millions)

Surplus/Deficit - 2017

HQ

UNAIDS

UNITAID

ICC

IARC

AFRO

AMERICAS

EMRO

EURO

SEARO

WPRO


Deficit

Surplus

53

However, the mechanism to earmark 25% of active staff contributions for the former staff deficit is working, as can be seen in Figure 13.

Fund Balance Reconciliation 9.2

-25.0

-20.0

-15.0

-10.0

-5.0

0.0

5.0

10.0

15.0

20.0

25.0

30.0

2009 2010 2011 2012 2013 2014 2015 2016 2017

US$ millions

Deficit - Former Staff 25% Earmarked Contributions Net of 25% Earmarked Contributions minus Deficit - Former Staff

Figure 13: 25 % Earmarked Contributions Mechanism - historic trend

In US$'000 Notes 31 December 2017 31 December 2016

FUND BALANCE RECONCILIATIONActuarial requirement for future costs of former staff and surv iv or dependants (Rule F.8.2) 1,274,703 1,045,155 Actuarial requirement for future costs of activ e staff (Rule F.8.3) 1,635,680 1,316,706 Long-term liabilities 4.10 2,910,384 2,361,861 Prov ision for outstanding claims 4.9 32,135 29,619 Total Liability 2,942,519 2,391,480 less Accounts receiv able - current (unfunded SHI long-term liability due element) 4.3 - (8,435) less Accounts receiv able - non-current 4.6 (1,963,292) (1,534,157) Fund Balance 979,226 848,888 % Unfunded Liability /Total Liability 67% 65%

54

Claims Processing 9.3The number of claims processed in 2017 for all offices was 117,221, as shown in Tables 8 and 9. This has increased by 21.5% compared to 2016.

To facilitate effective comparison with both AETNA and CVS claim statistics, it has been assumed that one claim per claimant per month has been processed in the Americas region. AETNA and CVS are both USA Third Party Administrators (for medical expenses and medicaments respectively). SHI will continue to work with PAHO to ensure comparability in future.

No. claims % % 17 vs 16HQ 33,620 29% 51.3%IARC 2,597 2% 26.5%ICC 1,633 1% 48.7%UNITAID 895 1% 61.0%UNAIDS HQ 2,935 3% 24.3%UNAIDS Field Staff 3,416 3% 22.1%Direct payments 7,486 6% 14.6%HQ - processed claims 52,582 45% 39.8%AFRO 9,285 8% 8.8%AMERICAS 27,594 24% 0.5%EMRO 8,258 7% 34.1%EURO 3,000 3% 31.8%SEARO 6,312 5% 13.5%WPRO 10,189 9% 14.7%Regions - processed claims 64,639 55% 9.8%Grand Total 117,221 100% 21.5%

2017

Number of claims paid in 2017Table 8

No. claims % No. claims % No. claims % No. claims % No. claims % % 17 vs 09 % 17 vs 16HQ - processed claims 32,858 40% 35,222 39% 35,868 39% 37,624 39% 52,582 45% 60.0% 39.8%Regions - processed claims 49,263 60% 54,905 61% 55,935 61% 58,874 61% 64,639 55% 31.2% 9.8%Grand Total 82,121 100% 90,127 100% 91,803 100% 96,498 100% 117,221 100% 42.7% 21.5%

Table 9Number of SHI claims paid as from 2009

201520142009 20172016

55

The processing time is measured from the time of submission of a claim to the time it is validated for payment via bank transfer. 2017 was a challenging year due to both the launch of the SHI-Online and technical issues encountered around this, and several long-term absences of SHI staff. The problems related to the introduction of the SHI-Online were resolved by the third quarter of the year and the latter issue will be addressed during the review of staffing which will take place in the tenth meeting of the GOC in June 2018.

