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Mr President,
Ministers,
Dr Samba,
Excellencies,
Ladies and
Gentlemen,
It gives me great pleasure to be with you all
today. Our gathering here in Brazzaville, and the reconstruction of
WHO’s Regional Office for Africa in this city, are signs of hope and
progress.
Throughout the region, Governments and civil
society are making heroic efforts - with really limited resources - to
respond to their people's health problems. Last month I saw this for
myself - at the launch of concerted action in the Democratic Republic
of Congo, Angola, Gabon and in this nation to immunize children
against polio.
In Kinshasa I saw how government and civil society
are creating a public health infrastructure as a bridge for peace. The
infrastructure is now focused on polio. But it is being developed to
address malaria, HIV infection, women’s and children’s health, and
other priority problems. Given the challenges posed by conflict and
mistrust, this response to ill health demands both vision and courage
from all concerned. I am delighted that WHO, and the rest of the UN
country team, are providing support for re-building the health
infrastructure. They are responding to a key concern of poor people in
the region - their need to be healthy enough to learn, to earn and to
climb out of the poverty trap.
In Abuja in April, for the second year running, I
witnessed Heads of State and Health Ministers, together with
representatives of civil society and the UN, as they committed
themselves to ensuring better health outcomes for all Africa's people.
This year the focus was on the devastating impact of HIV on the women,
men and children of Africa - on their productivity and their
prosperity. The call was for health systems that reach people;
commodities and medications that are affordable.
The international community is responding and
building on efforts already underway in Africa. Last week I listened
to the discussions in the Commission on Macroeconomics and Health.
They are likely to call for a dramatic and rapid scale up of action
for better health. If this does not happen soon in Africa, the people
of this continent will suffer greater deterioration in their wealth
and well-being
At the World Health Assembly, at the UN General
Assembly Special Session on HIV/AIDS, and at the G8 Summit and when
the OAU approved the New African Initiative, we heard of a real
increase in available resources. Different public, voluntary and
private sector bodies are already making new commitments, and plans
for the Global AIDS and Health Fund are being taken forward.
There are many health challenges facing the people
of Africa. They cannot access health systems that respond equitably
and efficiently to their health needs, and offer some protection
against the devastating consequences of illness. How can existing
health systems, already subject to reforms and restructuring, be
enabled to scale up and deliver service improvements as new resources
become available?
My answer is straightforward. Until there is a
significant increase in resources we cannot expect to see quantitative
improvements in overall health system performance.
That is why plans for the Global AIDS and Health
Fund are important. As we prepare to take our place in the
transitional working group designing the Fund, WHO will want to be
sure that it stimulates a build-up of national health system capacity.
It should help governments and civil society scale up health systems
in ways that are effective, responsive, making good use of resources,
and leading to measurable results.
The focus on priorities, attention to coverage and
quality of interventions, and careful monitoring, will improve the
efficiency for achieving results with scarce resources. The Fund will
encourage the further funding needed to drive up total health systems
spending towards the minimum levels of $60-$100 per person per year.
Such levels of spending are necessary if more comprehensive service
provision is to become feasible.
I would like to share with you my views on some of
current health priorities. I start with a focus on those who are at
risk of, or are infected with, HIV.
The UN General Assembly Special Session commits us
all to doing much more - to help people prevent themselves from
infection, and to increase the proportions of HIV-affected people who
can access care for their illnesses. You are all responding to the
challenge. The silence is broken: our actions must speak louder than
words.
Together with the other co-sponsors of UNAIDS, and
both government and non-governmental development partners, we are
working with you as you adapt evidence-based practice to the needs of
your people. To obtain evidence on what works, we coordinate and take
forward extensive research in the fields of diagnostics, spermicides,
vaccine development, operational research on care and support , and
assessments of programme effectiveness. We look forward to the further
development of the recently initiated African AIDS Vaccine Programme.
We are working with you to monitor the uptake of
preventive and care services, and to assess their impact on people's
well-being.
We are able to help country officials negotiate the
purchase of essential medicine, commodity and diagnostics supplies -
and to be wise buyers. They seek up-to-date information about
suppliers and drug prices.
I know that the regular publication, by WHO, of
Essential Drugs Price indicators within the African Region is helpful.
These complement global WHO price information on selected HIV/AIDS
related drugs and starting materials.
Country officials also need information about the
operation of trade agreements. WHO is continuing to help countries
examine the impact of international trade agreements on access to
life-saving medicines. Dr Samba last week convened a meeting of
health, trade and patent officials from 15 African countries.
