Global Health and Care Forum 2008: primary health care starts with people

Dr Margaret Chan
Director-General of the World Health Organization

International Federation of Red Cross and Red Crescent Societies
14 May 2008

Secretary-General Mr Niskala, distinguished delegates and guests, ladies and gentlemen,

First and foremost, let me express my deep appreciation for this opportunity to speak about the work of Red Cross and Red Crescent Societies, especially at an event focused on primary health care. My appreciation has several dimensions.

I appreciate the importance you give to the health of vulnerable populations, during emergencies but also in more stable situations, where you work to strengthen health infrastructures in sustainable ways.

I appreciate the enormous capacity embodied in the International Federation, with its global workforce of almost 100 million people. And this is a workforce uniquely well-placed to penetrate inaccessible areas under the most challenging conditions.

I admire the values that guide your mission. This should come as no surprise, as they are so close to those of the World Health Organization. We share the priority you give to vulnerable populations, including women. And we share your wider ambition to alleviate poverty, reduce inequities, and strengthen community capacities.

It is my firm conviction that no one should be denied access to life-saving or health-promoting interventions for unfair reasons, including those with economic, social, or political causes.

It is no surprise that the International Federation ranks among our most valued partners. With the vast sweep of your operations, unified by shared principles, policies, and practices, and the scale of your implementation force, you can quite literally operationalize WHO technical recommendations in every corner of the world.

I appreciate the International Federation’s growing role in bringing the benefits of global health initiatives to the grassroots level. This is one of your unique advantages, the gap that your work fills. It is through your efforts that the aspirations of so many ambitious and noble global goals can become a reality for households and communities.

Above all, I appreciate the Federation’s steadfast commitment to primary health care. I wholeheartedly welcome your decision to make primary health care the focus of this forum, and also to make it clear that primary health care starts with people.

Ladies and gentlemen,

When I took office at the start of last year, I called for a revitalization of primary health care as an approach to strengthening health systems. During the course of last year, I took that commitment a step further. I became convinced that we will not be able to reach the health-related Millennium Development Goals unless we return to the values, principles, and approaches of primary health care.

Let me be more specific. In just the past few years, health has acquired unprecedented prestige as a driver of overall development and a strategy for poverty reduction. Health is a foundation of prosperity and a contribution to social stability. These are assets in every country, and they strengthen our collective security as an international community.

The high profile of health on the development agenda has brought unprecedented attention and a boom in funding from new sources. We have cash, commitment, powerful interventions, and proven strategies for their implementation.

Finally, with so much working in our favour, we can see what is holding us back. It is this: we do not have the delivery systems capable of reaching those in greatest need, on an adequate scale. If we want health to work as a poverty-reduction strategy, we must reach the poor. And this is where we fall short.

As Red Cross and Red Crescent societies know very well, vulnerable populations tend to live in poorly accessible areas, beyond the reach of the formal health system. We are now seeing the consequences of decades of failure to invest adequately in essential health infrastructures.

Development agencies are now keenly aware of this major obstacle to progress. The need to strengthen health systems is fast becoming a priority for international health partnerships, UN organizations, and major funding agencies, including the Global Fund and the GAVI Alliance.

But ladies and gentlemen, let me be frank. It is exactly in this area that the International Federation has a head start at the most fundamental level. It is exactly in this area that you are way ahead of the curve. I am referring to the emphasis you have placed on primary health care, on community engagement and empowerment, on intersectoral action, on health promotion and prevention in addition to cure, and above all, the value you place on sustainable achievements.

In the health initiatives undertaken by this Federation, the starting point is often the total collapse of the health system and all the services it provides. Red Cross and Red Crescent societies have demonstrated the feasibility and effectiveness of primary health care in the hardest school possible: conflict zones, disasters, and humanitarian crises. You have demonstrated that a primary health care approach can provide an exit strategy – that is, an assurance that the impact achieved will be sustained.

Development agencies are now looking for ways to ensure that health initiatives are country-led and closely aligned with national priorities and capacities. This has long been one of your guiding principles.

The responsibility for health care is the duty of government. Your work supports those duties and responsibilities, but never competes or attempts to replace them.

Development agencies are concerned about the effectiveness of aid, the duplication of efforts, the fragmentation of results and the tremendous burden multiple implementing agencies place on national capacities. Your role, however, is unique and your volunteers are welcomed with open arms. The emblems of the red cross and red crescent are universally recognized as a symbol of help and hope. I would be surprised if there is any other humanitarian organization that enjoys such recognition, such respect, and such trust.

