REPORT OF THE REGIONAL DIRECTOR The Work of WHO in the Western Pacific Region 1 July 2012–30 June 2013
WPR/RC64/2
REPORT OF THE REGIONAL DIRECTOR The Work of WHO in the Western Pacific Region 1 July 2012–30 June 2013
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The Report of the Regional Director
Table of Contents Message from the Regional Director Combating Communicable Diseases Introduction Expanded Programme on Immunization Malaria, other Vectorborne and Parasitic Diseases HIV/AIDS and Sexually Transmitted Infections Tuberculosis and Leprosy Elimination Health Security and Emergencies Introduction Emerging Disease Surveillance and Response Emergency and Humanitarian Action Food Safety Building Healthy Communities and Populations Introduction Environmental Health Maternal and Child Health and Nutrition Noncommunicable Diseases and Health Promotion Mental Health and Injury Prevention Tobacco Free Initiative Health Sector Development Introduction Health Services Development Health Care Financing Human Resources for Health Essential Medicines and Technologies Health Information, Evidence and Research Asia Pacific Observatory on Health Systems and Policies Pacific Technical Support Support, Coordination and Leadership Administration and Finance Programme Management and Coordination Office of the Regional Director 1 10 11 13 16 23 25 28 29 31 34 36 38 39 40 41 44 49 54 56 57 58 60 64 66 68 70 72 80 81 83 86
The Work of WHO in the Western Pacific Region, 1 July 2012– 30 June 2013
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Message from the Regional Director
Message from the Regional Director
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his annual report, my fifth to the Regional Committee for the Western Pacific, highlights the work of WHO in the Western Pacific Region for the year ending 30 June 2013.
Communicable Diseases From malaria and tuberculosis to neglected tropical diseases and sexually transmitted infections, communicable diseases that were once the scourge of the Western Pacific Region are now some of WHO’s biggest success stories. The Region has maintained its polio-free status, despite an outbreak in China. Endemic measles virus transmission has likely been interrupted in 33 countries and areas in the Region. Nearly 30 countries and areas are believed to have achieved the Region’s 2012 milestone of reducing hepatitis B seroprevalence to less than 2% among five-year-olds, with eight countries certified as having achieved the goal of reducing infection rates in five-year-old children to less than 1%. There also have been great strides at the country level in the fight against malaria—a problem this Region has faced since WHO’s establishment. In fact, nine of the 10 malaria-endemic countries in our Region have now changed their programme goals from control to elimination. The 2015 target set by the World Health Assembly of a 75% decrease in malaria mortality as compared to 2000, has been achieved by Cambodia, the Lao People’s Democratic Republic,
Member States should take pride in the significant progress they have made over the past year in child and maternal health, malaria and tuberculosis control, and universal health coverage. As we review this progress, it is also important to consider how much has been achieved in reforming WHO in the Western Pacific Region. We are responding to Member States calls for a leaner and more effective organization, better attuned to individual country needs. Indeed, we are more focused than ever on helping Member States to deliver measurable results that improve health outcomes for their citizens. I will briefly highlight achievements and results over the past year. The chapters that follow provide a more detailed analysis of WHO’s work in the Western Pacific Region.
the Philippines and Viet Nam. China, the Republic of Korea and Viet Nam also achieved a similar decrease in malaria morbidity. Responding to Member States’ needs and Regional Committee mandates, WHO in the Western Pacific is continuing to battle neglected tropical diseases. Niue and Palau— which are among the 22 countries and areas in the Region with endemic lymphatic filariasis—are on the brink of announcing its elimination in 2013. In the coming three years, we expect to verify the elimination of lymphatic filariasis in American Samoa, Cambodia, Cook Islands, the Federated States of Micronesia, the Marshall Islands, Tuvalu, Vanuatu, Viet Nam, and Wallis and Futuna. Member States have made impressive progress towards providing universal access to HIV diagnosis and treatment as well as to prevention campaigns. We can report solid progress towards achieving the Millennium Development Goal target of reducing tuberculosis cases by half by 2015. In response to the threat of multidrug-resistant tuberculosis (MDR-TB), WHO has built a regional network of MDR-TB consultants and organized TB programme reviews in Cambodia, the Lao People’s Democratic Republic, Mongolia and Papua New Guinea.
Regional Director, Dr Shin Young-soo The Work of WHO in the Western Pacific Region, 1 July 2012– 30 June 2013
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Health Security and Emergencies WHO provided technical support to the Philippines in the wake of massive flooding on the island of Luzon in August 2012 and after Typhoon Bopha in December 2012, which was the strongest cyclone ever to hit the southern Philippines. Although we are eager to help in the aftermath of disasters, the Organization is undergoing a strategic shift towards helping Member States to mitigate the effects of disasters by addressing risks before disasters strike. In 2012, WHO improved its ability to assist countries during disasters by developing the WHO Emergency Response Framework. This focus on preparedness, prevention, response and recovery means Member States
will have to enhance their coordination with national disaster management centres and build up the resilience of vulnerable populations. The Regional Office inaugurated its new Emergency Operations Centre in March 2013, just weeks before China announced an outbreak of influenza not previously seen in humans that we now know as H7N9. Since then, the modern and well-equipped centre has been busy with almost constant meetings, teleconferences, videoconferences and briefings.
Healthy Communities and Populations The largest division in the Regional Office, the Division for Building Healthy Communities and
Regional Director Dr Shin Young-soo cuts the ribbon to inaugurate the new Emergency Operations Centre with Dr Ailan Li, Director, Division of Health Security and Emergencies.
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Populations, covers programmes ranging from maternal and child health and nutrition to environmental health and health promotion. Meeting Millennium Development Goals 4 (reducing child mortality) and 5 (improving maternal health) continue to be high priorities. Most Member States in the Region have registered major reductions in maternal mortality and the underfive mortality rate. In Cambodia, for example, the maternal death rate fell to 206 deaths per 100 000 live births in 2010 from 830 deaths in 1990. However, progress among and within countries has been uneven. Noncommunicable diseases (NCDs) continue to be the leading cause of death and disability in the Region. In November 2012, WHO and Member States set voluntary global targets for rolling back NCDs and created a global monitoring framework to measure progress. They also stressed the importance of cost-effective interventions for controlling alcohol and tobacco, reducing salt intake, reducing and replacing trans-fats, and providing essential drugs, medicines and services to manage NCDs. As part of its focus on country-level results, WHO helped Pacific island countries and areas develop a crisis-response package for their national NCD strategies. In response to a Regional Committee mandate, a draft Regional Action Plan for the Prevention and Control of Noncommunicable Diseases in the Western Pacific (2014–2018) has been developed. The Regional Office now has a full-time professional staff member assisting Member States on
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Message from the Regional Director
Philippine President Benigno S. Aquino III visits with WHO Regional Director Dr Shin Young-soo for World Health Day 2013 in April at the Regional Office. Dr Shin congratulated the President for his courageous positions on contentious health issues— especially reproductive health and “sin taxes”.
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visual impairment and blindness, of which 80% of cases are avoidable. Health promotion continues to be an important area of work. New health promotion foundations have been established in Malaysia, Mongolia and Tonga, supported by the WHO-organized capacity-building programme called ProLead. WHO is working with the Lao People’s Democratic Republic, Samoa and Viet Nam to use tobacco taxes to create special funds for health promotion. WHO is also encouraging governments to put health issues high on their agendas through the MacaoWHO Healthy Cities Leadership Programme, in which officials from well-established Healthy Cities mentor officials from other urban areas.
Mental health is another priority, with WHO convening the Seoul Forum on Suicide Prevention in the Western Pacific Region in September 2012. Guided by the global Comprehensive Mental Health Action Plan 2013–2020, WHO will collaborate with Member States to strengthen regional networks and partnerships and monitor information on regional trends and risk factors for such conditions as depression, suicidal behaviour and epilepsy. The WHO Framework Convention on Tobacco Control (WHO FCTC) provides a global mandate and a call to action. Many Member States have responded by increasing taxes on tobacco products, forming smokefree areas and banning advertising, promotion and sponsorship by tobacco companies.
WHO’s Pacific Tobacco Taxation Project provided training to finance ministry tax officials. In 2012, Cook Islands, Fiji, Papua New Guinea and Tonga raised their tobacco taxes. In December 2012, the President of the Philippines signed a so-called “sin tax” law that includes steeper taxes on tobacco and sets aside revenue for universal health coverage. Viet Nam passed the nation’s first comprehensive tobacco control law, which took effect in May 2013. In November 2012, Member States adopted the Protocol to Eliminate Illicit Trade in Tobacco Products at the Fifth session of the Conference of the parties to the WHO FCTC in Seoul, Republic of Korea. This treaty means all Parties must work to curb the smuggling of tobacco products.
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Health Systems The Division of Health Sector Development encourages Member States to build or strengthen health systems and appropriate policies with sound scientific evidence, as the best way to achieve real and lasting health gains. WHO has published service delivery profiles for 17 countries and areas in the Region. Health at a Glance: Asia/Pacific 2012 presented key indicators on health and health systems for 27 Member States. By some estimates as much as 40% of all funding for health is wasted, thus WHO intends to focus on hospital services and management, including quality of care, patient safety and the efficient use of resources. WHO works with Member States on health financing policies, especially those aimed at providing universal health coverage. The Lao People’s Democratic Republic health system reform strategy aims for universal health coverage, and WHO successfully advocated more public spending for essential health services in rural and remote areas of the country. WHO provided technical support to Viet Nam in revising its health insurance law and developing a health insurance road map. WHO also supported the development of a national monitoring and evaluation framework for universal health coverage in the Philippines. WHO has been strengthening its work on health and ageing in Member States. To increase awareness, World Health Day 2012 promoted the theme “Good health adds life to years”. What’s more, WHO has been working
on a draft Regional Framework of Action on Ageing and Health to provide guidance for Member States. Countries in the Region receive WHO assistance to ensure the quality and safety of traditional medicine and to integrate traditional medicine into national health systems. Cambodia, the Philippines and Viet Nam took part in high-level dialogues using in-depth country analyses to develop national policies on combating antimicrobial resistance. China, the Lao People’s Democratic Republic and the Philippines strengthened
regulatory capacity to ensure that medical products meet international standards of quality. In January 2012, the Regional Office launched the Health Information and Intelligence Platform (HIIP), which links users to new databases and visualization tools. The platform provides reliable, user-friendly information and WHO health indicators. WHO and partners also produced a regional action plan for achieving well-functioning civil registration and vital statistics systems by 2020 in Asia and the Pacific.
Deputy Prime Minister Thongloun Sysoulith of the Lao People’s Democratic Republic greets Regional Director Dr Shin Young-soo in March 2013 in Vientiane.
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Message from the Regional Director
Pacific Technical Support Pacific island countries account for 21 of the 37 countries and areas that make up the Western Pacific Region. Many Pacific islands share similar health challenges—from the health impact of climate change and the dual burden of NCDs and communicable diseases to training and retaining health workers to handle burgeoning health needs. WHO led the health response in December 2012 when a devastating cyclone struck Fiji and Samoa. WHO teams provided post-disaster surveillance on diseases and measured the impact on health facilities, nutrition, and food production. Likewise, WHO assisted in rapid assessment and establishing a system for reporting health problems after an underwater earthquake caused a deadly tsunami in Solomon Islands in February 2013. Based in Suva, Fiji, the Division of Pacific Technical Support (DPS) has greatly improved WHO’s performance at the country level. In the past, many countries received long-distance assistance from the WHO Regional Office for the Western Pacific. Now DPS addresses four out of five of requests for assistance directly in the Pacific. This hands-on model of assistance is spelled out in WHO’s Multi-Country Cooperation Strategy for the Pacific (2013–2017), which was launched at the sixty-third session of the Regional Committee for the Western Pacific. The strategy employs WHO guidelines for affordable, cost-effective interventions to help Pacific island countries and
Dr Shin Young-soo talks with children in Solomon Islands during a visit in August 2012. The Regional Director has been a frequent visitor to Pacific island countries and areas.
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areas make a real difference in the health of their populations. So far, the results are promising. Kiribati is prioritizing tobacco control legislation. Fiji is focusing on salt reduction strategies. Countries are strengthening primary health-care services with the help of the WHO Package of Essential NCD (PEN) Interventions for Primary Health Care.
Much like the restructuring of technical teams in the Regional Office, the creation of DPS has streamlined WHO assistance for reduced bureaucracy, increased efficiency and money saved. More importantly, the change has made WHO better able to assist Pacific island countries in overcoming the daunting health challenges they face.
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Support, Coordination and Leadership In the area of administration and finance, the Region has made significant investments to improve and streamline the physical environment in our offices. The Regional Office has continued the implementation of new processes to improve human resources planning and ensure administrative efficiencies, particularly in the area of travel. Improving the implementation of the programme budget and
developing stricter oversight mechanisms have been priorities of the Division of Programme Management. Particular efforts have been made to strengthen country office capacity on programme management and enhancing performance at the country level. Country cooperation strategies remain the main instrument for formalizing cooperation with Member States, and over the past year new strategies were launched for China and for the Pacific.
The Office of the Regional Director (RDO) continues to lead the implementation of WHO reforms across the Region and provides additional services in relation to external relations, communications and resource mobilization. In sum, RDO ensures leadership for the implementation of Member States’ decisions at the governing bodies.
Mr Xi Jinping, President of the People’s Republic of China (centre right), and Dr Chen Zhu, former Minister of Health, China (far right), meeting in Beijing with Dr Margaret Chan, WHO Director-General (centre left), and Dr Shin Young-soo, WHO Regional Director for the Western Pacific (far left).
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Message from the Regional Director
Going forward… In the Western Pacific Region, we have listened to our Member States and have fundamentally re-examined the way we work. The reforms we have instituted, with the guidance and support of Member States, have increased our agility and effectiveness, making WHO a more flexible partner, better able to deliver results at the country level. Many of the reforms in the Western Pacific Region over the past five years have led to a renewed emphasis on results at the country level. These reforms have been institutionalized with initiatives such as the Country Support Unit, the Division of Pacific Technical Support, Country and Technical Strategic Frameworks, greater staff mobility and rotation, and streamlining the structure of the Regional Office. In the process, we have broken down barriers and worked across technical divisions and programmes
within WHO. We have also reached out more effectively to various sectors of society and across governments to tailor our support to individual country needs. This new way of working has led to groundbreaking collaborations such as the Western Area Health Initiative in China, where WHO is working with the support of central Government directly with officials at the subnational level to deliver support where it is needed most. A similar initiative is under way in the southern Philippines. We understand that WHO cannot solve the world’s health problems alone. However, the Organization’s authoritative convening power allows it to bring together Member States, partners and stakeholders to develop multisectoral solutions to confront tomorrow’s challenges and crises. WHO’s focus is—and will continue to be—the health challenges faced by our Member States to safeguard the well-being of the 1.8 billion people in the Western Pacific Region.
Shin Young-soo, MD, Ph. D. Regional Director
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WHO Regional Office for the Western Pacific Organizational Chart REGIONAL DIRECTOR EXECUTIVE OFFICER TO THE REGIONAL DIRECTOR DIRECTOR, PROGRAMME MANAGEMENT division / Offices
Unit
External Relations and Communications
Public Information
DIRECTOR, PACIFIC TECHNICAL SUPPORT
DIRECTOR, HEALTH SECTOR DEVELOPMENT
DIRECTOR, BUILDING HEALTHY COMMUNITIES AND POPULATIONS
DIRECTOR, HEALTH SECURITY AND EMERGENCIES
DIRECTOR, COMBATING COMMUNICABLE DISEASES
DIRECTOR, ADMINISTRATION AND FINANCE
Combating Communicable Diseases and Health Security and Emergencies Health Sector Development Building Healthy Communities and Populations
Health Services Development
Environmental Health
Emerging Disease Surveillance and Response Emergency and Humanitarian Action
Expanded Programme on Immunization Malaria, other Vectorborne and Parasitic Diseases HIV/AIDS and Sexually Transmitted Infections Stop TB and Leprosy Elimination
Programme Development and Operations
Budget and Finance
Health Care Financing
Maternal, Child Health and Nutrition Noncommunicable Diseases and Health Promotion Mental Health and Injury Prevention
Country Support
Personnel
Human Resources for Health Essential Medicines and Health Technologies Health Information Evidence and Research
Food Safety
Editor
IT, Administration and Procurement
asia pacific observatory
Tobacco Free Initiative
WHO REPRESENTATIVES OFFICES Cambodia Mongolia China Papua New Guinea Lao People’s Democratic Republic Philippines Viet Nam Malaysia Samoa
COUNTRY LIAISON OFFICES Federated States of Micronesia Tonga Kiribati Vanuatu
Solomon Islands
South Pacific
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Message from the Regional Director
WHO Western Pacific Region Mongolia Republic of Korea China Lao People’s Democratic Republic Hong Kong (China) Commonwealth of Northern Mariana Islands Manila: WHO Regional Office for the Western Pacific Guam Palau Federated States of Micronesia Nauru Papua New Guinea Solomon Islands Marshall Islands Kiribati Tuvalu Tokelau Samoa American Samoa Niue Tonga Japan
Countries and Areas
Macao (China) Cambodia Viet Nam
Philippines
Singapore
Malaysia
Brunei Darussalam
Wallis and Futuna Vanuatu Fiji Australia New Caledonia
Cook Islands
French Polynesia
Pitcairn Islands
WHO Representatives Offices Cambodia n China n Lao People’s Democratic Republic n Malaysia (area of responsibility: Brunei Darussalam, Malaysia, Singapore) n Mongolia n Papua New Guinea n Philippines n Samoa (area of responsibility: American Samoa, Cook Islands, Niue, Samoa and Tokelau) n Solomon Island n South Pacific (area of responsibility: Fiji, French Polynesia, Kiribati, the Marshall Islands, the Federated States of Micronesia, the Commonwealth of the Northern Mariana Islands, Nauru, New Caledonia, New Zealand, Palau, Tonga, Tuvalu, Vanuatu, and Wallis and Futuna) n Viet Nam n
New Zealand
Country Liaison Offices Northern Micronesia (area of responsibility: the Marshall Islands, the Federated States of Micronesia, and Palau) n Kiribati n Tonga n Vanuatu n
Disclaimer: The boundaries and names shown and the designations used on this map do not imply the expression of an opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or areas or its authorities, or concerning the delimitation of its frontiers or boundaries.
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Combating Communicable Diseases
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Combating Communicable Diseases
Introduction
Measles vaccine has been in use for more than 40 years—safe, effective and inexpensive.
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he work of the Division of Combating Communicable Diseases (DCC) and its network of country office focal points aims to reduce morbidity and mortality related to HIV/AIDS, malaria, neglected tropical diseases, tuberculosis and vaccine-preventable diseases.
The Division also promotes cross-disciplinary approaches in communicable disease control, such as working with health systems and newborn health programmes. The burden of communicable diseases remains unacceptably high in some Member States, despite strong economic development in the Western Pacific Region. Those most at risk of communicable diseases are often the poor and marginalized who lack adequate access to health care. The disproportionate burden of communicable diseases on these groups leads not only to illness and death but also contributes to a
cycle of ill health, lack of education, unemployment and poverty. In 2012–2013, DCC continued to support Member States in the control of vaccine-preventable diseases. New vaccines were used to combat diarrhoea, meningitis, pneumonia and other significant causes of mortality in the Region. Progress has been made towards eliminating hepatitis B and measles. Thirty-three countries and areas have likely interrupted endemic measles virus transmission, and the Region has maintained its certified polio-free status. Where feasible, immunization is integrated with other programmes
A girl stoically endures an injection during a WHO-supported measles vaccination campaign in the Lao People’s Democratic Republic. WHO is working to eliminate this sometimes-fatal disease in the Western Pacific Region. The Work of WHO in the Western Pacific Region, 1 July 2012–30 June 2013
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Routine measles vaccination coverage has been selected as an indicator of progress towards achieving MDG 4.
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to foster sustainable methods of service delivery, such as vitamin A supplementation in conjunction with measles immunization. Despite the low burden of HIV/AIDS in the Region, there are danger signs. Populations driving the HIV/AIDS epidemic are men who have sex with men, people who inject drugs, sex workers and transgender people. DCC programmes assist Member States in developing new strategies and interventions, such as providing treatment as a means of prevention, increasing HIV testing and improving surveillance. DCC and the Joint United Nations Programme on HIV/AIDS have strengthened partnerships to make better use of limited resources. New diagnostic tools have been introduced to scale up detection of all forms of tuberculosis (TB), including multidrug-resistant TB, by providing
rapid diagnosis in peripheral facilities. To prevent the emergence of resistance to new TB drugs, DCC also assists Member States in the responsible introduction of treatments. New guidelines have been developed to engage the private sector and high-risk groups, such as migrants. Leprosy remains a public health problem, particularly in Pacific island countries, and case detection has been intensified. Significant progress has been made in reducing the number of malaria cases; however, gains are threatened by the emergence of artemisinin resistance in the Greater Mekong Subregion. To contain the spread of artemisinin resistance, WHO and partners have enhanced emergency response by establishing a regional hub in Cambodia. DCC personnel have also been working closely with counterparts in the
Regional Office’s Division of Health Security and Emergencies to conduct dengue surveillance and control activities. The Regional Committee for the Western Pacific in 2012 endorsed the Regional Action Plan for Neglected Tropical Diseases in the Western Pacific (2012–2016) and secured political commitments to move forward with campaigns to eliminate lymphatic filariasis, schistosomiasis, trachoma and yaws. Research is a WHO core function because it addresses programmatic gaps. DCC has developed the Regional Research Framework to Strengthen Communicable Diseases Control and Elimination in the Western Pacific (2013–2017) to address the research needs of Member States, the first WHO region to take such action.
