Summary report by the Chairperson of the sixty-ninth session of the Regional Committee for the Western Pacific : Honourable Sir Dr Puka Temu, Minister for Health and HIV/AIDS, Papua New Guinea

1 Sixty-ninth session of the WHO Regional Committee for the Western Pacific Summary report from the Chairperson (Honourable Sir Dr Puka Temu, Minister for Health and HIV/AIDS, Papua New Guinea) Part 1. Topics for global discussion Draft WHO global strategy on health, environment and climate change Discussing the regional progress report on environmental health, representatives raised concerns that may inform the development of the global strategy on health, environment and climate change. Several representatives from the Pacific emphasized the need for aggressive measures to mitigate potentially devastating impacts of climate change in their island states. Representatives cited health challenges related to the environment and health, specifically vulnerability to cyclones/typhoons, effects of rising sea levels, drinking-water contamination and severe heatwaves. One representative said that foreign investment and development in his country had increased the use of harmful substances, specifically chrysotile asbestos. Air pollution due to solid-fuel combustion was cited as an environmental issue by another representative. Several representatives urged the Secretariat to ensure that the Region’s climate change-related health priorities were adequately reflected in the Proposed Programme Budget 2020–2021, with increased investment in surveillance and early warning systems to mitigate the impacts of climate change. One representative noted the impact that climate change and environmental health had on health security, and called for additional support during health emergencies. Finally, it was noted that a geographically dispersed specialized office on environmental health being established in the Republic of Korea could provide support to Member States. The representatives did not propose a specific resolution on health, environment and climate. Proposed Programme Budget 2020–2021 Representatives expressed broad support for the Proposed Programme Budget, especially the country focus and bottom-up consultative process that informed its development. They commended the WHO commitment to monitor progress towards improved health outcomes and refocus investment on strategic priorities in line with the Sustainable Development Goals (SDGs). Representatives took note of the intent to broaden the Organization’s donor base, while also expressing concern about the feasibility of the budget in the current donor environment. Representatives were supportive of the planned reduction in funding for WHO headquarters, but sought clarification on its potential impact on the work of the Organization at its three levels. They said that they would need greater detail on several budget areas of the well in advance of the January Executive Board discussion. A number of representatives also noted the continued reliance on voluntary contributions and the attendant risk of unpredictability, expressing concerns that identified priorities would not be fully funded. The Chairperson said the discussion at the Regional Committee would be summarized and submitted to inform Executive Board discussions. 2 Part 2. Topics of regional significance NEGLECTED TROPICAL DISEASES Representatives acknowledged regional progress combating lymphatic filariasis, trachoma and schistosomiasis, achieved primarily through mass drug administration. They called for more comprehensive responses to tackle other neglected tropical diseases (NTDs), particularly in marginalized populations and isolated rural areas that often lack access to safe drinking water, safe food, adequate sanitation and vector-control services, and where basic health literacy is limited. Clean water and poor hygiene were cited as particular challenges in rural and remote areas. Some representatives recommended addressing these challenges through water, sanitation and hygiene (WASH) programmes or food hygiene initiatives. Following discussion of the issues, the Regional Committee adopted a resolution 1 that endorsed the Regional Action Framework for Control and Elimination of Neglected Tropical Diseases in the Western Pacific. The resolution urged Member States to use the Framework as a guide to develop or update multisectoral national NTD action plans and to ensure adequate resources to implement plans, noting that integrated efforts would be the most cost-effective and sustainable approach. The resolution also requested the Regional Director to provide technical support and to advocate and enhance collaboration in NTD control and elimination. REHABILITATION Representatives noted the growing demand for rehabilitation services in countries, with increases driven by ageing populations and rising incidences of noncommunicable diseases (NCDs), mental health disorders, natural disasters and road accidents. Some representatives spoke of country-level initiatives to meet this demand, but noted the need to mobilize and train an adequate rehabilitation workforce. Several representatives highlighted the need for human- rights-based, community-focused and culturally responsible approaches to rehabilitation, as well as the need to integrate rehabilitation services into the rest of the health system. The need for a multisectoral approach was noted, since rehabilitation concerns not only improving individual health but also removing barriers to work, education, social activities and the full enjoyment of life. Following a discussion of the issues, the Regional Committee adopted a resolution 2 that endorsed the Western Pacific Regional Framework on Rehabilitation 2018–2023. The resolution urged Member States prioritize rehabilitation, to mobilize technical and financial resources to deliver services integrated into their health system, and to pursue the development of services and the workforce for rehabilitation. The resolution also requested the Regional Director to provide technical support to Member States and to advocate integration of rehabilitation within all levels of the health system. 1 WPR/RC69.R4 2 WPR/RC69.R6 3 STRENGTHENING LEGAL FRAMEWORKS FOR HEALTH IN THE SUSTAINABLE DEVELOPMENT GOALS Member States have increasingly requested WHO technical assistance regarding ways to use law to promote health and well-being, an approach driven in part by the scale and complexity of the 2030 Agenda for Sustainable Development. Following consultations, the Secretariat developed the Western Pacific Regional Action Agenda on Strengthening Legal Frameworks for Health in the Sustainable Development Goals, which is the first such strategy developed by any WHO office. Legal frameworks, which include a combination of legislation and institutions, are seen as essential drivers to progress towards universal health coverage (UHC) and the health-related SDG targets. During Regional Committee deliberations, representatives broadly supported the Action Agenda and offered examples of legislation for health in their respective countries. Several representatives stressed the importance of legislating to achieve and sustain UHC, citing legislation on tobacco use, food additives and food labelling as examples of effective health laws that