0

5

10

15

20

25

30

35

40

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Days

2017

Figure 14 - Average Claims Processing Days

TARGET

HQ / IARC

AFRO

AMERICAS (non-USA)

AETNA (USA)

EMRO

EURO

SEARO

WPRO

0

5

10

15

20

25

Days

Region

Figure 15 - Average Claims Processing Days in 2017

TARGET

56

Analysis of claims by category 9.4The 2017 breakdown of expenses per category showed an increase in hospitalization:

1. Hospitalization (accommodation + medical care) represented the largest item of expenditure – 41.2% of total expenses

2. Medication – 16.9% of total expenses 3. Physicians' fees – 15.0% of total expenses 4. Dental care – 8.1% of total expenses 5. Domiciliary and Institutional nursing care – 3.0% of total expenses. Table 10 shows the distribution of claims and the variations between these five categories:

Claims increased in 2017 compared to 2016, due to higher hospitalization and medication costs paid (particularly in the Americas). Despite a decrease in the number of major claims (>US$ 50,000) in 2017, these were higher in value (as mentioned in Note 9.5).

Major cases >US$ 50,000 9.5In 2017, among the 232 major cases (>US$ 50,000) which total US$ 28.0 million, there are:

• 93 Americas region cases worth US$ 12.5 million, representing 40% of the Americas region claims; and

• 139 cases for HQ and ROs (excl. the Americas region) worth US$ 15.5 million, representing 27% of HQ and Regions claims.

For the Americas region, former staff represented 73% of major cases. For HQ and ROs (excl. the Americas region), former staff represented 74% of major cases. The above figures partly explain the large deficit for former staff.

As an overall comparison, there were 244 major cases (>US$ 50,000) in 2016, worth US$ 25.8 million.

In US$'000 Hospitalizations Medication Physicians Dental careDom/Inst

Nursing careOthers TOTAL

Active Staff (exc. App C) 15,767 5,796 6,414 4,315 310 8,007 40,610% 38.8% 14.3% 15.8% 10.6% 0.8% 19.7% 100.0%

Temporary (App C) Staff 0 1 6 0 0 4 11% 0.0% 11.7% 53.2% 0.0% 0.0% 35.1% 100.0%

Former Staff 21,543 9,533 7,168 3,031 2,387 6,198 49,861% 43.2% 19.1% 14.4% 6.1% 4.8% 12.4% 100.0%

2017 GRAND TOTAL 37,310 15,331 13,588 7,347 2,697 14,209 90,482% 41.2% 16.9% 15.0% 8.1% 3.0% 15.7% 100.0%

2016 GRAND TOTAL 33,805 14,294 12,396 7,091 2,729 13,533 83,847% 40.3% 17.0% 14.8% 8.5% 3.3% 16.1% 100.0%

VARIANCE 3,506 1,037 1,192 256 (32) 676 6,635% 0.9% (0.1%) 0.2% (0.3%) (0.3%) (0.4%) 0.0%

Table 10

57

Organization's Contributions 9.6The Organization's share of contributions both for active and former staff is two-thirds (the participants' share being one-third), as shown in Figure 16.

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

in US$ millions

Figure 16: Contributions Sharing Organization Share Staff Share

58

Statement of First Tier and Second Tier Contributions for Active Staff 9.7and Eligible Family Members (exc. App C)

In US$'000 CONTRIBUTIONS * CLAIMS BALANCE

FIRST TIER

Headquarters 26,246 15,560 10,687

Regional Office for Africa 13,430 2,869 10,560

Regional Office for Europe 3,645 861 2,784

Regional Office for South-East Asia 3,328 1,092 2,236

Regional Office for the Eastern Mediterranean 5,115 1,999 3,116

Regional Office for the Western Pacific 3,180 1,464 1,716

International Agency for Research on Cancer (IARC) 1,523 522 1,001

International Computing Centre (ICC) 2,140 1,697 443

International Drug Purchase Facility (UNITAID) 908 540 367

Pan American Health Organization (PAHO) 7,809 10,382 (2,573)

Trust Fund for the Joint United Nations Programme on HIV/AIDS (UNAIDS) 6,403 3,624 2,779

Total 73,726 40,610 33,117

PAN AMERICAN HEALTH ORGANIZATION (PAHO)

Opening Balance -

Deficit during the y ear 7,809 10,382 (2,573)

Second-Tier Contributions receiv ed during the y ear (SHI Rule F.3) 1,814

Closing Balance (amount to be recov ered from PAHO) (759)

* Ex cluding 25% of contributions w hich hav e been earmarked for former staff.

