Leading the way to a healthier future The World Health Organization in the Western Pacific Region
WHO in the Western Pacific Region
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© World Health Organization 2012 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: permissions@who.int). For WHO Western Pacific Regional Publications, request for permission to reproduce should be addressed to the Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines, (fax: +632 521 1036, e-mail: publications@wpro.who.int). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.
Leading the way to a healthier future The World Health Organization in the Western Pacific Region
Representative in the Western Mongolia office
The Lao People’s Democratic Republic office Philippines office
Cambodia office
Malaysia office
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Leading the way to a healthier future Papua New Guinea office
Viet Nam office
and Country Liaison Offices Pacific Region
Kiribati office
China office
Samoa office Northern Micronesia office
South Pacific office
Tonga office
WHO in the Western Pacific Region Vanuatu office Solomon Islands office
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Leading the way to a healthier future
“History has shown us that nothing helps countries develop faster overall than improving the health of their people.” Dr Shin Young-soo, WHO Regional Director for the Western Pacific Region
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or more than six decades WHO has been the leading authority on public health in the Western Pacific Region and has helped the Region’s countries and areas mount effective responses to health threats that have saved millions of lives and freed millions more from debilitating diseases. Carrying on that work today, staff at the WHO Regional Office in Manila, Philippines, and 15 country offices work hand-in-hand with 37 countries and areas, health authorities, partners and other stakeholders to provide the support, collaboration and guidance needed to bring better health to 1.8 billion people in the Region. Spanning a vast area from China to New Zealand the largest of WHO’s six regions harbours some of the world’s least-developed nations and most rapidly emerging economies creating a dynamic and complex array of public health challenges. In assisting governments to meet these challenges WHO core functions include leadership, shaping the research agenda and articulating policy options. The Organization also provides technical support, helps build capacity and monitors health trends. Ann G. Hirschey, Chief of the Office of Health, United States Agency for International Development (USAID), Philippines says, “USAID appreciates the technical expertise being provided by WHO specialists to countries in the Region. We highly value the partnership and professional collaboration that WHO fosters among development partners and stakeholders at the country level.” Health is a fundamental human right. Our mission is to act as the directing and coordinating authority on international health work towards the objective of the attainment by all people of the highest possible level of health. The three tiers of our Organization— headquarters, regions and countries—allow
us to reach out and provide governments and their people the widest range of assistance. WHO assigns health experts to work alongside ministry of health staff in Member States. This close cooperation is futher enhanced by having our country offices located inside or close to ministries of health.
Serving Member States Better
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hen Dr Shin Young-soo became Regional Director in 2009 he initiated Fit for the Future, a consultation that led to ambitious Organization-wide transformation, followed by Moving Forward, Making a Difference supported by Member States including Australia, Japan, the Republic of Korea and Macao (China). WHO has emerged a stronger and more responsive Organization that seeks value for money, practices cost-effectiveness and maximizes productivity. Our efforts are now more sharply focused at the country level, where we can better customize assistance to the specific needs of each Member State. The Division of Pacific Technical Support was established in Fiji to enhance technical coordination throughout the Pacific. Support for country offices has been improved and a Country Support unit created in the Regional Office, which helps develop and update country cooperation strategies. Philippine Secretary of Health, Dr Enrique T. Ona, said, “The Country Cooperation Strategy for 2011–2016 will be of great help in our pursuit of Kalusugan Pangkalahatan, or universal health care.” Dr Ona says that the strategies will help the Philippines to achieve the healthrelated Millennium Development Goals by 2015. “This will serve as well as the key document for planning, policy and programme development for the attainment of our common health goals,“ he says.
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“Australia looks forward to continuing to work with the Regional Office for the Western Pacific to improve the health of people in our Region.” Benedict David Principal Health Specialist, AusAID Saving lives is the first concern of the Australian Agency for International Development (AusAID), and WHO is an important partner in achieving this in the Asia Pacific region, says AusAID Principal Health Specialist Benedict David. He notes that WHO sets global norms and standards for health and the Regional Office and country offices play a critical role in translating these norms and standards at the country level to strengthen health systems, respond to health emergencies and help achieve Millennium Development Goals. “The leadership of the Regional Office for the Western Pacific is pioneering and advancing WHO reforms at a regional and country level,” he says. “Australia strongly supports these reforms. They are important to improving the efficiency and effectiveness of health systems and services on the ground. Australia looks forward to continuing to work with the Regional Office for the Western Pacific to improve the health of people in our Region.”
