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Thank you, Ambassador Akram,
Good morning everyone. I am really pleased to
welcome you: thank you for finding the time to be here.
Today we can all see how health issues are
increasingly of global concern. As people and goods travel around the
globe in ever-increasing volumes and speed, so do bacteria, viruses
and lifestyle patterns which influence health. Rift Valley fever in
Saudi Arabia and West Nile fever in the US, polio in Cap Verde
and Bulgaria and tuberculosis almost everywhere - these are just a few
examples of how infectious diseases spread around the globe. So do
tobacco-related diseases, driven by unrelenting marketing efforts to
replace reduced markets in the US, Japan and Europe. Diabetes and
heart disease also spread as far and wide as to Micronesia and the
slums of Lagos, far beyond those affluent in industrialized countries
whom such diseases were first associated.
Global issues demand a global response - begging
novel and innovative ways of working for us in health.
In addition, a significant increase in the
occurrence and impact of conflict and of natural disasters has
highlighted the need to protect health in complex emergencies.
For all these tasks, the world is increasingly
turning to international solutions, but it is also demanding greater
coordination between those who implement them. Reform in the United
Nations system aims to make organizations more responsive to the needs
of Member States, and to provide a rallying point for achievement of
the International Development Goals. This calls for more emphasis on
effectiveness through intergovernmental means, collective action, and
new forms of partnership. And those within the partnerships seek
guidance from UN specialized agencies, such as the WHO.
There are similar changes at country level. The
role of the State in many countries is evolving rapidly, and the
private sector and civil society are emerging as important players in
health. In the developing world, a growing number of international
organizations and financial institutions, private foundations and
nongovernmental organizations are active in national health sectors.
World-wide, people’s expectations of health care services are
rising. As a result, health systems are becoming more complex and more
difficult to manage. Ministers of Health and their partners in civil
society and the private sector want to know what WHO recommends as
best practice for health policy, for healthy behaviours and for health
services.
WHO is being asked to do more and more against this
background of profound social, political and economic transformation.
The demands on WHO are set to increase even
further. During the last few years, world leaders have focused on the
importance of people's good health as a pre-requisite for reduction in
poverty and improvements in well-being. Over the past twelve months,
we have seen this realization converted into action. Spearheaded by
the growing call for scaled-up responses to the HIV/AIDS pandemic,
national leaders, their peoples, and civil society at both global and
community levels are demanding that more resources be spent on health;
that new and more effective ways be found to reduce the burden of
diseases that perpetuate poverty; and that access to drugs and other
important commodities be widened.
The governments of industrialized countries,
foundations, development banks and others who contribute resources
have committed to renewed action, responding with new strategies and
with offers of additional resources for investing in equitable health
outcomes. Through their ongoing efforts to create a Global AIDS and
Health Fund, the industrialized nations have embarked on perhaps their
largest and most important partnership yet - with each other, with
financial institutions, with the UN system and with developing
countries and civil society.
In this situation, the experience and expertise of
the World Health Organization is crucial. Our staff - at country,
regional and global levels - have been asked to advise on what this
scaling up might mean in practice. Within the world's poorest
communities and countries, what kinds of health investments will have
the greatest and most sustained impact? How would they best be
financed, made available, sustained and monitored? Who should
participate in their provision?
Our contribution to this new momentum draws on
experiences over the last three decades: the experiences of
governments and of local communities; of the international and
national agencies who have supported local and national action; and of
the researchers, from north and south, who have analysed the results.
We know it is vital that people are ensured
equitable access to cost-effective interventions, that they are able
to use them, and to adhere to them so that benefits are achieved. For
responses to be sustained, all people depend on functioning health
systems that are financed fairly, and that are supported by well
trained and motivated personnel. Also vital are a viable, but minimal,
infrastructure; adequate logistical back-up; the regular evaluation of
results, and the use of such assessments to changing systems so that
they work better.
National governments, international agencies and
resource providers face increasing demands to step up their own
action, improving the effectiveness, efficiency and impact of their
efforts. WHO is responding - continually - to these new challenges.