59

Contributions Received and Claims Paid 9.8

Table 11

Table 12

PAYING MEMBERS SPOUSES CHILDREN SECONDARY

DEPENDANTSSTUDENTS

18-25HEADQUARTERS 8,066 3,325 3,385 387 396 15,560 26,246 10,687UNAIDS 1,835 704 545 42 498 3,624 6,403 2,779UNITAID 223 143 172 1 2 540 908 367ICC 677 399 521 28 72 1,697 2,140 443IARC 333 79 103 0 7 522 1,523 1,001AFRO 1,782 582 446 4 55 2,869 13,430 10,560AMERICAS 4,337 1,960 2,009 364 1,713 10,382 7,809 (2,573)EMRO 935 445 435 111 73 1,999 5,115 3,116EURO 501 180 122 13 46 861 3,645 2,784SEARO 617 258 137 45 35 1,092 3,328 2,236WPRO 618 443 182 195 25 1,464 3,180 1,716

GRAND TOTAL 19,924 8,517 8,058 1,190 2,922 40,610 73,726 33,117

* Excluding 25% of contributions collected which have been earmarked for retired staff.

CONTRIBUTIONS RECEIVED AND CLAIMS PAID DURING 2017BY OFFICE LOCATION AND CATEGORY

ACTIVE STAFF MEMBERS AND THEIR DEPENDANTS(EXCEPT TEMPORARY STAFF APP C)

(EXPRESSED IN US$'000)

CLAIMS PAID CLAIMS TOTAL

CONTRIBUTIONS TOTAL *

SURPLUS/ DEFICITOFFICE

DUTY STATION Physicians Medication Hospitalizat. Radiology Laborat. Dental care Optical Psych. Physio. Dom/Inst Nursing care Others TOTAL %

HEADQUARTERS 3,119 1,472 5,844 613 729 1,691 420 696 404 58 513 15,560 38.3%

UNAIDS 706 523 1,330 138 150 370 98 118 79 61 52 3,624 8.9%

UNITAID 133 39 191 22 23 59 15 36 14 0 7 540 1.3%

ICC 159 70 1,222 20 35 116 28 24 19 0 3 1,697 4.2%

IARC 82 46 126 20 18 103 49 34 23 1 20 522 1.3%

AFRO 193 412 1,479 131 130 254 173 11 21 22 44 2,869 7.1%

AMERICAS 1,516 2,506 3,584 491 480 843 131 326 290 100 116 10,382 25.6%

EMRO 187 233 926 64 63 284 113 15 22 45 47 1,999 4.9%

EURO 138 74 166 14 24 261 72 54 31 0 27 861 2.1%

SEARO 75 151 471 30 42 137 137 13 17 8 14 1,092 2.7%

WPRO 105 273 428 65 55 198 112 161 18 15 33 1,464 3.6%

Grand Total 6,414 5,796 15,767 1,609 1,748 4,315 1,347 1,488 940 310 875 40,610 100%

% 15.8% 14.3% 38.8% 4.0% 4.3% 10.6% 3.3% 3.7% 2.3% 0.8% 2.2% 100%

CLAIMS PAID DURING 2017 BY OFFICE LOCATION AND CATEGORYACTIVE STAFF MEMBERS AND THEIR DEPENDANTS

(EXCEPT TEMPORARY STAFF APP C)(EXPRESSED IN US$'000)

60

Table 13

Table 14

FORMER STAFF SURVIVORS SPOUSES CHILDREN SECONDARY

DEPENDANTSSTUDENTS

18-25HEADQUARTERS 13,733 2,178 5,419 517 276 166 22,289 16,981 (5,308)

