57th Session of the Regional Committee for South-East Asia

Male, Maldives
8 September 2004

Mr Chairman, Honourable Ministers, Distinguished Representatives, Colleagues,

I would like to thank the Government of Maldives for its generous hospitality in hosting this meeting of the Regional Committee. Having spent some of my younger days as a public health worker in an island setting, I know from firsthand experience that it provides an excellent stage for clear thinking and unhurried decision-making.

A year ago this Regional Committee nominated my old colleague and friend Dr Samlee Plianbangchang as Regional Director. It already seems like a long time ago, and I congratulate him on the smooth transition and the excellent work that is going on under his guidance.

I am going to suggest three reference points for your discussions as you continue them today and draw them to a close tomorrow. These are security, equity and unity in health.

Security in health work means protecting people from disease, disability and premature death. In many parts of South-East Asia, this is an overwhelming need. Meeting it requires constant attention not only to immediate dangers but to the long-term work of reducing them.

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 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. Your current cooperation on regional and bi-regional disease control reflects this need and points the way forward.

To put these principles into practice we also need to be practical. The first thing to do is ensure that we have enough money to do our work.

Yesterday you discussed the proposed Programme Budget for 2006– 2007. I would like briefly 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 discussion with many staff in 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.

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 increase represents a break with the practice adopted some years ago of zero nominal growth in the regular 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 and thereby defines WHO's role in the world. 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 important contribution to the Executive Board's recommendations, which then go to the Health Assembly.

To return to the question of security, major 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 at the UN Palais des Nations in Geneva.

The working draft will be made available later this 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 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. 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 latest information and coordinating the necessary action.

Recently we have seen timely and well-managed responses in South East Asia and the Western Pacific to outbreaks of avian influenza in humans, following epidemics of avian influenza in poultry on an unprecedented scale. However, the threat of transmission to humans remains, and we are still in the early stages of building a strong global outbreak alert and response system. 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.

Another kind of emergency occurred recently with the floods in Bangladesh. The rapid response of the local and national health services was highly impressive. With 30 million people driven from their homes and a million homes destroyed, a very high death toll was feared. In the event, there were 700 deaths, 260 of them by drowning. These numbers reflect very effective disease prevention and emergency care services, from which all countries can learn.

The immediate task of relief agencies in these situations is to save and sustain lives. The special responsibility of WHO, led by its Health Action in Crises department with Regional and Country offices, 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 we face in the world today. Lack of access to AIDS treatment and prevention methods continues to be a glaring example of that inequity and its impact on societies.

Some parts of this region face the danger of an expanding HIV epidemic which urgently requires accelerated preventive action. Others have a wealth of experience and practical information on the forms effective action can take. This presents a great opportunity for solidarity and cross-border learning within the region.

At the Bangkok conference on HIV/AIDS 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.

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 working towards the "3 by 5" target within countries and internationally.

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. We expect 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.

One of our most pressing needs 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 in South-East Asia and other regions.

The target of three million patients on antiretroviral treatment by 2005 has provoked much discussion. To many it seemed like an over-ambitious idea one year ago; now it is a strong commitment made by many countries, many organizations and many individuals. To speculate 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 possible time.

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 - set by many organizations and many people acting at every level, from local to international. Effective action on this emergency is an absolute necessity.

Global polio eradication now hangs in the balance in Asia, with just three countries remaining endemic: India, Pakistan, and Afghanistan. In this region, the intensified eradication effort that India launched in January has brought this disease to the verge of elimination. Only 46 cases have been reported here so far this year. That is nearly 70% lower than for the same period last year. More importantly, the virus is now cornered in just a few districts of Uttar Pradesh and Bihar in India.

I know that the Ministry of Health and Family Welfare, the Regional Director and all our partners are committed to rooting out polio from these few remaining districts by the end of this year. And I can assure you that this is a top priority for all of WHO. With a sustained effort in India, and continued high quality surveillance and routine vaccination in all countries of the region, the South-East Asia Region will be the next great success in this historic effort.

There has also been great progress in tuberculosis control in this region. The target of an 85% cure rate is now nearly achieved and the case detection rate is now 46%. DOTS expansion has been rapid and effective in several countries, notably India. TB control in the region still faces many challenges though. Sustainable financing is an urgent need, as is the strengthening of human resources at the local government primary health care level. Co-epidemics, with rising HIV infection, are an increasing danger; so is multidrug-resistant TB. Both these complications make case management very much more difficult and expensive. DOTS case-finding and management are the best means of preventing them.

Major efforts are under way to improve the malaria situation. These are aimed at increasing people's access to insecticide-treated bednets and widespread use of effective treatment regimens based on artesunate combination therapy. This combination of prevention and treatment measures can control malaria. The challenge before us all is to put the human resources and systems in place to ensure that it is adopted. Meanwhile, malaria still kills 30,000 people in this region, mainly children, every year.

As we see in the case of HIV/AIDS, malaria and tuberculosis, 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 and consolidate 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. In this region, our host country, Maldives, has ratified it, as have Bangladesh, Bhutan, India, Myanmar and Sri Lanka. I urge all the rest of you to follow their excellent example, so that the Convention can fulfill its great potential for saving lives.

It is research that has led to public recognition of some of the causes of chronic disease and how they can be tackled. The Ministerial Summit on Health Research, to be held in Mexico in November, aims to accelerate the same process for other causal factors of disease, especially the factors 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. I urge you to attend this important event. 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 particular concern in this region is the high rate of neonatal mortality and low-birth-weight infants.

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 report will be launched at a major event in India next April to celebrate World Health Day. We are working with our colleagues in UNICEF, UNFPA and the many other organizations involved through the new Partnership for Safe Motherhood and Newborn Health, which is housed in WHO's Geneva office.

The focus on maternal and child health is reinforced by our country-specific cooperation strategies, whose principal aim is to strengthen health systems. Combined with delegation of authority to the WHO Representatives, the work of decentralization, through the single WHO country plan and budget, is well under way in the South-East Asia Region. Your work on this is very much appreciated by all. The Regional Committee itself has been a powerful means of building unity between our Member States 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.

Your decisions here this week can help to build that strength. For the sake of all the people who stand to gain from it, in South-East Asia and beyond, I wish you every success.

Thank you.