Distinguished Ministers,
Dr Uton,
Colleagues,
Ladies and gentlemen,

It is a pleasure for me to be in New Delhi and to attend this Regional Committee for South-East Asia. I appreciated meeting the Ministers on Saturday, although briefly. And I look forward to listening to the debate and reflection in this plenary today and tomorrow.

The Regional Committee is truly regional - but it is also an integral part of WHO. The World Health Organization is a global organization. WHO is not complete - our identity is not intact - our course is not on target - if we do not include the regional dimensions - if we do not add them up. I see this as a main challenge - to make WHO one - not seven organizations - Geneva and the six Regional Offices.

South-East Asia has 10 of WHO's 191 Member States, yet the total population of this Region numbers one and a half billion people. Any major public health threat to South-East Asia is also a threat and a concern to the rest of the world. And any major progress in this Region, as is the case in the polio eradication campaign, spells progress for the rest of the world.

Never have so many in this world had such opportunities for health. Never has our knowledge been so great. Never has there been such a stream of discoveries and scientific breakthroughs.

And yet - so much remains to be accomplished. People in the developing world carry over 90 per cent of the disease burden - with access to only 10 per cent of the resources used for health. Changing this equation is the core of our challenge.

Great disparities remain between countries, and also within countries. The South-East Asia Region offers extreme examples of such disparities: between the rich and the poor; between the educated and the disempowered; between its top quality research and high tech capacity, and - for too many people - the lack of access to basic infrastructure.

Let me take this opportunity to share with you two important perspectives for WHO's work as we enter a century where the people we are serving have a right to expect real progress towards Health for All.

First - we need to anchor our quest for better health in a broad perspective - drawing in other sectors of society so essential for the health of billions. Second - we in WHO - working with you - need to focus our work, become more targeted, more efficient and more in line with the real needs in our Member States.

We need a broader perspective: Health is not only a vital asset for each individual, it is the very core of human development. We cannot point to more doctors and more affordable drugs alone and say that this is what we need to change the course in our world.

The deep roots of global health challenges are still linked to poverty and underdevelopment. Ill-health leads to poverty and poverty breeds ill-health. Unless we can help break that vicious circle, our efforts will matter only marginally.

There are plenty of reasons for being pessimistic, with more than 1.3 billion people living in absolute poverty and the number still growing. But pessimism is a poor tool for facing the future.

We have to look ahead and show that health provides a real path to a better society. We have the evidence: Investing in health gives tangible results. Less social and economic costs. More human progress. Enhanced capacity for society to harness the ultimate resource of the 21st century: The human resource.

You, Health Ministers already know. But we need to go beyond and tell the Heads of State, the Prime Ministers, and the Finance Ministers, that they are really Health Ministers themselves. Our broad mandate is to change the international agenda and put health at the very core of the development process.

I believe we can succeed in this effort. Not alone. But by gathering our evidence, by matching it with that of others, by becoming better advocates, and by reaching decision-makers with a convincing case. This requires new momentum, new methods of work and a new attitude. To succeed - you at a national level and WHO as an international organization - we all need to reach out.

Fundamentally we need to reach out and to work across sectors. Most determinants of better health lie outside the health system. They include better education. A cleaner and safer environment. Sustained reductions in poverty. A stop to armed conflict and excessive military expenditures.

This Region tells all about it. The floods in Bangladesh have dramatic health consequences, but the origin of the hardship goes far beyond the reach of the health sector alone. The population growth of India makes health gains for all increasingly difficult to achieve, but the health sector alone cannot turn the tide.

The mix of environmental change, energy consumption and social change are all drivers of both health and ill-health. The health sector is not the originator - it is most often on the receiving line - left with dealing with the outcomes.

WHO also has to reach out. The whole notion of a specialized agency has little meaning in this interdependent world if we fail to integrate our efforts with the other stakeholders.

I wish to invite all those who have real contributions to make to join us. Our UN partners. The international financial institutions. The NGO community. The private sector. And the people itself. We need constructive relations with the private sector and industry - being clear about our respective roles, where they differ and where they complement each other.

What, then, is the way ahead for WHO? To keep it short I see it as making a difference for people's health, for the Governments and for their ability to improve it.

To succeed we must secure better unity of purpose and better focus. We cannot do everything - but we should be very good at what we decide to do - and be ready to say that we cannot do all.

Let me take you through the main features of the change process. I have appointed a new senior management team at headquarters level. Five members from the South and five from the North.