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Women walk in terraced fields in China's Guangxi Zhuang Autonomous Region.
New Ways of Working with Governments
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HO is working directly at a subnational level in close collaboration with local governments to bring a wide range of public health benefits to 110 million people in China’s remote western region who face the double burden of communicable and noncommunicable diseases (NCDs). WHO appointed a Senior Health Adviser to work in China to lead the Western Area Health Initiative (WAHI). WHO internal funds and flexible funds from AusAID and the Republic of Korea were made available to expedite necessary baseline studies. This groundbreaking partnership between the Ministry of Health, WHO and
the governments of Guangxi, Chongqing and Shaanxi will serve as a model for other regions and developing countries. At the launch of the initiative in August 2012, China’s Health Minister Chen Zhu remarked that it was an excellent example of the health sector working closely with non-health sectors and local governments and that the initiative has opened a new chapter for collaboration between China and WHO. A second subnational project in the Philippines has been initiated to support the Government’s goal of universal access to health services in areas of the country most in need.
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Leading the way to a healthier future
Combating Communicable Diseases
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ommunicable diseases account for more than 60% of the disease burden in some countries and areas in the Region. WHO places a strong emphasis on inter-programmatic and intersectoral cooperation and strategies in the battle against communicable diseases. We are focused on sustaining gains, developing new strategies to address remaining challenges, and forging strong internal and external partnerships. We support Member States in their fight against vaccine-preventable diseases, which has contributed to reductions in child mortality (MDG 4) and improved maternal health (MDG 5). No single intervention is more cost-effective than immunization and WHO and its Member States have made some spectacular progress: 32 countries and areas likely eliminated measles ahead of the 2012 target and the 2012 milestone for hepatitis B control likely was met by the Region as a whole and by 30 individual countries and areas. A polio outbreak in China 2011 was successfully contained with close collaboration among China’s Ministry of Health, WHO and partners. Countries in the Region have pioneered effective health sector responses to HIV, such as developing national HIV strategies, implementing 100% condom use programmes, improving access to HIV testing and counseling and increasing antiretroviral coverage. However, there is a real danger of the gains made in recent years being eroded by dwindling resources. “HIV will remain endemic in key populations for many decades, with increasing public health and economic costs. Countries must now make strategic investments in HIV to halt new infections,” Dr Shin Youngsoo, Regional Director told representatives from Member States during the WHO sixtythird session of the Regional Committee for the Western Pacific in Hanoi, Viet Nam.
WHO continues to support Member States in their campaigns against vaccine-preventable diseases.
Measles cases and immunization coverage, Western Pacific Region, 1980–2011 1400
Cases (in thousands)
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1200 80% 1000 70% 60% 50% 600 40% 30% 20% 200 10% 0 0%
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Measles control
Measles accelerated control
Measles elimination
Measles cases
MCV1 coverage
MCV2 coverage
MCV1 = Measles containing vaccine first dose MCV2 = Measles containing vaccine second dose Source: WHO-UNICEF Joint Reporting Forms (JRF) for Immunization
2011
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Over the past decade significant progress has also been made in tuberculosis (TB) control in the Region. More than 1.3 million people are diagnosed with TB annually in the Region and more than 90% with infectious forms are treated successfully as a result of the expansion of quality TB services. The Region bears more than a quarter of the worldwide burden of multidrug-resistant TB (MDR-TB), strains which could become incurable. WHO offers Member States country-specific assistance against MDR-TB. WHO-supported programmes are addressing TB among Cambodia’s slum dwellers. In the Philippines and Viet Nam WHO initiated projects to engage hospitals in effective TB control. Frediric Seridio, a company driver in Manila, recounts how he felt weak and was losing weight before being treated for TB at a local health centre as a result of the CATCH-TB cases project, implemented by the National TB Control Program of the Philippines and funded by WHO and the Canadian International Development Agency (CIDA). Seridio is strong and healthy today, one of about 10 500 TB sufferers managed and referred by 17 hospitals in the project. In 2011 approximately 150 000 urban poor were covered by CATCH-TB. In 2011, Regional Director Dr Shin made a personal commitment to work toward eliminating Neglected Tropical Diseases (NTDs) that afflict many poor and marginalized people in 28 countries and areas in the Region. Nine countries are now preparing to verify elimination of lymphatic filariasis. Ms Tetenge in Kiribati contracted the disfiguring disease caused by mosquito-borne parasites in 2007. She lost her job and could barely walk on her swollen legs. “I felt useless and a burden to my family,” she recalls. That was before a team from WHO and the Ministry of Health visited her. “That is the day that changed my life,” she says. The team started her on a drug regimen and showed her how to care for her legs and where to get treatment. In addition to implementing the WHO-recommended strategy to stop the disease, Ministry of Health personnel have worked hard to alleviate the suffering and disability caused by the disease.
