Windhoek, Namibia, 
30 August – 3 September 1999

Regional Committee for Africa
Forty-ninth session

It gives me great pleasure to be with you in this beautiful country, and this great continent which is so much at the core of global attention. We are all grateful to the Government of Namibia for hosting this Regional Committee meeting of WHO.

Today I wish to take the opportunity to share with you the direction of work of the World Health Organization after a year of change. You know our mandate, we share the same values and commitment: We are after a better deal for world health. A better deal with the prime purpose of delivering a better, healthier future to all, but especially to the poor.

In order to make a difference to global health, WHO must make a difference in Africa. In aspiring to leadership in international development, WHO must demonstrate real leadership here in this Region.

With a combination of vision, commitment, successful leadership, effective organization, and working together with you, we can achieve notable accomplishments in the years ahead.

If we succeed, many of the world’s poor people will no longer suffer today’s burden of premature death and excessive disability. This will have a direct impact on levels of poverty. But it will not happen by itself. It needs extraordinary efforts by governments, by civil society, by financial institutions and the private sector. It needs a better deal to distribute resources, share innovations and ensure that drugs, medicines and vaccines are available to the people and countries that need them.

Mr President,

For many years you have heard WHO call for Health for All. It is a broad vision of equity and equal access.

Year 2000 is now only a few months away. At least a billion people – over half of whom live in this Region – will enter the next century without having shared in the gains of the health revolution of the 20^th century.

That we have to change. The knowledge which produced the revolution of past decades can still bring the excluded billion into our midst.

Working together more effectively, as one WHO, is key. It goes for all of us: In times of many conflicting challenges we must all learn to focus on the health issues that matter most – and we must reach out and convince our partners to do likewise. We – WHO – cannot do everything, but what we decide to do, we must do well.

We need to bring a new focus to our work in and with countries. We need a sharper focus on how we can make the best use of our scarce human and financial resources. You should be clear about what you can expect from WHO. Together we should be clear about our joint responsibilities. That is part of the better deal.

Let me share with you today our assessment of our work with the African Region, based on four global strategic directions.

First, we have to reduce the burden of excess mortality and disability, especially that suffered by poor and marginalised populations – the excluded billion I referred to.

In many countries in the African Region, five childhood conditions account for up to forty per cent of all healthy life lost. National policies and budgets prioritizing the interventions that we know work well could have greater impact on the health of the poorest – even within existing resource constraints.

This means intensified focus on the main childhood killers – and in addition, special attention to the fight against HIV/AIDS, malaria and tuberculosis.

Of all the health challenges facing Africa, the HIV/AIDS epidemic is certainly one of the most serious and most difficult to combat. Coordinated by UNAIDS, WHO through its Regional Office is helping to build the capacity in countries to face the epidemic. National and international authorities and the donor community are renewing their commitment to a real crisis developing particularly in southern African countries, where life expectancy may have been curtailed by as much as 10-15 years due to the impact of AIDS.

WHO’s commitment to the battle against HIV/AIDS globally is unshakeable and we are fighting it on every front, from issues of blood safety and mother-to-child transmission, to the use of anti-retroviral treatments and the care of people living with HIV, and of course, the dual epidemics of HIV and tuberculosis. We will push for new drugs and eventually the vaccine against HIV. And we will push for every deal that can make these innovations available for all – not least on this continent.

Even without HIV as its deadly ally, tuberculosis is a major global threat to health, and demands an urgent and massive response. Last month I moved all of WHO’s TB control efforts under the single umbrella of the Stop TB Initiative. It will redouble its efforts to bring new partners into the coalition working to control TB, and aims to double the worldwide expenditure on TB control within three years.

I have also requested the Special Programme on Tropical Disease Research to take over responsibility for development of a global TB research agenda that truly responds to the needs of people, families and communities.

In the African Region, we must all to commit ourselves to achieving 100% coverage with the DOTS TB control strategy by the year 2005 – a strategy that was, by the way, born in Africa.

As with our efforts on HIV/AIDS and tuberculosis control, Rolling Back Malaria is a critical element of the better deal for world health. Every year the world’s poor face an increasing burden as a result of malaria. Yet it would be possible to cut malaria-related mortality by half by the year 2010 if existing interventions are used according to available evidence. This goal can be achieved as health services become more focused on helping communities tackle priority diseases.

The global Roll Back Malaria partnership was launched last October, and consolidated in December. In June, partners met in Harare to support the Roll Back Malaria effort in Africa, an effort led by OAU Heads, and spearheaded by WHO’s Regional Office for Africa. Health officials in over 40 nations are now working with other sectors of government, civil society, the private sector, the research community and development agencies, to establish how best to Roll Back Malaria in their countries. They are studying the past lessons of malaria control and examining new concepts, based on recent research and evaluations.

