WHO Director-General addresses conference on health systems
Dr Margaret Chan
Director-General of the World Health Organization
Excellencies, distinguished delegates, colleagues in public health, ladies and gentlemen,
Many visitors to Oman come here because of the country’s beauty and the hospitality of its people. Others come here to learn, especially about the country’s health system and the remarkable results it has produced.
In the late 1980s, Richard Smith, who would later edit the British Medical Journal, came here to learn. What he saw took his breath away.
As he wrote, Sultan Qaboss bin Said brought the Omanis through developments that took a thousand years in Europe. He did so in less than 20 years.
Richard Smith visited the Royal Hospital, new at that time, and described it as “far and away the most beautiful hospital that I have ever seen.”
He also observed that audits of medical quality in Oman surpassed those practiced in the UK.
He attributed Oman’s progress to His Majesty the Sultan’s determination to craft a modern state, and the prominence given to health and education in his plans for realizing that vision.
Progress has truly been spectacular.
In less than 40 years, under-five mortality dropped by a stunning 95%, marking the fastest decline in young-child deaths ever recorded anywhere in the world.
In less than 35 years, life expectancy increased by more than 25 years. This means almost a generation of life added, within a generation.
Oman cut its birth rate in half, within a decade.
This country banished many infectious diseases, and controlled most of the rest.
All of this was, of course, noticed, with more than a touch of awe.
The 2000 World Health Report ranked Oman’s health system as number one in terms of performance in improving levels of health.
The 2008 World Health Report, on primary health care, opened with an account of Oman’s health achievements.
The Human Development Report for 2010 ranked Oman as the number one mover, the country that moved the fastest to catch up with the quality of life enjoyed in the world’s best-governed countries.
For public health, this is a land of miracles, of almost magical transformations.
Ladies and gentlemen,
Like others, I am here in Oman to observe and learn, but I am also here to advise.
This international conference has been convened to gather guidance as Oman crafts a long-term health vision to 2050.
Long-term planning is, in itself, a laudable undertaking, a further critical step in nation-building. Oman’s well-developed National Health Statistics and Information System supports this kind of planning, as does the country’s experience in devising evidence-based policies.
You are in line with the times, if not ahead of them. In just the past decade, the international community has come face-to-face with the urgent need to strengthen health systems.
As we all learned, commodities and the cash to buy them will not improve health outcomes in the absence of efficient, and sustainable, systems for service delivery.
The investment is worthwhile. Health systems are social institutions. Properly managed and adequately funded, a well-functioning health system contributes to social cohesion and stability.
In a world beset by one global crisis after another, social cohesion and stability are prized assets.
Health systems are highly context-specific.
They have their unique historical roots, and they operate in distinctive cultural and social environments. There is no single blueprint that can guide health system reform.
At the same time, vast experience exists. Best practices exist. Clear mistakes have been made, sometimes huge mistakes that have proved very difficult to correct.
For example, it is far easier to open a new hospital than it is to close one that is underutilized or over utilized for routine ills.
Oman’s vision 2050 is being designed as a long-term response to emerging challenges. There are many, and they are enormously complex.
They call for nothing less than a radical change in mindset, a fundamental rethinking of the way health systems deliver services and maintain good health outcomes.
As your own researchers and experts have noted, this country’s health achievements are under threat.
In a world of radically increased interdependence, health nearly everywhere is being shaped by the same powerful forces, like demographic ageing, rapid urbanization, and the globalization of unhealthy lifestyles.
These trends are expressed most explicitly, and most dramatically, as a rise in chronic noncommunicable diseases. NCDs have become the biggest killers, here in Oman and globally.
This shift in the disease burden comes at a time when public expectations are rising and health care costs are soaring.
You are seeking to reform Oman’s health system in ways that continue to provide quality care while sustaining health gains. Cost must inevitably be given close consideration.
A quest for ever-greater efficiency, in the use of resources and also of staff, must be the driving force.
Late last year, a study concluded that technologies for the treatment of cancer now carry costs that are unsustainable, even in the wealthiest countries. Some experts estimate that nearly half of the increase in health spending since 1960 can be attributed to the growth of sophisticated medical technologies.
NCDs are the diseases that break the bank. As we have seen in some Asian countries, the cost of caring for these chronic conditions can easily devour the gains of modernization and economic development.
Is this really progress?
Prevention is by far the better option. And here, Oman has some distinct assets.
Oman’s health sector has earned the public’s trust, an increasingly rare commodity these days. Keep it.
Primary health care has given Oman extensive experience in health promotion and disease prevention. Expand on this experience.
Health services must go beyond a relationship of generous providers and grateful recipients to truly engage communities in the protection of their health.
Prevention depends on this, as do early detection, prompt treatment, and patient compliance.
Oman has a tradition of multisectoral collaboration in the name of health. Deepen this collaboration. The root causes of NCDs lie in sectors beyond the purview of public health.
The health and medical professions can plead for lifestyle changes and tough tobacco legislation, treat patients, and issue the medical bills, but they cannot reengineer social environments to make healthy behavioural choices the easy choices.
During this conference, you will be looking at the comparative strengths and deficiencies of government and private-run health systems. Do this carefully.
In the private sector, incentives for providers are extremely important. Efficiencies are lost and resources wasted whenever unnecessary tests are ordered or unneeded medicines are prescribed.
Ladies and gentlemen,
I have a final comment, in this land of miracles for public health and almost magical transformations.
For ages, the mindset of public health has been geared towards the prevention and control of infectious diseases.
Most health systems were designed to manage acute episodes of infectious illness, and not to provide long-term, even life-long care.
All of this must change.
Making health systems fit-for-purpose amidst the enormous health challenges of the 21st century is an extremely demanding task.
Based on experience, Oman can do it, do it first, and do it best.
In so doing, you will give the rest of the world a model of practical value, but also of inspiration.