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Combating Communicable Diseases
Expanded Programme on Immunization I Strategy and actions mmunization programmes across the Western Pacific Region strive to protect every child from diseases that can be prevented with vaccines. These programmes include supporting countries to plan and implement campaigns that reach all children, providing technical expertise to help ensure vaccine quality, monitoring the impact of vaccinations and promoting the rational introduction of new vaccines. These programmes bring together various disciplines and partners to maximize public health benefits and efficiency. Helping hard-to-reach children is intrinsic to disease eradication or elimination efforts, which must protect all—or nearly all— communities to be successful. The Region has demonstrated leadership and commitment by adopting diseasereduction targets. The Region remains polio-free and is on the verge of eliminating measles and maternal and neonatal tetanus, while hepatitis B and rubella are under control. With its strong technical capacity, WHO helps countries measure the impact of their immunization programmes though surveillance systems and monitoring activities. A network of more than 400 laboratories throughout the Region provides critical and timely data to Member States. This network provides evidence of polio-free status, helps guide programmes designed to eliminate measles and control rubella, and provides disease burden evidence for the introduction of vaccines against Haemophilus influenzae, pneumococcal disease and rotavirus. In 2012, WHO supported the establishment of a Regional Alliance for National Regulatory Authorities for Vaccines in the Western Pacific. The alliance will develop or strengthen the regulatory capacities of countries to provide them with independent and expert assessments on the quality of vaccines for immunization programmes. WHO supports immunization activities that are harmonized with existing health systems and, where feasible, include other health benefits. For example, vitamin A and/or deworming medicines were integrated with measles supplemental immunization activities in two of the three countries conducting campaigns. Directors of immunization and maternal and newborn health from five priority countries met to coordinate the prevention of mother-to-child transmission of the hepatitis B virus and essential newborn care. The impact of hepatitis B immunization and lymphatic filariasis were jointly assessed in a seroprevalence survey in Wallis and Futuna.
In response to a 2012 polio outbreak in China, WHO helped conduct a vaccination campaign in the Xinjiang Uyghur Autonomous Region in April 2013.
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A nurse in China’s Yunnan province examines blood under a microscope. Painstaking laboratory work is the backbone of surveillance and verification efforts.
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Results achieved In November 2012, the 18th Meeting of the Regional Commission for the Certification of Poliomyelitis Eradication in the Western Pacific concluded that China had successfully responded to the 2011 polio outbreak that consisted of 21 cases. The commission also certified that China and the Region have maintained their polio-free status. By the end of 2012, 33 countries and areas have likely interrupted endemic measles transmission, a status that will later be confirmed by the Regional Verification Commission for Measles Elimination in the Western Pacific. Rubella control has been accelerated in the Region by combining measles- and rubella-related immunization and surveillance activities. In December 2012, China, WHO and UNICEF
confirmed that China had eliminated maternal and neonatal tetanus. It is estimated that the Region as a whole and at least 30 countries and areas individually are likely to have achieved the Region’s 2012 milestone of reducing hepatitis B seroprevalence to less than 2% among five-year-old children. In addition, it was officially verified that Australia, China, Hong Kong (China), Macao (China), Malaysia, Mongolia, New Zealand and the Republic of Korea have achieved the regional goal of reducing hepatitis B infection rates in five-year-old children to less than 1%. The Region has provided critical contributions to advances in accelerated disease control. For example, the Region has significantly strengthened laboratory capacity by improving poliovirus detection through the support of a new algorithm for virus isolation in
China following the wild poliovirus outbreak in Xinjiang. Virus tracking in the Region also improved thanks to the scaling up of molecular genotyping capacities at measles and rubella network laboratories. WHO assisted with comprehensive national immunization reviews in the Lao People’s Democratic Republic and Solomon Islands. The reviews showed that, despite some progress, routine vaccination coverage in many areas of the two countries remains low and that the majority of children are vaccinated late. The reviews prompted the two governments to increase their support for national immunization programmes. Training for mid-level managers in Kiribati and the Lao People’s Democratic Republic led to improved routine immunization programmes in the most remote districts and villages. In Cambodia, micro-planning guidelines for reaching high-risk populations were developed and lessons were shared globally in the effort to provide greater and more equal access to immunization services WHO supported efforts by the Philippines and Viet Nam to use costeffectiveness analyses and other data to quantify the potential benefits of introducing new vaccines. Between July 2012 and June 2013, Fiji, Kiribati and the Philippines each introduced one or more new vaccines to combat cervical cancer as well as pneumonia and diarrhoea in young children. Mongolia received WHO assistance in evaluating its pilot programme to provide human papillomavirus vaccinations, and the results highlighted a strong,
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school-based delivery system. WHO also supported the Philippines in carrying out an impact evaluation for rotavirus vaccination.
Future directions In May 2012, the Sixty-fifth World Health Assembly endorsed the Global Vaccine Action Plan, a road map to prevent millions of deaths by 2020 by providing more equitable access to vaccines. WHO is working with Member States to identify the best approaches and draft a plan for putting the Global Vaccine Action Plan in place.
The WHO action plan focuses on disease-reduction targets and promotes equal access to vaccinations, the rational introduction of new vaccines and high-level commitments from governments, partners and donors to ensure sustainability. The Region is raising awareness of the benefits of vaccinations by coordinating and providing financial support for World Immunization Week. The event is gaining a higher profile as more countries take part by setting
up media opportunities, educational seminars and immunization activities. The Regional Committee for the Western Pacific continues to drum up support and commitments to eliminate measles on the heels of its 2012 resolution calling for intensified efforts to combat the disease and defend advances made. To maintain the important progress towards the 2012 hepatitis B control milestone, the Regional Committee at its sixty-fourth session in October 2013 will consider setting a target year for the control of hepatitis B.
WHO supported a hepatitis B serologic survey of children in the remote Kairuku-Hiri district of Papua New Guinea.
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Cambodia’s success: zero measles cases in 2012
Malaria, other Malaria
E Women in Cambodia wait to immunize their babies. Thanks to intensified vaccination and monitoring efforts, Cambodia is on track for certification of measles elimination in 2014 by the Regional Verification Commission for Measles Elimination in the Western Pacific. One of the most infectious viruses known to humans, measles often strikes infants and children causing pneumonia, diarrhoea and blindness. However, in 2012 the Government’s National Immunization Program reported zero measles cases. That’s down from the more than 700 cases reported in 2011 and more than 1800 cases in 2008. Much of the credit goes to Reaching Every Community, a new plan that identifies, vaccinates and monitors infants and children in mostly poor, ethnic and minority communities that routine immunizations often pass by. “The new focus by the National Immunization Program in targeting communities most at risk is having a real impact,” says Dr Chham Samnang, WHO’s National Technical Officer, High-risk Communities and Measles Elimination. Key elements of Reaching Every Community include improving links between health workers and local volunteers and the introduction in 2012 of a second measles dose. Now, all infants receive two doses of measles vaccine, the first at nine months of age, the second at 18 months. Besides providing greater protection, the second AFP
Strategy and actions
dose helps health workers monitor immunization coverage. “To make sure we get rid of measles permanently the Ministry of Health is making great efforts to immunize chil dren and mothers, wherever they live,” says Health Minister Dr Mam Bunheng. “In 1997 we got rid of polio. Now we are building upon those experiences to get rid of measles.” Indeed, the anti-measles campaign was based, in part, on successful efforts in the 1990s to eradicate polio, which included national immunization days and intensive, house-to-house vaccination drives. Going forward, those two campaigns will serve as a template in Cambodia for combating rubella, a virus that can cause congenital rubella syndrome (CRS) and lead to severe heart disorders, blindness and deafness in newborn infants. In addition, immunization programmes allow health workers to provide isolated communities with other key services, including antenatal and postnatal care, information on contraception and childhood respiratory infections, and supplies of vitamins and rehydration fluid to treat diarrhoea. Sann Chan Soeung, an adviser to the Ministry of Health, calls this integration of immunization programmes with other health services an “interim step towards universal health coverage”.
fforts to meet the 2015 targets of the Regional Action Plan for Malaria Control and Elimination in the Western Pacific (2010–2015) are being intensified. Nine of the 10 malaria-endemic countries in the Region have changed their malaria programme goals from control to elimination. As a result, they are reorienting programmes and intensifying political commitment and resource mobilization. Despite progress on the Cambodia– Thailand border towards containing falciparum malaria parasites resistant to artemisinin, new suspected foci were detected in Myanmar and southern areas of Viet Nam. With four out of six Mekong countries now affected, the Region has scaled up efforts to respond to artemisinin resistance. The health of people living in border areas, particularly mobile and migrant populations, is a great concern to Member States and stakeholders. Some populations face high risks of contracting malaria. On Cambodia’s southern border with Viet Nam, more than 10 000 cases of malaria are reported every year. The situation requires greater crossborder and intersectoral collaboration. For example, Cambodian health officials are working closely with their Thai counterparts to prevent malaria infections among migrant workers along their common border.
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Vectorborne and Parasitic Diseases
A man sleeps safely under a mosquito net in a village in Pailin province in Cambodia.Armed with a little training—and their trusted cellphones—people from remote villages like this one have become foot soldiers in the fight against drug-resistant malaria. With a quick blood test, they can diagnose and treat people in far-flung villages. The service is free.
AFP
“Cambodian and Thai officials have agreed to communicate with one another to eliminate malaria and to offer treatment and health services free of charge at the border,” says Dr Char Meng Chuor, the head of Cambodia’s National Center for Parasitology, Entomology and Malaria Control. Financial sustainability is also a major challenge. The recent global economic downturn and changes in the donor landscape pose a major challenge for malaria control and elimination programmes. November 2012 brought unprecedented high-level political commitments in the Region to malaria programmes. Malaria 2012––Saving Lives in Asia and the Pacific, a conference organized by
the Australian Government, resulted in political commitments and a consensus on actions required to reach global malaria targets by 2015. In addition, the Declaration of the 7th East Asia Summit on Regional Responses to Malaria Control and Addressing Resistance to Antimalarial Medicines was issued by the Association of Southeast Asian Nations (ASEAN).
Results achieved Technical collaboration between WHO and all endemic countries was strengthened. WHO helped secure funding for more technical experts in the malaria-endemic countries of Cambodia, Papua New Guinea,
Solomon Islands and Vanuatu. Funding also went to combat artemisinin resistance in Viet Nam and to hire six experts for emergency response coordination. Efforts were intensified to achieve the 2015 targets set by the World Health Assembly resolution WHA58.2. In fact, the target of a 75% decrease in malaria mortality, as compared to 2000, has already been achieved by Cambodia, the Lao People’s Democratic Republic, the Philippines and Viet Nam, while China, the Republic of Korea and Viet Nam achieved a similar decrease in malaria morbidity. WHO provided support to review implementation, update national strategic and operational plans, build programme capacity, monitor and
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respond to artemisinin resistance, mobilize funds, and track and report progress. Programmatic and financial gap analyses by country continue. WHO was the lead technical partner for regional initiatives. Based on the Global Plan for Artemisinin Resistance Containment, WHO has developed the Emergency Response to Artemisinin Resistance in the Greater Mekong Subregion: Regional Framework for Action 2013–2015. WHO also led an effort to mobilize funding for a regional coordination hub in Cambodia, with additional staff based throughout the Greater Mekong Subregion.
Dengue
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Strategy and actions engue cases have increased over the past decade, placing significant burdens on families, communities, health systems and economies. Over the past five years, the Western Pacific Region has reported at least 200 000 new cases of dengue, with more than 600 deaths annually. Still, there is no specific treatment or vaccine for dengue. Aside from vector control and social mobilization, there are few effective and sustainable ways to control the disease. The Malaria, other Vectorborne and Parasitic Diseases unit has been working closely with the Emerging Disease Surveillance and Response unit in the Region. WHO responded to dengue outbreaks in Kosrae State in the Federated States of Micronesia and in Honiara, Solomon Islands, where WHO provided equipment and technical support for rapid entomological assessments and vector control. WHO carried out regional capacity-building activities for dengue laboratories, vector surveillance and integrated vector management efforts in the Region with support from WHO collaborating centres. Fiji is the site of a low-cost, yearround community vector-control pilot measure using larvivorous fish, commonly known as guppy fish.
Future directions The Regional Action Plan for Malaria Control and Elimination in the Western Pacific (2010–2015) will continue to serve as a road map for programme implementation. Programme reviews and capacity-building focused on eliminating malaria will continue. Countries relying on the Global Fund to Fight AIDS, Tuberculosis and Malaria will receive support to adapt to a new funding mechanism and to mobilize resources. The response to artemisinin resistance will be intensified greatly. Preparation continues for the Mekong Healthy Borders meeting, which will focus on improving the health of people living in border areas. WHO and stakeholders will also build on the Malaria 2012 conference Consensus on Malaria Control and Elimination in the Asia-Pacific
The communications for behavioural impact (COMBI) planning tool will be used in developing the framework for delivering the results to selected villages. WHO continues to support dengue vector surveillance and control in countries. In Cambodia, WHO provided technical support to secure essential funds for a project focusing on the response to climate-sensitive vectorborne diseases, which includes the annual Aedes survey. This project identifies trends in vector density and outbreak risk. It can also alert health authorities to respond to outbreaks when the number of dengue cases exceeds defined outbreak thresholds. Funds from the same project will be used to raise awareness about dengue risks and protective measures in vulnerable communities.
Results achieved WHO helped the Federated States of Micronesia and Solomon Islands with timely responses to dengue outbreaks. Dengue surveillance and data collection improved, and as dengue virus transmission was reduced so was the burden on local health clinics. There was broad intersectoral participation and coordination in implementing dengue activities. In Honiara, clinical management of dengue improved through the training of eight doctors and 50 nurses. National vectorborne disease control programmes and laboratory staff learnt more about the clinical management of dengue, laboratory and field surveillance,
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integrated vector management (IVM), laboratory isolation, and the detection of the dengue virus from mosquito vectors. Through capacity-building activities, WHO also promoted regional collaboration among training participants. The number of potential dengue breeding sites was reduced. Due to educational efforts and the use of COMBI, communities are now more aware of how dengue is spread and how to prevent transmission.
Future directions Dengue and its vectors are constantly spreading across national borders. Intersectoral collaboration with partners and stakeholders is essential to prevent and control dengue and carry out surveillance activities. Resource mobilization to provide consistent support for outbreak and inter-outbreak actions remains an important function of WHO. Immediate initiatives include monitoring the insecticide resistance of dengue vectors and improving the ability to predict and detect dengue outbreaks through coordinated epidemiological and entomological surveillance and more effective social mobilization and communication. A consultation to develop a regional IVM strategy for the Western Pacific will be conducted with the goal of creating consensus and improving understanding of IVM. A doctor checks up on a child at a hospital in Cambodia. Here and in other countries in the Region hit hard by dengue, WHO continues to support dengue vector surveillance and control to combat the disease, which has no cure. AFP
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Neglected tropical diseases
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Strategy and actions eglected tropical diseases (NTDs) are endemic in 28 countries and areas in the Western Pacific Region. Despite progress, critical gaps remain in the task of reducing the disease burden. With that in mind, the sixty-third session of the Regional Committee for the Western Pacific
in 2012 endorsed the Regional Action Plan for Neglected Tropical Diseases in the Western Pacific (2012–2016). The action plan is designed to secure political commitments from Member States and partners, integrate disease-specific plans and measure progress in the fight against NTDs.
elephantiasis, has moved towards its global goal of elimination. Among the remaining 22 endemic countries and areas in the Region, Niue and Palau have completed all post-intervention monitoring and are expected to confirm in 2013 that lymphatic filariasis has been eliminated. Over the next three years, verification that lymphatic filariasis has been eliminated is expected in American Samoa, Cambodia, Cook Islands, the Federated States of Micronesia, the Marshall Islands, Tuvalu, Vanuatu, Viet Nam, and Wallis and Futuna. Eight countries are implementing preventive chemotherapy, and three countries are conducting surveys to confirm transmission status. In an example of inter-programme coordination, Wallis and Fortuna conducted a combined prevalence survey of hepatitis B and lymphatic filariasis to measure the impact of the two programmes. Papua New Guinea drafted a national plan for NTDs and secured United States Agency for International Development (USAID) support for eliminating lymphatic filariasis. Schistosomiasis is endemic in Cambodia, China, the Lao People’s Democratic Republic and the Philippines. However, programme reviews conducted in all of these countries except China showed a large reduction in human infections. In Cambodia, the mass administration of
Results achieved The programme for lymphatic filariasis, commonly known as
A child takes deworming medicine in the Lao People’s Democratic Republic.
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drugs has reduced the prevalence of schistosomiasis from more than 70% in 1995 to less than 5% in 2011. In the last remaining endemic districts of the Lao People’s Democratic Republic, the rate has dropped from more than 50% in 1999 to 2.1% in Khong district and 0.4% in Mounlapamok district. This suggests that schisto somiasis may soon be eliminated in Cambodia and the Lao People’s Democratic Republic. In China, significant progress was also made. However, challenges remain, such as improving sanitation, water supplies and animal control and reducing contact with unsafe river water. Information from a situational analysis of three high-burden provinces in Solomon Islands is being used to draft a national strategy that integrates trachoma. Papua New Guinea is assessing its endemicity status in order to develop a national action plan. Progress was also made in the fight against other NTDs. Programmes are moving ahead in several countries to combat soil-transmitted helminthiases, but they need to be scaled up. Twelve countries in the Region carried out school deworming programmes, and three countries met the global target of 75% coverage. Three Mekong countries carried out mass treatments against foodborne trematode infections.
be eliminated and yaws must be eradicated by 2020, tasks that will require intensified intervention and monitoring. Treatment and complementary intersectoral transmission-control measures need to be put in place to reduce morbidity from soil-transmitted helminthiases and foodborne trematodiases.
Multi-disease, intersectoral actions
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arious diseases—such as dengue, malaria and neglected tropical diseases—are often endemic in the same areas. These diseases can be addressed using common health sector resources, strategies and tools. Non-health sectors can also play an important role, so WHO has been working with intersectoral partners in the Western Pacific Region to improve efficiency and sustainability of programmes to control vectorborne diseases and NTDs. Through collaboration with nonhealth sectors, WHO has been working on projects that protect vulnerable populations from the health impacts of climate change. Following a successful project funded by the Korean International Cooperation Agency (KOICA) that ended in June 2012, WHO has leveraged additional funds for the continuation of the most successful activities related to health and climate change in Cambodia. The impact of climate change on human health is an emerging area and one with the potential for considerable funding from developed countries that acknowledge their historical levels of greenhouse gas emissions. WHO has provided technical assistance to Member States to mobilize resources and develop
Future directions To meet the goals of the Regional Action Plan, lymphatic filariasis, schistosomiasis and trachoma must
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building activities. For example, WHO organized a workshop in Manila to improve skills in writing scientific manuscripts for researchers from the Lao People’s Democratic Republic, Mongolia and Viet Nam. Areas in which research on major NTDs need improvement were identified by the Regional Programme Review Group, WHO collaborating centres and other research institutions. The Malaria, other Vectorborne and Parasitic Diseases unit also focused on resource mobilization for research. In addition, the unit assisted the Regional Network for Asian Schistosomiasis and other Helminth Zoonosis (RNAS+) in developing a multinational research proposal on schistosomiasis and foodborne trematodiasis. The proposal was funded by a research grant from Canada’s International Development Research Centre. This project started in 2012 in Cambodia, China, the Lao People’s Democratic Republic and the Philippines. Greater efforts are required to mobilize resources to secure research grants, fellowships and scholarships for researchers in the Region. In addition, more collaboration with other government sectors, such as ministries of agriculture, education, and science and technology, would enhance research activities in the Region.
A child in Kratie, Cambodia, is examined for signs of schistosomiasis during a WHO field visit in November 2012 as part of the schistosomiasis programme review.
WHO
national plans to address health consequences linked to climate change.
Research on infectious diseases of poverty Significant programmatic and knowledge gaps exist in prevention and control of communicable diseases. Improved research can help fill these gaps. In order to strengthen research capacity, the Regional Office for the Western Pacific has been working closely with research institutions and
networks, WHO collaborating centres and the WHO Special Programme for Research and Training in Tropical Diseases. After consultations with stakeholders, WHO finalized the Regional Research Framework to Strengthen Communicable Diseases Control and Elimination in the Western Pacific (2013–2017). The framework recommends setting priorities for research, capacity-building, tool and strategy development, resource mobilization, and linking evidence and programmes. As part of the framework, WHO carried out capacity-
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HIV/AIDS and Sexually Transmitted Infections W Strategy and actions ith WHO assistance, Member States have made impressive progress over the past year towards providing their populations with universal access to HIV diagnosis and treatment, as well as to prevention programmes. These advances are a big step towards meeting the health-related Millennium Development Goals by 2015. Approximately 260 000 people in the Western Pacific Region received antiretroviral therapy (ART) in 2011, a 25% increase from the 203 000 who received ART the previous year. Yet more than half the people in the Region living with HIV—about 1.3 million people in 2011—are unaware of their HIV status and, therefore, do not seek treatment. Late diagnosis is largely responsible for the steady rise in annual AIDS-related deaths. The death toll in 2011 was 80 000, twice the number of AIDS-related fatalities reported in 2001. Over the past decade, the annual number of new HIV infections has stabilized at 130 000 to 150 000. However, in Asian cities HIV prevalence among men who have sex with men is increasing dramatically. In Ulaanbaatar, Mongolia, 10.6% of men in this population are infected, while in Chengdu, China, the rate is 16%. In addition, sudden outbreaks of HIV cases have been reported in low-prevalence countries. For example, in Cebu, Philippines, a 2011 survey revealed a 54% rate of HIV prevalence among people who inject drugs.
