59th WHO Regional Committee for South-East Asia, held 22-25 August 2006
Address by Anders Nordström, Acting-Director-General
It is a pleasure to be back in Bangladesh. It was on the 6th of June, little over three years ago, the day before I was scheduled to travel to Dhaka, that JW Lee asked me if I would like to be part of his team. I delayed my trip here by a day to talk to my family, then came here. I spent several very interesting days discussing the Bangladesh Health Sector Programme. I also visited BRAC, an organization - or perhaps one should say movement - that impressed me a lot. Tim Evans - one of my "to be" ADG colleagues - was also at BRAC at the same time.
Another memory from that trip is the impressive achievement made in reducing maternal mortality ratios. We have seen progress in reducing child mortality in many countries, but few countries have, like Bangladesh, been able to save more mothers.
This is a Region that has faced some exceptional challenges. Countries have suffered Tsunamis, earthquakes and floods as well as continued conflicts. Communities that are struggling to cope with the effects of disruption to their homes have concurrently faced the burden of avian flu, polio, HIV, tuberculosis, malaria, as well as of a growing epidemic of chronic diseases.
The progress you have made, and the solidarity you have shown, provide lessons for us all. Your experiences, especially in coping with the Tsunami of December 2004, have provided lessons that are important not only for this Region, but also for other parts of the world.
Last year you gave us your very valuable insights and input to the draft Eleventh General Programme of Work (GPW) for WHO. This May, the World Health Assembly approved it.
Thank you for all that you have contributed to its strategic direction.
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 (MTSP) for 2008 to 2013 and the Proposed Programme Budget for 2008 to 2009. Like the GPW 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;
- actions 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 countries.
To finance these plans, the Proposed Programme Budget for 2008-2009 has been costed at US$ 4.2 billion. This is an increase of 17% over the current biennium's expected expenditure.
For the South-East Asia Region, this amounts to a total increase of almost 40% against the current biennium.
The share of the total budget for the South-East Asia Region, excluding polio and emergencies, is suggested to significantly increase as well, in line with the validation mechanism.
The US$ 4.2 billion budget is proposed to be financed through a 8.6% increase of assessed contributions amounting totally to US$ 1 billion; the introduction of negotiated core voluntary contributions aiming at US$ 600 million; and through specific voluntary contributions.
The share of the assessed contributions will, even with this increase, continue to decline (to 23%), which 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 and 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.
A few more specific words about those areas:
We have made some good progress in child health, but much more remains to be done in addressing the underlying problems in mothers' 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 adolescents.
I hope that this Region will follow with concrete action in all countries.
I note, for example, that excellent progress is being made in Bangladesh and India in addressing adolescent health, both through "adolescent friendly health services" and in increasing life skills among adolescents themselves.
I have personally made maternal and reproductive health a priority during my few months in this Office. In June I met with Thoraya Obaid and other senior colleagues from UNFPA, to coordinate action to reverse the global trend of deteriorating levels of sexual and reproductive health.
Now I have just come from the XVI International AIDS conference in Toronto. One clear message there was the vital need to improve prevention, treatment and care for women. In 2005, worldwide, fewer than one in ten pregnant women living in low and middle income countries received antiretroviral (ARV) treatment to prevent HIV transmission to their newborn infants.
Here in this Region, there has been a significant scaling up of access to treatment. More than four times as many people are now on ARVs than in 2003. But the treatment gap is still huge. Coverage for the most vulnerable and high-risk behaviour groups is still very low.
Another key message from that conference was that we need a balanced approach to prevention, treatment, care and support. The very strong call to address the health workforce was very encouraging.
This Medium-term strategic plan and Proposed programme budget suggest a substantial increased focus on noncommunicable diseases. Reduction of the impact of chronic diseases, such as cancers, cardiovascular disease, chronic respiratory disease, or diabetes is a major aim. Currently, more than half of all deaths (54%) in this Region are from chronic disease.
I believe that there is now a regional framework for NCD control. This is a vital step forward in mainstreaming chronic diseases into public health services.
