The 73rd session of the WHO Regional Committee for Europe (RC73), held on 24–26 October 2023 in Astana, Kazakhstan, brought together the Region’s 53 Member States along with a range of health stakeholders, including civil society and, notably, youth representatives from across the Region.
Beginning with addresses by the WHO Director-General and Regional Director on the state of health globally and across the European Region, over 3 days resolutions and decisions were reached on strengthening the critical health and care workforce, advancing preparedness for emergencies, a roadmap to address the threat of antimicrobial resistance (AMR), an action plan on refugee and migrant health, WHO/Europe budget matters and other priority issues, all in the context of WHO’s 75th anniversary.
A year ago at the 72nd session of the WHO Regional Committee for Europe, the Regional Director, Dr Hans Henri P. Kluge, noted that the Region was grappling with a “permacrisis” on multiple fronts, from the impact of the COVID-19 pandemic and the mpox (monkeypox) outbreak to the humanitarian crisis in Ukraine, the re-emergence of polio and climate-related crises.
A year later at RC73, amid increasing challenges including humanitarian emergencies in Israel and the occupied Palestinian territory, and the Caucasus, the Regional Director stressed the importance of resilience to ensure health systems and health partners could face and overcome the crises of this time and better anticipate those that lie ahead.
Primary health care kicks off a week of events in Kazakhstan
Preceding this year’s Regional Committee session, alongside the Ministry of Health of Kazakhstan and the United Nations Children’s Fund (UNICEF) Regional Office for Europe and Central Asia, WHO/Europe co-hosted an international conference on primary health care (PHC), marking 45 years since the historic Declaration of Alma-Ata and the 5th anniversary of the Declaration of Astana, that reiterated the key role that PHC must play in health systems globally.
Addressing the opening of the PHC conference, the President of Kazakhstan, His Excellency, Kassym-Jomart Tokayev, praised the landmark 1978 Declaration of Alma-Ata, describing it as the “Magna Carta of global health care”. The President also underlined that PHC organizations have shown resilience and the ability to adapt quickly, and that we must carefully prepare for future health threats. He described the “significant strides” on access to health care that Kazakhstan has made in the past decade, with 6000 organizations employing 30 000 specialists, youth health centres in almost every settlement, and a 3-fold growth in settlement health centres since 2018.
Delegates stressed how crucial PHC is to global health, requiring high-level political commitment, adequate investments and strategic implementation. During the closing ceremony of the PHC conference, a youth-led outcome statement put forward 5 asks from young people, which was adopted by conference participants:
- ensure equitable access to PHC;
- commit to enhancing the quality of PHC services as the foundation of trust;
- invest in a PHC-oriented health and care workforce;
- ensure the human and relational aspects of PHC in the digital era;
- enhance resilience to current and emerging health and well-being challenges, such as mental health, social vulnerability, the impact of climate change, AMR and emergencies.
Regional Director’s address and discussion on the state of health in the European Region
Opening RC73, His Excellency Dr Älihan Smaiylov, Prime Minister of Kazakhstan welcomed all delegates and underlined the progress that has been made in his country in recent decades to create a world class PHC system. He explained that last year, a plan was approved to modernize rural health care, with 655 rural health centres to be established. Prime Minister Smaiylov also underlined the country’s support for the health workforce, and the introduction of new innovations, such as digital health passports. In conclusion, he commented, “We have ambitious plans for the future. We are always open to new ideas and to share our experiences that will drive the development of health systems in our Region”.
Dr Azhar Giniyat, Minister of Health of Kazakhstan, was elected President of RC73, and Dr Marat Shoranov of Kazakhstan as its Executive President.
Minister Giniyat welcomed delegates, noting with pleasure the many delegations with youth representatives at RC73. Referring to the PHC conference, as well as RC73, she said, “Astana has indeed become the capital of world health this week”.
During the opening segment of RC73, a video address by Her Royal Highness, The Crown Princess Mary of Denmark and WHO/Europe Patron was shown. Congratulating WHO on its 75th anniversary, she added, “We are living in challenging times, in the shadow of a pandemic, war in the Region, devastating earthquakes and an increasing number of climate-related extreme events. The work of WHO has never been more demanding, and relevant”.