1990–2011: The number of new HIV infections is stabilizing; however the number of AIDS deaths continues to rise 140 000 120 000 100 000 80 000 60 000 40 000 20 000 0
1990
1992
1994
1996
1998
2000
2002 Deaths
2004
2006
2008
2000 Source: WHO 2012
New HIV infections
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Results achieved There is strong evidence that ART reduces HIV transmission. Harnessing the full prevention benefits of treatment and mortality reduction will require enhancing a broad range of interventions. These include more efficient case-finding, links to care, timely initiation of ART, and retention in and adherence to lifelong treatment. WHO has developed a framework on metrics for monitoring the quality of HIV testing with links to care and treatment that allow countries to monitor interventions. Cambodia, China and Viet Nam began researching the acceptability and feasibility of HIV testing, retesting and immediate ART. Partner testing and earlier treatment will also affect the implementation of the Elimination of New Paediatric HIV Infections and Congenital Syphilis in Asia-Pacific, 2011–2015: Conceptual Framework & Monitoring and Evaluation Guide. The guide provides a systematic approach to reducing new cases of HIV infection among children and AIDS-related maternal mortality. WHO also worked with three countries on the integrated elimination of mother-to-child transmission of HIV, congenital syphilis and hepatitis. With more people receiving ART, higher rates of HIV drug resistance are expected. WHO has accredited two regional laboratories in Australia and one in China to provide support across the Region for HIV drug-resistance testing. WHO has also accredited four national laboratories—two in China and two in Viet Nam—that focus on HIV drug resistance.
In Cambodia, China and Viet Nam, WHO has also supported the application of early warning indicators for HIV drug-resistance prevention. For example, if on-time pick-up of antiretroviral drugs by patients at a particular site is 90% or less, that is considered an early warning indicator. Cambodia, China, Papua New Guinea and Viet Nam carried out surveys measuring the level of transmitted and acquired resistance to HIV drugs. WHO examined the rate of HIV, sexually transmitted infections (STIs) and other health issues among transgender people in the Region. Though scarce, data indicate high rates of HIV and STIs among transgender women and highlight the need for systematic collection
of strategic information through transgender people-specific HIV/ STI surveillance. This information should be incorporated with more operational and psychosocial research, including an estimate of the size of the transgender population.
Future directions The identification of new HIV infections and the strategic use of antiretrovirals for both prevention and treatment could be game changers in the quest to reduce new HIV infections. Innovative approaches targeting key populations, including pregnant women and people with the TB/HIV co-infection, are needed, as are tools to more accurately measure HIV incidence and mortality.
A Cambodian doctor offers antiretroviral drugs to a woman living with HIV at the Khmer-Soviet Friendship Hospital in Phnom Penh, Cambodia. WHO estimates that about 34 million people worldwide were living with HIV at the end of 2010.
AFP
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Tuberculosis and Leprosy Elimination Tuberculosis
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Strategy and actions
he Western Pacific Region made solid progress towards achieving the Millennium Development Goal of reducing tuberculosis (TB) cases by half by 2015. Still, the TB burden remains unacceptably high, with some 1.4 million people in the Region diagnosed each year and 130 000 deaths annually. Evidence suggests that elderly people have some of the highest rates of TB, but many are never diagnosed. Children and patients with multidrug-resistant TB (MDR-TB) often lack access to proper health care. In addition, poor people are often unaware of, or unable to access, the free TB care provided by most governments in the Region. As a result, they increasingly opt for private clinics and hospitals that often provide substandard TB care, an expensive alternative that can push low-income patients deeper into poverty. The Regional Strategy to Stop Tuberculosis in the Western Pacific Region 2011–2015 addresses such challenges. Under this strategy, ongoing actions include the introduction of new rapid diagnostics, the dissemination and implementation of new standards for treating childhood TB, and more aggressive searches for TB cases within high-risk groups.
This photograph shows tuberculosis spreading through the lungs of a child. TB burden remains too high in the Western Pacific Region, where each year 1.4 million people are diagnosed with TB and 130 000 die from it.
AFP
Additional actions include greater collaboration between governments and the private sector, technical assistance in cases of MDR-TB and TB/HIV co-infection, the strengthening of health systems, resource mobilization and drug management.
Results achieved Over the past year, WHO has built a regional network of consultants to work on MDR-TB and drug management and organized TB programme reviews in Cambodia, the Lao People’s Democratic Republic, Mongolia and Papua New Guinea. To better care for vulnerable populations, WHO consulted
with Member States to create the first regional framework for TB control among migrants. In the Philippines and Viet Nam, WHO helped launch diagnostics and is working with these countries to introduce the first new drugs to come along in decades for MDR-TB. Seven countries received support for MDR-TB care by way of the WHO Regional Green Light Committee Mechanism. WHO promoted collaboration between TB and HIV/AIDS programmes at a regional gathering of experts. Countries with high TB burdens received continuous technical assistance through the regional TB Technical Assistance Mecanism (TBTEAM), which also supports resource mobilization and programme
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implementation. With the technical support from WHO and financial support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Lao People’s Democratic Republic successfully completed its first national TB prevalence survey. The survey revealed a higher incidence of TB than was previously estimated. At a meeting hosted by Palau that WHO organized with the United States
Centers for Disease Control and Prevention and the Secretariat of the Pacific Community, all South Pacific countries discussed new strategies to control TB.
Future directions Dynamic changes in diagnostic tools and the emergence of new drugs and
vaccine trials are reshaping the future of TB control. WHO will help Member States introduce these tools while promoting equal access to TB care for all patients. Collaboration will be strengthened between programmes within WHO on social protection, laboratory improvements, public– private cooperation, high-risk groups and antimicrobial resistance.
Tackling multidrug-resistant tuberculosis in Papua New Guinea the Western Province, where WHO experts provided technical support for the newly established MDR-TB programme. Daru Hospital now has a diagnostic tool known as Gene Xpert, which can detect cases resistant to the antibiotic Rifampicin in less than two hours. Before, this diagnosis would usually have taken two months. The facility also has a specialized TB ward staffed with TB doctors, health workers and outreach personnel. All of this allows patients to receive high-level care for MDR-TB without leaving the Region. WHO plans to provide technical assistance and mobilize financial resources for similar MDR-TB programmes in other provinces in Papua New Guinea. The Daru Hospital proved to be a lifeline for one local teenager. Jimmy Dabad’s entire family, except for one brother, died from TB. The 15-year-old appeared to be heading for the same fate when he contracted MDR-TB in 2011. But thanks to the diagnosis and medications provided by the Daru Hospital, Dabad is now recovering. The experience has given Dabad a new outlook on life. He plans to return to school next year. “I want to become a doctor and help the people,” he says.
Friends visit Jimmy Dabad (second from left), who is hospitalized with MDR-TB. He is the only member of his family to survive the ravages of the disease.
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M
ultidrug-resistant tuberculosis, or MDRTB, does not respond to the normal six-month course of antibiotics. Such resistance can develop when patients receive inappropriate care, miss doses of anti biotics or fail to complete their treatment. When MDR-TB develops, a patient’s only hope for life is a complicated eight-month treatment regimen involving daily injections. New diagnostic capacity revealed that MDR-TB is spreading in the Western Prov-
ince of the Torres Strait region of Papua New Guinea. In just one small community, more than 50 people, mostly youngsters, were diagnosed in 2012. In response, WHO began working with the Government of Papua New Guinea, the Australian Agency for International Development (AusAID) and other partners to prevent, diagnose and provide clinical care for people infected with MDR-TB. A shining example is the Daru Hospital in
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and health assistants from Kiribati, the Marshall Islands, the Federated States of Micronesia and Tuvalu, in close collaboration with the United States Centers for Disease Control and Prevention and the United States National Hansen’s Disease (Leprosy) Program. The implementation of programmes improved at all levels, resulting in the discovery of many undetected cases of leprosy and, most likely, a reduction in transmission of the disease. AFP
The hands of a leprosy patient show the disease’s crippling effects.
Future directions WHO and its partners are looking for innovative interventions to further reduce or eliminate leprosy in hot spots in the Western Pacific Region. These new strategies may include experimenting with a variety of drug cocktails, their dosage and duration. Greater collaboration between partners in the Region will help ensure the efficient use of expertise and resources. WHO will pursue two parallel strategies that consist of strengthening existing leprosy programmes and designing and piloting new approaches. Efforts will continue to focus on the Pacific island countries and areas where leprosy has yet to be eliminated and on high-burden countries that continue to report significant numbers of new cases. The response will include programme evaluation and capacitybuilding to address gaps, including those related to broader health system issues, such as supply chain management. WHO will also adopt a new web-based data collection system to match global norms.
Leprosy Strategy and actions Efforts to strengthen leprosy control are beginning to show encouraging results. The Regional Director announced three years ago that WHO would make the fight against leprosy a high priority for the Western Pacific Region. This heightened commitment led to the hiring of a full-time leprosy expert at the Regional Office, made possible, in part, through the generosity of American Leprosy Missions. To combat leprosy, WHO focuses on four areas. These include disease assessment and analysis, training personnel and encouraging innovation, increased collaboration with partners, and close cooperation with programmes that target lymphatic filariasis and yaws. The ultimate goal is to ensure early detection and treatment of leprosy in order to interrupt the spread
of the disease. WHO data show that 7655 patients were diagnosed with leprosy in the Region in 2011. Of these patients, 550 suffered serious disabilities, and 458 were children. In response, WHO developed a comprehensive approach called the Enhanced Global Strategy for Further Reducing the Disease Burden due to Leprosy (Plan Period: 2011–2015).
Results WHO has developed a modern webbased system for data collection to replace the previous fax-based system. The new system reduces errors and allows for real-time validation, longterm data storage and easier reporting. The pilot system, put in place in 2012, demonstrated the advantages and feasibility of using new technology in the Region and led to significant improvements in the handling of data. WHO also organized training for leprosy coordinators, physicians
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Health Security and Emergencies
AFP
Health Security and Emergencies
Introduction
T
he traditional approach to managing emergencies has focused on response: rescuing and treating people after a natural disaster, putting in place containment measures once an outbreak has occurred or rooting out a food item making people sick.
Experience gained in confronting emerging diseases and other public health threats has highlighted the need to also focus on preparedness
and led to the revision in 2005 of the International Health Regulations, commonly referred to as IHR (2005). This legally binding set of regulations took effect in 2007. Once fully implemented, IHR (2005) will greatly increase the capacity of all countries to detect, assess, notify and respond to public health threats that have the potential to threaten people worldwide. It also provides a framework for the prevention and response to these threats and establishes procedures that WHO and countries must follow to uphold global public health security. In the Western Pacific Region, IHR
implementation is guided by the Asia Pacific Strategy for Emerging Diseases (APSED), a key tool for helping countries meet and maintain IHR core capacity requirements. The Division of Health Security and Emergencies (DSE) is working with Member States in the Western Pacific Region to implement IHR (2005), following the framework contained in APSED. APSED was updated in 2010 and has continued to guide support to countries to develop event-based surveillance, response logistics, emergency operations and risk communications. These and other capabilities make up the
Nurses shelter newborns at a Manila hospital during a fire and earthquake drill. WHO helps train health-care workers in the Philippines and many other countries in disaster preparedness and other life-saving skills. A nurse walks on the ruins of a hospital trying to rescue useful items in Sichuan province, China, which suffered a massive earthquake in June 2008. Health disaster risk reduction is a major focus for WHO in the Western Pacific Region—home to a disproportionate number of natural disasters. The Work of WHO in the Western Pacific Region, 1 July 2012–30 June 2013
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A health worker screens bird blood for avian influenza.
WHO
foundation of a resilient system that, once fully developed, can manage any hazard that threatens public health, such as unsafe food, a new infectious disease or a natural disaster. WHO’s role in health emergencies is guided by IHR (2005) and the United Nations humanitarian reform process established in 2005. Regarding food safety, the Division helps countries in the Region adhere to the Codex Alimentarius international food standards, using the approach outlined in the Western Pacific Regional Food Safety Strategy 2011–2015. These documents have a global and regional scope but focus on practical and manageable actions governments can take to improve the health and safety of their people. When there is no active emergency, the Division shares information about
unusual events reported by Member States, provides links to technical experts and facilitates support from other countries, when requested. If an emergency develops, the Division works within the Organization, across the Region and around the world. In 2012–2013, the Division sent experts and provided guidance following outbreaks and natural disasters in Cambodia, the Philippines and Solomon Islands, and held exercises in these and other countries to test and improve response mechanisms. The base of operations for this work is the Emergency Operations Centre located at the Regional Office for the Western Pacific. The centre is equipped with teleconferencing and videoconferencing facilities, maps and computers that run specialized incident-management software.
The centre serves as the technical, information and management hub for coordinating response operations during public health events. The Division also supports countries in the Region to develop similar centres in their ministries of health. Moving forward, there will be an increased focus on emergency risk management, which includes activities ranging from prevention and preparedness to response and recovery. Emergency risk management stresses the idea that these activities overlap and that preparation for a crisis requires investing in all of them. The WHO Emergency Response Framework will be used to guide the response to emergencies and disasters.
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Emerging Disease Surveillance and Response W Strategy and actions HO provided technical support to Member States in 2012 in their efforts to meet deadlines to comply with the International Health Regulations (2005), or IHR (2005)–– a set of global rules to enhance and protect public health. WHO also helped Member States establish core capacities to manage public health emergencies.
A key tool in these efforts has been the Asia Pacific Strategy for Emerging Diseases (APSED), which includes a five-year workplan countries can follow as they strive to meet or maintain IHR (2005) compliance. WHO also promoted the integration of the diverse components of APSED, the maintenance of advances made within each of the strategy’s focus areas, and the implementation of robust monitoring and evaluation frameworks.
Results achieved Classic indicator-based surveillance relies on the routine collection of health data and automated thresholds. Residents commute through floodwaters near Manila in August 2012. The Philippines was hit by a huge tropical storm that combined with seasonal rains to cause days of flooding in and around the capital. AFP
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But that system often fails to detect rare, high-impact outbreaks, such as avian influenza, and unknown diseases. By contrast, event-based surveillance relies on immediate reporting and is designed to detect
such outbreaks. Over the past year, WHO’s event-based surveillance system, located at the Regional Office for the Western Pacific, was strengthened through improved coordination mechanisms and by
working with countries in building laboratory networks. The information compiled with this reference tool enables the rapid assessment of and response to new or recurrent events. Such a database with both historical
Confronting H7N9
W
hen the Chinese Center for Disease Control and Prevention confirm ed in March 2013 that three people had been infected with H7N9, a new subtype of the avian influenza virus, Chinese authorities moved swiftly to control the outbreak and understand the behaviour of the virus. H7N9 appear ed to be very dangerous, infecting more than 130 people in three months. By comparison, H5N1—another avian influenza virus—has infec ted only 45 in China since it re-emerged in 2003. Animals show no signs of illness when infec ted with H7N9, which makes it harder to detect. In addition, the virus carries genetic markers that might make it adapt more easily to mammals—and thus to humans. After the existence of the new virus was confirmed by laboratory tests, China reported the outbreak to WHO, in line with the protocol of the International Health Regulations (2005). That same day, 31 March 2013, the Chinese Government provided the ge nomic sequences of viruses from the three identified human cases to the Global Initiative on Sharing Avian Influenza Data. China also shared the virus with all the WHO Collaborating Centres for Influenza Reference and Research, as well as other influenza laboratories, allowing scientists to further characterize the virus, develop diagnostic tests and potentially contribute to the creation of a vaccine.
WHO staff coordinate response to disasters and disease outbreaks from the new Emergency Response Centre in the Regional Office in Manila. A larger centre to manage global threats is located at WHO headquaters in Geneva.
WHO
China’s ability to respond so swiftly and effectively is the result of years of investment in surveillance and response capacities, laboratories, zoonoses collabo ration, risk communications and other key areas, particularly after the SARS outbreak in 2002.
Experts are still in the early stages of understanding H7N9. A virus such as this requires a response that brings together many levels of government, a broad range of ministries and a cooperative international community. This outbreak clearly demonstrates the importance of joint efforts to respond effectively to shared risks.
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and real-time event information for emerging diseases, food safety events and humanitarian emergencies fulfils an important function in enhancing the Region’s capacity for all hazardbased surveillance and response. The continued maintenance of this system will enhance understanding of the local context and capacity to assess and respond to events.
In Viet Nam, the effectiveness of national and local health emergency command-andresponse structures was tested through PanStop 2013, a national simulation exercise for the rapid containment of pandemic influenza. WHO also supported the Lao People’s Democratic Republic and Mongolia in establishing emergency operation centres. In 2012, WHO helped Cambodia analyse epidemiological, clinical and laboratory data that rapidly identified an initially undiagnosed syndrome as a severe form of hand, foot and mouth disease (HFMD). In 2013, WHO provided epidemiological and laboratory assistance when Cambodia faced an increased number of human cases of H5N1, a strain of avian influenza. Under the APSED framework, coordination between the network of national IHR focal points and WHO IHR contact points helped pave the way for collective action between countries and the international community.
For example, the national IHR focal points in Cambodia and other countries helped facilitate rapid communications, international cooperation and risk assessment of severe hand, foot and mouth disease. Communications capacities and procedures during health emergencies were tested in December 2012 through an annual IHR simulation, Exercise Crystal, with the participation of 26 Member States. WHO provided technical support to the Philippines in August 2012 following massive flooding on the island of Luzon and in December 2012 when Typhoon Bopha, the strongest tropical cyclone ever to hit the island of Mindanao, made landfall. WHO worked with the Philippine Government to improve surveillance for leptospirosis and other epidemicprone diseases. In Cambodia, the Lao People’s Democratic Republic, Viet Nam, and Pacific island countries and areas, WHO supported public health advocacy campaigns. These included Dengue Day, which promotes community involvement in vectorcontrol activities and shifting from a reactive to a proactive approach toward the disease. Publication of regional surveillance information in the Western Pacific Surveillance and Response Journal (WPSAR) provided a way to share newly acquired knowledge and best practices. In 2012, the journal published an average of 13 articles per issue, up from five per issue the previous year. Twelve countries and areas submitted articles for publication, and traffic on the WPSAR web site doubled since the previous year.
Future directions Of the 27 Member States that are signatory parties to IHR (2005), 13 are in compliance with core capacity requirements while 14 requested a two-year extension in 2012. Effective implementation of national plans is vital for IHR (2005) requirements to be met, but such implementation requires sustainable technical and financial support at the national level before, during and after emergencies.
Pacific island countries and areas face unique challenges. Their small populations, geographical isolation, and limited infrastructure and human and financial resources can make surveillance and response to emerging diseases especially difficult. As a result, they must tailor implementation of IHR (2005) to their needs. Many national capacities can be enhanced at the subregional level through collective efforts and resource sharing. As health emergencies become more complex, there is a growing need to ensure that surveillance systems are functional and sustainable and that links between organizations, sectors and partners are established and maintained.
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Emergency and Humanitarian Action W Strategy and actions hen Typhoon Bopha battered the island of Mindanao in the southern Philippines in December 2012, more than 1000 people were killed and thousands more were left homeless and without livelihoods. The epic typhoon served as another tragic reminder of the increasing toll in deaths, injuries, and environmental, social and economic destruction natural disasters have claimed in the Western Pacific Region over the last decade. As a result, there has been a strategic shift towards addressing risks before disasters strike. The focus on the management of health risks—which includes preparedness, prevention, response and recovery—has important implications for the ministries of health of Member States. In order to meet the challenge, governments will need to adapt their policies and strategies to new realities and enhance coordination with national disaster management centres. They will also have to focus on building resilience among vulnerable populations in the face of public health emergencies. Both the Regional Meeting on Health Emergency Risk Management for Disasters and the Health Cluster Forum were held in Manila, Philippines, in December 2012. These meetings brought together emergency management experts from around the Region to discuss the draft Health Emergency Risk Management of Natural Hazards: Western Pacific Regional Framework for Action. The concept of “building back better” following major health emergencies, including specific disaster risk-reduction measures for safer health systems and more resilient communities, was endorsed at the International Conference on Health Sector Recovery from Disasters, in Iwate, Japan, in March 2012. disasters. Improvements include the development of an evidence-based health sector response strategy, the establishment of early warning and response systems, and the provision of up-to-date health information and technical expertise to affected Member States and stakeholders. The global campaign called Hospitals Safe from Disasters encourages people, communities and businesses to make existing hospitals, or those that are under construction, safer, more resilient and more functional during and after disasters. The initiative continues to be implemented in Cambodia, the Lao People’s Democratic Republic, the Philippines and Viet Nam, and there are tentative plans to extend the programme to Papua New Guinea, Solomon Islands and Vanuatu in 2013. A major achievement has been the finalization of the Health Emergency Risk Management of Natural Hazards: Western Pacific Regional Framework for Action. Member States expressed their commitment to implement the strategic directions and priority actions of the framework’s four components: policy and coordination, information and knowledge management, health service delivery, and resources.