Ladies and Gentlemen,
Given the magnitude of the global health agenda, it
is evident that WHO cannot do everything. Through the process of
developing a General Programme of Work and a budget for 2002-2003, we
have aimed at clarifying WHO’s particular role in world health.
Two years ago, when I introduced WHO’s budget for
this biennium, I committed WHO to work differently. Selecting
priorities, and reducing the emphasis on - or even closing -
non-priority programmes. Concentrating resources on the priorities,
and cutting back on administration. Improving our capacity to work
together, strategically, at country as well as global level, and
increasing our income to enable us to do this.
This means:
- adopting a broader approach to health within the context of
human development, humanitarian action, equity between men and
women, and human rights, with a particular focus on the links
between health and poverty reduction;
-
assuming a greater role in establishing
wider national and international consensus on health policy,
strategies and standards - through managing the generation and
application of research, knowledge and expertise;
-
triggering more effective action to
promote and improve health and to decrease inequities in health
outcomes, through carefully negotiated partnerships and by making
use of the catalytic action of others;
-
creating an organizational culture that
encourages strategic thinking, prompt action, creative networking,
innovation and accountability, and strengthens global influence.
All of this comes together in an increased effort
to enable WHO to make the greatest possible contribution to world
health through developing its technical, intellectual, ethical and
political leadership.
It means a clearer focus on the link between health
and poverty. We are strengthening our focus on how health actions,
including those that affect the broader determinants of health, can
help reduce poverty.
In carrying out its activities, WHO’s Secretariat
is focusing on six core functions:
- articulating consistent, ethical and evidence-based policy and
advocacy positions;
-
managing information by assessing
trends and comparing performance; setting the agenda for, and
stimulating, research and development;
-
catalysing change through technical and
policy support, in ways that stimulate cooperation and
action and help to build sustainable national and intercountry
capacity;
-
negotiating and sustaining national and
global partnerships;
-
setting, validating, monitoring and
pursuing the proper implementation of norms and standards;
-
stimulating the development and testing
of new technologies, tools and guidelines for
disease control, risk reduction, health care management, and
service delivery.
I would like to stress that these functions are
carried out at all levels of WHO; Headquarters, Regional and Country
Offices. It is no longer useful to make a sharp separation between
technical cooperation on the one hand and normative work on the other.
Technical cooperation will include advocacy, development of
partnerships, encouragement of local research and development, and
policy advice. Depending on the needs of the specific country,
technical cooperation may involve staff from Headquarters, as well as
from Regional and Country Offices.
I said WHO cannot do everything. We must focus our
work. I would like to share with you how I see our major priorities
unfold during the next biennium.
When we talk of priorities, we refer to a limited
number of areas of work where we will strengthen our focus, increase
our efforts and provide additional resources. These are areas which
hold a potential for significant changes in the burden of disease with
the use of cost-effective interventions, health problems with major
socio-economic implications, or which have a disproportionate impact
on the lives of the poor, and areas where we see a real opportunity to
act.
But the notion of priorities is a complex one in an
Organization like ours. Critically important areas of work will
continue even if they are not singled out as specific priorities.
Delivering global public goods is in itself a priority - be it
expanding the network for surveillance of communicable diseases,
updating the International Health Regulations, taking forward the
Essential Drugs List or keeping up-to-date an evidence base available
to all. These are core activities and they cut across all areas of
work.
With a regular budget frozen at US$ 842 million for
still another biennium, we are finding it increasingly difficult to
carry out these core activities. This also affects the work we do in
priority areas, and as a result, we will have to seek additional
extra-budgetary funding for several of these areas.
The way that this extra-budgetary funding is
targeted is important. Some donors are now moving away from financing
specific projects and more into financing areas of work as a whole.
This helps greatly to achieve better integration of our work plans
from all sources of funding. I would like to encourage all our donors
to consider this approach.
The corporate strategy sets out the ways in which
WHO intends to address the challenges of the rapidly evolving context
of international health. The policy framework now provides the
inspiration and basics for the budget. In particular, on the basis of
the criteria set out in that framework, 11 priorities were
determined by the Executive Board at its 105th session.
