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WHO Regional Committee for South-East Asia: report of the sixty-sixth session, 11-13 September 2013

December 31, 2013 World Health Organization

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WHO Regional Committee for South-East Asia

Report of the

Session

New Delhi, India, 11–13 September 2013

SEA/RC66/25 Distribution: General

WHO Regional Committee for South-East Asia

Report of the

Sixty-sixth Session

WHO Regional Office for South-East Asia, New Delhi, India, 11–13 September 2013

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WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

Contents 1 2 Inaugural session................................................................................................1 Introductory session...........................................................................................5 Opening of the session......................................................................................... 5 Appointment of the Subcommittee on Credentials........................................ 5 Approval of the report of the Subcommittee on Credentials...........................6 Election of office-bearers............................................................................... 6 Adoption of the agenda................................................................................ 6 Drafting group on resolutions........................................................................ 6 Statements by representatives of United Nations and Specialized Agencies... 6 3 Business session..................................................................................................9 Key addresses and report on the work of WHO.................................................... 9 Introduction to the Regional Director’s Annual Report on the work of WHO in the South-East Asia Region covering the period 1 January to 31 December 2012................................................................... 9 Address by the Director-General of the World Health Organization............. 13 WHO reform and Programme Budget matters.................................................... 15 Implementation of Programme Budget 2012–2013.................................... 15 Twelfth General Programme of Work and Proposed Programme Budget 2014–2015................................................................................................. 17 WHO reform: Financing Dialogue and Programme Budget 2016–2017......... 18 Technical matters............................................................................................... 20 Consideration of the recommendations arising out of the Technical Discussions on Universal Health Coverage................................................... 20 Statements by representatives of nongovernmental organizations and international nongovernmental organizations.............................................. 22 Selection of a subject for the technical discussions to be held prior to the Sixty-seventh Session of the Regional Committee.............................. 24

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iii

Implementation of the International Health Regulations (2005)................... 25 Measles elimination and rubella control....................................................... 26 Regional action plan and targets for prevention and control of noncommunicable diseases (2013 –2020).................................................... 28 Statements by representatives of nongovernmental organizations and international nongovernmental organizations.............................................. 30 Reports of WHO global working/advisory groups........................................ 34 Pandemic Influenza Preparedness Framework.....................................34 Progress report on malaria..................................................................37 Statements by representatives of nongovernmental organizations and international nongovernmental organizations.............................................. 36 Progress reports on selected Regional Committee resolutions...................... 38 Challenges in polio eradication............................................................38 2012: Year of Intensification of Routine Immunization in the South-East Asia Region: Framework for Increasing and Sustaining Immunization Coverage..............................................40 National Essential Drug Policy Including the Rational Use of Medicines........................................................................................41 Consultative Expert Working Group on Research and Development: Financing and Coordination..........................................43 Governing Body matters..................................................................................... 45 Nomination of the Regional Director........................................................... 45 Revision to the Rules of Procedure of the WHO Regional Committee for South-East Asia...................................................................................... 46 Important issues arising out of the Sixty-sixth World Health Assembly and the 132nd and 133rd sessions of the WHO Executive Board................. 48 Review of the draft provisional agenda of the 134th Session of the WHO Executive Board....................................................................... 48

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

Special Programmes........................................................................................... 48 UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases: Joint Coordinating Board – Report on attendance at JCB in 2013........................................................................... 48 UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction: Policy and Coordination Committee – Report on attendance at PCC in 2013 and nomination of a member in place of Bhutan whose term expires on 31 December 2013...................................................................................... 49 Time and place of future sessions of the Regional Committee............................ 49 Adoption of resolutions ..................................................................................... 50 Adoption of the report of the Sixty-sixth Session of the Regional Committee...... 50 Closure of the Session........................................................................................ 50 Resolutions and Decisions.......................................................................................55 Resolutions......................................................................................................... 55 SEA/RC66/R1 SEA/RC66/R2 SEA/RC66/R3 SEA/RC66/R4 SEA/RC66/R5 SEA/RC66/R6 SEA/RC66/R7 SEA/RC66/R8 SEA/RC66/R9 Nomination of the Regional Director................................. 55 Resolution of Appreciation................................................ 56 Proposed Programme Budget 2014–2015......................... 56 Health Intervention and Technology Assessment in Support of Universal Health Coverage............................... 58 Measles Elimination and Rubella/Congenital Rubella Syndrome Control............................................................. 61 Regional Action Plan and Targets for Prevention and Control of Noncommunicable Diseases (2013–2020)........ 63 Effective management of medicines.................................. 66 Revision to Rules of Procedure of the WHO Regional Committee for South-East Asia........................... 68 Time and Place of Sixty-seventh Session............................ 69

SEA/RC66/R10 Resolution of Thanks......................................................... 69

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Decisions............................................................................................................ 70 SEA/RC66(1) Introduction to the Regional Director’s Annual Report on the Work of WHO in the South-East Asia Region covering the period 1 January to 31 December 2012...................... 70 Technical Discussions: Selection of a subject for the Technical Discussions to be held prior to the Sixty-seventh session of the Regional Committee................................... 70 Nomination of a Member State to the Policy and Coordination Committee (PCC) of the UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction........................................................ 70 Annexes 1. Text of inaugural speech by the President of India.............................................. 71 2. Text of inaugural address by the Minister of Health, Indonesia........................... 75 3. Text of welcome address by the Minister of Health and Family Welfare, Government of India ......................................................................................... 77 4. Text of opening remarks by the Director-General, World Health Organization.... 80 5. Text of address by the Regional Director, WHO South-East Asia......................... 82 6. Agenda.............................................................................................................. 84 7. List of participants.............................................................................................. 87 8. List of official documents.................................................................................. 105 9. Text of introductory remarks on the Annual Report on the work of WHO in the South-East Asia Region by the Regional Director..................................... 108 10. Text of address by the Director-General, World Health Organization................ 112

SEA/RC66(2)

SEA/RC66(3)

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

Inaugural session 1. The joint inauguration of the Thirty-first Meeting of Ministers of Health of Countries of the South-East Asia Region and the Sixty-sixth Session of the WHO Regional Committee for South-East Asia was hosted by the Honourable President of the Republic of India, in New Delhi, India, on 10 September 2013. 2. In his inaugural address, Dr Samlee Plianbangchang, Regional Director, WHO South-East Asia Region, expressed his appreciation to the Government of India for hosting the Meeting of Ministers of Health and the joint inauguration, and to His Excellency, the President of India, Shri Pranab Mukherjee, for his gracious presence at the joint inaugural session. Dr Samlee welcomed the ministers of health of Member States of the WHO South-East Asia Region, Dr Margaret Chan, WHO Director-General, and all other delegates to New Delhi. 3. The Regional Director noted with satisfaction that wild poliovirus transmission in the Region had been terminated in 2011. He added that many countries had already reached the Millennium Development Goal

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(MDG) targets, and had agreed on universal health coverage as a strategy in the post-2015 development agenda. 4. Thanking the Ministry of Health and Family Welfare, Government of India, for the excellent arrangements, he conveyed his best wishes to the distinguished participants for productive deliberations and successful outcomes. (For the full text of the address, see Annex 5.) 5. Her Excellency Dr Nafsiah Mboi, Minister of Health, Republic of Indonesia, and Chairperson of the Thirtieth Meeting of Health Ministers, recalled that at their previous meeting, hosted by the Government of Indonesia, the health ministers had adopted the Yogyakarta Declaration on Ageing and Health. Dr Mboi informed participants that much progress had been made, including the Regional Strategy on Ageing and Health which had been finalized in May 2013. Noting the progress made in universal health coverage and noncommunicable diseases, she called upon health ministers to ensure that equitable, affordable and accessible treatment and care was provided through a strengthened primary health-care system. Dr Mboi reiterated that health promotion and prevention were fundamental to raise the quality of life of the people of the Region. 6. The progress made in achieving the MDG targets was commended, while it was recognized that continued work was needed to promote economic growth and eliminate extreme poverty. In this context, the Honourable Minister welcomed the proposed health priorities outlined in the post-2015 sustainable development agenda. 7. Concluding with a special tribute, Dr Mboi applauded the presence of the Honourable President of India as an example of leadership, and noted that the inaugural address would inspire all those who are dedicated to raising the health status of their people. (For the full text of the address, see Annex 2.) 8. Dr Margaret Chan, WHO Director-General, thanked the Honourable President and the Government of India for hosting the Thirty-first Health Ministers Meeting.

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

9. The 2013 World Health Day theme “high blood pressure” was significant, since more than one in three adults worldwide are estimated to suffer from the condition. High blood pressure contributes to 9.4 million deaths each year due to heart disease and stroke and is a high risk factor for many other health outcomes. Unfortunately, it often goes unnoticed, even when values are dangerously high, and thus public health must focus on early testing and follow-up. Dr Chan encouraged the ministers to adopt the New Delhi Declaration on High Blood Pressure, and to build partnerships at the national, regional and global levels. 10. The Director-General noted that the High-level Panel of Eminent Persons on the post-2015 development agenda had submitted its report in June 2013. A major goal of the new agenda is to “ensure healthy lives”. Dr Chan urged Member States to promote their health priorities in the new development agenda, based on universal access to basic health care. 11. Dr Chan concluded by congratulating the Honourable Minister for Health and Family Welfare of India for his outstanding commitment to health, and wished all distinguished delegates a very constructive dialogue. (For the full text of the address, see Annex 4.) 12. His Excellency Mr Ghulam Nabi Azad, Minister for Health and Family Welfare, Government of India, expressed his gratitude to the Honourable President of India for gracing the joint inaugural session. It was a privilege for India to host the Health Ministers Meeting in New Delhi, with its rich history and cultural heritage. He also thanked the Director-General of WHO for her leadership for global health in the context of prolonged global economic slowdown. 13. The Honourable Minister noted that India’s journey to achieve polio-free status had been successful due to strong political will and leadership at the highest levels of government, WHO’s technical guidance and support, as well as the dedicated efforts of more than 2 million volunteers, partners, and health workers across the country.

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14. In the context of noncommunicable diseases, Mr Azad said that India had launched the National Programme on Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke in 2010. He also cited the high-level platforms that had been pivotal in raising the importance of prevention and control of noncommunicable diseases and forming the basis of the New Delhi Declaration on High Blood Pressure. 15. The Honourable Minister noted that the pharmaceutical industry in India had enabled a dramatic reduction in the cost of many treatments across the globe. Finally, His Excellency called for Member States to join hands to achieve the common goal of providing affordable and accessible health care to all people of the Region. (For the full text of the address, see Annex 3.) 16. His Excellency, the President of India, Shri Pranab Mukherjee, expressed his great pleasure to inaugurate the Thirty-first Meeting of Ministers of Health and the Sixtysixth Session of the WHO Regional Committee for South-East Asia. The Honourable President thanked Dr Margaret Chan, Director-General of WHO, for her strong leadership in the health arena, and extended a warm welcome to the ministers of health, the Regional Director, as well as to the ambassadors, representatives of United Nations agencies and the distinguished participants. 17. His Excellency noted that achieving universal health coverage would require solid primary health care systems, prevention and promotion activities, and optimal utilization of scarce resources. Strategic investment in medical training will enhance the availability of health-care professionals, particularly at the community level. Institutional mechanisms and community participation in oversight and governance will also lead to efficiencies in the supply chain and logistics management of drugs and vaccines. 18. Regarding the health of the elderly, the Honourable President underscored the need for effective implementation of the Yogyakarta Declaration on Ageing and Health 2012. Commending the efforts of Member States in achieving many of the Millennium Development Goals, His Excellency stressed the need to define health priorities for the global development agenda beyond 2015. 19. The Honourable President concluded that sharing best practices would set a road map for cooperation in the areas identified for the meeting, and result in the most productive outcome. (For the full text of the address, see Annex 1.)

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

Introductory session Opening of the session 20. As Chairperson of the Sixty-fifth session of the Regional Committee, Dr Nafsiah Mboi, Honourable Minister of Health, Indonesia, acknowledged the role of the Regional Committee in addressing the formidable challenges facing the health sector through enhanced collaboration. She noted that the Committee had important technical agenda items and matters related to WHO reform and Programme Budget to discuss, in addition to the task of selecting a new Regional Director for the WHO South-East Asia Region.

Appointment of the Subcommittee on Credentials (Agenda item 1.1) 21. A Subcommittee on Credentials, comprising representatives from the Democratic People’s Republic of Korea, Sri Lanka and Timor-Leste was appointed.

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Approval of the report of the Subcommittee on Credentials (Agenda item 1.2) 22. The Subcommittee nominated the distinguished representative from Sri Lanka as its Chairperson. The credentials submitted by the 11 Member States, viz Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste were found to be in order, thus entitling the representatives to take part in the work of the Regional Committee.

Election of office-bearers (Agenda item 1.3) 23. His Excellency Dr Ahmed Jamsheed Mohamed, Honourable Minister of Health, Republic of Maldives, was elected Chairperson and His Excellency Dr Sergio G C Lobo, Minister of Health, Timor-Leste, was elected Vice-chairperson.

Adoption of the agenda (Agenda item 1.4) 24. The Committee adopted the agenda as contained in Annex 6.

Drafting group on resolutions 25. The Committee constituted a drafting group on resolutions comprising a representative from each Member State, with Dr Supamit Chunsuttiwat, Thailand, as Rapporteur.

Statements by representatives of United Nations and Specialized Agencies 26. Ms Frederika Meijer of the United Nations Population Fund (UNFPA) commended the Region on a significant decrease in maternal mortality, infant mortality and total fertility rates. Policy-makers are also adapting health systems to manage the growing burden of noncommunicable diseases (NCDs) and the needs of an increasingly ageing population. UNFPA is working with governments to develop research on population ageing to address future challenges with appropriate policy and responses. 27. Empowering young people and improving their health-seeking behaviours can ensure that they are less likely to develop NCDs and other lifestyle diseases, thus preventing a future strain on health systems. To this end, UNFPA is strengthening adolescent health services to ensure that sexual and reproductive health education, information and services are availableand of good quality for young people.

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

28. National consultations on the post-2015 agenda have identified inequity in access to health services, including sexual and reproductive health, as a major obstacle to development. Therefore, Ms Meijer noted, the challenge was twofold: responding to the immediate health needs of a growing cohort of older persons, while caring for adolescents in a preventive manner to ensure that they are healthy now, and continue to be healthy in old age. 29. Dr S D Attri, representative of the World Meteorological Organization (WMO), stated that weather and climate are inextricably linked to the basic determinants of health: air, water, food, shelter and disease. Each year, extreme climate events claim countless lives and have significant socioeconomic impact, as well as indirect effects in terms of both communicable and noncommunicable diseases. The use of climate information for decision-making for health services can leverage enormous impact. However, Dr Attri noted there are significant gaps in the provision of climate services, particularly in climatevulnerable developing countries. 30. The Global Framework for Climate Services (GFCS) was established in 2009 to help develop tools for reliable climate predictions that will support health preparedness and extend the lead-time for preventive measures. Collaboration between WHO and WMO has also resulted in the Atlas of Health and Climate, a tool for protective action against climate-related health risks; and, a joint WMO-WHO Office is planned to implement the health component of the GFCS. These collaborative efforts will shape the provision and application of climate services by different user communities in the future, particularly the health community.

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WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

Business session Key addresses and report on the work of WHO (Agenda item 2) Introduction to the Regional Director’s Annual Report on the work of WHO in the South-East Asia Region covering the period 1 January to 31 December 2012 (Agenda item 2.1: Document number SEA/ RC66/2 and Inf. Doc.) 31. Introducing his report for the period 1 January to 31 December 2012, the Regional Director stated that Member States of the South-East Asia Region had made steady progress in reducing the burden of communicable diseases. The Region continued to maintain its leprosy elimination status, with a prevalence rate of less than 1 per 10 000 population. Furthermore, in February 2012, India was removed from the global list of polio-endemic countries and the Region was firmly on track for polio eradication certification in February 2014.

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32. Intensified efforts for routine immunization, which started in 2012, were progressing well with most countries achieving at least 90% national coverage. Significant progress had been made in measles immunization with a reported 78% regional coverage; four countries with 95% coverage were on track to achieve the measles elimination target in the next few years. Some neglected tropical diseases, such as lymphatic filariasis and yaws, were also targeted for elimination. 33. The Region is aiming at eliminating HIV infections in children by 2015. The estimated number of people living with HIV had remained stable in 2012, at 3.4 million. The number of people on antiretroviral treatment (ART) had increased from 5% in 2003 to 49% in 2012. The estimated annual deaths from AIDS-related illnesses had dropped by 14% from 2005 to 2012. 34. Tuberculosis (TB) prevalence had reduced by almost 40% between 1990 and 2012; however, this progress was threatened by coinfection with HIV. In 2011, there were an estimated 140 000 such cases in the Region, representing a prevalence rate of 7.7 per 100 000 population. The Region also recorded about 90 000 cases of multidrug-resistant TB, which remains a cause for serious concern. 35. The Regional Director noted that noncommunicable diseases (NCDs) are the leading cause of death in most Member States. More than 60% of all deaths are due to NCDs, and the associated loss of productivity presents a major problem for socioeconomic development in the Region. Recognition of NCDs as a priority on the public health agenda was increasing, and Member States were strengthening their national health systems for sustainable NCD prevention and control.

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

36. Environmental hazards continued to be a major public health challenge in the Region. Around 19% of all cancers are attributed to environmental factors, particularly occupational exposure to chemicals and chemical contamination in the food chain. The inclusion of “household indoor air pollution” monitoring in the Regional Action Plan for Prevention and Control of Noncommunicable Diseases 2013–2020 indicated recognition of this environmental dimension of NCDs. 37. The Region accounted for 41% of global deaths from disasters during 2001– 2010. Efforts have continued to ensure country capacity in disaster risk management, preparedness and response. Since 2002, 135 health professionals have been trained in emergency management by the Asian Disaster Preparedness Center in Thailand. The Center for Health Crisis in the Ministry of Health, Indonesia was designated a WHO Collaborating Centre for disaster risk reduction in 2012. The South-East Asia Regional Health Emergency Fund (SEARHEF) had also continued to provide essential financial back-up to countries during the acute phase of emergencies. 38. The Region had recorded impressive progress on several indicators of the healthrelated Millennium Development Goals (MDGs). Three countries are approaching a reduction of their maternal mortality ratio by half. From 2005 to 2010, maternal death was reduced from 270 per 100 000 live births to 200. Two countries have reduced their infant mortality rates by more than half. As of 2012, however, the Region’s prevalence rate of underweight children was 27.6%, which is much higher than the global average of 15.7%. 39. Five countries had already achieved a reduction in malaria incidence by three quarters against the related MDG target. However, the presence of artemisinin-resistant malaria in the Mekong Subregion is a concern that threatens global gains in malaria control. 40. All Member States in the Region are embarking on universal health coverage initiatives to enhance health gains, social cohesion and other aspects related to the quality of life. Access to essential medicines, and their rational use, remain of serious concern. National situation analyses in the area of medicines are nearing completion, and the outcomes will be used to ensure effective promotion and enforcement of the rational use of medicines. 41. The health workforce is an important pillar of national health systems. Countries are giving priority to strengthening health cadres to provide care at community and grassroots levels. Medical and public health specialists are being reoriented to ensure their back-up support to community health work, and a module for innovative teaching

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of public health in medical schools is being tested under coordination of the WHO Collaborating Centre for Medical Education at Chulalongkorn University in Bangkok. 42. The Regional Director said that development of the Programme Budget for 2014–2015 was in progress with the full involvement of Member States. Since 2004, an internal mechanism serves to ensure transparency and accountability in the budget implementation process. The Regional Office had also been working closely with headquarters in implementing various components of WHO reform, under the guidance of the Director-General. 43. Dr Samlee ended by expressing his appreciation to delegates and staff for their collaboration and support during his tenure. In addition, he launched the publication A Decade of Public Health Achievements in WHO’s South-East Asia Region, which highlights collaborative efforts over the past 10 years. (For the full text of the address, see Annex 9.) 44. The Honourable ministers applauded the dedication and support of the Regional Director to countries of the South-East Asia Region, which was illustrated by the achievements outlined in his 2012 Annual Report. 45. Delegates particularly noted the outstanding progress towards the elimination of polio and the control of communicable diseases. The health systems infrastructure that enabled the successful polio immunization campaign could be utilized to attain the global goal of measles elimination.

