AFR/RC56/3 9 June 2006
REGIONAL COMMITTEE FOR AFRICA Fifty-sixth session Brazzaville, Republic of Congo, 6–9 June 2006 PROGRAMME SUBCOMMITTEE Provisional agenda item 8
ORIGINAL: ENGLISH
REPORT OF THE PROGRAMME SUBCOMMITTEE CONTENTS Paragraphs OPENING OF THE MEETING ..................................................................................................... 1–11 REGIONAL STRATEGIC PLAN FOR THE EXPANDED PROGRAMME ON IMMUNIZATION, 2006-2009 (document AFR/RC56/PSC/3) ............................................. 12–23 CHILD SURVIVAL: A STRATEGY FOR THE AFRICAN REGION (document AFR/RC56/PSC/9)....................................................................................................... 24–35 HIV PREVENTION IN THE AFRICAN REGION: A STRATEGY FOR RENEWAL AND ACCELERATION (document AFR/RC56/PSC/4)......................................... 36–45 POVERTY, TRADE AND HEALTH: AN EMERGING HEALTH DEVELOPMENT ISSUE (document AFR/RC56/PSC/5............................................................................................ 46–55 HEALTH FINANCING: A STRATEGY FOR THE AFRICAN REGION (document AFR/RC56/PSC/6) ...................................................................................................... 56–67 MEDICINES REGULATORY AUTHORITIES: CURRENT STATUS AND THE WAY FORWARD (document AFR/RC56/PSC/7) ....................................................................... 68–76 REVITALIZING HEALTH SERVICES USING THE PRIMARY HEALTH CARE APPROACH IN THE AFRICAN REGION (document AFR/RC56/PSC/8)................................ 77–87 AVIAN INFLUENZA: PREPAREDNESS AND RESPONSE TO THE THREAT OF A PANDEMIC (document AFR/RC56/PSC/11)..................................................................... 88–99 HEALTH RESEARCH: AGENDA FOR THE WHO AFRICAN REGION (document AFR/RC56/PSC/10)................................................................................................. 100–108
KNOWLEDGE MANAGEMENT IN THE WHO AFRICAN REGION: STRATEGIC DIRECTIONS (document AFR/RC56/PSC/12)................................................. 109–118 SICKLE-CELL DISEASE IN THE AFRICAN REGION: CURRENT SITUATION AND THE WAY FORWARD (document AFR/RC56/PSC/13)............................................... 119–126 OTHER MATTERS................................................................................................................... 127–131 ADOPTION OF THE REPORT OF THE PROGRAMME SUBCOMMITTEE (document AFR/RC56/PSC/14)......................................................................................................... 132 ASSIGNMENT OF RESPONSIBILITIES FOR THE PRESENTATION OF THE REPORT OF THE PROGRAMME SUBCOMMITTEE TO THE REGIONAL COMMITTEE ...................................................................................................... 133–134 CLOSURE OF THE MEETING ............................................................................................... 135–140 ANNEXES Page 1. List of participants ......................................................................................................................... 28 2. Agenda........................................................................................................................................... 29 3. Programme of work ....................................................................................................................... 30 DRAFT RESOLUTIONS AFR/RC56/WP/1 AFR/RC56/WP/2 AFR/RC56/WP/3 AFR/RC56/WP/4 AFR/RC56/WP/5 AFR/RC56/WP/6 AFR/RC56/WP/7 Regional strategic plan for the Expanded Programme on Immunization, 2006-2009 HIV prevention in the African Region: a strategy for renewal and acceleration Health financing: a strategy for the African Region Revitalizing health services using the primary health care approach in the African Region Child survival: a strategy for the African Region Avian influenza: preparedness and response to the threat of a pandemic Knowledge management in the WHO African Region: strategic directions
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OPENING OF THE MEETING 1. The Programme Subcommittee met in Brazzaville, Republic of Congo, from 6 to 9 June 2006.
2. The Regional Director, Dr Luis Gomes Sambo, welcomed the members of the Programme Subcommittee (PSC) and a member of the WHO Executive Board from the African Region. 3. The Regional Director then asked the participants of the meeting to observe a minute of silence in memory of the Director-General of WHO, Dr Lee Jong-wook, who passed away on 22 May 2006. He also informed members that the process of electing the next Director-General has already started, and the new Director-General is expected to be elected on 9 November 2006. 4. The Regional Director then reminded the Programme Subcommittee members of their important functions in preparing the deliberations of the WHO Regional Committee for Africa. He pointed out three main functions of the PSC: reviewing regional health priorities and strategies in order to ensure that they are relevant to regional and country priorities; considering managerial issues and suggesting ways for improvement; and advising the Regional Director on important public health issues in the Region. Recognizing the importance of the agenda items tabled for discussion as well as the expertise and experience of members of the Programme Subcommittee, he wished the Subcommittee successful deliberations. 5. After the introduction of the members of the Programme Subcommittee and the directors of divisions at the Regional Office, the bureau was constituted as follows: Chairman: Vice-Chairman: Rapporteurs: Dr Shehu Sule (Nigeria) Dr Potougnima Tchamdja (Togo) Dr Jose Manuel Jesus Alves de Sousa Carvalho (Sao Tome & Principe) Dr Babacar Drame (Senegal) Dr Prince Albert T. Roberts (Sierra Leone). 6. The list of participants is attached as Annex 1.
7. The Chairperson thanked the Members of the Subcommittee for the confidence placed in him on behalf of his country and underlined the timeliness of the subjects chosen for discussion. He highlighted the weakness of health systems as an important public health challenge as well as the need to strengthen, monitor and evaluate programmes. 8. The agenda (Annex 2) and the programme of work (Annex 3) were discussed. It was proposed to change agenda item number 13 (on knowledge management) to agenda item 12, following item 11, which deals with health research. The proposal was accepted. 9. Proposals were also made to include discussions on the WHO Medium-Term Strategic Plan (2008–2013) and noncommunicable diseases as additional agenda items. A clarification was given that the formulation of the Medium-Term Strategic Plan was still in progress at the global level. Therefore the document was not ready for Programme Subcommittee discussion. The decision was
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made to distribute the document to PSC members for their information. The final version of the document will be available to members for their comments before the fifty-sixth session of the Regional Committee. 10. Recognizing the importance of noncommunicable diseases, the Secretariat informed members that the agenda already included sickle-cell disease, and that the previous Regional Committee session discussed cardiovascular diseases. There is also a plan to discuss diabetes mellitus during the fifty-seventh session of the Regional Committee. 11. The agenda was adopted with the proposed amendments as stated above. The following working hours were then agreed upon: 9 a.m. – 12.30 p.m., including a 30-minute coffee break 12.30 p.m. – 2 p.m. for lunch break 2 p.m. – 5 p.m. REGIONAL STRATEGIC PLAN FOR THE EXPANDED PROGRAMME ON IMMUNIZATION 2006–2009 (document AFR/RC56/PSC/3) 12. Dr James N. Mwanzia of the Secretariat introduced the regional strategic plan for the expanded programme on immunization. It consisted of an introduction, situation analysis, objectives, targets, guiding principles, priority interventions, roles and responsibilities, monitoring, and evaluation, and conclusion. 13. The document reported that vaccine-preventable diseases still accounted for a high burden of childhood morbidity and mortality in the African Region. The Fifty-eighth World Health Assembly approved the Global Immunization Vision and Strategy 2006–2015. The Regional Strategic Plan for the Expanded Programme on Immunization 2006–2009 aimed to improve performance of national EPI programmes, strengthen national health systems and contribute to the attainment of Millennium Development Goal number 4. 14. Diphtheria-pertussis-tetanus (DPT3) coverage in the African Region increased from 54% in 1995 to 69% in 2005. Only one country in the Region remained polio-endemic. There was approximately 60% decline in measles mortality in 2005 compared to 1999, and 16 countries had eliminated maternal and neonatal tetanus. In the African Region, 23 countries had included yellow fever vaccine in their routine immunization programmes. Only eight countries had introduced Haemophilus influenzae type b vaccine. In spite of the progress made, about 8 million African children were not fully immunized by the end of 2004. 15. The goal of the regional EPI strategic plan was to prevent mortality, morbidity and disability from vaccine-preventable diseases. Specific objectives were to strengthen district-based immunization programmes for improved access and utilization of services; to accelerate efforts to eradicate polio, control measles, eliminate maternal and neonatal tetanus and control yellow fever; to promote innovations, including vaccine research and the introduction of new and underutilized vaccines; to improve vaccine, immunization and injection safety; and to systematize access to integrated services and maximize benefits to mothers and children attending immunization sessions.