In the fight against soil-transmitted helminths, deworming programmes in Cambodia, the Lao People’s Democratic Republic, Tuvalu and Viet Nam achieved the global target of deworming at least 75% of primary school-aged children. Accurate data collection is crucial for any communicable disease control programme. Leprosy is not an exception. WHO has been collaborating with American Leprosy Missions on the development and implementation of a web-based data collection system for leprosy surveillance. The new system was launched in 2012. WHO has also intensified technical assistance to Pacific island countries that have yet to reach leprosy elimination, and to those countries that need to concentrate their efforts at the subnational level.
The Region bears more than a quarter of the worldwide burden of multidrugresistant TB (MDR-TB), strains which could become incurable.
The Ministry of Health in Kiribati implements the WHO-recommended strategy to interrupt transmission of lymphatic filariasis and cares for those afflicted.
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On the Frontlines in the War Against Artemisinin-resistant Malaria
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alaria is on the run with nine out of 10 malaria-endemic countries switching their national goals from control to elimination. In the past decade, more than US$ 850 million has been mobilized from the Global Fund to Fight AIDS, Tuberculosis and Malaria for endemic countries, but the fund’s current financial crisis may threaten the goal of elimination unless additional resources can be mobilized. Other key donors for malaria in the Region include USAID, AusAID and the Bill & Melinda Gates Foundation. WHO mobilized US$ 22 million through the Gates Foundation to battle artemisinin-resistant malaria along the Thai-Cambodia border where Yeang Chheang patrols the frontlines. The 74 year-old malaria field officer brings missionary-like zeal to containing and eliminating artemisinin-resistant malaria parasites. “I am happy with the joint WHO-National Malaria
Control Centre work,” he says, sheparding a mother and daughter to a blood screening area in Pailin in western Cambodia, which is ground zero for multiple drug-resistant malaria. Uncle Chheang, as his colleagues fondly refer to him, is a field team leader in the pilot project Focused Screening and Treatment that detects and treats hidden cases of malaria in remote villages. His task is to coordinate the liaison between health centres and village commune chiefs to ensure that all villagers report to screening sites where their temperatures are taken and blood samples obtained for rapid diagnostic test in the field which is then checked by more sensitive methods in Phnom Penh. He also coordinates transport by taxis of field blood samples to Phnom Penh for analysis at the Pasteur Institute of Cambodia. “My age is not a problem and both WHO and the National Malaria Control Centre recognize my field skills,” he says.
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Yeang Chheang (left) registers villagers in Cambodia to be screened for malaria parasites.