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

46. While primary health care remained the fundamental focus of South-East Asia countries, increased focus will be needed on noncommunicable diseases, and on improving progress in maternal and child health status, among other regional priorities. 47. New targets and indicators and an effective reporting mechanism must be developed for health in the post-2105 sustainable development agenda.

48. Close intercountry collaboration, improved public health programmes, and comprehensive strategies are needed for health care to be available, accessible and affordable by all. The health workforce must also be strengthened to achieve the goal of universal health coverage. 49. The Committee endorsed the Regional Director’s report on the Work of WHO in the South-East Asia Region during 2012, and agreed that it was well organized and comprehensive.

Address by the Director-General of the World Health Organization (Agenda item 2.2) 50. In her address to the Committee, Dr Margaret Chan, Director-General, said that universal health coverage was an important way to address inequalities and inequities in health. Universal health coverage is firmly rooted in primary health care and countries with health systems based on primary health care have had a head start. Dr Chan noted that the Technical Discussions on Universal Health Coverage recommended a phase-wise approach, whereby elimination of inequities and inefficiencies is the initial focus. Technical

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cooperation will identify options to reduce inefficiencies and expand coverage, which can act as mutually reinforcing goals. 51. Moving towards universal health coverage means increasing access to medicines, vaccines and other interventions, for which financing is a major challenge. The DirectorGeneral noted that the level of out-of-pocket expenditure on health in the South-East Asia Region was 60%, the highest of all WHO regions. A large proportion of this expenditure goes to the purchase of medicines that are overly expensive and not used rationally. She said that countries that have successfully achieved universal health coverage have dramatically reduced out-of-pocket expenses. Dr Chan further observed that the draft resolution on universal health coverage urged countries to conduct assessments of health technology for more efficient use of resources. 52. Dr Chan was confident that the goal of measles elimination and rubella control in the South-East Asia Region by 2020, while ambitious, was feasible. The challenge is to exceed 95% routine immunization coverage. Routine immunization intensification was launched in the South-East Asia Region in 2012, which expanded coverage with a strong emphasis on hard-to-reach populations. 53. The Director-General noted that the South-East Asia Region manufactures more than 70% of UNICEF’s global measles vaccine supply and that India was a leader in producing generic medicines and vaccines. She was delighted that the Government of India was prepared to work with other countries through technology transfer to assure the production of affordable medicines and vaccines of good quality.

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

54. Referring to the global health initiative of the GAVI Alliance to increase immunization coverage for new vaccines, Dr Chan suggested that countries apply for GAVI Alliance funding through WHO to achieve optimum vaccine coverage for measles elimination and rubella control. Initiatives that produce results encourage the commitment of donors. 55. The Director-General said that health experts had given careful attention to the prevention and control of noncommunicable diseases (NCDs), including the nine voluntary targets which were being assessed using available data in the regional context. Good baseline data exist, but the systems for civil registration and vital statistics and mortality surveillance need strengthening. She believed that participants were well aware of the public health problems posed by NCDs and the heavy financial burden they place on health systems in the Region. In facing the many challenges to achieving the targets, some countries may need to consider a fundamental reorientation of the health system. 56. In closing, the Director-General noted that all countries of the Region had completed critical assessments that had highlighted weaknesses in their national policies on essential drugs and medicines. These results had revealed the multiple dimensions of this issue, confirming that improved regulatory control and the rational use of medicines are the way forward. She concluded that once universal health coverage becomes a reality, it will give the poor “a route towards a decent life”. (For the full text of the address, see Annex 10.)

WHO reform and Programme Budget matters (Agenda item 3) Implementation of Programme Budget 2012–2013 (Agenda item 3.1: Document number SEA/RC66/3 and SEA/RC66/3 Add.1) 57. The Committee was informed on the status of both technical and financial implementation of the Programme Budget 2012–2013. The working paper presented an overview of progress towards the achievement of Office-specific expected results as determined during the mid-term review, and the changes in their status as per the updates carried out in May and July 2013. It also provided the results of an informal internal assessment of the Organization-wide expected results that reflect the major financial outlay by the Region. 58. The approved budget for the South-East Asia Region for 2012–2013 was US$ 384.2 million and the revised budget was US$ 417.8 million. Operational budget as per approved workplans was US$ 404.5 million. Total resources were US$ 381.9 million; implementation (expenditure), including payroll costs up to July 2013, stood at US$ 250.8 million, which

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was 62% against budget and 66% against resources. Fund utilization (encumbrances plus expenditure) stood at US$ 283.8 million. 59. The Committee took note of the uneven distribution of resources across countries as well as across technical areas, i.e. strategic objectives (SOs). While Bhutan, India and Nepal’s country programmes had mobilized resources in excess of 90% of their budgeted amounts, Sri Lanka, Thailand and Timor-Leste had mobilized funds to support less than 70% of their budgets. Similarly, a review of technical areas had revealed that SO1 (communicable diseases) and SO7 ( gender and human rights) had already received funds of up to 107% of their budgets, while SO5 (emergencies) and SO6 (tobacco, alcohol, unhealthy lifestyles) had received less than 65%. 60. The Committee took note of the working paper that provided an addendum including revised tables on implementation of assessed and voluntary contributions, split by budget centre and SO, up to 31 July 2013. Member States noted the financial and technical implementation status of each budget centre of the Region as at May 2013, and the updated status at July 2013. Some implementation levels were relatively low, and others differed depending on whether the budget source was assessed or voluntary funds. Notwithstanding, countries agreed to make concerted efforts to reach 100% implementation for all strategic objectives, wherever feasible, by the end of the current biennium. 61. The Committee took note of the recommendations of the Sixth Meeting of the Subcommittee on Policy and Programme Development and Management (SPPDM) submitted for its consideration.

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

Twelfth General Programme of Work and Proposed Programme Budget 2014–2015 (Agenda item 3.2: Document number SEA/RC66/4 and Inf. Docs. 1–4) 62. The Committee noted that the Sixty-sixth World Health Assembly in May 2013 had approved the Twelfth General Programme of Work (GPW), which establishes: the overarching health mission, principles and values of the Organization; changes to the results-based framework; 6 high-level health leadership priorities; 6 categories of work; 30 technical programme areas; and the aspiration of results of the Organization for a 6-year period 2014–2019. 63. It further noted that the Programme Budget 2014–2015 approved at the Sixtysixth World Health Assembly is to be the primary instrument to express the full scope of work of the Organization, along with the roles and responsibilities of all levels of the Organization (country offices, regional offices and headquarters). It would also be the basis for the detailed 2014–2015 operational planning to be initiated in late 2013. 64. Some Member States raised the issue of the decrease in their budget allocations for 2014–2015, and whether this issue could be reconsidered. The process used for identifying the country and regional office (or budget centre) budget-space for Programme Budget 2014–2015 was explained: this was based on a review of the implementation status as at May 2013 (as opposed to September 2012 used by WHO headquarters for the development of the WHO Programme Budget 2014–2015 approved at the Sixtysixth World Health Assembly, excluding in-kind and in-service expenditures of the current biennium, while also considering the original WHO headquarters database as a baseline comparison for the updated budget-space setting. 65. The Committee emphasized that Member States and WHO (regional and country offices) should work together to mobilize additional resources in order to complete activities and programmes of work. Horizontal as well as regional collaboration would help countries to meet the challenges presented by the regional budget allocation. Member States appreciated the guidance of WHO on technical prioritization and the development of workplans within the budget-space, to reflect country-wise priorities in line with country cooperation strategies. 66. It was noted that internal budget review exercises would be feasible during the Programme Budget period 2014–2015 to assist with optimal management of regional and country office budget-space allocations. Member States hoped that the budget-space allocated to the South-East Asia Region could be adjusted upwards when the extent of expected future contributions was known at the end of this biennium, and when required during implementation of the 2014–2015 budget.

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67. The Director-General urged the health ministries, when planning work to be conducted with WHO, to focus on a limited set of priorities in order to be able to deliver on key health objectives. 68. The Committee’s attention was drawn to the working paper that discussed the impact of the Twelfth GPW and the Programme Budget 2014–2015 in the context of the South-East Asia Region. The Committee noted the working paper and endorsed the relevant SPPDM recommendations. The Committee adopted resolution SEA/RC66/R3 “Proposed Programme Budget 2014–2015”.

WHO reform: Financing Dialogue and Programme Budget 2016–2017 (Agenda item 3.3: Document number SEA/RC66/5 and Inf. Docs. 1–5) 69. The Committee was informed that the WHO reform agenda was initiated to improve the financing and alignment of the Organization’s objectives and resources. It had since evolved into a Member States-driven process to determine health priorities, and a more fundamental approach to WHO governance and management to make the Organization more effective, efficient and accountable. 70. During the World Health Assembly in May 2013, WHO reform was discussed under documents A66/4 (summarized in Document SEA/RC66/5 Inf. Doc.1 on WHO reform: High-level implementation plan and report) and A66/48 (summarized in SEA/RC66/5 Inf. Doc.2 – WHO reform: Financing of WHO). 71. The report update given to the World Health Assembly presented a comprehensive overview of progress up to the end of the first quarter of 2013 in the three main areas

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of WHO reform: programmes and priority-setting; governance; and management, as well as a high-level implementation plan for reform. The report covered the 12 elements of reform identified in the monitoring and implementation framework considered by the Sixty-fifth World Health Assembly in May 2012, and included an additional element on change management. 72. The Committee emphasized its strong support for the reform process, which would allow greater predictability and transparency of financing within the Organization based on programmatic priorities and resource allocation rooted in the prinicples of transparency, equity and support to Member States in greatest needs. 73. In view of the approved regional budget for 2014–2015, the Financing Dialogue was viewed as a timely and important platform to discuss concerns and seek solutions to a possible budget deficit. The Committee requested that the proposed assessed and voluntary contributions be made known after the Financing Dialogue meeting in November 2013.

74. The Director-General emphasized that the health priorities of the Organization should be set by Member States, and funds should be channelled according to these priorities rather than by development partners or other non-State actors. Both WHO and Member States should have the courage to say “no” to funds that deflect support away from their priority areas of work. This will require behavioural change by Member States, UN agencies and development partners.

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75. The Director-General referred to the Financing Dialogue in June 2013, which aimed to share WHO and country priorities with donors and non-State partners. She urged Member States, or their missions in Geneva, to attend the next Financing Dialogue meeting in November 2013, all relevant documents for which would be shared with Member States as they become available.

76. The Committee noted the working paper and the information documents, and endorsed the SPPDM recommendations on this agenda item. The Regional Office was urged to provide full support to Member States in their preparation for the Financing Dialogue in November 2013.

Technical matters (Agenda item 4) Consideration of the recommendations arising out of the Technical Discussions on Universal Health Coverage (Agenda item 4.1: Document number SEA/RC66/6) 77. The Committee was informed that the Regional Director had convened a regional meeting to hold technical discussions on ”universal health coverage” (UHC) from 10 to 12 July 2013 in New Delhi, India, as per the decision of its Sixty-fifth Session in September 2012. The Committee noted the report of the technical discussions submitted for its information and consideration. 78. The Committee was reminded that the goal of UHC is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them. There were social, financial and geographic challenges in reaching out to

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the unreached populations. A focus on who to cover, with which services and at what level of protection provides a working definition of UHC and is a pragmatic and costeffective way of operationalizing the concept in countries. Detailed indicators based on country contexts and grouped under the three dimensions of UHC are a useful way to inform national policy formulation and revision. Evidence indicates that two areas cause significant inequities and inefficiencies in health in the Region: first, direct out-of-pocket payments for access to care that can push households into poverty; and, second, a significant proportion of these payments go towards the purchase of medicines. Healthrelated inequities need to be better understood to develop policy and strategy responses, including multisectoral action on social determinants of health. 79. Government financing is central to the UHC effort; however, this source can be supplemented by the principles of prepayment and pooling which could improve both equity and efficiency, notably social health insurance. Member States must examine the effective use of purchasing to improve performance, contain costs and restore the balance between preventive and curative care. 80. Access to essential medicines and technologies is vital for achieving universal access and is a fundamental part of primary health care. 81. Keeping in mind that human resources will be a crucial input for UHC, countries need to explore the use of financial and non-financial incentives to improve deployment, retention and performance, especially in remote and underserved areas. 82. Countries must meet health needs through people-centred integrated care that is available, accessible, acceptable and affordable. Accordingly, resolution SEA/RC65/R6, Regional Strategy for Universal Health Coverage, recommends that countries strengthen their health systems based on the primary health care approach – focusing on prevention and promotion activities, using appropriate technologies and based on domestic resources as far as possible. 83. The Committee noted that Resolution SEA/RC65/R6 had identified four strategic directions to accelerate progress on UHC. These comprised one conceptual strategic direction – placing primary health care-oriented health systems strengthening at the centre of UHC – and two technical strategic directions – improving equity through social protection and improving efficiency in service delivery. Lastly, an operational strategic direction was the strengthening of capacity for UHC in the South-East Asia Region. Given the different contexts within and across countries, the Regional Strategy needs to be flexible in applying these perspectives.

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84. Strong leadership and governance in the ministries of health will be critical for credible regulation of stakeholders and formulation of evidence-based policy, strategy planning and decision-making at all levels, including monitoring and evaluation. 85. All Member States have strong political commitment to UHC and shared some achievements and challenges in working towards the goal of “Health for All”. Before implementing UHC, a needs assessment should be done and health needs prioritized accordingly. Health services to be provided through UHC should be proportional to the health resources available. A balance should be maintained between achieving accessibility, quality and cost containment. UHC should be implemented in a flexible manner with each country identifying its own priorities, the section of population to be covered, and the type of financial mechanism to use. 86. Member States requested intercountry exchanges to share experiences to inform national UHC efforts. 87. The Committee adopted resolution SEA/RC66/R4 “Health intervention and technology assessment in support of universal health coverage”.

Statements by representatives of nongovernmental organizations and international nongovernmental organizations 88. Ms Nilofer Khan Habibullah of the International Federation of Medical Students’ Associations noted that financial risk reduction and research development were crucial for universal health coverage. However, she urged Member States to tackle the social determinants of health and stressed the need for a comprehensive strategy

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to address the health workforce crisis. Concrete steps towards open-source access of research knowledge, the rational use of technology, and provision of generic medication are also necessary for universal health coverage. She also called for sustainable health systems that are dynamic and responsive to the challenges of the globalized world. Ms Habibullah reaffirmed that universal health coverage and access are the means to fulfil the fundamental human right to health and health care. The next generation of global development goals should include universal health coverage as a key step toward health equity. 89. Mr Mohammed Aleem Arif, International Federation of Anti-Leprosy Associations (ILEP), said a priority challenge was innovative and intensive disease management, for which collaborative approaches are needed for sustainable control; morbidity management and prevention of disability; community-based rehabilitation; stigma reduction; and accessible funding. 90. ILEP aims to make leprosy control in line with the WHO Enhanced Global Strategy, pushing for quality interventions with measurable targets focused on reducing disability. The second core element is research and development, and ILEP has developed a five-year research strategy, and supports high-quality research in fields such as surveillance and diagnostic testing. ILEP is particularly interested in developing and implementing tools, such as chemoprophylaxis, to break the transmission of leprosy. Lastly, Mr Alif drew attention to the importance of advocacy and human rights, noting that international legal instruments exist with direct relevance to leprosy work, and that people affected had the same human rights as all others. ILEP is seeking synergies with partners for disease management, and advocating for local solutions and collaboration with governments. 91. Professor Pratap Narayan Prasad, representing the World Organization of Family Doctors (WONCA) said that its primary goal is to ensure that health care is affordable, safe, appropriate and equitable. Professor Prasad proposed universal health care strategies for countries facing a health workforce crisis and an uneven distribution of primary care physicians. The immediate need is to increase the number and quality of general practitioners through postgraduate training

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and continuing education. Member States should also create incentive schemes to attract young doctors to settle in rural areas. Professor Prasad stated that, in the long term, universal access to health care can be achieved through social insurance plans and mobile primary care clinics. He concluded that primary health care has the potential to tackle the social determinants of health through universal access and through its contribution to empowerment and social cohesion.

Selection of a subject for the technical discussions to be held prior to the Sixty-seventh Session of the Regional Committee (Agenda item 4.2: Document number SEA/RC66/7) 92. The Committee was briefed on the discussions of the High-Level Preparatory Meeting (HLP) held in July 2013 to identify a topic for the technical discussions at the Sixty-seventh Session of the Regional Committee in 2014. Having consulted the topics presented at all Regional Committee meetings since 2001, Civil Registration and Vital Statistics (CRVS) was selected from a short list of five subjects, for the consideration of the Committee. 93. The Committee noted that data on births and deaths were crucial for the health sector in developing countries, and form the basis of many health indicators. Routine immunization programmes, for example, rely on accurate knowledge about the number and geographical distribution of eligible children. 94. However, many developing countries do not have a well-functioning system for the collection of such data, and rely on supplementary methods such as household sample surveys and national censuses, which are costly. 95. Furthermore, CRVS systems are outside the remit of the Ministry of Health, and different data collection systems exist in the countries of the South-East Asia Region, which could usefully be harmonized so that data are mutually beneficial and comparable. It was recommended that, in a Region with the highest number of births in the world, countries should share their experiences to improve CRVS. There was also a need for timely access to data that are recent, and complete. 96. Participants commented that CRVS was receiving increasing attention at the international level, including the World Health Assembly. The Commission on Information and Accountability for Women’s and Children’s Health recommends that by 2015, countries will have made significant improvements to their CRVS system.

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97. The Committee endorsed the recommendation of the HLP Meeting, and decided to hold the technical discussions on the subject of “Covering every birth and death: improving civil registration and vital statistics” prior to its Sixty-seventh Session in 2014. 98. It was also proposed that, given the importance of multidrug-resistant tuberculosis, a regional consultation on this issue would be convened by the WHO South-East Asia Regional Office.

Implementation of the International Health Regulations (2005) (Agenda item 4.3: Document number SEA/RC66/8 Rev.1) 99. The Committee noted that the International Health Regulations (IHR, 2005) came into force in 2007 and require States Parties to establish core capacities to detect, assess and report potential health threats by 15 June 2012. All Member States of the SouthEast Asia Region had been granted a two-year extension until 15 June 2014 and had developed national IHR implementation extension plans. 100. Member States had undertaken the annual self-monitoring assessment of national IHR core capacities. Progress in establishing core capacities had been made, including for legislation and policy; surveillance; response; coordination and national focal point communication; and laboratory capacity. Some Member States reported progress in strengthening points of entry (in particular, air- and seaports), and human resource capacity at both national and subnational levels. However, country-specific challenges and gaps remained, such as workforce and geographical constraints in smaller Member States.

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101. The need for intersectoral collaboration and a multisectoral response was reaffirmed, as was the need for cooperation between Member States and other WHO regions to ensure the full implementation of the IHR (2005). 102. The Committee was informed that a regional framework had been drafted to address the particular challenges of chemical and radio-nuclear hazards, and this framework also focused on multisectoral involvement. 103. The Committee noted that the IHR (2005) allow an additional extension until June 2016, to be granted by the Director-General in exceptional circumstances. Any such request must be submitted four months in advance of the 15 June 2014 deadline, and be accompanied by a new implementation plan containing: a clear description of capacity gaps; progress made up until that date; proposed actions and a time frame towards establishment of capacities; and, technical and financial resources required for implementation, including any external assistance required. 104. Several Member States expressed their intention to apply for an extension, and endorsed the proposed criteria. It was requested that WHO provide technical support and standardized guidelines to facilitate the development of implementation plans to accompany a request for an extension until 2016. The Secretariat confirmed that WHO would work closely with Member States to assist them in the process. WHO would continue to work with Member States to meet country-specific needs in order to achieve full implementation of the IHR by 2016. 105. The Committee noted the working paper and endorsed the HLP Meeting recommendations made on this agenda item.

