Healthier WHO South-East Asia Region; responsive Regional Office
I take charge as Regional Director at an important moment in the history of public health and at a critical time in the evolution of WHO. I do so in all humility, knowing full well the challenges that lie ahead.
The public health arena is changing fast. The paradigm shifts are evident in the agendas of the World Health Assembly and Regional Committee meetings over the past decade. The dominance of communicable diseases, inspite of their continued relevance, stands eroded. Noncommunicable diseases, Millennium Development Goals (MDGs), universal health coverage, intellectual property rights, virus sharing, essential and affordable medical products and the impact of socioeconomic and environmental determinants on health are increasingly engaging the time and attention of our Governing Bodies.
I propose an ambitious “1 by 4” plan. The 1 refers to a more responsive WHO in the Region and the 4 refers to the 4 strategic areas:
- Addressing the persisting and emerging epidemiological and demographic challenges.
- Advancing universal health coverage and robust health systems.
- Strengthening emergency risk management for sustainable development.
- Articulating a strong Regional voice in the global health agenda.
Addressing the persisting and emerging epidemiological and demographic challenges
Member States in the Region have made spectacular health gains in recent years with concerted national efforts.
The most impressive achievement is the eradication of wild poliovirus. A few months from now, this Region is likely to be certified polio-free. This is certainly a testimony to the capability of the Region. This success must be replicated for other vaccine preventable childhood killers to fully protect all children from premature morbidity and mortality. We join the United Nations Secretary General in recognizing the achievements of Bangladesh and Nepal in MDGs 4 and 5.
We are progressing steadily in combating diseases enunciated in MDG 6. Since 1990 tuberculosis mortality has declined by 40% and malaria kills 82% fewer people. Maldives continues to be malaria free. The HIV epidemic in most of the high-burden countries has been reversed. However, we need to work together to protect these gains from the menace of drug resistance and coinfections.
Microorganisms continue to surprise us. These caused the influenza pandemic, SARS and avian flu leading to international chaos. The global response against these events is the International Health Regulations (2005). IHR demands substantial scaling-up of national capacity. We must enhance this capacity for ensuring health security in our Region.
While our fight against communicable diseases continues unabated, the escalating epidemic of noncommunicable diseases (NCDs) is stretching health systems. More than half of our mortality is caused by cardiovascular diseases, chronic respiratory diseases, cancers, and diabetes. It is a matter of concern that a third of these deaths occur in people under 60 years of age. Unhealthy lifestyles, unwholesome food, and increasing alcohol and tobacco use are major behavioural risk factors. Sri Lanka has taken the lead in our Region in declaring 2013 as the year of preventing NCDs. Ten countries have adopted legislative and administrative measures to curb the tobacco menace. Health promotion and primary prevention of NCDs is critical. Prevention requires multisectoral actions from multiple stakeholders in nonhealth sectors whose policies have adverse health effects.
Mental health is generally neglected. We need to integrate mental health services as part of primary care. Malnutrition in children under five is very high and needs to be addressed through a set of integrated interventions and multisectoral approaches.
The maternal mortality rate among young women continues to be worrisome. Pregnancies must be made safer than they are today. Gender-based violence needs to be tenaciously addressed. Tobacco consumption among women, including smokeless tobacco, has to be reduced. Our populations are ageing at an unprecedented rate. People aged above 65 will soon outnumber children under the age of five. We are committed to promoting health and well being across the whole life course.
Advancing on universal health coverage and robust systems
With its three dimensions of access, affordability and quality, universal health coverage (UHC) is the most important game changer in public health. Thailand has successfully made available to its entire population a health system that provides access to affordable, comprehensive, quality health services. We need to share Thailand’s experience across the Region.
Improving access requires overcoming four main barriers: geographical, technological, social and financial. These are not insurmountable. Efficient implementation of the telemedicine project in Democratic People’s Republic of Korea has demonstrated the reach and utility of technology to far-flung areas of this nation beset with difficult terrain. There is untapped opportunity to improve access to health through new cost-effective technologies. Research, innovation and affordable health technologies need to be encouraged.