Six women and four men. All WHO Regions are represented. Together it is a strong global team. People with first-class health experience - but also people with experience from other sectors of society.

WHO has dozens of good and skilled programmes and activities. But we need to develop a structure which can bind our efforts much more strongly together, which can cope with a changing world, and which the outside world can relate to.

At Headquarters we have grouped the programmes into nine clusters. There are the obvious ones: One on Communicable diseases, and one on Non-communicable diseases. Our fight against the communicable diseases - such as HIV/AIDS, polio, malaria, TB and leprosy must go on with renewed dedication. At the same time we need to prepare for the epidemic of non-communicable diseases - now hitting the poor countries and putting their health systems under great strain.

Then, we need to relate to a complex world. The cluster that deals with Sustainable Development and Health will focus on the broader intersectoral perspectives, addressing the environment and other effects of globalization and world trade.

The cluster on Social Change and Mental Health will help us to better understand and address the health consequences of some major social transitions such as the ageing of our populations and the growing strain from mental disorders.

The cluster on Evidence and Information for Policy - an innovation aimed at assembling, analysing and spreading the best evidence and lessons learned from the health-related sectors - will enable us all to take better, more cost-effective and more equitable decisions.

The overriding target is this: To organize our work throughout the Organization so that it has maximum impact where it matters most - at a country level. This has been requested by our Governing Bodies, including your own delegations. Time has come for the Secretariat to respond. We have set up a fast-track task force to work on this.

A key to all our work is to contribute to Health Sector Development. I have told the Executive Board that, unless what we do contributes to developing more sustainable health sectors, we should not consider becoming involved.

Your Regional Office is your skilled partner. But your WHO Headquarters also needs to link more closely with countries. I intend to establish more direct relations with the WHO country representatives, who are very important to the quality of our Organization. In a few months I will invite them all to Geneva to share their experience and see how relations can be made more beneficial for you.

We will build stronger bridges to our Member States - especially those in greatest need. This is a two-way challenge: We - in the Secretariat - must pull our act together, achieve better focus and efficiency. You - the Member States - must report back to the Organization on the health status of your population, and take responsibility for the targets you set.

There will be a change in the way we work. Besides the clusters of activities, we will work on specific projects, focusing on selected health issues. These projects will be time-limited, cut across clusters and regions, and frequently engage other partners.

We have launched two such projects since 21 July: - Roll Back Malaria, and Tobacco Free Initiative. These projects are aimed at providing new opportunities for catalyzing resources for countries and regions.

They will not mean relegating other health activities and regional concerns. They will serve to highlight and reinforce your own public health action.

Changes are also being made in our budgets. At the World Health Assembly, Member States decided after long discussions to change the regional allocations and to increase resources from the regular budget going to Africa and Europe.

I know this will face the other Regions with some painful decisions, especially at times of financial and economic turmoil. I shall do everything I can, looking beyond the regular budget, to mobilize funds to support our activities, especially towards the countries in greatest need.

Let me then turn to some specific health challenges in this Region:

First, let us talk about malaria. Eight countries in the Region are endemic and 1.2 billion people are at risk. In 1996, the Region reported 3.4 million cases but estimated that real incidence was much higher. Some of the major challenges you face include vector and parasite resistance, lack of intersectoral coordination - and lack of resources.

I have pledged WHO's determination to engage in a renewed effort to Roll Back Malaria. The Project staff is currently preparing the work in close dialogue with the Regional Offices, and gradually with the countries concerned. I urge you to join us.

It is a complex task. We know eradication is not an option. But we also know we can substantially reduce mortality and morbidity. We are attacking malaria by focusing on strengthened health systems. And once we succeed in this - once health systems can deal more effectively with malaria - then our fight against other communicable diseases will benefit as well.

Let us talk about HIV/AIDS - another crucial challenge for South-East Asia. The pandemic reached South-East Asia late, but it has spread rapidly. Infection rates are going up not only in the high-risk behaviour groups but in the general population. The potential for further spread within the Region and beyond is enormous.

WHO will work more intensively on HIV/AIDS in all our programmes. And in the year to come we will do all we can to lend our full support to UNAIDS as we serve as the Chair of the cosponsors. We will make every effort to support national initiatives. We will press for research on vaccines, for simple yet effective diagnostic tests, and for more equitable access to prevention and treatment - including anti-retroviral therapies.