Measles elimination and rubella control (Agenda item 4.4: Document number SEA/RC66/9) 106. The Committee was informed that measles remains a significant cause of morbidity and mortality worldwide, with the South-East Asia Region accounting for about half

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the estimated global measles deaths in 2011. All other WHO regions have a measles elimination target and some regions have additional rubella elimination or control targets. Through a regional consultative process in February 2013, Member States in the South-East Asia Region had agreed that measles elimination and rubella/congenital rubella syndrome (CRS) control were technically, biologically and programmatically feasible by 2020. 107. The Committee noted that in 2012, Member States had launched “intensification of routine immunization” in a drive to increase coverage. Routine immunization is the foundation for achieving and sustaining measles elimination and rubella/CRS control. Thus in 2012, routine measles immunization coverage of 79%, large supplementary immunization campaigns, and improvement in surveillance resulted in a 63% decline in the measles incidence rate and a 70% decline in measles deaths in the Region. In 2013, large-scale routine measles immunization and campaigns targeting young infants in the two most populated countries in the Region will reduce even further the deaths and disabilities due to measles and rubella in Member States. 108. The challenges to be faced were well known, and were in various stages of being addressed. For measles, these include the cost and quality of measles vaccine, sustained coverage with two doses of vaccine, case management, surveillance, and laboratory capacity. Regarding rubella/CRS, participants raised concerns regarding access to and administration of the vaccine, and the need for WHO technical support to design strategies, particularly to immunize adolescent girls. 109. Participants were pleased to learn that a Regional Surveillance Standards Workshop would be convened by WHO in September 2013 that will specifically address the concerns they had raised. 110. The Committee adopted resolution SEA/RC66/R5 Measles elimination and rubella/congenital rubella syndrome control.

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Regional action plan and targets for prevention and control of noncommunicable diseases (2013 –2020) (Agenda item 4.5: Document number SEA/RC66/10 and Inf. Doc.) 111. The Committee noted with concern that noncommunicable diseases (NCDs) were the leading cause of mortality globally and in the South-East Asia Region. Each year around 7.9 million people die due to NCDs, accounting for 55% of all deaths in the Region. 112. In May 2013, the Sixty-sixth World Health Assembly adopted resolution WHA66.10 endorsing the Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020. The action plan focuses on the four NCDs that make the largest contribution to morbidity and mortality (cardiovascular diseases, cancers, chronic respiratory diseases and diabetes) and on four shared behavioural risk factors (tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol). The World Health Assembly also adopted the global monitoring framework, including 25 indicators and 9 voluntary global targets, and urged Member States to consider setting national targets based on country situation and capacity. 113. The Committee was informed that to provide guidance to Member States on developing national action plans and setting national targets, the Regional Director had convened a technical working group (TWG) meeting on the “regional action plan and targets for prevention and control of noncommunicable diseases” in June 2013. The TWG took stock of the current data availability and capacity of Member States to report on the nine global voluntary targets; deliberated on three additional regional targets, namely cervical cancer, oral cancer and household air pollution; discussed mechanisms to build national capacity and strengthen national surveillance and monitoring systems; and provided inputs to finalize the regional action plan for prevention and control of NCDs. As a result of the discussions, in addition to the nine global voluntary targets, the TWG recommended including a 10th regional target on household air pollution. 114. Member States acknowledged the rising burden of NCDs due to changing lifestyles and ageing populations. NCDs not only pose an enormous health burden but also a huge economic strain on individuals and families as a result of long-term expensive treatment and high-out-of pocket expenditure. 115. As the origins of NCDs lie outside the health sector, it is imperative to address NCDs through multisectoral actions throughout the life-course. In this regard, strong national mechanisms are needed to facilitate multisectoral collaborations to reduce the exposure to risk factors.

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116. Member States shared country-level initiatives to address NCDs including multisectoral interventions to reduce exposure to NCDs, strengthening primary health care systems and progress made in collection of data through surveillance systems. They expressed a need to mobilize additional resources to comprehensively address the huge burden of NCDs. 117. While supporting the regional action plan and targets, Member States expressed concerns about the lack of baseline data for some targets and about the limited capacity at the country level to collect, analyse and use data effectively. Member States called for investment in surveillance and monitoring systems to collect the required data for monitoring and enable reporting on the global and regional targets. 118. Many Member States are in the process of developing or updating their national multisectoral action plans and setting national targets. Regional mechanisms are required for continuous coordination and to support Member States in the development and implementation of their national plan, including capacity building and sharing of good practices.

119. Oral health in general, and oral cancer in particular, is an important priority for many Member States in the Region and can be addressed in conjunction with NCDs, due to commonality of risk factors as well as synergies in strategies for their prevention and control. A regional oral health strategy has been prepared with inputs from Member States through a series of consultations. Implementation of the regional oral health strategy should complement the prevention and control of NCDs and the achievement of regional targets.

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120. The widespread use of areca nut, associated with oral submucus fibrosis (a potentially malignant disease) and oral cancer, should be combatted through regional cooperation to prevent its illegal importation from neighbouring countries. 121. The Committee made the following recommendations for WHO: • to establish regional mechanisms for continuous coordination and support for Member States on the development and implementation of their national action plans, including capacity building and sharing of good practices; • to build national capacity to undertake surveillance and monitoring, set national targets, analyse and use surveillance data effectively and enable reporting on the global voluntary targets; • to enhance regional cooperation in preventing the illicit importation of areca from neighbouring countries in order to combat the high burden of oral cancer in many countries in the Region. • to assist Member States in resource mobilization for implementing national action plans for prevention and control of NCDs. 122. The Committee made the following recommendations for Member States: • to develop national multisectoral action plans and set national indicators targets in accordance with global and regional action plans and voluntary targets and indicators; • to establish strong national mechanisms to facilitate multisectoral actions for addressing the various risk factors for NCDs; • to invest adequately in surveillance and monitoring systems and to collect baseline data for key indicators and targets. 123. The Committee adopted resolution SEA/RC66/R6 “Regional Action Plan and Targets for Prevention and Control of Noncommunicable Diseases (2013–2020)”.

Statements by representatives of nongovernmental organizations and international nongovernmental organizations 124. Ms Marion Pineros of the International Atomic Energy Agency (IAEA) representing its Programme of Action for Cancer Therapy (PACT), noted the burden of cancer in the Region and the projected increase of new cases. She stressed the need for countries to prepare their health systems and workforce for adequate diagnosis, treatment and care. IAEA established PACT to fully realize the public health impact gained through global partnerships in cancer control and technology transfer in radiation medicine. Through

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PACT, and with partner organizations, IAEA work to support low- and middle-income members in the implementation of comprehensive national cancer control programmes. 125. The imPACT Review is an assessment of a country’s cancer control capacity and needs, taking into consideration readiness to develop and implement a long-term plan to build capacity in radiation medicine. Ms Pineros said this activity has been undertaken in Indonesia, Nepal and Sri Lanka, and was soon to commence in Bangladesh. Sri Lanka, a PACT Model Demonstration Site, has developed a Strategic Plan for Cancer Prevention and Control, a 10-year Radiotherapy Action Plan and made big advances in palliative care. The coordination between the IAEA and WHO South-East Asia Region constitutes a good example of collaboration for assisting countries in the area of cancer control, which is an essential component to reach the target of 25% reduction in NCD mortality. 126. Dr Harvinder Singh Chhabra of the International Spinal Cord Society (ISCoS) said that although the prevalence of spinal cord injury is relatively low compared with other NCDs, the psychosocial, vocational and economic impacts on individuals and families, and the financial costs to society, warranted better preventative programmes and management services. One of the most common causes of spinal cord injury is trauma. WHO estimates that trauma is likely to be the fifth leading cause of morbidity and mortality by 2030. 127. Global experience shows that prevention strategies result in a decrease in number of trauma cases. ISCoS has undertaken initiatives for prevention of spinal cord injuries including: the global mapping of traumatic spinal cord injuries; developing tools for awareness campaigns; and establishing “elearnSCI.org” to disseminate information about

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comprehensive management of spinal cord injuries. Dr Chhabra said an opportunity existed for ISCoS and countries of the Region to work together to prevent such devastating injuries, formulate regional strategies, and deliberate on how to implement these strategies. He stated that ISCoS would be pleased to facilitate such a meeting.

128. Mr Iqbal Masud, representing The Framework Convention Alliance (FCA), congratulated Member States on their determination to tackle NCDs by adopting the Global Action Plan and voluntary targets. He noted that tobacco use is the one risk factor common to the main NCDs, and that it caused 1.4 million deaths in the Region each year. A coordinated response to NCDs with regards to tobacco control, as set out in the Global NCDs Action Plan, will support and accelerate implementation of the WHO Framework Convention on Tobacco Control (WHO FCTC). FCA encouraged WHO and its Member States to establish an NCD global coordination mechanism that builds upon already existing instruments, such as the WHO FCTC. 129. FCA also drew the attention of Member States to discussions on the post-2015 development agenda, including new priorities for health. As tobacco use is a major preventable cause of disease and death, and presents a threat to sustainable development, clear and ambitious commitments are needed. The recently adopted global target for tobacco use prevalence (30% relative reduction by the year 2020) should serve as the technical basis for a tobacco-related target in the post-2015 development agenda. 130. Dr Chandrakant S Pandav of the International Council for Control of Iodine Deficiency Disorders (ICCIDD) said that ICCIDD strives to ensure that every pregnant, lactating and child-bearing age woman, as well as every child, has access to optimal

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iodine to allow full realization of their mental and physical development potential, through advocacy with governments, citizens, and development agencies at all levels. Although the global household coverage of adequately iodized salt has increased dramatically, 1.92 billion people – including 565 million (31%) in the South-East Asia Region alone – still have insufficient iodine intake. 131. ICCIDD has been working to undertake a series of national-level initiatives to accelerate progress towards universal salt iodization in several countries of the Region. ICCIDD will also focus on aligning universal salt iodization and salt reduction strategies at national and regional levels, in partnership with WHO. Dr Pandav urged that optimal iodine nutrition of pregnant mothers be made a public health agenda, and that control of iodine deficiency disorders be considered an essential reproductive and child health intervention. He concluded by reiterating that the ICCIDD Network was committed to partner efforts to instil the habit of daily consumption of adequately iodized salt.

132. Mr Vivekanand Jha, International Society of Nephrology, noted that the prevalence of chronic kidney disease, estimated at 8–16% worldwide, is a growing public health issue. Strategies to reduce its burden and cost, such as awareness-raising, screening and intervention, need to be included in national programmes for noncommunicable diseases. 133. Regarding acute kidney failure, the developing world continues to face problems related to tropical infections as well as a lack of public health prioritization. Mortality and morbidity are increased because of lack of access to effective prevention and treatment modalities. ISN is undertaking a focused effort to curtail this mortality and improve

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health outcomes globally, especially in low-resource settings. This requires partnership with governments of developing countries to help eliminate disparities in access to, and affordability of, health care. A broader vision for public and private sector partnerships, greater emphasis on providing and funding primary health care services, as well as strategies to ensure that all citizens – including the most impoverished – have access to reliable and affordable life-saving care are required.

Reports of WHO global working/advisory groups (Agenda item 4.6) Pandemic Influenza Preparedness Framework (Agenda item 4.6.1: Document number SEA/RC66/11 Rev. 1) 134. The Committee noted that since 1957, influenza viruses had been shared by Member States through the WHO Global Influenza Surveillance and Response System (GISRS – earlier known as the Global Influenza Surveillance Network), but that in 2007 issues were raised about how this system might be linked to access to vaccines and other benefits. 135. To address these issues, World Health Assembly resolution WHA60.28 recommended the Director-General to: develop a framework and mechanism for benefit sharing; establish an international stockpile of influenza A (H5N1) vaccine; and prepare guidance on vaccine distribution. The resulting Pandemic Influenza Preparedness Framework (PIP Framework), adopted through resolution WHA64.5, was expected to enhance the capacity for surveillance, risk assessment and early warning.

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136. The Committee was informed that the PIP Framework was also aimed at prioritizing financial and “in-kind” benefits to developing (H5N1-affected) countries that lacked the capacity to produce/access influenza vaccines, diagnostics and pharmaceuticals according to public health risk and needs (i.e. there would be a structured approach to the proportional allocation of the benefit to Member States). The financial component of the expected benefit (the Partnership Contribution) was expected to be US$ 28 million per year. Approximately US$ 18 million of the Partnership Contribution was received by WHO in 2012. 137. In order to implement the PIP Framework at national level, Member States should continue to share influenza viruses with pandemic potential with a WHO reference laboratory of their choice. Transfer of influenza viruses, and products derived from them (also referred to as PIP biological materials), is governed by type 1 and type 2 Standard Material Transfer Agreements (SMTAs). Type 1 SMTAs govern the transfer of viruses from national influenza centres to GISRS laboratories, so their adoption is a part of national implementation. Type 2 SMTAs govern the transfer of viruses to third parties (typically manufacturers of vaccines and pharmaceuticals). To date, negotiation of type 2 SMTAs has been concluded by the WHO Secretariat with only two “third parties” (GSK and the University of Florida), although discussions are underway with an additional six entities. 138. The Committee appreciated that the principle underlying the PIP Framework is equity in the distribution the benefits that arise from virus sharing. 139. Member States are working to strengthen capacity for influenza surveillance and to enhance pandemic preparedness. However, much more needs to be done, and the recent appearance of avian influenza A (H7N9) in China serves as a reminder that novel

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influenza strains with pandemic potential will continue to emerge. Good information on influenza disease burden in countries will inform evidence-based policy decisions on the benefits of vaccination. 140. For these reasons, the capacity building that will follow distribution of the Partnership Contribution was welcomed. Member States would appreciate being updated on, and involved in, the process of planning for the use of these funds. 141. The negotiation of type 2 SMTAs should be accelerated and efforts made to advocate for the provision of “in-kind” benefit in the form of technology transfer aimed at strengthening regional capacity for the manufacture of influenza vaccine. 142. The Regional Office remains committed to strengthening capacity for influenza surveillance in the Region, including the establishment of national influenza centres in all Member States as well as a WHO Collaborating Centre for influenza at the animal– human interface.

Statements by representatives of nongovernmental organizations and international nongovernmental organizations 143. Mr Manindra Chaudhuri of the International Federation of Biomedical Laboratory Science (IFBLS) stressed the need for adequate training for biomedical laboratory scientists to meet public health challenges. He said that IFBLS had developed a set of globally acknowledged competencies to support biomedical laboratory scientists in performing accurate and appropriate laboratory tests. Proper education will also equip them for the performance of required tests and help rationalize laboratory services during

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an influenza pandemic. Measles elimination and rubella control measures also require laboratory testing and the proper use of control procedures. Moreover, for universal health coverage to be realized, a minimum standard of education is required for all health-care professionals. 144. Rapid changes in laboratory testing make it the responsibility of laboratory professionals to continuously upgrade their competencies. Training programmes can be expensive and difficult for developing nations to implement; however, IFBLS can help through conferences, workshops and computer-based e-learning. IFBLS and its members are ready to assist WHO by supporting quality education of biomedical laboratory scientists and ensuring that an adequate number of practitioners are available in laboratories.

Progress report on malaria (Agenda item 4.6.2: Document number SEA/RC66/12) 145. The Committee noted that in line with World Health Assembly resolution WHA64.17, Member States of the Region have made significant progress in malaria control. Malaria cases and deaths were reduced by 35% and 85%, respectively, in 2012 compared with 2000. 146. Resolution WHA58.2 had called upon Member States to achieve a 75% reduction in malaria case incidence and mortality rates by 2015. The Committee was informed that four countries have achieved the first target, while all countries except one have achieved the second target. The achievements are significant but fragile, and much more needs to be done to prevent the resurgence of malaria. The Committee noted the working paper that identified the key challenges to be addressed and outlined the strategic directions for malaria control and elimination in 2014–2020. 147. The Committee noted the political commitments expressed by Member States towards malaria control and elimination, and acknowledged the financial support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, and other partners, as well as technical support from WHO. As a result, significant progress had been made in reducing the malaria burden in most countries of the Region. 148. It was acknowledged that progress is fragile and resurgence may occur with devastating impact, as experienced in the past. Some key risk factors that may reverse the progress include parasite resistance to malaria medicines particularly artemisininbased combination treatment, vector resistance to insecticides, population movement across borders, weak surveillance and response systems, and declining technical and managerial capacities.

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149. The Committee noted the ongoing containment of artemisinin resistance in Myanmar and Thailand, as well as in Cambodia and Vietnam in the Western Pacific Region. 150. The Committee noted the varying epidemiology of malaria and that pockets of high endemicity still exist, particularly in tribal communities, forested areas and some development projects in rural areas. The various epidemiological factors needed to be taken into account for effective malaria control. Current tools, such as the rapid diagnostic test and artemisinin-based combination treatment, had facilitated the implementation of strategies to test, treat and track malaria cases. 151. The Committee noted the need for cross-border collaboration, not only on malaria but also on other health problems prevalent across borders. Support from WHO would be required to facilitate cross-border collaboration. 152. The Committee endorsed the HLP Meeting’s recommendations made on this agenda item.

Progress reports on selected Regional Committee resolutions (Agenda item 4.7) Challenges in polio eradication (SEA/RC60/R8) (Agenda item 4.7.1: Document number SEA/RC66/13) 153. The Committee was presented with an update on the progress and challenges to polio eradication in the South-East Asia Region.

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154. Polio eradication continues to be a priority, and tremendous progress has been made. The Committee was particularly pleased that the Region was on track for polio-free certification in February 2014, three years after the last reported wild poliovirus case. 155. The Region will remain at risk to importation of polioviruses as long as they are circulating anywhere in the world. Risk mitigation activities are critical to monitoring and maintaining regional gains in polio eradication, which include high-quality/sensitive acute flaccid paralysis (AFP) surveillance, high population immunity through routine immunization, and particular focus on containment activities related to international travel and health. 156. Polio eradication also requires sustained human and financial resources; a substantial proportion of polio activities is currently being met through external funding. Further discussions are underway for potential support from the GAVI Alliance for this historic initiative. Member States could help the eradication effort by committing funds for vaccine-preventable disease surveillance, outbreak response and strengthening routine immunization service delivery. 157. The Committee acknowledged that once polio-free certification is achieved, the major task will be the shift to post-polio eradication activities, which include implementation of the Polio Eradication and Endgame Strategic Plan 2013–2018 and for legacy planning. One Member State offered to make its highly experienced polio workforce available to assist countries of the Region during implementation of the Endgame Strategic Plan.

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158. Participants were informed that high-level discussions were ongoing to address all issues related to polio eradication. WHO confirmed its technical support towards ensuring an adequate supply of quality vaccines, implementation of the Endgame Strategic Plan, particularly the challenges of implementing the switch to IPV, and continuous monitoring. Negotiations for capacity-building and technology transfer for local vaccine development and production would also continue to be facilitated. 159. The Committee noted the working paper and endorsed the recommendations of the HLP Meeting.