In his opening address, the WHO Director-General, Dr Tedros Adhanom Ghebreyesus, acknowledged Kazakhstan as the birthplace of primary health care and provided updates on multiple emergencies in the Region, including the long-running war in Ukraine, the conflict in Israel and the occupied Palestinian territory, the ongoing earthquake response in Türkiye and the refugee crisis in Armenia.
Turning to the Regional Director’s address to delegates, one word summarized the speech: resilience. Dr Kluge recognized 3 pillars of a resilient WHO European Region: resilient governance, resilient health systems and resilient people.
On the first pillar, Dr Kluge explained how important it is to have participatory governance, aligned with global processes; on the second, strengthening the health workforce is crucial for more resilient health systems.
On the final pillar the Regional Director stressed the importance of peace as an essential prerequisite for both mental and physical resilience, for people across the Region.
During the discussion after the Regional Director’s address, Member States expressed strong support for WHO/Europe’s work and performance, and commended the Regional Office’s clear vision and dedication.
Elections, nominations and governance
The second day of the Regional Committee brought a greater focus on governance and budget matters. Following the private sessions, Bulgaria, Israel, Norway and Poland were nominated by the Committee to put forward their candidatures to the World Health Assembly in May 2024 for election to the Executive Board.
The Regional Committee selected Iceland, Serbia, Sweden and Tajikistan for membership of the Standing Committee of the Regional Committee (SCRC) for a 3-year term of office from October 2023 to October 2026.
In addition, for membership of the Regional Evaluation Group, Azerbaijan, Italy, Kazakhstan, Norway and Poland were selected.
The Regional Committee also considered the process for nominating elective posts for the World Health Assembly and for the Executive Board in May 2024.
Dr Kluge introduced WHO/Europe’s first Topline Accountability Report, providing an overview of how WHO/Europe is resourced, structured, managed and governed. He emphasized WHO/Europe’s actions to respond to calls for greater financial sustainability and efficiency, and better staff retention. The Regional Director stressed the necessity of preventing sexual exploitation, agile working, strengthened internal controls and a new approach to resource mobilization and bolstering partnerships.
Mr David Allen, Director, Division of Business Operations, Ms Gabrielle Jacob, Regional Advisor, Governance, and Dr Gundo Weiler, Director, Division of Country Support and Partnerships – all of WHO/Europe – then presented further details from the report, in the areas of business operations, governance, and leadership and partnership respectively. Mr Allen stressed that the European Programme of Work 2020–2025 had been impacted by large complex emergencies, causing a shift in business models with implications related to increasing staff costs and expenditure and a greater role for procurement. WHO/Europe has responded by offering new tools and more efficient ways of working.
Dr Weiler noted that there is now a greater network of national counterparts and a more strategic approach to country and subregional collaboration. He mentioned the Pan-European Leadership Academy and the successful launch of tier 2 for mid-career professionals, as well as intensified efforts to include youth in health decision-making through the Youth4Health network. Finally, he stressed the need to engage with non-state actors (NSAs) and leverage strong partnerships.
Ms Jacob presented elements of a comprehensive governance review overseen by the SCRC subgroup on WHO/Europe’s governance. This review set out 16 recommendations, including adding governance key performance indicators in future reporting, strengthening the engagement between SCRC members and Member States, building more meaningful engagement with NSAs and refining the processes for establishing, renewing and discontinuing geographically dispersed offices.
Following Member States’ discussions, the draft decision on NSAs, granting 8 of them accredited status was adopted, as was the decision on governance and its 16 recommendations.
Budget matters and matters arising from the World Health Assembly
On budget matters, Dr Corinne Capuano, the new Executive Director of the Office of the Regional Director, highlighted a strategic shift of budget to country offices. The Regional Director also stressed the importance of non-earmarked flexible funds and ensuring proper capacity within the secretariat to utilize funds.
Member States generally welcomed the greater transparency and noted that planned resources will mostly be used for country-level impact. There was also recognition that unpredictable funding restricts the work of the Regional Office.