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16. The strategic plan had nine targets, namely: at least 80% of countries will attain 90% DPT3 coverage at national level; at least 80% of countries will attain 80% DPT3 in all districts; no wild poliovirus associated with acute flaccid paralysis; at least 90% reduction in measles mortality; at least 80% of countries will eliminate maternal and neonatal tetanus; routine yellow fever vaccination coverage of at least 80% in countries at risk; all countries will have introduced hepatitis B vaccine into their national programmes; all countries will have adopted auto-disable syringes or an equally safe injection technology for all immunization injections; at least 80% of countries will have integrated additional child survival interventions with immunization. 17. Countries needed to implement the following priority interventions in order to achieve the above mentioned targets and sustain the gains: maximize access to immunization through the Reach Every District (RED) approach; build relevant capacities and strengthen community participation; put into place supplemental immunization activities; use evidence-based policies to guide the introduction of vaccines in the EPI programme; ensure vaccine, immunization and injection safety; integrate EPI with other child survival interventions. 18. The roles and responsibilities of countries included: development of comprehensive multi-year EPI plans; enhancement of multisectoral collaboration and partnerships; promotion of training, recruitment and retention of health workers; provision of financial resources for immunization; review and updating of national EPI policies and guidelines. WHO and partners will back up countries by advocating among policy-makers and international partners; providing technical, financial and material support for priority activities; and strengthening coordination and partnerships. 19. Despite recent progress in EPI in countries of the African Region, significant numbers of children were only partially immunized or not immunized. More progress was required in the African Region if global and regional EPI targets were to be met. 20. Members of the Programme Subcommittee made the following general comments for improving the document: (a) (b) (c) Add a small section on financing of the strategic plan and advocate strongly for governments to progressively take over financing of EPI for sustainability; In the Portuguese version, replace DTT3 with DPT3, in the entire document; There was need to highlight the importance of planning at the district level with the involvement of communities, and the document should emphasize the need for advocacy to scale up the RED approach; EPI should complement the child survival strategy through an integrated approach.
(d)
21. The following were specific changes to the document proposed by the Programme Subcommittee: (a) In the Executive Summary, there was need to highlight the sector-wide constraints: political, financial, infrastructure and equipment. Furthermore, there was need to build or strengthen monitoring and evaluation systems, and management and retention of human resources for health; In the French version, the years in paragraph 3 should read: “2006-2009”;
(b)
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(c)
In the Situation Analysis: (i) point out the lessons learnt from the implementation of the previous strategic plan for EPI; (ii) take into account the fact that sustainability of EPI gains are dependent on cultural factors and active community involvement; (iii) in the French version, paragraph 6, remove “d’entre eux” and replace with “est d’un seul pays en 2000 à 37 en 2004”; (iv) in paragraph 4, highlight the disparities between and within countries; (v) in paragraph 5, separate the epidemiological aspects from new vaccines, and enrich it with epidemiological data for other vaccine-preventable diseases; In Objectives: (i) mention the need for strengthening case-based surveillance as a means for monitoring; (ii) in the Portuguese version, paragraph 1, after the words “tendo havido” replace the word “quebra” with “reduçao”; (iii) add a new objective to read: “(f) to support countries in sustaining the achieved level of immunization coverage”; (iv) in 10(d) separate “vaccine management” from “immunization safety” and give prominence to vaccine management; (v) there is need for coherence between objective 10(e) and the situation analysis; In Targets: (i) add a target for Haemophilus influenzae; (ii) in paragraph 11(d), indicate the mortality situation in 1999; (iii) in paragraph 11(i) be more specific in terms of other child survival interventions; In Priority Interventions: (i) in paragraph 18, insert the words “vaccine-preventable” after the word “accelerate”; (ii) in paragraph 20, Portuguese version, after the word “gestao” replace the word “vicinal” with “de vacina” and in the second line replace the word “das” with “de” after “desenvolvimento”; (iii) in paragraph 21, add the contribution of the private sector in the expansion of the immunization coverage; In Roles and Responsibilities: (i) in paragraph 22(d), replace the word “provide” with “increase”; (ii) in paragraph 23, add “(d) continue providing leadership and stewardship in EPI (especially WHO)”; and “(e) sustain the achieved coverage of EPI”; In Monitoring and Evaluation, adjust the duration of evaluations to 2 years. There is need to add indicators related to integration of EPI with other priority programmes.
(d)
(e)
(f)
(g)
(h)
22. The Secretariat thanked members of the Programme Subcommittee for their comments and suggestions that would be used to enrich and finalize the document for the fifty-sixth session of the Regional Committee. The Regional Director underlined the pertinent inputs provided by the Subcommittee members and underscored the need to mention the lessons learnt in the situation analysis and to add a section on financing the strategic plan. He clarified that the objectives and targets in the document were related to Member States and the role of WHO was to provide support. He highlighted that governments should play a greater role in the procurement of vaccines. He acknowledged that harmonization of priority programmes at the local level was critically important. 23. The Subcommittee recommended the document with amendments and prepared a draft resolution (AFR/RC56/WP/1) on the subject to be submitted to the Regional Committee for adoption. CHILD SURVIVAL: A STRATEGY FOR THE AFRICAN REGION (document AFR/RC56/PSC/9) 24. Dr Tigest Ketsela of the Secretariat introduced the document “Child survival: A strategy for the African Region”. It consisted of introduction, situation analysis, the regional strategy (objectives,
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guiding principles, strategic approaches, priority interventions, implementation framework, roles and responsibilities, monitoring and evaluation) and conclusion. 25. The document defined child survival and provided an overview of disease and death burdens in children under five years of age; international treaties and conventions on the inherent right to life; the Millennium Development Goals (especially numbers 1, 4 and 5); existence of cost-effective interventions; and regional charters, strategies and declarations. 26. It further reported that the African Region experienced a 6% decline in child mortality in the decade 1990 to 2000. Infectious diseases were the main causes of mortality. Poverty, socioeconomic conditions, cultural factors and malnutrition also played major roles in child morbidity and mortality. Cost-effective interventions to reduce the burden of disease were available; Integrated Management of Childhood Illness was a major successful strategy for delivering these interventions, but it needed to be implemented using a life-course approach. 27. The goal of the strategy was to reduce neonatal and child mortality in line with Millennium Development Goal number 4 by achieving a high coverage of a defined set of effective interventions. The document proposed a number of strategic approaches: advocacy for harmonization of child survival goals and agendas; strengthening of health systems; empowering families and communities; organizing operational partnerships to fully implement promising interventions, with governments in the lead; and mobilization of resources. 28. The proposed priority interventions included newborn care; infant and young child feeding, including micronutrient supplementation and deworming; prevention and prompt treatment of malaria; immunization; prevention of mother-to-child transmission of HIV; management of common childhood illnesses; and care of children exposed to or infected with HIV. The document also provided an implementation framework. 29. In order to implement the proposed priority interventions, countries will need to develop policies, strategies and relevant capacities, including social mobilization. WHO and partners will complement countries’ efforts through advocacy, technical support and coordination. 30. The child survival strategy reflected a comprehensive life-course approach to child survival, growth and development. Because children represent the future of Africa, there was urgent need for strong commitment to prioritize and accelerate the implementation of available cost-effective interventions at high levels of population coverage. 31. Members of the Programme Subcommittee commended the Secretariat for a well-structured document. They made the following general comments for improving it: (a) (b) (c) Although poverty and other social determinants were mentioned in the document, it was better to emphasize poverty, education and hunger; Continuum of care and the integration of child and maternal health services were important to ensure the efficiency and effectiveness of services; It was important to address the issue of how to organize the structure of the ministries of health and health delivery systems to promote integration and continuum of care.
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32. The following were specific amendments to the document proposed by the Programme Subcommittee: (a) (b) In the Introduction, paragraph 7, include the December 2005 Child Survival meeting held in London; In the Regional Strategy: (i) Objective, change “reduce” to “accelerate the reduction of”; (ii) in Guiding principles, paragraph 21(f), include a statement that partnerships can contribute to sustainability of interventions; (iii) in Strategic approaches, paragraph 22(c), also consider including prevention of HIV, improved water supply, sanitation and hygiene, which are addressed as components of the community IMCI; in paragraph 22(e), add a statement on the integrated use of resources for child survival; (iv) in Essential package of services, paragraph 27, consider immunization services as an entry point to postnatal care; (v) in Implementation framework, French version, in paragraph 30(b), replace accoucheuses et accoucheur with sages femmes ou maïeuticien; and add community health workers; in paragraph 31(b), include emergency obstetric care as part of the expanded package; in the Portuguese version, paragraph 31 should be revised to accurately reflect the original; In Roles and Responsibilities: in paragraph 33, consider inclusion of exchange of experiences between countries; in paragraph 33(a), add “scaling up of interventions” at the end; in paragraphs 33(e) and 34(d), consider omitting “operational”; In Monitoring and evaluation, paragraph 35, consider inclusion of a timeline for evaluations (e.g. every two years).