UNAIDS 320 0 19 4 0 7 350 514 163

UNITAID 44 0 16 1 0 3 65 321 257

ICC 44 0 7 2 0 1 55 67 12

IARC 400 3 57 1 0 1 463 693 231

AFRO 828 107 298 25 2 4 1,263 4,002 2,738

AMERICAS 11,824 367 7,884 297 295 235 20,903 11,796 (9,107)

EMRO 348 89 167 4 26 4 638 1,487 849

EURO 125 13 201 5 0 0 345 777 432

SEARO 1,561 155 700 4 4 6 2,431 2,124 (307)

WPRO 597 140 235 31 45 13 1,060 1,743 684

GRAND TOTAL 29,825 3,052 15,004 892 648 441 49,861 40,505 (9,356)

CONTRIBUTIONS RECEIVED AND CLAIMS PAID DURING 2017BY OFFICE LOCATION AND CATEGORY

FORMER STAFF MEMBERS AND THEIR DEPENDANTS(EXPRESSED IN US$'000)

CLAIMS TOTAL

CONTRIBUTIONS TOTAL


CLAIMS PAID

DUTY STATION Physicians Medication Hospitalizat. Radiology Laborat. Dental care Optical Psych. Physio. Dom/Inst Nursing care Others TOTAL %

HEADQUARTERS 3,913 2,679 10,044 767 673 1,253 301 217 500 1,423 519 22,289 44.7%

UNAIDS 83 30 159 18 12 27 7 4 8 0 3 350 0.7%

UNITAID 14 27 2 2 3 9 2 6 1 0 0 65 0.1%

ICC 13 5 15 5 3 9 3 0 1 0 0 55 0.1%

IARC 51 72 180 15 9 84 20 1 11 3 16 463 0.9%

AFRO 108 313 532 73 63 67 49 0 7 43 9 1,263 2.5%

AMERICAS 2,758 5,591 8,122 700 583 1,223 136 150 506 808 325 20,903 41.9%

EMRO 33 175 272 15 22 63 24 0 5 17 11 638 1.3%

EURO 61 60 67 5 9 72 17 7 23 20 3 345 0.7%

SEARO 69 330 1,722 37 42 102 61 2 18 22 27 2,431 4.9%

WPRO 65 251 428 37 32 122 43 3 18 50 9 1,060 2.1%

Grand Total 7,168 9,533 21,543 1,673 1,450 3,031 664 390 1,099 2,387 922 49,861 100%

% 14.4% 19.1% 43.2% 3.4% 2.9% 6.1% 1.3% 0.8% 2.2% 4.8% 1.9% 100%

(EXPRESSED IN US$'000)

CLAIMS PAID DURING 2017 BY OFFICE LOCATION AND CATEGORYFORMER STAFF MEMBERS AND THEIR DEPENDANTS

61

Figure 17

Figure 18

To facilitate effective comparison with both AETNA and CVS claim statistics, it has been assumed that one claim per claimant per month has been processed in the Americas region. AETNA and CVS are both USA Third Party Administrators (for medical expenses and medicaments respectively). SHI will continue to work with PAHO to ensure comparability in future.

