Address of the Regional Director, Dr Poonam Khetrapal Singh to the Ministers of Health from South-East Asia Region at the Luncheon Meeting, 19 May 2014, Geneva
A warm welcome to this luncheon round table.
When we last met, in Delhi for polio-free certification of WHO South-East Asia Region in March, I committed to keep you abreast on the implementation of my vision for public health in the Region. So let me start by saying a few words about how it is evolving and the steps we are taking to put the vision into practice.
The principle I have followed is to align our regional strategic directions with the global strategy set out in the WHO 12th GPW. At the same time, I want to reflect the priorities expressed by you, our Member Countries.
The GPW starts from the premise that WHO must be responsive to a changing world and its emerging challenges. This was the inspiration for my first strategic direction “addressing persistent and emerging epidemiological and demographic challenges”.
This is a big agenda. For each of the strategic agenda I have defined a strategic direction with one or more flagship initiatives. These are immediate priorities and, in some cases, time-limited projects. They also reflect some very specific concerns that you have asked me to address.
I should stress that just because I have defined a flagship project in an area, it does not mean we will give up on all the other work to which we remain committed.
The flagship initiatives also serve one further purpose. For each there is a clear link to the categories and programme areas in the PB 2014-15. That is how WHO reports progress to its Governing Bodies. So they offer a built- in way for us to track our progress.
For Strategic Direction 1 we have defined two flagship initiatives: the elimination of measles by 2020 and advancing our work on NCDs in the region.
I should add here that when we met in March, we agreed that polio elimination has given us a strong foundation to eliminate measles from the Region. I believe that working together we could, in fact, achieve measles elimination sooner than that target date of 2020.
Let me now briefly take you through the logic of the other three strategic directions.
The GPW talks about the importance of integrative ways of working; breaking down silos; the importance of equity and health as a right. “Advancing universal health coverage and robust health systems” my second strategic direction fulfils these criteria and, of course, mirrors one of the overall global leadership priorities in the GPW.
The initial flagship priorities in this area are to focus on UHC policy development at country level, particularly in respect of financing and human resources. But I want to go a step further. UHC needs to deliver results in terms of health outcomes. I therefore also want to focus on how UHC can advance our work on MDG4 and 5.
Next, the GPW talks about the need to protect lives in times of emergencies - a vital issue given the incidence of emergencies and disasters in this region and their attendant cost in terms of human lives and economic damage. My third strategic direction “strengthening emergency risk management for sustainable development” reflects this concern directly and adds the idea that solutions must enhance sustainability.
Our flagships in this case are emergency preparedness and response for which we have defined 12 clear globally agreed benchmarks to monitor progress. In addition, we also want to focus on combating Anti-Microbial Resistance (AMR). AMR kills; it hampers the control of infectious diseases; and it dramatically increases the costs of health care. In the absence of urgent action current health gains are threatened, and the world faces the prospect of a return to a pre-antibiotic era, with the economic and social consequences that this implies.
Lastly, one of the objectives of WHO reform is greater coherence in global health. I am convinced, and you have supported me in this, that the region should have a stronger voice in global health. Thus “articulating a strong regional voice in the global health agenda” is the fourth strategic direction.
In a sense all of the flagship initiatives I have mentioned help to amplify our regional voice. But I have been thinking about a specific flagship initiative as part of strategic direction four. One idea would be to establish a process that builds capacity both for WHO and Member States in global health diplomacy. Another option, for the future perhaps would be to focus on the role of non-state actors as stakeholders in global health - an important issue in this region. I would very much appreciate your comments on how we define a flagship initiative in this area.
We have already started work on these flagship initiatives and I have also appointed technical focal points to build consensus on the way forward and to define measurable deliverables that are consistent with those in the Programme budget.
On Universal Health Coverage we agreed on best practices at the Conference on Advancing Universal Health Coverage in South-East Asia in Bhutan last month. Please review these for relevance in your country contexts, especially options for reducing avoidable inequities. A clear quick-win for UHC is reducing high and impoverishing out-of-pocket payment through government action to improve access to medicines.
I am pleased to report that the Regional heads of UNICEF and UNFPA joined me in issuing a joint statement on how our respective Organizations will work together to ensure improved quality of life for each woman, newborn and child. We launched the statement at a meeting on "2015 and beyond: the unfinished agenda of the MDG 4 and 5 in the South-East Asia Region" in Kathmandu last month.
The joint statement issued with UNICEF and UNFPA signals the importance of partnership. Since we last spoke, I participated in the special session on UHC in Myanmar co-hosted by WHO at the World Bank Spring meeting this March. At the Nepal meeting I also took the opportunity to meet the SAARC Secretary General to explore more collaborative work between WHO and SAARC. I shall continue to use every opportunity to build effective partnerships and profile the interest of our Member States at the global and regional levels.
Making WHO, and the South East Asia Regional Office a more responsive and forward-looking organization requires more than defining technical priorities.
We need to create an administrative environment that attracts the best and the brightest in public health and an environment that empowers people to be collaborative and creative.
Let me be clear, the days of silos and technical isolation, one department from another, are over. I am also committed to staff welfare and, while I will continue to be firm on the need for change, I will continue to insist on inclusive and consultative processes, so that staff are part of decision- making, regardless of their functions or levels. At the same time I am also putting emphasis on implementing recruitment policies in the most transparent and fair manner so that we get the best professionals to work in and for the Region.
On the specifics, I have reviewed potential areas for improving efficiency and taken immediate action in 3 areas:
First, I am bringing staff closer- to-clients. I was clear upon taking office that I would move some of my technical staff to countries where our resources can be employed most effectively. I have identified a small number of technical gaps in country offices and have initiated a process of reassignment of staff from SEARO to fill these. I am confident that you will provide me the support to make this move. With this we will make the country offices technical capacity stronger.
As a second efficiency measure to improve WHO country response, I am insisting that duty travel of SEARO staff must be focused on country support. I set up a Working Group that analyzed duty travel in-depth and on its recommendation, I have also placed a cap of 45 days on duty travel of which 2/3 must be for country support.
Third, I was quite astonished to be informed by another Working Group that there were 500 WHO-supported meetings in the last biennium. Disproportionate amounts of resources have been used for these activities without clear impact on public health in Member States. Proposals for meetings will henceforth be carefully scrutinized for alignment with WHO’s priorities for outcomes that respond substantively to country needs.
Efficiencies will contribute to our effort to tide us over the current financial downturn. But we also need to scale up our resource mobilization efforts. We are also stepping up implementation of my current biennial workplans.
Better implementation linked to demonstrable results will help us make a stronger case for resources for 2016-17. We do not have a major donor in our Region and, moreover, crisis-hit donors are themselves cutting back external assistance. Nevertheless, we are actively supporting countries to access resources from available sources like the Global Fund. And, we are also exploring country-specific funding, for example with the European Union for UHC in Myanmar.
Good planning is essential for enhanced efficiency. During mid-April, all Planning Officers from our country offices were invited to SEARO to discuss priority health issues for the next biennium for each country and to orient them on the new web-based planning tools that have been recently developed. In spite of tight deadlines, I am pleased to inform you that subsequent to the extensive deliberations between your senior staff and our country offices colleagues, the planning process with “bottom-up planning” and “need-based” as the guiding principles is proceeding well, and we are on track to deliver the PB2016-2017 within the scheduled global delivery timelines.
Such regular stocktaking is important for us to steer WHO together. I reiterate my request for your continued support to carry out the responsibilities you have entrusted me with, for the betterment of public health in the Member States of the South-East Asia Region.
Thank you for your time today and my best wishes for a useful World Health Assembly.