This helped participants see how these trade agreements can serve
public health interests.
Our goal is to help identify more effective
responses, ones that take account of people's cultural traditions and
social realities. To this end we have reorganized and substantially
scaled up the whole of WHO's contribution to HIV/AIDS action. Now we
are in a better position to respond promptly to countries' requests.
We have also been working closely with countries as
they take forward action to Roll Back Malaria. Africa's Heads of State
have made an explicit commitment to increasing people's access to
insecticide-treated nets, to prompt and effective malaria treatment,
to prevention of malaria in pregnancy and to the effective management
of malaria epidemics.
The Regional Director has proposed that
insecticide-treated mosquito nets be provided free to mothers and
children under the age of 5, in order to catalyse large-scale action
for those most in need. He is also keen to see community-based
interventions - for improving access to bednets, care for pregnant
women and home-based management of fevers. These approaches are being
taken forward imaginatively in several African countries by Roll Back
Malaria partners from the private, as well as the public, sectors.
Our work to Roll Back Malaria is one example of
effective action to improve the lives and futures of Africa's
children.
During the last two decades we have also seen
substantial improvements in the proportion of Africa's children who
are fully immunized. But progress is uneven. WHO and UNICEF have
worked with countries to update estimates of immunization coverage
from 1980 to 1999. Results will be collated and published at the UN
General Assembly Special Session on Children in New York next month.
It does look as though political and military conflicts have had a
serious impact on immunization coverage.
Indeed, emergencies and conflicts undermine efforts
to improve health. Africa has more than its share of emergencies
including natural disasters, armed conflict or threats of civil wars,
resulting in millions of refugees and displaced persons, as well as
affected host populations.
The efforts now made to ensure the eradication of
polio are among the largest and most impressive public health
interventions the world has ever seen. They are also among the most
difficult. But the end is within sight. The Global Polio Eradication
Initiative, has reduced the number of cases by 99 per cent. In 2000,
only 3,500 cases world wide were reported.
Our efforts mean three million people in the
developing world, who would have been paralysed, are walking today.
Last year alone, we immunized 550 million - 85 per cent - of the world’s
children.
Now in 2001, there are no more than 20 countries in
which the polio virus is continuously present. Of those, only eight
countries stand for 85 per cent of the total burden, and several of
them are in the African Region.
The first round of coordinated National
Immunization Days in the Central African sub-region was impressive.
But accessing every child indeed remains one of our greatest
challenges, and conflict still prevents us from reaching some
children. Together, we can finish the job and eradicate polio. But to
get there we must push ourselves even harder.
There are other major scourges. Nearly 800 000
children die every year from measles, half of them in the African
Region. Mass measles immunization campaigns are underway this year in
8 African countries, targeting approximately 21 million children.
WHO is providing technical assistance to ensure greatest possible
impact.
We are also supporting the strengthening of vaccine
programmes and the introduction of new vaccines. The Global Alliance
for Vaccines and Immunization is now in its second year. Vaccines
financed by the Alliance have reached several countries. Nine African
countries have received approval to introduce new vaccines.
Applications from 8 more are pending.
Africa is the region with the largest number of
countries receiving support from the Vaccine Fund. Seventien countries
are receiving Fund money for the strengthening of immunization
services. This is a tremendous achievement. It shows countries'
commitment to improving their children’s access to vaccines.
Mr President,
This year, I celebrated World Health Day in
Nairobi. I watched as the Kenyan authorities opened up their main
national mental hospital to the public. This openness is made possible
because of the new and effective means now available to treat and
prevent brain disorders and mental illness. Modern mental health care
focuses more on the family and the local community; uses effective and
relatively inexpensive medicines; and is geared to prevention, early
detection and treatment rather than incarceration.
The burden of mental ill health and brain disorders
in Africa is a serious challenge. The resources and the manpower to
deal with mental ill health are sparse. The Kenya experience shows
that reform is possible.
The forthcoming World Health Report, which this
year focuses on mental health, will provide a firm global overview of
the current and future burden of mental ill health and their main
contributing factors. It will contain strategies for ensuring that
effective prevention and treatment are both put in place and
adequately funded. It will show how countries like Kenya have started
to change the way they provide mental health care.
Information - on the burden of disease and on
health system responses - is essential if resources are to be used as
effectively as possible. Many Member States have initiated
surveillance of disease, and WHO is often able to help. The recent
Ebola outbreak in Uganda was an example of surveillance linked to
response. Different parts of WHO worked within a global response
network which brought over 120 experts from 22 international
organizations into the area. Coordinated by WHO, they helped the
Ugandan Government to contain the crisis.
