WHO Director-General addresses international symposium in Uzbekistan

Dr Margaret Chan
Director-General of the World Health Organization

Opening remarks at the International symposium on the national model of maternity and childhood health in Uzbekistan: healthy mother – healthy child
Tashkent, Republic of Uzbekistan

26 November 2011

Your Excellency, Mr Islam Karimov, President of the Republic of Uzbekistan, honourable ministers, distinguished delegates, ladies and gentlemen,

Let me begin by thanking the government of Uzbekistan for hosting this International symposium on maternal and child health.

Improving the health of mothers, their new babies, and young children is one of the most critical, and most difficult, challenges facing international public health today. Making maternal and child health a top priority is the right thing to do, for now and for the future.

You have clearly signalled this in the name you have given to your national policy: “healthy mother, healthy child”.

Your agenda covers all the right elements of good care for mothers and children: primary health care and hospital care, routine preventive care and emergency care, prevention through immunization, and early detection through screening, but also specialized care for acute events, like accidents and injuries, which are all too common in children.

I am especially pleased to see that you are giving deserved attention to nutrition. Many health programmes neglect nutrition, seeing it as something for other sectors, like agriculture or trade, to take care of.

You are also looking at the health of adolescents, another frequently neglected area, and you are emphasizing the health-promoting role of sports.

You are doing so when times are deeply troubled in many parts of the world.

This has been a year of unprecedented natural disasters, floods, tsunamis, a nuclear accident, massive starvation in the Horn of Africa, and civil uprisings in the Middle East that toppled governments.

Ours is a world beset by one global crisis after another. The economic downdown is getting worse. In much of the world, food prices are now sky high, leading to unhealthy diets, especially in lower-income households.

Processed foods, full of sugar, salt, and fat, yet lacking essential nutrients, have become the new staple food in nearly every corner of the world.

These foods are the cheapest and most convenient way to fill a hungry stomach. These foods are the ones that contribute so greatly to the rise of chronic noncommunicable diseases.

In the midst of these global crises, this country can be proud that the health of its population has not deteriorated and that life expectancy is increasing.

Uzbekistan’s Ministry of Health enjoys a close relationship with WHO, which is deeply valued. My staff tell me that this country has a well-functioning immunization programme, with excellent and sensitive surveillance.

This is an absolutely critical asset when protecting the health of children, but also in quickly detecting infectious diseases that could threaten the entire population.

Ladies and gentlemen,

This country has made maternal and child health a top priority since the beginning of its independence.

At the global level, the start of this century was marked by international agreement among Heads of State on the Millennium Development Goals. Maternal and child health are included as priorities among a small number of time-bound targets and goals.

The past decade has demonstrated the great value of setting clear priorities and focusing efforts on attaining well-defined goals.

For decades, the worldwide number of maternal deaths was stubbornly stuck at half a million each and every year. These deaths were regarded as the starkest, saddest, and most stubborn statistic in public health.

Finally, we saw a breakthrough in the past decade. WHO and UNICEF estimates for 2010 show a significant worldwide drop in maternal mortality, with the greatest declines, of around 60%, reported in Eastern Asia and Northern Africa.

We have more good news. During the previous decade, the number of under-five deaths dipped below 10 million for the first time in almost six decades and kept on dropping, with the figure now standing at 7.6 million deaths worldwide.

This is still way too many, as more than two-thirds of these deaths are entirely preventable through inexpensive and highly effective interventions. But we have to admit: this is progress, welcome and measurable progress.

Ladies and gentlemen,

This country can be proud of its achievements. As the global figures, over many decades, tell us: preventing maternal, infant, and young child deaths is not an easy task.

Why is this so hard? There are multiple reasons, but let me name just a few.

First, talk about these problems is usually filled with great passion. But historically, these intense expressions of concern have not been matched by high-level political commitment and resolve. Without this political commitment, we will never see progress.

This country has enjoyed the highest level of political commitment since 1991.

Second, for maternal mortality, we will never see progress in the absence of strong, well-functioning, affordable, and accessible health services, especially in rural areas. The prevention of maternal deaths depends absolutely on skilled attendance at birth and access to emergency obstetric services.

This country has addressed these problems, especially by reforming the health system in line with the principles and values of primary health care, including fairness in access to care.

Such reforms promote equity and social solidarity. They are also cost-effective.

We have very good evidence, for example, that young children with pneumonia, one of the top two killers in this age group, can be safely treated with antibiotics in homes.

These children do not always need to be hospitalized, where their already frail bodies are exposed to multiple additional pathogens in other hospitalized patients. The same is true with home care for malaria.

Finally, for women, the obstacles that stand in the way of better health are not primarily technical or medical in nature. They are social, cultural, and political.

These obstacles can be reduced or even removed. But only when the right policies are in place at the highest level of government, ideally backed by legislation and strong enforcement capacity.

Let me give an example. In many countries around the world, a women needs permission from her husband or in-laws before she can seek medical care, even if her life, or that of her children, is in danger.

And let me remind you of the pay-back, nationwide, that comes from addressing any of these problems.

A health system is a social institution. It does far more than just deliver babies and pills, the way a post office delivers letters. Properly managed and financed, a good health system contributes to social cohesion and stability.

In every country, social stability is a deeply desired goal in a world increasing disrupted by so much turmoil.

Ladies and gentlemen,

You are looking at achievements, but also at prospects for the future.

One purpose of an international symposium is to gather experiences from around the world, to look at best practices, and to identify solutions known to bring results.

While every country is unique, and most health problems are highly context-specific, let me suggest a few ingredients for success taken from vast international experience and some very solid evidence.

First, immunization is an easy win. Childhood immunization is one of the most powerful, and cost-effective preventive interventions available for safeguarding health.

Second, access to fair and affordable family planning services is another easy win. This is clearly acknowledged in health policies in Uzbekistan.

Third, reducing pregnancy in adolescent girls helps prevent low birth weight babies, and protects these girls from life-long complications that can mean a whole life spent in misery and social isolation.

Fourth, good nutrition plays a critical role for everyone, but especially for pregnant and lactating women and young children. As nutrition is on your agenda, you will be very familiar with the reasons why the right diet is so important. Exclusive breast feeding for six months or longer is especially important.

Recent evidence gives us more reasons to care about nutrition. A child malnourished as a fetus or during the earliest years of life has a significantly increased risk of developing chronic diseases, like heart disease, cancer, and most especially diabetes.

Ladies and gentlemen,

As I close, let me wish Uzbekistan, its government, doctors, nurses and other health care workers, its people, especially its mothers, new babies, young children, and adolescents, all the very best as you move forward in the right direction.

Your strategy, policies, and priorities are good ones.

Healthy mothers and healthy children are a clear route to future generations that live in harmony. And this brings social as well as physical health.

This is what everyone working in public health, and myself most especially, wants to see.

Thank you.