The long-term success of Roll Back Malaria will require better interventions, new preventive measures and treatments. We need to be innovative. New alliances for more effective research and product development, such as the Multilateral Initiative on Malaria, and the Medicines for Malaria Venture, are essential to this success.

The right research, to develop effective and affordable products, must be undertaken now. Action and research must go hand-in-hand. I want to see a well-developed intelligence system that enables the Global Cabinet – where I meet with the Regional Directors – to know where malaria is being rolled back, and where it is not – and where a little more support from WHO would make a big difference.

There is no respite in our other efforts.

We are on the final stretch of the Polio eradication campaign, and we need to spend every day until the end of next year to accomplish that task. A world free of Polio – what a gift to the generations of the next century. Here in Africa we need to put all the pressure we can on the parties to strife and conflict to have full respect for the truce needed in order that every child can be reached.

In the years ahead, we will intensify our work on reducing maternal mortality, a crucially important issue within Africa. More than 20 African nations have unacceptably high maternal mortality rates. To push the agenda on reproductive health forward, WHO has developed a strategy to make pregnancy safer, and a draft has been circulated among our regional colleagues for comments. The Making Pregnancy Safer Initiative will encourage governments and our international partners to ensure that safe motherhood, a matter of social responsibility and economic good sense, is placed high on the political agenda.

Then there is the area of immunization. Over the last year, the issue of vaccines and immunization has been reviewed by WHO with the major partners - Unicef, the World Bank, bilateral donors, and the private sector.

We all agree that, while we already have a range of approaches that work, efforts need to be intensified to improve access to sustainable services, the introduction of new cost-effective vaccines and to accelerate the development for new vaccines especially against HIV, Tuberculosis and Malaria.

In order to achieve this, we have agreed to establish a Global Alliance for Vaccines and Immunization, with participation of all concerned parties, and chaired by WHO in its first two years.

The new alliance will de facto cover the areas of work of the Children’s Vaccine Initiative, which was established in 1992. The CVI co-founders who are part of the Alliance have therefore decided to end the CVI. One of the new financial instruments to help accelerate the efforts is the establishment of a Children’s Vaccine Fund, which is to be located in Unicef.

Mr President,

Let me briefly move to the second strategic direction. Focusing on the things that matter does not just mean diseases. There is also the need to counter potential threats to health that result from economic crises, unhealthy environments and risky behaviour.

I wish to touch upon a threat that is already with us in a big way – an emerging epidemic about to hit the developing world. I am referring to tobacco.

African countries already have too many disease burdens without the threat of a tobacco epidemic. Industry is now focusing its attention and advertising power on the developing world and on Africa - and especially on Africa’s women and children.

We have a real window of opportunity to avoid loading yet another burden on Africa’s shoulders. I have called for concerted regional action to support our global tobacco control efforts. I am pleased to see that the development of a pan-African response to the tobacco epidemic has begun, and will be taken forward at a meeting of francophone African parliamentarians in October. Later that month, we will welcome African representatives at the meeting in Geneva of the working group on the WHO Framework Convention on Tobacco Control.

Still, some say that after all tobacco may be good for the economy because of employment opportunities and tax incomes to the government. But this is indeed questionable. Health is WHO’s business, so we let the World Bank answer – and in their latest report – Curbing the Epidemic – their message is clear: Tobacco is not only bad for health – it is also bad for the economy.

Mr President,

The third strategic focus concerns health systems. WHO must focus on helping countries to develop health systems which will contribute to the reduction of health inequalities in each society, which are responsive to people’s legitimate needs, and which are financially fair.

The challenge is to ensure health care coverage for all. This is the key message of the New Universalism that WHO spelled out in this year’s World Health Report. It means in short that we have to become better at setting priorities.

There will be tough choices: not just in deciding which services governments should cover, but in determining how health care should be financed. Health care has to be paid for – but solidarity through some form of pre-payment system places less of a burden on the poor than systems which rely on out-of-pocket payment. Increasingly, evidence suggests that pre-payment is an efficient as well as equitable financial policy.

As I speak to Ministers and health professionals on my visits to countries and at the Assembly, I hear their many concerns about health systems reform, looking to WHO for guidance. They want to engage us in how to handle the rapid growth of private medical care and to harness the energies of the private sector for public goals. We will respond to that call.

We must be clear about the goals that we expect health systems to achieve, and the means by which we assess their performance. Better health is one measure – but if we are concerned with equity – then we also need to know how health outcomes are distributed in the population.

We need to be able to understand why one country’s health system performs better than an other’s. We must point to our successes in areas such as immunization as pathfinders in addressing more system-wide problems. This understanding – of success, failure and best practice – needs to underpin the new agenda for health systems reform. To indicate the importance of this subject, the whole of the forthcoming World Health Report 2000 is being dedicated to it.

Mr President,

The fourth direction concerns the development agenda itself. I have pledged to do what I can to place health at the core of that agenda – where it belongs as a key to human development and progress.

Let me mention just one area where I propose that WHO be more active and vocal in the years to come. I am talking about debt relief.