(EXPRESSED IN US$'000)CLAIMS PAID UP TO 2017

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

50,000

2009 2010 2011 2012 2013 2014 2015 2016 2017

Claims Paid to Active Staff(exc App C) and dependants

0

10,000

20,000

30,000

40,000

50,000

60,000

2009 2010 2011 2012 2013 2014 2015 2016 2017

Claims Paid to Former Staff and dependants

010,00020,00030,00040,00050,00060,00070,00080,00090,000

100,000

2009 2010 2011 2012 2013 2014 2015 2016 2017

Total Claims Paid to Active (exc App C) & Former Staff and dependants

0

400

800

1,200

1,600

in US$ Cost per Claim in 2017

Active Staff (exc App C) and dependants

Former Staff and dependants

0

1,000

2,000

3,000

4,000

5,000

6,000

in US$ Cost per Claimant in 2017

Active Staff (exc App C) and dependants

Former Staff and dependants

62

Table 15

Table 16

PAYING MEMBERS SPOUSES CHILDREN SECONDARY

DEPENDANTSSTUDENTS

18-25HEADQUARTERS 3,435 3,006 1,608 4,608 1,391 2,625 4,428 1,803UNAIDS 2,711 1,847 644 2,475 4,146 1,775 3,136 1,361UNITAID 2,620 3,764 1,793 246 540 2,401 4,034 1,633ICC 2,594 2,974 2,003 9,430 9,027 2,548 3,213 665IARC 1,368 760 387 0 432 826 2,410 1,584AFRO 689 364 86 379 192 298 1,393 1,095AMERICAS 3,590 3,240 2,771 4,384 11,194 3,743 2,815 (928)EMRO 821 640 252 1,427 622 532 1,362 830EURO 883 736 258 1,138 816 637 2,696 2,059SEARO 908 509 198 1,462 349 544 1,658 1,114WPRO 1,020 1,283 289 1,760 350 830 1,804 974

GLOBAL PER CAPITA 1,916 1,480 621 2,755 2,397 1,319 2,395 1,076

* Excluding 25% of contributions collected which have been earmarked for retired staff.

CLAIMS TOTAL CONTRIBUTIONS TOTAL *

CLAIMS PAID SURPLUS/ DEFICIT

CONTRIBUTIONS RECEIVED AND CLAIMS PAID PER CAPITA DURING 2017ACTIVE STAFF MEMBERS AND THEIR DEPENDANTS

(EXCEPT TEMPORARY STAFF APP C)(EXPRESSED IN US$)

OFFICE

FORMER STAFF SURVIVORS SPOUSES CHILDREN SECONDARY

DEPENDANTSSTUDENTS

18-25HEADQUARTERS 8,792 8,927 7,742 4,739 55,118 2,338 8,283 6,310 (1,973)UNAIDS 5,417 800 687 771 3,574 5,241 1,667UNITAID 7,416 5,457 630 3,285 5,890 29,218 23,328ICC 4,928 2,418 2,407 959 3,927 4,785 858IARC 3,603 595 1,796 246 239 2,946 4,417 1,471AFRO 1,342 814 782 61 507 106 795 2,518 1,723AMERICAS 9,347 1,287 12,299 2,860 7,384 6,038 8,805 4,969 (3,836)EMRO 1,582 1,542 1,276 75 2,852 306 1,323 3,085 1,762EURO 1,020 1,642 5,747 1,300 118 2,018 4,542 2,524SEARO 4,539 1,519 2,693 232 4,336 718 3,308 2,890 (418)WPRO 2,321 2,633 1,533 1,611 7,535 879 2,107 3,466 1,359

GLOBAL PER CAPITA 6,522 3,445 6,350 1,208 10,120 2,195 5,650 4,590 (1,060)

(EXPRESSED IN US$)

CLAIMS TOTAL

CONTRIBUTIONS TOTAL


CLAIMS PAID

CONTRIBUTIONS RECEIVED AND CLAIMS PAID PER CAPITA DURING 2017FORMER STAFF MEMBERS AND THEIR DEPENDANTS

63

Figure 19

Insured Persons 9.9

The Spouses category includes voluntary spouses in Figure 20.

