REGIONAL COMMITTEE Sixty-fourth Session Jaipur, Rajasthan, India 6–9 September 2011
Provisional Agenda item 6.1 SEA/RC64/11 Rev.1 21 July 2011
Key issues and challenges arising out of the Sixty-fourth World Health Assembly and the 128th and 129th sessions of the WHO Executive Board The attached working paper highlights, from the perspective of the South-East Asia Region, the most significant and relevant resolutions emanating from the Sixty-fourth World Health Assembly (held from 16-24 May 2011) as well as the 128th and 129th sessions of the Executive Board (held from 17-25 January 2011 and on 25 May 2011 respectively). These resolutions are deemed to have important implications and merit follow-up action by both Member States as well as WHO at the Regional Office and country office levels. The background of the selected resolutions, their implications on collaborative activities with Member States, as applicable, along with actions proposed for Member States and WHO have been summarized. All the resolutions of the Sixty-fourth World Health Assembly are provided in the annex to this paper. The high-Level Preparatory (HLP) Meeting held in the Regional Office in New Delhi from 27 to 30 June 2011 reviewed the working paper and made the following recommendations: Actions by WHO-SEARO (1) The working paper on this agenda item needs to be improved, updated and revised based on the discussions at the HLP meeting and the revised version submitted to the Sixty-fourth Session of the Regional Committee for its consideration. To inform the Member States on how to implement the PIP framework and how it is to be rolled out. Organize a regional consultation on the framework of PIP in the SEA Region to facilitate its implementation.
(2) (3)
The revised working paper incorporating the changes suggested by the HLP meeting is submitted to the Sixty-fourth Session of the Regional Committee for review and noting, as appropriate.
Contents
Page
Introduction...................................................................................................................1 1. 2. 3. 4. 5. 6. 7. 8. 9. Implementation of the International Health Regulations (2005) (WHA64.1) .........1 The future of financing for WHO (WHA64.2) ......................................................2 Pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits (WHA64.5)...........................................................3 Health workforce strengthening (WHA64.6) ........................................................4 Strengthening nursing and midwifery (WHA64.7) ................................................5 Strengthening national policy dialogue to build more robust health policies, strategies and plans (WHA64.8)...........................................................................7 Sustainable health financing structures and universal coverage (WHA64.9) ..........9 Strengthening national health emergency and disaster management capacities and resilience of health systems (WHA64.10) ....................................10 Preparations for the High-level Meeting of the United Nations General Assembly on the prevention and control of noncommunicable diseases, following on the Moscow Conference (WHA64.11) ...........................................13 WHO’s role in the follow-up to the United Nations High-Level Plenary Meeting of the General Assembly on the Millennium Development Goals (New York, September 2010) (WHA64.12)........................................................15 Working towards the reduction of perinatal and neonatal mortality (WHA64.13) .....................................................................................................17 Draft global health sector strategy on HIV, 2011–2015 (WHA64.14)..................18 Cholera: Mechanism for control and prevention (WHA64.15) ...........................19 Malaria (WHA64.17).........................................................................................21 Drinking water, sanitation and health (WHA64.24)............................................22 Child injury prevention (WHA64.27) .................................................................23 Youth and health risks (WHA64.28)...................................................................25
10.
11. 12. 13. 14. 15. 16. 17.
Annex Resolutions of the Sixty-fourth World Health Assembly
SEA/RC64/11 Rev.1
Introduction The Sixty-fourth World Health Assembly and the 128th session of the Executive Board adopted a number of resolutions and decisions during the course of their deliberations. These decisions and resolutions relate to health matters as well as programme budget and financial matters. Resolutions on technical matters that have significant implications for the SEA Region have been presented in this paper. Salient information on implications of the resolutions, actions already taken and to be taken are included. Copies of all the resolutions of the Sixty-fourth World Health Assembly have been annexed to this paper, for easy reference.
1.
Implementation of the International Health Regulations (2005) (WHA64.1) Background
The International Health Regulations (IHR) 2005 came into force in 2007 and require States (Parties) to establish core capacities to detect, assess and report potential health threats by 15 June 2012. Implementation of IHR was the key area of focus in the final report of the Review Committee on the “Functioning of the International Health Regulations (IHR 2005) in relation to Pandemic (H1N1) 2009’, which concluded that “many States (Parties) lack capacities to detect, assess and report potential health threats” and “are not on a path to complete their obligations for plans and infrastructure by the 2012 deadline”. Countries who may not achieve compliance with development of core capacities by June 2012 can apply for a twoyear extension, accompanied by an implementation plan.
Implications on collaborative activities with Member States
Based on the established monitoring mechanism, the implementation of IHR core capacities in the Region in 2010 was 60%. However, levels of implementation vary between countries and across capacities, (for example the lowest implementation rates are seen for chemical and radio-nuclear hazards). Significant action would thus be required to ensure implementation of core capacities by June 2012.
Actions already taken in the Region
A “situation analysis” of regional IHR implementation ‘’ was undertaken, which identified priority areas for capacity building, including legislation, preparedness planning, surveillance and response, laboratory, Points of Entry and chemical/radionuclear safety. In addition, support to national capacity building was provided in
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related technical and policy areas, including legislation, preparedness, surveillance, risk assessment, outbreak response, hospital infection control and assessments of “Points of Entry”.
Actions to be taken in the Region
Member States will be expected to assess their progress towards full implementation by 15 June 2012 and judge whether an extension will be requested. A fourth SEA regional meeting on the implementation of the International Health Regulations (IHR 2005) will be held in November 2011 with the objective of accelerating core capacity implementation, including identification of strategic approaches, mobilization of resources and determination of next steps at national, intercountry and regional levels. If requested, support will also be provided to undertake IHR implementation reviews in priority countries to assess progress, identify needs and support the development of implementation plans. Focus will be placed on enhancing inter-sectoral collaboration to address identified human resource and laboratory capacity gaps in food safety and chemical / radio-nuclear safety, including the application of measures at points of entry.
2.