2012: Year of Intensification of Routine Immunization in the South-East Asia Region: Framework for Increasing and Sustaining Immunization Coverage (SEA/RC64/R3) (Agenda item 4.7.2: Document number SEA/RC66/14) 160. The Committee was informed that in 2011, the regional diphtheria–tetanus– pertussis (DTP3) coverage was only 75% and WHO estimated that about 9 million children missed out on the most basic package of immunization. Recognizing this, the Sixty-fourth Session of the Regional Committee had adopted resolution SEA/RC64/R3 declaring 2012 as the “Year of Intensification of Routine Immunization”. Pursuant to that resolution, all Member States developed plans of action focusing on high-risk or hard-to-reach areas and populations for intensified immunization services. 161. Intensification efforts include dramatically increased coverage, particularly children vaccinated for the first-time; strengthened regulatory systems; empowered health

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

workforce; improved advocacy and communication; enhanced community participation; partnership-building; better follow-up of infants; and supplementary immunization activities. The latter activities will significantly contribute to regional goals such as measles elimination. One Member State with a strong vaccine industry, and advanced regulatory and surveillance capacity, offered to take the lead in strengthening this capacity in other Member States of the Region. 162. The Committee applauded the progress made, and it was encouraging that many Member States had increased its human and financial resources dedicated to increasing immunization coverage in diseases of national and regional priority. However, it was cautioned that these gains will need to be sustained. Focus must now go on high-risk areas, reaching the many children in the Region still not being vaccinated, and on reducing the drop-out rates. It was also recommended that increased domestic production of vaccine to accelerate higher coverage for vaccine-preventable diseases. 163. To address the concerns of Member States related to the introduction of new vaccines into national immunization programmes, WHO will circulate the report of a dedicated meeting on this subject held in December 2012. The report, endorsed by the Regional Technical Advisory Group, contains criteria and algorithms that can be adapted for use in the country and disease-specific context. In addition, WHO would continue its technical support to monitoring and sustaining routine immunization coverage in the Region through comprehensive multiyear plans at country level. 164. The Committee noted the working paper and endorsed the HLP Meeting’s recommendations that were submitted to it for its consideration.

National Essential Drug Policy Including the Rational Use of Medicines (SEA/RC64/R5) (Agenda item 4.7.3: Document number SEA/RC66/15) 165. The Committee was informed that resolution SEA/RC64/R5 had urged Member States to undertake a national situational analysis to develop a contextualized roadmap for action to promote the rational use of medicines. 166. Such analyses were done by the Regional Office for South-East Asia in collaboration with ministries of health in the 11 Member States. A regional consultation on effective management of medicines, held in April 2013 and attended by all 11 countries, discussed the findings and concluded that: the situational analyses approach was very useful for monitoring and planning; that all areas of medicine management are under-resourced in most countries; and that partner support is generally limited and fragmented. The regional consultation recommended that:

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• governments and partners invest in all areas of the effective management of medicines, including supply, selection and use, regulation and policy; • WHO appoint adequate dedicated personnel at country and regional offices to ensure meaningful collaboration with ministries of health and coordinated support from partners; • the situational analysis tool used by the Regional Office be adapted and piloted for biennial use by countries in monitoring and planning; • Member States and partners implement all recommendations made by the regional consultation on effective management of medicines; • WHO convenes regular regional consultations to share information on progress and to plan the way forward.

167. The Committee noted the importance of electronic logistic management information systems in managing medicines supply and many Member States are in the process of implementing such systems. 168. Rational use of medicines is a priority in the Region and Member States are responding to this problem by: regularly updating national essential medicines lists, formulary and standard treatment guidelines; establishing Drug and Therapeutic Committees in hospitals; organizing continuing professional development through various institutions and societies; and undertaking prescription audits. 169. Sri Lanka was particularly congratulated on its establishment of an Independent Drug Authority.

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

170. Antimicrobial resistance is caused by inappropriate use of antibiotics and to this end one country had established a national taskforce and another had instituted a drug schedule for new generation antibiotics and anti-TB drugs. 171. Other specific areas of progress in various Member States included adoption of new national medicines policies, a core committee on rational use of medicines, thematic workshops, and the training of doctors at all levels on standard treatment guidelines. 172. Quality assurance is critical for countries who must import most of their drugs and a request was made to countries with manufacturing capacity to take action to assure the high quality of the drugs they export. 173. The Delhi Declaration on Traditional Medicines developed in February 2012 was commended and follow-up on the Declaration was encouraged by all Member States. 174. Member States endorsed the recommendations of the regional consultation on Effective Management of Medicines held in April 2013, taken up by the HLP Meeting in July 2013. These recommendations may form the basis of a regional strategy to promote rational use of medicines as recommended by resolution SEA/RC64/R5. 175. WHO was requested to provide technical support to implement the recommendations and to facilitate follow-up situational analyses to be carried out in countries every four years.The Committee adopted resolution SEA/RC66/R7 “Effective management of medicines”.

Consultative Expert Working Group on Research and Development: Financing and Coordination (SEA/RC65/R3) (Agenda item 4.7.4: Document number SEA/RC66/16) 176. The Committee noted that resolution SEA/RC65/R3 had given recommendations and action points for Member States and WHO on the follow-up of the Consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG). 177. The Committee was apprised of the background to this resolution. The CEWG presented its report to the Sixty-fifth World Health Assembly in May 2012. The report made a number of proposals for new and innovative sources of financing to stimulate research and development (R&D) related to Type II and Type III diseases, and the specific R&D needs of developing countries in relation to Type I diseases. By resolution WHA65.22, Member States resolved to hold consultations at the national level among all relevant stakeholders, as well as in the regional committee meetings scheduled for 2012. They also resolved to hold an open-ended meeting of Member States at WHO headquarters to develop consensus.

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178. Pursuant to this, Member States of the Region held consultations at the national level, and participated in a regional technical consultation in 2012, to develop a regional perspective on the CEWG report. This regional position was reflected in resolution SEA/ RC65/R3 adopted by the Regional Committee for South-East Asia in September 2012. Resolution SEA/RC65/R3 provided the basis for the draft resolution during the openended meeting of all WHO Member States, held in Geneva in November 2012, which led to the World Health Assembly resolution WHA66.22. 179. The regional resolution and WHA66.22, inter alia, urges Member States and WHO to strengthen health R&D capacities and investments for diseases that disproportionately affect developing countries. The resolutions also request WHO to establish a global health R&D observatory to monitor and analyse relevant information on health R&D as well as to promote advisory mechanisms. Resolution WHA66.22 calls for specific actions through a strategic workplan to improve monitoring and coordination, and to ensure sustainable funding for health R&D (in line with WHA61.21, Global strategy and plan of action on public health, innovation and intellectual property) and identify projects as a step towards achieving the goal of development and the delivery of affordable, effective, safe and high-quality health products. 180. To take SEA/RC65/R3 and WHA66.22 forward, the Regional Office organized a “Regional consultation for developing a strategic workplan as a follow-up of the Consultative Expert Working Group on Research and Development: Financing and Coordination” from 25 to 26 July 2013 in Bangkok, Thailand. This meeting enabled discussions on the next steps on both these resolutions and for prioritizing activities for the Region.

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181. As desired by The High-Level Preparatory (HLP) Meeting held in the Regional Office in New Delhi from 1 to 3 July 2013, the outcomes of the July regional consultation have been incorporated in the working paper for this Regional Committee (SEA/RC66/16). 182. Member States requested that these results be conveyed to the Director-General by the Regional Director of the South-East Asia Region to inform WHO headquarters on the regional position. This would also enable taking up of the demonstration projects for consideration at the global level in the proposed 3 to 5 December 2013 meeting. 183. Therefore, the Regional Committee requests the Regional Director, WHO SouthEast Asia Region: • to convey the regional priorities identified in the regional consultations on CEWG held in July 2013 to the WHO Director-General, and to forward the necessary proposals so that they could be considered as demonstration projects during the global technical consultative meeting to be held by the end of 2013; • to forward the proposed classification grid for health R&D, as proposed in the regional consultations, to the WHO Director-General as a South-East Asia Region proposal, with changes if any, after validation of the outcomes, for the global health R&D observatory.

Governing Body matters (Agenda item 5) Nomination of the Regional Director (Agenda item 5.1) 184. Considering Article 52 of the WHO Constitution and in accordance with Rule 49 of the Regional Committee’s Rules of Procedure, the Committee adopted a resolution (SEA/ RC66/R1) nominating Dr Poonam Khetrapal Singh as Regional Director, WHO South-East Asia Region for a five-year term from 1 February 2014. The Committee requested the Director-General to propose to the Executive Board the appointment of Dr Khetrapal Singh for a period of five years from 1 February 2014. 185. The Director-General congratulated the WHO Regional Committee for South-East Asia on conducting the new nomination process in a fair, transparent and efficient manner resulting in harmonization of the six regions in terms of nomination of the Regional Director. She congratulated Dr Khetrapal Singh on her nomination. 186. Member States’ representatives also congratulated Dr Khetrapal Singh on her nomination as Regional Director. They were confident that with her strategic leadership and experience she would further the Region’s efforts in improving public health.

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187. Dr Khetrapal Singh, the Regional Director nominee, expressed her gratitude to the Member States for the trust and confidence placed in her. She thanked the Director-General for being a role model as a woman leading WHO, and assured her that the South-East Asia Region would continue to work with WHO headquarters as well as with country offices in unison. Dr Khetrapal Singh also thanked the current Regional Director, Dr Samlee Plianbangchang, with whom she had the privilege of working closely for a decade, for his guidance. 188. The Director-General placed on record the excellent contribution of Dr Samlee Plianbangchang, during his two terms as Regional Director. 189. The Committee noted that the South-East Asia Region had seen significant progress in health development under the leadership of Dr Samlee. In recognition of his outstanding contributions for a decade in providing a new dimension and strategic direction to health development in the Member States, the Committee thanked the Regional Director and adopted a resolution of appreciation declaring Dr Samlee Plianbangchang as Regional Director Emeritus (SEA/RC66/R2). 190. The Regional Director, Dr Samlee Plianbangchang, warmly congratulated Dr Khetrapal Singh on her nomination and expressed his confidence in her ability to carry forward WHO work in the South-East Asia Region, in order to further the health of the populations. He thanked the Regional Committee for granting him the honourary title of Regional Director Emeritus, and pledged to continue his support to WHO’s work.

Revision to the Rules of Procedure of the WHO Regional Committee for South-East Asia (Agenda item 5.2: Document number SEA/RC66/18) 191. The Committee was informed that in May 2012, the Sixty-fifth World Health Assembly in its decision WHA65(9), endorsed the proposals for enhancing alignment between the Regional Committees and the Executive Board with the intent to strengthen, streamline and improve the methods of work and roles of the governing bodies. The proposals included increasing harmonization across the regional committees in relation

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to the nomination of Regional Directors, the review of credentials and participation of observers. 192. In September 2012, the Sixty-fifth Regional Committee for South-East Asia adopted resolution SEA/RC65/R1 to align its Rules of Procedure with respect to harmonization of the process of nomination of the Regional Director with those of the other regions. 193. To fully comply with the request of Member States at the Sixty-fifth World Health Assembly, the Rules of Procedure for the Regional Committee for South-East Asia must be amended, essentially to formalize that which is already in practice in the conduct of Regional Committee meetings in South-East Asia with respect to review of credentials and the participation of observers.

194. The working paper provided the proposed amended language to the Rules of Procedure for the Regional Committee of South-East Asia, in alignment with the language adopted previously in four other WHO regions. Included was a draft resolution for consideration by the Regional Committee. The Committee reviewed the draft resolution and adopted resolution SEA/RC66/R8 “Revision to Rules of Procedure of the WHO Regional Committee for South-East Asia”. 195. The SPPDM Meeting had reviewed the working paper and recommended that WHO country offices consult with ministries of health before suggesting names of nongovernmental organizations, partners and civil society organizations that would wish to participate in the Regional Committee as observers.

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Important issues arising out of the Sixty-sixth World Health Assembly and the 132nd and 133rd sessions of the WHO Executive Board (Agenda item 5.3: Document number SEA/RC66/19) 196. The Committee took note of the most significant and relevant resolutions from the perspective of the South-East Asia Region, emanating from the Sixty-sixth World Health Assembly (20–28 May 2013) as well as the 132nd and 133rd sessions of the Executive Board (21–29 January 2013 and 29–30 May 2013, respectively). These resolutions were deemed to have important implications and merited follow-up action by both Member States and WHO at its Regional Office and country office levels. 197. Member States were urged to study and review these resolutions in the context of their country situations and take necessary follow-up actions as appropriate. 198. Bangladesh thanked all the Member States for their support in the Executive Board for adopting resolution EB133.R1 ‘Comprehensive and coordinated efforts for the management of autism spectrum disorders’, which eventually led to 50 other Member States also endorsing it.

Review of the draft provisional agenda of the 134th Session of the WHO Executive Board (Agenda item 5.4: Document number SEA/RC66/20) 199. The Committee was informed that the 134th Session of the WHO Executive Board would be held at WHO headquarters in Geneva from 20 to 25 January 2014. It noted that any proposal from a Member State or Associate Member to include an item on the agenda should reach the Director-General not later than 12 weeks after circulation of the draft provisional agenda or 10 weeks before the commencement of the session of the Executive Board whichever is earlier. Proposals should, therefore, reach the DirectorGeneral by 16 September 2013.

Special Programmes (Agenda item 6) UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases: Joint Coordinating Board (JCB) – Report on attendance at JCB in 2013 (Agenda item 6.1: Document number SEA/RC66/21) 200. The Committee noted that the report of the Thirty-sixth Meeting of the Joint Coordinating Board (JCB) of the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases held in Geneva, Switzerland, from 17 to

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19 June 2013 was presented to the HLP meeting held in the Regional Office, New Delhi, from 1 to 3 July 2013. 201. At present, there are two Member States from the South-East Asia Region (India and Thailand) that are members of the JCB under paragraph 2.2.1. The Government of Indonesia is a member until 31 December 2013 and the Federal Democratic Republic of Nepal is a member until 31 December 2014 under paragraph 2.2.2 (selected by the WHO Regional Committee). 202. All country members have valid membership up to 2013. From 1 January 2014, membership under paragraph 2.2.2 will be reduced to one member per region; therefore, no action was required by the Regional Committee.

UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP): Policy and Coordination Committee (PCC) – Report on attendance at PCC in 2013 and nomination of a member in place of Bhutan whose term expires on 31 December 2013 (Agenda item 6.2: Document number SEA/RC66/22) 203. The Committee noted that the report of the Twenty-sixth Meeting of the Policy and Coordination Committee (PCC) of the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, held from 20 to 21 June 2013 in Geneva, Switzerland, was presented to the HLP meeting held in the Regional Office, New Delhi from 1 to 3 July 2013. 204. The Committee nominated Timor-Leste as a member of the PCC for a three-year term starting 1 January 2014, and requested the Regional Director to inform WHO headquarters accordingly.

Time and place of future sessions of the Regional Committee (Agenda item 7.1: Document number SEA/RC66/23) 205. The Committee decided to hold its Sixty-seventh Session in September 2014 in Dhaka, Bangladesh. 206. The Committee noted that in the event of there being no proposal for the venue of future sessions of the Regional Committee, the Sixty-eighth Session would be held in the Regional Office in September 2015. 207. The Committee adopted resolution SEA/RC66/R9 “Time and place of the Sixtyseventh Session”.

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Adoption of resolutions 208. The Committee adopted 10 resolutions and 3 decisions (see Section 4, p.55). 209. The Committee adopted resolution SEA/RC66/R10 “Resolution of thanks” thanking His Excellency, Shri Pranab Mukherjee, President of the Republic of India for inaugurating the Session and for his thought-provoking statement; Director-General, Dr Margaret Chan, for her inspiring address and participation; His Excellency, Mr Ghulam Nabi Azad, Minister of Health and Family Welfare, Government of India; and the officers and staff of the Ministry of Health and Family Welfare and other national authorities of the Government of India for facilitating the inauguration of the Session; and congratulating the Regional Director and his staff on their dedicated efforts towards the successful and smooth conduct of the Session.

Adoption of the report of the Sixty-sixth Session of the Regional Committee (Agenda item 7.3) 210. The Chairperson noted that the draft report had been circulated to all Member States and that it would be finalized after incorporating any comments received. With this guidance, the report was adopted as presented. 211. The Chair offered to prepare, with the Committee’s concurrence, a summary to complement the final report for submission to the Executive Board in January 2014.

Closure of the Session 212. The representatives of the Member States conveyed their sincere gratitude to the Regional Director, Dr Samlee Plianbangchang, for his dedicated service, leadership and guidance over the past decade. They also expressed their appreciation to the Honourable President of India for the memorable inauguration ceremony and the Government of India for their excellent hosting and cultural activities. They extended their appreciation to the WHO Secretariat for facilitating the smooth organization of the Regional Committee meeting. The representatives further thanked the Chairperson for his efficient and informed conduct of the proceedings, which had resulted in the successful completion of the meeting. 213. The Regional Director congratulated the Chairperson, along with the ViceChairperson, for conducting the meeting in the most efficient manner to successfully complete the agenda. He thanked the honourable ministers and distinguished country representatives for their effective and valuable contributions.

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214. The Regional Director highlighted the progress and development made in the Region, and the commitment that countries had made in the implementation of their health strategies. Despite many daunting challenges including natural disasters, disease outbreaks and limited resources, the countries had shown their strong determination to improve the health of their populations towards Health for All. He acknowledged the effective horizontal collaboration that existed between WHO country offices, as well as the intercountry cooperation that fostered such positive relations and respect among the Member States. 215. Dr Samlee gratefully thanked the Royal Thai Government for their continuous support, and overwhelmingly thanked all Member States for their trust and confidence in him over the course of his work for the WHO South-East Asia Region. He said that he felt sure that under the new leadership, WHO would continue its effective collaboration with Member States in order to improve the health of people in the Region. 216. The Chairperson thanked the distinguished representatives for their active participation, and the Vice-Chair for his full cooperation and support. He appreciated the useful indepth discussions on issues vital to health development in the Region. He said that the mutual cooperation and understanding of the participants had resulted in fruitful discussions, decisions and recommendations to take health forward in the Region. 217. The Chairperson conveyed his thanks to the drafting group on resolutions and the Secretariat for their hard work and dedication. 218. The Chairperson placed on record the Committee’s sincere gratitude to Dr Margaret Chan, WHO Director-General, for her contribution to the meeting. He also thanked the representatives of UN agencies, nongovernmental organizations and development partners for their useful contribution to the proceedings. 219. The Chairperson concluded by placing on record the Committee’s deep appreciation to Dr Samlee Plianbangchang, Regional Director, WHO South-East Asia Region.

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WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

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Resolutions and Decisions Resolutions SEA/RC66/R1 Nomination of the Regional Director

The Regional Committee, Considering Article 52 of the Constitution; and In accordance with Rule 49 of its Rules of Procedure, 1. NOMINATES Dr Poonam Khetrapal Singh as Regional Director for the South-East Asia Region; 2. REQUESTS the Director-General to propose to the Executive Board the appointment of Dr Poonam Khetrapal Singh from 1 February 2014.

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SEA/RC66/R2

Resolution of Appreciation

The Regional Committee, Noting that Dr Samlee Plianbangchang will be relinquishing his office after serving the South-East Asia Region of WHO with distinction and dedication for 10 years as Regional Director; Recognizing that his outstanding contributions, providing a new dimension and direction to health development in the Region, deserve due recognition by the World Health Organization and Member States of the Region, PLACES on record its deep appreciation of Dr Samlee Plianbangchang’s leadership in international health and, in particular, his invaluable commitment and contributions to the improvement of the health status of people of the South-East Asia Region; DECLARES Dr Samlee Plianbangchang Regional Director Emeritus of the World Health Organization.