In 2012, WHO improved its ability to assist countries during disasters by adopting the WHO Emergency Response Framework. The framework bolsters the institutional capacity of WHO to provide leadership, information, technical expertise and core services. The framework also strengthens WHO standard operating procedures for emergencies and includes clear timetables and performance standards for delivering assistance.
Results achieved WHO can now deliver more predictable responses to support Member States in the aftermath of
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Building back better after disasters
A father collects coconuts with his children among the piles of debris swept ashore when Typhoon Bopha hit the southern Philippines in December 2012. A series of storms left tens of thousands of people homeless that month in the Philippines.
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ealth sector recovery from a disaster should involve more than simple reconstruction and rehabilitation. It should be an opportunity to build a stronger health system that can serve as a critical component of social services. One example of using disaster response to meet needs that existed before a crisis occurred came in December 2012 in the wake of Typhoon Bopha, the strongest tropical cyclone ever to strike the southern island of Mindanao in the Philippines. Following Typhoon Bopha, a WHO team deployed to Davao Oriental, one of the hardest-hit provinces. There, a local mid
wife described how many of her colleagues lacked the skills to properly assist women in labour. As a result, the WHO country office, supported by several units of the Regional Office and in partnership with the inter national nongovernmental organization Merlin, is now working closely with local health authorities to set up two-day training sessions to improve midwives’ skills. The training on intrapartum and neo natal care focuses on some 40 midwives working in the municipalities of Boston and Cateel. Because birth asphyxia is a key factor in the high rate of neonatal morbidity in this area, WHO’s support includes the
provision of kits for newborn resuscitation to replace the ones lost in the typhoon. The WHO country office is supporting local authorities to train midwives working in two rural health units and in community health stations. WHO’s support helped a Member State respond to the health needs of disaster-affected populations. But the post-disaster response also provided an opportunity to train midwives in line with the mandate from the new WHO Emergency Response Framework. That training will help improve health outcomes in Mindanao for years to come.
Future directions A high-level political commitment will be needed to carry out the changes called for by the risk management framework. Key regional players
will need to reinforce partnerships at different levels in support of this commitment. The process of mapping local hazards and assessing vulnerabilities and coping capacities will require renewed energy as well
standardized approaches. With WHO’s support, regional surge capacity must be defined and standby agreements to respond to disasters must be in place to facilitate coordination throughout the Region.
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Food Safety Strategy and actions
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oodborne diseases associated with microbial pathogens, biotoxins and chemical contaminants continue to pose serious threats to the health of millions of people in the Western Pacific Region. More than 200 diseases are spread through unsafe food, ranging from various forms of cancer to diarrhoeal diseases, which kill approximately 2.2 million people globally each year. Foodborne disease and contamination events, which in the past affected only local communities, can now quickly become global health threats due to the growth of international trade and travel. Improved food safety not only reduces the disease burden, but it can contribute significantly to the prevention and control of noncommunicable diseases and undernutrition. The Western Pacific Regional Food Safety Strategy (2011–2015) serves as a key regional tool to reduce the health and social burden of foodborne diseases and contribute to the overall health security in the Region. The strategy focuses on strengthening national food control systems and promoting collaboration between countries, as well as between partners and national governments. At the regional level, WHO helped establish regional coordination mechanisms and strengthen the International Food Safety Authorities Network (INFOSAN) in Asia.
Vendors sit amid their produce at a street market in Phnom Penh, Cambodia. WHO helps countries strengthen food control systems to curb the more than 200 diseases spread through food that kill more than 2 million people a year globally.
AFP
At the country level, WHO focused support on strengthening national capacities to implement the food safety strategy, including the review and development of national laws, regulations and standards for delivering safer food. Improving the availability of food safety data, along with strengthening laboratories’ capacity to better guide policy and risk analysis, has been a challenging but important undertaking in several countries. WHO helped national food control authorities strengthen their capacities
through the development of technical guidelines and training programmes for risk-based food inspection. Food safety training and education efforts focused on pilot projects targeting priority groups and the development of key food safety messages, such as the need to improve food control and coordination from farm to table. The development and integration of food safety in public health emergency response plans, as well as testing those plans, have been critical for enhancing national capacities to detect, assess and manage
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food safety incidents and emergencies. In China and Fiji, for example, WHO provided technical assistance and support on risk assessments of chemical and microbiological hazards.
Results achieved Key achievements include the establishment of an informationsharing mechanism through INFOSAN and a broad-based Food Safety Cooperation Working Group. Key stakeholders within this group include food safety forums set up by Asia-Pacific Economic Cooperation (APEC), the Association of Southeast Asian Nations (ASEAN) and other international organizations, and the Food Secure Pacific Working Group.
prevent, eliminate or reduce risks to consumers to acceptable levels at all stages of the food chain. In 2012, for example, WHO assisted the Lao People’s Democratic Republic and Mongolia in developing food safety laws. WHO is supporting other steps to achieve key milestones. These include improved availability of information on foodborne diseases through event- and indicator-based surveillance and sustained food inspector training programmes backed by national legislation. Information sharing, monitoring and continued evaluation of progress have helped sustain these efforts.
Future directions The Western Pacific Regional Food Safety Strategy (2011–2015) will continue to serve as a road map for reducing health problems and the social burden related to foodborne disease in the Region. Overall, the safety of food has been improving, but progress is uneven, with some countries still lacking core capacities required to ensure food safety. A stronger focus on individual country needs will be required, given that countries and areas are at different stages in the quest to meet the strategy’s goal and objectives.
The Food Safety Cooperation Working Group serves as a platform for sharing information, pooling resources and coordinating actions, and has agreed to develop a food safety information-sharing network. WHO has identified key issues and provided expertise for the working group. Food legislation protects the rights of consumers and defines the responsibilities of food producers, processors, manufacturers, traders and consumers, helping to ensure that food is safe and wholesome. With WHO’s assistance, several countries have revised or enacted national laws, regulations and standards on control systems to
Food safety inspectors in China carefully check produce.
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Building Healthy Communities and Populations
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Building Healthy Communities and Populations
Introduction
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he Division of Building Healthy Communities and Populations covers areas ranging from noncommunicable diseases (NCDs) and maternal health to mental disorders and the way environmental factors impact public health. Overall goals are to provide leadership and action for the promotion of health and the prevention of premature death and disability.
health recommendations should include the rationale behind these proposals in order to convince more people to adopt them. Whether raising awareness about tobacco taxes, promoting breastfeeding or consulting with journalists on how to responsibly report suicides, WHO is working with Member States and the media on better ways to transmit important information on health to the general public. Programmes to strengthen public health systems and universal health care have been identified as critical entry points for WHO’s efforts. For example, the WHO-developed Package of Essential Noncommunicable (PEN) Disease Interventions for Primary Health Care in Low-resource Settings has been introduced in many countries, garnering strong support and commitment from governments. A life-course approach in primary care to integrate NCD and maternal and child health service packages is being developed. A document also is being developed by WHO to map issues and resources for the growing number of people with disabilities. WHO and Member States are cooperating with other sectors to address upstream health factors. These include the raising of tobacco taxes by finance ministries, addressing tobacco control in trade agreements,
Building healthier communities requires active participation of stakeholders at all levels in the decision-making process. WHO has worked with Member States on broadening engagement and participation in setting priorities and taking decisions on public health issues, such as nutrition, physical activity, the provision of wheelchairs and community-based rehabilitation. Communities can take steps to widen access to health care and improve local health conditions. These initiatives may include the creation of healthy settings, such as smoke-free areas or cafeterias stocked with nutritious food. Building healthier populations requires enlightened decision-making as well as effective advocacy and communication. In reaching out to target audiences, for example, public
working with the transport sector to reduce road injuries, and cooperating with environment ministries on issues such as access to clean water and sanitation, air quality, asbestos exposure and climate change. Over the past year, three Regional action plans have been developed in consultation with Member States as they pursue global strategies, targets and indicators. The draft Western Pacific Regional Action Plan for the Prevention and Control of Noncommunicable Diseases (2014–2018) outlines specific actions to meet the nine global voluntary indicators to reduce premature mortality. The draft Action Plan for Healthy Newborn Infants in the Western Pacific Region (2014–2020) focuses on why newborn deaths constitute half of all childhood deaths in the Region and how this can be addressed. The draft Western Pacific Regional Action Plan for the Prevention of Avoidable Blindness and Visual Impairment (2014–2019) identifies concrete steps that can be taken to avert the loss of vision and poor vision, which cause widespread suffering and debilitation. In addition, health promotion foundations and regional leadership programmes could help pave the way for a new generation of public health leaders. Their knowledge and skills will help prevent and control cancer and other NCDs, tobacco use and other public health burdens resulting from social, political, economic and environmental factors.
Schoolchildren in Cambodia look forward to a better future, as WHO strengthens Health Promoting Schools in the Region. The Work of WHO in the Western Pacific Region, 1 July 2012–30 June 2013
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Environmental Health W Strategy and actions HO supports Member States in addressing environmental health risks and threats, which are among the most serious public health issues in the Western Pacific Region. Despite progress, 31% of people in the Region still lack access to basic sanitation. Safe water would greatly improve health outcomes for millions of families in poor areas. Improvements in air quality could dramatically reduce respiratory illnesses. Fatalities and property losses could be reduced through rational land use, the preservation of watersheds, floodcontrol measures, safe waste disposal, and the enforcement of environmental and occupational health and safety regulations. The health impacts from energy policies and unplanned urbanization must be taken into account, while health systems must be prepared to adapt to climate change. Resolution WPR/RC56.R7 on environmental health, adopted by the fifty-sixth session of the WHO Regional Committee for the Western Pacific in 2005, provides a clear mandate. It recommends that countries develop and implement national environmental health action plans. It calls for strengthening capacity in environmental health risk assessment and management and improving multisectoral coordination mechanisms and opportunities. Health sectors, in turn, must encourage the implementation of international environmental agreements.
Results achieved The AusAID–World Health Organization Water Quality Partnership for Health includes Cambodia, the Lao People’s Democratic Republic, Mongolia, the Philippines, Viet Nam and the Pacific island countries of Cook Islands, Samoa, Tonga and Vanuatu. About 200 water safety plans — serving about 20 million people in the Region — will be in place by mid-2016. WHO has provided support for the safe storage and treatment of household water, as well as for the development of national standards and guidelines on drinking-water quality in Cambodia, the Lao People’s
Democratic Republic, the Philippines and Viet Nam. These same countries plus Mongolia received support for monitoring progress in water and sanitation through the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation and the UN–Water Global Annual Assessment of Sanitation and Drinking-Water. WHO continues to collaborate with Member States on developing national environmental health plans to address issues such as air pollution, the management of toxic chemicals and climate change. WHO serves as secretariat for the Regional Forum on Environment and Health in Southeast and East Asian Countries, which brings together 14 Member States to share knowledge and discuss best practices on environmental health issues. For example, officials
Villagers collect water from a stream in Mongolia. Is that water safe?
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from Seoul, Republic of Korea, and Tokyo, Japan, described their efforts to use vehicle and industrial emission controls and other measures to improve air quality in the world’s largest cities. On the vital issue of climate change and health, WHO is collaborating with Member States to implement the Regional Framework for Action to Protect Human Health from the Effects of Climate Change in the Asia-Pacific Region. WHO supported the drafting of a status report on the use of asbestos and the prevalence of asbestos-related diseases, such as lung cancer in China, Japan, the Lao People’s Democratic Republic, Malaysia, Mongolia, Palau, the Philippines, the Republic of Korea and Viet Nam.
Maternal and Child Health and Nutrition
Future directions Providing more people with access to safe drinking-water and sanitation remains one of WHO’s top priorities for the Region. Support for national environmental health action plans will continue. Strategic priorities for the Region will include climate change, children and the environment, occupational health and applying environmental-health risk assessment principles to energy projects. The Regional Forum on Environment and Health in Southeast and East Asian Countries will continue to serve as a strategic platform for advocacy and action.
A mother at a hospital in Ho Chi Minh City, Viet Nam, keeps her newborn baby close and warm, reducing by half the risk of infant death.
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Maternal and child health
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Strategy and actions he Global Strategy for Women’s and Children’s Health (2010) calls for accelerating efforts to meet Millennium Development Goal
(MDG) 4 on reducing child mortality and MDG 5 on improving maternal health. To ensure the full involvement of countries in the Global Strategy, WHO, other United Nations agencies and the World Bank formed the H4+ partnership to assist in mobilizing political support and building technical capacities to address reproductive, maternal, newborn and
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child health issues. Member States in the Western Pacific Region have increased their political and financial commitments for improving the health of women and children. As countries spend more on these programmes, official development assistance now accounts for a smaller percentage of the total investment in maternal and child health programmes. Most Member States have registered major reductions in maternal mortality and the under-five mortality rate, which is a leading indicator of the level of child health and overall development. In Cambodia, for example, the maternal death rate fell from 830 deaths per 100 000 live births in 1990 to 206 deaths in 2010. Every year, however, more than 10 000 women in the Region die from pregnancy or childbirth-related complications and 384 000 children die before the age of five. In addition, progress among and within countries towards meeting the health needs of women and children is uneven. Although the availability of maternal, reproductive and child health-care services has improved, quality and equal access to these services remain important challenges. Overall, the number of childhood deaths has declined, but more than half of these fatalities occur among newborn infants. Simple interventions, such as thorough drying of newborn infants and immediate skin-to-skin contact with their mothers, can radically reduce fatalities. Development partners, including WHO, must become more strategic and cohesive to respond to the needs of Member States.
Results achieved Two WHO documents, the Regional Framework for Reproductive Health in the Western Pacific Region in 2013 and Experiences in Expanding National Reproductive Health Programmes in 2012, provide important guidelines. To accelerate progress towards universal access to reproductive health, they call for integration of reproductive health-care services. To develop a coordinated response, China, the Philippines and Viet Nam held a workshop on the Minimum Initial Service Package for Reproductive Health in Crisis Situations to respond to problems such as sexual violence, HIV transmission and neonatal mortality. The Lao People’s Democratic Republic, Papua New Guinea, the Philippines and Viet Nam analysed their maternal care programmes to improve quality and reduce maternal deaths. Member States and technical experts reviewed and supported the draft Action Plan for Healthy Newborns in the Western Pacific (2014–2018). Tools and support from WHO and UNICEF are available to assist countries to carry out the action plan. WHO’s comprehensive implementation plan spells out recommendations for improving maternal, infant and young child nutrition in the Region. Cambodia, China, the Lao People’s Democratic Republic, Papua New Guinea, the Philippines and Viet Nam studied ways to promote breastfeeding in places where the practice has diminished amid the marketing of breast-milk substitutes and the growing number of working
mothers. Member States are looking for ways to address the findings in their national plans and strategies on the health of newborn children. In accordance with the recommen dations of the Commission on Information and Accountability for Women’s and Children’s Health, seven countries improved their oversight of resource use in pursuit of the health-related MDGs. In addition, senior officials from 17 countries attended the Asia-Pacific Leadership and Policy Dialogue for Women’s and Children’s Health in November 2012 and signed The Manila Declaration, which sets out concrete and measurable steps for improving the health of women and children.
Future directions MDGs 4 and 5 are high priorities on the global health agenda. Through better policies, more equitable health systems, and stronger monitoring and accountability, Member States and development partners, including WHO, are bolstering their efforts to upgrade the quality and coverage of reproductive, maternal and child health care.
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Nutrition
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Strategy and actions alnutrition causes a broad range of public health problems in the Western Pacific Region. Maternal and child undernutrition in the Asia Pacific region is responsible for more than 100 000 child deaths annually. Iron deficiency anaemia is responsible for 12.8% of maternal deaths. Half of all preschoolers in the Western Pacific Region are anaemic and one third suffer from vitamin A deficiency. Breastfeeding and improved diets, including fortified foods and supplements, can help address these problems, but more action is needed. Progress has been made in reducing cases of iodine deficiency, but this problem persists among vulnerable and marginalized groups.
Malnutrition can hurt social and economic development. In some countries, the rate of stunting among children under five may be as high as 48%. Stunting harms the overall development of children and reduces their productivity as adults. At the same time, the rate of obesity in the Region is projected to increase, which would increase the risk of chronic illness and premature death. Improving nutrition in the Region will require strategic interventions and cooperation among many government sectors, including the ministries of trade, environment and education. Stronger policies on agriculture, land use, trade and urban development can help improve food security and food systems. Gender equality and more education for women can improve household nutrition. Stronger efforts are needed to regulate the advertising
and sale of infant formula as well as the marketing of unhealthy foods and beverages to children. WHO supports the development of national nutrition plans, which should recommend optimal breastfeeding and complementary feeding and measures to improve the health and nutrition of women. These plans should also promote safe and good-quality food, improved diets, and food fortification and supplementation as a way of preventing vitamin and mineral deficiencies.
Results achieved Most countries in the Region have national action plans for nutrition. Cambodia and Solomon Islands lead the Region in exclusive breastfeeding rates, with three out of four infants receiving only breast milk during their first six months. Viet Nam passed laws to improve compliance with the International Code of Marketing of Breast-milk Substitutes and to provide mothers with six months of paid maternity leave. WHO continues to support the Philippines and other countries in drafting new policies and legislation to promote optimal infant feeding and in introducing new strategies, such as using a web site to report violations of marketing regulations. Viet Nam has a model programme to prevent and control iron deficiency anaemia in Hai Duong and Yen Bai provinces. The success of this pro gramme gave rise to a national strategy to eliminate anaemia among all age groups. WHO supported training on
Studies show that breastfeeding —though sometimes not convenient— reduces the risk of infant death by 22%.
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nutrition and the development of nutrition curricula in Cambodia, the Lao People’s Democratic Republic, Mongolia, Papua New Guinea and Viet Nam. WHO also helped develop a system to monitor the food and nutrition security situation in Pacific island countries and areas. For the first time, WHO and other United Nations agencies are producing joint nutrition profiles of Member States. School programmes in Cambodia and the Lao People’s Democratic Republic seek to develop costeffective ways to improve the quality of food and water and to address micronutrient deficiencies.
Noncommunicable Diseases Noncommunicable diseases Strategy and actions States took part in a workshop on NCD prevention and control in primary health care at a regional consultation in Beijing, China, in August 2012. Support was provided in 14 countries for the introduction and expansion of the WHO Package of Essential Noncommunicable (PEN) Disease Interventions for Primary Health Care in Low-resource Settings. WHO convened a capacity-building workshop for NCD surveillance and monitoring in Seoul, Republic of Korea, in December 2012. Training was held in Auckland, New Zealand, on WHO’s STEPwise approach to Surveillance (STEPS), a simple, standardized method for collecting, analysing and disseminating data. STEPS surveys were completed in the Lao People’s Democratic Republic, Niue and Vanuatu. Health officials from three Member States also received training in Manila, Philippines, on the Global School-based Student Health Survey, which measures behavioural risks and protective factors among young people. WHO held a capacity-building workshop on cancer control (CanLEAD) for nine countries in Seoul in June 2013. WHO also helped Cambodia, Fiji, the Lao People’s Democratic Republic and Mongolia strengthen national cancer-control programmes. WHO worked with five countries to develop NCD action plans that go beyond the health sectors to bring in ministries of agriculture, finance, planning and trade.
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Future directions WHO will continue supporting efforts to address micronutrient malnutrition in Member States. WHO will also support efforts to strengthen food fortification and labelling and to regulate the marketing of infant formula and unhealthy food and beverages to children. WHO will stress the importance of nutrition in national development and will work with ministries of health to influence policies on food systems, urban development and land use. WHO will also provide Member States with support in their efforts to restrict, regulate and tax unhealthy food products.
oncommunicable diseases (NCDs) are the leading cause of death and disability in the Western Pacific Region. Cardiovascular diseases, cancer, diabetes and chronic respiratory infections impose a growing burden on health and development and cause 80% of all deaths in the Region. The prevention and control of NCDs has been stifled by the lack of data, indicators and targets. Countries vowed to step up the fight in November 2012 when WHO and Member States set voluntary global targets for rolling back NCDs. Countries pledged to create a comprehensive global monitoring framework with indicators for measuring progress. They also stressed the importance of “best buys”, or evidence-based and cost-effective interventions, for controlling alcohol and tobacco, reducing salt intake, reducing and replacing trans fats, and providing essential drugs, medicines and services to manage NCDs.
Results achieved Significant progress has been made in surveillance, the reduction of risk factors, the provision of services, and the strengthening of capacity for NCD prevention and control. Ten Member
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and Health Promotion
Students get some exercise in China, which has one of the highest rates of childhood obesity in the Region. WHO promotes initiatives to increase physical activity and well-being in a variety of setting, from schools to entire cities.