The future of financing for WHO (WHA64.2) Background
The rapidly changing environment in which WHO works requires changes in ways of working and improved clarity on WHO’s role in relation to other global actors. The current financial crisis has added urgency to introduce such changes. In this context the organization is in the process of introducing a package of changes, which is referred to as “programme of reform”. In response to the Director-General’s report entitled “World Health Organization: Reforms for a healthy future”, by Resolution WHA64.2 the Member States endorsed the proposed agenda for reform as set out in the said report. While the Resolution requested Member States to support its implementation it also requested the Director-General to further develop necessary modalities and to report the progress of the reform process to the Sixty-fifth World Health Assembly through the 130th session of the Executive Board. The detailed working papers on selected topics are being developed by WHO to be shared with Member States by July 2011.
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Implications on collaborative activities with Member States
The five core business areas identified in the agenda need to be carefully examined in the regional context. Based on the level of development, vulnerability to disasters, disease burden and trends and many other factors, the expectations of Member States of the SEA Region can vary significantly. The implications of the proposed reforms on staffing of the SEA Region might be significant. Increasing staff costs against a reduced programme budget will further affect staff/activity ratios in Budget Centres of the Region. HR profiling needs to be re-examined. There is a need to further simplify the results-based planning, management and accountability framework.
Actions already taken in the Region
The downward revision of the Programme Budget 2012-2013 is recognized as a transitional budget that will help the Organization respond to the financial austerity scenario and prepare for a series of reforms being proposed. Operational planning 2012-2013, which is being currently undertaken to take into consideration WHO’s focus and staff structure for the next biennium.
Actions to be taken in the Region
The reform-related working papers when developed by working groups will be circulated among all Member States of the Region and presented at the Sixty-fourth session of the Regional Committee for consultation.
3.
Pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits (WHA64.5) Background
Since 1957, influenza viruses have been shared by Member States through the WHO global influenza surveillance network (GISN). However, in 2007 important issues were raised about how such virus sharing might be linked to access to vaccines and other benefits. To resolve these issues, the World Health Assembly resolution WHA60.28 recommended the Director-General (DG) to develop a framework and mechanism for benefit sharing; to establish an international stockpile of influenza A (H5N1) vaccine and to prepare guidance on vaccine distribution. In response, an ‘Open-Ended Working Group on Pandemic Influenza Preparedness was convened to facilitate agreement between parties concerned on these issues. The resulting document, the “Pandemic Influenza Preparedness Framework (PIPFW)” was adopted through Resolution WHA64.5.
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Implications on collaborative activities with Member States
The World Health Assembly Resolution 64.5 urges implementation of the PIPFW and places requirements on both Member States and WHO. Member States are therefore requested to provide PIP Biological Materials from all influenza viruses with human pandemic potential to a WHO Reference Laboratory of their choice in a timely manner: it is also taken to be understood that in providing such materials, Member States give consent for their onward transfer and use to third party institutions, subject to provisions in any standard Material Transfer Agreement. In return, genetic sequence data and related analyses must be shared in a timely manner with the originating laboratory and with WHO Global Influenza Surveillance and Response System laboratories. It is expected that the PIP Benefit Sharing System will provide information and build capacity for pandemic surveillance and risk assessment, as well as for early warning purposes. The PIPFW also ensures prioritization of benefits including antiviral medicines and vaccines to developing (especially affected) countries, according to public health risk and needs, particularly where countries lack the capacity to produce or access influenza vaccines, diagnostics and pharmaceuticals. Discussion has commenced on arrangements to ensure traceability of specimens and define new proposed Material Transfer Agreements to ensure benefits are shared, but the process is expected to take time.
Actions already taken in the Region
Discussion has commenced with colleagues at WHO headquarters to define specific actions required at global, regional and national levels to implement the PIPFW.
Actions to be taken in the Region
An informal consultation on implementation of the PIPFW will be organized by the Regional Office at the earliest convenient time. Influenza laboratories and other parties concerned in the Region who participate in regional and global influenza surveillance networks, following consultation with national authorities, may consider the practical steps required to implement the PIPFW, including adjusting the Terms of Reference and adoption of new Material Transfer Agreements. Regional representation on the existing PIPFW Advisory Group will also be reviewed and new nominations considered.
4.
Health workforce strengthening (WHA64.6) Background
The global health workforce crisis is a major concern of Member States. Most countries have an imbalance in skills mix and a maldistribution of the health workforce. While the majority of population live in rural and remote areas, most
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health workers work in cities. The capacity of countries to increase production and improve the quality of the health workforce’s education is limited. For the SEA Region, six countries face an HRH crisis.
WHO responses included the 63rd WHA adopted the WHO Global Code of Practice on the International Recruitment of Health Personnel; and the Global Policy Recommendations on Increasing Access to Health Workers in Remote and Rural Areas through Improved Retention, which was issued in 2010. WHO is also currently developing policy guidelines on scaling up and transforming health professional education to increase production, improve quality and enhance the relevance of education.
Implications on the collaborative activities with Member States
To provide concerted support to Member States to develop/maintain national health workforce plans as an integral part of a national health plan; and to implement priority strategic actions to address workforce shortage, inappropriate skills mix and maldistribution as well as to strengthen the HRH information system. To support the health ministry in working with other relevant sectors to determine and employ special scheme(s) to encourage and support rural employment.
Actions already taken in the Region
Guidelines for developing a national strategic plan for HRH development were developed and disseminated. A template for preparing HRH country profile was developed and APWs were concluded with countries to prepare HRH country profiles with the aim to improve HRH information for informed decisions in the country.
Actions to be taken in the Region
To intensify technical support to Member States, especially those going through an HRH crisis, for the development/updating of the national health workforce plan and implementation of priority strategic actions to address HRH challenges in the country.
5.
