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Mr Chairman,
Dr Uton,
Excellencies,
Ladies and Gentlemen:
It gives me great pleasure to be in Dhaka and to attend the
Regional Committee meeting for a Region which faces so many health
challenges, but also a Region where there is so much we can do to give
people the opportunity to live healthy lives.
Year 2000 is now only a few months away and the world is taking
stock. We who devote our work to health can celebrate many remarkable
achievements. But there is also a legacy. More than a billion people
– hundreds of millions of whom live in this Region – will enter
the next century without having shared in the gains of the health
revolution of the 20th century.
That we have to change. With a combination of vision, commitment,
successful leadership, effective organization, and working together,
we can achieve notable accomplishments in the years ahead. The
knowledge which produced the revolution of past decades can still
bring the excluded billion into our midst.
Mr Chairman,
Today I wish to take the opportunity to share with you how I see
the role of the World Health Organization in this major transition.
You know our mandate and I can assure you of our 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.
Such a better deal will matter immensely in this Region, which is
home to a quarter of the world’s population.
As Director-General of WHO, I have seen it as one of my prime tasks
to improve the effectiveness of our Organization’s work. Working
together more effectively, as one WHO, is key. We – WHO – cannot
do everything, but what we decide to do, we must do well. 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. Reaching out to
civil society, NGOs, our UN partners and to the private sector – as
we do it in this region – increases the impact we can make.
Let me share with you today our assessment of our work with the
South East Asia 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 marginalized
populations.
The South-East Asia Region, while containing a quarter of the world’s
population, bears 40% of the world’s total burden of disease.
Communicable diseases are responsible for nearly every second death.
The five traditional child killers bear responsibility for a large
part of this mortality, and maternal and perinatal problems also take
a serious toll on women and infants.
Six countries in the Region have already adopted the Integrated
Management of Childhood Illness, a highly effective strategy to attack
the traditional childhood killers by breaking down the limitations of
single-disease treatment, and to educate health workers and parents to
see their child’s health and nutrition as a whole.
Roll Back Malaria is another example of such a cross-cutting health
initiative. Roll Back Malaria is also a critical element of the better
deal for world health as it engages our partners and mobilises across
societies.
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 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.
Countries in the South-East Asia Region are showing the way in
identifying actions to Roll Back Malaria. They are breaking new
ground. Thailand and Myanmar are working with China, Vietnam, Cambodia
and Laos from the Western Pacific Region to establish the Mekong
Region initiative which will harmonise responses to malaria across
borders and ensure that all adopt consistent strategies and
action.
India, after hosting the South Asia inception meeting, has
initiated pilot studies to assess institutional and political
requirements for rolling back malaria. Bangladesh, Sri Lanka and Nepal
have all indicated their intentions. In all countries, the Roll Back
Malaria movement will be supported by a range of development partners,
and will contribute to measurable reductions in malaria morbidity and
mortality.
Mr. Chairman,
For those of us who work in public health, the horizon can often
seem so far away. The journey to real progress may seem so long and
arduous. We work for decades against diseases which seem to have a
nearly endless ability to escape our efforts to contain them. This
makes me all the more delighted to tell you that we can be just months
away from eradication of one of the greatest disabling diseases of
humankind.
We are making great progress towards eliminating poliomyelitis –
and the progress is mainly made in this Region where, last year, 60%
of all polio cases were reported. Already, Thailand, Indonesia, Bhutan
and Sri Lanka are moving towards being polio free. Myanmar has also
made great progress.
Over the past year, India and Nepal have taken some impressive
steps towards vaccinating all children against polio. The ongoing
series of National Immunization Days is the largest public health
campaign ever undertaken. More than 130 million children are reached
on each of these days. In India alone, an unprecedented 1 billion
doses will be given during the immunization days over the next six
months. These are truly impressive feats of logistics and commitment
by tens of thousands of health workers and volunteers.