AFP
WHO helped all Pacific island countries and areas to develop an NCD crisis-response package for their national strategies. WHO supported efforts by 10 countries to strengthen salt-reduction policies. Mongolia and the Philippines carried out feasibility studies on WHO guidelines for marketing food and non-alcoholic beverages to children. WHO worked with Brunei Darussalam, China, Cook Islands, Fiji, the Federated States of Micronesia,
Kiribati, the Marshall Islands, Nauru, Palau, Samoa, Tuvalu and Vanuatu on campaigns to promote more physical activity in daily life.
Future directions In response to Regional Committee resolution WPR/RC62.R2, a draft Regional Action Plan for the Prevention and Control of NCDs in the Western Pacific (2014–2018) was developed. The proposals and goals of this action plan are aligned with the Global Action Plan for the Prevention
and Control of Non communicable Diseases 2013–2020 and will help countries meet their voluntary global targets. There is broad consensus as well as a growing body of evidence on the most efficient and cost-effective ways to control NCDs and save lives. Additional financial and material support will be important for sustaining progress in surveillance, policy development, capacitybuilding, services and access to drugs for managing NCDs.
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Prevention of avoidable blindness and visual impairment
Results achieved WHO supports countries in their efforts to develop national eye health plans. In Mongolia, for example, WHO provided support for a national blindness survey that also identified potential policies and actions to respond to the problem. WHO is also working with Member States and partners to combat trachoma. Support and technical assistance have been provided for trachoma surveys in Cambodia, the Lao People’s Democratic Republic and Viet Nam. New survey data, collected with support from WHO, revealed that trachoma is a public health problem in parts of Fiji and Solomon Islands. A draft Towards Universal Eye Health: Regional Action Plan for the Western Pacific (2014–2019) has been developed in consultation with Member States to guide strategic interventions. This action plan closely coincides with the WHO’s Universal Eye Health: A Global Action Plan 2014–2019.
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Strategy and actions
lindness and visual impairment are extremely debilitating and reduce opportunities for education and productive employment. These problems are more pronounced among the poor who often lack access to basic eye care. Globally, the main causes of avoidable blindness and visual impairment are cataracts and uncorrected refractive error, which occurs when the eye cannot focus on images and vision becomes blurred. Cost-effective interventions can avoid or cure 80% of these cases. For example, cataract surgery should cost less than US$ 150 in most low- and middle-income countries, while eyeglasses to correct refractive error should cost less than US$ 5. Yet neither intervention is widely available to poor people because cataract surgery and eyeglasses are rarely included in public health programmes and cost far more in the private sector. WHO estimated that the number of people with visual impairment in the Western Pacific Region in 2010 stood at more than 90 million, including more than 10 million cases of blindness. Another survey predicted that global economic losses from blindness and visual impairment would reach US$ 110 billion by 2020. Blindness and visual impairment are also linked to other illnesses.
A nurse checks a man’s vital signs at a community health centre in Viet Nam.
AFP
Trachoma, for example, is the most common infectious cause of blindness. Diabetes and hypertension can cause visual problems such as retinopathy, in which the vessels supplying blood to the retina become damaged. However, nine out of 10 patients with retinopathy do not go blind when treated early. Therefore, it is critical that such cost-effective interventions are included in national eye-care plans and that capacities are built to integrate these programmes into primary health-care systems.
Future directions Policies, programmes and training are needed to provide poor people with better access to quality eye care. WHO will continue to work with Member States to build capacity to integrate eye care with primary health care and health insurance systems, address equity issues and explore financing options. WHO will also support efforts to mobilize political and public support for quality eye care, especially for the poor.
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Health Promotion
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Strategy and actions
An elderly farmer in rural Viet Nam is examined for trachoma, which causes blindness. Studies show that 80% of visual impairment and blindness can be treated and prevented.
AFP
Trachoma rachoma is the most common infec tious cause of blindness in the world. Chronic infection usually starts during childhood and continues into adult hood. The infection can distort the eyelid causing the lashes to turn inward, rub on the eye and scar the cornea.
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antibiotics, facial cleanliness and environmental improvement.
While substantial progress has been made towards the goal of elimi nating trachoma in the Region by 2020, new data suggest that it remains a serious public health problem in some Pacific In the Western Pacific Region, 10 nations island countries and areas. are suspected of being endemic for Accurately identifying trachoma cases trachoma, including China and coun requires detailed clinical surveys. tries in the Mekong region and the South In 2012, WHO organized a workshop Pacific. The disease hits poor people at the Regional Office on strategies and living in unhygienic surround ings hardest. methodologies for carrying out clinical Better access to education, clean water and sanitary living conditions can help eliminate trachoma, and antibiotics may be required to stop the cycle of reinfection. This is why WHO continues to promote a combination of inter ventions known as SAFE, which stands for surgery for in-turned eye lashes,
ealth promotion enables people to improve their health and increase control over their lives. Public policies, healthy settings and enhanced health literacy can empower people to make better decisions in the quest for a state of optimal physical, mental and social well-being. The infrastructure for health promotion must be responsive to the needs of individuals, families and populations. Local actions in communities, schools and workplaces can improve health outcomes and reduce risk factors for many diseases. Sustainable financial resources for health promotion must be made available to governments, communities, nongovernmental organizations, institutions and partners. Health issues must be at the centre of local and national development decisions. The health-in-all-policies approach holds that every personal or political decision should take into account its impact on health. It also provides a powerful rationale and platform for counteracting commercial influences that may promote economic and material development harmful to human health and welfare.
surveys in Cambodia, the Lao People’s Democratic Republic and Viet Nam. WHO is also helping to fund a work shop with the goal of putting together a trachoma action plan for Solomon Islands and is supporting the training of nurses in Vanuatu to carry out clinical surveys.
Results achieved The Western Pacific Region is the only WHO region that has sustained and expanded foundations, boards and councils tasked with
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carrying out innovative health promotion. Since 2003, new health promotion foundations have been established in Malaysia, Mongolia and Tonga supported by the WHO-organized capacity-building programme called ProLead. Increasingly, countries are allocating a percentage of tax revenue from tobacco and other products harmful to health for health promotion infrastructure and action. WHO is also working with the Lao People’s Democratic Republic, Samoa and Viet Nam to use tobacco taxes to create special funds for health promotion. In Solomon Islands and Vanuatu progress has been made in proposing health
promotion foundations through laws or executive decrees. WHO is encouraging governments to put health issues high on their agendas through the Macao–WHO Healthy Cities Leadership Programme, in which officials from well-established Healthy Cities mentor less-experienced officials from other urban areas. Local governments, for example, in China’s Western Area Health Initiative areas and in Viet Nam have participated in the programme. WHO has also supported Healthy Cities and
Healthy Islands initiatives in Phnom Penh, Cambodia, Ulaanbaatar, Mongolia, and Vientiane, Lao People’s Democratic Republic. In partnership with the Alliance for Healthy Cities, WHO continues to recognize cities making the most progress on health issues, such as Tagaytay, Philippines, and Owariasahi, Japan. In 2012, WHO also recognized national governments for expanding the Healthy Cities initiatives. Another priority is Health Promoting Schools, which focus on providing healthy settings for living, learning and working. To do so, WHO has supported pilot projects in Cambodia, the Lao People’s Democratic Republic, Pacific island countries and areas, and Viet Nam. A new publication, The Role of Schools in Promoting Health: Lessons Learnt in the Western Pacific Region, will share best practices and highlight effective policies.
Future directions Priorities will be centre on advocacy and capacity-building for health promotion foundations, boards and councils in the Region. WHO will continue to support Healthy Cities, Healthy Islands and other initiatives. Health will continue to be held up as a critical issue at the heart of development efforts. WHO will support specific areas, such as the health of workplaces, transportation systems and urban development. Tools, such as training manuals for health-in-all-policies approaches, will be tested, adapted and disseminated.
In the capital of the Lao People’s Democratic Republic, students practice washing their hands, among the simplest and most effective means of avoiding sickness.
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Mental Health and Injury Prevention Mental health
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Strategy and actions ental disorders are generally characterized by some combination of abnormal thoughts, emotions, behaviour and relationships. Examples are depression, disorders due to substance abuse, mental retardation and schizophrenia. Most of these disorders can be successfully treated, yet they are among the leading causes of disease burden in the Western Pacific Region and can have significant social and economic consequences. For example, about one third of global suicides, which are often brought on by mental disorders, occur in the Region. Although suicide rates are highest among elderly males, suicide among young people has become a major concern, particularly in Pacific island countries and areas. Many factors impact mental health, including fears about natural hazards in the Region, rapidly ageing populations, and dramatic changes in social norms and values that come with globalization and socioeconomic development.
A policewoman in Changchun, China, offers a hand to a young woman threatening to throw herself from the roof of an apartment building.
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in China, Hong Kong (China), the Philippines, the Republic of Korea and Viet Nam. WHO continues to support efforts to strengthen mental health systems in Member States. These efforts include the development or updating of national policies on mental health, capacity-building for integrated mental health services and the improvement of mental healthrelated information systems. WHO also supported the implementation of strategies to promote mental health and prevent mental disorders in China, Cambodia, the Federated States of Micronesia, Fiji, Japan, the Lao People’s Democratic Republic, Nauru, Papua New Guinea, the Republic of Korea, Samoa and Tonga.
Results achieved In September 2012 in Seoul, Republic of Korea, WHO convened the Seoul Forum on Suicide Prevention in the Western Pacific Region. The forum brought together experts from
19 countries and areas who discussed trends and risk factors for suicidal behaviour in the Region. They also shared best practices and lessons learnt on suicide prevention and made specific recommendations to WHO and Member States. Some countries reported significant progress in restricting means of suicide, such as access to firearms and toxic substances. Still, policy-makers and the public tend to underestimate the urgency of the issue. Sensational media coverage of suicides can provoke increased suicidal behaviour. To address this issue, WHO has facilitated discussions between journalists, governments and nongovernmental sectors on the way the media covers the issue of suicide
Future directions In May 2013, the Sixty-sixth World Health Assembly endorsed the Comprehensive Mental Health Action Plan 2013–2020. Guided by this strategy, WHO will collaborate with Member States to strengthen regional networks and partnerships and monitor information on regional trends and risk factors for such conditions as depression, suicidal behaviour and epilepsy. WHO will also support docu mentation and pilot projects on the effectiveness of evidence-based interventions to improve the ability of health and social systems to prevent and manage mental disorders.
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Alcohol-related harm
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Strategy and actions
ach year, an estimated 640 000 people in the Western Pacific Region die from complications related to the harmful use of alcohol. Alcohol is also associated with many social and developmental problems, including road crashes, violence, suicides, child maltreatment and absenteeism in the workplace. Excessive drinking is linked to more than 60 diseases, including hepatitis, cirrhosis, hypertension, stroke and coronary heart problems, and is responsible for 5.5% of the global disease burden. It also increases the risk of developing noncommunicable diseases (NCDs) because consuming alcohol can increase caloric intake, lower dietary quality and lead to a reduction in physical activity. Regulations aimed at reducing the harmful use of alcohol require action from many actors, including the health sector, which must raise awareness and promote a comprehensive approach. With WHO’s support, Cambodia, China, the Lao People’s Democratic Republic, Mongolia and Viet Nam are developing public health-oriented alcohol policies through multisectoral action, the building of national capacity and the implementation of cost-effective interventions.
Traffic police conduct a drink-driving prevention campaign in Viet Nam.
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Results achieved Under President Elbegdorj Tsakhia, Mongolia initiated a multisectoral campaign to reduce alcohol
consumption. President Tsakhia is also promoting legal reforms covering the production, sale and distribution of alcohol. In October 2012, the President received WHO’s Special Recognition Award for public health leadership for his work on alcohol control. A national network of 80 governmental and nongovernmental organizations is actively engaged in raising public awareness on alcohol-related harm. WHO has also supported the development and implementation of two successive national programmes on alcohol control. In Cambodia, WHO has supported the Government’s working group on alcohol. Since 2010, this working group has supported policies that raised the alcohol tax from 20% to 25%, banned alcohol use in schools, and ensured that public celebrations
and sporting events are alcohol-free. The Ministry of Education, Youth and Sport is implementing these new measures with support from WHO. In addition, the Ministry of Information banned the promotion of rewards, incentives, prizes and lottery draws by alcohol companies. Several members of the National Assembly are supporting national capacity-building and awareness-raising activities. WHO called attention to the links between the harmful use of alcohol and NCDs at the Regional Meeting on NCD Prevention and Control through the Reduction of Alcohol RelatedHarm in Hong Kong (China) in April 2012. WHO conducted the Biregional Workshop on Building Capacity for Reducing the Harmful Use of Alcohol at the Country Level in Coordination with NCD Prevention and Control in Bangkok, Thailand, in October 2012.
Future directions WHO will continue to support advocacy and political mobilization to reduce the harmful use of alcohol. In particular, WHO will collaborate with Member States in implementing the Regional Strategy to Reduce Alcoholrelated Harm and the Global Strategy to Reduce the Harmful Use of Alcohol. The main priorities of these strategies will be pricing and taxation, regulation of marketing and availability, drink-driving, screening for harmful drinking, and brief interventions, such as counselling sessions by physicians on the consequences of drinking alcohol.
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take urgent steps to reverse this trend if the goal of the United Nations Decade for Action for Road Safety of saving 5 million lives by 2020 is to be achieved. WHO and partner organizations continued to support the implementation of the Road Safety in 10 Countries (RS10) programme in Cambodia, China and Viet Nam. Country programmes are addressing speeding, drinkdriving and the use of motorcycle helmets, and important progress is being made in all countries. In two RS10 provinces in Viet Nam, for example, road traffic mortality rates decreased by 20% and 25% between 2009 and 2011. By contrast, the rate increased by 26% in a comparison province during the same time period. Cambodia and China are closing loopholes in road safety legislation and improving capacity for police enforcement. In the Philippines, WHO has been working with the province of Guimaras to implement local legislation to reduce drink-driving. Community health education and police enforcement helped reduce road traffic mortalities by 22% and road traffic injuries by 38% between 2009 and 2011. The success of this pilot project has been instrumental to the current efforts by the Government of the Philippines towards a national drink-driving law. WHO has piloted low-cost drowning prevention programmes in Cambodia. These community- based interventions have restricted child
Commuters slog through rush-hour traffic in Hanoi, Viet Nam.
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Injury and violence prevention
session of the WHO Regional Committee for the Western Pacific in September 2012 in Hanoi, Viet Nam.
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Strategy and actions njuries kill an estimated 1.2 million people each year and account for 9% of all deaths in the Western Pacific Region. Road traffic injuries, falls, drowning and interpersonal violence are leading causes of death and disability. Reflecting the growing priority of this issue, Member States called for stronger action to prevent injuries and violence at the sixty-third
Results achieved The Global Status Report on Road Safety 2013: Supporting a Decade of Action provides a baseline to measure progress during the United Nations Decade of Action for Road Safety 2011– 2020. The report highlights the increase in road traffic injuries on the Region’s roads, where more than 900 people are killed each day. Member States must
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access to water bodies, provided personal floatation devices to children and provided training for bystander resuscitation. In Mongolia, WHO support has focused on the prevention of burns among children, particularly in remote areas. WHO provided guidance for crashscene and hospital-based trauma care in Cambodia, the Lao People’s Democratic Republic, Malaysia, Mongolia, the Philippines and Viet Nam.
Disability and rehabilitation
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Strategy and actions
Future directions Data collection continues for the Global Status Report for Violence Prevention, to be published in 2014. The findings from this survey will be instrumental for advocating and supporting effective programmes for the prevention of violence in the Region. An expert consultation will be held in August 2013 to develop a framework for regional engagement with Member States on the prevention of violence against women and children. To facilitate effective support to Member States as requested by the Regional Committee, a comprehensive situational assessment has commenced. It will be followed by a meeting of regional focal persons, who will debate the objectives and targets of a new five-year regional action plan for violence and injury prevention. A boy in the Philippines works to master moving around with his improvised walker. Therapy and family involvement are important to support development for children with disabilities. WHO
he lack of access and availability of quality care for people with disabilities is a major issue in the Western Pacific Region. People with disabilities are usually less healthy than the general population and do not receive the care they need. They are also far more likely to find the skills of health-care providers inadequate, be denied care or receive poor medical treatment. This is often due to a lack of medical specialization or access to services such as physiotherapy. In many countries, rehabilitation is a low priority. Rehabilitation may be the responsibility of ministries of health, welfare or education or a combination of government agencies. Nongovernmental organizations and civil society also play key roles. As a result, the lines of accountability and leadership on issues affecting the disabled are often blurred. Because these multiple players interact in complex ways, it can be difficult to lead, manage, navigate and coordinate strategic policies and action. Quality comparable data and information about people with disabilities and their service needs are often unavailable. Although such data are essential building blocks for putting together effective national programmes and sustained actions on disabilities, the lack of timely and accurate information should not be an excuse for inaction.
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Results achieved WHO contributed to regional events to discuss policies on people with disabilities. This work included the development of three background papers for the 2nd Forum Disability Ministers’ Meeting held in Port Moresby, Papua New Guinea, in October 2012. WHO also supported the designation of the current decade as the Asian and Pacific Decade of Disabled Persons 2013–2022 and promoted the Incheon Strategy to “Make the Right Real” for Persons with Disabilities in Asia and the Pacific. National events were organized to launch the World Report on Disability 2011 in Cambodia, the Lao People’s Democratic Republic and Samoa. WHO supported Cambodia and the Lao People’s Democratic Republic in carrying out national rehabilitation sector analyses. WHO also helped Fiji to establish and Mongolia to implement national rehabilitation strategies. High-quality wheelchairs that are appropriately fitted can make a huge difference in the lives of people with mobility impairments. Member States took part in a regional training workshop focusing on the new WHO Wheelchair Service Training Package: Basic Level. WHO also supported national training initiatives in Cambodia, Mongolia, the Philippines and Viet Nam. In June 2012, the First Pacific Islands Community-based Rehabilitation (CBR) Forum endorsed an action plan and established a Pacific CBR Network group. Kiribati, Samoa,
Solomon Islands and Vanuatu carried out follow-up activities to support these rehabilitation efforts. WHO worked with Pacific island countries and areas on a preliminary estimate of the extent of disabilities related to noncommunicable diseases. Extending disability prevention and rehabilitation services across all levels of health systems is of critical importance, noted the Sixty-sixth World Health Assembly in May 2013. This issue will also be discussed at the United Nations High-level Meeting of the General Assembly on Disability and Development in September 2013.
Future directions WHO is currently conducting a regional situational analysis on disability and rehabilitation. Support will be sustained to strengthen national leadership in the rehabilitation sector. Community-based rehabilitation will continue to be a priority to ensure that services are accessible to those who need them most. More effort will be made to integrate disability issues in public health programmes. Mechanisms to enhance disability prevention principles and rehabilitation services in universal health care will be a priority.
A man in the Philippines is fitted with a prosthesis after an amputation as a result of diabetes. WHO supported a national analysis regarding the provision of assistive devices.
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Tobacco Free Initiative T Strategy and actions obacco use is one of the main risk factors for a number of chronic diseases, including cancer and lung and cardiovascular diseases. Evidence shows that tobacco-control initiatives can help reduce risks for noncommunicable diseases. The WHO Framework Convention on Tobacco Control (WHO FCTC) provides a global mandate and a call to action. Many Member States have responded by taxing tobacco, forming smoke-free areas, and banning advertising, promotion and sponsorship by tobacco companies. In November 2012, Member States adopted the Protocol to Eliminate Illicit Trade in Tobacco Products at the fifth session of the Conference of the Parties to the WHO FCTC in Seoul, Republic of Korea. This treaty means all parties to the WHO FCTC must work to curb the smuggling of tobacco products. sponsorships by tobacco companies have also been extended. Revenue from tobacco taxes will be used to help enforce the new law and to implement other Government tobacco control programmes. The High Court of Australia dismissed an appeal by the tobacco industry to halt the introduction of plain tobacco packaging. As of December 2012, all tobacco products in Australia were sold in plain packaging. In February 2013, New Zealand announced plans to introduce similar legislation. Several Pacific island countries and areas have bolstered community partnership programmes and settings-based policies to protect the public from second-hand smoke through the Blue Ribbon Campaign. The campaign aims to empower people and institutions to promote smoke-free environments and build political constituencies to lobby for stronger smoke-free laws. WHO’s Pacific Tobacco Taxation Project, supported by the Australian Agency for International Development (AusAID), provided training to finance ministry tax officials. A training software called “TaXSiM” was introduced to estimate the impact of tobacco tax increases. A WHO team travelled to Cambodia, Samoa, Solomon Islands and Tonga to consult with government officials about raising tobacco taxes. In 2012, Cook Islands, Fiji, Papua New Guinea and Tonga raised their tobacco taxes. WHO also organized an event for senior finance officials from Cook Islands, Fiji, Samoa, Solomon Islands, Tonga and Vanuatu. They met to discuss the benefits of raising tobacco taxes in Nadi, Fiji, in April 2013. In December 2012, the President of the Philippines signed a so-called “sin tax” law that includes steeper taxes on tobacco. The tax on cigarettes will double to about US$ 0.72 per pack by 2017. The law is expected to reduce tobacco consumption and raise revenue to be set aside for universal health care and for upgrading health facilities and prevention programmes. WHO provided technical support to both the Department of Finance and the Department of Health in the Philippines for a successful communications campaign to counteract lobbying by the tobacco industry against the tax increase. At the Western Pacific Region’s first-ever meeting on tobacco and trade issues in July 2012, senior government officials discussed how the tobacco industry is exploiting trade and investment agreements to challenge implementation of the WHO FCTC. Fifteen countries and areas from the Region participated. In September 2012, paediatricians from 13 countries met in Kuching, Malaysia, to form an alliance of child and family health-care professionals
Results achieved Viet Nam passed its first comprehensive tobacco control law, which took effect in May 2013. The law expands the number of smoke-free public places and includes a ban on smoking in all restaurants. It requires graphic health warnings on tobacco packaging and extends the ban on tobacco advertising to include the international media. Bans on promotions and
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“Sin tax” used to fight cancer
dedicated to curbing youth smoking and protecting children from exposure to tobacco products. WHO conducted workshops in Cambodia, Solomon Islands and Vanuatu to build capacity for counteracting tobacco industry resistance to tobacco control measures. The Region launched World No Tobacco Day 2013 in Cambodia, with countries and areas throughout the Western Pacific participating with public rallies, scientific meetings, radio and television interviews, and other advocacy events.