(c)
(d)
33. The Secretariat thanked members of the Programme Subcommittee for their comments and suggestions. It was stated that the suggested changes would be taken into consideration when finalizing the document for the fifty-sixth session of the Regional Committee. Clarification was also provided on the title which was limited to child survival because the document deals with child mortality and that was also agreed upon by WHO and partners. 34. The Secretariat also informed the participants that the document was developed in partnership with UNICEF, and accepted by the World Bank. The next step was for countries to discuss, adopt and own this strategy. 35. The Subcommittee recommended the document with amendments and prepared a draft resolution (AFR/RC56/WP/5) on the subject to be submitted to the Regional Committee for adoption. HIV PREVENTION IN THE AFRICAN REGION: A STRATEGY FOR RENEWAL AND ACCELERATION (document AFR/RC56/PSC/4) 36. Dr Antoine Kabore of the Secretariat introduced the paper entitled “HIV prevention in the African Region: a strategy for renewal and acceleration”. It consisted of an introduction, situation analysis, objectives, guiding principles, strategic approaches, roles and responsibilities, monitoring and evaluation, and conclusion. 37. In 1996, the WHO Regional Committee for Africa adopted a regional strategy on HIV which reaffirmed the major role of the health sector in HIV prevention. Despite resources and efforts
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invested in HIV prevention, treatment and care, there was a rising trend in HIV incidence; consequently, Millennium Development Goal number 6 was unlikely to be met. The need to increase measures to control further spread of HIV led to the adoption of a resolution to accelerate HIV prevention. Current global initiatives and commitments provided an enabling environment to scale up HIV prevention efforts in the Region. The strategy document proposed key interventions and actions for accelerating the prevention of HIV. 38. The strategy document stated that about 3.2 million (65%) of the global 4.9 million new HIV infections in 2005 occurred in sub-Saharan Africa. Coverage for HIV prevention services remained low: voluntary counselling and testing was 7%, and prevention of mother-to-child transmission was 5%. High-risk behaviour was still prevalent: condom use with high-risk partners was only about 20%. Efforts to accelerate HIV prevention and move towards universal access to prevention, treatment and care were still facing numerous challenges. However, several opportunities existed for scaling up comprehensive interventions for HIV prevention and control. 39. The general objective of the new HIV prevention strategy was to accelerate prevention and reduce the impact of HIV/AIDS in the context of universal access to prevention, treatment, care and support. The specific objectives were to increase access to HIV prevention interventions; increase access to comprehensive HIV/AIDS services; advocate for increased resources; and improve environments that support HIV prevention. Efforts to achieve these objectives should be guided by the following principles: human rights approach, adaptation of proven interventions, linkages between prevention and treatment, community participation, the “Three Ones” principle, and sustainability and accountability. 40. The document proposed a number of strategic approaches, namely: creating an enabling policy environment; expanding and intensifying effective HIV prevention interventions; linking HIV/AIDS prevention, treatment, care and support in an essential package; increasing access by scaling up implementation and adopting a national simplified public health approach; strengthening health systems to meet increasing demand; and increasing and sustaining financial resources. 41. Countries will develop plans; mobilize resources for implementation, monitoring and evaluation; and ensure coordination of partners. WHO and other partners will provide technical support and normative guidance to countries and reinforce their capacities for planning, implementation and resource mobilization. Adaptation and implementation of an effective strategy for renewal and acceleration of HIV prevention, as outlined in the draft document, will contribute to reducing significantly the incidence, morbidity and mortality of HIV/AIDS in the Region. 42. Members of the Programme Subcommittee recalled the current trends in HIV/AIDS epidemic and the interventions implemented in their countries. They commended the document for its comprehensiveness, pertinence, timeliness and quality; however, they made general comments about the need to look beyond the health sector on activities related to HIV/AIDS prevention, and to clearly state the leadership role of the ministries of health in HIV prevention. 43. The following were specific amendments to the document proposed by the Programme Subcommittee: (a) In paragraph 2, replace the term rethink with reshape;
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(b) (c) (d) (e)
In paragraph 8, introduce the range of HIV prevalence after the overall prevalence of 7.2%; Paragraph 11(a) should be more specific, taking into account the issues raised in paragraph 16; Paragraph 11(f) should include the coordination of partnerships for effective utilization of resources made available by partners; In Objectives: there was a need to separate objectives from targets which also should be more realistic, measurable and evidence-based; the scope of the specific objectives in terms of access or use should be clarified; Consider adding to paragraph 13(a), “routine counselling and testing, i.e. for TB patients”; Guiding principles: in paragraph 14(a), consider adding, “criminalization of conscious transmission of HIV and sexual violence, against children and during conflicts”; Strategic approaches: in paragraph 16, take into consideration the proposal made above for paragraph 14(a); Paragraph 22 needed to be gender-balanced reflecting men; add a sentence linking prenatal care, postnatal care and PMTCT; Paragraph 25 should include use of condoms (including female condoms) by commercial sex workers and their clients; promotion of condom use should be throughout the society rather than the health sector only; In paragraph 39, delete the second sentence about user fees but retain the footnote (14); Roles and Responsibilities: emphasize the stewardship, leadership and coordinating roles of government; ministries of health should provide technical guidance within the framework of intersectoral collaboration;
(f) (g) (h) (i) (j)
(k) (l)
(m) Conclusion: in paragraph 46, add the words care and support after treatment in the last sentence; (n) The Executive Summary needs to reflect inadequate enabling policy environment.
44. The Secretariat thanked members of the Programme Subcommittee for their valuable comments and suggestions that would be used to further improve the quality of the document for the fifty-sixth session of the Regional Committee. Various issues raised during the discussion were clarified. It was explained that paragraph 4 referred to universal access to prevention, treatment, care and support for all people in need by 2010. In addition, the basis for setting the proposed targets derived from the Gleneagles commitment, United Nations General Assembly Special Session and Millennium Development Goals. The Secretariat expressed optimism about the possibility of attaining the set targets because of positive past experience but added that it was subject to availability of resources. On the issue of criminalization of conscious transmission of HIV, they drew attention to the need for careful discussion based on existing legal frameworks in countries. 45. The Subcommittee recommended the document as amended and prepared a draft resolution (AFR/RC56/WP/2) on the subject to be submitted to the Regional Committee for adoption.
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POVERTY, TRADE AND HEALTH: AN EMERGING HEALTH DEVELOPMENT ISSUE (document AFR/RC56/PSC/5) 46. Dr Chris N. Mwikisa of the Secretariat introduced the document on poverty, trade and health. It consisted of an introduction, situation analysis, the way forward and conclusion. 47. The document underscored that health, trade and development were interrelated through human capital and labour productivity. Trade liberalization was a key challenge to overall development and poverty reduction efforts and was now a major challenge for country health sectors. The General Agreement on Trade in Services (GATS) called on World Trade Organization Member countries to progressively liberalize trade in services, including health-related services. There was need for greater understanding of the implications of the increased trade in health services, especially with regard to social and development objectives. 48. GATS defined four modes of trade in health services: cross-border delivery of health services; consumption of health services abroad; commercial presence; and movement of health personnel. Three other World Trade Organization multilateral trade agreements had implications for health: Trade-Related Aspects of Intellectual Property Rights (TRIPS); Application of Sanitary and Phytosanitary Measures (SPS); and Technical Barriers to Trade (TBT). 49. The information on trade in health services in the African Region was scanty. However, anecdotal evidence suggests that all four GATS modes existed. Trade in health services can impact positively or negatively on social and health development. Ministries of health needed to accurately assess the risks and opportunities for human health and development posed by the increasing openness of health services under GATS. Unfortunately, most ministries of health in the Region were not able to respond adequately to trade-related issues. The document also discussed the health opportunities and risks of increased trade in health services. 50. In order to mitigate the risks and take advantage of the increased trade in health services, countries needed to: establish or strengthen mechanisms for harmonization of trade issues; provide relevant training or orientation to all senior and middle-level administrators in the health, trade and legislation sectors; and identify and promote the work of regional and national centres of excellence on globalization, trade and health. WHO and partners should ensure that health was taken into account when international trade policies were framed; continue providing relevant information and advice to Member States regarding health and trade; and support the strengthening of relevant national capacities. 51. The document concluded that trade in health services offered opportunities to countries. However, there were associated risks. Countries should strive to take advantage of the emerging global opportunities while at the same time mitigate against the adverse effects. Countries would do this only if they fully appreciated the potential effects of multilateral trade agreements, particularly those relating to health.
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52. Members of the Programme Subcommittee welcomed the document as relevant, timely and well-structured. They made the following general comments for improving the document: (a) (b) (c) The issue of poverty in the context of globalization and liberalization of trade in health services needed to be emphasized in the document; There was a need to ensure that the document was not giving the impression that it was anti-liberalization or anti-globalization; Include clear orientations for Member States on how they can organize themselves regionally or subregionally to better benefit from the opportunities and tackle the challenges of liberalization of trade in health services.
53. The document was discussed section by section and the following were specific amendments proposed by the Programme Subcommittee: (a) In the Introduction, paragraph 2, there was a need to qualify the statement on the cost of medical treatment impoverishing families by specifying its impact, especially on the poor and those without health insurance; In the Situation Analysis: (i) in paragraph 5, make sure that the first sentence on the trend of poverty in the Region is factual; (ii) there is a need to be more explicit about the role of existing regional and subregional treaties on trade in health services; (iii) in paragraph 8, include more details on the TRIPS, SPS and GATS agreements; In the Way Forward, paragraph 15, include “to take advantage of opportunities offered by liberalization and” after the word “strategically”, and insert a new statement as (a) “form or strengthen regional cooperation frameworks or agreements that take advantage of the opportunities offered by liberalization”; In the Title, after an extensive discussion on whether to omit the word poverty, it was agreed to keep the title as it was approved at the fifty-fifth session of the Regional Committee and to ensure that poverty was adequately covered in the document; In the Executive Summary, there was a need to reflect the improvements proposed by the Programme Subcommittee.