Yet, success must not lead to complacency. We need to spend every
day until the end of next year to accomplish the task we have set
ourselves. We are anxiously awaiting detailed plans from Bangladesh,
Myanmar and the Democratic People’s Republic of Korea on their
efforts to improve surveillance and introduce additional rounds of
National Immunization Days. The importance of surveillance cannot be
stressed enough. It is part and parcel of the eradication campaign.
A world free of polio – what a gift to the generations of the
next century! But it will take an extraordinary effort. We need to go
from house to house, from marketplace to marketplace, again and again,
until every single child has felt the drop of the vaccine on his or
her tongue. We may never again have the opportunity to rid the world
of polio forever.
As an example of the kind of synergy we always try to achieve, the
polio vaccinations have been combined with doses of vitamin A.
Globally, 3 million children suffer clinical vitamin A deficiency.
However, an estimated 140-250 million children under five years of age
are at risk of sub-clinical deficiency. These children suffer a
dramatically increased risk of death and illness, particularly from
measles and diarrhoea, as a consequence. By including vitamin A doses
in the polio vaccines, we use resources better and achieve great
health gains.
Contrasting these positive developments is the formidable global
battle against HIV/AIDS. WHO’s commitment to this battle is
unshakeable. 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.
I would like to say some words of praise to Thailand, in
particular, for its comprehensive and courageous approach to the
HIV/AIDS prevention issue. Thailand has been a leader in policy
development for prevention of HIV/AIDS, and it is carrying out a broad
educational campaign. It is also taking a leadership role in
development of an AIDS vaccine, with its third-stage trials, which
could for the first time show us whether a vaccine will be able to
prevent infection.
Through its open and decisive approach to its HIV/AIDS problem,
Thailand stands as an example for the Region and, indeed, the world.
Unfortunately, other countries, including in this Region, continue
to avoid some of the hard decisions of facing up to the HIV/AIDS
pandemic. I want to be frank. By hoping that silence and traditional
values will be sufficient to protect their populations, these leaders
are exposing them to serious risk of mass infection with the
devastating suffering and economic consequences this entails. I have
made this clear to political leaders in my direct communications with
them.
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.
We must all commit ourselves to achieving 100% coverage with the
DOTS TB control strategy by the year 2005. Again, countries in this
Region hold some of the highest numbers of TB patients in the world,
and success here will go a long way to achieving success world-wide.
But DOTS is not enough. Several countries in the Region need to
increase their surveillance for anti-tuberculosis drug resistance. We
are confident we will see more reliable data on this issue in the year
to come.
Mr. Chairman,
In the years ahead, we will intensify our work on reducing maternal
mortality. In many countries in the Region, maternal mortality remains
unacceptably high. In part this results from the long-standing
division of responsibilities between "health" and
"family welfare". We need to sort out such administrative
‘turf’ issues. The health of women must not continue to fall
between the cracks.
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 is placed high
on the political agenda. It is a matter of social responsibility and
economic good sense.
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 have agreed to establish a Global Alliance for Vaccines and
Immunization to push for a renewed effort to develop new vaccines and
to help increase immunization rates all over the world. WHO will be
chairing this Alliance in its first two years.
Let me end by also stressing the critical rising tide of
non-communicable diseases – exposing all countries in this region to
new challenges. At WHO we are building capacity to better advise and
support countries, especially as health sectors have to go through
profound change.
One of the most critical areas that needs our attention is mental
health. The Global Burden of Disease tells us that mental health
conditions are emerging as one of tomorrow’s major public health
concerns, in rich and poor countries alike. We have to rise to
properly face this challenge.
Mr. Chairman,
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.
The issue of unhealthy environments is urgent here in Bangladesh.
Here, a 30-year long successful campaign to ensure clean drinking
water has unwittingly lead to what has been called "perhaps the
largest case of mass poisoning in the history of mankind".