Let us talk about tuberculosis, now so closely linked to the HIV pandemic. In 1995, about 3.5 million new TB cases occurred in the Region. Last year, about one million people died from TB. In some countries it is estimated that 60 to 80 per cent of people with AIDS develop tuberculosis.

We need new efforts in the struggle against TB, and WHO will demonstrate leadership - by placing our TB effort in a broader context, by focusing on the health sector and by working more closely with other partners.

Let us talk about women's health and development. I welcome the emphasis you are giving to women's health. Urgent action is required on two particular issues: anemia and maternal mortality.

More than half of the world's malnourished live in this Region. Iron deficiency anemia affects 60 per cent of women and nearly 80 per cent of pregnant women in South-East Asia, with the dramatic risks that means for them and for their infants.

Poverty and underdevelopment are major causes of malnutrition. But inequality between women and men also accounts for the exceptionally high rates of malnutrition recorded amongst women. Interventions to improve women's health must be integrated into a coherent developmental effort.

We will support your efforts to improve women's health and reduce maternal mortality. With an estimated 235 000 maternal deaths, this Region has the heaviest toll and shoulders almost half of the global burden of 600 000 maternal deaths. Count down on these tragic, preventable deaths must start now.

The actions needed are known and within our grasp. I am heartened by the personal commitment made by several leaders of the South-East Asia Region on World Health Day 1998, dedicated this year to promoting Safe Motherhood. I see it as an indication of their determination to finally come to grips with this vital human challenge.

Let us talk about access to essential drugs and vaccines.

Globally one-in-three people lack regular access to essential drugs. The public sector may lack critical drugs while private pharmacies have them in large quantities but affordable only to a few. Some countries spend 20 to 40 per cent of the health care budgets on importing drugs.

We cannot change this overnight. We are looking for the right balance. National strategies must ensure equity of access, rational use, and quality for existing drugs. Industry must push for new and effective drugs and vaccines. And we must push for research, for funding and a distributive system that can make these advances available and affordable to all - specially to those who need them most.

I have invited industry at large to sit down with us to map out the challenges and reach a clearer understanding of what we can achieve together and where we differ. I believe there is a lot to achieve, and we must work it out.

WHO has an overriding responsibility to see to it that essential drugs are developed and that they are made available to those in need. New international trade agreements present new opportunities, challenges and uncertainties.

We need to do our part - and you, the Governments need to do yours. WHO will speak out. WHO will be more active and vocal in its dialogue with the World Trade Organization (WTO). But before trade issues reach the international negotiation table, public health needs must be fully considered at the national negotiation table. Governments must have a coherent policy - and send the same, consistent, message about this policy in different international bodies.

And, to conclude, let us talk about health sector reform.

How can we build sustainable health systems that can stand the test of changing times and economic constraints? How can we ensure access to basic health services in situations where the base of public

finance threatens to collapse? Many of your countries experience just that as the world economy is going through such turbulent times.

Each country must choose its own path - based on its pattern of disease, its institutions, its resources, and the needs of its people. But WHO will be there, ready and able to assist you.

Market forces have led to enormous increases in productivity in many sectors of the world economy. But they have failed to achieve similar success in health. In general terms the private sector may be good at allocating resources cost-effectively. But industry will never become the key provider of primary health stations or guarantor of health services to the poor. It cannot on its own define and certify universal standards of quality and safety. Neither will it ensure equitable and universal access to care and services.

Universal access to quality services is a bedrock principle which WHO and Governments must stand for. Governments should provide strategic leadership - by setting priorities and standards. There are limits to the care they can finance. But defining priorities, standards and limits requires evidence, and knowledge of which efforts are likely to be the most effective, have the best overall impact, and reach the most people.

Government-financed services must come from the most efficient source. This may mean providers from the private sector. Or from NGOs. Governments should engage capacity for health development wherever it may be, to meet their responsibility to ensure universal access to care.

I believe we need to start a discussion on norms and standards, to define a "new universalism" - in other words, a new perspective and new ways to promote and achieve universal coverage. You are facing the challenges and you have to find answers in accordance with your own situation. But WHO will be there to assist you.

Yes, the challenges are many, but so are the opportunities. Together with my colleagues, in Geneva, the Regional Directors and the Regional Offices and the many dedicated WHO Representatives we embark on a course into a new century where our determination is to make a difference.

I look forward to working with you, and hopefully to be able to report on progress when we gather at the Regional Committee next year.