(b)
(c)
(d)
(e)
54. The Secretariat thanked members of the Programme Subcommittee for their comments and suggestions that would be used to finalize the document for the fifty-sixth session of the Regional Committee. More specifically, the issue of poverty would be emphasized in the revised version. The Secretariat also clarified that the key message of the document was to inform countries about the need to address public health issues in the context of increased trade in health services. 55. The Subcommittee recommended the revised document to be submitted to the Regional Committee for approval. HEALTH FINANCING: A STRATEGY FOR THE AFRICAN REGION (document AFR/RC56/PSC/6) 56. Dr Alimata J. Diarra-Nama of the Secretariat presented an overview of the regional strategy for health financing. It consisted of an introduction, situation analysis, the regional strategy, roles and responsibilities, monitoring and evaluation, and conclusion.
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57. The paper stated that the manner in which a health system was financed affected its stewardship, input creation, service provision and achievement of goals such as good health, responsiveness to people’s non-medical expectations and fair financial contributions. 58. Countries were confronted with a number of challenges, including: low investment in health, dearth of comprehensive health financing policies and strategic plans, extensive out-of-pocket payments, limited coverage by health insurance, lack of social safety nets to protect the poor, inefficient resource use, and weak mechanisms for coordinating partner support in the health sector. 59. The objective of the strategy was to foster development of equitable, efficient and sustainable national health financing to achieve the health Millennium Development Goals (MDGs) and other national health goals. Specifically, the document provided guidance to countries on how to secure the level of funding needed to achieve desired health goals and objectives in a sustainable manner; ensure equitable financial access to quality health services; and ensure efficiency in the allocation and use of health sector resources. 60. The document proposed priority interventions for strengthening the health financing functions of revenue collection, pooling and purchasing of services. Some of the interventions for strengthening revenue collection included: strengthening revenue collection mechanisms; honouring past regional commitments; monitoring multi-donor budgetary support; managing removal or reduction of out-of-pocket payments; and improving efficiency in revenue collection. Pooling can be enhanced through development of prepayment systems (i.e. insurance, tax-based or a mix), establishment of new health financing agencies for coordination of various financing functions, and strengthening safety nets (exemption mechanisms) to protect the poor. 61. The paper suggested that the purchasing function can be reinforced by financing the strengthening of health systems, using priority disease (e.g. HIV/AIDS, malaria, tuberculosis) resources to strengthen health systems, contracting the private sector and nongovernmental organizations, reforming provider payment mechanisms, and improving health sector coordination mechanisms (e.g. sector-wide approaches). 62. In order to reach the MDGs, meet national health development objectives and expand coverage of health services, countries in the African Region urgently needed increased funding; greater equity in financing and access to health services; and improved efficiency in the use of health resources. 63. Members of the Programme Subcommittee made the following general comments for improving the document: (a) There was a need to highlight the difficulty of the ministries of health in influencing the change in countries with regard to health financing mechanisms because budgeting decisions are centralized in ministries of finance; The paper should highlight the lessons learnt from the previous health financing initiatives in the Region and their comparative advantages; The issue was not user fees per se but contributions according to an individual’s ability to pay; Explicitly link the level of financing to health systems performance through research;
(b) (c) (d)
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(e)
Mention the need to support countries to build or strengthen health insurance systems, ensuring community participation; create prepayment systems to take the Region beyond the Bamako Initiative; and highlight the importance of public expenditure review or national health accounts.
64. The following were specific amendments to the document proposed by the Programme Subcommittee: (a) (b) In the Introduction: paragraph 2, French version, after the word “dépend” introduce “entre autres de sa capacité”; Under Situation Analysis: (i) paragraph 13, French version, replace the words “piètre qualité des services de santé publics” with “qualité insuffisante des services de santé publics”; (ii) French version, paragraph 14, last line, replace the “mécanismes de paiement des établissements” by “mécanismes de paiement au niveau des établissements publics”; replace “dissuadesaient” with “dissuadent”; Under Objectives, paragraph 16, French version, replace the word “system” with “mécanismes”; In paragraph 21, add the “need to consider tax-related mechanisms for mobilizing additional resources for health, including earmarked taxes from alcohol and tobacco”; In paragraph 26, rephrase the first sentence to read as follows: “Countries should introduce or expand prepayment systems, for example, funds collected through taxes or insurance contributions”; In paragraph 27, first sentence, remove the contents in brackets; In paragraph 28, rephrase the paragraph in order to capture the spirit of protecting the poor, without putting emphasis on free services; In paragraph 29, add something on costing of services before allocation of resources; In paragraph 31, in the last sentence, replace the word “from” with “to”; Under paragraph 36(g), insert the word “stewardship” after the word “sector” and consider removing the word “corruption”; In paragraph 36(k), after the words “health financing” include the words “including costing”; In paragraph 37, end the second sentence with the word “countries”, and remove the rest of the sentence;
(c) (d) (e)
(f) (g) (h) (i) (j) (k) (l)
(m) In paragraph 38(b), French version, replace the word “devraient” with “doivent”; in all versions, paragraph 38(b) should stop at the word “objectives”; (n) (o) Paragraph 38(c) should read: “Ensuring that the donation commitments made at various international forums are fulfilled, including commitments made in the Paris Declaration”; Under Monitoring and Evaluation, in paragraph 40, after the word “should” add “conduct regular national health accounts exercises”; in paragraph 41, mention the need to monitor every three years; In the Executive Summary, paragraph 1, explain the meaning of “responsiveness to nonmedical expectations” and “fairness in financing contributions”; in paragraph 2, French
(p)
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version, replace the words “nombre de sérieux défis” with “nombre de défis majeurs”; add a sentence at the end of paragraph 3 reading: “Countries are urged to institutionalize national health accounts to facilitate planning, monitoring and evaluation”; include national health accounts; in paragraph 4, French version, replace the word “system” with “mecanismes”. 65. The Secretariat thanked members of the Programme Subcommittee for their comments and suggestions that would be used to finalize the document for the fifty-sixth session of the Regional Committee. 66. The Regional Director thanked members for the rich debate. He said that even though the subject is not new, we recognize the need for developing a comprehensive strategy. He informed the Programme Subcommittee that the current strategy has been developed in close collaboration with the regional economic communities, the World Bank, ILO and UNICEF to create a good environment for implementation. He recognized that the Region needs to move a step further in terms of health financing from systems dominated by direct out-of-pocket payments to prepaid mechanisms. He explained that the Heads of State target of allocating 15% of national budgets to health and the Commission on Macroeconomics and Health (CMH) recommendation to spend a minimum of US$ 34 per person were not conflicting but complementary. He said that even if all the countries achieved the Abuja target, they might not have followed the CMH recommendation. He underscored the relevance of national health accounts in the health financing reform process. He said that since this document is not a blueprint, it should have flexibility regarding “Establishing new health financing agencies” and “Strengthening safety nets to protect the poor”. 67. The Subcommittee recommended the document with amendments and prepared a draft resolution (AFR/RC56/WP/3) on the subject to be submitted to the Regional Committee for adoption. MEDICINES REGULATORY AUTHORITIES: CURRENT STATUS AND THE WAY FORWARD (document AFR/RC56/PSC/7) 68. Dr Alimata J. Diarra-Nama of the Secretariat presented an overview of the document on medicines regulatory authorities. It consisted of introduction, current status, the way forward and conclusion. 69. The paper said that the mission of medicines regulatory authorities (MRAs) was to coordinate and oversee the medicine sector in order to protect public health. MRAs had administrative elements (including mission, policy, legislation, regulations, organizational structure, human resources, financing), technical elements (including standards, specifications, guidelines, norms, procedures) and verification elements. Their main functions were licensing of persons and companies; marketing authorization (registration); authorization of clinical trials; inspection of manufacturers, distribution and clinical trial sites; monitoring quality and safety of products; and information and control of promotion and advertising. 70. The objective of the document was to review the current status of MRAs; review the regulation of medicines, including vaccines and narcotic medicines; and propose the way forward to enhance the performance of MRAs in the African Region.
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71. The document recommended a number of priority actions that countries needed to implement in order to reinforce medicines regulatory authorities. The first action concerned development of legal and organizational frameworks. These would provide a clear mission and adequate legal authority for MRAs; develop and enforce comprehensive legislation in accordance with national and regional contexts; and put in place appropriate organizational structure, facilities and resources. Secondly, strengthening MRA capacities should be preceded by development of a sustainable human resources development plan. The third action was to carry out regulatory functions. This included developing and updating guidelines and procedures related to regulatory functions; cooperating with academic, health-care and research institutions and professional associations; creating and strengthening MRA network and subregional initiatives for harmonization of medicines regulation; achieving a balance between regulatory requirements for control of narcotics and their availability and accessibility. 72. With globalization and the rapidly-increasing high-tech medicines, issues of quality, efficacy and safety of medicines were of great concern for Member States and WHO. Thus, Member States should establish or strengthen medicines regulatory authorities to enable them to carry out their missions. 73. Members of the Programme Subcommittee welcomed the paper and commended the relevance, conciseness and clarity of the document. The following general comments were made to improve it: (a) (b) The role of MRAs in traditional medicine was missing; Considering the centrality of medicines within the health sector and their financial and economic importance, there was a need for the document to be more precise about the autonomy and composition of the MRAs, including their multisectoral nature; Involvement of the veterinary sector in the MRAs; The importance of enforcement of laws and regulations was stressed; Clarification was sought on the definition of traditional medicine as it related to the location of production and use.
