REGIONAL COMMITTEE Sixtieth session Thimphu, Bhutan 31 August – 3 September 2007
Provisional Agenda item 15.1
SEA/RC60/15 13 July 2007
REVIEW OF THE DECISIONS AND RESOLUTIONS OF THE SIXTIETH WORLD HEALTH ASSEMBLY AND THE 120TH AND 121ST SESSIONS OF THE EXECUTIVE BOARD The attached working paper highlights the most significant and relevant decisions and resolutions emanating from the Sixtieth World Health Assembly (held from 14-23 May 2007), as well as the 120th and 121st sessions of the Executive Board (held from 22-30 January 2007 and 24-26 May 2007 respectively). These decisions and resolutions are particularly relevant to the South-East Asia Region and merit follow-up action, both by Member States as well as WHO at the Regional Office and at country levels. The background of the selected decisions/resolutions, highlights from the main operative paragraphs of these selected decisions/resolutions, as well as the regional implications of each decision and/or resolution, as applicable, and actions proposed for Member States and WHO, have been presented. The working paper was submitted for consideration by the Joint Meeting of Health Secretaries of the Consultative Committee for Programme Development and Management (CCPDM) in July 2007. From among the selected decisions/resolutions, the Joint Meeting recommended that the Regional Office reviews and synthesizes the current situation of workers’ health in Member States and to present it as an agenda item at the sixty-first session of the Regional Committee in 2008. The document is submitted to the Sixtieth session of the Regional Committee for review and noting, as appropriate.
Contents Introduction ............................................................................................................................... 1 Control of leishmaniasis (WHA60.13) ......................................................................................... 1 Background.........................................................................................................................1 Main operative paragraph for the attention of the Regional Committee ...............................1 Actions taken in SEAR .........................................................................................................2 Implications on SEARO collaborative activities with countries ..............................................2 Actions to be taken in SEAR ................................................................................................3 WHO’S role and responsibilities in health research (WHA60.15 and EB120.R15) ...................... 3 Background.........................................................................................................................3 Main operative paragraph for the attention of the Regional Committee ...............................3 Specific policy -related technical comments ........................................................................3 Implications on SEARO collaborative activities with countries ..............................................4 Action already taken in SEAR ..............................................................................................4 Action to be taken in SEAR..................................................................................................4 Progress in the rational use of medicines and better medicines for children (WHA60.16 &.20 and EB120.R12 & R13) .................................................................................. 4 Background.........................................................................................................................4 Main operative paragraph for the attention of the Regional Committee ...............................4 Specific policy-related technical comments .........................................................................5 Implications on SEARO collaborative activities with countries ..............................................5 Actions already taken in SEAR .............................................................................................5 Actions to be taken in SEAR ................................................................................................5 Health promotion in a globalized world (WHA60.24 & EB120.R14) ........................................... 6 Background.........................................................................................................................6 Main operative paragraph for the attention of the Regional Committee ...............................6 Specific policy-related technical comments .........................................................................6 Implications on SEAR collaborative activities with countries .................................................6 Actions already taken in SEAR .............................................................................................7 Actions to be taken in SEAR ................................................................................................7 Workers’ health: global plan of action (WHA60.26).................................................................... 7 Background.........................................................................................................................7 Main operative paragraph for the attention of the Regional Committee ...............................7 Specific policy-related technical comments .........................................................................7
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Implications on SEARO collaborative activities with countries ..............................................8 Actions already taken in SEAR .............................................................................................8 Actions to be taken in SEAR ................................................................................................8 Pandemic influenza preparedness (WHA60.28 & EB120.R7) ...................................................... 8 Background.........................................................................................................................8 Main operative paragraph for the attention of the Regional Committee ...............................9 Specific policy-related technical comments .........................................................................9 Implications on SEARO collaborative activities with countries ..............................................9 Actions already taken in SEAR .............................................................................................9 Action to be taken in SEAR..................................................................................................9 Public health, innovation and intellectual property (WHA60.30)............................................... 10 Background.......................................................................................................................10 Main operative paragraph for the attention of the Regional Committee .............................10 Specific policy-related technical comments .......................................................................10 Implications on SEARO collaborative activities with countries ............................................10 Actions already taken in SEAR ...........................................................................................11 Action to be taken in SEAR................................................................................................11
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Introduction 1. The Sixtieth World Health Assembly and the 120th and 121st sessions of the Executive Board have adopted a number of resolutions and decisions during the course of their deliberations. These decisions and resolutions relate to both health matters and financial subjects. 2. Decisions and resolutions on technical and financial matters that have significant implications for the South-East Asia Region have been presented in this paper, highlighting salient information from the operative paragraphs that would be relevant to WHO and the countries of the South-East Asia Region, and briefly describing the actions to be taken. 3. Copies of all the decisions and resolutions of the governing bodies have been annexed to this paper, for easy reference.