I am talking, of course, about arsenic contamination in the
drinking water. A major obstacle to solving this problem is a lack of
knowledge. We need to find technical solutions to clean contaminated
water, and to find uncontaminated water sources. We need to know more
about the health effects, the size of the population affected and the
severity of the problem, and we need to spread the knowledge we have
to local health officials so they can better detect and eventually
prevent poisoning.
We need to strengthen the focus on how sectors outside the health
sector have a major impact on health. In the environmental field, the
arsenic issue is evident. But so is the dramatic burden of indoor air
pollution, especially exposing millions of women to dangerous
substances. And let me also include the smog seen in too many cities
in this Region.
Talking about air pollution – there is another threat that is
already with us in a big way – an emerging epidemic about to hit the
developing world. I am referring to tobacco.
South-East Asian 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 Asia -
and especially on Asian women and children.
We have a real window of opportunity to avoid loading yet another
burden on Asia’s shoulders. I have called for concerted Regional
action to support our global tobacco control efforts. In October, we
will welcome South-East Asian representatives at the meeting in Geneva
of the working group on the WHO Framework Convention on Tobacco
Control.
Still, some continue to say that after all tobacco may be good for
the economy because of employment opportunities and tax incomes to the
government. They are making a big mistake. 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 Chairman,
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.
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 a
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 need to be able to understand why one country’s health system
performs better than another’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 Chairman,
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. Health is key to human development and
progress.
Research, some of it carried out here in Bangladesh, illustrates
clearly how illness is not only a result of poverty – but can also
cause it. What we are increasingly seeing is that improved health
conditions can turn this vicious circle around. Healthier, better fed
people are more productive and can focus their resources on improving
their livelihood. It is no coincidence that marked improvements in
health status and life expectancy preceded the 20-year period of
strong economic growth in East and South-East Asia. One of this Region’s
own leading economists, Nobel Laureate Amartya Sen, has eminently
shown how closely linked health is to progress and development.
The challenge for those of us who are gathered here today is to
turn this knowledge into concrete policies and to execute them. Our
responsibility is to see that enough resources are spent on health -
and spent in an equitable fashion – so that the poor are given their
chance to join the rest of us in enjoying the health achievements of
the 20th century.
Mr Chairman,
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 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 where can we call on our collaborating
centres?
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 coming
budget.
Focusing means having clearer priorities 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 coordination between our
activities. We are in the process of changing that, and I hope you
will support this process.
Mr. Chairman,
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.
You know where I stand: WHO’s most important tasks lie in
countries, and our budgets and joint efforts will reflect this. The
efficiency shifts we have to make in the 2000-2001 budget will not
lead to a reduction in spending at the country level. But throughout
WHO, we can become more efficient.
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. I know that
procurement is important for many countries. But even here, there
should be scope for switching from low to high priority areas.
Globally, I have decided on a figure for efficiency measures of
around $50 to $60 million at this stage, in line with 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 Chairman,
Excellencies,
Ladies and Gentlemen,
This is a Region of rapid change. In every country, we are facing
new challenges, both political, cultural and economic. The answer to
fundamental questions such as the durability of popular democracy and
the peaceful solution of disputes in a nuclear age are highly relevant
to the people and nations of the South-East Asian Region.
Conflict and strife are the worst enemies of health. Apart from the
casualties, armed conflict can ruin decades of progress in health in a
matter of days. This is as true in the high mountains as it is in the
lush archipelagos of this Region. We must not let conflict ruin the
progress your people have achieved through decades of hard work.
Respecting fundamental human rights means securing people’s right to
health.
We should also remember that essential lesson of Dr Amartya Sen:
Democracy and a free press help prevent famine. These two basic
institutions also are crucial in improving health and reducing
poverty. Only when there is a commitment among the leaders to respect
the will and the basic rights of its people can real development take
place.
This Region holds the key to answering the question of eradicating
poverty and creating a world where all its citizens enjoy the basic
human rights of health and nourishment. The world’s eyes are on you.
I am confident that you will succeed, and WHO stands ready to support
you.
Thank you. |