(c) (d) (e)
74. The following were specific amendments to the document proposed by the Programme Subcommittee: (a) (b) (c) (d) (e) (f) In paragraph 1, the last sentence should be revised to include traditional medicine: “set up a system of medicine regulation, including traditional medicine, and”; In paragraph 17, add “establish or” before strengthen; The subhead preceding paragraph 18 should read “Institutional and organizational framework”; Paragraph 19 should discuss the issue of autonomy of the MRAs; Paragraph 29 should include “encourage regional collaboration”; The Executive Summary should reflect traditional medicines.
75. The Secretariat thanked members of the Programme Subcommittee for their comments and suggestions that would be used to finalize the document for the fifty-sixth session of the Regional
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Committee. Clarification was provided on the definition and categorization of traditional medicines. As regards the level of autonomy, composition and operational mechanisms of MRAs, the Secretariat drew the attention of members to the importance of adapting to the national context while ensuring that the mission of MRAs is met. WHO will continue to provide the appropriate support to countries. 76. The Subcommittee recommended the document with amendments to be submitted to the Regional Committee for approval. REVITALIZING HEALTH SERVICES USING THE PRIMARY HEALTH CARE APPROACH IN THE AFRICAN REGION (document AFR/RC56/PSC/8) 77. Dr Alimata J. Diarra-Nama of the Secretariat introduced the document on revitalizing health services using the primary health care approach. It consisted of an introduction, situation analysis, approaches to revitalizing health services, roles and responsibilities, monitoring and evaluation, and conclusion. 78. The document recalled that currently there was global commitment concerning internationallyagreed health-related goals. However, the slow progress in achieving these goals in the African Region called for accelerated access to essential health services. The World Health Assembly in 1998 reaffirmed their commitment to improving the availability of essential elements of primary health care through the health-for-all policy for the 21st century. The document argued that primary health care, adapted to current and anticipated environments, offered a good framework for universal access to essential health services. 79. The challenges that will confront countries attempting to revitalize their health services included increasing access to essential health interventions and strengthening coordination and collaboration between stakeholders. On the other hand, countries should take advantage of opportunities such as successful implementation of policies, programmes and initiatives; global health initiatives; increasing advocacy for funding; and special attention to the social determinants of health. 80. The goal of the proposed approach to revitalizing health services was to improve equity and access to quality health services in the context of primary health care for better health outcomes. 81. Some of the priority interventions that countries needed to implement were enhancing community participation; improving availability of human resources for health; improving availability of financial and material resources; strengthening managerial capacity; strengthening generation and use of evidence; improving health service quality and coverage; and strengthening collaboration and partnerships. 82. The report said that for successful revitalization of their health services, countries need to develop or strengthen their health plans; coordinate the various levels of services; mobilize and allocate resources; and improve coordination, partnerships and intersectoral collaboration. WHO and partners will complement country efforts through advocacy at various forums for increased resources; provision of technical support; harmonization of support for service delivery; and participation in joint performance reviews.
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83. It was further reported that universal access to essential health services was only possible through functional health services at district and community levels. Primary health care was still a relevant strategy, but it needed to be adapted to new global and national challenges. 84. Members of the Programme Subcommittee made the following general comments for improving the document: (a) Some delegates underscored the primary health care principles, including decentralization and community participation, and highlighted the need to put more emphasis on prevention and health promotion; The proposed changes in health systems should be client-centred to respond to the needs of the population; There was need to clarify the concept of community; There was need to provide guidelines for community participation, including the appropriate orientation of health personnel.
(b) (c) (d)
85.
The Programme Subcommittee proposed the following specific amendments to the document: (a) In the Introduction: (i) in paragraph 1, the number of health-related MDGs is 4 instead of 3; (ii) paragraph 3, insert before the last sentence: “Primary health care is a cost-effective approach”; (iii) paragraph 7 should be harmonized with the title of the document; In Situation Analysis: (i) in paragraph 14, add “etc” at the end of the sentence; (ii) add a paragraph highlighting opportunities provided by poverty reduction strategies; (iii) add at the end of paragraph 21: “There is need to strengthen the capacity of communities to improve the quality of health services.”; (iv) paragraph 25 should be rephrased to make it clearer, and quality of care should be mentioned; In Approaches to Revitalizing Health Services: (i) in paragraph 28(a), replace “foster” with “strengthen”; in the French version, in the section subheading, replace “methode” with “approche”; (ii) in paragraph 29, add “intersectoral collaboration” and “partnership development” to the list; (iii) in paragraph 30(a), insert “need-based and” after “enhance” to read: “enhance need-based and demand-driven provision”; In Monitoring and Evaluation, paragraph 40, there is need to be more specific about the mandate of the task force; In the Executive Summary: paragraph 1, after “constraints”, delete the comma and the word “including”, then replace them with “related to”; also; in the French version, replace “et l’insuffissance des bases factuelles et des capacités de recherche” with “les bases factuelles et les capacités de recherche”.
(b)
(c)
(d) (e)
86. The Secretariat thanked members of the Programme Subcommittee for their comments and suggestions that would be used to enrich and finalize the document for the fifty-sixth session of the Regional Committee. Responding to what should be done to make the PHC Strategy more relevant, the Regional Director indicated that it will depend on what will be done at country level. He mentioned that the PHC Strategy is relevant and the problems countries have been facing are related to the negative impact of structural adjustment programmes, natural and manmade disasters, HIV/AIDS, and poor involvement of communities. He stressed the need to strengthen capacities at all levels, especially at the community level. There is need to sensitize partners and governments to
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strengthen capacity at local level. The health systems should take advantage of global initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Global Alliance for Vaccines and Immunization to strengthen decentralization and improve support to the operational level. The Regional Director insisted on the importance of using a holistic approach in addressing health and development issues. The priority programmes should be harmonized at local level in a comprehensive manner to facilitate service delivery and improve health outcomes. He advised under the monitoring and evaluation section to review the periodicity of that exercise to every 3 or 4 years instead of every year. 87. The Subcommittee recommended the document with the amendments and prepared a draft resolution (AFR/RC56/WP/4) on the subject to be submitted to the Regional Committee for adoption. AVIAN INFLUENZA: PREPAREDNESS AND RESPONSE TO THE THREAT OF A PANDEMIC (document AFR/RC56/PSC/11) 88. Dr James N. Mwanzia of the Secretariat introduced the document on avian influenza preparedness and response. It contained an introduction, situation analysis, preparedness and response, roles and responsibilities, and conclusion. 89. The paper indicated that avian influenza was an infectious disease of birds caused by influenza virus type A strain. Human influenza was transmitted by inhalation of infectious droplets. Three influenza pandemics were recorded in 1918, 1957 and 1968, with the first one resulting in 40–50 million deaths globally. The African Region is highly vulnerable to the disease. The Fifty-sixth World Health Assembly urged Member States to draw up and implement national preparedness plans and requested the Director-General to continue to provide leadership in pandemic preparedness. 90. As of 10 May 2006, 53 countries globally and five in the African Region had confirmed the presence of H5N1 in domestic and wild birds. Nine countries worldwide had reported 207 people infected with H5N1 of which 115 died, a case fatality rate of 56%. The direct and indirect impact of an influenza pandemic would be enormous, affecting health systems and health-care services. Economic losses due to culling of domestic birds and travel and trade restrictions were already considerable and worsening. 91. It was reported that the Regional Office has provided technical support, guidelines and tools to Member States; established an ad hoc panel of experts; put in place a regional influenza laboratory network for diagnosis of human influenza; developed a regional preparedness and response plan; convened regional avian influenza meetings; and remained committed to implementing strategies and actions in collaboration with other UN agencies and regional economic groupings. 92. The document also stressed that the constraints confronting countries included: lack of adequate financial resources; weak health systems; shortage of skilled human resources for dealing with the potential increased workload; limited number of well-equipped laboratories with capacity to confirm avian influenza; weak transport and communication infrastructure; weak administration and logistics systems; high rate of illiteracy; and widespread poverty. The document also contained a summary of challenges and opportunities.