Senator Pia Cayetano, a staunch supporter of the Philippine “sin tax”, receives a symbolic bear from children with cancer and health advocates.
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Future directions WHO will continue to support Member States to accelerate implementation of the WHO FCTC and will work to ensure that they sign and ratify the Protocol for Eliminating the Illicit Trade on Tobacco. High priority will be given to building capacity in Member States to monitor the impact of tobacco control policies at both national and subnational levels. Continued support will be provided for efforts to counteract tobacco industry interference. WHO will continue to engage with other government sectors, such as finance, trade and agriculture, to strengthen multisectoral action for tobacco control. WHO will also sustain partnerships with nongovernmental organizations that serve as advocates for the protection of child and adolescent health from tobacco harm. Strengthening of cessation systems will also continue to be a priority.
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n January 2013, President Benigno S. Aquino III of the Philippines signed into law a controversial tobacco tax. The tax is projected to raise US$ 817 million in its first year. The lion’s share of these funds—US$ 694 million, or about 85%—will be spent on universal health care to provide insurance for 40 million poor Filipinos who earn less than US$ 130 per month. The tax has raised the price of the most popular cigarettes from US$ 0.73 to US$ 1.20 per pack. The price of an indi vidual cigarette has jumped from US$ 0.05 to US$ 0.12. The tobacco industry lobbied hard to derail the tax bill. WHO worked with the Government’s health and finance departments to develop an effective communications strategy to frame the law as a vital health necessity rather than just another tax. The effort paid off. The first major newspaper story about
the campaign was headlined: “Sin tax is anti-cancer tax”. Civil society, anti-smoking activists and the media worked together to spread this message. Scientists and wellknown health experts testified at senate hearings. The massive media campaign led to a broader discussion about the harms of tobacco and the critical impor tance of raising tobacco prices to curb youth smoking. More than 450 news stories appeared in mainstream Filipino media during the three-month senate debate. Senator Franklin Drilon, Chairperson of the Ways and Means Committee, cred ited WHO for providing vital support. “We profusely thank WHO for helping operationalize our crucial strategy to sponsor the bill as a health measure, which ultimately clinched for us popular support and victory in the legislative deliberations,” he said.
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Health Sector Development
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Health Sector Development
Introduction
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ealth systems are the foundation of public health efforts aimed at combating diseases and building healthy communities. The mission of the Division of Health Sector Development is to help Member States attain universal coverage of health services for better and more equitable health outcomes.
Over the past year, countries in the Western Pacific Region have made universal health coverage central to their vision and goals. For example, Cambodia, China, the Lao People’s Democratic Republic, Mongolia, the Philippines, Solomon Islands and Viet Nam have carried out policy dialogues on technical aspects of universal health coverage. This is a hugely positive development in light of United Nations discussions that will begin this year to decide on new health-related goals for the period after 2015. Regional strategies and action frameworks for health systems comprise a major part of WHO’s support to Member States. All health system strategies have a common goal—to support Member States in their efforts to attain universal health coverage and equity in health outcomes. WHO experts and external advisers reviewed strategies
to determine their usefulness and gauge the progress of countries. In a Region with few low-income countries, the focus in health systems will be on more equitable access to health so all may benefit from the Region’s economic development. At the request of the Minister of Health of the Lao People’s Democratic Republic, WHO organized a policy dialogue to assist the country in developing its Health Sector Reform Strategy. These efforts are designed to help the Lao People’s Democratic Republic meet the Millennium Development Goals (MDGs) by 2015, transform into a middle-income country by 2020 and demonstrate progress towards universal health coverage by 2025. The realization that health systems must be strengthened for programmes to be effective has led to broader collaboration among divisions at the Regional Office. The result has been improved service delivery of programmes on antimicrobial resistance, malaria, maternal and child health, noncommunicable diseases (NCDs) and tuberculosis. Advances have also been made in developing strategic frameworks on NCDs, reproductive health and newborn care. The launch of both the Asia Pacific Observatory on Health Systems and Policies and the Health Information and Intelligence Platform has improved the flow of information about health systems in the Western
Pacific Region and has made this data more accessible and user-friendly. Member States are also developing and improving civil registration and vital statistics systems. WHO, in collaboration with other United Nations agencies and partners, produced Accelerating Equitable Achievements of the MDGs: Closing Gaps in Health and Nutrition Outcomes, a country-by-country progress report. Health at a Glance: Asia/Pacific 2012, a report jointly produced by WHO, the Organisation for Economic Co-operation and Development (OECD) and the OECD Korea Policy Centre, provides easy-to-use information and broad indicators related to health and health systems.
“Ageing and health” was the theme of World Health Day 2012. This year Member States have been analysing the health profile of their older populations and assessing their health policies in the context of ageing. Amid fiscal and political decentralization in some countries, WHO has consulted with Member States to provide support at the subnational level for universal health coverage. Health systems development is an important component of a subnational project in the Philippines and the Western Area Health Initiative in China.
Nurses compete to see who can put in a drip needle faster at a hospital in central China. A chronic shortage of nurses threatens patient safety in China. The country is one of many in the Region that WHO assists in health professions training to meet the growing demand for services. The Work of WHO in the Western Pacific Region, 1 July 2012 – 30 June 2013
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Health Services Development E Strategy and actions ffective health services provide safe, high-quality care with a minimal waste of resources to the majority of people. However, across the Western Pacific Region, there are gaps in coverage due to unavailability of health services, personnel and medicines, high fees for services and confusion due to the existence of so many separate disease programmes, among other factors. The Health Services Delivery unit works closely with Member States to build strong national health plans, engage in national policy dialogue and work towards universal health coverage through the advocacy of people-centred, integrated, quality service delivery. WHO supports Member States to address service delivery from grassroots community health services to hospital services, including palliative care. Secondly the unit supports the strengthening of the governance role of ministries of health, which set the vision and objectives for the health sector and guide and monitor service delivery. This also involves ensuring the development and implementation of effective public health laws. on the Regional Office web site, these profiles provide concise, userfriendly briefs of the service delivery model, health-care financing, human resources for health, medicines and technologies, and the quality and equity of each health-care system. Region— Cambodia, the Lao People’s Democratic Republic, Mongolia, Papua New Guinea, Solomon Islands and Viet Nam—with health systems grants that led to integrated service delivery for the diseases and improved availability of vaccines and immunization coverage. Cambodia, the Lao People’s Democratic Republic and Viet Nam have put in place strategies to improve patient safety, such as safe-surgery checklists, hand-washing campaigns, and the translation into local languages in all institutions of WHO’s curricula on patient safety.
WHO’s six regional health system strategies on human resources, health-care financing, essential medicines, traditional medicine, laboratory services and health systems strengthening based on the values of primary health care, were comprehensively reviewed. Member States discussed the findings and lessons learnt. Cambodia, the Philippines, the Republic of Korea, Samoa and Vanuatu were the first to review their health sector legislative framework using a WHO-developed public health law assessment tool. The Lao People’s Democratic Republic, Mongolia, Papua New Guinea and Solomon Islands had local researchers trained, who subsequently assisted those countries also to complete the assessment tool. Analysis of the data will help countries identify gaps in their public health laws on issues such as food safety, mother and child health and violence against women. The GAVI Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria provided six countries in the
Results achieved WHO published service delivery profiles for 17 countries and areas in the Western Pacific Region. Available
WHO has assisted Member States and institutions in the Western Pacific Region to establish a network to share information, experiences and lessons learnt on the quality of health care.
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Through a collaborative effort between OECD and the WHO SouthEast Asia and Western Pacific regional offices, key indicators on health and health systems for 27 Member States were presented in Health at a Glance: Asia/Pacific 2012. This publication includes a detailed chapter on quality of care, with case studies from Cambodia, China, Malaysia and the Philippines. With the launch of the publication at an expert meeting, Member States and institutions established a network to share information, experiences and lessons on the quality of health care.
Health sector reform in the Lao People’s Democratic Republic
Future directions With ageing populations and the increasing burden of noncommunicable diseases, integrated services will be a focus for the future. Continuity of care––from community and primary level through tertiary and palliative care––is essential for efficient and effective treatment. It is estimated that as much as 40% of all funding for health is wasted due to inefficiencies, such as poor staff distribution and unnecessary equipment, drug prescriptions and diagnostic tests. In this regard WHO intends to have a special focus on hospital services and management that includes quality of care, patient safety and the efficient use of resources. An online course will be available to WHO staff in early 2014 to support capacity development in health sector planning, policy dialogue and stakeholder engagement.
A nurse listens to the heart of a child in the Lao People’s Democratic Republic. The country is working to increase access to health services. here is a growing commitment in the Lao People’s Democratic Republic to improve access to health services for all citizens. This drive for broader health coverage is fuelled, in part, by efforts to meet the United Nations Millennium Development Goals (MDGs). The Lao People’s Democratic Republic is working to graduate from the United Nations list of leastdeveloped countries, and public health improvements are a key to that effort. In June 2012, Health Minister Dr Eksavang Vongvichit asked WHO to provide technical assistance for the development of the country’s Health Sector Reform Strategy. Thanks in part to a coordinated effort by the Ministry of Health, WHO, the Japan International Cooperation Agency, the Korea International Cooperation Agency and other development partners, the Health Sector Reform Strategy was approved by the National Assembly in December 2012. The two main objectives of the Health Sector Reform Strategy are to meet
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health-related MDGs and to achieve universal health coverage by 2025. Putting the new strategy into practice has become one of the Government’s top priorities. “Talking and designing a strategy is good,” Dr Vongvichit says. “Now we need action.” WHO helped the Ministry of Health draw up a comprehensive framework and an action plan for nationwide implementation of the Health Sector Reform Strategy. The strategy has three phases. The first focuses on laying the foundation for universal health coverage and accom plishing the MDGs by 2015. The second aims to ensure that essential health services of reasonable quality are available to the majority of the population by 2020. The final phase calls for achieving universal coverage by 2025. “The expected impact of the reform is to achieve not only the health MDGs, but also to improve the lives of children and women,” Dr Vongvichit says. “The reform represents a new way, a breakthrough, in how to achieve universal health coverage.”
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Health Care Financing Health-care financing
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Strategy and actions
ealth-care financing involves mobilizing resources for health spending and making the best use of those resources. WHO works with Member States in the Western Pacific Region on health financing policies, especially those aimed at providing universal health coverage, which has become a top priority for many countries. WHO’s Health Financing Strategy for the Asia Pacific Region (2010–2015) and the World Health Report on Health System Financing: the Path to Universal Coverage provide guidance to Member States on how to move towards universal health coverage. WHO works with countries on improving financial risk protection, which involves lowering the burden that health payments place on people. WHO also collaborates with countries to make interventions more accessible and works with all sectors to make health a major part of national development agendas.
WHO successfully advocated for more public spending for essential health services in rural and remote areas of the country. WHO provided technical support and facilitated a policy dialogue to help Viet Nam revise its health insurance law and develop a health insurance road map. At the sixty-third session of the Regional Committee for the Western Pacific in September 2012, Viet Nam organized an event on universal health coverage. At the meeting, which was chaired by Dr Shin Young-soo, WHO Regional Director for the Western Pacific, Viet Nam affirmed its commitment to universal health coverage, while China, Japan and the Republic of Korea shared their knowledge on the subject.
Mongolia pledged to use government subsidies to expand national insurance coverage, with a special focus on poor people and informal workers. WHO collaborated with the Ministry of Health and the Ministry of Population Development and Social Protection in Mongolia to develop a long-term national health insurance strategy. WHO helped engage different sectors in Cambodia and provided technical support to the Government to revise its health financing charter and to develop a health financing policy. WHO also supported the
Results achieved The Lao People’s Democratic Republic Health Sector Reform Strategy aims for universal health coverage. Working with the Ministry of Health, other ministries and development partners, Mongolian dairy farmers in a remote village take a rest between milking sessions. Universal health coverage must reach everyone—even people in the most far-flung stretches of the Region—to keep populations safe. AFP
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Vaccination campaigns are among the most cost-effective public health interventions and key to building sustainable universal health coverage systems in the Region.
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headquarters and the World Bank organized a high-level policy meeting on universal health coverage, and the Regional Office for the Western Pacific facilitated the participation of ministers of health and finance, as well as other government officials. Together with partners, WHO hosted the AsiaPacific Leadership and Policy Dialogue for Women’s and Children’s Health, an event for government officials and international agencies that included topics such as how to mobilize more money for health and how to spend it more efficiently.
Equity, Social Determinants of Health, Gender and Human Rights
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Strategy and actions ork on health equity, gender mainstreaming and the right to health in the Western Pacific Region broadly follows three strategic approaches: technical or programmatic collaboration; building capacity; and strengthening evidence, technical tools and resources.
Future directions WHO continues to support Member States in making progress towards universal health coverage. Member States will receive technical support for high-level dialogue and evidencebased policy-making. WHO will help countries improve governance and institutions involved in health financing. The Organization will also help governments explore innovative ways to use alcohol and tobacco taxes for health expenditures. WHO is providing assistance to Member States to improve incentive and payment systems for health workers. As public hospitals become more autonomous, the Organization intends to evaluate their management and efficiency. Snapshots of the health financing systems of Member States will be updated in Health Financing Country Profiles 1995–2011, which will be published in 2013.
Results achieved Examples of technical and programmatic collaboration on social determinants of health include the introduction of Island HEART (an adaptation of Urban HEART, or Health Equity Assessment and Response Tool) in Fiji, in collaboration with the WHO Kobe Centre. This tool is a user-friendly guide to identify health inequities and plan actions to reduce them. WHO took part in the Second Pacific Islands Health Research Symposium, whose theme was the social determinants of health. The Regional Office also assessed approaches to Health in All Policies in the Region and reviewed the book Health in All Policies in preparation for the 8th Global Conference on Health Promotion held in Helsinki, Finland in June 2013, whose theme was Health in All Policies.
development of a national monitoring and evaluation framework for universal health coverage in the Philippines. WHO facilitated country consultations to verify reporting for national health accounts, which provide evidence to monitor trends in health spending for all sectors and to make financial projections of countries’ health system requirements. That reporting will be included in World Health Statistics 2013. Eight Member States participated in a WHOsupported national health accounts workshop that trained government officials on how to track health expenditures. WHO produced six policy briefs and a report comparing countries in the Region on their use of health services and financial protection. WHO
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on Health in All Policies and held a workshop in Manila, Philippines, on Health in All Policies. To strengthen evidence, technical tools and resources, WHO and the Government of the Philippines organized a national workshop that resulted in a report on equity and the health of women and children in the Philippines. Selected WHO country cooperation strategies and national health plans were reviewed from the perspective of equity, gender and human rights. The Regional Office also contributed to the development of a WHO sectoral brief on the social determinants of health, with a focus on energy and health issues. Selected regional publications were translated into Chinese, Khmer, Mongolian and Vietnamese.
Future directions A woman in Papua New Guinea makes tapa, a traditional cloth made with tree bark. WHO supports gender mainstreaming across the Region. AFP
The Regional Office is providing technical support to address genderbased violence in Cambodia and the Lao People’s Democratic Republic. WHO also compiled evidence on injuries, violence and reproductive health to inform the sixty-third session of the Regional Committee for the Western Pacific in September 2012. Capacity-building activities supported by WHO included workshops on gender mainstreaming
in Malaysia and Papua New Guinea. WHO also supported the Government of Papua New Guinea in producing its health sector gender policy. Few Member States in the Region have such policies, despite the huge need to promote gender equality and address critical issues such as widespread violence against women. In collaboration with the Government of South Australia, WHO supported the development of a training manual
Equity remains the key health and development challenge in the Region. Health inequities have increased within and between countries over the past few decades. Reversing this trend will require action on the social determinants of health through an intersectoral approach as well as equity-focused, gender-responsive and human rights-based policies and actions within the health sector. Due to increased awareness of these issues, requests for technical collaboration from Member States are expected to increase.
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Ageing
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opulation ageing constitutes a key public health challenge for Member States in the Western Pacific Region. Due to declining fertility rates and longer life expectancies, the proportion of people over 60 years old is growing faster than any other age group in the Region. This trend reflects, in part, the success of public health and development policies. It also poses challenges to societies and health systems as they try to maximize the functional capacity, security and participation in society of older people. These issues are especially challenging in low- and middle-income countries, where the proportion of older people has been increasing even more rapidly, leaving less time to prepare for the consequences.
WHO has been strengthening its work on ageing and health in Member States. To increase awareness of these issues in a positive way, World Health Day 2012 promoted the theme: Good health adds life to years. WHO recognizes the contributions of older people to society and frames ageing not as a process of inevitable decline, but one in which people can continue to carry out meaningful and productive activities as they grow older. To provide guidance for Member States, WHO has been working on a draft Regional Framework for Action on Ageing and Health in the Western Pacific. The draft framework recommends four pillars of action. These include: fostering age-friendly environments through action across sectors; promoting healthy ageing across the life course and preventing functional decline and disease among older
people; reorienting health systems to respond to the needs of older people; and strengthening the evidence base on ageing and health. The draft framework builds on evidence brought together in two pieces of analytical work: a comparative analysis of the health status and needs of older people and a review of policies related to ageing and health in selected Member States. An informal experts’ consultation was held in April 2013 to review the findings and policy implications of these analyses and to provide further guidance for the draft framework. Preparations are being made to convene a regional meeting with Member States in July 2013 to seek Member States’ inputs in finalizing the draft framework.
Member States are becoming more aware of health issues related to ageing, and many are seeking technical collaboration with WHO in this area. They will discuss ageing and health at the sixty-fourth session of the Regional Committee for the Western Pacific in October 2013. Much of the work on ageing is led by those working in other sectors, such as social security, housing and urban planning. As a result, increased advocacy and strengthened partnerships with Member States, United Nations partners, older people’s associations and other stakeholders will be important in taking forward the work on ageing and health.
Two women in Zambales, Philippines, proudly represent the fastest-growing demographic in the Region—people older than 60.
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Human Resources for Health
Healing hands: Nursing school graduates who recently passed the licensing test in the Philippines take their oath of service during a ceremony in Manila.
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Strategy and actions he efforts towards universal health coverage are challenged without competent and productive health workers, who are vital in making progress towards the Millennium Development Goals. Decades of cost-cutting, poor salaries, and underinvestment in education and training have led to critical shortages
in health workers and imbalances in their mix of skills. WHO supports Member States in addressing these disparities in workforce distribution, mobility and skill mix. This support includes human resources for health (HRH) strategic planning, implementation and monitoring, as well as help in aligning high-quality workforce education with health needs.
Results achieved WHO cooperates with countries and partners in advancing the HRH agenda shaped through the Human Resources for Health Action Framework for the Western Pacific Region (2011– 2015). WHO is developing a database to monitor progress towards regional HRH indicators. The database will include information collected through
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HRH country profiles that have been developed for 10 countries, as well as data routinely collected through the Health Information and Intelligence Platform (HIIP). In-depth analysis of HRH information systems was carried out in the Lao People’s Democratic Republic. WHO also supported capacity-building for an analysis of health workforce inequalities. Country databanks on nurses and midwives were updated for 17 Member States. WHO provided support to a project funded by the China Medical Board to strengthen human resources for health research capacities and knowledge in the western provinces of China. In collaboration with the Australian Agency for International Development (AusAID), WHO worked with ministries of health to address workforce challenges in Solomon Islands and Vanuatu and HRH strategic planning. WHO also collaborated with the Philippines to monitor
degrees in nursing. The University of the Philippines and Seoul National University designated their teacher training centres as regional education development centres to promote collaborative education and the sharing of information on health professions education development. The Western Pacific Region has addressed quality improvement in nursing education by developing measurement criteria to accompany the Global Standards for the Initial Education of Professional Nurses and Midwives. The Pacific Open Learning Health Network provides online and hybrid courses, course materials and information to health professionals in the Pacific island countries and areas. Delegates to the Asia Pacific Emergency and Disaster Nursing Network Meeting held in October 2012 in Kuala Lumpur, Malaysia, agreed on a research action framework, and 25 network members participated in AusAID-sponsored research training
at James Cook University, a WHO collaborating centre in Australia. In an important WHO contribution to capacity-building for Member States, 280 fellowships and study tours were awarded in 2012. The first group of fellows under the Health Leadership Development Initiative has completed the programme, and the second group of fellows has been recruited.