Strengthening nursing and midwifery (WHA64.7) Background
Nursing and midwifery in countries of the South-East Asia Region faces various challenges and issues. Among others, there is ineffective implementation of nursing and midwifery policies and plan; inadequate number of competent nursing and
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midwifery teachers and practitioners, inadequate quality of education and service, ineffective functioning of the councils and the lack of evidences or research to support practices and policy decisions. Countries in other regions are also facing similar issues. In 2006, the WHA resolution on strengthening nursing and midwifery was adopted. Governments of Member States have given more attention to the development of nursing and midwifery but the progress is very slow. In order to support health systems strengthening and health workforce strengthening, this resolution on strengthening nursing and midwifery is readdressed and emphasized.
Implications on the collaborative activities with Member States
WHO will collaborate and support Member States to strengthen nursing and midwifery in various areas including the development of a national nursing and midwifery policy and plan; scaling up transformative education and training; strengthening the legislation process; and implementation of health programmes including community nursing in support of MDGs and the health- related agenda; and active participation in workforce planning and activities to maintain adequate and competent nurses and midwives. The activities will include advocacy; providing the technical advice; development of guidelines, modules and technical papers; mobilization of resources; organization of regional meetings/workshops, training and study visits; and provision of WHO fellowships.
Actions already taken in the Region
Support was provided to strengthen nursing and midwifery through various means including the development of guidelines, upgradation of educational programme (Bhutan), revision of curriculum (Bangladesh, Bhutan & Nepal), improving competencies of teachers and infrastructure of educational institutions in (all SEA Region countries), building capacity of nurses and midwives in health-care facilities and the community (all SEA Region countries) and strengthening/establishing the nursing and midwifery council (Nepal & Sri Lanka). Guidelines on “Nursing and midwifery workforce planning” and “Quality assurances and accreditation of nursing and midwifery educational institutions” were published and disseminated. The roles of public health nurses or community health nurses in the Region were reviewed. The strategies to strengthen the deployment of public health nurses in support of MDGs have been developed. A conceptual framework on community health nursing education was published.
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Actions to be taken in the Region
The strategic directions to strengthen nursing and midwifery 2012-2016 will be finalized to guide countries in developing targets and an action plan for the development of nursing and midwifery. More efforts will be provided to countries with critical nursing shortage to increase production capacity under a quality framework. Development of nursing and midwifery workforce planning, scaling of transformative education and training, and the implementation of retention strategies will be emphasized. Support will be provided to countries with high maternal and newborn mortality to scale up midwifery personnel and service to meet the MDG targets or national targets. Strategies to strengthen the deployment and retention of public health nurses will be widely advocated. Support will be provided to strengthen the roles of public health nurses in the health system-based primary health care, including the role in maternal, newborn and child health; nutrition; mental health; and noncommunicable diseases. The nursing and midwifery workforce information system will be initiated in collaboration with the Human Resource for Health unit for the Regional HRH observatory. Awareness and the capacity of nurses and midwives in research, evidence-based practice and evidence-based policy will be advocated and promoted.
6.
Strengthening national policy dialogue to build more robust health policies, strategies and plans (WHA64.8) Background
The World Health Reports of 2008 Primary Health Care: Now More Than Ever and 2010 Health Systems Financing: The path to Universal Coverage as well as WHA resolution 62.12 on primary health care, including health system strengthening provide the background to the WHA 64.8: Strengthening national policy dialogue to build more robust health policies, strategies and plans. Other Regions have passed similar resolutions to move forward in their national policy dialogues such as EUR/RC60/R5, WPR/RC61/R2, AFR/RC60/R1 and to provide documentary evidence such as AFR/RC60/7 and SEA/RC63/9 on the development of national health plans and strategies.
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Implications on collaborative activities with Member States There are implications for both Member States and WHO. They are:
Member States need to take effective leadership and ownership of the process of establishing robust national or subnational health policies and strategies, in a process of continuous consultation and engagement of all relevant stake holders. These policies, strategies and plans should address the overarching goals of universal coverage, social determinants of health, people-centered primary care and health in all policies, and it should also support comprehensive, balanced and evidence-based assessment of the country’s health and its health system challenges. Director General has requested to renew the Organization’s role at country level as a facilitator of inclusive policy dialogue around national health policies, strategies and plans, and to provide technical inputs for conducting the planning process as appropriate. Also requested to support Member States in their efforts to ensure the ownership, quality and coordination of the technical support they receive and to foster cross-country and regional learning and cooperation.
Actions already taken in the Region
NHPSP country assessments using the JANS Tool were conducted in six countries. Regional consultation on Strengthening National Health Planning was conducted in Bali, Indonesia, in August 2010 to make recommendations to WHO and Member countries on NHPSP. HQ developed a global learning programme (GLP) to be conducted globally among WHO staff to develop the organization’s capacity in National Health Policies, Strategies and Plans (NHPSP). Also developed learning modules, teaching and learning materials and provided technical assistance to Regions. SEARO customized the modules and teaching/learning materials to fit in to SEA regional requirements, and conducted a pilot programme in Jaipur in 2010. Two inception workshops were conducted in the Region (Kathmandu and Bali) to train 50 staff from seven fast-track WCOs and from the Regional office on GLPNHPSP. Countries are identifying “entry points” and some have already begun a policy dialogue at the country level. Global Learning Programme, SEARO module, is a product that incorporated inputs from the two inception workshops. Provided technical assistance as requested by Member countries in their national health planning process.
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Actions to be taken in the Region
One GLP-NHPSP training workshop will be held during October 2011 to train WCO staff who have not undergone this training as well as staff from the Regional Office. A training programme is being developed with Mahidol University to train government officials from Member countries to develop country capacity in national health planning. National and sub-national-level training programmes on health planning have been planned for the 2012-2013 biennium.
7.
Sustainable health financing structures and universal coverage (WHA64.9) Background
Universal coverage through sustainable health financing structures has been high on the global, regional and national agendas. The World Health Reports 2008 (Primary Health Care: Now More Than Ever) and the recent 2010 (Health Systems Financing: The Path to Universal Coverage) and the World Health Assembly resolutions: WHA 58.33 on sustainable health financing, universal coverage and social health insurance; 62.12 on primary health care highlighted universal coverage as one of the four key pillars of primary health care and provided the background to WHA 64.9 Sustainable health financing structures and universal coverage.
