Director-General

Regional Committee for the Eastern Mediterranean

Cairo, Egypt
3 October 2004

Mr Chairman, Honourable Ministers, Distinguished Representatives, Dr Al Gezairy, Regional Director, dear guests, colleagues,

We see how conflict leads to escalating illness, disability and death. We are aware of how in conflict situations it is the most vulnerable who suffer most — children, old people, pregnant women, and those with chronic diseases.

When I visited Sudan in July with Dr Osman and Dr Al Gezairy, I was deeply concerned to see the suffering of the internally displaced people there. I was also deeply impressed by the health workers' selfless courage and dedication.

Liaison and cooperation with state and national health authorities, as well as with UN agencies and nongovernmental groups, is an essential part of work during crises. Much of this joint effort goes on behind the scenes and usually remains unrecognized. I would like to take this opportunity to recognize it now, and express my respect and gratitude to all those working for health in extremely difficult conditions in Iraq, Afghanistan, the occupied Palestinian territories, Sudan and other parts of this Region.

We are taking steps to improve the security of our staff, given the increasing threats to their own safety. During the next three years we will ensure that our WHO country teams are better equipped and prepared to help national authorities in crisis situations. However, it must also be recognized that in a crisis situation danger is an occupational hazard for health workers. It should neither paralyse us nor fill us with self-pity. If we want absolute safety we should stay at home.

More generally, the need for good health as fundamental to human security may be a useful reference point 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. Health for all means health for every child, every woman, and every man.

Unity is indispensable for effective action, and it requires us to work more closely than ever before with our partners. Your current cooperation on disease control reflects this need and points the way forward.

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 in the use of resources. These measures delegate responsibility while calling for the highest standards of transparency and accountability.

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.

The practice of zero nominal growth in Regular Budgets has 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. You will be discussing both these items this week, and they will be on the agenda of the Executive Board at its next meeting in January.

Your input through this session of the Regional Committee will make an important contribution to the Executive Board's recommendations, which then go to the World Health Assembly.

To return to the question of security, disease outbreaks and epidemics continue to be a threat both to this region 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 in Geneva.

The working draft has just been distributed. If progress continues at the current rate, the revised Regulations can be adopted at the World Health Assembly in May 2005. The fullest possible participation 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 are followed. This will require strong commitment within regions and countries, with the necessary investment in early warning and response systems.

Recently we have seen timely and well-managed responses to avian influenza, and to Ebola haemorrhagic fever. However, we are still in the early stages of building an adequate global outbreak alert and response 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 relevant areas of expertise.

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

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

In this region, with 700 000 people living with HIV/AIDS and the numbers rising rapidly in some countries, decisive action is needed now. Reducing stigma is a particular challenge for preventive action and making treatment available. We know that prevention and treatment strengthen each other, and they must be integrated in a comprehensive way.

Financing through the Global Fund will contribute significantly to the excellent work you are doing to achieve this. Building up health infrastructure is the most urgent need in many countries, and HIV/AIDS control should be used as a catalyst for doing this.

Globally, with all sources combined, almost 20 billion dollars have been pledged for integrated AIDS prevention and care over the next five years. 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 global 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.

Regarding other campaigns, this Region is poised to achieve its goal of stopping polio transmission by the end of this year.

In two very difficult situations — Sudan's Darfur area and Iraq — immunization activities have been encouraging. Twenty thousand Iraqis spent five days last month immunizing 4.6 million under-five-year-olds in Iraq, and are now engaged in a second round. In spite of the dangers and difficulties caused by conflict, the health workers and volunteers have succeeded in protecting at least 95% of these children from imported poliovirus. This is a great achievement.

In the last six months the Region has forced polio to retreat to just a few remaining areas. Pakistan is preparing to tackle these this year. In Egypt the highest levels of authority are committed to this last intense phase of the eradication effort. In Afghanistan health workers and volunteers continue to risk their lives to deliver polio vaccine, despite the absence of health services.

On tuberculosis, we need to sustain the current strong commitment to rapid DOTS expansion in high-burden countries, especially Afghanistan and Pakistan. Effective quality assurance for DOTS activities is needed in all countries. Equally important now, as we saw in the Addis Ababa conference two weeks ago, is the collaboration between TB and HIV/AIDS activities, to control the joint epidemic.

As we see with disease control, 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. Regional and country-level input will be indispensable for this effort, and I encourage you all to contribute to the Commission's work.

The WHO Framework Convention on Tobacco Control, also aimed at tackling social and economic determinants of health, is proceeding well towards coming into force. Eighteen of the 21 countries in this Region are signatories, and two have ratified it: Jordan and Qatar. I urge all the rest of you to follow their excellent example, so that the Convention can come into force without delay, and fulfill 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 the strategy and preventing and controlling 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 some 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, is aimed at tackling 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. There has been very good progress in formulating the country strategies in this Region. With the delegation of authority to the WHO Representatives, this work is making a valuable contribution to the decentralization process. A single country plan and budget allows us to adjust our presence in countries to the great variety of needs and circumstances in this Region. This Regional Committee also plays a vital part in building unity between our Member States. Health is for all people and this forum provides a unique opportunity to recognize this reality and take the steps that it calls for.

Your decisions here this week will point the way ahead. For the sake of all the people who stand to gain from your work, in the Eastern Mediterranean and beyond, I wish you every success.

Thank you.

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