Matters arising from the World Health Assembly
In the final session of the second day, delegates discussed matters arising from the World Health Assembly and Executive Board. Dr Bruce Aylward, WHO Assistant Director-General, the Universal Health Coverage, Life Course Division, provided an overview of progress and the consultative process towards developing the WHO 14th General Programme of Work 2025–2028 (GPW14). This includes 6 strategic objectives: achieve transformative action on climate change and health; place health and well-being at the centre of policy agendas in sectors that drive the determinants and root causes of ill health; substantially reduce inequities in coverage of essential health services; reverse the trend in catastrophic health spending; ensure every country is fully prepared to prevent and mitigate emerging health risks due to epidemics, pandemics and other hazards; and rapidly detect and respond to all acute health emergencies.
In addition, Dr Capuano spoke of the upcoming first financial investment round in 2024, describing it as “a unique opportunity to provide the best conditions to deliver GPW14”, to rally all partners around GPW14 and deliver the Sustainable Development Goals. Dr Capuano shared that a consultation plan is ongoing.
In responding to the Member State interventions, Dr Aylward explained that through GPW14, “We seek to remain true to the normative role of WHO especially as we strengthen our country and regional offices,” stating that only through a core, predictable country presence would WHO be able to make sure that its normative work is introduced quickly and effectively.
Member States endorse plans for WHO/Europe to tackle a range of health topics
During a session presenting a framework for action on the health and care workforce, Member States highlighted the importance of this blueprint at a time of acute crisis impacting doctors, nurses and other health providers region wide. Delegates from Member States and nongovernmental organizations noted the significant stress that health workers have faced in recent years, particularly during the COVID-19 pandemic and amid ongoing emergencies in the Region, as well as the challenges posed by both an ageing population and an ageing health and care workforce, before adopting a Member State led resolution.
Antimicrobial resistance is a global concern for both human and animal health and was associated with the deaths of some 500 000 people in the Region in 2019. Member States endorsed a roadmap outlined during the Regional Committee – identifying, prioritizing and implementing proven interventions to combat AMR. Dr Jeremy Farrar, WHO Chief Scientist, while congratulating the European Region for its leadership, pointed out the global nature of AMR and laid out in stark terms the threat it poses to medical procedures such as routine surgeries and safe maternal care, including the real possibility that critical antibiotics could be rendered useless.
Several emergencies have affected the European Region in recent years, generating a sense of “permacrisis”. In order to tackle this, Dr Gerald Rockenschaub, the Regional Emergency Director, introduced the Preparedness 2.0 strategy and action plan on health emergency preparedness, response and resilience in the WHO European Region (2024–2029), calling on Member States to focus on how best to anticipate and prepare for the health emergencies that lie ahead. In addition, Dr Gail Carson, Chair of the Technical Advisory Group (TAG) on Preparedness 2.0, gave an update on the Group’s recent activities. She urged the need for action through strategic and collaborative partnerships bringing a diverse range of stakeholders together, and emphasized that the TAG process was only just beginning.
During one of the final sessions before the closure of RC73, delegates turned their attention to refugee and migrant health. Following the expiration of the Strategy and Action Plan for Refugee and Migrant Health in the WHO European Region 2016–2022, Member States of the Region adopted a new action plan for refugee and migrant health 2023–2030 to address both the acute needs of refugees and migrants, as well as their long-term integration in health systems. The discussion focused on universal health coverage, labour migration, migration of the health workforce, and the impacts of climate change on migration and displacement.
Closing of RC73
Following a vote, it was confirmed that the next session of the WHO Regional Committee for Europe will be held in Copenhagen, Denmark, where WHO/Europe is based.
Closing the session, Dr Kluge said, “Together, this week, we have accomplished so much – demonstrating what wonderful work we can do if we come together. For WHO/Europe, our mission of promoting, providing and protecting health everywhere in our Region, in our world, has never been so relevant in these tragic times of conflict we are going through. And to fulfil our mandate amid the realities of our time, we need to be ever more resilient: resilient governance, health systems and people”.
This article was amended on 31 October to include a mention of the nomination of the Member States set to put forward their candidatures for the election to the Executive Board.