Mr
Chairman,
Ministers,
Dr Uton,
Excellencies,
Ladies and Gentlemen,
This is an important meeting – the first in the new millennium and
one held at a time when there are both great opportunities and great
challenges in front of us.
Most often, turning points in world history are only reported in
retrospect. Events that may seem important at the time quickly fade into
oblivion. Momentous achievements may be inconspicuous at the start. Only
years later can one see a pattern and identify the starting point for
fundamental change.
I begin today’s address to you by explaining why - for me - this
year will be seen as a turning point for improvements in health for all
the world's people.
I have always believed that it is difficult to make real changes in
society unless decision makers fully appreciate the economic dimensions
of the issues affecting their people. This is how thinking about the
environment has shifted. It used to be a cause for convinced and
marginalised greens: it now commands the attention by all the major
players within national and international society.
When we last met, in Geneva in May, there were already several
promising signs that the world's decision makers saw a new and important
linkage. They recognised that health is a central factor in economic and
social development. Improving health is key in breaking the debilitating
cycles of poverty .
Since then, we have seen signs that the world is willing and eager to
act. In July, the 13th International AIDS conference in
Durban established new norms: that all people living with HIV/AIDS
world-wide should have access to adequate care, and that everyone
everywhere should be in a position to prevent themselves from HIV
infection.
Also in Durban, the European Commission announced renewed support for
the fight against HIV/AIDS, malaria and tuberculosis. Later the same
month in Okinawa, I joined leaders of the G8 nations as they met with
leaders of key G77 countries, including the Prime Minister of Thailand.
Subsequently the G8 called for a step change in
international health outcomes. They 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. You also took part in a range of national, regional and
international conferences - on conditions that disproportionately affect
the world's poorest people such as malaria, tuberculosis, HIV.
Mr Chairman,
While health problems have dominated the headlines, we are also on
the brink of several important achievements.
I speak first about Polio and Leprosy. A few years ago, Polio was one
of the leading causes of disability. We are now very close to
eradicating this disease. World-wide, polio transmission now only occurs
in 30 countries. In this region you have made extraordinary progress.
Still, the closer we are to success, the harder we need to work. We can
achieve full eradication if we work together. We need to ensure that
immunisation days are of the highest possible quality, and that we reach
every child. We also need to maintain and improve the capacity and
quality of surveillance.
Within the next year or two, we expect that the global target of
eliminating leprosy as a public health problem will be achieved. 12
countries in the world now carry 90% of the disease burden: these
include India, Nepal, Myanmar and Indonesia. The leaders of these
countries have shown political courage in backing intensive efforts to
eliminate this disease. I encourage them to maintain this commitment and
ensure everyone concerned does what is necessary to ensure successful
elimination of the disease.
HIV/AIDS is a global pandemic. Recently, the focus has been on the
tragedy unfolding in Africa, as countries there are devastated by HIV
infection rates of up to 30%. Yet, lower infection rates in this region
should lead no-one to complacency. Many of the elements that have led to
the disastrous infections levels in part of Africa also apply in parts
of Southeast Asia. Unless we act wisely and forcefully to prevent spread
of HIV, we could face a economic, social and human disaster of enormous
proportions.
On the issue of HIV/AIDS care, there has been change. Over the past
few months, governments and other partners have worked together to
enable many more people living with HIV to access the care they need.
Rhetoric is becoming reality.
Following the World Health Assembly in May, WHO - together with
UNAIDS, and other UN agencies - has pursued its mandate and progressed
in a 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 other global and regional
partnerships against AIDS. Efforts are initially being taken forward in
Africa, but they will move elsewhere soon afterwards, and swiftly lead
to some real change.
Several other priority health problems are now being addressed by
partners working together in new and effective ways. In my speech to the
World Health Assembly in May, I presented 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 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 Global Fund supports programmes that are designed by countries.
It contributes to the sustainability of national health systems, and to
synergy between immunisation services and other health system
components. For example, with the polio eradication initiative. GAVI
partners are fully committed to the effort to eradicate polio.
Similar principles are being applied as we join forces to roll back
malaria, stop TB and make pregnancy safer. Countries are at the hub of
each partnership, with partners reflecting shared goals, strategies and
values. We try to respond to people's needs in ways that reflect the
best available evidence. Resources are used and accounted for with care,
so that those who provide funds are confident that they are used to best
effect. The process of implementing country-level partnerships provides
an opportunity to assess the current situation. It leads to more
collaborative and sustainable approaches to building more effective
health systems. It gives partners an opportunity to re-engage and
re-activate their financial and technical contributions to countries’
health services.