SEA/RC66/R3

Proposed Programme Budget 2014–2015

The Regional Committee, Acknowledging that the Sixty-sixth World Health Assembly in May 2013 approved the Programme Budget 2014–2015 as a primary instrument to express the planned scope of technical work of the Organization, along with planned budgetary allocations; Noting that the approved Programme Budget 2014–2015 is the first biennial budget of the Twelfth General Programme of Work, and is structured around Categories and Programme Areas, as detailed in the Annex of A66/7. Reaffirming its concern that the South-East Asia Region has seen a reduction of 11.5% in budget space for the 2014–2015 biennium compared with the 2012–2013 biennium; Reaffirming further its concern with the methodology in which the first nine months of expenditure data from the biennium 2012–2013 were used as the basis to develop the Programme Budget 2014–2015; Considering that the Sixty-sixth World Health Assembly approved an integrated budget, authorizing the Director-General to use the assessed contributions (AC) together

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with voluntary contributions (VC), subject to the availability of resources, to finance the Programme Budget 2014–2015 as approved; Noting that this integrated budget does not distinguish between assessed and voluntary contributions for the Programme Budget 2014–2015; Reaffirming that emergencies remain a concern in the South-East Asia Region and that the South-East Asia Region Health Emergency Fund (SEARHEF) is vital in providing immediate financial support for health interventions during these emergencies; Endorsing the report and the recommendations of the Sixth Meeting of the Subcommittee on Policy and Programme Development and Management (SPPDM), 1. URGES Member States: (1) to conduct country-level review of the programme areas to establish focused priorities in preparation for the 2014-2015 biennial budget; (2) to monitor the budget space allocation needs within the categories and programme areas, both during operational planning and implementation, with a view to matching resources to areas of highest programmatic need; (3) to collaborate on technical work of regional importance, seeking improved management and optimum utilization of available resources; (4) to strengthen programme management capacities with the objective of improving the efficiency and effectiveness of implementation; 2. REQUESTS the Regional Director: (1) to ensure efficient management of the budget for the Region, through appropriate consultations with Member States, in light of the budget allocation, in a manner that aligns the budget with priority programme areas as reflected by the Member States of the Region; (2) to convey to the Director-General the South-East Asia Region’s requirements for adjustments in budget allocations, in consultation with Member States if necessary; (3) to convey to the Director-General that additional flexible voluntary contributions for the South-East Asia Region must be linked to the disease burden and priorities of the Member States in the Region;

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(4) to support the mobilization of voluntary contributions, especially to support countries and programmes that have been unable to achieve full funding of their workplans; (5) to communicate actual budget figures for assessed and voluntary contributions by category, for country offices and regional offices, to Member States as soon as possible after the November 2013 Financing Dialogue.

SEA/RC66/R4

Health Intervention and Technology Assessment in Support of Universal Health Coverage

The Regional Committee, Recalling World Health Assembly resolutions WHA52.19 (Revised drug strategy, 1999), WHA60.16 (Progress in the rational use of medicines, 2007), WHA60.29 (Health technologies, 2007) and WHA63.21 (WHO’s roles and responsibilities in health research, 2010), and its own resolutions SEA/RC55/R4 (Accessibility to essential medicines, 2002), SEA/RC62/R6 (Measures to ensure access to safe, efficacious, quality and affordable medicinal products, 2009), and SEA/RC63/R5 (Regional Strategy on Universal Health Coverage, 2010); Recognizing the importance of evidence-based policy development in health systems including the decisions on resource allocation, service system designs and translation of policies into practice, as well as reaffirming the roles and responsibilities of the World Health Organization to provide support to strengthen health research capacity and utilization in Member States; Noting that efficient use of resources is among crucial factors of sustainable health systems, especially when significant increase in access to essential medicines, including generic medicines, medical devices, procedures and other healthcare interventions is pursued by Member States in the South-East Asia Region, as they are moving towards universal health coverage; Noting that the World Health Report 2010 indicates that the waste in spending on health is as high as 20–40% of the total and, therefore, the urgent need for systematic, effective solutions to reduce such inefficiencies. Acknowledging the critical role of health intervention and technology assessment, as multidisciplinary policy research, in generating evidence to inform prioritization, selection,

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distribution, management and introduction of interventions for health promotion, disease prevention, diagnosis, treatment and rehabilitation; Emphasizing that with rigorous research methodology and transparent and inclusive processes, assessment of pharmaceuticals, vaccines, medical devices, equipment and procedures could help address the demand for reliable information on the safety, effectiveness, quality and efficiency dimensions of the technologies when they are integrated into particular health systems; Concerned that capacities to research and document the public health, economic, fiscal, social and ethical implications of health interventions are inadequate in most developing countries, resulting in inadequate information to guide rational policy and professional decisions; Recognizing the importance of improved national capacity on health intervention and technology assessment and regional networking for evidence-based health policy; 1. URGES Member States: (1) to consider developing national methodological and process guidelines for health intervention and technology assessment to ensure transparency, quality, and policy-relevance of related research; (2) to consider integrating health intervention and technology assessment into national frameworks such as those for health systems research, health professionals education, health systems development, and universal health coverage; (3) to use evidence generated from health technology assessments for policy decisions; (4) to consider, as appropriate, collaborating with health organizations, academic institutes and other key stakeholders in the countries to formulate national strategic plans concerning capacity development for and introduction of health intervention and technology assessment research; (5) to identify and prioritize the countries’ gaps in regard to promoting evidencebased health policy as well as improving related research capacity, and consider seeking technical support and exchange of information from other Member States and international agencies, including WHO Regional Office for SouthEast Asia;

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(6) to consider the potential of health systems research including health intervention and technology assessment, in contributing to national policy development, planning and implementation, including enhancing capacity of regulatory authorities; (7) to consider co-sponsoring of an agenda item to discuss the role of health intervention and technology assessment in support of universal health coverage at the 134th Session of the WHO Executive Board and the Sixty-seventh World Health Assembly; 2. REQUESTS the Regional Director: (1) to ascertain the status of health intervention and technology assessment in Member States of the Region, in terms of human resources and institutional capacity, governance, linkage between health intervention and technology assessment units/network with policy authorities, policy utilization of assessment results, and interests and impediments in strengthening the capacity; (2) to foster knowledge on health intervention and technology assessment among national policy-makers and other stakeholders by drawing lessons from the operation, performance and contributions of competent research institutes within and outside the Region, and transferring such experiences to Member States through appropriate channels and activities, including regional networks and academic institutions; (3) to integrate health intervention and technology assessment concepts and principles into relevant regional strategies including, but not limited to, those on universal health coverage and rational use of medicines and health technology; (4) to provide technical support to Member States, in order to strengthen health intervention and technology assessment capacity; (5) to ensure adequate technical and management competency in the Regional Office for South-East Asia and country offices that is essential for addressing the demand for support to facilitate evidence-based policy decisions in Member States; (6) to identify and support focal points at the regional and country levels to ensure active, effective and sustainable collaboration, sharing information within and outside the Region;

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(7) to support exchange of information and capacity building in health technology assessment and regulation; (8) to report the progress and outcome of the implementation of this resolution to the Sixty-eighth Session of the Regional Committee.

SEA/RC66/R5

Measles Elimination and Rubella/Congenital Rubella Syndrome Control

The Regional Committee, Noting a significant reduction in global measles mortality by 71% between 2000 and 2011, from an estimated 542 000 deaths in 2000 to 158 000 in 2011, and an increase in the global routine measles immunization coverage from 72% in 2000 to 84% in 2011; Concerned that measles mortality is one of the barriers to achieving Millennium Development Goal 4, and that the South-East Asia Region accounted for approximately half of global measles deaths (158 000) in 2011; Recognizing that the South-East Asia Region hosts major vaccines manufacturing capacity, and that one Member State is the largest manufacturer of measles vaccines in the world; Noting progress in the South-East Asia Region of an increase in first-dose measles vaccine coverage from 61% to 79% between 2000 and 2012; Recalling resolution WHA65.17, urging Member States to apply the vision and strategies of the Global Vaccine Action Plan to develop the vaccines and immunization components of their national health strategy and plans; Cognizant that in order to achieve elimination, the vaccine coverage target of two doses of measles-containing vaccine needs to be greater than 95% in all country districts, and that this can be achieved through a combination of routine services and periodic mass campaigns; Concerned that the South-East Asia Region is the only WHO region without a measles elimination goal and that circulating viruses pose a threat to countries and regions which have already eliminated measles or are close to doing so;

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Recognizing that various health systems challenges need to be addressed in the efforts towards measles elimination and rubella/congenital rubella syndrome (CRS) control, in particular sustaining a high level of routine immunization coverage, other public health priorities that compete for limited resources, and maintenance of highquality surveillance systems; Noting concern about the social and political implications from adverse events following immunization (AEFI) and stressing that utmost efforts need to be made to ensure vaccines and injections are safe and that effective information, education and communication strategies and responses to AEFI are in place; Noting with concern the inadequately addressed burden of rubella and CRS in the South-East Asia Region; Acknowledging the early stage of rubella/CRS control in the Region and the challenges that remain, and recognizing that measles elimination is an opportunity for rubella/CRS elimination and that with use of combined measles-rubella vaccine, when measles is eliminated, rubella/CRS will also likely be eliminated; Citing the results of the February 2013 regional consultation of technical and policy officials in Kathmandu on feasibility of measles elimination and rubella/CRS control, and the recommendation by the South-East Asia Region Immunization Technical Advisory Group; 1. DECIDES to adopt the goal of measles elimination and rubella/CRS control in the South-East Asia Region by 2020; 2. URGES Member States: (1) to strengthen immunization and surveillance systems in the context of health systems, including laboratory capacity, for increasing and sustaining high levels of immunization coverage, high-quality case-based surveillance and wellfunctioning AEFI monitoring systems; (2) to conduct epidemiological assessments of population susceptibility to measles and rubella/CRS as a way of informing policy and planning preventive strategies to increase immunity levels uniformly; (3) to develop measles elimination and rubella/CRS control policy strategies using evidence-based data;

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

(4) to mobilize political, societal and financial support to eliminate measles and control rubella/CRS in the South-East Asia Region by 2020; 3. REQUESTS the Regional Director: (1) to provide technical support to Member States in their efforts to develop elimination policy and strategies, while strengthening their immunization and surveillance systems and improving their programme performance; (2) to mobilize the required resources, build on existing partnerships and foster the development of new ones in support of measles elimination and rubella/ CRS control efforts; (3) to report to the Regional Committee every two years on the status of global measles elimination and rubella/CRS control targets, milestones and progress of ongoing activities in countries towards achieving the goal by 2020 in the South-East Asia Region.

SEA/RC66/R6

Regional Action Plan and Targets for Prevention and Control of Noncommunicable Diseases (2013–2020)

The Regional Committee, Having considered the Regional Action Plan and Targets for Prevention and Control of Noncommunicable Diseases (2013–2020) and noting the recommendations of the Technical Working Group on the Regional Action Plan and Targets (Document SEA/ RC/4.5); Recalling World Health Assembly resolutions and decisions WHA53.17, WHA56.1, WHA57.17, WHA60.23, WHA64.11 and WHA65(8), and its own resolutions SEA/RC52/ R7, SEA/RC53/R10, SEA/RC60/R4 and SEA/RC65/R5, relating to the prevention and control of noncommunicable diseases; Welcoming resolution WHA66.10, adopted by the Sixty-sixth World Health Assembly, endorsing the Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020 and nine global voluntary targets; Recalling the Political Declaration of the High-Level Meeting of the United Nations General Assembly on the Prevention and Control of Non-communicable Diseases, the

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Moscow Declaration adopted at the First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Diseases Control, and the Rio Political Declaration on Social Determinants of Health; Concerned that noncommunicable diseases such as cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, which are linked to four main risk factors namely tobacco use, harmful use of alcohol, an unhealthy diet and lack of physical activity, are the leading causes of premature death and disability in the South-East Asia Region, and that they disproportionately affect the poor, impoverish families, and place a growing burden on health-care systems; Acknowledging that household air pollution is a major contributor to morbidity and mortality due to chronic respiratory diseases and the third leading risk factor for DALYS in the South-East Asia Region; Alarmed that South-East Asia Region countries contribute to over 35% of the global burden of cervical cancer incidence and mortality despite availability of simple costeffective interventions for its prevention, early detection and management; Recognizing with great concern that the South-East Asia Region is burdened with the highest rates of oral cancer among all WHO regions making it a major public health problem in many countries of the Region, with cancer of the lip and oral cavity ranking second for males and third for females among the most common types of cancer; Cognizant that cost-effective interventions are available for prevention, early detection and management of noncommunicable diseases and their risk factors throughout the life-course, and that coordinated actions across all sectors of society are required, including partnerships among governments, civil society, academia, international organizations and the private sector; Noting the Regional Oral Health Strategy (2013–2020), which calls for integration of oral diseases into the NCD context, and recognizing that oral diseases share the same risk factors and determinants and benefit from interventions aimed at the four main NCDs; 1. DECIDES: (1) to endorse the Regional Action Plan for the Prevention and Control of Noncommunicable Diseases (2013–2020); (2) to adopt 10 regional voluntary targets for prevention and control of NCDs to be achieved by 2025;

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

2. URGES Member States: (1) to develop new or strengthen existing national noncommunicable disease action plans by the end of 2013, in collaboration with stakeholders across different sectors and taking into account global and regional action plans; and to subsequently cost the action plans by the end of 2014; (2) to set national targets for prevention and control of noncommunicable diseases according to the country situation and capacity and taking into account the global and regional targets, and collect baseline data by the end of 2015; (3) to strengthen national surveillance and monitoring systems for prevention and control of noncommunicable diseases including but not limited to vital registration systems, medical cause of death, disease registries, population- and school-based integrated risk factor surveys, and health facility surveys; (4) to accelerate the implementation of the WHO Framework Convention on Tobacco Control, the WHO Global Strategy on Diet, Physical Activity and Health, the WHO Global Strategy to Reduce the Harmful Use of Alcohol and the WHO Set of Recommendations on the Marketing of Foods and Non-alcoholic Beverages to Children; (5) to develop and expand to national scale programmes for prevention and control of cervical cancer, particularly cervical cancer screening, based on national policies, and set up appropriate surveillance mechanisms to monitor the coverage; (6) to ensure early diagnosis, timely referral and appropriate management of oral potentially malignant disorders and oral cancer patients by strengthening surveillance and registration of oral cancer, establishing periodic screening programmes for at-risk populations (tobacco and alcohol users, users of carcinogenic substances such as betel nut and areca nut) consisting of simple visual screening and building capacity within appropriate health workforce cadres to conduct such screenings in the context of primary health care; (7) to actively participate in the global consultations for development of terms of reference for a global coordination mechanism aimed at facilitating engagement among Member States, UN Funds, Programmes and Agencies and other international partners and non-state actors;

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3. REQUESTS the Regional Director: (1) to provide technical support to Member States, as required, to develop costed national action plans supported by national monitoring frameworks, including indicators and national targets for prevention and control of NCDs; (2) to establish regional mechanisms for continuous coordination and support for Member States on the implementation of national plans, including capacity building and sharing of good practices; (3) to build capacity of Member States in strengthening national surveillance and monitoring systems, including vital registration, risk factor surveys and health facility surveys, as well as to provide support for reporting on the global and regional voluntary targets; (4) to convene a mid-course regional consultation (during 2018–2019) to review baseline data and regional targets, and make adjustments as required; (5) to submit reports on progress achieved in attaining the 10 voluntary regional targets in 2016, 2021 and 2026.

SEA/RC66/R7

Effective management of medicines

The Regional Committee, Having considered the Secretariat’s progress report on Resolution SEA/RC64/ R5 on National Essential Drug Policy including the rational use of medicines and the recommendations of the Regional Consultation on Effective Management of Medicines, 23–26 April 2013, in Bangkok; Noting that irrational use of medicines continues and that its causes are multifactorial and include problems of effective management of medicines; Understanding that effective management of medicines requires efficient systems with regard to medicines supply, medicines selection, medicines use, medicines regulation, medicines policy, and coordination of all these; Recognizing that a coordinated, comprehensive, national health systems approach is needed to promote rational use of medicines and ensure effective management of medicines;

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

Knowing that effective management of medicines is a high priority for the Region, 1. ENDORSES the progress report of Resolution SEA/RC64/R5, including its recommendations; 2. URGES Member States: (1) to invest in all areas of medicines management and to implement, as appropriate, the recommendations with regard to medicines regulation, medicines policy and coordination, medicines supply, medicines selection and use, as agreed at the Regional Consultation on Effective Management of Medicines 23–26 April 2013 in Bangkok and as stated in the progress report; (2) to speed up implementation of recommendations in Resolution SEA/RC64/R5; (3) to undertake a situational analysis of medicines in health-care delivery at least every four years for monitoring and planning purposes and to publish such reports. 3. REQUESTS the Regional Director: (1) to continue to collect, share and analyse reports on use of medicines and policy implementation to use for advocacy and to monitor progress; (2) to develop a tool for country use from the protocol used by the WHO Regional Office for South-East Asia for situational analyses and to support countries to undertake such analyses at least every four years for monitoring and planning purposes; (3) to convene a regional meeting at least every four years to share information on progress and plan the way forward; (4) to appoint sufficient dedicated personnel and allocate adequate resources for the management of medicines at regional and/or country level to ensure meaningful technical collaboration and ensure better coordinated support from partners; (5) to provide technical support and explore options of assisting small countries with procurement of medicines to achieve economies of scale and quality assurance;

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(6) to report biennially to Member States at the Regional Committee on progress achieved, problems encountered and further actions proposed to ensure effective management of medicines.

SEA/RC66/R8

Revision to Rules of Procedure of the WHO Regional Committee for South-East Asia

The Regional Committee, Having considered decision WHA65(9), by which the Sixty-fifth World Health Assembly decided inter alia that the regional committees should harmonize their practices in relation to the nomination of regional directors, the review of credentials and the participation of observers; and Having considered the report of the Secretariat, 1. DECIDES to amend Rule 2 of its Rules of Procedure concerning participation of observers in the work of the Regional Committee by replacing the text in its entirety with the following: “Subject to the terms of any existing agreements, the Committee may arrange for consultation with the respective regional committees of the United Nations and with those of other specialized agencies and with other regional international organizations having interests in common with the Organization and for their participation, without vote, in its discussions. The Regional Director (hereinafter referred to as “the Director”), in consultation with Member States, may invite States that are not members of the Committee to participate, without vote, in the sessions of the Committee. The Director, in consultation with Member States, may also invite nongovernmental organizations to participate in the deliberations of the Committee as provided in section 5 of the ’Principles governing relations between the World Health Organization and nongovernmental organizations’.” 2. DECIDES to replace Rule 3 of its Rules of Procedure with the following text and to add a new Rule 3 bis as provided below: “The Members shall communicate to the Director, not less than 15 days before the date fixed for the opening of the session of the Committee, the names of their representatives, including all alternates and advisers. Similarly, the organizations and States referred to in Rule 2 invited to be represented at the session shall communicate the names of the persons by whom they will be represented.

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

The credentials of representatives, including all alternates and advisers, shall be submitted to the Director, if possible not less than one day before the opening of the session of the Committee. Such credentials shall be issued by one of the following: the Head of State, the Head of Government, the Minister for Foreign Affairs, the Minister of Health or any other equivalent authority. Rule 3 bis. The officers of the Committee shall examine the credentials and report thereon to the Committee. Any representative to whose admission a Member has made an objection shall be seated provisionally with the same rights as other representatives, until the officers have reported and the Committee has given its decision.” 3. DECIDES that the foregoing amendments will become effective at the conclusion of the Sixty-sixth Session of the Committee.

SEA/RC66/R9

Time and Place of Sixty-seventh Session

The Regional Committee, 1. THANKS the Government of the People’s Republic of Bangladesh for confirming its invitation to host the Sixty-seventh Session of the Regional Committee in Bangladesh in 2014; 2. DECIDES to hold the Sixty-seventh Session in Bangladesh in September 2014.

SEA/RC66/R10 Resolution of Thanks The Regional Committee, Having brought its Sixty-sixth Session to a successful conclusion, 1. THANKS His Excellency, Shri Pranab Mukherjee, President of the Republic of India for inaugurating the Session and for his thought-provoking statement; 2. THANKS the Director-General, Dr Margaret Chan, for her inspiring address and participation;

REPORT OF THE SIXTY-SIXTH SESSION

3. CONVEYS its gratitude to His Excellency, Mr Ghulam Nabi Azad, Minister of Health and Family Welfare, Government of India, the officers and staff of the Ministry of Health and Family Welfare and other national authorities of the Government of India for facilitating the inauguration of the Session; 4. CONGRATULATES the Regional Director and his staff on their dedicated efforts towards the successful and smooth conduct of the Session.

Decisions SEA/RC66(1) Introduction to the Regional Director’s Annual Report on the Work of WHO in the South-East Asia Region covering the period 1 January to 31 December 2012

The Committee endorsed the Regional Director’s report on the Work of WHO in the South-East Asia Region during 2012 and agreed that it was well organized, comprehensive and covered all areas.

