Address of Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia at the SEAR Health Ministers Luncheon Roundtable Meeting SEARO on 27 March 2014
Today is my 50th day in office as the Regional Director. The last time I met your Excellences was in September 2013 at the 66th SEA Regional Committee Meeting in which Your Excellences nominated me as the Regional Director, which was subsequently endorsed by the Executive Board in Geneva. On that occasion I presented to you my vision for the health of the people of South-East Region. I shared with you my 4x1 strategy, the four strategic directions of which are, (i) addressing the persisting, emerging epidemiological and demographic challenges, (ii) promoting universal health coverage and building robust health systems, (iii) strengthening emergency risk management for sustainable development, and (iv) articulating a strong voice in the global health agenda. These strategic directions were the result of my intensive and extensive interactions with your Presidents, Prime Ministers, Ministers, eminent global public health experts and social scientists.
Today I would like to take a few moments of your time to update you on what I have done in these 50 days and to share with you my plan for the coming months.
In my vision statement, I had emphasized that for a healthier Region we need a more responsive, accountable and a sensitive WHO in the Region. Immediately on assuming the responsibilities of Regional Director, I started revisiting the current practices to improve our internal performance.
I have had extensive discussions with staff members in the Regional Office. All WRs were invited by me within a week of taking up office for a frank discussion on the challenges we face, and the solutions we can find in providing seamless technical support to Member States.
Based upon these interactions I have initiated several administrative steps to improve efficiency and effectiveness in fulfilling our mandate. I give you three examples.
• I have reduced the number of regional meetings to make them more aligned to country needs,
• I am improving our internal administration processes to enhance efficiency and reduce redundancies,
• I am also streamlining travel of the staff to various WHO events for better efficiency and effective technical assistance to Member States
For all of the above I have set up working groups consisting of some staff members and WRs.
It goes without saying that we consider the entire spectrum of public health as important. However, to achieve tangible results in a defined time period, we also need to identify a few priority areas that are important and can be a game-changer in public health, have long term implications and sustainable gains, target vulnerable populations, and improve health, as well as the economy of the Region.
I propose to designate these priorities as Flagship Priority Areas with the aim of denoting their highest level of importance in our collaborative work. These Flagship Areas will be linked not only with the Strategic Directions of my vision statement, but also aligned with WHO’s Reform which seeks a higher degree of technical prioritization and support to accelerate national capacity building.
Under these Flagship Areas, WHO will focus on multi-sectoral collaboration and developing cohesive and comprehensive national policies, strategies and programmes. We expect these to cascade into sustainable and result oriented national efforts to reduce mortality and morbidity, improve healthy life expectancy which would promote greater economic productivity.
Based upon these criteria, I am proposing the following 6 Flagship Priority Areas.
1. Measles elimination
2. Containing Non-communicable Diseases
3. Reduction in maternal and child mortality
4. Universal health coverage
5. Combating Antimicrobial Resistance
6. Response to emergencies
I would like to note that these flagship priority areas align well with my vision statement. Measles and NCDs with the persisting epidemiological and demographic challenges, reduction of maternal and child mortality with the unfinished MDG 4 and 5 agenda, universal health coverage as the WHO’s game changer leadership priority, antimicrobial resistance and response to emergencies are linked to my vision on strengthening emergency risk management for sustainable development. Cutting across all of these is the articulation of health on the global development agenda as a core component of each of these flagship areas of work. Further, these flagship areas are aligned with the 5 technical Categories that the World Health Assembly has approved within its new results-based structure. Measles belong to Category 1, NCDs to Category 2, maternal and child mortality to Category 3 and 4, UHC to Category 4, and Emergencies as well as antimicrobial resistance with Category 5.The alignment will facilitate implementation within the current Work Plans of WHO. To kick start these, I have already identified several regional activities which will take place in various countries prior to the 67th Session of Regional Committee in Dhaka, Bangladesh, in September 2014.