Implications on collaborative activities with Member States There are implications for both Member States and WHO. They are:
Member States need to move towards affordable, equitable universal coverage through provision of adequate, comprehensive and affordable health care services that include preventive services. They need to pursue and make choices in healthfinancing reforms which involve mix of public and private approaches and financing mix of contribution-based and tax financed inputs. They need to strengthen mechanisms of prepayment of financial contributions and pooling of risks among the population. Steps need to be taken to reduce direct payments at the point of service so as to not lead to catastrophic health-care expenditure and impoverishment of those seeking health care. Director-General has requested to provide technical support to countries for strengthening capacities and expertise in the development of health-financing systems, to estimate the number of people covered by health insurance by country and region and prepare plan of action for WHO in realizing Universal Coverage. Facilitate sharing of experiences and lessons learnt, work closely with UN organization and other stake holders in efforts to achieving UC.
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Actions already taken in the Region
The Regional Office for the South-East Asia and Western Pacific formulated Health Financing Strategy for the Asia Pacific Region (2010-2015). Regional consultations were held on relevant issues of financing for UC –
Financial crisis and its potential impact on health in SEA Region countries, Colombo, March 2009. Social protection in low-income settings. Bali, March, 2009. Strategic purchasing for social protection, Bangkok December, 2009. Contracting in low-income settings, Jakarta, March 2009.
Regional training programmes were held to develop country capacities in: – – –
National Consultation on Health Financing, Maldives, April 2010. Supported capacity- building in technical issues on National Health Accounts and Economic and Impact evaluation at the country level (Bhutan, Indonesia, Maldives, Myanmar, Sri Lanka). Provided technical support to countries in the areas of health financing reform, health financing and expenditure review, financing options for social protection (Bangladesh, Bhutan, DPR Korea, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka and Thailand). Supported evaluation of universal health coverage after decade of implementation in Thailand.
Actions to be taken in the Region
Regional Strategy for Universal Health Coverage is being developed and will be submitted to Sixty-fourth Session of the Regional Committee for approval. National-level workshop on health financing is planned for Maldives Continue supporting countries on health financing aspects and country- capacity building.
8.
Strengthening national health emergency and disaster management capacities and resilience of health systems (WHA64.10) Background
This resolution calls for strengthening capacities in disaster risk management and resilience of health systems. However, to begin to do this systematically, there is a
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critical need to organize comprehensive measurement of management capacity. In order to address this, work began long before this resolution. After the tsunami of 2004, this has already been an identified need. In 2005, the WHO Regional Office for South-East Asia together with 11 Member States of the Region developed a set of benchmarks for emergency preparedness at the country level to assess and address quality and improve performance in emergency preparedness and response.
These are all in line with the International agreements and declarations such as the Hyogo Framework for Action, International Health Regulations (IHRs) and previous WHA resolutions.
Implications on collaborative activities with Member States
The SEA benchmark Framework for Emergency Preparedness and Response has a corresponding set of standards and indicators and a scaling mechanism that further elaborates the best practices/interventions around each benchmark. The SEA Region benchmarks cover all the aspects mentioned in the areas where Member States are requested to act in the operative paragraphs (eg. legal and policy, community work, human resource strengthening, subnational level interventions). This measurement system/monitoring guide also ensures that multisectoral systems are in place for work before, during and after an emergency/disaster. It also highlights specifically key areas on how to keep health facilities safer and functioning in emergencies caused by several hazards. By reviewing very well the various aspects needed for disaster risk management and resilient health systems, work with Member States can proceed more precisely.
Actions already taken in the Region
The following are the updates on benchmark assessments: – –
Nepal has taken the exercise forward and completed an assessment using the allinclusive tool in December 2010. It is planned and budgeted to roll out this comprehensive assessment in all SEA Region countries to clearly identify gaps and address them for better preparedness.
Application of a systematic assessment identifies key gaps and priorities at the national and subnational levels and helps to clarify WHO and Ministry of Health inputs in the health sector in the largely multisectoral approach for disaster management.
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The other key issue is that of resilient and functioning health facilities. In its efforts to promote safe health facilities, Health Ministers of the South-East Asia Region adopted the Kathmandu Declaration on Protecting Health Facilities from Disasters in 2009. Progress in this area is as follows: –
New policy/regulation has been set out in India and Indonesia to ensure that all new health facilities are resilient to hazards in the location in which they are built. With support of the Regional Office, a national preparedness and contingency plan with an all-hazards approach is being developed in Bhutan. As mentioned, monitoring tools (benchmark, standards, indicators specific to safer health facilities) have been made available to countries in order to assess progress and identify gaps on all aspects of preparedness and response and its implementation supported. Tools for assessment are being adapted and developed taking into consideration existing methodologies for structural assessment of buildings, as well as availability of global guidelines such as WHO’s Hospital Safety Index in Bangladesh, India, Indonesia, Maldives and Nepal. An assessment for disaster resilience was conducted in four selected hospitals in Bangladesh. The Ministry of Health in India is working on several assessments both structural and non-structural for existing health facilities. In Indonesia, assessments are being conducted for more health facilities in the areas affected by the most recent earthquake in Sumatra. In Maldives, a hospital vulnerability assessment was conducted with UNDP and a more comprehensive assessment is planned. In Nepal, further structural and non-structural assessments in existing health facilities are being conducted. As part of new policies in countries such as India and Indonesia, the enforcement of national building codes and specific standards for health facilities has become the central point of implementation. Using social media, Region-wide advocacy efforts are being made to enhance public awareness on the need to make health facilities safe and functional in emergencies.
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Actions to be taken in the Region
Work on mapping out capacities, roles and needs of nurses in disaster risk management is underway and a regional strategic options approach to strengthen nurses’ roles and responsibilities in emergencies and disasters will be developed by the end of 2011.