Future directions WHO provides technical cooperation to help countries develop clearer strategies and plans to address HRH challenges that take into account population needs and the dynamics of the labour market. WHO will build governance and financing capacity for implementation of HRH strategies. Member States will also receive assistance to strengthen HRH information and train people to carry out labour market analysis.
The WHO Global Code of Practice on International Recruitment of Health Personnel and on the integration of Cubantrained physicians in Pacific island countries and areas. WHO support continues in Cambodia and the Lao People’s Democratic Republic for education development centres designed to improve education capacities and quality. With financial support from AusAID, a programme in Cambodia puts nurses with associate degrees on track to earn bachelor of science
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Essential Medicines and Technologies Strategy and actions
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he Essential Medicines and Technologies unit promotes development of national policies to improve access to safe and affordable medical products, health technologies and laboratory services. The Regional Framework for Action on Access to Essential Medicines in the Western Pacific (2011–2016) provides strategic guidance for improving quality, safety and access to affordable medicines. It is crucial that national policies on medicines be integrated with overall health goals. Equitable health financing policies that reduce out-of-pocket spending on essential medicines, especially for the poor, contribute significantly to progress towards universal health coverage. Through regional collaboration, WHO helps Member States strengthen their regulatory authorities and adhere to international standards on medicine quality. Countries also receive WHO assistance to ensure the quality and safety of traditional medicine and to integrate traditional medicine into national health systems.
Results achieved Through regional collaboration, WHO helps Member States strengthen regulatory authorities and enforce international quality standards on medicine. AFP
Key achievements over the past year include the revision and development of national policies on financing of essential medicines, development
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of local production of medical products and improvements in rational drug use. Member States sought WHO assistance to develop practical treatment guidelines to manage noncommunicable diseases at the primary care level and ensure uninterrupted supplies of essential medicines and health technologies. Cambodia, the Philippines and Viet Nam took part in high-level dialogues using in-depth country analyses to develop national policies on combating antimicrobial resistance. China, the Lao People’s Democratic Republic and the Philippines strengthened regulatory capacity to ensure that medical products are fabricated and controlled according to good manufacturing practices and quality standards. Training was conducted for regulatory authorities on the use of the new global Rapid Alert System to report and collect data on substandard and counterfeit medicines. WHO assisted Pacific island countries and areas in developing national strategies for health laboratory services and in strengthening capacity for providing safe blood services. Cambodia and the Lao People’s Democratic Republic collaborated with WHO to develop national strategies on traditional medicine. Service delivery profiles on traditional medicines systems were developed for 17 countries in the Region. WHO also supported Member States in adopting the principles and strategies recommended in The Regional Strategy for Traditional Medicine in the Western Pacific (2011–2020).
Future directions The Regional Framework for Action on Access to Essential Medicines in the Western Pacific (2011–2016) lists indicators with targets to monitor progress on access to safe and affordable medical products. Data on framework implementation by Member States are regularly monitored to identify achievements as well as areas in which countries require WHO support.
Viet Nam will be reinforced. WHO will continue to promote evidencebased selection of essential medicines and their responsible use. Proper treatment of tuberculosis, malaria and other infections is essential to avoid organisms becoming resistant to medicines available today, leaving the world unprotected tomorrow.
WHO will continue providing technical support to strengthen national laboratory services, ensure the safety and quality of traditional medicines, and promote access to products needed to most cost-effectively manage the growing burden of noncommunicable diseases. Through a regional network of policy-makers, countries will be able to share their experiences of using pricing policies to improve affordability and equitable access to medicines. National regulatory authorities will attend a regional forum to share experiences and lessons on enforcement of standards for medical products. Support for developing national policy responses to the threats of antimicrobial resistance will be critical. The Emergency Response to Artemisinin Resistance in Cambodia, China, the Lao People’s Democratic Republic, Myanmar, Thailand and
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Health Information, Evidence and Research A Strategy and actions Results achieved In January 2013, WHO launched the Health Information and Intelligence Platform (HIIP) for the Western Pacific Region, which links users to new databases and sophisticated analytical and visualization tools. WHO contributed to multi-partner progress reports, such as Health at a Glance: Asia/ Pacific 2012 and Accelerating Equitable Achievements of the MDGs: Closing Gaps in Health and Nutrition Outcomes. Under the direction of the Commission on Information and Accountability for Women’s and Children’s Health and with support from the Health Metrics Network, WHO and partners produced a regional action plan for achieving well-functioning CRVS systems by 2020 in Asia and the Pacific. These partners included the Economic and Social Commission for Asia and the Pacific, the Secretariat of the Pacific Community, the University of Queensland and others. WHO is also collaborating with partners to improve CRVS systems in Cambodia, Fiji, the Lao People’s Democratic Republic, Mongolia, the Philippines, Samoa, Solomon Islands, and Vanuatu. For example, health officials are being trained to go beyond the immediate cause of death to identify underlying factors on death certificates to improve quality of burden of disease statistics. ccurate and timely health information is vital for making decisions on public health. Too often, however, health information systems (HIS) are unreliable and fragmented, and data are isolated and not employed in decision-making, which obscures the true drivers of morbidity and mortality. Multisectoral engagement and investments in HIS are insufficient. Information and communications technology, or eHealth, is poorly implemented and does not adhere to health data standards, which constricts the ability to link systems and share data. Data managers lack analytical skills, making it harder for them to generate quality and timely evidence to support policy-makers. In recent years in health research, the supply of trained staff has not kept pace with the substantial increase of health data and surveys in Member States, which is why many of these investigations are carried out by external organizations.
Member States received support to strengthen capacity on HIS and on the use of eHealth standards. WHO implemented training and mobilized peer networks of HIS and eHealth professionals for knowledge sharing. WHO hosts the secretariat for the Asia eHealth Information Network (AeHIN) and supports the Pacific Health Information Network (PHIN). WHO coordinates with other development partners through these networks for the development of national HIS, CRVS, and eHealth assessments, strategies and plans and the implementation of multisectoral governance mechanisms. WHO and Member States developed frameworks to guide prioritization and investment in health research and to make research results broadly accessible. WHO also helped countries develop ethical standards and oversight systems to protect the rights of participants in health research projects. Fiji and the Lao People’s Democratic Republic received support to develop national guidelines for conducting health research. In the past year, WHO helped countries prioritize investment in systems development and support, such as the launch of Mongol Med to increase online access to Mongolian public health literature.
WHO supports Member States in upgrading their HIS and civil registration and vital statistics (CRVS) systems and improving governance and management of health research.
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Future directions WHO will focus on the transfer to Member States of HIIP data and metadata standards to improve the consistency and quality of health indicators used in national health information systems. Nine Member States will be supported to design interoperable HIS solutions and receive training on routine data quality analysis, so they can better track changes in health system performance and universal health coverage. Six Member States will be supported to develop national eHealth
strategies to encompass HIS, mHealth, eLearning, knowledge management, standardization and interoperability, and other priority eHealth areas according to national priorities. WHO is working with stakeholders to increase coverage of birth and death registration and improve the quality of mortality data within CRVS systems in all Member States by 2020. WHO supports strategic components of existing HIS and eHealth networks, AeHIN and PHIN, to build skills and enhance leadership and governance by institutions as part of long-term strategies and plans.
WHO continues to support the strengthening of national governance and management structures for health research in Cambodia, Fiji, the Lao People’s Democratic Republic, Mongolia, Papua New Guinea and Viet Nam. These countries also receive assistance to establish policies for public archiving and access to health research data. WHO provides capacity-building assistance in some countries to teach students and health workers to analyse data, rather than just compile it.
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ealth information often is hard to find and stored in ways that make it difficult to use and impossible to share. The Health Information and Intelligence Platform (HIIP) for the Western Pacific Region (http://hiip.wpro.who.int) helps meet the growing demand for reliable, user-friendly country health information. A collaborative public health platform launched in January 2013, HIIP provides easy access to databases containing all WHO health-related indicators. Now, government officials, policy-makers, researchers, donors and the public can access and compare country and regional health data using HIIP. With greater ease, users can tabulate data from many sources on a range of health indicators to compile charts, graphics and reports covering various countries and
time periods. Users can find country-level data for all countries in the Region. HIIP also allows users to track historical trends, such as progress towards the Millennium Development Goals, tobacco control efforts and maternal health outcomes. In addition, HIIP provides easy, one-stop access to statistical and analytical reports. The platform was used to develop information and analysis for World Health Day and International Women’s Day. It also allows for charting, mapping and tabulation of health data using dashboards and other innovative techniques. The platform’s easy-to-use features encourage the transfer of knowledge as well as the harmonization and standardization of the Region’s health indicators. HIIP helps public health officials make betterinformed decisions. The Health Information and Intelligence Platform logo: Look for it!
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Asia Pacific Observatory on Health Systems and Policies
A fisherman and his children watch the world go by from their traditional stilt house in Tatana village in Papua New Guinea. WHO is working to ensure that the advances in global health do not also bypass them.
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Strategy and actions
he Asia Pacific Observatory on Health Systems and Policies (APO) links research with decisionmakers in an effort to promote evidence-based national health-care policies. Established in 2011 and hosted by the WHO Regional Office for the Western Pacific, the APO
is a partnership of governments, development organizations and the research community. Governments include Bangladesh, Hong Kong (China), Myanmar, the Philippines and Singapore. Development agencies include AusAID, the Asian Development Bank, the World Bank and the WHO regions for the Western Pacific and South-East Asia. Research
institutions active in the APO include: the Institute of Health Policy, Sri Lanka; the International Health Policy Program, Thailand; and The University of Queensland and the Nossal Institute at the University of Melbourne, Australia. Japan and the Republic of Korea provide regular financial contributions to the APO.
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Over the past year, the APO has worked to broaden recognition of its role and utility by increasing familiarity with its publications and expanding the range of activities it supports to inform national health policy development in the Asia Pacific region. The observatory has sought to create new collaborative working arrangements with other important research institutions, such as the Organisation for Economic Co-operation and Development and the National Institute for Health and Care Excellence, as well as expanding its network of universities within the region.
In addition to the HiTs, the APO produces a policy briefs series that presents the best available evidence on key policy topics confronting countries throughout the Asia Pacific region. In 2013 the APO published one policy brief on the dual practice of public sector medical professionals, and has commissioned an additional six policy briefs for release in late 2013 or early 2014. The APO began a new series of country comparative studies on the governance of public hospitals that will release seven country case studies on hospital autonomy.
seven country case studies on reforms intended to increase the autonomy, quality and efficiency of public hospitals. The investigations will be conducted by national researchers and will be released during 2013 at seminars in each country, then published as a book with comparative analyses in 2014. The APO will also conduct countrylevel policy dialogues to strengthen national capacity for evidence-based decision-making on health issues as a follow up to activities to complete HiTs.
Results achieved The Health Systems in Transition (HiT) reviews—profiles that categorically describe and assess the core components of a country’s health system—are the observatory’s flagship publications. HiT reviews provide an objective, user-friendly description of the entire health sector of a country in a single volume. The APO has completed HiT reviews for Fiji, Malaysia, Mongolia and the Philippines. There are currently 13 country HiTs in progress. Five more HiT reviews should be completed in 2013: the Lao People’s Democratic Republic, Myanmar, New Zealand, Solomon Islands and Tonga. The APO launched a new “Living HiTs” series in 2013 that will update published HiTs with new information and evidence on developments in countries’ health sectors.
Future directions The observatory will expand its range of analytical products, targeting new areas of health policy development for countries in the Asia Pacific region. Among the topics to be examined are: trends in ageing and the implications of the compression of morbidities for health systems; experiences with using diagnostic related groups as a payment mechanism; and governance of alternative purchasing mechanisms for health-care services. Regional seminars for academics from leading national universities will be organized, with special editions of high-impact journals publishing scholarly papers presented. Additional calls for policy brief proposals will be advertised and subsequently commissioned. The APO plans to publish comparative analyses of the original
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Pacific Technical Support
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any Pacific island countries and areas share similar challenges, such as the health impact of climate change and a growing burden of noncommunicable diseases (NCDs), including cancer and diabetes.
The availability of skilled health workers, infrastructure and financial resources is often limited. And the geographic locations of these far-flung islands, some of which are among the world’s smallest states, only compound these challenges. In the past, efforts to address public health issues in the Pacific were fragmented and not well coordinated. Global and regional guidelines often were not applicable, given the unique demographics and cultures of the Pacific islands. The Division of Pacific Technical Support (DPS) was created in August 2010 to address these challenges and more directly serve 21 of the 37 countries and areas that make up the Western Pacific Region. The establishment of DPS marked a giant step forward in the effort to improve WHO’s performance at the country level. Today, when countries request WHO support, 80% of those requests can be dealt with in the Pacific at the country level, rather than thousands of miles and several time zones away at the Regional Office for the Western Pacific.
The Division, based in Suva, Fiji, is organized into three programmatic teams: Combating Communicable Diseases and Health Security and Emergencies; Health Sector Development; and Building Healthy Communities and Populations. This new structure has enhanced communication among various programmes in the Pacific. It has also allowed for decentralized budget management that has reduced delays and improved responsiveness to country needs. The creation of the new Division, much like the restructuring of technical teams in the Regional Office, has reduced bureaucracy, increased efficiency and saved money. DPS closely collaborates with partner organizations in the Pacific, such as the Secretariat of the Pacific Community (SPC), the Pacific Islands Forum Secretariat and various United Nations agencies. Main funding partners, including the Australian Agency for International Development (AusAID) and the New Zealand Aid Programme (NZAID), attend the DPS annual meeting, leading to more open exchanges and the sharing of ideas that have brought a new level of cooperation to the Pacific. At the most recent DPS annual meeting, topics included improving internal management, priorities and implementation plans at the country level, the allocation of resources for research across strategic areas and performance evaluations. WHO’s reach in the Pacific extends far beyond the main office in Suva. There are offices in Kiribati, Samoa,
Solomon Islands, Tonga and Vanuatu. A new WHO Country Liaison Office was opened in Pohnpei in the Federated States of Micronesia to serve the Federated States of Micronesia, the Marshall Islands and Palau. In addition, the Country Liaison Office in Solomon Islands has been upgraded to a full WHO Representative Office.
A more strategic approach to countrylevel outcomes Over the past year, DPS has taken a more strategic approach by focusing on individual countries and areas and by improving management and coordination. The Multi-Country Cooperation Strategy for the Pacific (2013–2017), or MCCS, is the guiding framework for coordination between WHO and countries to meet national health goals. The MCCS, launched in September 2012 at the sixty-third session of the Regional Committee for the Western Pacific, includes specific strategies for each of the 21 countries and areas in the Pacific, with a synopsis of country health plans and WHO’s role in those plans. There have been significant achievements in the Pacific, but real challenges remain in each of the division’s three main areas of work: Combating Communicable Diseases and Health Security and Emergencies; Health Sector Development; and Building Healthy Communities and Populations.
Children look out to sea in Tuvalu, one of the world’s smallest states. The island nation is vulnerable to rising ocean levels because none of the atolls is more than five metres above sea level. WHO assists Tuvalu and other Pacific island countries and areas in dealing with environmental changes and other public health challenges. The Work of WHO in the Western Pacific Region, 1 July 2012–30 June 2013
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Combating Communicable Diseases and Health Security and Emergencies Neglected tropical diseases (NTDs), such as leprosy, lymphatic filariasis and yaws, continue to burden several Pacific island countries and areas. In response, DPS supported mass drug administrations and surveillance work in line with global guidelines to eliminate these diseases. In 2012, Palau and Vanuatu completed their final lymphatic filariasis antigen surveys, and in 2013 they will join Niue in applying for official certification that the disease has been eliminated. Within 10 years, all Pacific island countries and areas are expected to eliminate lymphatic filariasis as a public health problem. Three PICs have not yet achieved leprosy elimination, with the Federated States of Micronesia, Kiribati and the Marshall Islands reporting national leprosy prevalence rates higher than 1 per 10 000 people. The Pacific Island Countries Action Framework for Leprosy Control and Rehabilitation adopted in 2012 recommends integrating leprosy services into primary health care services, aims to intensify early case detection through contact tracing and mass screening of high-risk groups. The framework also calls for strengthening rehabilitation support in the three endemic countries. Over the past year, leprosy coordinators, physicians and health assistants from Kiribati, the Marshall Islands, the Federated States of
A satellite image captures the power and fury of Tropical Cyclone Evan as it passes over Fiji in December 2012. WHO is helping countries to address risks before disasters strike to reduce damage, destruction and death in the aftermath.
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Micronesia and Tuvalu benefitted from training organized by WHO in close collaboration with the United States Centers for Disease Control and Prevention and the United States National Hansen’s Disease (Leprosy) Program. Yaws remains a problem in some remote areas of Solomon Islands and Vanuatu. In July 2012, Vanuatu approved a national strategy to combat yaws, developed with technical support from WHO. Over the past year, WHO supported a joint assessment of the impact of hepatitis B immunization and lymphatic filariasis in a seroprevalence survey in Wallis and Futuna. The Organization also assisted with a comprehensive national immunization review in Solomon Islands that prompted the Government to increase support for national immunization programmes. Training was conducted for mid-level managers in Kiribati in an effort to improve routine immunization programmes in remote districts and villages. Dengue also remains a problem in the Pacific. WHO provided equipment and technical support for rapid entomological assessments and vector control in response to dengue outbreaks in Kosrae State in the Federated States of Micronesia and in Honiara, Solomon Islands. Eight doctors and 50 nurses were trained in Honiara to improve the clinical management of dengue. An innovative pilot study, using larvivorous fish known as guppies to control malaria vectors, is under way in Fiji. Health security and emergencies also are important issues in the Pacific,
an area at high risk for disasters. There have been 24 major disasters in the Pacific since 2009. Four Pacific island countries and areas are ranked among the world’s top 15 at-risk countries, with Vanuatu ranking first, Tonga second, Solomon Islands sixth and Fiji 15th. The severe health and nonhealth consequences of disasters will continue to impact Pacific island countries and areas, with the poorest and most vulnerable populations bearing the greatest burden.
Flooding and the resulting population displacement are important factors predisposing Pacific islanders to outbreaks. In December 2012, Fiji and Samoa were hit by a Category 4 tropical cyclone. WHO led the health response by United Nations agencies and bilateral donors and provided post-disaster disease surveillance. WHO teams also measured the short- and long-term impacts of disasters on health facilities, nutrition, food production and other areas. After an 8.0 magnitude earthquake caused a deadly tsunami in Solomon Islands, DPS assisted in rapid assessment and in establishing a system for reporting health problems. Several Pacific island countries and areas have been working on surveillance and response systems. Solomon Islands, in particular, has demonstrated how to assess and respond effectively to disease threats in post-disaster settings.
In May 2013, the Fiji Ministry of Health convened the International Expert Meeting on Controlling Leptospirosis, with 10 global leptospirosis experts and 30 country counterparts attending the Suva meeting. Key outputs from the meeting were the finalization—with the WHO, SPC and the University of Queensland—of a Fiji Leptospirosis National Strategic Plan and the identification of key projects to inform efficient leptospirosis control. The series of steps taken in Fiji—from the response to flooding and associated outbreaks to conceiving and planning the leptospirosis summit—demonstrate a strong commitment to address important public health threats. Hospitals Safe from Disasters is a global campaign that encourages people, communities and businesses to make existing hospitals, or those that are under construction, safer, more resilient and more functional during and after disasters. There are plans to initiate the programme in Solomon Islands and Vanuatu in 2013. The International Health Regulations, or IHR (2005), and the Asia Pacific Strategy for Emerging Diseases (APSED) are two important public health emergency frameworks that have significant implications for Pacific island countries and areas. Thirteen Pacific island countries and areas are State Parties to IHR (2005) and use the IHR global monitoring questionnaire to assess their capacity to detect and respond to important public health emergencies. By June 2012, six of those 13 State Parties reported achieving the core capacities obligations as defined in IHR (2005).
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The remaining seven requested a twoyear extension to meet these global obligations. All seven are actively engaged in strengthening capacities, including IHR workplan reviews, cross-sectoral IHR workshops, specific IHR capacity implementation and the engagement of external expertise to help address specific gaps.
Building Healthy Communities and Populations Noncommunicable diseases (NCDs), namely cardiovascular disease, diabetes mellitus, chronic respiratory disease and cancer, are responsible for approximately 75% of deaths in
the Pacific island countries and areas and most premature deaths. This heavy burden of mortality reflects the alarmingly high prevalence of the risk factors for NCDs, particular high rates of tobacco use, physical inactivity, unhealthy diets and the harmful use of alcohol. As a result, Pacific island countries and areas and their health systems are straining to cope with elevated rates of blood pressure, blood sugar, cholesterol and obesity, including childhood obesity. NCDs have become one of the major barriers to achieving the vision of Healthy Islands that Pacific health leaders articulated in 1995 in the Yanuca Declaration. Within and between countries, inequities in the
Boys in Tonga play rugby. An active lifestyle—along with avoiding tobacco and alcohol—is one of the best ways to avoid the ravaging effects of noncommunicable disease.
