Excellencies,
It is a pleasure to come together once more to build momentum in this crucial area of work.
The emergence and spread of COVID-19 has put immense strain on health systems across the South-East Asia Region, as across the world.
Previous disease outbreaks have shown that the disruption to essential health services caused by an outbreak can be more destructive than the outbreak itself.
We must do all we can to avoid that happening, and I commend you for your efforts thus far.
I have been in constant touch with all of you from very early on, beginning in January, before the full import of the global crisis had unfolded.
In March WHO issued guidance on maintaining essential health services as a core part of the pandemic response, which is reflected in Pillar 9 of WHO’s strategic preparedness and response plan.
That guidance and its June update has been a critical part of the Region’s response to date, which we have been implementing for more than six months now.
The Regional Office has developed a detailed document that defines regional strategic priorities and action points for maintaining essential health services that will be disseminated very soon.
At a WHO-convened meeting last week, more than 200 partners from across the Region and the world pledged their steadfast support to our efforts, which will be vital to protecting the many gains we have made across all areas of health.
Throughout the immediate response and into the recovery we must continue to focus on achieving the Region’s eight Flagship Priorities, for which our “Sustain. Accelerate. Innovate” vision must remain central.
In the coming meeting our focus will primarily be technical. The outcomes reached will lay a firm foundation for the Ministerial Round Table planned for next month’s Regional Committee, which will be held online.
Before proceeding, let us examine the global and regional epidemiological burden.
Across the world, more than 18.3 million cases of COVID-19 have been reported, and more than 700 000 deaths.
In the past three months the global burden has increased more than fivefold, and the number of deaths has more than tripled.
All continents have been affected, and we continue to see flare-ups in countries and areas that had previously contained the virus.
To date, the South-East Asia Region has reported just under 2.3 million cases and more than 48 000 deaths.
The change in the cumulative number of cases in the Region compared to a week ago is 22%, which indicates significant acceleration.
This is largely the result of several hot-spots and clusters that Member States continue to respond to based on WHO’s transmission classification model.
In several countries there has been a recent surge of cases, particularly among returning migrant workers and in densely populated mega-cities, and after the easing of physical distancing measures.
In the Region’s larger countries, such as Bangladesh, India and Indonesia, we see great variance in transmission at the subnational level, highlighting the local nature of the outbreaks and the need to respond accordingly.
The good but not surprising news is that fundamental public health measures work.
For example, for over 70 days now Thailand has been free of local transmission.
Until two days ago, Timor-Leste had not reported a single case for more than 100 days.
We all agree that whatever a country’s transmission scenario we must remain vigilant and apply best practices based on the local context.
As a Region we must continue to learn from one another in all aspects of the response, including the imperative that we have gathered to address: maintaining essential health services.
Let us turn to the results of a rapid assessment that WHO carried out in May looking at the provision of 25 essential services.
Each of our Flagship Priorities has been affected.
On eliminating measles and rubella, disruptions to routine immunization and supplementary campaigns have been experienced in eight of the Region’s 11 countries.
On preventing and controlling noncommunicable diseases, both outpatient and in-patient services have been greatly affected, especially for mental health, which is an urgent and pressing need.
Across the Region, the availability of antenatal care services has been reduced by as much as 46% and institutional deliveries by as much as 58%, impacting our capacity to accelerate reductions in maternal, neonatal and under-five mortality.
Health system pressures, reduced service utilization, damaged supply chains and the potential for reductions in health spending could inhibit progress towards universal health coverage (UHC), and also weaken the battle against antimicrobial resistance.
We must continue to fill gaps in emergency risk management, in line with the Delhi Declaration, which the Region adopted in 2019.
In several countries we see a rise in cases of diseases on the verge of elimination, including malaria, which is of great concern given how far we’ve come.
If case detection for TB drops by 50% over a period of three months, the Region could return to the morbidity and mortality last reported in 2012.
We must protect and defend our many gains.
To be sure, our Region is not unique in these disruptions. The same WHO survey shows significant disruptions to essential health services across the world, in all WHO regions.
In our battle to revive and maintain essential health services we must continue to drive progress on each of the Region’s Flagship Priorities, contribute to WHO’s “triple billion” targets and advance towards the Sustainable Development Goals (SDGs).
Excellencies,
It is not enough to simply document the scale of disruptions. Rather, we must understand why those disruptions are occurring.
On the supply side, the regional assessment found several key drivers.
The repurposing of health workers; the cancellation of elective care; the closure of outpatient services; insufficient personal protective equipment; and changes in treatment policy have been especially significant.
On the demand side, we see that changes in health-seeking behaviour, constrained physical access and financial hardship have limited service uptake.