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Based on the assessments using the SEA Region’s benchmarks through the EHA programme, strengths, weaknesses and gaps in disaster risk reduction programmes in Member States can be identified and addressed. This helps to further harmonize programme activities with other health programmes and those outside the health sector. Based on the needs support will be mobilized for WHO country offices and Member States to strengthen disaster risk management in the health sector and keep health systems resilient and functioning in case of any event due to various hazards.
9.
Preparations for the High-level Meeting of the United Nations General Assembly on the prevention and control of noncommunicable diseases, following on the Moscow Conference (WHA64.11) Background
NCDs diseases (NCDs) are the most frequent cause of death in the SEA Region causing nearly 8 million mortalities each year, or 55% of all deaths in the Region. It is expected that over a 10-year period, there will be a 21% increase in the number of deaths due to NCDs in the Region. The High-Level Meeting (HLM) of the UN General Assembly on the Prevention and Control of NCDs is a unique opportunity for SEA Member States to highlight the growing health and development challenges posed by NCDs in the Region and call urgent attention to address NCDs through multisectoral actions.
Implications on collaborative activities with Member States There are implications for both Member States and WHO:
NCDs pose an unacceptable health and development burden. There is a need to prioritize the primary prevention which is of utmost importance. Following a WHO Global Strategy on Prevention and Control of NCDs, countries should implement right policies (best buys) early on to reduce the negative impact of NCDs, in addressing the major risk factors in a culturally appropriate way. Integrated and multi-sectoral action is imperative for tackling NCDs, including the community and family participation and empowerment. Effective and equitable NCD prevention and control based on principles of social justice requires a primary heath care approach. Programmatic research is needed to assess epidemiology of NCDs and risk factors, awareness, policy and programme development, capacity strengthening / resource mobilization / infrastructure development, multisectoral and multilateral action to modify risk factors at population level and health sector interventions.
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There is a need for a paradigm shift in terms of priority given to NCDs as a part of national policy and programme as well as from resources allocation point of view. A paradigm shift is needed from addressing each NCD separately as a single disease to cluster of diseases collectively together and in an integrated manner since risk factors are common and they each contribute to a variety of NCDs; from bio-medical approach to a public health approach to NCDs (based on evidence, scaling-up effective approaches and moving towards universal access, using the principles of Primary Health Care); and from clinical or treatment-oriented approach to a more comprehensive approach with emphasis on surveillance, health promotion and primary prevention, and to early detection and early intervention.
Actions already taken in the Region
Regional situation analyses on NCD and their risk factors, as well as an assessment of national capacity, has been undertaken and working papers have been prepared. WHO Regional Office and country offices are supporting situation analyses of NCDs diseases in several countries. Inputs to the “outcome document” of the UN HLM have been provided from the SEA regional level by way of the Jakarta Call for Action and a report containing ten key messages for UN HLM, which emanated from the Regional Meeting on Health and Development Challenges of NCDs held in Jakarta earlier. With support from WHO, each of the 11 Member Countries are organizing a national meeting to build consensus on the role of multiple sectors in the prevention and control of NCDs. These meetings will include as participants a wide variety of stakeholders including government representatives from health, education, youth affairs and food and other sectors, as well as civil society, academia and NGOs.
Actions to be taken in the Region
To provide technical support to Member countries in the national multisectoral meetings on NCDs planned in each country during July-August. To prepare a regional status report on NCDs and their risk factors in the SEA Region. To continue to advocate for the representation of Heads of State and Government at the high-level meeting of the UN General Assembly.
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10.
WHO’s role in the follow-up to the United Nations High-Level Plenary Meeting of the General Assembly on the Millennium Development Goals (New York, September 2010) (WHA64.12) Background
The UN Secretary-General launched the Global Strategy for Women’s and Children’s Health (WCH) in September 2010 to accelerate progress in achieving MDG 4 and 5 and mobilized commitments at US$ 40 billion. The main goal is to save 16 million lives by 2015 in 49 poorest countries. Given that accountability for results and resources is critical, the Secretary-General asked the Director-General of WHO to determine the most effective institutional arrangements for global reporting, oversight and accountability through the Commission on Information and Accountability for WCH. The Commission constituted two Working Groups “Accountability for Results”, “Accountability for Resources”). The work of these WGs was compiled in the final report that was deliberated at WHA 64 and a resolution adopted.
Implications on collaborative activities with Member States
The accountability framework’s three interconnected processes – monitor, review and act – are aimed at learning and continuous improvement. It places accountability soundly where it belongs: at the country level, with the active engagement of governments, communities and civil society; with strong links to global mechanisms. The 10 specific recommendations are measurable, attainable and time-bound for implementing the accountability framework, under three domains: – – –
Better information for better results (3). Better resources tracking (3). Stronger oversight of results and resources, nationally and globally (4).
There can be no accountability without timely, reliable and accessible health information and data. Major efforts are required through WHO collaborative activities to move towards one sound country Health-Information Systems that meets all data needs specified by the Commission.
Actions already taken in the Region
A comprehensive Regional Strategy for Strengthening Health-Information Systems has been endorsed by 63rd session of the Regional Committee.
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Six countries were supported by Health Metrics Network for Health-Information Systems assessment. Resources mobilized through Health Metrics Network along with partner agencies totaling US$ 1 million for Vital Registration Systems (VRS). MDG indicators were analysed from the latest available data and regional perspective in achievement of MDGs was shared. Work initiated on development of the Regional Health Observatory (RHO) to facilitate reporting timely data and utilization of consistent data across the region. Work initiated on the development of the Asia-Pacific Health Observatory on Health Systems and Policies (APO) together with WHO Regional Office for Western Pacific Region. Work on development of common Monitoring and Evaluation framework across development partners has been initiated in one Member State.