SEA/RC66(2)

Technical Discussions: Selection of a subject for the Technical Discussions to be held prior to the Sixtyseventh session of the Regional Committee

The Committee decided on the subject of “Covering every birth and death: improving civil registration and vital statistics” as the subject for Technical Discussions to be held prior to the Sixty-seventh Session of the Regional Committee in 2014.

SEA/RC66(3)

Nomination of a Member State to the Policy and Coordination Committee (PCC) of the UNDP/ UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction

The Committee nominated Timor-Leste as a member of the PCC for a three-year term starting 1 January 2014, and requested the Regional Director to inform WHO headquarters accordingly.

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

Annexes Annex 1

Text of inaugural speech by the President of India It gives me immense pleasure to extend a very warm welcome to you all to the Inaugural Session of the Thirty-first Meeting of Ministers of Health and the Sixty-sixth Session of the WHO Regional Committee for South-East Asia. I hope that your stay in the historic city of Delhi would be comfortable and will invigorate you with the zeal, energy and enthusiasm necessary for successful deliberations during the meetings. I would also like to take this opportunity to congratulate Dr Margaret Chan, Director- General, World Health Organization for her untiring efforts in pursuing the goal of ‘health for all’ and for her commitment to the cause of public health in the international community of nations. Excellencies, ladies and gentlemen, I feel honoured that we are hosting the Thirty-first Health Ministers’ Meeting, where Health Ministers from the 11 countries of this Region – Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste – would be discussing the key health issues and challenges facing the Region. This international platform at the regional level is crucial for this Region which houses 1.79 billion people – about 26.4% of the global population. Around 46% of the population in this Region is living below the poverty line. A significant portion of the disease burden in this Region, more than 28%, arises from communicable diseases, maternal and perinatal conditions and nutritional deficiencies, which are closely related to poverty. The data also reveal that the South-East Asia Region has more than 27% of the global disease burden due to noncommunicable diseases, which indicates their increasing prevalence in the Region.

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It is also a matter of concern that the South-East Asia Region registers the lowest total expenditure on health as a percentage of gross domestic product (3.8%) and per capita total expenditure on health as per World Health Statistics 2009, with 84.4% outof-pocket expenditure. In this background, I am sure that the meeting of the Health Ministers of the Region followed by the session of the WHO Regional Committee for South-East Asia would map the way forward for the entire Region, and would throw up broad agreements and the desired joint commitment on important initiatives and strategies. Ladies and gentlemen, It is an urgent necessity to build a conducive environment to ensure the highest quality of health for the people of the Region. However, this needs a multidimensional approach on the part of the respective governments. I am happy to note that the agenda for these two events include most of the health issues in the Region warranting serious discussion and immediate interventions thereupon. It is a matter of some satisfaction that several countries of the Region are on track to achieve the majority of health-related Millennium Development Goals due to their ongoing systematic efforts as well as WHO support. These efforts have led to some remarkable achievements like the eradication of polio and smallpox, improvement in life expectancy and reduction in infant and maternal mortality rates. However, the situation is not uniform in all countries of the Region. Some countries are still lagging far behind and would require much more efforts as well as resources to achieve the health-related Millennium Development Goals. An estimated 142 million people, or 8% of the population of the WHO South-East Asia Region are above the age of 60 years. This number will continue to increase and by 2025, the estimated proportion of the population over 60 years will be twice that of 2000, and by 2050, will have further increased to three times the proportion of 2000. The Yogyakarta Declaration on Ageing and Health 2012 rightly affirms that elderly people are a precious social asset and serious efforts should be made by the Member States and partners in the South-East Asia Region to adopt a holistic and multidisciplinary approach to promote healthy ageing in the Member States. All stakeholders in the Region should advocate jointly and follow up effectively on all aspects of the Yogyakarta Declaration. The unabated rise in the prevalence of hypertension among the population in the Region cannot also be ignored. It is all the more alarming that the incidence of

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

hypertension is especially increasing among the youth. Stressful modern lifestyles further aggravate the situation. We know that hypertension has serious health implications, especially in the long run. Thus, necessary cost-effective and timely interventions need to be explored by countries in the Region to check this undesirable trend. As the 2015 target date for achievement of the Millennium Development Goals approaches, there is wide debate as to what development goals the global community should set next. The United Nations has already appointed a High-level Panel to advise on the global development agenda beyond 2015. In support of this process, the United Nations Development Group is also leading efforts to catalyse a “global conversation” on the post-2015 agenda through a series of global thematic consultations. Thus, this may be the ideal time for the Ministers of Health of the Region to debate on this imperative issue, keeping Region-specific preferences in context. An ideal health-care delivery system should be accessible to all in the Region. Considering the current lack of access to quality healthcare at an affordable cost for the majority of the population in the Region, the proposal for universal health coverage seems to be a very plausible solution. However, evidence indicates that two areas cause significant inequities and inefficiencies in health in the Region: first, direct out-of-pocket payments for access to care that can push households into poverty; and, second, a significant proportion of these payments go towards the purchase of medicines. It is important that the countries in the Region strengthen their health systems based on the primary health care approach – focusing on public health including prevention and promotion activities; using appropriate technologies; using domestic resources as far as possible. Strategic investments in medical education and training would be needed to enhance the availability of scientifically accredited professionals for all communities. The existing inefficiencies in the supply chain and logistics management of drugs and vaccines should also be addressed on a priority basis. Strengthening of institutional mechanisms for community participation in oversight and governance of health at multiple levels – rural and urban – would also be crucial.

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Noncommunicable diseases are the leading cause of mortality globally and in the Region. Each year, around 7.9 million people die due to noncommunicable diseases, accounting for 55% of all deaths in the Region. In order to control this epidemic, it seems appropriate that besides adopting the nine global voluntary targets, a detailed Regional Action Plan is drawn up and strictly adhered to. The world has been implementing the International Health Regulations – IHR (2005) since 2007. This legally-binding agreement significantly contributes to global public health security by providing a new framework for coordinating the management of events that may constitute a public health emergency of international concern, and will improve the capacity of all countries to detect, assess, notify and respond to public health threats. It is important for all the countries in the Region to discuss the developments in this regard and to ensure that they meet the IHR core surveillance and response requirements. In conclusion, I sincerely hope that these sessions would contribute significantly towards an improved health-care environment in the Region. Before I conclude, let me again wish you a memorable and enjoyable stay in New Delhi and successful deliberations. Ladies and gentlemen, With these words, I hereby declare the Thirty-first Meeting of the Ministers of Health and the Sixty-sixth Session of the WHO Regional Committee for South-East Asia officially open. Thank you for your attention.

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

Annex 2

Text of inaugural address by the Minister of Health, Indonesia Your Excellency, Shri Pranab Mukherjee, President of the Republic of India, Honourable Ministers of Health of Member States of the WHO South-East Asia Region, Dr Margaret Chan, Director-General of the World Health Organization, Dr Samlee Plianbangchang, Regional Director WHO Regional Office for South-East Asia, Representatives from Partner Countries and International Organizations, Distinguished Delegates and Participants, Ladies and Gentlemen, Good morning, At the outset, it is a privilege and great honour for me to address this distinguished Joint Inaugural of the Thirty First Meeting of the Ministers of Health and the Sixty-Sixth Session of the WHO Regional Committee for South-East Asia. Last year, the Thirtieth Meeting of Ministers of Health and Sixty-Fifth Session of the WHO Regional Committee was held in Yogyakarta, Indonesia. The meeting discussed various important health issues and adopted the Yogyakarta Declaration on Ageing and Health. The importance of Yogyakarta Declaration is in acknowledging the issue of Ageing and Health as a priority public health challenge in the South East Asia Region. Since then, the Declaration had been implemented in the Region through various innovative national programmes and interventions for Ageing and Health. In this regard, the Regional Strategy on Ageing and Health was finalized in May 2013. Excellencies, Ladies and Gentlemen, As the Chair of the Thirtieth Meeting of the Ministers of Health and the Sixty-Fifth Session of the WHO Regional Committee for South-East Asia Region, I have observed the significant health progress in this Region. This includes, among others, the incremental progress of the Universal Health Coverage programme, the development of a Regional Framework on Noncommunicable Diseases, and the significant development of Health Systems Strengthening.

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These are our achievements, but there also challenges to bear in mind with the dynamic future situation globally and regionally. I also would like to stress the importance of a promotion and prevention approach as a fundamental aspect of health care, as well as the importance of the primary health care principle. Currently, we are heading to the last phase of the Millennium Development Goals period. Many targets have already been achieved and some targets require extraordinary efforts. Parallely, we are preparing and developing a strategy for the post-2015 development agenda, and we are highly expecting that the issue of health would be one of the important issues in the Sustainable Development Goals. Excellencies, Ladies and Gentlemen, Leadership and solidarity are very important measures for controlling the public health problem in our Region. In the future, we should provide our very best to achieve the highest possible health status of our Region. It is my hope that this Thirty First Meeting of the Ministers of Health and the Sixty-Sixth Session of the WHO Regional Committee for South-East Asia here in New Delhi, India, will trigger the strongest cooperation and solidarity among South-East Asia Region Member States. Thank you.

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

Annex 3

Text of welcome address by the Minister of Health and Family Welfare, Government of India At the outset, I would like to thank the Honourable President of India for sparing his valuable time to be with us today, to grace this joint inaugural session of the Thirty-first Meeting of Health Ministers and Sixty-sixth Session of the Regional Committee of WHO South-East Asia Region. Honourable President Sir, we are truly honoured by your august presence on this important occasion. Honourable Ministers, it is a privilege for India to host all of you at these meetings in the capital city of Delhi which carries rich culture, history and heritage and I thank you that you have made it possible to attend these meetings. We are equally glad to have the Director-General of WHO, Dr Margaret Chan, who has provided global leadership of a complex health scenario in the most difficult times of prolonged global economic slowdown and has been very ably carrying forward all activities, despite the limited resources at her command. It is a matter of great satisfaction for us that we are meeting at a time when we are just four months away from becoming a polio-free country. This long and worthwhile journey has been made possible due to strong political will and continuous leadership at the highest levels of Government and the undivided support of WHO, translating into adequate financial resources, vastly improved coverage, quick response times, adoption of technological innovations, dedicated officers and massive efforts by more than two million volunteers, partners, supervisors and health workers across the country. We have also seen significant reductions in maternal and infant mortality rates, total fertility rate and HIV/AIDS in our progress towards achieving the MDGs in the Region. We are happy that the Health Ministers’ Meeting will address a number of equally important issues on health cooperation among the Member countries of the WHO SouthEast Asia Region, and review the progress made in earlier Declarations by the health ministers. Being home to almost 1.8 billion people, this Region is the most populated of all the six WHO Regions and therefore, our voice overwhelmingly reflects the voice of the developing countries across the globe. REPORT OF THE SIXTY-SIXTH SESSION

This Health Ministers’ Meeting will take up the theme of World Health Day 2013 on high-blood pressure (hypertension), which is an important component of the broader group of noncommunicable diseases (NCDs) and will come out with the “Delhi Declaration on High Blood Pressure”. Noncommunicable diseases, especially hypertension, are now globally recognized as major challenges to human health and economic growth and are now the major causes of premature deaths in our Region as well, striking the poor and the vulnerable the hardest and driving them deeper into poverty. WHO highlighted this increasingly serious problem by adopting a resolution on NCDs at the Sixty-third World Health Assembly in May 2010 in Geneva. Thereafter, the Moscow Declaration adopted at the first Global Ministerial Conference on Healthy Lifestyles and NCDs in Moscow, Russia in April 2011, called for strengthening policy coherence to maximize the positive and minimize the negative impacts of NCD risk factors. To sensitize Heads of State, Heads of Governments and Health Ministers of the world on the importance of prevention and control of NCDs, a Special Session was organized in New York in September 2011 by the UN General Assembly. I would like to inform this august gathering with a sense of great satisfaction, that much before the UN Special Session, India had already brought about a paradigm shift in 2010 by launching the National Programme on Prevention and Control of Cancer, Diabetes, CVDs, and Stroke. More than 43 million persons have been screened for diabetes and 38 million for hypertension in its pilot phase. We have worked out the modalities to implement the CVD and cancer component of the programme, by associating both private and government medical colleges to roll out this programme across the country by the end of this year. Therefore, the Delhi Declaration on High Blood Pressure comes at an opportune time to carry the NCD agenda forward. The discussions in the Regional Committee will cover a wide spectrum of health issues that confront the Region, including universal health coverage. These meetings will provide a platform not only to share experiences, but also to identify areas of mutual cooperation and reinforce our common goal to guarantee higher health status in the Region. The South-East Asia Region has resolved to work together and demonstrate solidarity in various international forums. Excellencies, Here, I would like to briefly mention some areas where India remains committed to further strengthen the mutual bonds of cooperation in the South-East Asia Region. As you know, India is called the “Pharmacy of the World” for producing high quality and affordable generic drugs which have substantially brought down the prices; a case in point being the dramatic reduction in costs of HIV/AIDS treatment across the globe.

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

India also has several excellent public health institutions that are open to our neighbouring countries for capacity building of their health personnel, with the aim of increasing the overall availability of skilled human resources in health in the Region. We will also be happy to share our experience in the field of medical education and training. Similarly, scientists working in the Ministry of Health and Family Welfare are continuously striving to develop new technologies that can be used across the Region. Some of the recent innovations in health research which have taken place during the past three years are worth emulating, should any neighbouring country so desire. For example, we have developed indigenous vaccines and testing reagents for H1N1 and other influenzas as well as indigenous vaccine for Japanese encephalitis (JE). A number of other products ready for launch are: a magnifying device for cervical cancer screening in the field; a new food safety test for detection of pathogens in food; a test for molecular diagnosis of thalassemia for early diagnosis and pre-natal screening and ELISA test for diagnosis of lung fluke. As many as 75 leads are being translated for development of affordable products and are at various stages of development and testing. Sixteen new biosafety laboratories have been established for working on viral diseases, TB, and other infectious diseases. I take great pride in stating that a BSL-IV Lab, which is Asia’s first active laboratory for human medicine, was established in 2012 at Pune, to deal with the most dangerous lethal infections like haemorrhagic fevers and agents of bioterrorism. I am sure that many more such innovations in other fields of medical education and healthcare must be happening in the South-East Asia Region, and India would be glad to take advantage of them. I urge the Member States of the South-East Asia Region to join hands to develop and share new initiatives and technologies to achieve our common goal of providing affordable and accessible health care to our people in the Region. Honourable President, This is an important year for the Region, as we come together to elect a Regional Director in this Session. In this situation of global economic slowdown, the role of the Regional Director, WHO South-East Asia Region will be especially important, since the Regional Director is a key player in shaping and implementing the regional agenda and priorities. Before I conclude, I once again express our gratitude to the Honourable President of India for being with us today and would like to thank him sincerely for taking keen interest in health. His constant support and encouragement have enabled us to revolutionize public health in India. I once again welcome the Honourable Health Ministers of the Region, the accompanying delegates and the Director-General, WHO and look forward to further expanding our cooperation. With these words, I wish Honourable Ministers and their delegations, a very pleasant and productive stay in New Delhi. I thank you very much.

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Annex 4

Text of opening remarks by the Director-General, World Health Organization Honourable ministers, distinguished guests, Dr Samlee, ladies and gentlemen, Let me join others in thanking India for hosting this session of the Regional Committee for South-East Asia. I will be commenting on some of the agenda items tomorrow. The Thirty-first Health Ministers Meeting will discuss high blood pressure and the place of health in the post-2015 development agenda. High blood pressure is a huge and usually silent problem, but a manageable one. High blood pressure is preventable, and it is treatable. The scale of the problem is a challenge. WHO estimates that more than one in three adults worldwide has high blood pressure. This is a deadly challenge. Each year, high blood pressure contributes to nearly 9.4 million deaths due to heart disease and stroke. High blood pressure also increases the risk of kidney failure, blindness, and several other conditions. It often occurs together with other risk factors, like obesity, diabetes, and high cholesterol, increasing the health risk even further. For all these reasons, high blood pressure contributes substantially to the escalating costs of health care associated with the rise of noncommunicable diseases. High blood pressure is a strong and reliable warning signal that health is at risk and that something needs to be done. But high blood pressure is also a silent warning signal, usually showing no symptoms for years or even decades, even when values are dangerously high. When symptoms do appear, cardiovascular disease is usually advanced and the risk of sudden acute events, like a heart attack or a stroke, is greatly increased.

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

This is the key challenge for public health: to get more people tested early, ideally routinely, and then properly managed, whether through lifestyle changes or medication. Countries with health systems based on primary health care are in the best position to do so. Wellness programmes at the workplace can also provide a good entry point for blood pressure measurement. Measurement devices for use in low-resource settings are available. The Regional Committee will be discussing the nine voluntary targets in the noncommunicable diseases global monitoring framework, including the target set for reducing the prevalence of raised blood pressure. Ladies and gentlemen, Consultations about the place of health in the post-2015 development agenda have moved forward. The High-level Panel of Eminent Persons, convened by the UN SecretaryGeneral, delivered its report in early June. The report’s key message is a call to end absolute poverty in the context of sustainable development by 2030. The report articulates five fundamental principles. Leave no one behind. Put sustainable development at the core. Transform economies for jobs and inclusive growth. Build peace and effective, open and accountable public institutions. And, finally, forge a new global partnership. These principles are then translated into 12 proposed goals. Goal four is to “ensure healthy lives”. The goal has five targets. These cover infant and young-child mortality, maternal mortality, immunization coverage, sexual and reproductive health, and the disease burden from HIV/AIDS, tuberculosis, malaria, neglected tropical diseases, and priority noncommunicable diseases. As the report states, achieving goal four “requires universal access to basic health care.” Health also has a role in several other proposed goals. This is where we stand today. The first phase of the process has been completed. In my view, health is in a good place. But the debate continues, as Member States negotiate and eventually agree on the best agenda for sustainable development in the years to come. I look forward to your discussions. Thank you. REPORT OF THE SIXTY-SIXTH SESSION

Annex 5

Text of address by the Regional Director, WHO South-East Asia Excellency, Shri Pranab Mukherjee, President of the Republic of India; Excellency, Mr Ghulam Nabi Azad, Minister of Health and Family Welfare, the Government of the Republic of India; Dr Margaret Chan, WHO Director-General; Honourable Ministers of Health from countries of the WHO South-East Asia Region; distinguished country representatives; honourable guests; ladies and gentlemen: On behalf of the WHO South-East Asia Region, it is my privilege to warmly welcome you all to the joint inauguration of the Thirty-first Meeting of Health Ministers of the countries of the WHO South-East Asia Region and the Sixty-sixth Session of WHO Regional Committee for South-East Asia. I gratefully thank the Ministry of Health and Family Welfare, the Government of the Republic of India, for organizing this joint inauguration. And I overwhelmingly thank His Excellency, Shri Pranab Mukherjee, President of the Republic of India for his gracious presence to inaugurate the joint opening. Excellencies, ladies and gentlemen, Over the past decade, the health of populations in all countries of the South-East Asia Region has been steadily improved. First and foremost is the termination of wild poliovirus transmission in the Region in early 2011, and the health ministers agreed to launch “Regional Intensification of Routine Immunization” in 2012, resulting in a significant increase in the immunization coverage in the Region, up to 90%. In the area of prevention and control of noncommunicable diseases, all countries now have solid roadmaps to move forward towards time-bound risk reduction targets. Concerning the progress towards health-related Millennium Development Goals (MDGs), some countries have already reached the MDG targets. To contribute to the “post-2015 development agenda framework”, a regional consultation was held

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

to highlight our Member States’ perspectives. The consultation considered “universal health coverage” as the best way forward in addressing the wide range of current health concerns. Emerging infectious diseases will continue to haunt us. Control of diseases will continue to drain the scarce health resources. Health challenges today become more complex, and we are dealing with them mostly on the surface. We need to go deeper, to the bottom of the matter, in order to bring all people with various health risks for health promotion and health protection that can lead to our healthier populations. Honourable health ministers and distinguished representatives, I wish you all successful meetings. Thank you.

REPORT OF THE SIXTY-SIXTH SESSION

Annex 6

Agenda 1. Opening of the session 1.1 Appointment of the Subcommittee on Credentials Approval of the report of the Subcommittee on Credentials Election of office bearers Adoption of the agenda

1.2

1.3 1.4 2.

