Address by H.E. Prof. Dr Paulo Ivo GARRIDO
Minister of Health of the Republic of Mozambique
The Vice Presidents of the Assembly,
The Acting Director-General of World Health Organization
Honourable Ministers of Health,
Excellencies,
Distinguished Delegates,
Ladies and Gentlemen
I am deeply saddened indeed that I assume this Presidency under this sombre and difficult moment we are going through following the sudden passing away of the Director-General of our Organization.
Let me reiterate the message of condolences expressed by the outgoing President this morning on behalf of all of us.
Definitely we will miss Dr Lee's warmness, his humble advices and, of course, his steadfast leadership as a great source of inspiration in our common efforts to tackle the challenges of the health problems afflicting millions of people around the world.
Our sympathies go particularly to Dr Lee's family, the Government and the people of the Republic of Korea in general.
As we go forward, we know we will be constantly guided by the work and wisdom of Dr Lee. He will be remembered in all our deliberations.
Let me take this opportunity to express my sincere thanks, personally and on behalf of the people and Government of Mozambique, the Southern African Development Community and the African Region, for the honour and privilege you have bestowed on me by electing me as President of the 59th Session of the World Health Assembly.
The African region cherishes this chairmanship wholeheartedly, especially because it is the African people that is hard hit by extreme poverty and disease and therefore the region that most needs your support. I assure you of my determination and firm commitment to do my best, with your support, to make this a successful Assembly.
As I assume the chairmanship of this August Assembly, I feel duty-bound to commend the President of the 58th Session of the World Health Assembly, the Honourable Minister of Health and Consumer Affairs of Spain, Dra Elena Salgado for ably steering the deliberations of last year.
The Director-General's World Health Report 2006 entitled "Working Together for Health" is highly commendable for focusing on building robust health systems and developing capable, motivated and supported health workers that remain in the countries where they were trained and where they are most needed.
The Vice Presidents of the Assembly,
The Acting Director-General of World Health Organization
Honourable Ministers,
Distinguished Delegates,
In the course of our deliberations our attention we will be focussing on very important issues concerning both the health problems of the world at large and the way in which we organize ourselves to strengthen our Organization and the health systems of individual countries in order for them to give adequate global, regional and national responses to those health problems that we are called upon to overcome.
We will have to thoroughly discuss and to deliberate on our preparedness and response to the ever threatening challenge of the avian influenza pandemic. Yet this can not make us deviate our attention from other pressing health problems, like malnutrition, HIV/AIDS, tuberculosis, malaria and other transmissible diseases, but also arterial hypertension, diabetes, asthma, cancer, injuries and deaths resulting from traffic accidents, sickle-cell anaemia, blindness and visual and auditive impairment. We also must not underemphasise the behavioural related health problems that upset humankind and that can have an adequate response if we thoroughly cope with the appropriate strategies and if we join efforts to promote healthier behaviour in our uprooted world.
Another very important matter that we will have to discuss and to deliberate upon, in this Assembly, is the final effort to eradicate poliomyelitis. The world has made considerable progress on this matter up to 2003. However during the last 2 years the situation has worsened. Not only have we not been able to effectively contain further transmission in the endemic countries, but considerable spreading of the virus occurred to a number of countries already polio free for a number of years. The last global update on the polio situation shows that in the first quarter of this year, the global picture has not improved. This worrying situation imposes on us to embark on a thorough discussion of the strategies in place so far and the adoption of strong and courageous measures to put a final end to this disease.
The international migration of health personnel: a challenge for health systems in developing countries will also deserve our attention. As the past Director-General very rightly pointed out in his 2006 Report (I quote) "there is a chronic shortage of well-trained health workers. The shortage is global, but most acutely felt in the countries that need them most. For a variety of reasons, such as the migration, illness or death of health workers, countries are unable to educate and sustain the health workforce that would improve people's chances of survival and their well-being" (end of quotation). The report draws our attention about an estimated shortage of almost 4.3 million doctors, midwives, nurses and support workers worldwide. The shortage is most severe in the poorest countries, especially in sub-Saharan Africa, where health workers are most needed. Human Resources are fundamental for the strengthening of health systems.
Honourable Ministers,
Distinguished Delegates,
Allow me on behalf of my colleagues of the African Region to stress upon a number of important health issues which deserved most attention at our Regional Committee that I had the honour to chair in September last year in Maputo.
First of all, let me reiterate our commitment to achieve the Millenium Development Goals. Five years have elapsed since developing countries have been put in face of this ambitious challenge. We deeply regret that the vast majority of developed countries have not yet assigned the needed resources that such challenges require. We have only less than 10 years to go, and all our developing countries have to define urgently the appropriate strategies to assure that this ambitious goals will be achieved in due time. With hope we see signs, still very timid, from some of the developed countries to commit more resources to the developing countries on this common and fruitful partnership. But I take this opportunity to make an urgent call for action, by all countries of the world and an appeal for the rich countries to urgently make available the needed resources. Time is of essence and we require action and coherence with expressed engagements.