Actions to be taken in the Region
How the recommendations can be achieved is in the Agenda for Action in the Commission’s report. Listed below are the immediate priorities for country support: – – – – – – –
Alignment of strategies recommendations.
and
mobilizing
resources
to
implement
VRS systems for registration of births, deaths and causes of death. Health-Information Systems to combine data from facilities, administrative sources and surveys and share it publicly. Produce disaggregated data by gender and other equity considerations for indicators prioritized by the Commission. Use ICT in Health-Information Systems and health infrastructure. Realigning Health-Information Systems National Strategies and plans using the HMN assessment reports and regional strategy. Development of institutional capacity for Health-Information Systems to accelerate implementation of plans on strengthening Health-Information Systems at the national, sub-national and community levels using the Regional Strategy. Resource tracking systems in HMIS. Common M&E framework. Promote awareness, coordination, mutual cooperation and trust through consultative meetings, national commissions, country “compacts” and other cooperation platforms.
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11.
Working towards the reduction of perinatal and neonatal mortality (WHA64.13) Background
Neonatal mortality contributes significantly to under-five mortality. MDG4 aims at reducing under-five mortality by two thirds by 2015 from its 1990 level. MDG5 calls for a three-quarters reduction in maternal mortality. Because of the inextricable relationship between maternal, perinatal and neonatal health, any effort to reduce maternal mortality will contribute towards reduction in perinatal and neonatal mortality, and efforts must concentrate during pregnancy, delivery and the postnatal period. While progress is being made in almost all Member States of the SEA Region in these two MDGs, the levels of perinatal and neonatal mortality remain unacceptably high.
Implications on collaborative activities with Member States
Collaborative activities will need to be further strengthened in the major normative roles of WHO: advocacy, capacity building (programme/service strengthening, including human resources), generating and disseminating evidence and information and partnerships with other agencies. Collaboration will continue to use several mechanisms: - meetings/consultations with Member States and expert groups for specific topics, support to individual countries in specific areas of concern, and dissemination of tools, publications and guidelines.
Actions already taken in the Region
Efforts to reduce maternal, perinatal and neonatal mortality include capacity-building for improved access to services and working towards skilled care, use of evidencebased tools, advocacy and advice to strengthen emergency obstetrics care, conduct of studies on maternal death audits in five countries, and needs assessment and training on essential newborn care. The sociocultural determinants of maternal and newborn health have been reviewed; countries are addressing these in the context of their local situation. Partnership meetings have been held to optimize intersectoral collaboration. Systematic programme reviews are being conducted. Substantial collaborative work has begun to strengthen the prevention of mother-to-child transmission (PMTCT) of HIV and congenital syphilis in four of the five high-burden countries (India, Indonesia, Myanmar and Nepal). Thailand has successfully implemented PMTCT.
Actions to be taken in the Region
Strategies on scaling up will be refined and specified following the workshop in July. Technical support will be provided to improve estimation of mortality data (maternal
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and child, which will also include perinatal and neonatal mortality) for tracking MDGs. The WHO guidelines on audit of perinatal deaths will be introduced in Member countries following the dissemination workshop on maternal death audits. For countries with low SBA coverage (India, Nepal and Bangladesh), a review of the situation will be conducted to be followed by recommendations of the best practical ways forward to achieve universal access to skilled care at birth. Efforts to strengthen family planning will be intensified after a review meeting in September. Efforts are underway to expand the use of the short programme review and the programme management tools; to address sociocultural determinants of MNH including partnership with the other sectors including the private sector in India. Newer areas of concern will begin to be addressed, including birth defects that contribute to perinatal and neonatal mortality.
12.
Draft global health sector strategy on HIV, 2011–2015 (WHA64.14) Background
The past 10 years have seen unprecedented commitments to global health and development, beginning in 2000 with the United Nations Millennium Development Goals (MDGs). These commitments have been matched by dramatic increases in resources – through the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank, Multi-country AIDS Programme (MAP), US President’s Emergency Fund for HIV/AIDS Relief (PEPFAR), other bilateral donors, private foundations, new global initiatives such as UNITAID, and domestic resources that have catalysed and expanded the health response to HIV. Despite the achievements, the global HIV epidemic continues to remain a serious public health problem with an estimated 33.3 million people currently living with HIV. National HIV responses are too often poorly targeted to national epidemics, and the type and quality of HIV interventions delivered in many settings do not adequately focus on populations at highest risk for HIV infection: people who inject drugs, sex workers and men who have sex with men.
Implications on collaborative activities with Member States
There are implications for both Member States and WHO. There is a: –
need to incorporate, based on national contexts, the policies, strategies, programmes and interventions and tools recommended by WHO in order to implement effective HIV prevention measures, early diagnosis, treatment and care; and take further steps towards minimizing social stigmatization and discrimination which hamper access to prevention, treatment and care.
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– –
need to take forward new WHO priorities, including revitalization of primary health care, integrated services delivery, and equitable access to health services. need to strengthening links between HIV, TB, SRH and MNCH and other programmes and services in order to ensure sustainability and maximize efficiencies and effectiveness.
Actions already taken in the Region
Draft Regional Health Sector Strategy on HIV, 2011–2015, has been developed with inputs from Member States. The Regional Strategy is aligned with the Global Health Sector Strategy on HIV 2011–2015. External reviews of the health sector response to sexually transmitted infections and HIV/AIDS have been conducted in several Member States. Member States are in preparation to update their new five-year strategic plans. SEAR Training Modules on Strategic and Operational Planning for the health sector response to HIV is being printed.
Actions to be taken in the Region
The draft Regional WHO HIV/AIDS Strategy for 2011–2015 to be submitted to the Regional Committee for South-East Asia in September 2011 for endorsement. Support country adaptation and adoption of the Regional HIV/AIDS Strategy for 2011–2015. Support Member States to develop national strategic plans on HIV based on the Regional Health Sector Strategy on HIV, 2011–2015. Conduct the regional training on strategic and operational planning for the health sector response to HIV as planned.
13.
Cholera: Mechanism for control and prevention (WHA64.15) Background
The burden of acute diarrhoea, including cholera and other enteric infections is high in the SEA Region. Acute diarrhoea is the leading cause of child mortality and a significant factor impeding regional progress towards achieving the Millennium Development Goals (MDG)-4. In addition to endemic cholera, large outbreaks are also known to occur almost every year, especially during the time of population displacement, water scarcity and flooding. Important risk factors in the Region include lack of access to safe water and sanitation, poverty, poor hygiene practices and weak health infrastructure.