Control of leishmaniasis (WHA60.13) Background 4. Visceral leishmaniasis or kala-azar is endemic in three countries of WHO’s South East Asia Region (SEAR) – Bangladesh, India and Nepal. Approximately 200 million people in 209 districts of these countries of the Region are “at risk” from the disease. Of the estimated 500,000 people in the world infected each year, approximately 100,000 live in the Region. Leishmaniasis is one of the most neglected tropical diseases and affects the poorest populations, placing a heavy economic burden on families, communities. The three endemic countries, have committed themselves to collaborate in efforts to eliminate visceral leishmaniasis (kala-azar) from the Region by 2015.
Main operative paragraph for the attention of the Regional Committee 5. In the three endemic countries – Bangladesh, India and Nepal - where leishmaniasis is a public health problem, efforts are being made to strengthen prevention, detection and treatment of cases of visceral leishmaniasis. The capacity of peripheral health centres to deliver primary and secondary care has been strengthened. Delegates from the three endemic countries were requested to ensure that the kala-azar elimination programme in these three countries is included in the resolution of the Sixtieth session of the World Health Assembly (WHA60) as proposed. However, the programme implementation has been behind the scheduled plan of the elimination programme.
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Actions taken in SEAR 6. Since the first meeting of the Regional Technical Advisory Group (RTAG) in 2004, health ministers of the three effected Member States of the SEAR– Bangladesh, India and Nepal signed a memorandum of understanding (MoU) on 18 May 2005 pledging to collaborate to eliminate kala-azar from this part of the world by 2015. A technical meeting of the partners endorsed the Regional Strategic Framework (2005-2015) in August 2005.The national operational plans were developed at a meeting of the national programme managers of the three affected countries in September 2005. Implementation research on the key interventions has been initiated by the Special Programme for Research and Training in Tropical Diseases (TDR) and Member countries. The progress of implementation was reviewed at a meeting organized and chaired by the Minister of Health of Bangladesh on the sidelines of the Fifty-ninth session of the Regional Committee in Dhaka, Bangladesh in August 2006.The World Bank has also committed support for the kala-azar elimination programme in India. 7. The Second Meeting of the RTAG on kala-azar elimination held in Nepal in 2006 recommended the formulation of guidelines and standard operating procedures. 8. The WHO Regional Office for South-East Asia organized a meeting to discuss the guidelines and standard operating procedures for kala-azar elimination in Kolkata, India, on 1620 April 2007. A Regional Training of Trainers Course is planned for August 2007. 9. The Regional Office has provided support to Bhutan to verify the occurrence and presence of kala-azar. 10. The regional strategies for kala-azar elimination have emphasized the need for high quality and affordable medicines and appropriate national drug policies for effective and complete treatment and elimination of kala-azar in the three endemic countries of the SEA Region. 11. The Regional Office, together with TDR and researchers in the three endemic countries have been actively undertaken research activities on Kala-azar elimination. 12. Multi-centric studies have been carried out since 2006 and the projects have been extended to 2008, with funding supported from TDR.
Implications on SEARO collaborative activities with countries 13. It is imperative to emphasize that collaborative efforts among the three endemic countries, i.e. Bangladesh, India and Nepal, require effective follow-up action to sustain the elimination programme. Progress reports should be presented annually to the highest authorities of the three endemic countries. 14. These endemic countries should also review the implementation of their kala-azar elimination programmes.
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Actions to be taken in SEAR 15. The Regional Office should assist the three endemic Member countries in mobilizing resources and strengthening capacity to enhance programme management to eliminate kala-azar from the three countries by 2015.
WHO’S role and responsibilities in health research (WHA60.15 and EB120.R15) Background •
Health research is an integral component of health services as it serves to focus on and improve the same. WHO plays a pivotal role in conducting such research following the practices and adhering to the highest ethical standards. This resolution evaluates WHO’s role in health research and the ways in which it can be aligned with similar efforts by the countries.
Main operative paragraph for the attention of the Regional Committee •
The role of WHO’s cosponsored research programmes to bolster research in neglected areas that are relevant to the poor and disadvantaged people, particularly povertyrelated diseases, tuberculosis, malaria and AIDS, and recognizing the contribution of WHO towards strengthening research capacity is reaffirmed. Commitment to ensuring ethical standards in the conduct of health research supported by the Organization.