Despite some technological developments in recent years, HIV/AIDS, tuberculosis, malaria and other transmissible diseases are still afflicting our peoples pausing serious challenges for our Governments. The first three diseases alone kill an estimated four million Africans every year. The facts stand by themselves:
In my own country, Mozambique, despite all investment and considerable efforts made we have not yet been able to reverse the trend of HIV seroprevalence to increase.
Last year in Maputo the Regional Committee for Africa decided to renew efforts to step up the pace of HIV prevention and declared tuberculosis as an emergency in the Region. As a follow up of the pertinent Regional Committee Resolution, on April this year, a major initiative emerged from African political leaders for 2006 to be the "Year for Accelerating HIV Prevention in the African Region". Innovative approaches, creative thinking and more holistic actions are needed across Africa, from all involved, if prevention is to succeed.
Early this month a special Summit of the African Union took place in Abuja, Nigeria, with the adoption of far-reaching decisions to stem the tide of HIV/AIDS, tuberculosis and malaria.
The Summit adopted the Abuja Call for accelerated action towards universal access to AIDS/Tuberculosis/Malaria services in Africa, and a resolution to achieve this by 2010. It also adopted an African Common Position to be presented to the High Level Meeting of the UN General Assembly (UNGASS) on AIDS in June this year.
Distinguished Delegates,
Before I conclude, I would remise if I do not refer to 3 issues of crucial importance, namely: the social determinants of health, the strengthening of health systems and Primary Health Care.
Let me start by the social determinants of health. It is common sense that action in the health care sector is only one of the influences on a population's health. Major influences come from across the social and economic spectrum. These influences - which we call the social determinants of health - explain why throughout the world, vulnerable and socially disadvantaged people get sicker and die earlier than people in more privileged social conditions. The social determinants of health (such as social exclusion and gender discrimination, insecure employment conditions, urban development, shortcomings in safeguarding early childhood development, and insufficient quality of health systems) account for most of the global burden of disease, and for the bulk of existing health inequities between and within countries. These social determinants can and must be addressed in health policies and leadership.
Action on the social determinants of health is the fairest and most effective way to improve health for all people and reduce health inequities. We all know that good medical care is vital, but unless the root social causes that undermine people's health are addressed, the opportunity for well being will not be achieved. The question is very simple: Why treat people's illness without changing what made them sick in the first place?
I commend our beloved and the sadly late Director-General, Dr Lee for the creation of the Commission on Social Determinants of Health. I also salute the fact that the proposal of the Eleventh General Programme of Work, which will guide our organization for the next decade, makes specific mention of the social determinants of health. Based on the evidence already collected, I urge WHO, the member countries and the global health partners to start focussing now more and more on the socio-economic factors leading to ill health and health inequities.
Fair health opportunities require collective action from all of us and, in each country, from different government ministries and civil society. We must all work together to place health equity at the heart of development.
I turn now to the issue of the strengthening of health systems. During the last 3 decades WHO developed a number of very efficient and effective programmes that have been fundamental to improve the health conditions all over the world. These WHO initiatives raised a lot of support from other UN Agencies, International Development and Financing Agencies, other International Organizations, bilateral Development Agencies and NGOs. In recent years, a number of public private partnerships also joined the movement. Developing countries, like mine, benefited from all these global efforts. However, the funding Agencies have put too much focus on assuring that their money would be strictly spent to the agreed purpose and, consequently, all these initiatives became vertical oriented programmes with all the inconveniences that arise from that verticality.
I would like to use this respected tribune to make a very strong plea for integration of all these programmes in the National Health Systems which need to be strongly strengthened. Only robust and strengthened National Health Systems can properly deliver comprehensive and integrated health care.
And this leads me the third and final issue. I saw with deep appreciation that WHO organized in Madrid, in October 2003, a "Global Meeting on Future Strategic Directions for Primary Health Care". This meeting was intended to examine lessons of the past 25 years and to identify Future Strategic Directions for Primary Health Care. I have not been able to see an adequate follow up of this meeting.
It is my strong conviction, almost 30 years after Alma Ata, that the Alma Ata Declaration on Primary Health Care is still valid and that the Primary Health Care approach is still very appropriate, not only for Africa but for the rest of the world. If something has not functioned well, we shall identify the constraints and remove them. We shall adapt Primary Health Care to the 21st Century. Therefore, I strongly call upon all of you, the WHO and our health partners to put Primary Health Care again on the focus of the priorities of the international Health Agenda.
The Vice Presidents of the Assembly,
The Acting Director-General of World Health Organization,
Honourable Ministers
Distinguished Delegates,
Ladies and Gentlemen
As we are assembled at this historic building, the world at large has its eyes turned on us, and I hope that our deliberations will strongly contribute to overcoming challenges ahead of us and to build healthier and more prosperous and equitable world. The world that Dr Lee loved and for which he worked tirelessly.
I now call on you to join me and move the work of the Assembly forward. I look forward to your cooperation and support over the next coming days. I thank you all for your kind attention.
Geneva, 22th of May 2006