56th WHO Regional Committee for Africa, held 28 August - 1 September 2006

Address by Anders Nordström, Acting-Director-General

28 August 2006

Mr Chairman,
Honourable Ministers,
Distinguished representatives,
Dear Colleagues,

It is a great pleasure coming back to Ethiopia and Addis. I have been here a few times already.

I would like to thank Dr Sambo for his report which shows very clear direction and excellent progress.

You are not simply coping with the present situation. You are looking forward.

I am extremely encouraged to see the concrete strategic plans for: immunization; HIV prevention; health financing; child survival; and knowledge management.

I am also pleased to see your emphasis on the development issues of poverty, trade and health, as well as health services and health research.

These, among other vital areas, clearly indicate how seriously we need to work together on the key strategic areas for health in this Region.

Last year you gave us your very valuable insights and input to the draft Eleventh General Programme of Work. This May, the World Health Assembly approved it. Here it is. In all six languages. Thank you for all that you have contributed to its strategic direction. It clearly sets out the gaps and the challenges, the seven priority areas for action, and the core functions of WHO.

The title, "Engaging for health", describes what we have to do now. Together, we have to implement the shared vision of the global health agenda.

Shortly we will discuss the Medium-Term Strategic Plan for 2008 to 2013 and the Proposed Programme Budget for 2008 to 2009.

Like the general programme of work, it draws on countries' practical experiences, challenges and needs.

The MTSP suggests that WHO should focus its work in five main areas:

  • support for countries in moving to universal coverage with effective public health interventions;
  • strengthening global and local health security;
  • generating and sustaining action across sectors to modify the behavioural, social, economic and environmental determinants of health;
  • increasing institutional capacities to deliver core public health functions through strengthening of health systems;
  • strengthening WHO leadership, both at the global and regional levels, to support the work of governments in countries.

To finance these plans, the Proposed Programme Budget for 2008-2009 has been costed at US$4.2 billion.

This is a landmark. For the first time, the African Region's budget exceeds $1 billion, at $1.189 billion.

This amounts to a total increase of about 25% against the current biennium and an absolute increase of $ 239 million.

The proposed financing of the programme budget is through:

  • an 8.6% increase in assessed contributions from the Member States amounting to $1 billion,
  • the introduction of negotiated core voluntary contributions amounting to $600 million
  • and the remainder through specific voluntary contributions.

Even with this increase, the share of the assessed contributions will continue to decline (23%). This is unfortunate. We hope however that the introduction of negotiated core voluntary contributions will achieve better alignment and reduce the transaction costs.

This Region accounts for over one quarter of the Organization's resources. With this comes the responsibility and accountability to use these resources efficiently and effectively.

The WHO Secretariat is implementing ambitious managerial reforms to strengthen its operations in this Region, and in particular its capacity to support countries.

Decentralization is a key component of this effort. The setting-up of intercountry support teams, together with our country offices, will provide even more timely and comprehensive technical support of the highest quality.

The "Global Management System": this Region will be the first to implement the new, modern, global information system. It will integrate programme management with the management of human, financial and infrastructure resources.

The increase in the budget is a direct reflection of increased expectations and demands from Member States.

It will target core areas of need, namely:

  • achieving the Millennium Development Goals for maternal and child health;
  • increasing the focus on noncommunicable diseases;
  • making health development sustainable through greater attention to the determinants of health;
  • implementing the International Health Regulations,
  • and strengthening of the health systems.

A few specific comments on selected issues:

To reach the Millennium Development Goal for child health, the key is reaching every newborn and child in every district with a set of priority interventions.

WHO is playing an active role in the Partnership for Maternal, Newborn and Child Health.

We see success stories in this Region gained through effective interventions. These show the way forward. In Tanzania there has been a 24 % reduction in child mortality, from 147 per thousand in 1999 to 112 per thousand in 2004.

The 2005 Accelerated Child Survival and Development initiative in West and Central African countries is preventing 18 000 child deaths per year.

I applaud also the discussion of sickle cell disease in this Region, in line with the recent World Health Assembly and Executive Board resolutions. This has a serious impact on child mortality and morbidity.

Immunization is a crucial part of our work and one of our most successful tools. Yet 2-3 million children each year are not vaccinated, and die from preventable diseases.