As you know, last year's publication of the first global report on chronic disease was an important step in raising the profile of these diseases and their huge contribution to global mortality.
With the WHO Framework Convention on Tobacco Control, 168 countries have now signed up to one of the most important interventions for control of the risk factors leading to chronic disease. I congratulate the countries of this Region that have become Parties to the Convention.
Linked to noncommunicable diseases is of course the importance of addressing the underlying determinants of health.
One of the seven items on the GPW global health agenda is "tackling the determinants of health". The more we are able to influence and have control over the factors that influence health, the greater chance we have to improve the health and well-being of people.
The action required to tackle most of these determinants goes beyond the influence of ministries of health, and involves a large number of government and commercial responsibilities and a wide range of sectors.
The challenge is how to move from knowledge of the association of social and environmental determinants and health equity to specific policies that we can implement.
Last year the Bangkok Charter for Health Promotion explicitly called for policy coherence, investment, and partnering across governments, international organizations, civil society and the private sector.
I am pleased to see that this Committee's active engagement in this process through the regional strategy for health promotion. 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 involved in revising the International Health Regulations know first-hand 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 17 August, there had been 239 confirmed cases and 140 deaths.
Forty-five of these were in Indonesia, where, earlier this year, the largest family cluster of cases on record was documented.
Fortunately, any possible human-to-human transmission reached a dead-end. Despite multiple opportunities for the virus to spread into the general community, it did not do so. Therefore, this experience did not result in a global pandemic alert phase change but did underscore the importance of constant vigilance and rapid and thorough investigation of any unusual events.
It also underscored the high level of global attention that any country affected by H5N1 must be prepared to face.
Too often, the first signal that this avian flu virus is present in a country comes with the confirmation of a human case. That is the wrong way round. Surveillance on the animal side needs to improve. With support from WHO, almost all countries now have preparedness plans for responding to a pandemic. The next step is to make these plans as realistic and operational as possible.
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 vaccine, and finding ways to expand manufacturing capacity. These are difficult problems but much work has progressed and some clinical trials are now producing encouraging results.
We are all committed to polio eradication. Some challenges remain. In Indonesia, last year's explosive outbreak which left 305 children paralysed for life appears to have been curbed. However, important subnational surveillance gaps means that undetected virus circulation cannot be ruled out.
Bangladesh is continuing to conduct high-quality immunization responses after having been re-infected this year. In Nepal, too, following re-infection last year, no new cases have been reported since March 2006.
Major challenges remain in India. Although polio has been beaten back to just a handful of key districts of Bihar state and western Uttar Pradesh state, a new outbreak in western Uttar Pradesh is increasing the risk of further national and international spread.
The challenge to India is clear: all efforts must be undertaken to rapidly stop the outbreak in and around Moradabad district. It is paramount that each and every child is reached during every immunization campaign.
Finally and perhaps most importantly, we need to continue strengthening health systems.
There is today a general agreement and understanding that, without functioning and efficient health systems, we will not be able to scale up basic health services nor achieve the MDGs.
We need policy options for how to finance health service, how to best organize the system, how to best engage different stakeholders and we need systems to provide us with data and evidence. But without a stronger health workforce we will fail.
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.
This joins wider global efforts to sustain and build through the Health Workforce Alliance.
We have to tackle this problem not just at the national and local level, but at the global level, to get the level of commitment that will see changes in employment and training policies, as well the broader fiscal issues related to human resources policies and strategies.
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. During a recent visit by the Secretary-General to WHO he shared his appreciation for the work of WHO. Similarly, WHO staff were also able to share their appreciation for his support.
I believe that we need now to look more widely throughout the Organization at how we can further improve our work. We have seen major improvements in terms of a coherent strategic direction throughout the organization responding to country needs. The financial situation is improving.
Our efforts need now to focus even more on our staff. We need to attract and retain the highest possible standard of competence. We must make sure we have the right staff in the right place, with the right competencies.
I am looking forward to hearing your thoughts on those different issues, following Dr Samlee's presentation of his Report on the Work of WHO in the Region.