Director-General

56th Session of the Regional Committee for the Americas

Washington, USA
27 September 2004

Mr President, Secretary-General of the OAS, Honourable Ministers, Distinguished Representatives, Colleagues,

First of all, I would like to express my deep condolences, sympathy and support for all those who have lost loved ones, properties, and are still struggling to survive the recent hurricanes in the countries of the Caribbean and in Florida.

Last week in New York it was very encouraging to see the leaders from this region, such as President Lula and President Lagos taking the lead in organizing the work of world leaders on poverty and hunger. Action on these root causes of ill-health is the most effective way to establish peace and security in the world. The Americas have the abundant experience, resources and innovative ideas needed to make a tremendous contribution to this effort. I would like to suggest this need for security as one of the reference points for your discussions here this week. It is very closely linked to the need for equity, and for unity. All three - security, equity and unity - are fundamental principles of WHO, as our Constitution states. Awareness of them is particularly needed now, both in public health and in international cooperation.

Equity has to be strongly reasserted, as the health effects of extreme disparities between communities become more and more evident.

Unity is indispensable for effective action, and it requires us to work more closely than ever before with our partners.

To uphold these principles we have to be practical. The first thing to do is ensure that we have the resources to do our work.

During this meeting you will be discussing the proposed Programme Budget for 2006-2007. I would like to stress some important aspects of this budget.

First, it builds on our experience with results-based budgeting and the lessons learnt from the performance assessment of the 2002–2003 Programme Budget. Second, it reflects the priorities expressed by Member States in recent World Health Assembly resolutions and has been drafted in consultation between the headquarters, regional and country offices. Third, it reinforces and accelerates the decentralization process initiated last year.

You will note that it proposes an overall increase of 12.8%, all of which will be allocated to countries and regions. The increase is accompanied by measures to ensure maximum efficiency and transparency in the use of resources.

Previous projections of budget growth have been matched by the generosity of our donors, enabling us to achieve the results to which we were committed. But essential activities cannot depend on generosity alone. That is why I am proposing an increase of 9% in assessed contributions from Member States.

Years of zero nominal growth in the Regular Budgets have been gradually turning WHO into an organization that depends mainly on voluntary contributions. At present, the Regular Budget, consisting of assessed contributions, represents only 30% of WHO's overall expenditure. If the current trend were to continue, it would be only 17% by 2015. To formulate and carry out a well-balanced global policy, a significant regular budget is needed.

The budget question becomes urgent in the context of our General Programme of Work for 2006 to 2015, which sets our longer-term objectives and thereby defines WHO's role in the world. Your discussions this week on these two agenda items, and on PAHO in the 21st century, will make an important contribution to this ongoing work on broad policy issues.

The Programme Budget and the General Programme of Work will be on the agenda of WHO's Executive Board at its next meeting in January. Your input through this session of the Regional Committee will help them shape their recommendations, which then go to the World Health Assembly.

To return to the question of security, epidemics continue to be a threat both to the Americas and to the world. The International Health Regulations are designed to minimize that danger. The revision now in progress has benefited from a high level of input from Member States through the regional consultations. The next step will be to agree on a revised text in the open-ended Intergovernmental Working Group which meets from 1 to 12 November, at the UN Palais des Nations in Geneva.

The working draft should be distributed to Member States and posted on the web shortly. If progress continues at the current rate, the revised Regulations can be adopted at the World Health Assembly in May 2005. The fullest participation possible of Member States in the Working Group discussions will be our best guarantee of success.

The longer-term challenge will be to ensure that the revised regulations do lead to improved international disease control. This will require strong commitment within regions and countries, with the necessary investment in early warning and response systems.

These systems will be supported by WHO's Operations Centre, recently opened at headquarters. The Centre enables us to respond rapidly to early signs of outbreaks and other health emergencies by circulating the latest information and coordinating the necessary action. It has received strong support from Secretary Thompson, which we very much appreciate.

We have seen timely and well-managed responses to SARS, Ebola fever and, most recently, avian influenza. However, real dangers remain, such as the transmission of avian influenza to humans, and we are still in the early stages of building a strong global health security system. This will require a sustained effort of investment. It involves not only the national, regional, and global information hubs but also our many collaborating centres in the Global Outbreak Alert and Response Network.

Prevention is the first requirement but the health services also have to be prepared for crises that do occur, because of natural events, accidents or violence. Preparedness can save millions of lives.

Devastation can also happen cumulatively, over a number of years. Lack of access to AIDS treatment and prevention methods continues to be a glaring example both of insecurity and of inequity.