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Specific policy -related technical comments • • • •
To integrate research into the mainstream of national programme activities and plans, and to promote wider access to research findings; To draw up or strengthen health research policies and health-research legislative documents, as appropriate; To improve the career management of researchers who do not necessarily come under the authority of the ministry responsible for research, as appropriate; and To develop and strengthen a participatory mechanism, as appropriate, for all stakeholders in order to prioritize the health-research agenda on the basis of dynamic changes in health systems, disease burdens and emerging health-related issues.
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Implications on SEARO collaborative activities with countries • •
Encourage Member countries to invest at least 2% of their national health expenditure in research capacity strengthening and 5% from health development programmes. Formulate and integrate research into mainstream national programme activities and plans.
Action already taken in SEAR •
Strengthening of national research capacity and institutionalizing research ethical review committees.
Action to be taken in SEAR •
WHO to assist Member countries in mobilizing resources and strengthen capacity to enhance health research management through the integration of information, research evidence, policy and practice.
Progress in the rational use of medicines and better medicines for children (WHA60.16 &.20 and EB120.R12 & R13) Background 16. WHO has promoted the Rational Use of Medicines (RUM) from 1985 to realise the full potential of essential medicines. A series of World Health Assembly resolutions on specific areas in the use of medicines such as the ethical criteria for medicinal drug promotion, measures on limiting antimicrobial resistance, and on incentives and disincentives in the pricing of medicines have addressed certain basic concerns involving the rational use of medicines. However, there has been a lack of coordinated action at the national level in developed countries with most activities being limited to the public sector. 17. The Essential Medicines Concept (EMC) and the WHO Model Essential Medicines List (EML) that emerges from it has been the most significant public health activity in medicine, completing 30 years of existence in 2007. The focus on “Essential Medicines for Children” has emerged with the growing realization that children as a segment are underserved with regard to their medicinal needs.
Main operative paragraph for the attention of the Regional Committee 18. World Health Assembly resolution WHA60.16 calls on Member States to invest in human resources as well as the institutional capacity to promote RUM. In particular, it calls upon countries to establish a multidisciplinary body to monitor and promote the rational use of medicines both in the public and private sectors.
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19. World Health Assembly resolution WHA60.20 calls upon Member States to facilitate activities that would accelerate the availability of paediatric formulations of medicines. These include appropriate research and development, timely licensing of high-quality medicines for children, and the inclusion of paediatric formulations in national medicine lists.
Specific policy-related technical comments 20. These two resolutions provide a strong basis for Member States to expand activities in essential medicines with a specific remit for national activities, thereby including both the public and private sectors. The focus on paediatric medicines is a fresh impetus and will require modification or development of new tools and their implementation.
Implications on SEARO collaborative activities with countries 21. There are many tools for promoting RUM. Following a request from Member countries, the Regional Office will provide technical support to use these tools in their national activities on essential medicines and RUM. Measures and strategies on paediatric formulations will be developed in collaboration with Member countries and made available.
Actions already taken in SEAR • •
Two monographs (Education in RUM and Ethics in RUM) have already been published by the Regional Office. Most countries have developed and revised their National Essential Medicines List. Activities related to essential medicines have been supported by the Regional Office.
Actions to be taken in SEAR • • • •
A Regional Workshop on Recent Developments in Selection of Essential Medicines Lists is scheduled for late October. Paediatric essential medicines will be the special focus at this workshop. Revision of Essential Medicines Lists in the countries is an activity planned subsequent to the workshop. Developing (in collaboration with WHO Headquarters and Member countries) a regional programme to undertake national situation analyses and establishing national programmes for RUM on the basis of these situational analyses.
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Health promotion in a globalized world (WHA60.24 & EB120.R14) Background 22. Having considered the Report of the Secretariat as a sequel to the sixth Global Conference on Health Promotion held in Bangkok, Thailand in August 2005, along with the Bangkok Charter for Health Promotion in a Globalized World, the Sixtieth World Health Assembly adopted resolution WHA60.24 urging Member States inter alia: (1) To increase, as appropriate, investment in, and to frame sound policies for, health promotion; (2) To establish as appropriate, effective mechanisms for a multisectoral, including interministerial, approach; (3) To support and foster the active engagement in health promotion of communities, civil society, the public, businesses and associations and other bodies; and (4) To strengthen the capacity to gather and disseminate the evidence regarding the effectiveness of health promotion actions.
Main operative paragraph for the attention of the Regional Committee 23. The Health Assembly also requested the Director-General, among others to (1) Strengthen the capacity for health promotion across the Organization; (2) Provide support to Member States in their continuous efforts to strengthen national health systems; and (3) Encourage national, subregional, regional and global multisectoral conferences on health promotion on a regular basis.
