Regional Committee for the Eastern Mediterranean, Isfahan, Islamic Republic of Iran

Address by Anders Nordström, Acting-Director-General

8 September 2006

Mr Chairman,
Honourable Ministers,
Distinguished representatives,

As I have joined regional committees around the world, it has been a true pleasure to see the clear relevance and importance of WHO's role and core functions, whether providing technical support, assessing health trends, setting norms and standards, articulating policy options, or providing leadership. In executing those functions, engagement with partners is central to our work.

Let me first address the situation in Lebanon. I would like to thank all our colleagues - the national government of Lebanon, His Excellency the Prime Minister, the Minister of Health, UN partners, NGOs and many others - who have worked together tirelessly, with a very strong spirit of cooperation.

I have been following the events closely together with Dr Alwan, Dr Gezairy, Dr Jama and the whole WHO team. Allow me to express my sincere appreciation for your work.

For WHO, quick response to emergencies is important. This Region has unfortunately been prone to both conflicts and natural disasters. In all of those situations it is essential to focus also on the rebuilding of sustainable health services. The assessments in Lebanon conducted by the Ministry of Health and WHO show clearly that the health structure in the south has been severely affected. At the request of the World Health Assembly an emergency meeting in June reviewed the health conditions in the occupied Palestinian territory. Severe challenges to the health services remain. This leaves the Palestinian population vulnerable. I am pleased that the Stockholm Conference resulted in concrete pledges to support Lebanon as well as the health system in Gaza and the West Bank. WHO will continue to work with partners to support the health system and to sustain public health services. Critical failures in health can potentially have broad economic and social implications.

One of WHOs priority areas of work with partners is to build individual and global health security. This will be the theme for next year's World Health Report and World Health Day.

Within the United Nations system WHO has effectively taken the health cluster lead in emergency issues. In this, as well as in an increasing range of development issues, health is today a driver for wider change and reform.

Over the past 18 months there has been extensive consultation over the development of the Eleventh General Programme of Work for WHO. Last year you gave us your very important insights and input. This May, the World Health Assembly approved it. I thank you all for all that you have contributed to its strategic direction.

We now have an analysis of the key challenges and gaps. We have a broad global health agenda for the future comprising seven interrelated areas, and we have refined the six core functions of WHO.

The title, "Engaging for health", describes what we have to do. Together, we have to implement the shared vision of the global health agenda and improving health. Please read it and use it! Shortly we will discuss the Medium-Term Strategic Plan (MTSP) for 2008 to 2013 and the Proposed Programme Budget for 2008 to 2009.

Like the GPW this plan 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; actions across sectors to modify the behavioural, social, economic and environmental determinants of health; increasing institutional capacities through strengthening of health systems; and strengthening WHO leadership, both at the global and regional levels, to support the work of countries.

To finance these plans, the Proposed Programme Budget for 2008-2009 has been costed at US$ 4.2 billion. This is a proposed increase of 17% over the current biennium's expected expenditure. For this Region, this amounts to a total proposed increase of about 23% against the current biennium. This represents an absolute increase of $87 million and a total of $469 million.

The share of the total budget for this Region, excluding polio and emergencies, is suggested to increase from 9.9% to 10.6%.

The total budget is proposed to be financed through a 8.6% increase of assessed contributions amounting totally to $1 billion, the introduction of negotiated core voluntary contributions aiming at $600 million; and through specific voluntary contributions.

The share of the assessed contributions will, even with this increase, continue to decline (to 23%). This is unfortunate.

We hope, however, that the introduction of negotiated core voluntary contributions will achieve better alignment and reduce transaction costs.

The increase of the budget is a direct reflection of the increased expectations from Member States. It will target some 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 health systems.

Let me now provide some more specific comments on some key issues.

I will start with maternal and child health, which is a cornerstone to our work.

To reach the Millennium Development Goal four, the key is to reach every newborn and child with a set of priority interventions. 1.5 million children under five are dying each year in the Region. Forty per cent of these deaths are in the first month of life.

The Islamic Republic of Iran has achieved a dramatic drop in its infant mortality rate - from 120 in 1974 to 28 in 2000. An impressive achievement.

Children must be a priority in the Region, with a sustained commitment. I am very pleased to see that many countries are implementing the Child Health Policy Initiative. Immunization is a crucial part of our work and one of our most successful tools. Yet globally 2-3 million children each year are not vaccinated, and die from preventable diseases. The Region has 78% immunization coverage. The GAVI Alliance continues to increase access to vaccines, and to improve immunization safety. All six GAVI-eligible countries have received funding to support immunization services - a total commitment of $61 million.

In terms of maternal health, much more remains to be done to address the underlying problems in mothers' and women's health. We are still far behind the goals set for 2015 and progress is too slow. If you excuse me making a reference to the Islamic Republic of Iran again, this country has decreased maternal mortality ratios from 245 per 100 000 live births in 1976 to 27 per 100 000 in 2004. Another remarkable achievement.

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. Together with senior colleagues we reviewed how we can better coordinate our action in the areas of sexual and reproductive health especially in countries.