Finally, there is deep concern about the critical shortage of health workers. The International Federation has an implementation force of 100 million people, with around 30 million working on health. Of course, Red Cross and Red Crescent nurses and volunteers cannot provide the full range of essential health services. But the stalled progress in reaching global health goals, especially those for reducing maternal and child mortality, comes largely from the failure of delivery mechanisms.

Many life-saving interventions are safe, simple, highly effective, and inexpensive. In this day and age, more than 10 million young children and pregnant women continue to die each year, largely for want of access to these simple interventions. More than one billion people – the “bottom billion” – suffer from disabilities caused by the neglected tropical diseases, which likewise have simple low-cost interventions. This is where I see the great power of the International Federation to contribute innovative and cost-effective delivery mechanisms on a scale that can make a huge difference, quickly.

Fortunately, interventions are constantly being simplified. Just this year, for example, research coordinated by WHO demonstrated that pneumonia – the number one killer of young children – can be treated just as effectively in homes as in hospitals, and possibly even more safely. The doors keep opening wider for the kind of support your societies can provide.

Ladies and gentlemen,

Let me mention a few achievements in areas where my staff have asked me to convey a special expression of thanks. In terms of bringing the benefits of global initiatives to bear on vulnerable populations, your volunteers not only reach every household, moving door to door, but you reach them in the right way.

You help bring children to immunization sites, but you also educate households in the importance of immunization. I am aware of the contribution, in 2007 alone, of more that 20,000 of your volunteers to the stunning success of the Measles Initiative. I am aware of your contribution to polio eradication, especially in conflict zones.

In mass campaigns to prevent malaria, you help deliver bednets to remote populations, but you also follow-up to be sure the nets are being properly used. In tuberculosis control, your volunteers not only support adherence to the DOTS strategy, but they also provide critical social, nutritional, and psychological support.

The support you provide to WHO during outbreaks is invaluable, especially when control depends on community mobilization. This is true during the panic surrounding Ebola and Marburg haemorrhagic fevers, and during the potential chaos of mass vaccination for yellow fever and epidemic meningitis.

You have scaled up your HIV/AIDS efforts globally, and you have set a goal of quadrupling your impact in 10 hard-hit African countries. I thank you for your strong collaboration with WHO in preparing the training packages for HIV prevention, treatment, care and support, and using these tools to reach millions of people. It is initiatives like this one that have the power to make a life-and-death difference on a grand scale.

Ladies and gentlemen,

This forum will be looking at future challenges. Let me mention three. These are looming crises that ought to make us run for the kind of shelter primary health care provides.

First, the crisis caused by soaring food prices is already with us. Personally, I have no illusions. The causes are deep-rooted and will not be easily resolved. Though the media will cover food riots and ousted officials, it is the health sector that will have to cope with the very real and significant human consequences.

Second, the effects of climate change are already being felt. This year, we focused World Health Day on the consequences for human health. These consequences are now inevitable, and they will be severe. All the major studies agree: developing countries will be the first and hardest hit.They further agree: those developing countries with an efficient and resilient health system will be best able to cope.

We must all brace for more humanitarian crises, and more appeals for international assistance, as we are seeing, right now, in Myanmar and China. These needs will arise at a time when all countries are stressed, to greater or lesser degrees, by climate change.

Finally, we must anticipate more new diseases, and we must accept that the speed of spread and the social and economic impact will be much greater in our globalized society. We must accept that the best defence strategy is to detect and contain emerging diseases at source. That means good local surveillance and reporting systems. We must continue to step up preparedness for the next influenza pandemic. The threat has by no means receded.

All three of these events are high-profile security threats at the international level. For all three, the ability of the health sector to respond, and thus protect global health security, depends on the kind of equitable, sustainable, and broad-based services provided by primary health care.

Again, let me thank you for making primary health care the focus of this forum.

Ladies and gentlemen,

I have one final comment. Primary health care starts with people. Our common humanity compels us to respect people’s universal aspiration for a better life. It compels us to respect the resilience and ingenuity of the human spirit, and the great capacity of individuals and communities to solve their own problems. This is where the unique ethic of volunteer service also counts most.

This is how I interpret your mission of mobilizing the power of humanity. And this is why I have so much valued this opportunity to speak to you.

Thank you.