It is a great pleasure for me to be in Beirut and to be with you today. I recall with gratitude the very warm welcome I received nearly eighteen months ago when I came here to attend the WHO Regional Committee meeting shortly after becoming Director-General.

I would like to thank the Minister of Public Health, Dr Karam, for his invitation to participate in your work. I want also to take this opportunity to show my appreciation for the efforts of Dr Karam and the Lebanese Government to develop the health system in Lebanon, and in particular to bring support to the most vulnerable elements of the population.

It is always very welcome to support discussion and cooperation amongst our Member States. Your Council has Members from two of our WHO Regions, but with many common interests, and I hope to learn from your experiences and in turn build this into our programme development.

You have a very broad and forward-looking agenda. I look forward to taking part later in the session on smoking control. At the present session, the theme is reform of the health sector and I would like to speak about health systems in this context.

Back in 1998, when I addressed the Regional Committee here, I said the following:

"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 is under pressure?

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 must always be there, ready and able to assist you, and to share with you the experiences gathered through different models applied in various countries"

Since then we have been working to build up our ability to assist countries in this. We are seeking to develop country strategies that better integrate the work of all levels of the Organization .

WHO continues to work with Member States to establish strategies and best practice for tackling major health issues. At the moment we are concentrating on polio elimination, as well as Rolling Back Malaria, Stopping TB, and Making Pregnancy Safer. In all this work, WHO country, Regional and HQ offices work as one. Political commitment to strategic criteria in these areas is vital. We will help broker the commitment and the mobilization of resources.

To ensure that benefits reach people in need, health systems have a critical role in our overall work. Health systems have a continuing responsibility to people throughout their life-span, from the newest addition to our families to the oldest members of our families. They are crucial to the healthy development of individuals, families and societies everywhere.

Profound political and economic changes of the last 20 years or so have changed the context in which health systems function. These changes have included the transformation from centrally planned to market oriented economies, reduced state interventions in national economies, fewer government controls, and more decentralization.

Ideologically, this has meant greater emphasis on individual choice and responsibility, and sometimes lower expectations about what governments should do.

But at the same time people’s expectations of health systems are greater than ever before. Almost every day we learn of yet another new drug or treatment, or a further advance in medicine and health technology. This pace of progress is matched only by the rate at which the population seeks its share of the benefits.

The result is increasing demands and pressures on health systems, including both their public and private sectors, in all countries, rich and poor. Clearly, limits exist on what governments can finance and on what services they can deliver. This, everybody realises. But many countries have not made the difficult choices needed to ensure that the services that are provided must be shared by all.

The result is a widening gap between the services that are available to the rich and the middle class, and those that serve the poor. In particular, poor people cannot access the services and medicines they need. Left unchecked, market forces tend to reinforce a swing in resources towards those who can pay the most. Government policy too often becomes ad hoc, accepting increasing inequalities as a fait accompli.

There is now a need to stimulate public policies which recognise the limits of health systems – and recognise that if services are to be provided for all, then not all services can be provided.

This means tough choices. But how can we make the right choices, the fairest choices, on behalf of the population? I believe the answer lies again in our commonality – in agreeing basic goals for our health systems – and finding common paths towards attaining them.

I would like to share with you a preview of the forthcoming World Health Report, which will be published in a few weeks’ time and which is devoted entirely to improving health systems performance. This report identifies three common goals:

• improving health,

• responding to the legitimate expectations of the people,

• and assuring fairness of financial contribution.

Progress towards these goals depends crucially on how well health systems carry out four vital functions examined in the report. These are service provision, resource generation, financing and stewardship. The report will place special emphasis on stewardship, which has a profound influence on the other three, and which I believe is of special relevance to all of us here today.

I say this because the ultimate responsibility for the overall performance of a country’s health system lies with government, which in turn should involve all sectors of society in its stewardship. The careful and responsible management of the well-being of the population – stewardship – is the very essence of good government.

Government also has the responsibility of assuring that the financial burden related to health care is distributed in a fair manner. In particular, people should not become impoverished because they take care of their health. Solidarity in financing means that those who are healthy at a given point in time help to pay for the care of those who are sick. This is a fundamental principle of justice – and it can only be attained through the leadership of governments.

More generally, governments have the crucial role of establishing a method of financing that will assure access for everyone to essential health care.

All of this gets translated into good health system performance. Until now, many of the questions about performance have had no clear or simple answers – partly because there have been few reliable methods for measurement. Building on a valuable body of previous work, the World Health Report will introduce the "WHO Health System Performance Assessment Framework".

This is a set of powerful and exciting new tools. It is a framework to help countries measure their own health system performance, improve it, and thereby respond better to the health requirements and expectations of the people they serve and represent. The framework makes it possible to analyse and synthesise a wealth of information on health systems. Its summary is a performance index, which again could trigger a great amount of exciting new work. The index will be a regular feature of forthcoming World Health Reports, and will be expanded, improved and updated every year.

I believe policy-makers need to know why health systems perform in certain ways and what can be done to improve the situation.

Comparing the way the different functions of a health system are actually carried out provides a basis for understanding variations in performance over time and among countries. WHO will be offering you an improved framework for assessing health system performance and understanding the factors that contribute to it.

This is important. If health systems fail to serve populations in an efficient and fair way, the result is very large numbers of preventable deaths and disabilities. There is unnecessary suffering; injustice and inequality. The impact is most severe on the poor, who are driven deeper into poverty by lack of financial protection against ill-health. The difference in performance among health systems are creating a gap in health indicators – even among countries at similar economic income levels.

Undoubtedly, many of the concepts and measures used in our framework will require refinement. All of us can work together to develop more and better data on goal attainment and on health system functions.

But already there is much to be learnt. The World Health Report will present the best available evidence to date. It will push forward national and global development of skills and information. It will build a solid body of evidence on the levels and determinants of system performance. It will provide a basis for improving their operation.

"Improving performance" are therefore the two most important words of my message today. They represent our common goal. The overall mission of WHO is the attainment by all people of the highest possible level of health, with special emphasis on closing the gaps within and among countries.

Our ability to fulfil this mission depends greatly on the effectiveness of our health systems – and strengthening those systems is one of WHO’s four strategic directions. It connects very well with the other three: reducing the excess mortality of poor and marginalized populations; dealing effectively with the leading risk factors; placing health at the centre of the broader development agenda.

I hope WHO’s evolving work on health systems will help you and policy-makers everywhere to weigh the many complex issues involved, examine options, and make wise choices. Substantial gains will be possible for all countries, and the poor will be the principal beneficiaries.