I very much welcome the recently endorsed regional strategy for strengthening the health sector response to HIV/AIDS and STI (2006-2010).

I recently attended the 16th International AIDS Conference in Toronto. One clear message was the vital need to improve prevention, treatment and care for women.

At the Conference I introduced the "3 Ms": the three key areas for action of Money, Medicines and a Motivated workforce. We have seen an increase in terms of financial resources. Yet more is needed. There have also been major improvements in terms of access to drugs. Prices have come down and new products are available. Yet neither of these two will bring more than short-term benefits if the longer-term development issues of an effective health system and the health workforce crisis are not dealt with.

Most countries in the Region are low-prevalence for HIV. However, there are substantial risks related to injecting-drug use and high-risk sexual behaviours. Scale up of access to treatment in the Region is somewhat slow. Coverage of antiretroviral therapy was only 5% in June 2006. Low awareness and high levels of stigma and discrimination are important challenges, where religious leaders can play an important role.

Let me now turn to malaria and congratulate you on the success of your regional strategy. In all nine malaria-endemic countries, the burden of disease has decreased relative to 2000. Malaria elimination in Egypt, Morocco, Oman and Syria is potentially sustainable. We need now to take forward this success to be reflected in other priority areas.

You have made tremendous efforts to keep TB control going, even in the most challenging environments. However, despite recent significant progress, the Region's countries together have not reached the 2005 WHO target of 70% case detection or TB treatment success of 85%. A regional TB control partnership needs to be created and supported. This would mobilize new resources and partners and support implementation of regional and country plans to Stop TB.

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. The preparation of a regional strategy on preparedness and response for human pandemic influenza is of great importance. The recent re-emergence of infections in chickens in Egypt underscores the importance of staying alert, and of educating people on how to protect themselves. The greatest risk to human health from the virus comes not from the big commercial poultry farms, but from the small backyard flocks. In these informal domestic 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.

Turning now to another virus - polio. I congratulate this Region on making very important progress. Egypt was officially removed from the endemic country list in January 2006. Truly a historic moment. The epidemic in Yemen - the largest, single-country outbreak of recent years - has been successfully curbed. However, challenges remain in Afghanistan and Pakistan. The success of the global polio eradication effort depends upon two factors. Both are issues of political will. Both must be confronted.

The first: Interrupting final chains of polio transmission in the four remaining endemic countries. In the Regional Committees for South-East Asia, and for Africa, I stressed the critical situation in India and the need to confront the other great challenge in Northern Nigeria. It is of vital strategic importance to the global polio eradication effort that Afghanistan and Pakistan stop polio as rapidly as possible. I thank President Hamid Karzai of Afghanistan, who established a 'National Polio Action Group' to ensure that every child is reached during polio immunization campaigns.

The second: For 2006 we urgently need $50 million by October to ensure activities through to the rest of the year can proceed as planned. For 2007-2008 we face a $390 million funding gap.

We have also to look seriously at noncommunicable diseases. Last year's regional committee resolution urged Member States to prioritize NCDs, in particular hypertension and diabetes. I am pleased to see how we are now taking this forward. And I am also very happy that my colleague Catherine Le Gales Camus will later today launch the Arabic version of the Preventing Chronic Diseases Report.

Chronic noncommunicable diseases are the major cause of death and disability worldwide. They already account for 52% of all deaths in this Region. Deaths in this Region from diabetes are projected to increase by 50% in the next 10 years. The solution: prevention through healthy diet, regular physical exercise and avoidance of tobacco products.

The principal approach is the reduction of exposure to the risk factors.

As a global community, we have committed to tobacco control through the WHO Framework Convention on Tobacco Control. 136 countries and the EC have become Parties to the Convention. Seven Member States from this Region 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.

We need also to address the underlying determinants of health. The more we are able to control those factors the greater chance we have to improve people's health and well-being. The action required to tackle most of the 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.

I am very happy to see the leadership and how this Region is pioneering a unique partnership which promises to make a major contribution to strengthening national and regional action on social determinants of health. This will enable six countries to develop country-level diagnoses of key determinants, as well as identifying solutions and supporting their implementation.

Turning to the last of the core areas identified in the proposed Programme Budget: 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.

All governments must make it a priority to increase the number of motivated health workers. That will take political leadership, a comprehensive plan human resources and commitment to the necessary funding.

In conclusion: for me, this Region and the work of this Regional Committee are clear illustrations of the dimensions and complexity of health, and the challenges set out in our General Programme of Work and Global Health Agenda.

Here we are addressing health issues in some of the poorest settings of the world. There are historic successes against vaccine-preventable diseases to celebrate - like the end of polio in Egypt, and the progress across the Region in measles prevention and control. At the same time we need to make sure that we tackle the growing burden of noncommunicable diseases. We are also looking at issues relating to the broader determinants of health, the role of health within poverty reduction and development, and how to build effective health systems and address the health workforce crisis.

I look forward very much hearing Dr Gezairy´s report on those shared challenges and responsibilities, and to exchanging views with all of you here.

I thank you.