(EXPRESSED IN US$)CONTRIBUTIONS RECEIVED AND CLAIMS PAID PER CAPITA UP TO 2017

-2,000

-1,000

0

1,000

2,000

3,000

4,000

5,000

2009 2010 2011 2012 2013 2014 2015 2016 2017

Contributions and Claims per CapitaActive Staff (exc App C) and dependants

Claims

Contributions

SURPLUS/DEFICIT

-3,000

-2,000

-1,000

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

2009 2010 2011 2012 2013 2014 2015 2016 2017

Contributions and Claims per CapitaFormer Staff and dependants

Claims

Contributions

SURPLUS/DEFICIT

Children < 2142%

Children aged 21-254%

Sec. Dependants1%

Spouses19%

Staff Members34%

Figure 20: Insured Persons (Active Staff exc App C) 2017 by Category

64

Table 17

Figure 21

DUTY STATION PAYING MEMBERS SPOUSES CHILDREN SECONDARY

DEPENDANTSSTUDENTS

18-25 TOTAL

HEADQUARTERS 2,348 1,106 2,105 84 285 5,928UNAIDS 677 381 847 17 120 2,042UNITAID 85 38 96 3 3 225ICC 261 134 260 3 8 666IARC 243 104 267 1 17 632AFRO 2,585 1,597 5,160 10 288 9,640AMERICAS 1,208 605 725 83 153 2,774EMRO 1,139 695 1,725 78 117 3,754EURO 567 244 474 11 56 1,352SEARO 680 507 689 31 100 2,007WPRO 606 345 629 111 72 1,763

TOTAL 10,399 5,756 12,977 432 1,219 30,783

NUMBER OF INSURED PERSONS AS AT 31 DECEMBER 2017ACTIVE STAFF MEMBERS AND THEIR DEPENDANTS

(EXCEPT TEMPORARY STAFF APP C)

(EXCEPT TEMPORARY STAFF APP C)

NUMBER OF INSURED PERSONS AS AT 31 DECEMBER 2017ACTIVE STAFF MEMBERS AND THEIR DEPENDANTS

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Spouses

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000Paying Members

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Children

0

500

1,000

1,500

2,000Secondary dependants

0

500

1,000

1,500

2,000

Students 18 - 25

65

Table 18

Figure 22

DUTY STATION FORMER STAFF SURVIVORS SPOUSES CHILDREN SECONDARY DEPENDANTS

STUDENTS 18-25 TOTAL

HEADQUARTERS 1,562 244 700 109 5 71 2,691UNAIDS 59 0 24 6 0 9 98UNITAID 6 0 3 1 0 1 11ICC 9 0 3 1 0 1 14IARC 111 5 32 5 0 4 157AFRO 617 131 381 418 3 39 1,589AMERICAS 1,265 285 641 104 40 39 2,374EMRO 220 58 131 52 9 12 482EURO 123 8 35 4 0 1 171SEARO 344 102 260 19 1 9 735WPRO 257 53 153 19 6 15 503

TOTAL 4,573 886 2,363 738 64 201 8,825

NUMBER OF INSURED PERSONS AS AT 31 DECEMBER 2017FORMER STAFF MEMBERS AND THEIR DEPENDANTS

NUMBER OF INSURED PERSONS AS AT 31 DECEMBER 2017FORMER STAFF MEMBERS AND THEIR DEPENDANTS

0500

1,0001,5002,0002,5003,0003,5004,0004,5005,000

Paying Members

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

Survivors

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

Spouses

0

200

400

600

800

1,000

Children

0

200

400

600

800

1,000

Secondary dependants

0

200

400

600

800

1,000

Students 18 - 25

66

Composition of Global Oversight Committee (GOC) 9.10

Members Alternates

Chairman Mr S. SIMONSON Mr N. JEFFREYS

Regional Director of Administration and Finance (DAF) Mr T. LANDESZ Mr G. ANDERSON

Regional Director of Programme Management (DPM/DRD) Dr N. EMIROGLU Mr W.J. CABORE

Designated by the Staff (HQ) Mr L. CONSTANTIN Ms M. APPIAHDesignated by the Staff (Regions) Dr B. REWARI Mr W. PALM

Designated by the Former Staff Mrs A. VAN HULLE-COLBERT Ms H. WILD

External Advisers Mrs C. BODINProf. T. ZELTNERMr J. ROSE

Internal Advisers Ms F. MOURAIN-SCHUT Mrs A. SCHEPENSMrs F. NOCQUET Mr P. CRONINDr C. CROSS Dr E. REYMOND