Some countries have initiated programmes of
national health surveys so as to provide a regular assessment of the
status of their people's health and the working of health systems. WHO
is offering more help to countries as they undertake these surveys,
for policymakers and programme staff to make more informed decisions
about how best to use resources.
Mr President,
Africa's nations are playing a critical role in the
negotiations of a framework convention on tobacco control. During the
second round of negotiations in May, the first draft of the convention
was debated at length. The next round of the negotiation process will
take place in November. I am confident that we will end up with a
Convention that really helps countries to confront the threat of
tobacco for their people. I stress the need for countries to continue
to be engaged until the convention has been finalized - hopefully in
2003.
We read in journals of new advances in medical
technology, yet experience - in our daily work - people's difficulties
with accessing inexpensive care for malaria or TB. We watch - each day
- as health professionals make difficult choices, and wonder when the
results of recent advances in genetics will have a positive impact on
the health of Africa's people.
WHO's Regional Offices and Geneva departments are
helping countries to start to handle complex ethical issues - such as
codes of conduct for research involving human subjects. It is now time
to draw together this work, providing Member States with the
opportunity to share experiences, establish consensus and be in a
better position to handle individual ethical challenges.
So I propose to establish a cross-WHO initiative on
health ethics which focuses on Ethics in Public Health, Health
Research Ethics and Biotechnology Ethics: This will include ethical
aspects of genome related work, stem cell research, cloning and other
ethical areas of biomedical science. The initiative would be designed
to help increase Member States' capacities to handle ethical issues,
and to provide support for inter-governmental action on health and
ethics issues.
The issue of genetically modified food is one area
where health, ethics and economics have come together, and there have
been some tensions. Increasingly they are portrayed as elements of a
conflict between commercial interests and those of consumers. Both
sides have developed strong positions.
But genetically modified food crops are already in
widespread use. Those of us concerned with public health are asking
whether these products are safe and beneficial for consumers. If they
are, we want to know how best to enable developing nations - and the
poorest farmers and consumers - to benefit from them.
GM food has the potential to lead to a steep
increase in food production - comparable with that brought in by the
green revolution of the 1960s. GM crops rich in vitamin A and iron can
dramatically reduce levels of these deficiencies in populations at
risk.
But serious negative effects are also possible,
especially if GM products are too expensive for poorer people or have
not been adequately tested. So authorities with responsibility for
food standards and safety must focus primarily on the well-being of
consumers, and not on the profits of producers or suppliers. WHO is
working with FAO to help countries answer questions about the safety
of all foods - including those that have been genetically modified.
This means encouraging international agreement on standardized
methods, including pre-market evaluations rather than post-market
monitoring.
All WHO's work is for countries, but only a part of
it is in countries. Country work, though, is critical, and our country
representatives are at the centre of all we seek to do.
We are committed to improving the capacity of the
WHO teams within countries who need us the most, so that they are
better equipped to contribute to better and more equitable health
outcomes. WHO country representatives and Regional Offices will play a
central role in making this happen, building on our recent experiences
with establishing strategies for our cooperation with individual
countries.
We anticipate exploring the options for developing
our country teams in country offices in Africa within the next few
months.
The work of WHO's Regional Offices and Geneva
departments is summarized within the corporate strategy for WHO's
Secretariat that was agreed by Member States during 1999. This is the
basis of the General Programme of work for 2002 to 2005. During 2000,
the Secretariat established a Strategic Programme Budget, identifying
35 areas of work across the organization. This formed the basis for
the expected results, milestones, activities and allocation of regular
and extra-budget resources for the 2002-2003 biennium.
I will be working with the Regional Directors over
the coming months to develop a proposed set of global priorities for
the next period, 2004-2005. We will draw on your deliberations at this
Regional Committee. My proposals will then be presented to the
Executive Board when it meets in Geneva in January 2002.
On this and other issues, including human
resources, we will have discussions later in the session.
Mr President, Honourable Ministers,
Later today we will be going out to our newly
refurbished Regional Office for the hand over ceremony. I want to
thank the President and all of those who have worked so hard on the
restoration project. Dr Samba will lead an advance party to
Brazzaville in October to plan for the next phases of the return.
I want to also thank the Government and people of
Zimbabwe for their magnificent support.
I would conclude by expressing my appreciation and
that of the whole of the WHO staff to our colleagues in the African
Region for managing so well during this difficult period. I pay
particular respect to Dr Samba who has shown great courage and
statesmanship. This is being reflected in the new momentum for better
health in Africa.
Thank you.
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