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93. Countries needed to urgently implement the following priority interventions: enhancing national and regional preparedness and response coordination; strengthening early warning systems; reducing opportunities for human H5N1 infection; halting or delaying spread of influenza at source; strengthening national health system capacity; implementing health promotion components; developing and enforcing legislation and policy; and contributing to influenza research. 94. Member States needed to develop and implement national preparedness and response plans; monitor and evaluate implementation of the plans; and share information in accordance with the International Health Regulations. WHO and partners (e.g. the Food and Agriculture Organization and the World Organization for Animal Health) needed to provide countries with guidelines for developing national preparedness and response plans; facilitate resource mobilization to support implementation of the plans; and reactivate the WHO Global and Regional Outbreak Alert and Response Network to support Member States. 95. With the confirmation of avian influenza in the Region, the risk of an influenza pandemic persisted. The occurrence of human cases would create enormous new challenges for already fragile and overburdened health systems and services. The impending emergency called for strong government leadership for timely implementation of national preparedness and response plans. Government response should be well-coordinated, well-resourced and based on the principles of equity and global partnership. 96. Members of the Programme Subcommittee found the document to be well-structured and informative for putting in place an adequate preparedness and response plan for a potential pandemic. Members also shared their countries’ experiences in handling the epidemic in the avian population. They made the following general comments for improving the document: (a) There was a need to further consider the issue of mobilizing adequate resources to finance the national and regional plans by governments and partners, as funds pledged by partners are not forthcoming; The issue of capacity-building was highlighted particularly for training of laboratory personnel and clinicians; there was also need for strengthening of laboratory capacity for confirmation of diagnosis of the H5N1 virus in the Region; this was urgent because countries are facing difficulties in using airlines to transport samples overseas; Include ways of enhancing dissemination of relevant information about the current epidemiological situation, including exchange of country experiences; Although it was important to strengthen preparedness for the pandemic, there was need to ensure dissemination of public information without raising undue alarm; care should be taken that ongoing public health programmes should not be negatively impacted if their resources are diverted to avian influenza preparedness and response; The situation analysis should include information about statistics shared by countries, bird migratory maps and laboratory networks; The translation of the Portuguese version should be reviewed, especially the translation of International Health Regulations throughout the document; The document should also discuss issues related to the difficulties of transporting specimens across borders, and solutions should be proposed.
(b)
(c) (d)
(e) (f) (g)
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97.
The Programme Subcommittee proposed the following specific amendments to the document: (a) Under Situation Analysis: (i) paragraph 8, update the statistics; (ii) in paragraphs 11 and 14, review the text on availability of guidelines and make it coherent; (iii) highlight the lessons learnt from countries in the African Region and other regions in terms of preparedness and response; (iv) include a paragraph on constraints related to access to funding; Under Preparedness and Response: (i) include a specific section on funding with two aspects—the role of WHO in providing technical guidance and medicines using the WHO emergency funds, and the roles of partners and countries in setting up mechanisms for farmers’ compensation and providing alternative sources of protein for human diets; (ii) in paragraph 24, rephrase the second sentence to read as “Efforts should be made to ensure availability of and access to recommended reagents as well as specimen referral systems…”; (iii) in the Portuguese version, the first sentence of paragraph 25 should be revised; the paragraph should be rephrased to clarify the issue of availability of an international WHO stockpile of antiviral drugs; In the Roles and Responsibilities section, include the need for countries to establish funding mechanisms with partners’ support; Include funding issues in the conclusion; In the Executive Summary, paragraph 3, emphasize the need for funding mechanisms.
(b)
(c) (d) (e)
98. The Secretariat thanked members of the Programme Subcommittee for their comments and suggestions that would be used to finalize the document for the fifty-sixth session of the Regional Committee. The Regional Director reported that the United Nations System Influenza Coordinator office was created by the UN Secretary-General for joint UN coordinated efforts on preparedness and response to avian influenza. He informed the participants that WHO was working in close collaboration with all the other relevant UN agencies. He lamented that the African Region and countries were not receiving adequate funding, and the document would be revised to be more explicit on this matter in order to appeal to governments and international partners to increase funding for avian influenza preparedness and response. Concerning the WHO international stockpile of antiviral drugs, he informed the Subcommittee that the available quantities of drugs were limited and thus could not meet all the global needs. He expressed his hope that more drugs would be available in the market and that access would be fair to countries in the African Region. 99. The Programme Subcommittee recommended the document with amendments and prepared a draft resolution (AFR/RC56/WP/6) on the subject to be submitted to the Regional Committee for adoption. HEALTH RESEARCH: AGENDA FOR THE WHO AFRICAN REGION (document AFR/RC56/PSC/10) 100. Dr Paul-Samson Lusamba-Dikassa of the Secretariat introduced the document on health research. It contained an introduction, situation analysis, agenda for the African Region, roles and responsibilities, and conclusion. 101. The document underscored the fact that research was important for achieving health development goals, including the Millennium Development Goals. The forty-eighth session of the
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Regional Committee adopted a regional health research strategic plan. The Fifty-eighth World Health Assembly adopted a resolution (WHA58.34) endorsing the recommendations of the Mexico 2004 Ministerial Summit on Health Research. The second Global Conference on Research for Health is scheduled to take place in Africa in 2008. 102. The document also acknowledged the current knowledge gaps in the performance of health systems in the African Region which limit the capabilities of countries to achieve national and international health development goals and objectives. Health research was under-funded. A knowdo gap existed, meaning that research was not translated into policy and action. National health research systems were not fully functional and hence capacity for health research was weak. This situation was compounded by a number of constraints: political and social instability, high levels of illiteracy and innumeracy, low level of national economic development, and limited computer and internet access. The document highlighted that in spite of the many challenges that existed, there were opportunities which countries needed to seize, e.g. increased global and regional awareness of the importance of research, increased external funding, and existing initiatives and mechanisms. 103. The document further mentioned that in order to strengthen national health research systems, countries needed to expand the health research agenda to include broad multidimensional determinants of health, ensure linkages with other (non-health) sectors, promote systematic reviews, including the use of grey literature; link research to policy and action which may entail forming networks and building capacity for translation of research into action; mobilize more internal and external funding; build relevant capacities, including human resources, organization and infrastructure; strengthen various partnerships, e.g. North-South, South-South, intersectoral, publicprivate, researchers and decision-makers; and allocate at least 2% of health budgets to research, ensure strong national health research systems, enhance support to health systems research, promote the translation of research into policy and action, and continue supporting basic research on drugs, vaccines, diagnostics and other tools. WHO and other partners will support countries to promote the importance of research, advocate for increased funding, set norms and standards (including ethical oversight), provide technical support, promote review, synthesis, dissemination and application of research results and improve access to health information. 104. Countries were urged to devote adequate resources and efforts to health research and translate research findings into action in order to contribute to health development and the attainment of health goals, including the Millennium Development Goals. 105. Members of the Programme Subcommittee commended the Secretariat for producing a wellstructured, well-presented and informative document. They then made the following general comments: (a) The document should be regarded as a work-in-progress to be continuously updated, taking into account the outcome of ongoing initiatives such as the Abuja and Accra meetings, as well as future preparatory activities for the 2008 World Conference on Research for Health scheduled to take place in the African Region; There was need to highlight the importance of: (i) developing national plans; (ii) setting up national coordinating structures and ensuring efficiency and national ownership; (iii) multidisciplinary technical and ethical review committees; (iv) country and intercountry networks; (v) advocacy for resource mobilization among Member States and partners; (vi) including research in the curricula of health training institutions in order to develop a
(b)
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research culture; (vii) allocating to health research at least 2% of the budgets of all programmes and projects; (viii) the complementary nature of clinical and health systems research, including field research; (c) (d) (e) The definition of health research and their various types should be included in the document as footnotes; There was need to take into account the research being done under ministries of education, science and technology, etc. There was also need to consider how best to communicate research results to the public, including the non-literate segment.
106. The Programme Subcommittee proposed the following specific amendments to the document: (a) (b) (c) (d) (e) Paragraph 5, in the Portuguese version, replace the words “todos os financiadores with “todos os parceiros”; Paragraph 8: Align the Portuguese version to the English version; Paragraph 10(d): Rephrase as follows: “limited access to, and use of, information and communication technology (computers, internet etc)”; Paragraph 11(d): Include a report on existing WHO collaborating centres; Paragraph 12: Include an introductory statement on the need for urgent measures to strengthen health research within the health sector; state the need for national mechanisms for research coordination in the health and non-health sectors; Paragraph 13: State the need to build the capacity of policy-makers, decision-makers and managers (including provision of training in statistical skills) to enable them to use research evidence; Paragraph 17: Include a subparagraph on the establishment of a central registry, databank, or depository for health research which could be web-based to enhance data access and sharing; Paragraph 17(a): Use the word “complement” instead of “balance”; Paragraph 18: Include a statement on the support of multi-centre, multi-site, crosscountry studies in order to address common problems and increase efficiency; Paragraph 17(b): Include a statement on a national coordinating structure to guide and ensure national ownership; Paragraph 18(c): Add: “in conjunction with Member States”.
(f)
(g)
(h) (i) (j) (k)
107. The Secretariat thanked members of the Subcommittee for their valuable comments and suggestions that would be used to finalize the document for submission to the fifty-sixth session of the Regional Committee. Clarifications were provided on the rationale behind the proposed 2% budget allocation to research, and the use of the term “constraints” instead of “challenges”. It was also stated that the use of the expression “national health research systems” includes the functions of stewardship and governance, and the required organizations and structures. The document would also be improved by linking it with ongoing initiatives and activities related to the preparation of the 2008 World Conference on Research for Health.
