Despite financial constraints, health commands support at the top of the international agenda
Dr Margaret Chan
Director-General of the World Health Organization
Excellencies, honourable ministers, distinguished delegates, representatives of the African Union, Dr Sambo, ladies and gentlemen,
Let me join others in expressing my profound dismay over Friday's bombing of the UN compound in Nigeria. This touched the UN family and it touched WHO, as our staff are among the dead and severely injured. I extend my deepest sympathy to the families and loved ones of those affected. I express my outrage at those who attack people devoted to helping, to preventing harm.
Ladies and gentlemen, the signs are evident in many areas. The lean years are upon us in terms of the global economic outlook.
The year 2008, with its fuel, food, and financial crises, was the tipping point in terms of demonstrating the perils of living in a world of radically increased interdependence.
Under such conditions, a crisis in one part of the world is globally contagious and profoundly unfair in its consequences, adversely affecting countries that had nothing to do with the causes. All too often, public health is on the receiving end of collateral damage from policies it had no say in shaping.
We must have no illusions. These crises are not just temporary events in the up-and-down cycle of human history.
Outside experts have advised WHO to regard the current and deepening financial crisis as the new reality. The world has entered a new era of financial austerity with profound implications for national health budgets, the financing of development assistance, and the future of financing for WHO.
This new reality has added to the urgency of the reform process now under way at WHO, with issues and implications that will be debated during this session, as during other Regional Committees
Likewise, the fuel and food crises are still very much with us, also with profound implications for health. Global food prices reached an historical high this past February, surpassing the spike of 2008, which was already the highest peak in prices in two decades.
The current crises of drought, famine, and the desperate displacement of hundreds of thousands of people in the Horn of Africa are heartbreaking, as is the inability of the international humanitarian community to provide the kind of massive and swift aid that is needed.
These crises have multiple causes, including political ones, but high food prices are a contributing factor, as are land-use policies that have undermined the traditional practices of farming and herding communities, developed over the centuries, to cope with erratic rainfall.
I thank the countries in this region that have opened their borders to the hordes of people fleeing starvation and violence. I thank them, too, for facilitating the delivery of humanitarian aid.
Ladies and gentlemen,
This year has already delivered an unprecedented cascade of calamities, catastrophes, and humanitarian crises.
In just the past few months, we have witnessed natural disasters, a devastating nuclear accident, debt crises, waves of civil protest and unrest, and hot-spots of warfare under conditions that make humanitarian aid extremely difficult and dangerous to deliver.
Yet despite so many signs that our world is in a mess, I am awestruck and deeply inspired by the determination of ministries of health, development partners, and donors to maintain the momentum for better health that marked the start of this century.
Here, too, the signs are evident in many places.
High-level efforts continue to find new sources of funding. New partnerships and mechanisms are working to stimulate technical innovation and reward creativity.
Africa has a new conjugate vaccine with the power to eliminate epidemics in the meningitis belt. New drugs for malaria are at advanced stages of development.
A patent pool, established by UNITAID for HIV medicines, is gaining momentum through milestone licensing agreements with industry, governments, and academia.
The patent pool does three things. It increases supplies. It lowers prices by allowing generic competition. And it facilitates the production of badly needed formulations, like fixed drug combinations that simplify treatment and improve compliance.
The UN Global Strategy for Women’s and Children’s Health, launched by the Secretary-General last September, has attracted $40 billion in commitments.
Launch of the strategy was backed by the establishment of a Commission on Information and Accountability for Women’s and Children’s Health, set up to oversee the wise use of these financial commitments to the benefit of countries and donors alike. The Commission’s Report, delivered in May, is a milestone in the quest for more effective aid. Its 10 recommendations build national capacity, rather than overburden it.
They give high priority to the establishment of badly needed information systems for the registration of births, deaths, and cause of deaths.
On 6 June, leading drug companies announced dramatic slashes in vaccine prices for the developing world, including a 95% price cut on the new rotavirus vaccine that can prevent diarrhoeal deaths.
On 13 June, donors pledged more than $4 billion to support the work of GAVI, an amount that exceeded anyone’s wildest dreams. This money will hasten the introduction of new vaccines and extend campaigns to introduce the new meningitis vaccine to more countries in Africa.
The lesson, I believe, is this. Even though money is tight nearly everywhere, health continues to command support at the top of the international agenda.
If a country, a programme, or a global health initiative produces measurable results, money can still be found to maintain or even strengthen the momentum for improving health.
It is our job at WHO, at all three levels of the Organization, supported by initiatives such as the Harmonization for Health in Africa and the International Health Partnership Plus, to help African countries tap into this support, on your own terms.
This is good news, but it has an important qualification. Intense domestic pressure in traditional donor countries is reshaping development assistance with a firm emphasis on value for money and a growing demand to demonstrate that investment brings measurable results.