The Cologne Initiative for debt relief covers 42 Highly Indebted Poor Countries, of which 34 are in sub-Saharan Africa – representing about three-quarters of the population of 700 million. In many of these countries, life expectancy is not even 50 years, and infant mortality can be over 17 times higher than in rich nations.

The Cologne Initiative is an important step towards draining the debt quagmire, but it is just the basis for further efforts. WHO will work with the indebted countries, the G8, the IMF, the World Bank and others on several fronts.

First, we will argue that debt relief must be viewed in the totality of the resources these governments require to confront urgent social crises, including HIV/AIDS and malaria. New resource flows must come hand-in-hand with debt relief.

Second, we will argue that specific and core health investments must be protected in reshaping the budgets and debt flows. The details of such core investments need further work and tailoring to individual countries, including fair participation by those hardest hit by social crises. In the coming months, I will announce specific steps to take to help ensure rapid debt relief is used efficiently to improve the health of the poorest.

Mr President,
Ministers,

You have to face many players in development – and we all are facing many players in international health. As the lead agency in health with a broad mandate WHO needs to refine its role and see how we can best be of use to our Member States. Let me share with you some of the issues. They will indeed be brought to your attention as we start planning for the 2002-2003 budget. In this process, a key role will be given to the WHO Representative identifying needs with each Member State. Then we will mobilize the whole of WHO to support the implementation of other work programmes that we identify together.

In each area – be it HIV/AIDS, or making pregnancy safer – we need to ask ourselves where WHO’s comparative advantage really lies. Which functions are we best equipped to perform? Which are better left to other organizations or governments? Or where can we call on our collaborating centres? They play a key role. We have revised the procedure for designation and redesignation of collaborating centres, and the new procedures will be submitted to the Executive Board in January.

WHO is a technical agency, not a major donor. We also need to think of ourselves as a catalyst – forging alliances and building consensus in many different contexts – at national and international level. This catalytic role lies at the heart of all our core functions, and will be a dominant theme as we prepare our budget for the biennium 2002-3.

Focusing our work means having clearer priorities. That means in turn stopping some of our current activities, so that we can have a greater impact where the needs are greatest. There is the famous example of how in one country US$ 4.9 million from WHO’s regular budget was allocated to cover the cost of 428 priority activities in 44 different national health programmes. That is not the best way to make a difference and should now be a history lesson.

In too many countries our resources are divided between too many disparate activities, and there is little co-ordination between the activities of the Regions and Headquarters. We are in the process of changing that, and I hope you will support this process.

In contrast to health problems, WHO’s resources will not multiply overnight. There is a need for more explicit discussions with you, our Member States, on "Organizational focus".

A more strategic approach signals a break with past practice in several ways. It will mean a much greater concern for outcomes. We must be able to show that our contribution to national health development delivers results. Results that positively influence the lives of poor people.

I would like to conclude with some comments on the World Health Assembly budget resolution, and the work that is now underway in response to it. The Assembly decided not to compensate us for cost increases. And in addition we were asked to shift resources from so- called low priority areas to high priority areas.

It has been a tough task – but I believe we have found a realistic way forward, one which avoids cutting our key activities.

In reviewing the options for efficiencies, I have looked first at measures that are applicable across the whole of WHO. We are concentrating on cutting our travel bill, for example, and taking a critical look at what we publish and what we procure. Globally, I have decided on a figure for efficiency measures of around $50 to $60 million at this stage, in line of what the World Health Assembly called for. I would ask for your cooperation as Ministers when it comes to focusing the funding that this will free up for priority health areas within your country.

Mr President,
Ministers,
Ladies and Gentlemen,

Let me conclude with some words of admiration.

We are rightfully focusing on Africa’s problems and challenges. The disease burden is often daunting. For the last decades the social sector in Africa has had to do more with less resources. Africa has seen more money leaving the continent to pay for goods and service debt than it has received in aid and for the sale of its products. The average African household consumes far less today than it did 25 years ago. We need to reverse these trends, and you can count on WHO being at your side.

But a story of remarkable African achievement is all too often ignored against the reporting of daunting health challenges. Africa has built a remarkable surveillance system against disease. Africa has paved the way in controlling complex diseases such as onchocerciasis or river blindness. Africa has given glowing examples of how regional cooperation and donor resilience can lead to drastically improved health conditions.

Before the AIDS epidemic so tragically began to erode the health gains made through decades of hard work, infant mortality had been significantly reduced in many countries. Against powerful odds, Africa has demonstrated that the tides of ill health can be turned.

My message today, as it was when I travelled in Africa in April, is to pay tribute to the tremendous efforts that are being made by health workers under difficult conditions. Without the dedicated work of these brave people, the health situation in many African countries would have been far worse. Many other countries can learn valuable lessons from Africa’s innovative health policies and practices drawing on broad networks of community involvement.

Thank you.