Specific policy-related technical comments 24. WHO, in collaboration with Member States has undertaken health promotion on a priority basis. A Regional Strategy for Health Promotion was developed through a consultative process and was endorsed by Member States at the Fifty-ninth session of the Regional Committee for South-East Asia. The Regional Committee Resolution SEA/RC59/R9 urged Member States to increase investment in health promotion and enhance capacity.
Implications on SEAR collaborative activities with countries 25. The WHO Regional Office, in collaboration with experts from the Asia-Pacific National Health Account Network, is conducting country case studies on financing health promotion in five countries (India, Indonesia, Nepal, Sri Lanka and Thailand), and the preliminary results of these studies will be shared at the Regional Conference on legislative and policy actions for health promotion to be held in Indonesia in October 2007. Another set of case studies is also being undertaken to determine health inequities related to social determinants of health among five SEAR countries. WHO worked with national health promotion focal points in building the capacity in school health promotion, communication for behaviour change, socio-behavioural research and policy development and their participation in regional, bi-regional, global conferences and technical meetings on health promotion.
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Actions already taken in SEAR 26. WHO is promoting inter-sectoral collaboration to address social determinants of health using a “whole of government” approach; addressing new threats to health including noncommunicable diseases and avian influenza; gathering and disseminating evidence regarding effectiveness of health promotion including school health promotion across sectors.
Actions to be taken in SEAR 27. WHO and Member States need to work closely in areas such as: (a) Strengthening capacity; (b) Fully utilizing existing networks and alliances, and forums of Member States, in order to implement multi-sectoral interventions; and (c) Convening and/or participating in national, subregional and regional, and global conferences on health promotion.
Workers’ health: global plan of action (WHA60.26) Background 28. This resolution recalls the earlier World Health Assembly resolution WHA 49.12 on strategy for occupational health for all and the recommendations of the World Summit on Sustainable Development regarding occupational health. Twenty eight countries had issued statements on the issue of workers' health in Committee A of the Health Assembly. Among members of the SEA Region, Maldives and Thailand expressed support for the plan of action. Indonesia, Sri Lanka and Thailand had commented in favour of the then draft resolution earlier at the 120th session of the Executive Board.
Main operative paragraph for the attention of the Regional Committee 29. The main operative paragraphs are: change in approach from occupational health to public health; consideration of determinants of workers’ health other than workplace hazards such as – social and individual factors and access to the health-care system; formulation of occupational policy and plan of action by Member States and provision for protection and promotion of health; provision of basic occupational health services for all and the incorporation of workers’ health into other policies. WHO commits to assist nations in capacity building to formulate policy and plans of action. WHO’s activities will also include global campaigns for the elimination of asbestos-related diseases and immunization of health-care workers against hepatitis B infections.
Specific policy-related technical comments 30. The main features of the resolution are a public health-related approach to workers’ health rather than a traditional labour-oriented approach, and the utilization of opportunities provided
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by the workplace to implement major public health interventions such as the HIV/AIDS and tobacco control programmes etc.
Implications on SEARO collaborative activities with countries 31. Countries of the SEA Region record an estimated aggregated loss of over 8 million Disability-Adjusted Life Years (DALYs) annually due to occupational risk factors. Incidentally, these countries also have the highest burden of disease due to occupational risk factors. About 90% of the population is employed in the informal industry sector. The Regional Office will join Member States in strengthening the capacities of the ministries of health to formulate and implement policies and action plans and stimulate intersectoral collaboration. Its activities will also include the campaign for elimination of asbestos-related diseases as well as immunization of health-care workers against hepatitis B and other actions to address priority work-related health outcomes.
Actions already taken in SEAR 32. The secretariat at the Regional Office has prepared a situation analysis on workers’ health for the Region using occupational health indicators. Technical support was provided to Bhutan to develop a country profile and a plan of action for workers’ health. Technical support was also provided to Thailand and India for organizing national workshops targeting the elimination of asbestos-related diseases. One more WHO Collaborating Centre for occupational health in India was approved by the Director-General in April 2007.
Actions to be taken in SEAR 33. The Regional Office is now preparing a situation analysis for individual Member countries. A biregional meeting is scheduled in November 2007 to discuss the implementation of a Global Plan of Action for Workers’ Health based on regional and country situation analyses. This meeting will be attended by staff from WHO Hq, and the Regional Offices for South-East Asia and the Western Pacific, the International Labour Organization as well as representatives from Member countries.
