WHO Director-General addresses the Regional Committee for South-East Asia
Dr Margaret Chan
Director-General of the World Health Organization
Mr Chairman, Excellencies, honourable ministers, distinguished delegates, Dr Samlee, colleagues in the UN family, ladies and gentlemen,
I appreciate the very serious way this region has responded to calls to move health systems towards universal coverage. This commitment is readily apparent in the recommendations arising from your technical discussions on universal health coverage (UHC).
Countries in this region have been staunch supporters of primary health care as the best way to improve health. The results have been outstanding, especially in your large populations of the poor. This experience gives the region a head start, as universal coverage is firmly rooted in the principles and values of primary health care.
Your ministries of health are experts at developing detailed national and subnational health plans, and then acting on them. You are now applying this expertise to define UHC strategies that can work well, at low cost and in resource-constrained settings.
The technical discussions recommended a phase-wise approach to universal coverage, whereby the elimination of inequalities and inefficiencies is the initial focus. When the requisite systems and institutional capacities are in place, expansion of coverage can follow. This is a wise way forward.
Financing expanded coverage is, of course, a major challenge. Moving towards UHC means increasing access to essential medicines, vaccines, diagnostics, screening tests, and other interventions.
It also requires systems for social protection, eventually shielding all citizens from impoverishment caused by health care costs. It is not cheap, but when well-planned and managed, it is affordable.
Again wisely, the technical discussions were alert to sources of waste and inefficiency, and identified options for reducing them. In this way, reducing inefficiency and expanding coverage can work together as mutually reinforcing goals.
This region knows its problems well.
Out-of-pocket payments are the highest of any WHO region, accounting for more than 60% of total health expenditure. A large proportion of this expenditure goes to the purchase of medicines, which are priced higher than need be and are not being rationally used. Underpinning this problem are the limited capacities of national drug regulatory authorities and drug testing laboratories.
The marketing and promotion of medicines also need better regulation, especially given their contribution to the overuse of medicines. For many doctors, the pharmaceutical industry is the principal source of prescribing information.
The dominance of privately provided services is another problem. It is pushing the region away from primary care and preventive services towards high-cost curative care using high-end technologies. Incentive schemes for provider payment, especially fee-for-service schemes, contribute to the over-provision of care and its escalating costs.
This trend, in turn, is aggravated by the rise of chronic noncommunicable diseases (NCDs) and the region’s growing population of the elderly, with their multiple chronic conditions and impairments. The region’s large informal sector reduces the tax base and the number of people gaining health insurance through their employers. Systems for social protection are weak, further adding to the region’s growing inequalities in income levels, opportunities, and health outcomes.
You know these problems well. You have analyzed their causes and possible solutions, and are addressing them.
Commitment to universal health coverage boosts determination to solve these and other long-standing problems. For example, countries that have achieved universal coverage have reduced out-of-pocket payments to as little as 15% of total health expenditure.
Your draft resolution on universal health coverage addresses the need for countries to conduct assessments of health technologies and interventions as a strategy for the more efficient use of resources.
Again, reducing inefficiency increases the capacity to serve more people well.
UHC brings important social dividends as well. In the absence of public spending policies that make equity an explicit objective, economic growth will not automatically give the poor a decent life.
This point was underscored in last month’s report from the Asian Development Bank, on Ending Asian Deprivations. Economic growth alone will not end poverty, deprivation, and the misery of ill health. Policy choices, such as those embodied in universal health coverage, make the difference.
Ladies and gentlemen,
This region knows its problems well, but it also knows its strengths.
Your experts have concluded that measles elimination and rubella control by 2020 is an entirely feasible goal. You reached this consensus carefully. It is based on experiences in other WHO regions, but also on a detailed feasibility study. That study supported the goal as technically, biologically, and operationally feasible.
The stage is set. Routine immunization is the foundation. The initiative to intensify routine immunization, launched last year, began a drive to expand coverage substantially, with a strong emphasis on hard-to-reach populations. Some countries engaged more staff. Others trained mid-level managers. Still others upgraded cold-chain facilities.
A surveillance system is in place, using a network of 23 WHO-accredited measles laboratories equipped to study the virus at the genetic level. The vaccine is safe, effective, inexpensive, and available. In fact, this region manufactures more than 70% of UNICEF’s global measles vaccine supply. SEAR (South-East Asia Region) can count on vaccine self-sufficiency.
Reaching this ambitious goal will be a challenge, as greater than 95% immunization coverage is required. This high level of coverage pushes routine immunization to new heights of performance.
You will need financial and other support from partners, and I am optimistic that this will come. The quality of your feasibility study builds confidence, and confidence inspires commitment.
SEAR health experts have given equally careful attention to the regional action plan and targets for the prevention and control of noncommunicable diseases. As noted, the targets are ambitious for this region.
You have given these ambitions a reality check by assessing each of the nine voluntary targets against regional capacities to establish national surveillance and reporting systems.
For some of the targets, good baseline data exist in every country in the region. For others, few, if any, countries have systems for collecting the relevant data.
Given the region’s weak systems for civil and vital registration, mortality surveillance is inadequate everywhere. The key steps identified to improve the availability and use of data offer solutions that will benefit other health and development initiatives.
We are all aware of the challenges that noncommunicable diseases create for health systems and the heavy burden they impose on financial and human resources. In many countries, a fundamental reorientation of the health system is needed. This region can be a model of how the prevention and control of NCDs, and the monitoring of trends, can operate within the context of primary health care.
Ladies and gentlemen,
There is a final recent achievement that needs to be mentioned.
All countries in this region have now completed a critical assessment of weaknesses in their national policies for essential medicines. This is a solid starting point for improving the regulatory control and rational use of medicines and other medical products.
The exercise was described as an eye-opener, revealing the multiple dimensions of this long-standing problem, but also revealing opportunities to take corrective action. This work provides another strong foundation as countries continue to turn their commitment to universal health coverage into a reality.
Doing so will benefit the health of all your citizens, and give even more of the poor a route towards a decent life.