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108. The Programme Subcommittee recommended the document with some amendments to be submitted to the Regional Committee for adoption. KNOWLEDGE MANAGEMENT IN THE WHO AFRICAN REGION: STRATEGIC DIRECTIONS (document AFR/RC56/PSC/12) 109. Dr Paul-Samson Lusamba-Dikassa of the Secretariat introduced the document entitled “Knowledge management in the WHO African Region: strategic directions”. It consisted of an introduction, situation analysis, regional agenda, roles and responsibilities, monitoring and evaluation, and conclusion. 110. The document stressed that knowledge management (KM) was a set of principles, tools and practices that enabled people to create knowledge, and to share, translate and apply what they know to create value and improve effectiveness. It was meant to improve the performance (i.e. time, quality service, innovation and cost reduction) of decision-making entities (countries and organizations). 111. The paper pointed out that the challenges confronting the African Region were related to the dearth of policies, norms, standards and strategies, communications connectivity and relevant management capacities to enable countries to leverage information and communications technology for KM. 112. The objective of the strategy was to improve health system performance and outcomes through effective KM in health. The specific objectives were to enhance access to health information and knowledge, maximize the impact of explicit and tacit knowledge through knowledge sharing and application, and foster e-Health and telemedicine. 113. The document presented priority interventions that would focus on advocacy; improving data and evidence collection; developing policies and plans; setting standards and norms; building relevant capacities (people, processes, technologies); fostering partnerships; and mobilizing resources. 114. In order to strengthen knowledge management capacities, Member States would need to develop relevant policies, strategies, plans and coordination mechanisms and mobilize resources to implement the plans. WHO and partners will provide adequate technical support and guidelines to Member States for implementation of the strategic orientations contained in this document. 115. Members of the Programme Subcommittee commended the Secretariat for a well-structured and informative document and for its presentation. They made the following general comments for improving the document: (a) The document offers opportunities to address human resource problems and advocate for both knowledge management and information and communication technology (ICT) for health with decision-makers. There is a need to include ICT benefits for the assessment of health systems performance; WHO should play a coordinating role to guide the various regional initiatives on KM and e-Health;
(b)
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(c)
Highlight the importance of linking KM to health research and management information systems, and integrating it into programmes at all levels; also emphasize technological support for KM; Consider the use of funding mechanisms such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Global Alliance for Vaccines and Immunization, to mobilize resources for KM and e-Health at national level; Highlight the issue of equity in access to health knowledge and bridging the digital divide.
(d)
(e)
116. The following were specific amendments to the document proposed by the Programme Subcommittee: (a) (b) (c) (d) (e) (f) (g) In the French version, paragraph 1 needs to be revised (savoir/faire); In paragraph 12, include more details, including the project on development of e-Health funded by the Government of India in partnership with the African Union; In paragraph 17, strengthen the section on advocacy by fostering leadership on ICT and KM and encouraging their use by leaders; this will facilitate leading by setting examples; In paragraph 18, include a statement that best practices should also be cost-effective; In paragraph 21, mention challenges related to technology such as ensuring continued maintenance and troubleshooting; In paragraph 24, replace “programmes” with “strategies” to avoid the notion of verticality; In paragraph 27, indicators need to be carefully designed and selected to reflect the relative novelty and cross-cutting characteristics of KM, also taking into consideration non-health sectors.
117. The Secretariat thanked members of the Subcommittee for their comments and suggestions that would be used to finalize the document for the fifty-sixth session of the Regional Committee. Clarifications were given on the three important aspects of KM: the people, process and technology. The importance of improving the culture of knowledge sharing and application, in addition to the effective use of information and communication technology, was stressed. The need for increased investment in this relatively new area was also underlined, especially for KM capacity-building and development of ICT. 118. The Programme Subcommittee recommended the document with amendments and prepared a draft resolution (AFR/RC56/WP/7) on the subject to be submitted to the Regional Committee for adoption. SICKLE-CELL DISEASE IN THE AFRICAN REGION: CURRENT SITUATION AND THE WAY FORWARD (document AFR/RC56/PSC/13) 119. Dr Rufaro Chatora of the Secretariat introduced the document on sickle-cell disease. The document consisted of five sections: introduction, situation analysis, way forward, roles and responsibilities, and conclusion.
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120. He reported that sickle-cell disease was a genetic blood disorder that affected the haemoglobin within the red blood cells. The recurrent pain and complications caused by the disease can interfere with many aspects of patients’ lives, including education, employment and psychosocial development. Neonatal screening for the sickle-cell trait, when linked to timely diagnostic testing, parental education and comprehensive care, can markedly reduce morbidity and mortality from the disease in infancy and early childhood. 121. The document stressed that in most of the countries where sickle-cell disease was a major public health concern, national programmes for its control did not exist; basic facilities to manage patients were usually absent; systematic screening for sickle-cell disease was not a common practice; and the diagnosis of the disease was usually made when a severe complication occurred. As a result, more than 50% of the children with the most severe form of the disease died before the age of five, usually from an infection or severe anaemia. 122. Countries were encouraged to strengthen or set up national programmes which focused on advocacy; prevention and counselling; early detection and treatment; surveillance and research; and community education and partnership. 123. Members of the Programme Subcommittee appreciated the document as highly informative and relevant for increasing awareness on this important yet neglected disease. They however made the following general comments for improving the document: (a) (b) There was a need to harmonize the prevalence figures in the text and the map; There was need to avoid verticalization of the sickle-cell disease prevention and control programme and instead include it as an integral part of noncommunicable disease programmes; There was a need to further emphasize the ethical issues surrounding the screening process; There was a possibility of under-reporting the incidence of the disease due to lack of screening capacity, particularly in remote areas; There was a proposal to use sickle-cell disease control as an entry point for reproductive health programmes and devise more effective mechanisms for increasing male involvement in reproductive health issues; There was need to highlight the importance of the involvement of civil society in sicklecell disease prevention and control; There was need to be more explicit about what can be done regarding screening at the primary care level of the health care system.
(c) (d) (e)
(f) (g)
124. The Programme Subcommittee proposed the following specific amendments to the document: (a) (b) In the introduction, paragraph 4 should refer to the Fifty-ninth World Health Assembly resolution on sickle-cell anaemia; In Situation Analysis: (i) paragraph 6, include Sierra Leone in the list of countries with the highest prevalence rates; (ii) in paragraph 10, add the word “community” after
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“family”, (iii) in the French version, paragraph 11, add the word “curatif” after “traitement”; add “antimalarials” at the end of the second sentence; (c) (d) In The Way Forward, the last sentence in paragraph 14 should include screening of parents living in highly prevalent areas; The conclusion should include the need to increase advocacy and awareness.
125. The Secretariat thanked members of the Programme Subcommittee for their comments and suggestions which would be used to finalize the document for the fifty-sixth session of the Regional Committee. 126. The Programme Subcommittee recommended the document with amendments to be submitted to the Regional Committee. OTHER MATTERS 127. A member of the Programme Subcommittee informed the Subcommittee of a request from the Honourable Minister of Health of South Africa to include three additional items for discussion on the agenda of the fifty-sixth session of the Regional Committee. These issues relate to the following: (a) (b) (c) Destruction of variola virus stocks; Participation of the Member States of the African Region in the process to elect the next Director-General of the World Health Organization; Activation of the post of Deputy Director-General of WHO.
128. The Regional Director recalled that the agenda of the fifty-sixth session of the Regional Committee had already been agreed upon during the fifty-fifth session of the Committee. However, he explained that the Rules of Procedure of the Regional Committee for Africa provide for the possibility of adding items for discussion in consultation with the Chairman of the Regional Committee. 129. Regarding the destruction of variola virus stocks, the Regional Director informed the Members of the Programme Subcommittee that a special informal session is envisaged and would involve the participation of experts during the period of the Regional Committee meeting. The special session would focus on technical and scientific considerations related to progress in research with live variola virus. Should the Republic of South Africa request a formal discussion during the fifty-sixth session of the Regional Committee, then the Regional Director would, in consultation with the Chairman, consider the inclusion of this matter in the agenda according to the Rules of Procedure. 130. Concerning the nomination of the new Director-General, the Regional Director indicated that in its one-hundred-and-eighteenth session of 30 May 2006, the Executive Board had suspended rule 52 in order to allow an accelerated nomination which will be confirmed by a special session of the World Health Assembly to be held by 9 November 2006. In order to facilitate consultations among the ministers of health of the African Region, the Secretariat is making arrangements for a conference room with simultaneous interpretation facilities for the ministers to meet in Addis Ababa on the morning of Sunday, 27 August 2006, at the Economic Commission for Africa premises. He reiterated the availability of the WHO Secretariat to facilitate the participation of Member States in the implementation of Executive Board resolution EB118.R2.