Pandemic influenza preparedness (WHA60.28 & EB120.R7) Background 34. Pandemic influenza preparedness has been developed, in accordance with the provisions of the International Health Regulations (IHR) (2005) and the World Health Assembly resolutions WHA58.5 and WHA59.2, to mitigate public health risks. Moreover, World Health Assembly resolution WHA60.28 acknowledges the sovereign right of Member States over their biological resources and the crucial aspect of sharing them with WHO collaborating centres.
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Main operative paragraph for the attention of the Regional Committee 35. World Health Assembly resolution WHA60.28 also urges Member States to strengthen the WHO Global Influenza Surveillance Network by sharing information, diagnostics, medicines, vaccines and other technologies, and to foster research to develop better tools for public health.
Specific policy-related technical comments 36. Member States need to strengthen existing policies on influenza vaccines in their NIPPP, and to encourage national and regional collaboration among regulatory authorities.
Implications on SEARO collaborative activities with countries 37. The regional implications of close coordination among SEA Region Member States, since several countries are affected by pandemic threats, include envisaging that countries: •
Identify and formulate frameworks and mechanisms in the areas of financial planning, manufacturing of influenza vaccine internally, manpower enhancement, establishment and strengthening of Member States, testing capacity for H5 and other influenza viruses, international stockpiling, and equitable distribution and timely mobilization of stocks; and Strengthen coordination among the Regional Office, Member States, WHO collaborating centres, influenza vaccine manufacturers and donors.
•
Actions already taken in SEAR 38. Assessment of NIPPP in nine member States of SEAR has been conducted and gaps identified. Table-top exercises have been conducted in 8 Member States to test various component of NIPPP.
Action to be taken in SEAR • • • • •
To continue technical support to strengthen national influenza centre laboratory capacity; To establish WHO H5 reference laboratory in the Region; To provide technical briefing for delegates from the Region attending the InterDisciplinary Working Group meeting; To monitor progress of vaccine production facilities in countries of the Region and provide technical support as needed To establish a regional stockpile of vaccine once the meeting is concluded.
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Public health, innovation and intellectual property (WHA60.30) Background 39. Only 13 of about 1400 new drugs developed between 1975 and 1999 are for tropical or neglected diseases. Concerned about this imbalance, the World Health Assembly in 2003 requested the Director-General to establish The Commission on Intellectual Property Rights, Innovation and Public Health (CIPIH). The CIPIH Report of April 2006 addressed a wide range of issues from basic research to the delivery of medicines. In response, World Health Assembly resolution WHA59.24 in May 2006 established an Intergovernmental Working Group (IGWG) to draw up a global strategy and plan of action. Subsequently, the Regional Committee for the SEA Region adopted resolution SEA/RC59/R7 urging participation in the work of the IGWG while making full use of the flexibilities allowed in the TRIPS agreement. The resolution also requested the Regional Director to convene regional consultations and support participation by Member countries. 40. The IGWG at its first meeting in December 2006 produced the draft “Elements of a Global Strategy and Plan of Action”. Member States have submitted written inputs and comments and a pool of experts has been identified for the next meeting.
Main operative paragraph for the attention of the Regional Committee 41. World Health Assembly resolution WHA60.30 calls for active participation in the IGWG process and requests WHO to provide technical and financial support for both the IGWG as well as preparatory regional consultations. WHO is requested to enables the preparation of proposals and background papers on each of the elements of the draft plan of action. 42. The resolution also establishes a firm and explicit mandate for WHO to support countries, on request, in making use of the flexibilities in the TRIPS Agreement and other international instruments in order to promote easier access to pharmaceutical products.
Specific policy-related technical comments 43. This resolution provides a strong impetus to Member States to expand access to essential medicines. Member States should, for public health purposes, make full use of the flexibilities contained in the TRIPS agreement.
Implications on SEARO collaborative activities with countries 44. At the request of Member States, the Regional Office will provide support for participation in the IGWG and in their efforts to ensure equitable distribution of essential medicines through the implementation of TRIPS flexibilities.
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Actions already taken in SEAR • •
Two Member countries, Indonesia and Thailand have already made use of the TRIPS flexibilities to increase access to medicines. A third regional consultation has been planned to be held prior to the second and last meeting of the IGWG in collaboration with the Ministry of Public Health of Thailand.
Action to be taken in SEAR • • •
Facilitate the development of proposals and background papers on each of the elements of the draft plan of action, as requested by Member States. Facilitate and support Member States to participate in the second IGWG Meeting in Geneva. The Regional Office will provide technical assistance to Member States in the area of public health, innovation and intellectual property, including use of TRIPS flexibilities, as appropriate to the needs of each country.