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Ensuring Health Security In recent years the Region has been at the epicentre of public health events of international concern and disasters of epic proportions, such as pandemic influenza in 2009 and earthquakes in Japan and New Zealand in 2011. Other emergencies and disasters in 2011 included typhoons and floods in Cambodia, the Lao People’s Democratic Republic, the Philippines and Viet Nam and a landside in Papua New Guinea. As the leader of the health cluster response to disasters and emergencies WHO, in collaboration with Member States, has incorporated lessons learnt from these disasters to strengthen preparedness and response efforts in the future. The Emergency Operations Centre in the Regional Office serves as a key management and coordination hub for health emergency response in the Region. The centre facilitates information collection and display, joint risk assessments, and timely decision-making and response. WHO has made technical support available to several countries and areas in the Region to strengthen their national and local capacities for the prevention, detection and management of public health threats arising from emerging infectious diseases, food safety hazards, disasters and emergencies. WHO continues to support Member States in implementing International Health Regulations, known as IHR (2005). The workplan for the Asia Pacific Strategy for Emerging Diseases —APSED (2010)—has been a valuable tool for countries in fulfilling IHR (2005). WHO worked with Member States to develop and implement the Western Pacific Regional Food Safety Strategy (2011–2015). Support was provided to Cambodia, the Lao People’s Democratic Republic and Viet Nam for laboratory capacity-building, foodborne disease outbreak investigation and laboratory
needs assessment with funding from USAID. Additional support on microbial risk assessment was provided in Fiji and Viet Nam. In Qingdao, China, foodborne disease surveillance and microbial and chemical risk assessment was supported. Using WHO collaborating centres throughout the Region, laboratory assistance was provided to a number of countries in response to foodborne disease outbreaks. In Emergency and Humanitarian Action, WHO reviewed lessons learnt from recent disaster responses and identified strategic directions in strengthening health emergency risk management. The Western Pacific Region is at the epicentre of various health security risks, including infectious diseases with pandemic potential. WHO continually monitors these threats using a regional event-based surveillance system that detected more than 300 public health events between July 2011 and June 2012.
The Emergency Operations Centre in the Regional Office serves as a key management and coordination hub for health emergency response in the Region.
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In collaboration with Japan, WHO documented and disseminated lessons learnt from the ongoing recovery from the March 2011 earthquake and tsunami.
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Leading the way to a healthier future
Building Healthy Communities and Populations Environmental health risks and threats cause approximately 2.9 million deaths in the Region each year and result in 58.8 million disability-adjusted life years (DALYs) lost in the Region annually. More than 90% of the disease burden and associated deaths occur in developing countries in the Region. Besides unsafe water and poor sanitation, other emerging threats include indoor and outdoor air pollution,
toxic and hazardous chemicals and wastes, climate change and poor occupational conditions. WHO supported Member States in developing and implementing national environmental health policies and actions for water and sanitation; chemical and hazardous substances, including the establishment of poison control centres; management of solid and hazardous waste, particularly health-care waste; health impact assessments; health in other sectors, such as transport, agriculture, energy and industry; and environmental health for children.
The First Embrace: Saving Newborns very two minutes a newborn dies in the Western Pacific Region. Dr Howard Sobel, WHO Maternal and Child Health and Nutrition Team Leader points out that newborns account for more than half of all child deaths. “Immediate newborn care interventions will prevent 35% to 65% of these deaths,” he
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said. That translates into over 88 000 lives saved annually in the Region. The First Embrace is a programme developed in the Philippines with support from WHO that lays out a protocol for promoting maternal and newborn health in simple, user-friendly guidelines.
Newborn Dania Camacho, declared the world's symbolic seven-billionth baby by the United Nations, rests on her mother's chest in the Fabella Maternity Hospital in Manila, October 31, 2011.
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Students and teachers at primary schools in Yen Bai and Binh Duong provinces received high quality helmets through WHO's collaboration on road safety with the Government of Viet Nam.