Notably, the impact of each driver was experienced differently across the Region, both as a result of the policies implemented and the local disease burden.
I commend Member States for the innovative measures they have developed and implemented in recent months to ensure health systems continue to provide the essential services on which people rely.
Triaging and task-shifting; leveraging the potential of telemedicine; developing novel supply chains and medicine dispensary options; and better engaging the private sector and communities have all achieved a measure of success.
As a Region we must continue to share experiences and learn from one another, adapting policies to suit local contexts and transmission scenarios.
Beyond these and other technical concerns, I take the opportunity to highlight the economic impact the virus has had and how it could affect our efforts.
In just six months the pandemic has caused an economic crisis that is deeper and more global than anything experienced since World War II.
While higher income countries are projected to experience the greatest decline in economic growth, lower-income countries have the least resilience to shocks.
At last week’s Regional Health Partners’ Forum, which was the second such meeting – the earlier being held in March – the World Bank estimated that the pandemic could push per capita GDP in the Region from US$ 4100 to US$ 3800.
This is especially significant given that the Region had several of the world’s fastest growing economies pre-COVID.
As compared with the decadal per capita growth seen between 2009-2019, the economic contractions experienced by countries will range from -5% to more than -10%.
Though the crisis is first and foremost a health crisis, amid the complex economic recovery that will follow it is by no means certain that budgetary allocations to the health sector will be prioritised, whether to maintain and strengthen health services as part of the ongoing response, or to ensure they can adequately guard against such events in future.
Importantly, COVID-19 has not only revealed the critical interdependence of UHC and health security, but also between health, the economy, the environment and other social sectors.
This lesson cannot be lost.
Together we must continue to make a strong, consistent and impassioned case for continued investments in health system strengthening – yes today, but also over the coming months.
WHO will continue to mobilize its many international partners to secure sustained, flexible funding that can be applied throughout the pandemic response and beyond.
We will continue to highlight the need for all people everywhere to have access to quality health services, without financial hardship – in other words, to achieve UHC, the Flagship Priority and SDG target that underpins all others.
Excellencies,
I wish to highlight three key areas in which we should focus our efforts, and which reflect our “Sustain. Accelerate. Innovate” vision, the recommendations from the Partners’ Forum and meetings with WRs, and the strategic priorities and action points defined in the regional guidance on maintaining essential health services, which is currently being finalized.
First, we must strengthen health system resilience with a focus on primary health care.
The emergence and spread of COVID-19 underscores the critical importance of building strong primary health care systems able to withstand acute events while continuing to provide the services required to meet most people’s health needs.
Increased public investments in health services over the near and long-term – including for health workforce strengthening and financial protection to reduce out-of-pocket costs – will ensure that services can continue to be accessed, whatever the local transmission scenario, and however health workers are repurposed.
Crucially, all health care facilities must have access to secure supply chains, efficient procurement procedures, and quality-assured medical products.
Second, we must strengthen our evidence and knowledge base on how essential services can be maintained.
As I mentioned earlier, several countries in the Region have already developed and implemented innovative ways to overcome challenges and ensure people can access the services they need to stay healthy and productive. Strengthening and expanding telemedicine in particular has been of great value.
A harmonized approach to data collection, including in-depth epidemiological analysis, is needed to provide a rich evidence base from which countries can adapt and apply best practices.
Specific attention should be given to better monitoring and understanding the social impact of the pandemic and how it affects the health-seeking behaviour of disadvantaged and vulnerable groups and their access to services.
Communities must continue to be at the centre of the response, and must continue to be empowered through effective risk communication and strategies to tackle misinformation.
Third, we must strengthen the joint response of key actors across sectors.
Successfully implementing a whole-of-government, whole-of-society approach to the pandemic requires the mainstreaming of health concerns into non-health sectors.
Doing so will increase efficiency and the ability to rapidly control and suppress flare-ups, and to move towards the recovery phase.
WHO will continue to prioritize collaboration among our many partners, especially at the country level, to ensure that countries can respond with speed and scale across all relevant sectors.
The situation we face demands innovative responses, and I urge you to request your teams to continue to be as innovative as possible.
We are building the ship as we sail and must be creative in the solutions we find to stay on course, to weather the storm, and to move toward safety.
I look forward to learning more about your successes and the challenges you face in maintaining essential health services throughout the pandemic response.
I reiterate WHO’s full and ongoing technical and operational support.
We are facing a once-in-a-generation challenge and must continue to draw on our collective knowledge and expertise to protect the health and well-being of all people in the Region today, tomorrow and for as long as it takes.
I wish you a productive meeting and appreciate your keen support and engagement.
Thank you.