Ouagadougou, Burkina Faso,
28 August 2000

Regional Committee for Africa - Fiftieth session

It gives me great pleasure to be with you in this proud and strong country. We are all grateful to the Government of Burkina Faso for hosting this Regional Committee meeting of WHO.

Most often, turning points can only be found in retrospect. Events that may seem important at the time, may quickly fade into oblivion, while momentous achievements may start out as inconspicuous. Only years later can one see a pattern that explains the starting point for fundamental change.

Allow me to begin today’s address to you by briefly explaining why I believe this year is such a turning point for better health in Africa.

I have always believed that it is difficult to make real changes in society unless the economic dimension of the issue is fully realised by those who make decisions. This is what took the environment from being a cause for the convinced and marginal green to becoming an issue for real societal attention by major players.

When we last met, in Geneva in May, there were already several promising signs that the world is taking in the knowledge of health as a central factor in economic and social development. Improving health is key in breaking the debilitating cycle of poverty.

Since then, we have seen signs that the world is willing and eager to act. In July, the Durban conference established as a norm that all people living with HIV/AIDS world-wide should have access to adequate care and that prevention activities also should be universal.

Also in Durban, the European Commission announced a new focus to fight HIV/AIDS, malaria and tuberculosis. Later the same month in Okinawa, the G8 countries agreed to specific targets to reduce the tolls from malaria, HIV/AIDS, TB and children’s diseases by 2010.

These announcements are fruits of the hard work carried out by you, your political leaders, and thousands of other health workers in this region, before, during and in the aftermath of the conferences on malaria in Abuja in March, The OAU meeting in Lomé and the international Durban Conference in July. I would like to pay a particular tribute to President Obasanjo of Nigeria for his relentless work to push health’s and Africa’s cause on the international agenda.

Mr President,

While health problems have dominated the headlines, Africa has quietly arrived on the brink of a phenomenal achievement. The "Kick Polio Out of Africa" campaign launched in 1996 has brought the number of polio cases to an all time low in our countries.

This disease, which until just a few years ago was one of the leading causes of disability, is now nearly eradicated, with only 30 countries remaining infected world wide. Eighteen of the highest risk countries, however, are in West and Central Africa. We can achieve full eradication if we join together to synchronize our National Immunization Days (NIDs) this fall, and again in 2001. We also need to ensure they are of the highest possible quality, reaching every child.

For logistical and epidemiological reasons, this year, the weeks of 16 October and 20 November are the optimal time for these NIDs rounds. Our joint leadership during the coming months is key to forever stopping polio transmission in Africa.

In my speech to the World Health Assembly in May, I discussed the Global Alliance for Vaccines and Immunization - GAVI - as a prime example of a new model for partnerships in international health. During the Assembly, delegates from the 74 eligible countries received guidelines for the submission of proposals to the Global Fund for Children’s Vaccines, and I encouraged a quick response so that support could start to flow to countries by the end of this year.

This urge for expediency was heeded .. and how! Twenty four countries submitted proposals to the GAVI Secretariat in the very tight timeframe required. Of those proposals, an independent review committee found that 13 countries - nine of them in Africa - were ready to receive vaccines and/or direct financial support, with disbursements starting already in September. The rest will be submitting additional information for the next round so that they too can receive support as soon as possible. And another 20 or so countries are expected to submit proposals during the next review in October.

The urgency of the response from countries gives great optimism. Never before has this approach been tried - issuing an open call to eligible countries and letting the countries design their programs. Never before has there been so much international support for such a promising new approach.

Launched with an initial investment of $750 million from the Bill and Melinda Gates Foundation, the Fund has also secured substantial commitments from the Norwegian Government, the United States, and the United Kingdom. Other governments - the Netherlands and Canada, for example - have also expressed interest in contributing to the Fund. And approximately 98% of current Fund resources will go directly to countries.