The GAVI Alliance continues to increase access to vaccines and to improve immunization safety.

Twelve countries in West Africa will shortly benefit from a GAVI initiative to extend the yellow fever vaccine stockpile, and to support emergency outbreak and preventive campaign activities. The $64.5 million provided by GAVI for yellow fever over five years will also contribute towards building health system capacity as it encourages manufacturing and distribution of the vaccine.

In maternal health, much more remains to be done in addressing the underlying problems in mother's and women's health. We are still far behind the goals set for 2015 and progress is too slow.

Globally, momentum is increasing to address sexual and reproductive health. WHO's governing bodies have approved a series of strategies and measures aimed at tackling sexually transmitted infections and improving reproductive health, especially among young people.

I have personally made maternal and reproductive health a priority during my few months in this Office. In June I met with Thoraya Obaid, the Executive Director of UNFPA and together with senior colleagues reviewed how we can better coordinate our action in the areas of sexual and reproductive health. The meeting in Maputo of Ministers of Health is important in this regard.

I recently attended the XVI International AIDS Conference in Toronto, Canada. One of the clear messages to emerge there was the vital need to improve prevention, treatment and care for women.

Three-quarters of all women 15 years and older living with HIV are in sub-Saharan Africa. This is a terrible situation both for them and for their families. Preventing transmission from mother to child is a high priority, as well as expansion of treatment for children. More than 90% of those living with HIV in high-burden countries are not aware of their status. Without this knowledge, they have no way of accessing treatment and counselling, nor of preventing further spread.

The treatment gap remains critical. You have made remarkable progress in increasing access to antiretroviral treatment, from 100 000 people in 2003 to one million in June 2006. But the Region still represents 70% of global unmet need.

The Toronto Conference emphasized the need for a balanced approach to HIV prevention, treatment, care and support. The theme of the Conference was "Time to deliver". In my address I highlighted the three vital areas for delivery: money, medicines and a motivated health workforce.

Of these, the key area to deliver on is the health workforce. Yet we all acknowledge that this workforce is in crisis. More people registered to attend the Toronto Conference than there are doctors in the whole of Eastern and Central Africa.

Of the 4.2 million health worker shortage globally, nearly one million are needed in Africa alone.

We have to address the underlying issues. Health workers are being driven away by low salaries and poor working conditions. Some are forced away to other jobs, either nationally or elsewhere in the world.

The shortage is crippling - for all healthcare. This year's World Health Day and World Health Report had the theme "Working together for health" to highlight this. The Report proposes immediate country-based actions within a 10-year plan.

This Medium-term strategic plan and Proposed programme budget also suggest a substantial increased focus on noncommunicable diseases.

Infectious diseases, maternal, perinatal and nutritional deficiencies continue to account for the vast majority of deaths in this Region. However, we should not underestimate the growing impact of cancers, cardiovascular disease, and especially diabetes. In this Region, chronic noncommunicable diseases are projected to account for 23% of all deaths in 2005.

Over the next 10 years, it is anticipated that deaths from chronic diseases will increase by 27%, with deaths from diabetes increasing by 42%. These can be prevented through healthy diet, regular physical activity and avoidance of tobacco products.

With the WHO Framework Convention on Tobacco Control, 137 countries have become Parties to the Convention. There are 17 Member States from this Region that have not yet ratified, accepted approved or acceded to the Convention. I urge you to do so at the earliest possible opportunity. This instrument is one of the most important interventions for control of the risk factors leading to chronic disease. Tobacco use is a leading preventable cause of death.

We need to address the underlying determinants of health.

The more we are able to control the factors that influence health, the greater chance we have to improve people's health and well-being. The action required to tackle most of these determinants goes beyond the influence of ministries of health. It involves a large number of government and commercial responsibilities and sectors.

The challenge is how to move from knowledge of social determinants and health equity, to specific and pragmatic policies. In that regard I particularly welcome the roundtable discussion on intersectoral action for health promotion and disease prevention that will take place later this week. Intersectoral action is key.

The recognition of the threat to human health from emerging infectious diseases has catalysed action in many areas not previously viewed as a priority in public health.

Let me now turn to the implementation of the International Health Regulations, and to avian influenza.