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Implications on collaborative activities with Member States
Prevention and control measures require strong leadership, political commitment and a coordinated multidisciplinary approach involving sectors concerned with health, water, sanitation and hygiene. In addition, the capacity for surveillance and laboratory diagnosis needs to be strengthened in both endemic and outbreak-prone areas. This would allow better estimation of disease burden and facilitate monitoring of seasonality, risk factors, antibiotic resistance and the impact of interventions in high-risk populations. Effective implementation of prevention and control measures will require national and international support, but also mobilization of communities by empowering and involving them in planning and implementation. Immunization with low-cost, locally-produced oral cholera vaccines should be used to supplement other prevention and control strategies in endemic areas and should be considered in areas at risk for outbreaks. Community-based strategies that integrate prevention and control measures for pneumonia and acute diarrhoea across all age groups may also increase effectiveness.
Actions already taken in the Region
In order to address this important issue a Regional Technical Advisory Group (RTAG) on acute diarrhoea diseases and respiratory infections has been established at WHOSEARO. Following the first RATG meeting, a strategy for coordinated approach to prevention and control of acute diarrhoea and respiratory infections across all age groups in the Region was developed, which was adopted through a resolution by the Sixty-third Session of the Regional Committee.
Actions to be taken in the Region
Specific actions required at regional and national levels to facilitate inter-sectoral implementation of the strategy are currently being defined by the Regional Office in consultation with Member States, including strengthening surveillance and response capacities and behaviour change initiatives. A second RTAG meeting with expanded membership and remit will be held to review the current situation and provide guidance on accelerating the implementation of the strategy. Advocacy and resource mobilization will also be important to support adaptation and implementation through a coordinated approach by Member States.
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14.
Malaria (WHA64.17) Background
Malaria is endemic in 10 of the 11 Member States in the SEA Region. Investments in malaria control have yielded significant results in decreasing the malaria burden. Some countries are moving towards elimination of malaria, but other countries continue to have high burden of malaria. Around 70% (or 1.22 billion) of the total population in the SEA Region are at risk of malaria. There were 2.7 million confirmed cases and 3188 confirmed deaths due to malaria were reported by Member States in the SEA Region in 2009. WHO estimated that in 2009 malaria cases could be between 28 million to 41 million and malaria deaths may number around 49 000. There is a need to ensure full expansion of malaria control and prevention activities. It will require adequately-resourced national programmes functioning within effective health systems that provide for an uninterrupted supply of quality-assured commodities and services. Another key challenge is the emergence of resistance to artemisinin in the Thailand-Cambodia border and possibly in the Thailand-Myanmar border area. It threatens progress in malaria control not only in those countries but also globally.
Implications on collaborative activities with Member States
WHA64.17 calls for sustained financial commitments for malaria control in order to accelerate implementation of the policies and strategies recommended by WHO, thereby achieving malaria-related MDGs. It also calls for immediate action to combat the major threats, namely: resistance to artemisinin-based medicines and resistance to insecticides. It emphasized the need to further strengthen the health system and to implement malaria control interventions in an integrated manner.
Actions already taken in the Region
Adoption of artemisinin-based combination treatment. Periodic malaria control programme reviews. Each Member country has National Malaria Control Strategic Plans in place.
Actions to be taken in the Region
Strengthen regulatory capacities to ensure quality of malaria drugs and diagnostics. Halt the use of artemisinin monotherapy and substandard drugs. Improve pesticide management.
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Further expand coverage of key interventions for malaria control. Maintain core national competencies for malaria control by sustaining a strong cadre of malaria experts, including entomologists, at all levels of the health-care system.
15.
Drinking water, sanitation and health (WHA64.24) Background
About 85 per cent of the population of the SEA Region have access to improved drinking water and 65 per cent have access to improved sanitation. Few of the countries may miss their sanitation MDG if implementation is not accelerated. Improved drinking water may not be safe always and therefore there is great need to ensure the safety of drinking water. In 2008, 1.18 million people in the SEA Region have died from diarrhoeal diseases. About 88% of diarrhoeal diseases can be prevented with the provision of safe drinking water, proper sanitation and good hygiene practices. The WHA resolution on water, sanitation and health would provide the needed impetus in the Region for strengthening collaboration among various sectors.
Implications on collaborative activities with Member States
Further collaborations needed in strengthening safety of drinking water and promotion of sanitation and hygiene in the region. Inter-sectoral coordination between health and water and sanitation sectors is very crucial for implementing the resolution. Advocacy and implementation of water safety require expansion in other countries in the region. Collaboration with member states to strengthen water, sanitation and hygiene through the revitalization of primary health care. Lot of efforts are also required in translating the WHO guidelines for safe use of waste water in agriculture, minimum WSH standards for health care facilities and schools.
Actions already taken in the Region
Development of drinking water quality standards and water quality monitoring guidelines. A water safety plan is being implemented in six countries. Capacity building on water quality testing, sanitation, health-care waste management and water safety plans. Pilot-testing of appropriate and sustainable sanitation technologies in several countries. Promotion of rainwater harvesting as an alternative water source in several countries where surface water is contaminated by microbiological and chemical substances.
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Promotion of sanitation, sound management of health-care waste, household water treatment and safe storage and hygiene practices with a focus on hand washing. Strengthen monitoring systems through involvement in the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation. Three countries participated in the first Global Analysis and Assessment of sanitation and drinkingwater survey (GLAAS). Situation analysis and assessment of water, sanitation and waste management in health-care facilities have been initiated in India, Nepal and Timor-Leste.
Actions to be taken in the Region
Prepare a Regional Strategy on Water, Sanitation and Health with a focus on intersectoral collaboration to address the current and emerging water and sanitation challenges. Introduce water safety plan in the remaining five Member States and continue implementation in the existing countries. Capacity-building and promotion of sanitation and hygiene, water quality management, household water treatment and safe storage. Facilitate the participation of all Member States in the 2011 GLAAS survey and future surveys. Assessment of water, sanitation and waste management in the remaining eight Member States.