Despite the unorthodox approach, sustainability, and synergy with other health components, is being maintained. For example, with the polio eradication initiative. The GAVI partners are fully committed to the effort to eradicate polio. In countries where there is still wild polio virus, it is important to maintain focus, to continue to prioritize eradication efforts. For this reason, we have added another round of proposal reviews in January of 2001, so that countries planning NIDs in the Autumn will have more time to prepare their GAVI proposals.

For it is the process, and not just the end result, that is one of the most fascinating and encouraging aspects of GAVI. We have been hearing from countries that the process of preparing country proposals is giving them the opportunity to critically assess their current services and to identify strategies to adopt more collaborative, sustainable approaches to the integration of immunization activities in the health service. Many GAVI partners in countries view the GAVI proposal process as an opportunity to re-engage and re-activate their financial and technical contributions to countries’ immunization services.

If it continues in this encouraging manner, GAVI could set the stage for a massive reform in development funding. A reform that puts countries clearly in charge and in control of their programs and future opportunities for funding and support.

Over the past few months, activities have intensified to turn the demand for access to care for a wider number of people living with HIV from words to reality.

Following the World Health Assembly in May, UNAIDS, WHO and other UN agencies have progressed in our dialogue with the pharmaceutical industry. A contact group due to hold its first meeting next month will bring together Member States, UN agencies and representatives of the industry and NGOs, in what we hope will be a fruitful exchange of information and views.

The initiative is being harmonized with the International Partnership against AIDS in Africa. A number of countries signalled their interest in participating in a first round of trials in the initial joint effort to drastically improving access to care.

Our aim is to launch these concrete country projects by November and we are confident that we can move swiftly toward some real change.

Also in the area of mother-to-child transmission there is exiting progress. In October we will review new data on mother-to-child transmission of HIV and the effectiveness and safety of optional drug regimens. We expect this meeting to make recommendations for drug use and feeding practices that can substantially reduce the transmission rates in Africa. It is high time. We have no time to lose in order to save thousands of babies from HIV infection.

River blindness in Africa is being eliminated as a public health problem and as an impediment to socio economic development by the two WHO-executed intercountry programmes: the Onchocerciasis Control Programme in West Africa which will end in 2002 and the African Programme for Onchocerciasis Control planned to continue until 2007.

I would like to emphasize that the successes of the two Programmes would not have been possible without the active involvement of the participating countries. As OCP is drawing to a close, this involvement will be particularly important in terms of continued surveillance to detect and control any recurrence of the disease. Similarly, participating APOC countries will eventually need to make allowance for reinforced surveillance and control of recrudescence, once the elimination stage has been reached.

I am taking this opportunity to stress the importance of such continued surveillance and control, and I have no doubt that the countries concerned are fully aware of this so that we together can ensure that onchocerciasis will remain a disease of the past on the African continent.

Over the past year WHO has searched for new roads to achieve real progress in the fight against the main infectious diseases: HIV/AIDS, malaria, TB and several childhood diseases.

The point of departure is clear: Infectious diseases are today responsible for around 45% of the mortality in developing countries. Approximately half of infectious disease mortality can be attributed to just three diseases - HIV/AIDS, TB and malaria. They cause over 300 million illnesses and nearly 5 million deaths each year - and for none of them is there an effective vaccine to prevent infection in children and adults.

They penalise poor communities, as they perpetuate poverty through work loss, school drop-out, decreased financial investment and increased social instability - at staggering social and economic costs. For example, a recent study has shown that Africa’s annual GDP would be up to $100 billion greater today if malaria had been eliminated 30 years ago.

We have drugs that can cure malaria, TB and the opportunistic infections associated with HIV. We have bed nets and condoms that can prevent malaria and HIV infection. Yet for far too many people - especially poor people - these lifesaving measures are unavailable, unaffordable, or improperly used.

At the same time , some of the drugs we have are losing their effectiveness - slowly but surely - because of the relentless development of antimicrobial resistance. Windows of opportunity to cure these infections are therefore closing. The research and development pipeline has not kept up with needs, and new drugs and vaccines have been slow to appear on the market.