Those of you here who were involved in the careful negotiations to revise the International Health Regulations know how highly this instrument is regarded by Member States.

We see no signs today that the threat posed by the H5N1 avian influenza virus is diminishing.

Today, more than 50 countries in central and southern Asia, Europe, Africa and the Middle East have reported outbreaks in birds. Human cases have now been reported in 10 countries. As at 23 August there had been 241 confirmed cases and 141 deaths.

So far no countries in this Region have confirmed either human cases or deaths from avian influenza. However, the presence of avian flu in bird populations in Nigeria and elsewhere are a clear warning to stay vigilant.

The greatest risk to human health from H5N1 comes not from the big commercial poultry farms, but from the small backyard flocks. In these informal settings, people's knowledge of how to protect themselves from infection is less, and their vulnerability is therefore greater. Information and communication are top priorities.

A vital part of preparedness is a close working relationship between the health and agriculture sectors. Almost all countries now have pandemic preparedness plans. These now need to become operational. Manufacturing capacity of antiviral drugs has improved considerably. Licenses have been granted to produce these drugs in several developing countries. Much attention is being given to the development of a pandemic vaccine, and finding ways to expand manufacturing capacity. Some clinical trials are now producing encouraging results.

Turning now to polio: we are all committed to polio eradication. Some challenges remain. Under the strong leadership of Dr Sambo, important progress has been achieved. The 2003-2005 multi-country epidemic in 10 countries of west and central Africa has been successfully stopped.

Last week I was in Dhaka, Bangladesh, where the Regional Committee discussed the critical situation in India. Similarly now, we must confront the other great challenge in Northern Nigeria. Until transmission is stopped in Nigeria, all countries across Africa, and particularly countries in west and central Africa, remain at high risk of re-infection. Five states in the north of the country account for more than half of all new cases worldwide.

We know polio can be eradicated from Nigeria. This is now the time to increase action. We must also ensure our tremendous progress elsewhere in Region is secured by rapidly stopping the ongoing outbreaks in Angola, Namibia, DR Congo and Ethiopia.

Finally and perhaps most importantly, we need to continue strengthening health systems.

Without functioning and efficient health systems we will not be able to scale up basic health services nor achieve the MDGs.

We need to improve the organization, management and delivery of health services. This means looking at how to best organize the system, and how to best engage different stakeholders and providers.

We need fair, adequate and sustainable financing. This means looking at policy options for how to finance health services, exploring different financing alternatives, and reviewing the most effective allocation of resources.

We also need to strengthen the evidence base of health systems to support policy-making and implementation. This means good information and surveillance systems and investing in national capacity for research.

However, without a stronger health workforce we will fail in all of these.

Last month, in St Petersburg, I spoke on this to the G8. For universal coverage and access to become a reality, every country needs a motivated health workforce.

I have just made the same point very strongly in Toronto at the AIDS Conference, where we launched the "Treat, train, retain" initiative to protect and support health workers living with HIV.

This joins wider global efforts to sustain and build through the Health Workforce Alliance. The HRH observatory to be established in this Region will also support this.

Appropriate channelling of development aid remains a challenge. We have to worry when a country like Rwanda has $47 million for HIV/AIDS but only $1 million for child health, with only 14% of health spending under the control of government.

The Programs Assistance Facility for Health (PAFH) is an important initiative. I welcome the proposed work in the Region to increase aid effectiveness, scale up access to health services, and improve effectiveness in working with partners. This initiative should be launched by the end of the year jointly with the World Bank and other partners.

In concluding: the goal is to make WHO more responsive to the needs of countries. This lies at the heart of the strategic planning that we will be discussing later.

I am proud that WHO is perceived as working effectively in the United Nations system. I believe that we need now to look more widely throughout the Organization at how we can further improve our work.

This Region bears a huge responsibility. The countries of this Region have the biggest programme budget. It is essential that those programmes be carried out with transparency, accountability and efficiency.

Our efforts need now to focus even more on our staff. We must make sure we have the right staff in the right place and with the right competences.

I feel certain that, under Dr Sambo's leadership, and with your continued active engagement and direction in the process, this Region will be able to tackle the big challenges we have in front of us.

I thank you.