The Region suffers an estimated 278 000 road traffic deaths annually and with increasing urbanization and motorization this toll is certain to rise without substantial investments in prevention. Viet Nam’s roads claim more than 11 000 lives each year and Nguyen Thanh Thao, a salesman in Da Nang, never felt right carrying his 11-year-old daughter to school on the back of his motorbike without a helmet. “My wife and I wear helmets and now so does our daughter. It’s the best way to protect her in the event of a crash.” Along with primary schools in Yen Bai and Binh Duong provinces, the 1000 students and teachers at Be Van Dam primary school in Da Nang received a new high-quality tropical helmet through WHO’s programme of collaboration in road safety with the Government in Viet Nam. Ms Ton Nu Lan Anh, a teacher at Be Van Dam Primary School, noted a big increase in helmet wearing after the programme. “After each child was given a helmet and taught how to wear it properly, wearing rates increased from 50% to more than 80%,” she says. With support from Bloomberg Philanthropies, WHO supported Cambodia, China and Viet Nam in the implementation of multisectoral community-based interventions for road safety, in particular legislation on motorcycle helmets, seatbelts and drink-driving. With WHO guidance, the province of Guimaras became the first province in the Philippines to promulgate a law on drink-driving. The Region is experiencing soaring rates of cardiovascular disease, diabetes and cancer, primarily caused by tobacco and alcohol use, poor diets high in fats, sugar and salt, obesity and lack of exercise. These NCDs are now responsible for four out of five deaths in the Region and threaten to overwhelm the healthcare systems of Member States. The prevention and control of NCDs were given a high priority at the September 2011 High-level Meeting of the United Nations General Assembly on the Prevention and Control of Noncommunicable Diseases and at the sixty-second session of the WHO Regional Committee for the Western Pacific in October 2011. WHO is supporting Member States to scale up whole-of-government
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Leading the way to a healthier future
and whole-of-society approaches which are key to curbing the epidemic of NCDs. A regional meeting on developing national multisectoral plans for NCD prevention and control was organized in June 2012 in Malaysia. Support was provided to Mongolia for salt reduction and integrated NCD prevention in the cities of Darkhan and Ulaanbaatar. A regional meeting on NCD prevention through reducing alcohol-related harm was organized in Hong Kong, China in April 2012. An informal dialogue with the food industry was organized in Manila, Philippines in the same month to exchange information on salt reduction and develop WHO recommendations on the marketing of food and non-alcoholic beverages
to children. Technical support was provided to the Philippines for introducing the WHO Package of Essential NCD Interventions. In the Lao People’s Democratic Republic, a draft strategy and operational plan for cervical cancer control was developed and in Cambodia, WHO provided support to the Ministry of Health for developing the national strategy for cancer control. WHO is also now currently preparing a regional action plan for NCD prevention and control for 2014–2018 which will further consolidate ongoing efforts, especially strengthening health systems for NCD management in primary care and improving surveillance and monitoring of NCDs in the Region.
Banishing Anaemia in Viet Nam demonstration project in Viet Nam’s Yen Bai Province has proven weekly iron and folic acid supplementation (WIFS) combined with deworming medicine for women of reproductive age is a cost-effective preventative approach to reducing the prevalence of anaemia in women, which leaves them prone to infections and other health problems and maternal and neonatal mortality. In a 12-month period anaemia fell by 45% and hookworm infections dropped from 76% to 25%. The success and low cost of the WHO-supported intervention prompted provincial authorities to upscale the project province-wide to reach 250 000 women.
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WHO is supporting Member States to scale up wholeof-government and whole-ofsociety approaches which are key to curbing the epidemic of NCDs.
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It is estimated that worldwide there are 469 million anaemic women of reproductive age.
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Sample of plain packaging with graphic health warnings
To promote healthy living, WHO Mental health interventions in the Region implemented a Healthy Settings approach, aim to reduce the treatment gap of mental including Healthy Cities, Healthy Islands and disorders, prevent suicide and advance peopleHealth Promoting Schools. Implementation of the centred health care. Efforts are underway to Regional Framework on Scaling up and Expanding build partnerships for mental health, strengthen Healthy Cities in the Western Pacific (2011–2015) integrated and systematic prevention and is a priority. Advocacy of the Framework for management of mental disorders and generate Action for Health Promoting Schools led to more and disseminate relevant information. Through schools adopting the approach and designing the innovative Media and the Prevention of interventions to create supportive environments. Suicide (MAPS) initiative, WHO is engaging As high-level political commitment is critical in media professionals and organizations to the Healthy Cities approach, WHO provided play a more active role in suicide prevention support to Member States in developing their and mental health promotion through more national and local advocacy initiatives. sensitized reporting and advocacy measures. The passage of plain packaging Disability prevalence in the Region is legislation in the Australian Parliament was increasing due to ageing populations and a landmark victory against tobacco use. chronic health conditions. It is estimated that New legislation on plain packaging in 15% of the population have some difficulties Australia is a breakthrough in global public functioning and 3%–4% have very significant health and creates a new standard for bans on difficulties. In 2011, WHO increased its support tobacco advertising, promotion and sponsorship. to Member States, supporting disability policy Dr Susan Mercado, of WHO’s Tobacco Free dialogue events and promoting national Initiative unit says, “The recent High Court leadership and coordination. Within the Region ruling in favor of the Government means that there remains significant unmet need for implementation will move ahead as planned on 1 December 2012. Other countries like New Zealand and the United Kingdom are expected to introduce similar legislation.” An estimated 100 million people in the Region suffer from mental and neurological disorders. At least 2% of the population suffers from the most severe disorders, including schizophrenia, bipolar disorder, severe mental retardation and the consequences of brain injuries while another 3%–4% suffer from depressive disorders, anxiety and obsessive–compulsive disorder. As populations also age in many countries, the number of people living with dementia in the Region is expected to reach 66 million by 2030. Suicide is another urgent concern. Every year, about 800 000 people worldwide commit suicide and A patient in the Philippines is fitted with prosthesis after an almost one in four – or 600 suicides daily - happens in the Western Pacific. amputation as a result of diabetes. WHO supports analysis and
ASH-Australia
capacity development of the rehabilitation sector in the Philippines.
