Director-General

Regional Committee for Africa, Fifty-fourth session

Brazzaville, Republic of Congo
31 August 2004

Mr Chairman, Honourable Ministers, Distinguished Representatives, Colleagues,

Some of the most important health work in the world is being done by the people of this region, and key decisions in support of that work will be made here this week. I'm sure you're all thinking in particular about the decision on who should be the successor for Dr Samba. This choice is a great responsibility and I have no doubt that you will make it with all the wisdom and good judgment it requires.

The new Regional Director will be taking up a difficult task at a critical point in the life of this region, and will need our wholehearted support.

This is the last session of the Regional Committee Dr Samba will be attending as Regional Director, and he will be sorely missed. I would like to take this opportunity to congratulate and thank him for his strong leadership, his dynamism, and his great achievements as Director of the onchocerciasis control programme and as Regional Director. Dr Samba, you will be a very hard act to follow. Please accept our warmest thanks for the past and good wishes for the future.

Security, equity and unity — these are the guiding principles for our work on health in the African Region and globally.

Health security means protection from poverty, displacement, disease, disability and premature death. Building and maintaining that security means responding to the urgent needs and dangers now facing us. With conflicts and epidemics in so many parts of the continent, this is an especially high priority for Africa.

Equity has been WHO's fundamental principle from the very beginning, as our constitution states. It needs to be strongly reasserted now, as the health effects of disparities between communities, nations and continents 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. The new African Union renews hope and strength in the struggle to achieve this in Africa. We must work to promote synergy with it, NEPAD and the initiatives coming from regional economic communities in the coming months.

Absolute realism is needed as well, to put our principles into practice. We must make sure we have the necessary means to do our work. I will therefore begin with the question of resources.

During this meeting, you will be discussing the proposed Programme Budget for 2006– 2007. I would like to draw your attention to some important aspects of this budget.

First, it builds on our experience with results-based budgeting. Second, it reflects the priorities expressed by Member States in recent World Health Assembly resolutions and has been drafted on the basis of consultation between the headquarters, regional and country offices. Third, it reinforces and accelerates the decentralization process I 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.

In view of its particular needs, the African Region benefits from the single largest dollar increase, of $143 million. AFRO will receive, for the first time, more than any region or headquarters. The increase is accompanied by measures to ensure maximum efficiency in the use of resources. These measures are aimed at delegating responsibility while maintaining the highest standards of transparency and accountability.

Our capacity to mobilize additional resources will increase only to the extent that we continue to demonstrate our ability to use them effectively and accountably in pursuit of global health.

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. We continue to propose an increase in voluntary funding for the next biennium. But essential activities cannot depend on generosity alone. I am therefore proposing an increase of 9% in assessed contributions from Member States.

The increase represents a break with the practice adopted some years ago of zero nominal growth in the budgets of UN agencies, which 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. Both of these items — the Programme Budget and the General Programme of Work — 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 essential contribution to those discussions. Please feel free to say exactly what you think, so that the budget is fully representative of your views and your needs.

With regard to health security, major outbreaks of disease continue to be a threat both within the region and globally. The revision of the International Health Regulations has enjoyed a high level of input from Member States through the regional consultations. The next step will be to agree on revisions 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 will be available next month. 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 are followed. This will require strong commitment within countries, with the necessary investment in early warning and response systems.

Their activities will be supported by the Strategic Health Information Centre, recently constructed at headquarters, which is now fully operational. Using the most up-to-date technology, it enables us to respond rapidly to the earliest signs of outbreaks and other health emergencies by circulating the necessary information and organizing effective action to contain them. The WHO regional and country offices are a vital component of this system, as has been seen with their superb response to recent emergencies.

Recently, we have seen early and coordinated responses to outbreaks of Ebola in central Africa, and Lassa fever in west Africa, and to avian influenza in several Asian countries. However, we are still in the early stages of building an adequate global alert and response system. It involves not only our central and regional information hubs but also our partners such as the Global Outbreak Alert and Response Network, and our many collaborating centres in the relevant areas of expertise.

We will shortly be contacting Member States with further information on ways in which you can link up your own information centres with our regional and headquarters centres, to access and add to the information provided.

Millions of people on this continent live in extremely difficult circumstances. This is particularly so for those who are caught up in the horror of a humanitarian crisis. Last month I visited Darfur in Sudan, and saw some of the overwhelming challenges faced by the people and health workers there, mirrored by those in Chad. I was impressed by the work of our national and international staff as they seek to reduce suffering and ensure survival.

People in numerous other conflict and disaster areas of this region are suffering extreme distress though outside of the media spotlight. Our immediate work in these areas is to save and sustain lives. But the special responsibility of WHO is to do this in a way that builds up essential health services for the long term.