WHO will be focussing on the need to increase access to essential drugs and prevention methods such as bed nets and condoms. We remain committed to working with governments and with our development partners to explore all possible mechanisms to expand financing, ensure affordability, and promote effective use of essential drugs and preventive health technologies.

An immediate and large scale action is urgently required. There are differences in the strategies and approaches for HIV, TB and malaria. However, for each the locus of prevention and care is most often at the home - not in established health services. Governments have a central role to play in setting the environment and providing leadership. But action to turn back these three diseases will also require the efforts and innovation of a wider range of partners.

To achieve the targets of cutting TB and HIV/AIDS mortality by 50%, and HIV infection rates by 25%, we need a new mechanism to take proven, effective interventions to scale.

It is an immense challenge for all of us, but the rewards are also promising. It means we all will have to think new - make new alliances and improve our performance. We must also draw the best lessons from existing experiments, such as GAVI and the work in Stop TB, Roll Back Malaria, as well as from the successes against polio, onchocerciasis, leprosy, guinea worm and lymphatic filariasis.

The G8 have embraced the overall targets and the concept of a massive effort against infectious diseases. The European Commission will convene a roundtable at the end of September and the G8 are planning a meeting in early December to discuss how to move further towards such a new mechanism.

If our joint efforts are to succeed, we must have channels through which resources for health reach those who need them, and systems for ensuring that resources are used effectively and equitably, and that they are accounted for.

A renewed effort to address diseases associated with poverty can contribute to health systems development.

The management of any health system is a balancing act: coping with competing demands, matching resources to need, and attempting to ensure that all have access to the care necessary for good health. The balancing act is particularly difficult for those countries whose per capita spending on people's health is less than, say, $100 per person per year. It is even more difficult in settings where the institutions of government are undermined - or even paralysed - by conflict.

We need to find ways to assess the performance of health systems that reflect the three purposes: improving health outcomes, responding to the people and fairness of financing. As you know, this year, WHO attempted such a first assessment, using the limited data available, in the World Health Report 2000.

Not surprisingly, the Report proved controversial. Its publication led to wide-spread discussions both in national and international media and among health professionals about how to assess health systems, as well as a more fundamental debate about what makes a good health system.

This debate is good. The debate on the World Health Report has added new insight. To continue the global dialogue on how to get the most out of health systems, we will work closely with Member States to make better uses of existing data sources and where necessary to collect new information so that the annual assessments of health systems performance are based on the best available evidence.

Even more importantly, this wave of interest in improving performance offers a unique opportunity for many Member States to assess the future of their health systems, and efforts that could be made to improve performance.

WHO is aware that there are no quick and easy answers. And we know that even when there are some agreed basic policy directions, for example expanding pre-payment, it can mean hard work to put them into practice.

In response to numerous requests, WHO will be working closely with a number of Member States in an Initiative to Enhance the Performance of Health Systems to apply the new WHO assessment framework at national and also sub-national levels; to use this analysis as an aid to national policy formulation; and to work together to facilitate positive change. Within AFRO, five countries are already participating in the Initiative.

In Africa, the focus of our attention is clearly on HIV/AIDS, malaria and on other infectious diseases. Yet, the rapid shift of the burden of disease from infectious to noncommunicable diseases will seriously challenge health care systems in the near future and difficult decisions will have to be taken.

For most conditions, there is a lag between exposure to risk and visible outcomes, but policy decisions to deal with this shifting burden of disease is required now. Based on the evidence, global tobacco control is a key priority area. During the next 12 months we will also be looking at a vastly neglected area public health. I am talking about mental health.

Next year, mental health will be the focus of World Health Day on April 7. No country and no community is immune to mental disorders and their impact in psychological, social and economic terms is huge. Yet, societies raise barriers to both care and the reintegration of people with mental orders. What makes our task doubly urgent is that there is no reason for inaction - much less exclusion. World Health Day, the World Health Assembly in May 2001 and the World Health Report 2001 - all will focus on mental health. Together, we will find solutions and strive to make the necessary change.