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131. On the activation of the post of WHO Deputy Director-General, the one-hundred-andeighteenth session of the Executive Board had already clarified that there is currently no vacancy. Indeed, Dr Anders Nordstrom had been appointed to that position by the former Director-General. Furthermore, the Executive Board had designated Dr Nordstrom as Acting Director-General, in addition to being Deputy Director-General. ADOPTION OF THE REPORT OF THE PROGRAMME SUBCOMMITTEE (document AFR/RC56/PSC/14) 132. After a review of the document and some discussions and amendments, the Programme Subcommittee adopted the report as amended. ASSIGNMENT OF RESPONSIBILITIES FOR THE PRESENTATION OF THE REPORT OF THE PROGRAMME SUBCOMMITTEE TO THE REGIONAL COMMITTEE 133. The Programme Subcommittee decided that the Chairman and the Rapporteurs would present the report to the Regional Committee, and that in the event that any of the Rapporteurs were unable to attend the Regional Committee, the Chairman would present that section of the report. 134. The assignment of responsibilities for presentation of the report to the Regional Committee was as follows: (a) Dr Shehu Sule (Chairman), agenda items: 8.1 8.2 8.3 Regional strategic plan for the Expanded Programme on Immunization, 2006-2009 HIV prevention in the African Region: A strategy for renewal and acceleration Poverty, trade and health: An emerging health development issue
(b) Dr Babacar Drame (French Rapporteur), agenda items: 8.4 8.5 8.6 Health financing: A strategy for the African Region Medicines regulatory authorities: Current status and the way forward Revitalizing health services using the primary health care approach in the African Region
(c) Dr Prince Albert T. Roberts (English Rapporteur), agenda items: 8.7 8.8 Child survival: A strategy for the African Region Health research: Agenda for the WHO African Region
8.9. Review of the draft Medium-Term Strategic Plan 2008-2013 and the draft Programme Budget 2008-2009 (d) Dr Jose Manuel Jesus Alves de Sousa Carvalho (Portuguese Rapporteur), agenda items: 8.10 Avian influenza: Preparedness and response to the threat of a pandemic 8.11 Knowledge management in the WHO African Region: Strategic directions 8.12 Sickle-cell disease in the African Region: Current situation and the way forward.
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CLOSURE OF THE MEETING 135. The Chairman thanked the Programme Subcommittee members for their active participation in the deliberations. He also thanked the Secretariat for well articulated documents and overall facilitation. In addition, he thanked the Regional Director, the Director of Programme Management and the divisional directors for moving the frontiers of health forward in the Region. 136. The Chairman informed the participants that the term of Programme Subcommittee membership held by Namibia, Niger, Nigeria, Rwanda, Sao Tome and Principe, and Senegal had come to an end. He thanked them for their valuable contributions to the work of the Subcommittee. They will be replaced by Algeria, Angola, Benin, Uganda, Zambia and Zimbabwe. The outgoing members of the PSC thanked the Secretariat for facilitating their work and the technical assistance offered to countries. They also reiterated the need to review the terms of reference of the PSC as well as the WHO medium-term strategic plan before the fifty-sixth session of the WHO Regional Committee for Africa. 137. In his closing remarks, the Regional Director thanked members of the PSC for their active participation and excellent inputs. He highlighted the need to come up with innovative ideas to support health system reforms in Member States. The role of WHO at the Regional Office is focused on exchange of information and provision of technical support. At the country level, the WHO country teams should increasingly play more active roles in facilitating collaboration between the various partners. This would enable better resource mobilization to support country efforts. 138. Responding to the specific requests of members of the PSC, the Regional Director reaffirmed the need to review the size, functions and terms of reference of the Programme Subcommittee. The membership could be expanded to include three or four additional countries. Its functions could also be expanded to link the work of the Regional Committee, World Health Assembly and Executive Board. This could improve communications and briefings for the regional delegates attending these forums. Referring to the medium-term strategic plan, he said that the document is still under review, but it will be made available to PSC members as soon as it is finalized in the three official languages. 139. The Regional Director thanked the Secretariat and the interpreters for doing an excellent job that had contributed to making the meeting a success.
140. The Chairman then declared the meeting closed.
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LIST OF PARTICIPANT 1. MEMBER STATES OF SUBCOMMITTEE NAMIBIA Dr Norbert P. Forster Under Secretary Health and Social Welfare Policy NIGER Dr Fatimata Moussa Secrétaire générale Ministére de la Santé NIGERIA Dr Shehu Sule Director, Community Health and Population Activities RWANDA Dr Eliphaz Ben Karenzi Secrétaire Général au Ministère de la Santé SAO TOME AND PRINCIPE Dr José Manuel Jesus Alves De Sousa Carvalho Directeur des Soins de Santé SENEGAL Dr Babacar Dramé Médecin Colonel Directeur de la Santé SEYCHELLES Dr Bernard Valentin Director General for Health Planning and Information SIERRA LEONE Dr Prince Albert T. Roberts Deputy Director-General for Primary Health Care ____________ * Unable to attend
SOUTH AFRICA Yogan Pillay Director of Planning Department of Health SWAZILAND Dr Cesphina Mabuza Director of Medical Services TANZANIA Dr Z.A. Berege Director of Hospital Services TOGO Dr Potougnima Tchamdja Directeur Général de la Santé 2. AFRICAN ADVISORY COMMITTEE FOR HEALTH RESEARCH AND DEVELOPMENT (AACHRD) MAURITIUS Dr Sylvain Shunker Manraj Chairman of the African Advisory Committee for Health Research and Development 3. EXECUTIVE BOARD MEMBERS LIBERIA* MADAGASCAR (Mme) Dr Marie Perline Odette Rahantanirina Directeur de la Santé de la Famille
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ANNEX 2
AGENDA 1. 2. 3. 4. 5. 6. 7. 8. 9. Opening of the meeting Election of the Chairman, the Vice-Chairman and the Rapporteurs Adoption of the Agenda (document AFR/RC56/PSC/1) Regional strategic plan for the Expanded Programme on Immunization, 2006-2009 (document AFR/RC56/PSC/3) HIV prevention in the African Region: a strategy for renewal and acceleration (document AFR/RC56/PSC/4) Poverty, trade and health: an emerging health development issue (document AFR/RC56/PSC/5) Health financing: a strategy for the African Region (document AFR/RC56/PSC/6) Medicines regulatory authorities: current status and the way forward (document AFR/RC56/PSC/7) Revitalizing health services using the primary health care approach in the African Region (document AFR/RC56/PSC/8)
10. Child survival: a strategy for the African Region (document AFR/RC56/PSC/9) 11. Health research: agenda for the WHO African Region (document AFR/RC56/PSC/10) 12. Avian influenza: preparedness and response to the threat of a pandemic (document AFR/RC56/PSC/11) 13. Knowledge management in the WHO African Region: strategic directions (document AFR/RC56/PSC/12) 14. Sickle-cell disease in the African Region: current situation and the way forward (document AFR/RC56/PSC/13) 15. Adoption of the report of the Programme Subcommittee (document AFR/RC56/PSC/14) 16. Assignment of responsibilities for the presentation of the report of the Programme Subcommittee to the Regional Committee 17. Closure of the meeting
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ANNEX 3 PROGRAMME OF WORK DAY 1: TUESDAY, 6 JUNE 2006 10 a.m. – 10.10 a.m. 10.10 a.m. – 10.20 a.m. Agenda item 1 Agenda item 2 Opening of the meeting Election of the Chairman, the Vice-Chairman and the Rapporteurs Adoption of the Agenda (document AFR/RC56/PSC/1) Regional strategic plan for the Expanded Programme on Immunization 2006 - 2009 (document AFR/RC56/PSC/3) HIV prevention in the African Region: a strategy for renewal and acceleration (document AFR/RC56/PSC/4) Poverty, trade and health: an emerging health development issue (document AFR/RC56/PSC/5) Health financing: a strategy for the African Region (document AFR/RC56/PSC/6) Medicines regulatory authorities: current status and the way forward (document AFR/RC56/PSC/7) Revitalizing health services using the primary health care approach (document AFR/RC55/PSC/8) Child survival: a strategy for the African Region (document AFR/RC56/PSC/9)
10.20 a.m. – 10.30 a.m. Agenda item 3 10.30 a.m. – 11.00 a.m. 11.00 a.m. – 12.30 p.m.
Break: Tea and Fruits Agenda item 4
12.30 p.m. – 2 p.m. 2 p.m. – 3.30 p.m.
Lunch Break Agenda item 5
3.30 p.m. – 5 p.m.
Agenda item 6
DAY 2: WEDNESDAY, 7 JUNE 2006 9 a.m. – 10.30 a.m. Agenda item 7
10.30 a.m. – 11.00 a.m. Break: Tea and Fruits 11.00 a.m. – 12.30 p.m. Agenda item 8 12.30 p.m. – 2 p.m. 2 p.m. – 3.30 p.m. 3.30 p.m. – 4.30 p.m. 5 p.m. Lunch Break Agenda item 9 Agenda item 10 Reception
AFR/RC56/PSC/3 Page 31 DAY 3: THURSDAY, 8 JUNE 2006 9 a.m. – 10.00 a.m. 10.00 a.m. – 10.30 a.m. 10.30 a.m. – 12 noon Agenda item 11 Health research: agenda for the WHO African Region (document AFR/RC56/PSC/10) Knowledge management in the WHO African Region: strategic directions (document AFR/RC56/PSC/12) Avian influenza: preparedness and response to the threat of a pandemic (document AFR/RC56/PSC/11) Sickle-cell disease in the African Region: current situation and the way forward (document AFR/RC56/PSC/13)
Break: Tea and Fruits Agenda item 12
12 noon – 2 p.m. 2 p.m. – 3 p.m.
Lunch Break Agenda item 13
3 p.m. – 4 p.m.
Agenda item 14
DAY 4: FRIDAY, 9 JUNE 2006 9 a.m. – 1 p.m. 2 p.m. Report writing Agenda item 15 Agenda item 16 Adoption of the report of the Programme Subcommittee (document AFR/RC55/PSC/14) Assignment of responsibilities for the presentation of the Report of the Programme Subcommittee to the Regional Committee Closure of the meeting.
Agenda item 17
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