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impact of NCDs are evident, with the poorest who are most affected being least likely to receive the primary prevention or curative interventions from health services inadequately equipped to manage NCDs. At the Fourth Pacific NCD Forum: Mitigating the Crisis, held in Auckland, New Zealand, in 2012, countries identified actions to respond to growing rates of cardiovascular and chronic respiratory diseases, cancer and other NCDs, including the development of Crisis Response Packages (CRPs). Thirteen PICs have now developed CRPs within the context of their NCD strategies. The actions identified at the forum are based on WHO guidelines for affordable, cost-effective interventions. For example, Kiribati is prioritizing tobacco control legislation, while Fiji is focusing on salt reduction strategies. DPS helped countries strengthen primary health-care services through the implementation of the WHO Package of Essential Noncommunicable Disease Interventions for Primary Health Care in Low-resource Settings in Cook Islands, the Federated States of Micronesia, Fiji, Kiribati, the Marshall Islands, Samoa, Solomon Islands and Vanuatu. Campaigns to promote more physical activity are critically important in the Pacific, where there is an alarming increase in obesity. WHO supported such efforts in Cook Islands, Fiji, the Federated States of Micronesia, Kiribati, the Marshall Islands, Nauru, Palau, Samoa, Tuvalu and Vanuatu. Strides were made in tobacco control in the Pacific, Cook Islands, Fiji, Papua New Guinea and Tonga raising
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Health sector development Human resources for health (HRH) are a particular challenge in the Pacific. Several Pacific island countries and areas have healthworker-to-population ratios below the WHO-recommended minimum threshold of 2.3 per 1000 of population. Many face external labour market forces that make it difficult to balance health workforce demand, supply and affordability with existing and emerging population health needs. The imminent return of large numbers of foreign-trained medical graduates will place further demands on workforce planning and health budgets in several countries and areas. Fiji, Kiribati, the Marshall Islands, Samoa, Solomon Islands, Tuvalu and Vanuatu have all established national HRH task forces to support HRH broadly or address specific issues, such as the integration of foreign-trained medical graduates. Due to limitations in most Pacific island countries and areas, many health professionals are trained overseas. Some return home to find few job opportunities and limited appreciation for their new skills. As a result, DPS has been working closely with technical partners—such as Fiji National University and ministries of health in Kiribati, Solomon Islands and Tuvalu—to integrate foreign-trained medical students into their respective health systems. The Pacific is one of the few regions in the world where countries continue to struggle to provide accurate, complete and timely data from their
Mothers in Vanuatu show off their babies. WHO works at the country level with governments throughout the Pacific to strengthen maternal and child health programmes.
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tobacco taxes in 2012. Under the Pacific Tobacco Taxation Project, a WHO programme supported by AusAID, a team met with government officials in Samoa, Solomon Islands and Tonga to discuss initiatives to raise tobacco taxes. At an April 2013 meeting in Fiji, senior finance officials from Cook Islands, Fiji, Samoa, Solomon Islands, Tonga and Vanuatu discussed the benefits of higher tobacco taxes. Workshops in Solomon Islands and Vanuatu focused on capacity-building for efforts to counteract tobacco industry resistance.
Maternal and child health are priorities in the Pacific, with countries on track to meet the Millennium Development Goals on child mortality and maternal health by 2015.
However, in Kiribati, Solomon Islands and Vanuatu, the under-five mortality rate remains high, and WHO is working in partnership with UNICEF to improve child health. In Vanuatu, for example, WHO has been identifying ways to integrate child health into primary health care. In other areas of work, WHO supported efforts to implement strategies to promote mental health and prevent mental disorders in the Federated States of Micronesia, Fiji, Nauru, Samoa and Tonga. In addition, efforts are under way to develop preliminary estimates of the disability burden related to NCDs in the Pacific. Kiribati, Samoa, Solomon Islands and Vanuatu carried out follow-up activities, an action plan and other outcomes of the First Pacific Islands Community-based Rehabilitation Forum.
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own health information systems (HIS), and consequently, must rely on partial data or external global and country estimations. For this reason, health information has become a priority. WHO is working to help solve the absence of reliable and timely data, which is a significant barrier to effective planning and cost-effective resource allocation.
Pacific island areas, are able to generate reliable measures of births and deaths from registration data for the National Minimum Development Indicators. Fewer still are able to generate reliable cause-of-death data by age, sex and geographical location. Universal health coverage is an important goal for many countries in the Western Pacific Region. Solomon Islands has taken the lead on universal
coverage, launching a policy dialogue on technical aspects of universal health coverage. Meanwhile, Samoa and Vanuatu have tested a WHO-developed public health law assessment tool to help identify gaps in public health laws on issues such as food safety and violence against women. Solomon Islands also plans to use the data tool.
A number of Pacific island countries and areas have begun the task of improving and strengthening their HIS by comprehensively assessing and reviewing their systems and developing detailed HIS strategic plans that address core weaknesses. Some countries needed to develop or update HIS policies, legislation and regulations and strengthen their relationships with other government agencies. All Pacific island countries and areas have been involved in capacity-building activities, including supporting staff to attend workshops and training opportunities on HIS and civil registration and vital statistics principles and practices. While some countries and areas have complete or near complete reporting of births and deaths, others still rely on indirect methods through the census to obtain annual estimates. Under the Vital Statistics Action Plan countries are focused on achieving 80% coverage of registrations. Cook Islands, Fiji, Nauru, Niue, Palau, Tonga and Tuvalu, along with all of the
A woman in Solomon Islands displays the few possessions she could salvage after her home was destroyed by an earthquake-generated tsunami in February 2013. WHO is working with countries throughout the Pacific to strengthen disaster preparedness.
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Towards the Healthy Islands vision for the Pacific ince 1995, the Healthy Islands vision has served as a framework for promoting healthier lifestyles in Pacific island countries and areas. This vision helped shape the WHO Multi-Country Cooperation Strategy for the Pacific (2013–2017) (MCCS). The first such multi-country strategy in the Western Pacific Region, the MCCS represents a medium-term vision for WHO’s technical cooperation by laying out directions and priorities for 21 Pacific island countries and areas. Developed in line with national health policies, the MCCS identifies priority areas, such as maternal and child health and universal access to health services. One of the most pressing MCCS pri or ities is reducing morbidity, prema ture
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deaths and disabilities from non c om mun ic able diseases (NCDs). Cardio vascular disease, cancer, chronic respiratory disease and diabetes cause 75% of all deaths in Pacific island countries and areas, a fact that prompted Pacific Islands Forum leaders in 2011 to declare an NCD crisis in the Pacific. A road map for addressing this crisis is the WHO-developed Package of Essential Noncommunicable Disease Interventions for Primary Health Care in Low-resource Settings. Known as PEN, the package includes guidelines for basic cost-effective interventions. To encourage their adoption in resource-poor settings, PEN recom mends easy-to-use, risk-prediction charts to screen patients for diabetes and heart problems and to provide low-cost generic
drugs. PEN sets minimum standards for the availability of essential medicines and technology at all levels of health care so patients can be treated and counselled at their local clinic. The guidelines are also adaptable. In Cook Islands, women’s clinics provide the opportunity to measure blood pressure and blood sugar, ascertain tobacco use and screen women for NCDs using the PEN risk-prediction chart. Dr Ramdinthara Sailo, clinical superintendent of the Helena Goldie Hospital in Solomon Islands, makes use of the PEN interventions. “Of all the ideas that WHO has come up with, this is one of the best,” says Dr Sailo.
A rally celebrates the Healthy Islands vision.
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Support, Coordination and Leadership
All hands on deck: the Regional Director (centre right) is joined at a brainstorming session by the Director, Administration and Finance (centre left), and the Director, Programme Management (left), as well as the Executive Officer to the Regional Director (right). “Support, Coordination and Leadership” are more than mere buzzwords at the WHO Regional Office for the Western Pacific. They are a recipe for helping Member States improve the well-being of their people. WHO
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Administration and Finance T Budget and Finance he Budget and Finance unit provides financial and administrative support to WHO country offices and to all divisions of the Regional Office for the Western Pacific. Assistance to all budget centres across the Western Pacific Region strengthened internal financial control in the areas of compliance and quality assurance. This included improved financial operations in country offices and a reduction in the number of rejected transactions under travel and other services. Over the past year, the Budget and Finance unit also supported country offices and the Regional Office during four external and internal audits, then helped put into effect the recommendations of the auditors. The Global Management System, which centralizes all transactions, has become a powerful resource-planning tool for financial management of WHO offices in the Region. aligned with the strategic direction of the Regional Office. Country offices now use a set of generic post descriptions for technical professional positions, which provide the same terms of reference even if the positions are in different offices. These standard job descriptions allow management to more efficiently recruit staff and to support regional efforts on staff mobility. These changes and other refinements of the recruitment process are designed to reduce by half the average time it takes to recruit and hire new staff. The unit has also instituted hands-on training on recruiting staff for WHO positions. Information Technology Office helped plan and coordinate the installation of Microsoft Windows 7 and Office 2010 in the Region. It was also involved in upgrading the Emergency Operations Centre and multimedia studio in the Regional Office and the migration of the Region’s web presence to the WHO global content management system. The Network and User Support team covers all aspects of computer infrastructure. The team deployed new, more reliable server infrastructure and updated e-mail services in all country offices in the Region. The team also improved network connectivity in Papua New Guinea, Samoa and Solomon Islands, as well as remote connectivity to give staffers better access to the Regional Office intranet and to global WHO services. The Application Management and Development team administers regional applications that provide access to Internet and intranet services and other information. In addition, this team develops applications for the Regional Office and country offices. The team played a lead technical role putting in place the Health Information Intelligence Platform, developing administrative dashboards and applications, and providing web-based collaboration, such as a system that allows partner organizations and officials of Member States access to WHO internal sites.
Information and Communications Technology The Information and Communications Technology unit plans and delivers reliable, secure and cost-effective solutions for WHO and consists of three teams: the Information Technology Office, Network and User Support, and Application Management and Development. The Information Technology Office provides regional strategies, plans and implements projects, and coordinates and collaborates on global projects with WHO headquarters and regional offices. In the past year, the
Personnel To streamline the process of creating positions and recruiting, hiring, training and developing WHO staff, human resources policies have been
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Administrative Services The Administrative Services unit is responsible for supporting staff at the Regional Office in the areas of travel and meeting management, registry and logistics, security and safety, and building and grounds maintenance. Over the past year, the unit streamlined office workspaces, such as the Public Information Office, by improving the layout and by scanning and archiving documents to reduce the space required for document storage. The unit oversaw construction of a modern library in a previously unused space, as well as a communications
studio for the Regional Office. The unit also coordinated the modernization of the Emergency Operations Centre. There was also a renewed focus on safety and security. The unit helped update a business continuity plan and carried out an earthquake analysis, waterproofing and re-cabling to provide backup power in case of electrical failures. Due to these efforts and plans to overhaul the system of security cameras and building access, the United Nations Department of Safety and Security declared the Regional Office in compliance with all security requirements.
Reimbursable procurement During the past year, the Regional Office provided US$ 2.8 million in reimbursable procurement services to Member States, specialized agencies and nongovernmental organizations. The bulk of these goods consisted of medical supplies and drugs for eight Member States. Emergency procurement The supply team supported emergency response activities by procuring and delivering urgently needed medical supplies throughout the Region.
The recently renovated library at the Regional Office beckons researchers from all over the Region.
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Programme Management and Coordination
Senior management from the Regional Office discussed how to better tailor support to country needs with WHO representatives and country liaison officers at a retreat in Batangas, Philippines, in November 2012.
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Strategy and actions he Division of Programme Management provides general direction for managing regional technical cooperation with countries and areas in the Western Pacific Region. This involves the planning, development, implementation, monitoring and evaluation of strategic programme budgets. Under the guidance of the Programme Committee, the Division directs strategic and operational planning and the allocation of resources based on priorities identified in country cooperation strategies and by the World Health Assembly, the Executive Board and the Regional Committee
for the Western Pacific, which are WHO governing bodies. The Division also evaluates the performance of technical programmes and fosters cross-programmatic collaboration and partnerships, including those with other United Nations agencies. In line with WHO management reforms, the Regional Office for the Western Pacific finds ways to improve the implementation of the programme budget and to provide stricter oversight of staff funding. Various mechanisms serve to improve the management of programmes, such as the Awards Oversight Group, the Regional Programme Management Network, and WHO country office programme
committees and groups. These groups meet regularly to communicate decisions and review budgets, awards management, human resources, programme implementation and monitoring, resource mobilization and donor reporting. In addition, these groups share lessons, discuss issues and initiatives, and make recommendations to the Programme Committee and budget centre managers in the Region. Closer collaboration between programme management officers at the Regional Office and country offices has improved the rate of implementation of the Programme Budget 2012–2013 as well as the quality of programme results. The Programme Management User Handbook and its web-based version were launched in 2013 to strengthen programme management across the Region. The handbook lays out policies, rules, procedures and stepby-step guidance on the use of existing programme management tools. Annual training in programmerelated transactions and processes using the Global Management System builds capacity for Division members and other relevant staff. For operational planning purposes, all Regional and country office budget centres have started projecting voluntary contributions for the Programme Budget 2014–2015 and reviewing their human resources structures.
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Future directions The Division is preparing for the challenges put forward by WHO reform and will take the lead in directing budget centres and in developing a modern programme management environment for the Organization. Towards this end, future projects will include the strengthening of technical programme evaluations, the development of performance indicators for budget centres and for the Programme Management Officers Network, and the development of an awards management database.
Over the past year, the unit launched the WHO MultiCountry Cooperation Strategy for the Pacific 2013–2017 and the China–WHO Country Cooperation Strategy 2013–2015. Following the guidelines of the WHO reform agenda, the Regional Office for the first time has completed assessments of the functions of country offices. In addition, external assessments of country offices were carried out in Cambodia, Papua New Guinea and Solomon Islands. The recommendations of these assessments are now being implemented. The unit is also helping
Country support Enhancing performance at the country level is one of the top priorities of the reform agenda in the Region. With this goal in mind, the Country Support Unit provides coordinated and effective support to Member States. It has also developed a strategic focus on improving country office capacity by working with WHO Representatives and Country Liaison Officers and by strengthening links between the Regional Office and country offices. The unit coordinates the development of country cooperation strategies. These strategies reflect WHO’s medium-term vision for technical collaboration with Member States and support for their national health strategies or plans. Country cooperation strategies are the main instrument for formalizing priorities and harmonizing WHO’s cooperation with Member States, United Nations agencies and development partners.
develop models for subnational engagement in China and the Philippines, as well as initiatives to improve primary health care through intercountry collaboration in Cambodia, the Lao People’s Democratic Republic and Viet Nam. The unit continues to coordinate the Regional Office’s global health partnerships, especially with the Global Fund to Fight AIDS, Tuberculosis and Malaria, which is well-suited to strengthen WHO’s country support. Another priority is working with country offices to prepare Member States for the Global Fund’s new funding mechanism, which could lead to significant increases or decreases in financing.
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Library, Publications and Translation Services The Fifth Joint Meeting of the Asia Pacific Association of Medical Journal Editors (APAME) and the Western Pacific Region Index Medicus (WPRIM) was held in Kuala Lumpur, Malaysia, from 31 August to 3 September 2012. Twenty-three new medical and health journals were approved for indexing in WPRIM, bringing the total to 496. Of these, 335 journals published in Member States are now accessible through WPRIM. In March 2013, a course was held in Goroka, Papua New Guinea, to train health personnel and medical librarians and researchers on the HINARI programme, which was set up by WHO and major publishers to allow developing countries to gain access to one of the world’s largest collections of biomedical and health literature. In April 2013, the Regional Office Library moved to its new location and a large portion of its collection was digitized and reassessed. Online access to WHO official records and publications was improved through the launch of the WHO Institutional Repository for Information Sharing.
Sharing knowledge, building capacity: A staff member from the library at the Regional Office conducts a HINARI training in Goroka, Papua New Guinea, for health personnel, medical librarians and researchers in March 2013.
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The Publications unit continued to support technical programmes throughout the Region by producing high-quality information products. A revamped publication process aims to increase the visual identity, accessibility and quality of the Organization’s information products. Two workshops––an introduction to publishing at WHO and a practical approach to copyright and related
The Translation unit continues to provide translation services for major events and publications. These services have also assisted in the development of events at the Regional Office, including a permanent photo exhibition and activities related to World Health Day.
publishing issues––were conducted in collaboration with the WHO Press.
Editorial Services The Editorial Services unit (EDT) is responsible for making certain that official documents and communications are written in proper English and in accordance with WHO style. As such, the unit handles
everything from documents for the Regional Committee for the Western Pacific to letters and speeches by the Regional Director. EDT also monitors the submission of all mission and meeting reports and their editing. In general, the unit is responsible for helping maintain editorial standards of quality and consistency, including liaising with the Publishing Policy Coordination Group at headquarters to make certain that the Region stays current with editorial practices. EDT will offer workshops to help technical units communicate more clearly the value of their work and, by extension, the growing role of WHO on the world health stage.
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Office of the Regional Director T Regional reform process he consolidation of external relations, resource mobilization and communications into the Office of the Regional Director in 2012 has increased visibility and improved the capacity of WHO to engage and coordinate with partners to meet public health needs in the Western Pacific Region. The External Relations and Communications (ERC) unit also moved forward with the second phase of the Regional Director’s reform agenda. The reform aims to make WHO more effective and efficient in the Region by virtue of four key organizational attributes: focusing on country needs; delivering value for money; convening and coordinating for better health; and improving strategic and technical communications. Particular attention has been given to human resource planning and leadership training—both valuable enablers that help bring about these desirable organizational attributes. The unit provided leadership for managerial and technical reforms in the Region. The Executive Officer to the Regional Director, a position created in early 2012, further strengthened coordination and spearheaded several new initiatives. An example of reform can be seen in the way the Regional Office now plans meetings and workshops. After conducting a detailed analysis, a new cross-divisional planning
in the WHO Western Pacific Region Progress Report January–June 2013 Supported by the Australian Agency for International Development (AusAID)
system was introduced. Now, meetings are scheduled 12 months in advance and listed in a yearly planner. The objective is to be more cost-efficient and rationalize the number of meetings. The Regional Office is also trying to encourage the participation of the most appropriate attendees by providing clear and timely information about upcoming meetings to WHO staff, Member States, partners and donors. This information will also be available to the public to help promote productive synergies even outside the Organization. ERC assisted in the documentation of the reform achievements within the Region, including the production of
two interim reports on reform efforts, studies on human resources (including mobility) and external assessments. The Office of the Regional Director was strongly engaged in two global task forces established as part of the global reforms. The Regional Director was asked by the WHO Global Policy Group to co-chair the Taskforce on the Roles and Functions of the Three Levels of WHO, which developed a framework to delineate and articulate the functions of the various structures within WHO. The Executive Officer to the Regional Director participated both as a task force member and as part of the secretariat of the Taskforce on Resource Mobilization and Management Strategies, which looked at reforms required to improve WHO financing. The task force made critical recommendations for the progress of reforms within the Organization.
External Relations and Communications Following the recommendations of the Partners Coordination and Engagement Strategy (2013–2019), a corresponding action plan is being implemented. An essential part of the strategy involves training staff at the Regional Office and country offices for fundraising. ERC, the technical divisions and the country offices have worked together to mobilize US$ 187 million in voluntary contributions during 2012. The unit has
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engaged with more than 150 donors that support the Western Pacific Region. Additional partners, including nongovernmental organizations in official relations with WHO, have also been engaged throughout the reporting period. Particular attention has been paid to strengthening relationships with other regional organizations and forums such as the Association of Southeast Asian Nations. With partners increasingly concerned about the timely use of resources, WHO is implementing a centralized system for providing them with progress reports. The Information and Communications Technology unit has developed a system to track the preparation of reports for donors and alert WHO staff to deadlines for delivering these reports. This is improving the quality, consistency and timeliness of reports and allowing WHO to communicate with donors through a single institutional voice. ERC has been coordinating the regional contribution to the financing dialogue requested by the Sixtysixth World Health Assembly. The dialogue will provide an additional opportunity for donor coordination. More human and financial resources, however, are required to better engage with partners in the Region and fully implement the Partners Coordination and Engagement Strategy (2013–2019). The Office of the Regional Director is updating intelligence on all health sector actors in the Region, fostering a more direct face-to-face relationship with partners and developing new communications and media products with technical units.
Public Information Office At a time when more foundations and organizations are involved in public health issues and competing for resources, effective communications are essential to explain the work of WHO, including its unique role in coordinating health sector actors to work on common goals. In addition, timely public health messages and alerts from WHO can contribute to the achievement of national and regional health goals and help save lives.
For these reasons the Regional Office developed a Communication Strategy for the WHO Western Pacific Region (2013–2019). The document harmonizes WHO communications in the Region and guides staff on
the role that communications should play in advancing the essential mission of WHO. The web site of the Regional Office was also improved by generating new content and designing a new page for videos, photo essays and other multimedia presentations. The country offices for China, Mongolia, the Philippines and Viet Nam also launched new web sites. New communication products are being developed to ensure that information is timely and effectively shared within the Organization and across Member States. A corporate brochure, Leading the way to a healthier future: The World Health Organization in the Western Pacific Region, was developed, as were region-specific communications and advocacy materials for public health days mandated by the World Health Assembly.
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WHO Regional Office for the Western Pacific
REPORT OF THE REGIONAL DIRECTOR The Work of WHO in the Western Pacific Region 1 July 2012–30 June 2013