Inequity is the root cause of much of the danger and insecurity we face in the world today. Lack of access to AIDS prevention methods and treatment continues to be a glaring example of both insecurity and inequity. But action on an unprecedented scale is now in progress to tackle this injustice. At the International Conference on AIDS in Bangkok in July there was plenty of debate over methods of prevention and treatment, but absolute agreement about the need for both. We know that prevention bolsters treatment and vice versa, and that they must be integrated in a comprehensive way.

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 costing $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 working towards the '3 by 5' target within countries and internationally.

Twelve countries have now set targets for 2005 to get treatment to 50% or more of the people who need it, and 10 of them are in this region. Guidelines for high-quality treatment using standardized regimens and simplified clinical monitoring are now available. We have also 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. Fifty-six countries have appealed to WHO for technical assistance in scaling up treatment and we are actively supporting them. We expect Canada to provide 100 million Canadian dollars next month and to have at least 20 "3 by 5" country officers in place by the end of this year, greatly increasing our effectiveness on the ground.

Improving human resource capacity is one of our most pressing challenges, not only to support HIV treatment but across the health sector. This means retaining, training and deploying health care workers, and supporting more people to fight HIV/AIDS, including people living with the disease themselves.

The '3 by 5' target itself has also provoked much discussion. What seemed to many like an over-ambitious idea one year ago is now a strong commitment made by many countries, many organizations, and many individuals. To speculate at present about whether we will meet the deadline is to miss the point. The point in the AIDS treatment emergency is the same as in other emergencies: to do as much as is humanly possible to save lives and reduce danger in the shortest time possible.

The initiative has helped to focus the world's attention on dealing with this emergency, and has galvanized action within our own organization. We must not relent in our efforts to reach the target for treatment and to accelerate HIV/AIDS prevention well beyond December 2005.

I am committed to continuing to mobilize all the human and material resources at our disposal to support you in this. It is not just a WHO target, it is your target, it is set by many organizations and many people acting at every level, from local to international. They know that effective action on this emergency is an absolute necessity.

On other campaigns, polio eradication now hangs in the balance. The re-infection of 12 polio-free countries in Africa shows both the extraordinary progress that has been made and its fragility. The 22-country synchronized campaigns that will begin in the first week of October must reach nearly 74 million children to get the eradication campaign back on track. This effort, which will protect the massive investment you have made, has the support and good wishes of the whole world behind it.

Guinea worm is close to eradication, and only six countries in Africa remain endemic for leprosy. It is essential that we sustain these efforts until the work is complete.

There has been less progress in reaching the Abuja targets for malaria but major efforts are being made to change this in the near future. Increasing people's access to insecticide-treated bednets, and widespread adoption of effective treatment regimens based on artesunate combination therapy can lead to major progress against malaria — a disease which still kills one million people, mainly children on this continent, every year.

Universal access to adequate health services is the main aim of all our work, but it is only one part of what it takes to promote health for all. As we see in the case of HIV/AIDS, malaria and tuberculosis this is an enormous challenge in itself. But health also depends to a very significant extent on social 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 and consolidate the evidence needed for effective policies to enhance equity, 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. In this region Kenya, Mauritius and Seychelles have ratified it. I urge you all to follow their excellent example, so that the Convention can fulfill its great potential for saving lives.

The evidence produced by research has been the key to public recognition of these problems and finding solutions for them. The Ministerial Summit on Health Research, to be held in Mexico in November, will attempt to do the same for other causal factors of disease, especially those that block the way to the Millennium Development Goals. In addition, the Sixth Global Conference on Health Promotion will be held in Bangkok in August 2005. Its title will be Policy and Partnership for Action. Unity is the key to achieving the security and equity the world so desperately needs now. In the coming months, maternal and child health will provide special opportunities to achieve it, particularly in this region. Africa is the only region in which the number of mothers dying giving birth is actually rising. The lifetime risk of maternal death in the African region is now estimated at one in 16. In North America it is estimated at one in 3500, in Asia at one in 100.

A large number of key organizations have combined forces to change this situation. 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. We are working closely with our colleagues in UNICEF, UNFPA, the Partnership for Safe Motherhood and other organizations.

This focus is reinforced by our country-specific cooperation strategies, which are aimed primarily at strengthening health systems. AFRO is leading the way in developing this cooperation strategy, with almost every country in the region participating very actively. It shows how each programme and each level of activity can contribute to national health development goals through one WHO country budget and plan. This is giving a strong sense of direction to our work in this region and beyond. It is exactly the trend we need to be setting today as we adjust our programmes and budgets to meet the increasing demands on us.

This Regional Committee itself has been a powerful means of building and maintaining unity between the Member States of Africa over the years. Health problems have no respect for national boundaries, and the means of solving them must transcend those boundaries as well. Solidarity is the key to disease control, especially for the diseases linked to poverty.

You have many important decisions to make during this meeting. The health of many people depends on the outcome of your discussions. For their sake, I wish you every success.

Thank you.

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