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Leading the way to a healthier future
rehabilitation services and WHO is supporting development and implementation of national rehabilitation strategies in Fiji and the Lao People’s Democratic Republic and Mongolia. Wheelchair provision was strengthened through a regional training workshop in September 2012 and initiatives to strengthen provision of other assistive technologies are underway. In June 2012, WHO facilitated the first Pacific Community Based Rehabilitation (CBR) Forum where a regional action plan and network were developed. Country level initiatives to improve CBR are underway in Kiribati, Solomon Islands and Vanuatu. WHO estimates 11 million blind people and 90 million visually impaired are living in the Western Pacific Region. As an estimated 80% of blindness and visual impairment is avoidable or curable, WHO launched regional programmes for the prevention of avoidable blindness and visual impairment in 2011.
Supporting Stronger Health Systems Health sector development acts as the foundation that both underpins and unifies public health efforts aimed at combating diseases and building healthy communities. The mission of WHO’s Division of Health
Sector Development is to support countries to attain universal health coverage for better and equitable health outcomes. WHO works with Member States to build and strengthen their health systems. This is a process that begins with policy dialogue to develop national health strategies, policies and plans. This year, WHO engaged in two highlevel policy dialogue events on national health insurance development in Viet Nam where all relevant ministries and government offices assembled to discuss key issues and challenges in progressing towards universal health coverage. In China, Mongolia and Philippines governments committed to more public funding to ensure that informal and poor populations have access to essential services and financial protection. Regional strategies on health system development provide direction and guidance for countries developing national health strategies with the goal of achieving universal access to quality health services while protecting households from financial risks. A variety of expertise in health sector development supports these efforts to reach universal health coverage and helps countries to develop a strong platform from which to deliver a whole range of health services, be they in maternal and child health, NCDs or other programme areas.
Universal health coverage is at the top of the agenda in all countries.
Strengthening Health Systems for Universal Health Coverage Every year 80 million people in the Western Pacific Region face financial hardship and 50 million people are pushed below the poverty line because of payments associated with health services. Meanwhile, most of the poor and vulnerable cannot access needed services. Universal health coverage ensures that everyone has access to good quality health services at an affordable cost. WHO advocates for universal health coverage and this vision is reflected in regional strategies and in health system development. WHO supports governments to develop strategies to increase investment and public spending on health, and also to be more efficient in the way they use funds allocated for health. Dr Shin Young-soo, WHO Regional Director for the Western Pacific, calls for universal access to quality health services without excessive financial burdens. “If health systems do not provide universal coverage and adequate financial protection, large numbers of households can be pushed into poverty both by ill-health and by paying out-of-pocket for health care,” he said. In the past five years, WHO has been working closely with countries in the Region, such as Cambodia, China, the Lao People’s Democratic Republic, Mongolia, the Philippines and Viet Nam to make services available and affordable for the poor and vulnerable.