I would like to look at each of these Flagship priority areas in turn.
To sustain the gains of the polio eradication, Member States will need to strengthen routine immunizations services. I expect measles elimination to be catalytic in strengthening routine immunization programmes in countries so that measles elimination by 2020 can be achieved within the context of a strong and sustainable routine immunization programme that ensures access by all children to all vaccines in the national immunization programmes of countries. Measles elimination is the logical follow-up of the success in polio eradication. Measles continues to be a major preventable public health issue in the Region. Realising its importance, the Sixty-sixth Session of the WHO Regional Committee for South-East Asia adopted the target of measles elimination by 2020.
Containing Non Communicable Diseases
Noncommunicable diseases (NCDs) have emerged as the leading killers causing 55% of total deaths in our Region. An increase of 21% in mortality is anticipated in the next decade. One-third of all deaths due to NCDs is premature and in people aged less than 60 years who are productive national citizens. The region accounts for 90% of global smokeless tobacco users which could contribute largely to around 1.2 million cancer deaths in SEA Region. NCDs are the most common cause of high out-of pocket expenditure. These have the potential to set back the economic gains made by the countries. The determinants of NCDs lie beyond the health sector, and warrant the close collaboration of all sectors invovled, preferably through a “Health in All Policies” approach. By Adopting the UN Political Declaration on NCDs and subsequent WHA and RC resolutions, a Flagship Priority Area on NCDs, through multisectoral national policies and plans, will strive to support national efforts to reduce premature mortality due to NCDs. The flagship programme will also build institutional capacity in countries to strengthen health systems for early detection and management of NCDs as well as generating local data for monitoring the progress towards global NCD targets.
Reducing maternal and child mortality
Women and children have been historically vulnerable populations in developing countries and have attracted greater attention from national authorities. Yet, several countries in the Region are less likely to achieve the MDGs 4 and 5 targets of reduction in maternal and child mortality by 2015.
The Region needs to make rapid progress to accelerate annual rate of reduction from current 4.9% of maternal mortality rate and 3.9% of under-five mortality rate in all SEAR countries. To achieve a higher annual rate of reduction of maternal, newborn and child mortality, a Flagship has been launched that will support expansion of effective interventions with quality services in an efficient manner to bring about perceptible reduction in maternal and child mortality.
Universal health coverage
With its three dimensions of access, affordability and quality, universal health coverage has become the most important game changer in contemporary public health to counter the highest out-of-pocket spending on health and a relatively low public investment. Improving coverage requires overcoming four main barriers: geographical, technological, social and financial. These are key causes of overall inequities which need to be overcome.
All these aspects require priority consideration and will be addressed through our Flagship involving UHC. The Flagship will strongly advocate UHC based on the four pillars of the Regional Strategy and would stress access to a packet of quality integrated health services, built on the principles of primary health care using a multi-sectoral approach.
Combating Antimicrobial Resistance
For the past seven decades antibiotics have been our mainstay against communicable diseases. Irrational use of antibiotics in both human and animal health is rapidly accelerating emergence and spread of resistance against these wonder drugs. Currently, antimicrobial resistance or AMR is perceived as the greatest threat to the control of communicable diseases.
The Health Ministers of our Region, in 2011, committed and gave a call for concerted action through Jaipur Declaration on Antimicrobial Resistance. This Flagship will strive to assist Member States in implementation of this Declaration and will facilitate working together with regional stakeholders and global partners to reverse the trend of emergence and spread of AMR in both community and hospital acquired infections.
Response to emergencies
Our Region is extremely vulnerable to disasters. Over the past decades, around 45% of global mortality from disasters was from this Region. Subsequent to the Tsunami of 2004 you were instrumental in establishing the South-East Asia Regional Health Emergency Fund which since 2008 has helped meet immediate financial needs of almost all countries of our Region for quick response during emergencies.