Key addresses and report on the work of WHO 2.1 Introduction to the Regional Director’s Annual Report on the Work of WHO in the South-East Asia Region covering the period 1 January–31 December 2012 Address by the Director-General of the World Health Organization SEA/RC66/2 and Inf. Doc.

2.2

WHO reform and Programme Budget matters 3.1 Implementation of Programme Budget 2012–2013 Twelfth General Programme of Work (GPW) and Proposed Programme Budget 2014–2015 SEA/RC66/3 and Add.1 SEA/RC66/4, Inf. Doc.1, Inf. Doc.2, Inf. Doc.3 and Inf. Doc.4 SEA/RC66/5, Inf. Doc.1, Inf. Doc.2, Inf. Doc.3, Inf. Doc.4 and Inf. Doc.5

3.2

3.3

WHO reform: financing dialogue and Programme Budget 2016–2017

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

Technical matters 4.1 Consideration of the recommendations arising out of the Technical Discussions on Universal Health Coverage (UHC) Selection of a subject for the technical discussions to be held prior to the Sixty-seventh Session of the Regional Committee Implementation of the International Health Regulations (2005) Measles elimination and rubella control Regional Action Plan and Targets for Prevention and Control of Noncommunicable Diseases (2013–2020) Reports of WHO global working/advisory groups 4.6.1 Pandemic Influenza Preparedness Framework Progress report on malaria SEA/RC66/11 Rev.1 SEA/RC66/12 SEA/RC66/6

4.2

SEA/RC66/7

4.3

SEA/RC66/8 Rev.1 SEA/RC66/9 SEA/RC66/10 and Inf. Doc.

4.4 4.5

4.6

4.6.2

4.7 Progress reports on selected Regional Committee resolutions 4.7.1 Challenges in polio eradication (SEA/RC60/R8) 2012: Year of Intensification of Routine Immunization in the South-East Asia Region: Framework for Increasing and Sustaining Coverage (SEA/RC64/R3) National Essential Drug Policy Including the Rational Use of Medicines (SEA/RC64/R5) Consultative Expert Working Group on Research and Development: Financing and Coordination (SEA/RC65/R3) SEA/RC66/13

4.7.2

SEA/RC66/14

4.7.3

SEA/RC66/15

4.7.4

SEA/RC66/16

REPORT OF THE SIXTY-SIXTH SESSION

Governing Body matters 5.1 Nomination of the Regional Director SEA/RC66/18

5.2 Revision to the Rules of Procedure of the WHO Regional Committee for South-East Asia 5.3 Important issues arising out of the Sixty-sixth World Health Assembly and the 132nd and 133rd sessions of the WHO Executive Board Review of the draft provisional agenda of the 134th Session of the WHO Executive Board

SEA/RC66/19

5.4

SEA/RC66/20

Special programmes 6.1 UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases: Joint Coordinating Board (JCB) – Report on attendance at JCB in 2013 UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP): Policy and Coordination Committee (PCC) – Report on attendance at PCC in 2013 and nomination of a member in place of Bhutan whose term expires on 31 December 2013 SEA/RC66/21

6.2

SEA/RC66/22

Closure of the session 7.1 Time and place of future sessions of the Regional Committee Adoption of resolutions Adoption of the report of the Sixty-sixth Session of the Regional Committee Closing of the session SEA/RC66/23

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

Annex 7

List of participants 1. Representatives, Alternates and Advisers Bangladesh Representative Advisers H.E. Dr AFM Ruhal Haque Minister of Health and Family Welfare Professor Dr Syed Modasser Ali Advisor to the Honorable Prime Minister on Health & Family Welfare and Social Welfare Affairs Ministry of Health and Family Welfare H.E. Mr A Tariq Karim Honorable High Commissioner High Commission of Bangladesh in India Professor Dr Abul Kalam Azad ADG (Planning and Development) and Line Director MIS Directorate-General of Health Services Ministry of Health and Family Welfare Mr A K M Mohiul Islam Quazi Private Secretary (Joint Secretary) to Minister of Health and Family Welfare Mr Mahbub Hassan Saleh Deputy High Commissioner High Commission of Bangladesh in India New Delhi Mr Kazi Faiyaz Murshid Director (UN) Ministry of Foreign Affairs Dr Baizid Khoorshid Riaz Project Director Dhaka Medical College Hospital Dr Md. Habibe Millat Honorary Director Bangladesh Medical and Dental Council Dr S K Nazmul Huda Special Advisor for GAVI Alliance to Minister of Health and Family Welfare Mr Syed Borhan Kabir Executive Editor The Daily Amader Orthoniti

REPORT OF THE SIXTY-SIXTH SESSION

Bhutan Representative H.E. Lyonpo Tandin Wangchuk Minister Ministry of Health Dasho Nima Wangdi Secretary Ministry of Health Mr Kado Zangpo Deputy Chief Planning Officer Policy and Planning Division Ministry of Health Mr Lekey Khandu Personal Secretary to Health Minister Ministry of Health Mr Karma Jurmin Thinlay First Secretary Royal Bhutanese Embassy Chandragupta Marg, Chanakyapuri New Delhi Democratic People’s Republic of Korea Representative Alternates H.E. Dr Kang Ha Guk Minister of Public Health H.E. Mr Pak Kyong Son Ambassador Extraordinary and Plenipotentiary Embassy of the Democratic People's Republic of Korea New Delhi Dr Pak Jong Min Director, Department of External Affairs Ministry of Public Health Mr Jong Myong Hak Senior Official Department of International Organizations Ministry of Foreign Affairs Mr Kim Hyon Official Ministry of Public Health

Alternate

Advisers

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

India Representative Alternates H.E. Mr Ghulam Nabi Azad Minister of Health and Family Welfare Mr Keshav Desiraju Secretary (Health and Family Welfare) Ministry of Health and Family Welfare Dr Jagdish Prasad Director General of Health Services Ministry of Health and Family Welfare Dr Poonam Khetrapal Singh Advisor, International Health Ministry of Health and Family Welfare Mr R K Jain Additional Secretary & DG (CGHS) Ministry of Health and Family Welfare Mr C K Mishra Additional Secretary (Health) Ministry of Health and Family Welfare Mr S K Rao Joint Secretary (International Health) Ministry of Health and Family Welfare Mr Anshu Prakash(*) Joint Secretary Ministry of Health and Family Welfare Mr Amal Pusp Director, International Health Ministry of Health and Family Welfare Dr Rajesh Ranjan First Secretary (Specialised Agencies) Permanent Mission of India to UN Geneva Mr Hemant Kotalwar Counsellor Permanent Mission of India to WTO Geneva Adviser Dr Sharat Chauhan Private Secretary to Minister for Health Family Welfare Ministry of Health Family Welfare

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Indonesia Representative Alternates H.E. Dr Nafsiah Mboi Minister of Health Professor Dr Tjandra Yoga Aditama Director-General of Diseases Control and Environmental Health Ministry of Health H.E. Rizali Wilmar Indrakesuma Ambassador of the Republic of Indonesia to India New Delhi Advisers Dr Desak Made Wismarini Director, Surveillance, Immunization, Quarantine and Matra Health Ministry of Health Dr Ekowati Rahajeng Director of Non-Communicable Diseases Control Ministry of Health Dr Eka Viora Head, Center for Health Intelligentsia Ministry of Health Dr Budi Dhewajani Head, Center for International Cooperation Ministry of Health Dr Agus Suprapto Head, Center for Humanities, Health Policies and Community Empowerment Ministry of Health Ms Dettie Yuliati Director of Pharmaceutical Services Management Ministry of Health Dr Tini Suriyanti Suhandi Head of Bureau of Budget and Planning Ministry of Health Dr Widiyarti Head, Bilateral and Multilateral Health Cooperation Division Center for International Cooperation Ministry of Health Dr Andi Saguni Head of Budget Revenues and State Expenditures Bureau of Budget and Planning Ministry of Health

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

Dr Upik Rukmini Head, Standardization Section Special Health Care, Elderly and Blood Services Directorate of Primary Health Care Ministry of Health Maldives Representative Alternate H.E. Dr Ahmed Jamsheed Mohamed Minister of Health H.E Mr Mohammed Naseer High Commission of the Republic of Maldives New Delhi India Ms Geela Ali Permanent Secretary Ministry of Health Ms Aishath Samiya Director, Ministry of Health Ms Asma Ibrahim Director, Health Protection Agency Ministry of Health Myanmar Representative H.E. Professor Pe Thet Khin Union Minister Ministry of Health H.E. Aung Khin Soe(*) Ambassador Embassy of the Republic of Union of Myanmar New Delhi Mr U Ba Hla Aye(*) Minister Counsellor Embassy of the Republic of Union of Myanmar New Delhi Dr Myint Htwe Chairman, Ethical Review Committee Department of Medical Research Ministry of Health Dr Soe Lwin Nyein Deputy Director General (Disease Control) Department of Health Dr Zaw Lin Aung Professor/Head Department of Medicine University of Medicine, Mandalay

Advisers

Alternate

Advisers

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Dr Kyaw Khaing Deputy Director International Health Division Ministry of Health Nepal Representative Alternates H.E. Mr Vidyadhar Mallik Minister for Health and Population Dr Praveen Mishra Secretary Ministry of Health and Population Dr Padam Bahadur Chand Chief Policy, Planning and International Cooperation Division Ministry of Health and Population Adviser Mr Khaga Nath Adhikari Charge’d’ Affaires a.i. Embassy of Nepal New Delhi

Sri Lanka Representative Alternates H.E. Mr Maithripala Yapa Sirisena Minister of Health Dr Y D Nihal Jayathilake Secretary Ministry of Health Ms Mahishini Colonne Dy. High Commissioner High Commission of Sri Lanka New Delhi Advisers Mr Kapila Fonseka Counsellor High Commission of Sri Lanka New Delhi Dr (Mrs) S C Wickramasinghe Senior Assistant Secretary (Medical Services) Ministry of Health Dr J M W Jayasundara Bandara Deputy Director General (Planning) Ministry of Health

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

Thailand Representative Dr Chanvit Tharathep Deputy Permanent Secretary Ministry of Public Health Dr Supamit Chunsuttiwat Medical Officer (Advisory Level) Department of Disease Control Ministry of Public Health Dr Sopida Chavanichkul Director, Bureau of International Health Office of the Permanent Secretary Ministry of Public Health Dr Pawana Aunkasith Director, ASEAN Health Service Support Division Department of Health Service Support Ministry of Public Health Dr Pitakpol Boonyamalik Director, Galya Rajanagarindra Institute Department of Mental Health Ministry of Public Health Dr Woraya Luang-on Medical Officer (Senior Professional Level) Bureau of Emerging Infectious Diseases Department of Disease Control Ministry of Public Health Ms Cholluedee Sootsukon Foreign Relations Officer, Practitioner Level Bureau of International Health Office of the Permanent Secretary Ministry of Public Health Timor-Leste Representative Alternate Advisers H.E. Dr Sergio G C Lobo Minister of Health Mr Ivo Ireneu da C Freitas National Director, Planning, Policy Cooperation Dr (Ms) Ines Teodora da Silva Almeida Director, Disease Control Dr (Ms) Odete Maria Freitas Belo President, Central Medical Store (SAMES) Dr (Ms) Olinda Dos Reis Albino Chief of Medical Equipment Department of Medical Equipment

Alternate

Advisers

REPORT OF THE SIXTY-SIXTH SESSION

Dr (Ms) Celeste Fernandes Xavier Cham Chief of Pharmacy and Drugs Control Dr (Ms) Carla Madeira Sub-Inspector, Quality Control Ministry of Health Ms Herminia Ornai Chief of Staff Office of the Minister of Health Mr U S Baweja Administration Adviser to the Minister of Health 2. Representatives of the United Nations and Specialized Agencies Asia-Pacific Centre for Technology Transfer (APCTT) Food and Agricultural Organization of the United Nations (FAO) International Atomic Energy Agency Mr Michael Williamson Head, APCTT, ESCAP New Delhi India Dr Peter E Kenmore FAO Representative in India New Delhi India Dr Marion Piñeros Cancer Control Specialist PACT Programme, IAEA Vienna Austria Ms Tine Staermose(*) Director ILO DWT for South Asia and Country Office for India New Delhi India Mr Vaibhav Gupta Maternal, Newborn, and Child Health Technical Officer Geneva Switzerland Mr Ramesh Govindaraj Lead Health Specialist The World Bank New Delhi India Mr Oussama Tawil Country Coordinator UNAIDS New Delhi India

International Labour Organization (ILO)

Partnership for the Maternal, Newborn, and Child Health

The World Bank

UNAIDS

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

United Nations ESCAP South and South-West Asia Office (ESCAPSSWA) United Nations Fund for Population Activities (UNFPA) UNHCR

Dr Nagesh Kumar Director, ESCAP South and South-West Asia and Chief Economist New Delhi India Ms Frederika Meijer UNFPA Representative to India New Delhi India Mr Hans Schodder(*) Deputy Chief of Mission UNHCR New Delhi India Ms Yasmin Keith Krelik(*) Senior Programme/Admin Officer UNHCR New Delhi India

United Nations Resident Coordinator

Ms Lise Grande United Nations Resident Coordinator for India New Delhi India Mr Louis-Georges Arsenault India Representative UNICEF House New Delhi India Dr Genevieve Begkoyian Chief of Health UNICEF India Country Office UNICEF House New Delhi India Dr Satish Kumar Gupta Health Specialist UNICEF India Country Office UNICEF House New Delhi India Dr Malalay Ahmadzai(*) Health Specialist UNICEF India Country Office UNICEF House New Delhi India

United Nations Children’s Fund (UNICEF)

REPORT OF THE SIXTY-SIXTH SESSION

United Nations Information Centre (UNIC)

Ms Kiran Mehra-Kerpelman Director UN Information Centre (UNIC) for India & Bhutan New Delhi India Dr Rebecca Reichmann Tavares Representative UN Women Office for India, Bhutan, Maldives, Sri Lanka New Delhi India Ms Sushama Kapoor Deputy Representative UN Women Office for India, Bhutan, Maldives Sri Lanka New Delhi India

UN Women Office for India, Bhutan, Maldives, Sri Lanka

World Metereological Organization (WMO)

Dr L S Rathore Director General and Permanent Representative of India with WMO India Meteorological Department New Delhi India Dr S D Attri Deputy Director General India Meteorological Department New Delhi India

3. Intergovernmental organizations International Organization for Migration (IOM) Dr Jaime F. Calderon Jr Regional Migration Health Adviser International Organization for Migration Bangkok Thailand

4. Representatives from nongovernmental organizations in official relations with WHO Alzheimer's Disease International (ADI) Dr Jacob Roy Kuriakose(*) Chairman Alzheimer’s Disease International Kerala India Dr Sara Varughese Regional Director CBM India Bengaluru India

Christian Blind Mission (CBM)

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

Framework Convention Alliance for Tobacco Control (FCA) Italian Association of Friends of Raoul Follereau (AIFO)

Mr Shailesh Dwarkanath Vaite Regional Coordinator (SEAR) New Delhi India Dr Manikkathan Jose Representative AIFO Amici di Raoul Follereau Bengaluru India Professor Man Mohan Mehndiratta Vice-President Director, Professor & HOD, Department of Neurology Janakpuri Super Speciality Hospital New Delhi India Dr Kapil Yadav Faculty Member Centre for Community Medicine All India Institute of Medical Sciences New Delhi India Dr K R Gangadharan President, International Federation on Ageing Chairman, Heritage Foundation Hyderabad India Mr Manindra Nath Chaudhuri Member International Federation of Biomedical Laboratory Science Hamilton, ON Canada Dr Sadhana Gupta Chairperson, Safe Motherhood Committee Jeevan Jyoti Hospital & Medical Research Center Gorakhpur, Uttar Pradesh India Ms Nilofer Khan Habibullah Representative Bangalore India Rtd Adm Purushottam Dutt Sharma Vice President ILSF/ President RLSS (I) Pune India

International Bureau for Epilepsy (IBE)

International Council for Control of Iodine Deficiency Disorders (ICCIDD)

International Federation on Ageing (IFA) Heritage Foundation

International Federation of Biomedical Laboratory Science (IFBLS)

International Federation of Gynecology and Obstetrics (FIGO)

International Federation of Medical Students Associations (IFMSA) International Life Saving Federation (ILS)

REPORT OF THE SIXTY-SIXTH SESSION

International Life Science Institute (ILSI)

Ms Rekha Sinha Executive Director, ILSI-India New Delhi India Dr Swati Bhave Executive Committee Member Technical Adviser, Adolescent Health Executive Director Association of Adolescent and Child Care in India New Delhi India Ms Anjali Sen Regional Director IPPF House New Delhi India Mr Prafull Sheth Vice President International Pharmaceutical Federation The Hague The Netherlands Ms Venetta Miranda Member International Special Dietary Foods Industries Brussels Belgium Dr Vivekanand Jha Professor of Nephrology Secretary, Indian Society of Nephrology Postgraduate Medical Institute Chandigarh India Dr Harvinder Singh Chhabra Chief of Spine Service and Medical Director Indian Spinal Injuries Centre New Delhi India Mr Prabodh Bhambal(*) Interim Deputy Executive Director International Union Against Tuberculosis and Lung Diseases New Delhi India

International Paediatric Association (IPA)

International Planned Parenthood Federation South Asia Region (IPPF-SAR) International Pharmaceutical Federation (FIP)

International Special Dietary Foods Industries (ISDI)

International Society of Nephrology (ISN)

International Spinal Cord Society (ISCoS)

International Union Against Tuberculosis and Lung Diseases (IUATLD)

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

Mr Ashish Kumar Pandey Technical Officer International Union Against Tuberculosis and Lung Diseases New Delhi India Medicine Mundi International (MMI) Mr Kappoori Gopakumar Researcher Medicine Mundi International New Delhi India Ms Shailly Gupta Policy Advocacy Officer MSF Access Campaign Médecins Sans Frontières New Delhi India Dr Mohammad Aleem Arif Country Representative (NLR) New Delhi India Dr Rajiv Tandon Senior Advisor–Maternal, Newborn, Child Health Nutrition New Delhi India Professor Pratap Narayan Prasad President, South Asian Region, WONCA Tribhuvan University Teaching Hospital (TUTH) Institute of Medicine, Maharajgunj Kathmandu Nepal Professor Jeyaraj Durai Pandian Board of Director Professor and Head, Department of Neurology Christian Medical College, Ludhiana Punjab India Mrs Esther Indriani MCH Nutrition Specialist for South Asia and Pacific South Asia Pacific Regional Office (SAPO) World Vision International Jakarta Indonesia

Médecins Sans Frontières (MSF)

Netherlands Leprosy Relief Representing ILEP

Save The Children

World Organization of Family Doctors (WONCA)

World Stroke Organisation (WSO)

World Vision International (WVI)

REPORT OF THE SIXTY-SIXTH SESSION

5. Observers Ministry of Health Republic of Indonesia Mr Ferdinan Samson Tarigan Head, Multilateral Health Cooperation Sub-Division Centre for International Cooperation Ministry of Health Jakarta Indonesia Dr Mohammad Elvinoreza Hutagalung Staff, Multilateral Health Cooperation Sub-Division Centre for International Cooperation Ministry of Health Jakarta Indonesia Ms Kurniasih Asih Kosasih ADC Ministry of Health Jakarta Indonesia Ms Dwi Puspasari Head of Administration and Wages Dwi Puspasari Jl Pejambon No.6 Jakarta Indonesia Ms Rizky Zakiyah Staff of Directorate of Socio-cultural Affairs and International Organizations of Developing Countries Jakarta Indonesia Embassy of Indonesia Mrs Ninik Rahayu Second Secretary Indonesian Embassy New Delhi India Mrs Rospinda Uliani Saragih Counsellor, New Delhi India Mrs Anti Kurnadi Third Secretary New Delhi India Mr Rizki Multazam Staff Member New Delhi India