To facilitate tracking - in terms of both resource shifts toward
priority areas, and the achievement of results - these priorities have
been clearly reflected in the budget.
The preparation of the coming biennium’s budget
is significantly different in several ways: first, it has been
prepared in a truly collaborative spirit between the Regional Offices
and Geneva; secondly, it applies principles of results-based budgeting
through the identification of expected results and performance
indicators for all of the Organization’s strategic areas; and
thirdly, it has for the first time been reviewed in its entirety by
the Regional Committees before being transmitted to the Executive
Board.
Thirty-five areas of work have been identified for
the whole Organization. They are reflected in the agreed Global
Programme of Work and constitute the common building blocks of our
WHO-wide workplan. Twenty six of them cover technical areas, and
eleven reflect the priorities endorsed by both the Executive Board and
the World Health Assembly. The Organization's contribution to each of
the areas of work, the results we expect to achieve using both regular
budget and additional voluntary contributions, and the milestones
against which progress can be assessed, are set out in the Strategic
Programme Budget for 2002-2003. The aim has been to reflect as
accurately as possible the current range of activities of WHO’s
Secretariat and to provide a sufficient degree of continuity with the
previous budget to enable meaningful comparison and analysis of
trends.
The Programme Budget for each area of work has been
drawn up through an organization-wide process, involving staff from
Regional Offices and Headquarters. This process expresses more fully
the interdependence of the different levels of WHO within agreed
global objectives, strategies and expected results. At the same time,
the process has been associated with a reallocation of available
regular budget funds to the priority work areas.
As the new budget is implemented, the process also
enables the different elements of the WHO network to function in
synergy with common strategies and plans of work that are open to all.
The next parts of this "one WHO" process are to improve our
information systems so that we are better able to assess spending and
review performance in relation to each work area. We would also like
to take the principles of the strategic budget through to WHO's work
at country level, so that regional and Geneva-based programmes work
effectively in support of country action. To this end, we will invest
in the greater capacity of our country teams so that they are better
able to contribute to equitable health outcomes from all country-level
health investments.
As a part of the process, we are integrating the
two year Cabinet Project on Strategies for Cooperation and Partnership
into the main work of the Organization through an initiative within
the Cluster for External Relations and Governing Bodies. It will build
on the work of the Cabinet Project as well as the results of the
Global Meeting of WHO Representatives and Liaison Officers held in
March and the continuous work of the WHO Global Programme Management
Group.
Ladies and Gentlemen,
When our Executive Board met last month, it
discussed the ways in which the availability of new resources will be
linked to the ways in which they are used. The discussion was
structured around six elements.
The first element is that resources really must
increase - steeply, from all sources - both national and
international - to cover the investments needed. The first priority
will be to confront HIV infection, tuberculosis and malaria.
The second element is ensuring that essential
global functions take place, such as:
- programmes of strategic research for, and development of,
necessary drugs and vaccines;
-
strategic partnerships to reduce prices
of new technologies - for prevention, for diagnosis, for treatment
and for communication - to increase the potential for them to be
accessed in poorer communities;
-
and the implementation of global
agreements - such as the Framework Convention on Tobacco Control
or the International Health Regulations.
But we also will need schemes for the efficient
purchase and equitable distribution of critical commodities, in ways
that take advantage of the safeguards in TRIPS legislation while
respecting the importance of intellectual property for continuous
innovation. This means building on existing international trade
agreements in ways that enable advances in biotechnology - that are
relevant for health equity - to be treated as public goods.
The third element is innovative and urgent action
to secure the effective operation of health systems even when
they are seriously under-funded. The overall goal would be to ensure
that health systems are able to deliver services that are as
effective, responsive and fairly financed as possible given the
resources available.
The fourth element is to ensure the independent
authoritative monitoring and review of results, relating these
to investments, accompanied by rapid reporting and public relations -
in order to sustain long-term involvement.