informed people about health risks and shaped social norms. Following discussions, the Regional Committee adopted a resolution 3 that endorsed the Action Agenda. The resolution urged Member States to use the Action Agenda to strengthen legal frameworks for health in their country, as appropriate to their own context. The resolution also requested the Regional Director to facilitate dialogue and knowledge-sharing and to provide technical support and expertise to Member States to strengthen legal frameworks for health. HARNESSING E-HEALTH FOR IMPROVED SERVICE DELIVERY The roll-out in the Western Pacific Region of e-health, which refers to the use of information and communication technologies in health service delivery, has been uneven. Many Member States have piloted e-health programmes, but not scaled up those initiatives. These experiences, however, have helped inform the development of the Regional Action Agenda on Harnessing e- health for Improved Health Service Delivery in the Western Pacific. The Action Agenda offers practical guidance to Member States on how e-health can improve access to and quality of services in a cost-effective manner through the development of appropriate infrastructure, information-sharing, and confidentiality and security mechanisms. Representatives expressed strong support for the Action Agenda and described e-health initiatives in their respective countries, citing the value of technology in enhancing patient experience. They also said e-health can help minimize fragmentation of care through, for example, the introduction of a unique e-health identifier that acts as a person’s “passport” through the entire health system. Such technology can help boost access, enhance quality and contain costs of health services. Several representatives emphasized the crucial role of e-health in expanding UHC and contributing to health-related SDG targets, as well as its importance for telemedicine and remote diagnostics in small island settings. 3 WPR/RC69.R5 4 Following the discussion, the Regional Committee adopted a resolution 4 that endorsed the Action Agenda. The resolution urged Member States to use the Action Agenda to develop or strengthen national e-health strategies, to ensure key foundations and enablers for e-health are in place, and to strengthen governance and leadership for e-health with broad multisectoral coordination. The resolution also requested the Regional Director to work with partners to help raise awareness and support for e-health and to provide technical support and guidance to Member States for e-health development and implementation. IMPROVING HOSPITAL PLANNING AND MANAGEMENT Hospitals play a central role in advancing UHC and maintaining and improving health for the more than 1.9 billion people in the Region. However, weak management, inefficiencies, high costs and poor clinical governance continue to be key challenges to performance at the facility level. At the health-system level, hospital performance in the Region has been hampered by limited integration and coordination with primary health-care providers and other hospitals, inadequate feedback mechanisms and procedures, perverse financial incentives and weak regulation. Representatives described specific challenges faced by hospitals in their countries, including overburdened facilities and systems, demographic changes and ageing populations, and escalating costs. They also cited workforce shortages and a lack of training – including management training – for hospital staff, especially in remote areas. Representatives expressed broad support for the Regional Action Framework on Improving Hospital Planning and Management in the Western Pacific, which contains proposed actions that Member States could adapt and implement according to their individual contexts and needs. Following the discussion, the Regional Committee adopted a resolution 5 that endorsed the Action Framework. The resolution urged Member States to use the Action Framework as guidance to improve hospital performance; to allocate sufficient financial, human and technological resources to promote efficiency, accountability and quality in hospital services; and to monitor hospital performance based on nationally agreed indicators. The resolution also requested the Regional Director to provide technical support to Member States in building capacity and taking action to improve hospital planning and management and to foster regional exchanges of knowledge. HEALTH SECURITY Representatives participated in a broad discussion of health security, noting the value of the Asia Pacific Strategy for Emerging Diseases and Public Health Emergencies and the Joint External Evaluations conducted in association with the International Health Regulations (2005). They also reiterated support for Western Pacific Regional Framework for Action for Disaster Risk Management for Health. With regard to antimicrobial resistance (AMR), representatives 4 WPR/RC69.R2 5 WPR/RC69.R3 5 outlined steps being taken to tackle AMR at the country level under the Action Agenda for Antimicrobial Resistance in the Western Pacific Region. Several representatives noted the need to increase financial and human resources as well as overall systemic capacity to combat AMR. The Secretariat pledged to continue to support Member States in these areas. NONCOMMUNICABLE DISEASES Representatives discussed NCD-related challenges in countries, as well as efforts to address risk factors and social determinants of health. Tobacco control efforts were highlighted, including graphic health warnings, bans on advertising and taxes on tobacco products. Several representatives drew attention to efforts to combat overweight and obesity. The Secretariat outlined ongoing efforts, including the development of a regional action plan on protecting children from the harmful effects of food marketing. There was broad agreement that NCDs are a serious public health threat and that governments and WHO need to do more. ENVIRONMENTAL HEALTH Representatives expressed broad agreement on the need for aggressive climate change mitigation measures globally, given that climate change represents a real and imminent threat to several Pacific island countries and areas. Country-specific concerns were highlighted with regard to vulnerability to typhoons, the encroachment of sea, contamination of drinking-water, extreme heatwaves and the use of toxic chemicals. A number of representatives requested WHO technical assistance, specifically to strengthen WASH programmes. COMMUNICABLE DISEASES Representatives highlighted ongoing initiatives to prevent and control communicable diseases in their countries, noting progress in combating vaccine-preventable diseases under the Regional Framework for Implementation of the Global Vaccine Action Plan in the Western Pacific. They also noted the need for continuing WHO support to ensure vaccine quality and safety. Some representatives offered to share expertise and best practices with other countries. Representatives discussed progress on malaria control and elimination as well as measles and rubella elimination, in line with strategies endorsed in past sessions. The Secretariat pledged to continue to provide support to health authorities in Papua New Guinea to contain the current outbreak of polio.