In the case of tobacco, you are making it happen. WHO is at the front of this global public health struggle. We are not interested in tobacco wars. We want tobacco solutions.

In October, we will begin the negotiations on the Framework Convention on Tobacco Control; this will be the first time that the public health community has led treaty negotiations. The process we set in motion has already fostered a global debate and pushed countries as well as tobacco companies to think about their actions from a public health perspective. The success of the FCTC will depend on our ability to link compelling data to robust decisions.

First, there will be two days of public hearings in Geneva. We will listen to the views of all interested parties, including the tobacco producers and the industry as we prepare to write global rules for tobacco control. This is an occasion for everyone interested to contribute to a global tool for public health.

Mr President,

Given the challenges that face us all - governments and technical agencies - how will we respond, and what can you, our Member States, now expect from WHO?

WHO continues to have a unique role. At all times we pursue the best interests of our constituency - the optimum health of all the people within our 191 Member States.

At all times we try to ensure that we are guided by the best available evidence - based on the careful analysis of experience, on the results of relevant research.

The clearest reflection of how WHO is changing to serve Member States better is the upcoming budget, which you will discuss later this week. The Programme Budget 2002-2003 is a key instrument for advancing the process of change and reform in WHO. Both in its content and in the way it is being prepared, it marks a significant departure from previous bienniums.

The budget is a manifestation of the new corporate strategy, which sets out the ways in which WHO’s Secretariat intends to address the challenges of rapid evolution in international health. The programme and budget for each area of work has been worked out through an Organization-wide process, jointly between staff from Regional Offices and from Headquarters.

Thirty-five areas of work have been identified for the whole Organization and constitute our common building blocks. In the process, we clearly identify the 11 priorities endorsed by the Executive Board and have moved additional resources to those priorities.

There is a substantial increase proposed in the funds allocated for the African Region. This reflects the substantial needs in this Region. Reading the budget, it is important to keep in mind, however, that WHO is not a fund. We are a service institution for health.

The new approach to budgeting and planning has particular significance for our work in countries. We want to facilitate a strategic approach to the development of WHO's country co-operation. Defining clear priorities will help to ensure that there is a better match between country needs and globally agreed strategies. We will be discussing with countries also, how to focus better on country co-operation.

Mr President,

We are seeing a change in perceptions. Health is big news. Health is accepted as a central and necessary element in reducing poverty and ensuring economic growth and social progress. There is movement among donors to allocate more money towards interventions that will fight diseases. There is a growing realization that we need international agreements and co-operation to fight threats to health, such as from tobacco. In short - health has been placed at the centre of the development agenda.

The first decade of this century can become the one in which the world’s two billion poorest can share in the health revolution.

But there is nothing irreversible in this process. We need to continue our hard work to maintain the momentum. The tiniest sense of complacency may turn health’s central role in development from a permanent paradigm shift to little more than this year’s fashionable theory.

We are on the brink of seeing real and substantial gains for the health of the poorest, but to do so we need to have realistic perceptions of what we can achieve and what will be necessary for us to succeed.

First of all, we have every reason to request, but not realistically to expect dramatic increases in development assistance from the world’s major donors. The shift in resources may be more a shift within existing or slightly expanding budgets than a large windfall from the increasing wealth of the richest nations.

Secondly, the demand for improved results and measurable outcomes will be relentless. Those that can not show that increased activities have led to improved indicators within a relatively short period of time, will find that funding will dry up.

Thirdly, of course, the challenge is more than anything for developing countries themselves. A new focus on health will put increasing demands on countries own funding, on absorption capacity, and on governance. To make substantial and lasting improvements to health, people themselves and their governments will always be the main driving force.

Let us work together to grasp this opportunity. Let us make this decade the decade that spread the health revolution to all.

Thank you.