The fifth element is intense social mobilization
about the central role of investing in health as a contributor to
poverty reduction at country and global levels. This means credible
and upbeat programmes to inform political leaders and key public
figures about what matters in this rapidly evolving field. It
means working through governments, NGOs, and the media with the theme
of working together to "make the forces of globalization work for
the secure future of humanity ".
Last, but not least, we need an effective, fast
mechanism for moving money and spending it well where it is needed.
To this effect, WHO is now deeply engaged with our UN partners and
countries to work out the technicalities of the proposed AIDS and
Health Fund. This will not be business as usual.
At the same time, we are preparing WHO for the
demands this global scaling up will bring. The demands on WHO - at all
levels - will be substantial. This is the context for our meeting over
the next two weeks.
Ladies and Gentlemen,
Let me be clear. The demands on WHO will continue
to increase. The resources are scarce. WHO has implemented significant
efficiency savings during the past three years. We have redistributed
what funds we can to back work in agreed priority areas. Our normative
work remains in demand from all our Member States, yet its continuance
is in danger because we have been required to do what is expected of
us, and respond to new global priorities, within a declining regular
budget. The situation has now been compounded by the results of the
debate on assessed contributions at last month's World Health
Assembly. If we are to stick to a Zero Nominal Growth regular budget,
we will rely on additional contributions from Member States so that
our miscellaneous income covers the US$ 37 million that will
still be required.
So WHO has to secure additional - extra-budgetary -
resources to make its best contribution to world health, and to use
these alongside regular budget funds. To make the most of the
resources that are available, and to maximize pledges of un-earmarked
multi-year funding, we need input from you. We know that you are
committed to, involved with, and interested in, the kind of
contribution that WHO can make. Whether you are here in an individual
capacity, representing a government, coming from a non-profit or
private organization, or representing another international agency,
you are most welcome.
I would like to take this opportunity to thank all
who have provided backing for our responses to the wide range of
challenges we face - especially those who have offered us additional
resources. I am particularly grateful to those who have been able to
provide us with resources that are not tightly earmarked and are made
available over a number of years.
We intend that the Meeting of Interested Parties
becomes the core of the performance assessment process for each of the
areas of work set out in the Strategic Programme Budget. That is why
we have moved to this new format before the 2002-2003 budget comes
into force. We have designed the event as an opportunity for an open
dialogue between all interested parties and WHO staff, with the
emphasis on the open review of what has been achieved with all
available resources in the last year, and plans for future years. The
format of this year's MIP builds on the lessons of the past, and we
will continue to explore ways of broader and deeper involvement of all
parties in preparing for future MIPs. We are keen to receive your
assessments of this new structure for the MIP, and would very much
value you views on what works and what can be further improved.
In this MIP we will try to assemble a summary of
the main issues emerging from the discussions of each work area. It
will be based on syntheses developed by WHO Executive Directors after
discussion with meeting participants, and will be circulated as a
bulletin at intervals during the meeting. I anticipate that this
will become a cumulative report that will be of use to those who can
only attend some of the sessions.
Ladies and Gentlemen,
The MIP is taking on an important role in the
overall scheme for evaluating the Organization’s achievements. We
intend that it will become a major annual landmark both for WHO’s
own staff and for those who contribute resources. We will ensure that
the work undertaken within each annual MIP feeds properly into WHO’s
Governing Bodies. We will thus ensure that the main outcomes of this
meeting are made available to the Executive Board during its next
session so that the Board can comment both on the evolving MIP process
and the results obtained by WHO as a whole, as well as within the
individual work areas.
I believe these coming days will see a unique process of building and
developing a mutual understanding of our shared goals. We look forward
to your full participation, and hope that this meeting serves us all
as we are responding to the critical challenges of equitable health
and development.
I am most grateful to His Excellency, the Permanent
Representative of Pakistan to the United Nations, Ambassador Akram,
for kindly agreeing to chair the first sessions of this Meeting of
Interested Parties. It is with pleasure that I revert back to him as
he navigates through our important business within the next two days.
Thank you. |