This new approach to international health action is setting the stage
for a reform in development funding. A reform that puts countries
clearly in charge and in control of health programs and future
opportunities for funding and support.
It has encouraged WHO to search for new roads to scale up the
global effort to tackle the infectious diseases particularly affecting
the world's poorest people: HIV/AIDS, malaria, TB, diarrhoea and other
diseases of childhood.
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 global 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 build on the best achievements
of 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 new
mechanisms.
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
there is accountability.
Mr Chairman
A renewed effort to address diseases associated with poverty should
contribute to the development of health systems.
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 better 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. Discussion about the concepts and analyses in
the World Health Report has given us all new insights. 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 SEARO, four countries are already participating in the
Initiative.
Mr Chairman
In many countries, 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 non-communicable 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.
As I saw in Bangkok earlier this year, you are making it happen when
it comes to tobacco. 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 Chairman,
The South East Asian Region is unfortunately no exception to the fact
that all of the WHO regions have over the past year been heavily
affected by disasters and crises, both natural and man-made.
Cyclone Orissa has had a devastating impact in India. Bangladesh
faces regular disruption from cyclones and floods. Sri Lanka is
continuing to experience armed conflict in the North. The Democratic
People’s Republic of Korea is the subject of United Nations System
Inter-Agency Consolidated Appeal. Indonesia is seeking to cope with
sectarian violence in some parts. And we are all working to achieve a
succesful transition in East Timor.
What lessons can we draw? The first is that in situations of
sustained conflict, health can serve as one of the bridges to peace. As
we saw in the course on this subject held in Sri Lanka earlier this
year, health professionals can make a contribution. to peace building
and conflict reduction. I hope that health can be one element in taking
forward the discussions between North and South Korea.
The second is that there is no short cut to dealing with emergencies.
Spending on preparedness for disaster may seem like resources not being
fully used, but the lesson is always that each of our countries will be
affected one day in one way or another. There needs to be focus on
training, hospital and health services planning, and stockpiling of
supplies.
WHO has an important function to perform before,
during and after emergencies. Our role is to assist nations with
accurate assessments of damage and needs. It is to ensure the best
possible coordination of agencies involved, and to make sure that
long-term health perspectives are built into the emergency relief, so
that money spent on an emergency can benefit long-term development
needs. And afterwards, we in WHO need to help countries share their
experiences.
Mr Chairman,
Given the major 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
biennia.
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.
The proposals for 2002-2003 also follow the decision of the Health
Assembly in 1998 to reallocate some regular budget resources between
regions. In line with the flexibility given by the Health Assembly, I
have however proposed a somewhat lower level of reallocation in the next
biennium. This will benefit those regions, like SEARO, which are
contributing considerably to the transfers.
There are also some changes in the balance of regular budget funding
within the Region. As most delegates would be aware, over the past few
biennia, the programme budget implementation rate in the South-East Asia
Region has been the slowest compared to other Regions. In keeping with
the budget reform process underway in WHO, we need to look at this issue
objectively.
The facts are that some countries in the Region are not able to fully
absorb their budgetary allocations in time. Often, towards the end of
the biennium, this leads to activities that are not really of priority
interest, either to the countries or to WHO. In the process, the quality
of programmes also suffers. What we need to ensure is that priority
concerns are addressed seriously.
This can be done by strengthening the Regional Office and
inter-country programme to enable more effective and timely technical
support being extended to the countries. This needs a rationalization of
the regional budget to provide for an increase the Regional Office and
inter.country programme allocation. Not for extra staff. Not for extra
travel. Not for more meetings. But to increase collaborative activities
in the established WHO priority areas at the country level.
All of this will also give greater importance to the need to focus on
a strategic approach to our work in countries. You have made great
progress in developing a strategic approach within SEARO. Defining clear
priorities helps to ensure that there is a better match between country
needs and globally agreed strategies.
Mr Chairman,
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 all achieve and what will be necessary for us
to succeed.
First of all, we need to see increases in development assistance from
bilaterals and development banks and complemented by resources from
other donors such as the foundations. Their contribution should add to
and not replace existing financial commitments.
Secondly, the demand for improved results and measurable outcomes
will be relentless. Funding will dry up unless it can be shown that
increased activities have led to improved indicators within a relatively
short period of time.
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. |