With two million people living with HIV/AIDS in Latin America and the Caribbean, increased coverage with prevention and treatment programmes is urgently needed. WHO applauds the goal adopted by the Heads of State of the Americas in January of this year of achieving near universal access to antiretroviral therapy by November 2005. This bold decision, and the work now going on to implement it, is pointing the way forward globally.

Evidence from this region, particularly Brazil, has played an important part in making clear that both treatment and prevention are indispensable. We know that prevention bolsters treatment and vice versa, and that they must be integrated in a comprehensive way.

Globally, with all sources combined, almost twenty billion dollars have been pledged for integrated AIDS prevention and care over the next five years. The resources being made available, particularly through the US President's Emergency Plan for HIV/AIDS Relief, represent a huge potential for effective action. At the same time, drug prices continue to fall, with the lowest-price triple-drug regimen coming down towards $140 per person per year. HIV treatment is now financially within reach for more countries, and more people, than ever before.

Enormous logistical and technical difficulties remain, but there are signs that they too are yielding to the persistent efforts of our many partners. The work towards our goal of three million people on treatment by the end of 2005 is gathering momentum.

Guidelines for high-quality treatment using standardized regimens and simplified clinical monitoring are now available. We have developed training and monitoring systems to ensure the quality of treatment, and to increase the involvement of nurses and community workers in providing care and support.

One of our most pressing needs, in this region as in the others, is to improve human resource capacity to support HIV treatment and strengthen activities across the health sector. This means retaining, training and deploying health care workers, and creating new types of treatment supporters, including people living with HIV/AIDS themselves. Social mobilization, with the very active involvement of community health workers, will be a key to achieving our goals.

On tuberculosis, it is encouraging to see that many countries in the Region are close to achieving the control targets for 2005. But programmes still need strengthening to achieve stability and to serve the people hardest to reach. There also needs to be closer collaboration between national TB and HIV/AIDS programmes to tackle the joint epidemic.

As we see with malaria and other diseases as well, making adequate health services available where they are needed is an enormous challenge in itself. But it is only one part of what it takes to promote health for all. Health also depends, to a very significant extent, on socially determined factors such as the environment, education and employment.

Knowledge about how these factors affect health enables us to target our activities for maximum effect. To gather the evidence needed for effective policies, the Commission on the Social Determinants of Health will begin its work in December. The preparatory work has been enjoying excellent support from this Region. We particularly appreciate the strong contribution President Lagos of Chile is making to this initiative. Regional and country-level input will be indispensable for this effort and I encourage you all to participate in every way you can.

The WHO Framework Convention on Tobacco Control, also aimed at tackling social and economic determinants of health, is proceeding well towards coming into force. Thirty-two of the thirty-five Member States in this Region are signatories to the Convention. I congratulate Mexico, Panama, Trinidad and Tobago and Uruguay on having moved swiftly to ratify it. I urge all the rest of you to follow their excellent example, so that the Convention can come into force without delay, and fulfil its great potential for saving lives.

In May, the WHO Strategy on Diet and Physical Activity was strongly endorsed by the Health Assembly. Knowledge-sharing will be a major asset for implementing it and finding effective ways to control noncommunicable diseases. These are now the major cause of death and illness in every region of the world except Africa.

It is research that has led to public recognition of the causes of health problems and how they can be tackled. The Ministerial Summit on Health Research, to be held in Mexico in November, aims to discuss how to remove the factors that block the way to the Millennium Development Goals. I encourage you all to attend this meeting. Unity is the key to achieving the security and equity the world so desperately needs now. In the coming months, our focus on maternal and child health will provide special opportunities to achieve it.

A large number of key organizations have combined forces to tackle the problems in this area. Their first step, earlier this year, was to draft a road map for attaining the Millennium Development Goals for maternal and child health. The World Health Report and World Health Day for 2005 will build on this momentum.

The focus on maternal and child health is reinforced by our country-specific cooperation strategies, whose principal aim is to strengthen health systems. With the delegation of authority to the country offices, the work of decentralization through single country support plans and budgets is well under way in this Region. This Regional Committee or Directing Council itself has been for many years a powerful means of building mutual support and unity between the peoples of North America, South America and the Caribbean, and between this region and the others. Health is a global necessity and the means of achieving it transcend national and regional boundaries. Today, even more than in previous centuries, solidarity is the key to disease control and health promotion.

The discussions we will have here this week are a great opportunity to clarify some of the specifics of our common task. For the sake of all the people who stand to gain from our work, in the Americas and beyond, I wish us all every success.

Thank you.

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