16.
Child injury prevention (WHA64.27) Background
Child injuries are threats to child survival and health. The leading causes of child deaths from unintentional injury are road traffic, drowning, falls, burns and poisoning. They are a neglected public health problem with significant consequences in terms of mortality, morbidity, quality of life, social and economic costs, and can conspicuously impede the attainment of the Millennium Development Goals if urgent action is not taken. Developing, low- and middle-income countries bear a significant global burden of child injuries.
Implications on collaborative activities with Member States
The context of the SEA Region differs vastly from developed countries, mere adaptation and transfer of knowledge from HICs may not be relevant. Extra resources have to be mobilized to build capacity and encourage cost-effective research and interventions for Member States.
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WHO should assist countries in collecting data, research and translation into affordable safety products; public health policies and interventions; providing technical support to national injury focal points/units; building institutional and individual capacity to develop cost-effective intervention; strengthening emergency care and rehabilitation; and to report progress of the same at the 67th WHA.
Actions already taken in the Region
WHO SEARO’s publication Profile of Child Injuries in Asia-Pacific, Factsheet on Child Injury Prevention in SEA Region and Status Report on Road Safety in SEA Region which includes child traffic safety, disseminated multisectorally and with multisectoral collaboration being ongoing. Several intercountry workshops and trainings have been held to discuss the issue and interventions. The SEA Region MoH FP on injury prevention met regularly since 2007. Recommendations from the SEA Expert Group Meeting on Preventing Motorcycle Injuries in Children in 2010 were disseminated to all SEA Region countries, HQ and other regional offices. Two intercountry training sessions on RTI research and pre-hospital care inclusive of child injuries will be held in end-2011. Five countries have national road traffic policy and strategies in place. Indonesia and Thailand have national standards on the manufacture of child motorcycle helmets (for children aged 2 – 6 years). Bangladesh and Thailand have significant national survey, research and intervention in child injuries, especially on childhood drowning. Child injury prevention is included in the Handbook for Undergraduate Medical Curriculum, 2011.
Actions to be taken in the Region
Improve national data system. Define priority for research and work closely with relevant manufacturers and distributors of safety products and build research capacity for cost–effective interventions relevant to the regional context. Assignation of a leadership role to a government agency or unit for child injury prevention to facilitate multisectoral collaboration. Integrate child injury prevention in national child development and relevant programmes and ensure intersectoral mechanisms.
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Advocate for strengthening legislative, administrative, social and educational measures and enforcement of law and regulation to protect children injuries. Promote standards and codes on product safety, schools, play spaces and transportation for child safety. Raise awareness and health literacy in child safety among parents, children, employers, professional groups and society.
17.
Youth and health risks (WHA64.28) Background
Young people (10–24 years) constitute more than 500 million of the total population in Member States of the South-East Asia Region. It is estimated that nearly two thirds of premature deaths and one third of the total disease burden in adults are associated with conditions or behaviours started during adolescence. From a public health perspective, the long term implications of morbidities and health behaviours are the most compelling reason to address the needs of young people. In SEA Region Member countries injury is the most common cause of death among young men and maternal mortality among young women, because of early childbearing. Additionally the young people are faced with STIs, HIV, unsafe abortions; under-nutrition and anemia on one hand and obesity on the other; and several risky behaviour related problems (alcohol and tobacco use, violence, injuries, accidents, suicide, etc.).
Implications on collaborative activities with Member States
In many SEA Region countries age-disaggregated data related to adolescent/young people’s health has not been available. In some countries limited data related to the 15–24 age group, mostly females, is available from the national DHS. Early pregnancy (before the age of 18 years) is common in Bangladesh, India and Nepal and out of about 37 million births in the SEA Region each year, around four million babies are born to adolescent mothers. Young mothers and their children face risks of morbidity and mortality related to early pregnancy and early childbearing. This age group is significantly responsible for putting the achievement of MDG 4 and 5 to risk. Unmet needs for contraception are high and condom use remains low among adolescents in many countries of the Region. Young people remain at a greater risk of STIs, HIV and unwanted pregnancy. Each year about one third of new HIV infections are reported to occur among young people.
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Anaemia and under-nutrition continue to be a problem in many countries and the burden of obesity due to faulty eating habits and lack of physical activity is increasing. Tobacco and alcohol use, and injuries and violence among young people are on the rise due to urbanization, globalization and other sociocultural changes.
Actions already taken in the Region
Child and Adolescent Health-SEARO has focused on the provision of adolescent/youth-friendly health services (AFHS/YFHS) within the health sector. Member countries have been supported to develop/strengthen national strategies and plans for adolescent/young people’s health. Bangladesh, India, Nepal, Myanmar have developed national strategies for adolescent/young people’s health. National standards, implementation guidelines and packages for capacity-building of healthcare providers have been developed and used in Bangladesh, India, Indonesia, Nepal, Sri Lanka and Thailand. Regional training packages to support the capacity of district programme managers have been developed in collaboration with UNFPA. Strengthening strategic information analysis of national DHS data to obtain age and sex disaggregation has been supported in Bangladesh, India, Nepal and Sri Lanka. Country and regional factsheets on adolescent health and HIV/AIDS among young people have been updated. Intersectoral collaboration has been initiated towards demand generation for services as well as prevention and health promotion among adolescents/young people. Efforts have been initiated to mainstream activities to address young people’s needs in school health, mental health and tobacco prevention programmes as well as for prevention of injuries and accidents. Health promotion activities with in the school health programmes have been supported in Member countries to address issues related to diet and physical activity and prevention of risky behaviours.
Actions to be taken in the Region
Support Member countries to scale up adolescent/youth-friendly health services (AFHS/YFHS) and develop capacity for programme management, monitoring and assessment of quality and coverage of services. Strengthen efforts for strengthening multisectoral policy environment for youth health and awareness generation. Collaboration with relevant technical units in SEARO is being undertaken for programme development on school health, nutrition, tobacco use, mental health, injuries and accidents.