We have developed 12 Benchmarks for Emergency Preparedness and Response that are globally acclaimed. With these benchmarks a holistic approach in the form of Flagship is being initiated to integrate capacities in prevention, risk reduction, preparedness, response and recovery. The objective shall be to scale up existing initiatives, intensifying efforts, engaging and nurturing national and international partnerships that deliver. I will be establishing a department in the Regional Office with a focus on emergency and outbreak response.
For all the Flagship areas, focal points have been identified within the Regional Office, and they are developing concept notes and approach papers in consultation with WRs and colleagues from Ministries of Health, and other experts.
Through this consultative process, for each of the Flagship Areas, we propose to develop outcomes, outputs, and relevant activities for a defined period which will be in harmony with WHO SEA Region’s biennial work plans. Successful delivery of these flagship areas of focus will also require a sustained regionalized approach to resource mobilization efforts.
Linked to each of the priority areas, I have decided to visit the countries to coincide with a major event supported by WHO. I have already visited Maldives to focus attention on dengue as an emerging priority health issue. I will visit Bhutan next month to engage in discussions around UHC. Following that I will visit Nepal to deliberate on the unfinished MDGs 4 & 5 agenda and beyond. Similarly I have already chalked out visits to other countries to coincide with a major event linked to my vision statement.
I am conscious of the fact that such Flagships warrant strong continuous monitoring and periodic evaluations to achieve the desired outcomes. The Regional Office will assiduously undertake this oversight function. I will personally be involved to ensure the efficient and effective implementation of these Flagships. At the country office level too, similar mechanisms will be instituted. I will keep you informed of the progress at every opportunity of our interaction, be it World Health Assembly or the Regional Committee meeting. I will also seek your guidance and support along the way, for this is a joint effort.
I would like to spend a moment on the matter of planning our technical work for the forthcoming 2016-17 period. I bring this up now as it is timely to do so. Member States have requested the Director General, through the Governing Bodies meetings, to develop a more “bottom up” approach to the Programme Budget. This necessitates having an advanced first draft WHO 2016-2017 Programme Budget ready for consideration by the 2014 Regional Committee. Our country office staff are already working on this, and having dialogue with their ministry counterparts.
The higher level details will be developed making use of the 12th General Programme of Work, the current 2014-15 Programme Budget, the Country Cooperation Strategies, as well as consideration of the Flagship areas I have just outlined. The “bottom up” planning will need to happen within the WHO results framework.
Though the timeframes are very tight, may I request you to please ensure that your staff can undertake suitable consultations. This will help us to improve the previous collegial approach to planning.
This sort of collaboration and cooperation is essential to ensure that health is at the centre of development agenda dialogue, both at the country level and at the global level. To do that we have to also strengthen partnerships. I have initiated dialogues with our partners to elicit greater collaboration with them; for example, Dr Tom Friedan, Director of US CDC, and Chris Elias of the Gates Foundation, are currently with us and we are discussing areas for mutual collaboration. We share our health challenges with Western Pacific Region of WHO. I have recently had extensive discussions with RD/WPRO to align our actions, as well as synergise our responses for the benefit of people in the Asia Pacific Region. I will also seek to strengthen our collaboration with SAARC and ASEAN.
Our implementation of 2014-15 biennial budget needs to improve compared to the previous biennium. Successful implementation is a joint effort, and requires the closest collaboration.
I need your support to find and institute innovative ways to do things in order to achieve what we are setting out to do, against a USD 44 million budget cut back-drop in our current biennium. The budget cut is proving to be the hardest to manage at the Regional office level, as 47% of the 44 million cut was at this level, which means that I need to be very prudent in my management of staffing and activity implementation of the regional office.
I conclude by expressing my sincere appreciation of your giving us your valuable time to be here today, congratulating you for your untiring efforts towards an unprecedented success in eradicating polio, and assuring you of our commitment to our joint efforts to do what is necessary to address the health needs of the people of our Region.