Collectively, we must show a thirst for efficiency and an intolerance of waste. I find this desire readily apparent in the documents prepared for this session.
Ladies and gentlemen,
You have a focused and highly relevant agenda, supported by excellent documentation. When I look at your agenda items and documents as a group, I can make one generalization. You know the problems, the obstacles to progress, the barriers, bottlenecks and unmet needs with admirable precision.
These problems, especially well-documented in the report on the Millennium Development Goals, appear overwhelming. And yet individual countries are making progress, steady progress, sometimes stunning progress, against the odds. Above all, your documents, and especially the panel discussion on health financing, recognize the need to tackle waste and inefficiency and ensure that all resources, whether domestic or external, are used to maximum effect.
At the same time, let me repeat my warning about making generalizations about the lack of progress in health development in Africa, especially with uniform pessimism.
Let me back this statement up with just a few statistics.
In line with your roadmap for improving maternal and newborn health, some 28 countries have introduced Maternal Death Reviews, and four countries have made maternal death a notifiable event within 48 hours.
In a short time, more countries have achieved 50% coverage of deliveries with skilled birth attendants, and seven countries have reached coverage exceeding 80%.
The proportion of HIV-positive pregnant women receiving antiretrovirals to prevent mother-to-child transmission of HIV increased from 15% in 2005 to 54% in 2009. That is well over a three-fold increase over a very short time.
And let us look at some of the latest statistics for neglected tropical diseases that have, for ages, anchored so many of your people in poverty.
In 2010, nearly 17 million African children were treated for schistosomiasis, up from 4.2 million in 2006, just four years ago. Your commitment made this stunning success possible.
Only 1,797 cases of guinea-worm disease were reported in 2010, compared with 3.5 million in 1986.
The number of people treated for river blindness increased from 52 million in 2005 to around 84 million in 2009. This nearly 70% increase is largely attributed to the community-directed ivermectin distribution strategy developed by the African Programme for Onchocerciasis Control.
In 2010, the number of cases of human African sleeping sickness dropped to just above 7,000, the lowest number in six decades, signalling the potential elimination of this disease as a public health problem.
As programme staff repeatedly remind me, all this happens because of national leadership. When high-level political commitment is present, the support comes, the results follow, and support intensifies. We have also seen this happen with malaria.
This is a good way to make progress in many other areas. This is a sound and persuasive way to gain a competitive edge when seeking resources during difficult financial times. You have an excellent investment case, prepared by the Harmonization for Health in Africa initiative, for strengthening health systems.
The report portrays health as a productive sector and provides a robust economic case for investment, but it also pinpoints specific areas for improving efficiency.
For example, it cites a recent medicine pricing study indicating that African governments pay 34% to 44% more than necessary when they purchase medicines. There is great potential for savings here.
It also notes that high quality reliable information can exponentially improve the performance of the health system it supports. This aligns well with recommendations from the Commission on Information and Accountability.
Climate change is on your agenda, and here you have made two smart moves.
First, you recognize that strong health systems, based on primary health care, are the cornerstone for coping with the shocks of extreme weather events and the disease outbreaks they can bring.
Second, you have ensured that ministers of the environment work in tandem with ministers of health, as articulated in the Libreville Declaration on Health and the Environment in Africa.
This gives health its proper place as a principal victim of climate change and ensures joined up policies, strategies, and regulations for coping with challenges that are now inevitable.
You will be considering a strategy for measles elimination. Again, the strategy wisely promotes both the integrated delivery of child survival interventions and the integration of efforts to eliminate measles into overall national plans for strengthening health systems.
Polio is on your agenda, supported by a document that notes the establishment, at the request of the Health Assembly, of an Independent Monitoring Board. The Board has just issued its second report, which expresses concern about the challenges in Chad, the Democratic Republic of Congo, Nigeria, and Angola.
Since then, Côte d'Ivoire has experienced the largest outbreak of type 3 poliovirus in the world this year, requiring a massive and ongoing emergency response by the government
As the Board’s report praises your Regional Director twice for his personal dedication, leadership, and quick action, I find it most appropriate for Dr Sambo to update you on the situation in Africa.
Let me just say that recommendations directed at WHO headquarters have received my urgent personal attention.
Ladies and gentlemen, let me conclude by expressing my particular appreciation for the document setting out views from this Region that can guide WHO reform.
Your views will certainly be given prime consideration, especially your request for continued direct technical assistance from WHO, for a re-profiling of staff in country offices to provide a more appropriate mix of skills and competencies, and for strengthening resource mobilization.
Rest assured. The impact of our work at country level and especially in Africa, is the true measure of overall WHO performance and a driving force behind many proposed reforms.