Observers CHAIR, GLOBAL STANDING COMMITTEEUNAIDS Representative

Secretary Mrs C. HENNETIER-ROSSIER Mrs S. BELL-SHIERS

Other secretariat Ms J. HOLLANDMr S. SENANAYAKE

GLOBAL OVERSIGHT COMMITTEE as at 31 December 2017

67

Composition of Global Standing Committee (GSC) and Interim GSC 9.11

Members Alternates

Chairman Ms C. DEYNOUT Dr R. BALOCCO

Advisers Dr E. REYMOND NoneMs F. MOURAIN-SCHUT Mrs A. SCHEPENS

Administration Ms C. DEYNOUT Mr C. LISSNERDr E. RENGANATHAN VacantMr P. PHORI (AFRO) Ms E. TOTH MANKAMPA (AFRO)Mr A. DAS (EMRO) Dr H. KHATTABI (EMRO)Dr M. WEBER (EURO) Dr M. IVANUSA (EURO)Dr R. MEHTA (SEARO) Dr S. KUMAR BAHL (SEARO)Dr H. SOBEL (WPRO) Mr A. PARTOW (WPRO)Ms C. BAROGLIO (UNAIDS) Mr P KOOPMANS (UNAIDS)

Designated by the Staff Dr R. BALOCCO Dr A. BELLAHMr K. R. HOSSAIN VacantMrs M. METWALLY (EMRO) Vacant (EURO)Dr N. RAINA (SEARO) Mrs H. ACABADO (WPRO)Mr V. BIZA (AFRO) NoneDr A. BOCCARDI VIDARTE (UNAIDS) DR C. MALLOURIS (UNAIDS)

Designated by the Former StaffMs M. DAM Ms F. HERY-PERSIN

Secretary Ms S. BELL-SHIERS Ms C. HENNETIER-ROSSIER

GLOBAL STANDING COMMITTEE as at 31 December 2017

Mrs C. COLLADODr J.P. MENU

Members Alternates

Chairman Ms C. DEYNOUT Dr R. BALOCCO

Advisers Dr E. REYMOND Dr C. CROSSMs F. MOURAIN-SCHUT Mrs A. SCHEPENS

Administration Ms C. DEYNOUT Dr H. SOBEL Mr P KOOPMANS (UNAIDS) Mr C. LISSNER

Participants Ms F. HERY-PERSINDR C. MALLOURIS (UNAIDS)

Dr R. BALOCCODr A. BOCCARDI VIDARTE

INTERIM GLOBAL STANDING COMMITTEE as at 31 December 2017

68

Composition of PAHO Sub-Committee of the GSC 9.12

Surveillance meetings & Briefing/Visits 9.13

Composition of Medical Review Committee 9.14

Members Alternates

Chairman Dr M. MONTEIRO Dr A. PORRAS

Advisers Dr E. REYMOND Dr N. MACHADO CLOUGH

Administration Dr M. MONTEIRO Dr S. LUCIANI

Dr A. PORRAS Dr L. REVEIZ HERAULT

Designated by the Staff Dr P. RAMON PRADO Dr O. J. A. MUJICA

Designated by the Former Staff

Secretary Mr C. SAENZ Mrs G. MARTINEZ

PAHO SUB-COMMITTEE OF THE GLOBAL STANDING COMMITTEE as at 31 December 2017

Dr M. BOYER Dr G. PERDOMO

RegionStandard Meeting

of Surveillance Committees

Emergency/Ad hoc Meeting (usually held by email) of Surveillance Committees

Briefings/Visits

GSC (HQ, AFRO, EURO, EMRO,

SEARO, WPRO)10 2

35 +including various SHI-Online

launch briefings in all Regions and 2 days workshop with representatives from each

regional SHI teamPAHO Sub-Committee 4 0 11

Meetings of Global Standing CommitteeRegional Surveillance Committees & Briefings/Visits - 2017

Members Alternates

Chairman Dr A. REIS Dr S.A.L. HUGONNET

Designated by the Director-General Dr A. GRIEKSPOOR Dr M. NEIRA

Designated by the Staff Dr K. SCHOTTE Dr M.O. LAMUNU

Secretary Ms C. HENNETIER-ROSSIER

MEDICAL REVIEW COMMITTEE as at 31 December 2017

2017

Printe

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y W

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Cover

by

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contents · 3 director-general’s foreword i am pleased to present the staff health insurance...

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