100

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

Embassy of Sweden

Ms Yasmin Zaveri Roy, Senior National Advisor New Delhi India Professor Vinod Kumar President Emirates, ARDSI c/o ARDSI National Office New Delhi India Dr Raj Shankar Ghosh(*) Deputy Director Interim Vaccine Delivery Bill and Melinda Gates Foundation New Delhi India Mr Vinod Kumar Programme Officer Bill and Melinda Gates Foundation New Delhi India

Alzheimer’s Disease International (ADI)

Bill and Melinda Gates Foundation (BMGF)

Global Alliance for Vaccines Initiative (GAVI)

Dr Hind Khatib-Othman Managing Director Country Programmes Global Alliance for Vaccines Initiative Geneva Switzerland Dr Ranjana Kumar Head of Asia and Pacific Region Global Alliance for Vaccines Initiative Geneva Switzerland

US Agency for International Development (USAID)

Ms Godfrey Nancy Director, Health Office US Agency for International Development American Embassy New Delhi India Mr Altaf Lal(*) CDC, Country Director and US Food and Drug Administration United States Embassy New Delhi India

US Food and Drug Administration (US FDA)

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101

FHI 360

Dr Bitra George Country Director FHI 360 New Delhi India Mr Iqbal Masud(*) Board Member Framework Convention Alliance Dhaka Bangladesh Dr Rameshwar Dolas Dean D.Y. Patil Dental College Pune India Professor Chandrakant S Pandav Regional Coordinator International Council for Control of Iodine Deficiency Disorders Center for Community Medicine All India Institute of Medical Sciences New Delhi India Dr Gurvinder Singh Chief Executive Officer International Life Saving Federation Pune India Mr Kumar Bhatia Advisor International Life Sciences Institute New Delhi India Dr Tarek Meguid Member of the iERG Secretariat hosted by the World Health Organization Windhoek Namibia Mrs Melanie Galvin Regional Director Micronutrient Initiative New Delhi India

Framework Convention Alliance (FCA)

Indian Dental Association

International Council for Control of Iodine Deficiency Disorders (ICCIDD)

International Life Saving Federation (ILSF)

International Life Sciences Institute (ILSI)

Independent Expert Review Group (iERG)

Micronutrient Initiative (MI)

102

WHO REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

International Special Dietary Foods Industries (ISDI)

Mr Sanjay Khajuria Member International Special Dietary Foods Industrie Brussels Belgium Ms Anshu Gupta Member International Special Dietary Foods Industrie Brussels Belgium

Jhpiego

Dr Bulbul Sood Country Director Jhpiego New Delhi India Dr R K Srivastava(*) Chairman Medical Council of India New Delhi India Ms Leena Menghaney(*) Campaign Coordinator (India) MSF Access Campaign New Delhi India Dr Amit Sengupta(*) Associate Global Coordinator Peoples Health Movement New Delhi India Mr Abhilash Jacob Philip Senior Manager Population Services International New Delhi India Professor Jayantilal Satia Senior Vice President Public Health Foundation of India New Delhi India Ms Meena Sehgal Fellow TERI Tata Energy Research Institute New Delhi India

Medical Council of India (MCI)

Médecins Sans Frontières (MSF)

Peoples Health Movement (PHM)

Population Services International (PSI)

Public Health Foundation of India (PHFI)

Tata Energy Research Institute (TERI)

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103

International Clinical Epidemiology Network (The INCLEN Trust)

Professor Narendra K Arora Executive Director International Clinical Epidemiology Network New Delhi India Dr Archisman Mohapatra Senior Programme Officer International Clinical Epidemiology Network New Delhi India

Voluntary Health Association of India (VHAI)

Mr Alok Nath Mukhopadhyay Chief Executive Voluntary Health Association of India New Delhi India Professor Vasantha Padma Department of Neurology All India Institute of Medical Sciences New Delhi India Dr Rajesh Kumar(*) Executive Director Society for Promotion of Youth and Masses New Delhi India Mr Siddharth Sibal(*) Project Manager IMS Health New Delhi India

World Stroke Organisation (WSO)

Society for Promotion of Youth and Masses (SPYM)

IMS Health

________________ (*) did not attend

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Annex 8

List of official documents SEA/RC66/1 Rev.3 SEA/RC66/2 and Inf. Doc. Agenda Introduction to the Regional Director’s Annual Report on the Work of WHO in the South-East Asia Region covering the period 1 January–31 December 2012 Implementation of Programme Budget 2012–2013 Twelfth General Programme of Work (GPW) and Proposed Programme Budget 2014–2015

SEA/RC66/3 and Add.1

SEA/RC66/4, Inf. Doc.1, Inf. Doc.2, Inf. Doc.3 and Inf. Doc.4 SEA/RC66/5, Inf. Doc.1, Inf. Doc.2, Inf. Doc.3, Inf. Doc.4 and Inf. Doc.5 SEA/RC66/6

WHO reform: financing dialogue and Programme Budget 2016–2017

Consideration of the recommendations arising out of the Technical Discussions on Universal Health Coverage (UHC) Selection of a subject for the technical discussions to be held prior to the Sixty-seventh Session of the Regional Committee Implementation of the International Health Regulations (2005) Measles elimination and rubella control

SEA/RC66/7

SEA/RC66/8 Rev.1

SEA/RC66/9

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105

SEA/RC66/10 and Inf. Doc.

Regional Action Plan and Targets for Prevention and Control of Noncommunicable Diseases (2013–2020) Pandemic Influenza Preparedness Framework Progress report on malaria Challenges in polio eradication (SEA/RC60/R8) 2012: Year of Intensification of Routine Immunization in the South-East Asia Region: Framework for Increasing and Sustaining Coverage (SEA/RC64/R3) National Essential Drug Policy Including the Rational Use of Medicines (SEA/RC64/R5) Consultative Expert Working Group on Research and Development: Financing and Coordination (SEA/RC65/R3) Revision to the Rules of Procedure of the WHO Regional Committee for South-East Asia Important issues arising out of the Sixty-sixth World Health Assembly and the 132nd and 133rd sessions of the WHO Executive Board Review of the draft provisional agenda of the 134th Session of the WHO Executive Board UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases: Joint Coordinating Board (JCB) – Report on attendance at JCB in 2013

SEA/RC66/11 Rev.1 SEA/RC66/12 SEA/RC66/13 SEA/RC66/14

SEA/RC66/15

SEA/RC66/16

SEA/RC66/18

SEA/RC66/19

SEA/RC66/20

SEA/RC66/21

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SEA/RC66/22

UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP): Policy and Coordination Committee (PCC) – Report on attendance at PCC in 2013 and nomination of a member in place of Bhutan whose term expires on 31 December 2013 Time and place of future sessions of the Regional Committee List of Participants Draft Report of the Sixty-sixth Session of the WHO Regional Committee for South-East Asia List of Resolutions and Decisions List of official documents Report of Subcommittee on Credentials Report of the Sixty-sixth Session of the WHO Regional Committee for South-East Asia

SEA/RC66/23

SEA/RC66/24 Rev.3 SEA/RC66/25

SEA/RC65/26 SEA/RC66/27 SEA/RC66/28 SEA/RC66/29

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Annex 9

Text of introductory remarks on the Annual Report on the work of WHO in the South-East Asia Region by the Regional Director Mr Chairman, Please allow me to present my Annual Report on the work of WHO in South-East Asia Region covering the period from 1 January to 31 December 2012, inclusive. Since the full report (Document SEA/RC66/2) has already been distributed, I will only touch on some of its salient features. May I also refer you to the publication entitled “A Decade of Public Health Achievement in WHO’s South-East Asia Region”, which has been circulated separately for information purposes. It highlights our collaborative efforts over the past 10 years during which I have had the privilege of serving as Regional Director. Mr Chairman, Countries of our Region still face a significant burden of communicable diseases. However, steady progress is noted in reducing this burden. The Region continues to maintain its “leprosy elimination” status, with a prevalence rate of less than 1 per 10 000 population since 2010. In February 2012, India was removed from the global list of polio-endemic countries. The Region is now firmly on track for “polio-eradication certification” in February 2014. Intensified efforts for “routine immunization”, which started in 2012, are progressing well with all countries reaching at least 90% national coverage. Significant progress has been made in measles immunization with a reported 86% regional coverage. Five countries with 95% coverage are on track to achieve the “measles elimination” target in the next few years.

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The Region is aiming at eliminating HIV infections in children by 2015. In 2012, the estimated number of people living with HIV remained stable at 3.4 million. Due to improved access to antiretroviral treatment (ART), the number of people on ART has increased from 55 000 (5% coverage) in 2003 to 900 000 (49% coverage) in 2012. Estimated annual deaths from AIDS-related illnesses have dropped by 14% from 2005 to 2012. Tuberculosis (TB) prevalence was reduced by almost 40% between 1990 and 2012; however this progress remains threatened by coinfection with HIV. In 2011, there were 140 000 such cases in the Region, representing a prevalence rate of 7.7 per 100 000 population. The Region also recorded about 90 000 cases of multidrug resistant TB which, despite the figure being low, remains a cause for serious concern. The presence of artemisinin resistant malaria in Mekong Sub-region is a global concern that threatens global gains in malaria control. Some of the neglected tropical diseases, like lymphatic filariasis and yaws, are also targeted for elimination. Mr Chairman, Noncommunicable diseases (NCDs) are the leading cause of death in most countries of the Region. More than 60% of all deaths are due to NCDs, and the associated loss of productivity and premature death present major issues to social and economic development. In the Region, recognition of NCDs as a priority on the public health agenda is increasing. Countries are paying particular attention to strengthening their national health systems for sustainable NCD prevention and control. A wide range of environmental hazards continue to be major public health challenges in all countries of the Region. Around 19% of all cancers are attributed to environmental factors, particularly occupational exposure to chemicals and chemical contamination in the food chain. The inclusion of “household indoor air pollution” monitoring in the Regional Action Plan for Prevention and Control of Noncommunicable Diseases 2013–2020 indicates the recognition of further environmental dimension of NCDs. The Region accounted for 41% of global deaths from disasters during 2001–2010. Efforts continue to ensure country capacities in disaster risk management, preparedness and response. Since 2002, with WHO technical support, 135 health professionals have been trained in emergency management by the Asian Disaster Preparedness Center in Thailand.

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The Center for Health Crisis in the Ministry of Health, Indonesia was designated as a WHO Collaborating Centre in 2012. It is the first WHO Collaborating Centre which focuses its work on disaster “risk reduction”. The South-East Asia Regional Health Emergency Fund (SEARHEF), established in 2007, continues to provide essential financial back-up to countries during the acute phase of an emergency. Mr Chairman, The Region has recorded impressive progress on several indicators of health-related the Millennium Development Goals (MDGs). Three countries are approaching the reduction of maternal mortality ratio by half. Regionally, from 2005 to 2010, maternal death was reduced from 270 per 100 000 live births to 200. Alongside this achievement, the regional coverage by skilled birth attendants was 60% in 2010. Two countries have achieved a reduction of their infant mortality ratio by more than half. As of 2012, however, the Region’s prevalence rate of underweight children was 27.6%, which is much higher than the global average of 15.7%. Five countries have already achieved a reduction in malaria incidence by three quarters against the related MDG target. On certain health-related MDG indicators, however, countries with large populations have registered slow progress. As far as the development of national health systems is concerned, all countries in the Region are embarking on universal health coverage initiatives with the view to enhancing health gains, social cohesion and other aspects related to the quality of life. Access to essential medicines and rational use of medicines are still a serious concern. National situation analyses in the area of medicines are nearing completion, and the outcome of the analyses will be used to ensure effective promotion and rigorous enforcement of the rational use of medicines. Mr Chairman, The health workforce continues to be an important pillar of the functioning of national health systems. The countries are giving priority attention to strengthening community-based health cadre to provide health care at the community and grassroots levels. Medical and public health specialists are reoriented to ensure their effective back-up support to community and peripheral health work. Efforts have been made to improve the teaching of public health in medical schools. This exercise has been undertaken in partnership with the: • South-East Asia Public Health Education Institutions Network (SEAPHEIN); • South-East Asia Regional Association of Medical Education (SEARAME);

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• Regional Network of Medical Councils; • and several other health professional bodies. A module for innovative teaching of public health in medical schools is being finalized and tested under coordination of the WHO Collaborating Centre for Medical Education at Chulalongkorn University in Bangkok. The implementation of the current regional budget for 2012–2013 and the development of Programme Budget for 2014–2015 are in progress, with the full involvement of Member States. Programme Budget matters, including the financing dialogue, are agenda items for this Regional Committee session. Mr Chairman, I have endeavoured to implement the regional Programme Budget in the most transparent and accountable manner. In 2004 the Internal Review and Technical Assessment initiative was initiated and has continued till date. This internal mechanism is to help ensure such transparency and accountability. As far as WHO reform is concerned, the Regional Office has worked closely with headquarters in implementing various components of the reform. We very much appreciate the strong leadership role of the Director-General, Dr Margaret Chan, in providing us with efficient guidance and support in the implementation process. Excellencies, ladies and gentlemen, As this Regional Committee session will be my last, I would like to express my sincere appreciation to your Excellencies, distinguished representatives, Dr Margaret Chan, WHO Director-General; and all staff and colleagues at headquarters, regional and country offices, for their kind cooperation and generous support extended to me during my tenure as WHO Regional Director for South-East Asia. I overwhelmingly thank them all. And I thank you especially, Mr Chairman, for your kind attention. Thank you.

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Annex 10

Text of address by the DirectorGeneral, World Health Organization Mr Chairman, Excellencies, honourable ministers, distinguished delegates, Dr Samlee, colleagues in the UN family, ladies and gentlemen, I appreciate the very serious way this Region has responded to calls to move health systems towards universal coverage. This commitment is readily apparent in the recommendations arising from your technical discussions on universal health coverage. Countries in this Region have been staunch supporters of primary health care as the best way to improve health. The results have been outstanding, especially in your large populations of the poor. This experience gives the Region a head start, as universal coverage is firmly rooted in the principles and values of primary health care. Your ministries of health are experts at developing detailed national and subnational health plans, and then acting on them. You are now applying this expertise to define universal health coverage strategies that can work well, at low cost and in resourceconstrained settings. The technical discussions recommended a phase-wise approach to universal coverage, whereby the elimination of inequalities and inefficiencies is the initial focus. When the requisite systems and institutional capacities are in place, expansion of coverage can follow. This is a wise way forward. Financing expanded coverage is, of course, a major challenge. Moving towards universal health coverage means increasing access to essential medicines, vaccines, diagnostics, screening tests, and other interventions. It also requires systems for social protection, eventually shielding all citizens from impoverishment caused by health care costs. It is not cheap, but when well-planned and managed, it is affordable.

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Again wisely, the technical discussions were alert to sources of waste and inefficiency, and identified options for reducing them. In this way, reducing inefficiency and expanding coverage can work together as mutually reinforcing goals. This region knows its problems well. Out-of-pocket payments are the highest of any WHO region, accounting for more than 60% of total health expenditure. A large proportion of this expenditure goes to the purchase of medicines, which are priced higher than need be and are not being rationally used. Underpinning this problem are the limited capacities of national drug regulatory authorities and drug testing laboratories. The marketing and promotion of medicines also need better regulation, especially given their contribution to the overuse of medicines. For many doctors, the pharmaceutical industry is the principal source of prescribing information. The dominance of privately provided services is another problem. It is pushing the Region away from primary care and preventive services towards high-cost curative care using high-end technologies. Incentive schemes for provider payment, especially fee-forservice schemes, contribute to the over-provision of care and its escalating costs. This trend, in turn, is aggravated by the rise of chronic noncommunicable diseases and the Region’s growing population of the elderly, with their multiple chronic conditions and impairments. The Region’s large informal sector reduces the tax base and the number of people gaining health insurance through their employers. Systems for social protection are weak, further adding to the Region’s growing inequalities in income levels, opportunities, and health outcomes. You know these problems well. You have analysed their causes and possible solutions, and are addressing them. Commitment to universal health coverage boosts determination to solve these and other long-standing problems. For example, countries that have achieved universal coverage have reduced out-of-pocket payments to as little as 15% of total health expenditure. Your draft resolution on universal health coverage addresses the need for countries to conduct assessments of health technologies and interventions as a strategy for the more efficient use of resources. Again, reducing inefficiency increases the capacity to serve more people well.

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Universal health coverage brings important social dividends as well. In the absence of public spending policies that make equity an explicit objective, economic growth will not automatically give the poor a decent life. This point was underscored in last month’s report from the Asian Development Bank, on Ending Asian Deprivations. Economic growth alone will not end poverty, deprivation, and the misery of ill health. Policy choices, such as those embodied in universal health coverage, make the difference. Ladies and gentlemen, This Region knows its problems well, but it also knows its strengths. Your experts have concluded that measles elimination and rubella control by 2020 is an entirely feasible goal. You reached this consensus carefully. It is based on experiences in other WHO regions, but also on a detailed feasibility study. That study supported the goal as technically, biologically, and operationally feasible. The stage is set. Routine immunization is the foundation. The initiative to intensify routine immunization, launched last year, began a drive to expand coverage substantially, with a strong emphasis on hard-to-reach populations. Some countries engaged more staff. Others trained mid-level managers. Still others upgraded cold-chain facilities. A surveillance system is in place, using a network of 23 WHO-accredited measles laboratories equipped to study the virus at the genetic level. The vaccine is safe, effective, inexpensive, and available. In fact, this region manufactures more than 70% of UNICEF’s global measles vaccine supply. The South-East Asia Region can count on vaccine selfsufficiency. Reaching this ambitious goal will be a challenge, as greater than 95% immunization coverage is required. This high level of coverage pushes routine immunization to new heights of performance. You will need financial and other support from partners, and I am optimistic that this will come. The quality of your feasibility study builds confidence, and confidence inspires commitment. South-East Asia Region health experts have given equally careful attention to the regional action plan and targets for the prevention and control of noncommunicable diseases. As noted, the targets are ambitious for this Region.

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You have given these ambitions a reality check by assessing each of the nine voluntary targets against regional capacities to establish national surveillance and reporting systems. For some of the targets, good baseline data exist in every country in the Region. For others, few, if any, countries have systems for collecting the relevant data. Given the Region’s weak systems for civil and vital registration, mortality surveillance is inadequate everywhere. The key steps identified to improve the availability and use of data offer solutions that will benefit other health and development initiatives. We are all aware of the challenges that noncommunicable diseases create for health systems and the heavy burden they impose on financial and human resources. In many countries, a fundamental reorientation of the health system is needed. This region can be a model of how the prevention and control of noncommunicable diseases, and the monitoring of trends, can operate within the context of primary health care. Ladies and gentlemen, There is a final recent achievement that needs to be mentioned. All countries in this region have now completed a critical assessment of weaknesses in their national policies for essential medicines. This is a solid starting point for improving the regulatory control and rational use of medicines and other medical products. The exercise was described as an eye-opener, revealing the multiple dimensions of this long-standing problem, but also revealing opportunities to take corrective action. This work provides another strong foundation as countries continue to turn their commitment to universal health coverage into a reality. Doing so will benefit the health of all your citizens, and give even more of the poor a route towards a decent life. Thank you.

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The Regional Committee for South-East Asia is WHO's decision-making body in the South-East Asia Region. It meets in September every year to review progress and regional implications of the World Health Assembly resolutions, with representation from all 11 Member States of the Region. This report summarizes the discussions of the Sixty-sixth Session of the Regional Committee held in the Regional Office, New Delhi, India, from 11 to 13 September 2013. At this session, the Committee discussed a number of public health issues important to the Region, such as universal health coverage, noncommunicable diseases, measles elimination, polio eradication, rational use of medicines, financing of research and development, International Health Regulations, and the WHO reform process. It adopted a number of resolutions on these issues. The Committee also nominated Dr Poonam Khetrapal Singh as Regional Director for the Region from 1 February 2014.

World Health House Indraprastha Estate Mahatma Gandhi Marg New Delhi-110002, India

Key facts

Organisation World Health Organization (WHO)

Document type Governing Bodies documents

Adoption date December 31, 2013

Source World Health Organization