The WHO South-East Asia Region has the highest out-of-pocket spending on health and relatively low public investment in health. This is a key cause of overall inequities. In 1978, Alma-Ata showed the importance of primary health care rooted in the community and attuned to its economic, social and cultural aspirations. With escalating NCDs and ageing, health-care costs will spiral upwards. A comprehensive approach is needed to meet people’s expectations. Our health systems must deliver quality preventive, promotive, curative and rehabilitative health services. Public–private partnerships could be a pragmatic way to complement the efforts of the public sector. The Rural Health Insurance Scheme from India holds valuable lessons for public–private partnerships especially those for the poorest.
Increased access to essential, high-quality and affordable medical products remains a major concern. The pharmaceutical industry, regulatory authorities and even the judiciary have roles ensuring universal access to quality medicines. Prices, patents, generic versions and innovation drive pharmaceutical markets. Intellectual property issues carry global sensitivity and complexity requiring deft navigation. While innovative approaches are needed to encourage medical research and development, flexibilities in international agreements provide access to those who cannot afford high prices. The right balance must be sought. In addition, cost-effective procurement mechanisms need to be explored. We must facilitate this especially for countries in greatest need, such as Bhutan, Democratic People’s Republic of Korea, Maldives, and Timor-Leste.
Delivery of quality health services is possible through adequate production, management and training of health workforces, backed by appropriate infrastructure and functioning referral systems. Critical shortages, inadequate skill mix, uneven geographical distribution, internal migration from rural to urban areas or public to private sectors are challenges that need to be addressed through renewed approaches regarding their production, education and training as well as their working conditions and remuneration. Health workforce strengthening will be given utmost importance.
Strengthening emergency risk management
The WHO South-East Asia Region is extremely disaster prone. The World disaster report 2012 reveals that in the past decade, 41% of global mortality from natural hazards was in countries of the Region. The Tsunami of December 2004, taught us several lessons. Member States were instrumental in establishing the South-East Asia Regional Health Emergency Fund in 2007, which has helped meet immediate financial needs of our countries for a quick response in emergencies. The 12 Benchmarks for Emergency Preparedness and Response have received global recognition and provide a framework for national capacity-building.
Political conflicts have been as challenging. Timor-Leste, during its struggle for independence in 2002, had 70% of its infrastructure destroyed and 70% of its population displaced, which had a significant impact on its health systems and the health status of its people. However, the country has exhibited exceptional progress in its rehabilitation, reconstruction and rebuilding efforts. We need to take a holistic approach and integrate prevention, risk reduction, preparedness, response and recovery. We must make disaster risk reduction an integral part of national strategies and sustainable development policy.
A strong voice in the global health agenda
South-Asian thinkers have led the international debate on health and development – from Professor Amartya Sen’s seminal work on the human development index that emphasized social development, to the global attention that Bhutan has drawn on gross national happiness as a guiding principle for the post-2015 MDG agenda.
In this era of interdependency and cooperation, stronger voices are generated through alliances and partnerships. The Tsunami demonstrated the multisectoral and multicountry coordinated support for immediate response and rapid recovery. We will strengthen existing partnerships and engage in new ones.
To deliver effectively on these four strategic areas, the WHO Regional Office for South-East Asia needs to be more responsive and align with the health needs of Member States. The time-tested “honest broker” role of WHO shall be assiduously augmented through human resources of the highest calibre with proven competence, commitment and a focus on:
- providing technical and policy support that is objective and apolitical;
- mobilizing expertise for institutional- and capacity-building in countries;
- supporting ministries of health in coordinating all stakeholders including development partners around the national health agenda.
Our diversity is a rich one. We belong to a Region that is blessed with some of the best health experts, state-of-the-art collaborating centres, finest medical facilities and a booming pharmaceutical industry. We will promote intercountry cooperation. We must work to create a common vision that builds incrementally on each and every country’s strengths and capacities, that shares information and best practices, and uses local and regional networks for capacity-building.
My vision is to partner you in eliminating gross health inequalities and enhancing human welfare. My vision is to augment the capacities of all Member States so that our Region is recognized for its intellectual vigour and evidence-based decision-making. My vision and determination are to make the WHO South-East Asia Region an excellence-pursuing, responsive, and accountable organization. My vision is to make our Region globally known as a leader in public health.
Dr Poonam Khetrapal Singh
Regional Director, WHO South-East Asia