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National health strategies, policies and plans In an era of results-based financing, more than ever countries need to be able to measure and evaluate their efforts and share that information with stakeholders as well as each other to better plan their national health systems and monitor their own progress towards concrete targets. In 2010, the Western Pacific Regional Strategy for Health Systems Strengthening Based on the Values of Primary Health Care was endorsed by WHO Regional Committee for the Western Pacific. This strategy boosts support to countries as they engage in national policy dialogue, develop national plans and support health sector reforms. In the Lao People’s Democratic Republic, the Government recognized that health is one of the main challenges in achieving MDGs and ensuring the nation graduates from low-income status. Provision of accessible health services of good quality are key to achieving MDGs. Health system reform to reach universal health
coverage is currently under consideration, including improved delivery of services and increased Government spending on health. The endorsement of the Action Framework for Human Resources for Health 2011–2015 at the 2011 WHO Regional Committee Meeting gave a tremendous boost to WHO’s work in the field of human resources for health, as it represented a commitment by the Region’s health ministers to implement meaningful country-level support. In Cambodia, strong high-level political commitment enabled the deployment of one midwife for each health centre in rural areas. This together with financial incentives for facilitybased delivery resulted in a dramatic increase of skilled-birth attendants from 44% to 71% (2005– 2010) and a substantial reduction in maternal mortality. In health professions education and training, the focus is on the overarching goals of improved quality of education and strengthened governance of educational institutions in ensuring that countries prepare quality health workers to meet population health needs. WHO contributed by developing quality standards for nursing education and ensuring institutional
Building National Regulatory Authorities There is wide variation across the Region in the capacity of national regulatory authorities to ensure quality, safety and efficacy of medicines, vaccines, blood products, medical devices and other health products. As a consequence, poor quality, substandard or counterfeit medicines and other health products remain a public health threat in several countries. These products continue to contribute to health problems such as the emergence of antimicrobial resistance, including the development of resistance to the malaria drug artemisinin in the Mekong region. WHO provides support in two ways to strengthen the capacity of national regulatory authorities to exert effective market control for all such products. Firstly, WHO develops and disseminates internationally recognized norms, standards and guidelines. Secondly, it delivers tailored technical assistance and training to enable regulatory agencies to implement international guidelines and standards in their countries. For example, China’s State Food and Drug Administration (SFDA) received WHO approval for its vaccine regulatory system in 2011. Compliance of SFDA with WHO standards opens up the possibility for Chinese vaccine manufacturers to contribute to meeting the world’s needs for quality-assured vaccines. In an increasingly globalized environment, WHO also supports countries to find new innovative approaches for more efficient use of available regulatory capacity, reducing duplication of efforts and improving the availability of quality-assured products in both international and national markets. WHO’s support to countries participating in the STORM network to fight counterfeit medicines within and across their borders is an example of such an innovative approach. Trafficking of illegal medicines is a lucrative trade often organized by transnational criminal syndicates. To combat this growing threat, the STORM network facilitates close collaboration between regulatory authorities and law enforcement agencies and builds their capacity to share timely intelligence for effective regulatory and legal action.
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mechanisms for improvement of educational approaches and faculty development such as Education Development Centres in Cambodia and the Lao People’s Democratic Republic. WHO supports Member States to improve equitable access to high-quality, safe pharmaceuticals, traditional medicines, medical technologies and laboratory and blood services. The new Regional Framework for Action on Access to Essential Medicines in the Western Pacific 2011–2016 devised by WHO provides strategic direction and guidance. The Regional Strategy for Traditional Medicine in the Western Pacific 2011–2020 promotes the principle of evidence-based traditional medicine, advocates inclusion of traditional medicine in national health systems and promotes the access and use of safe and effective traditional medicine. Ageing is an increasingly important health issue and WHO is working with countries to analyze the health profile of their elderly population and assess their health policies in the context of ageing populations. As the Region continues to develop economically, WHO expects to see a stronger focus on tackling health inequity, with equity and gender an increasingly important part of our work.
An age-friendly community benefits people of all ages.
Free flow of vital information The recently developed Health Information and Intelligence Platform (HIIP) takes countryand regional-level data and packages them in a form that policy-makers, researchers and the public can compare, visualise and manipulate (see box). The Asia Pacific Observatory on Health Systems and Policies is a new and exciting partnership across the Asia Pacific region that will transform decision-makers’ access to vital health systems information about their own country and others.
Too often health information is hidden in isolated pockets or stored in ways that make it difficult to use and impossible to share. The Health Information and Intelligence Platform (HIIP) answers the call for health information to be accessible and user-friendly. HIIP provides access to the interactive database that contains all WHO regional and global collected health-related indicators. Using HIIP, policy-makers, researchers and the public can compare, visualize and manipulate country- and regional-level data.
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Tailored Support for the Pacific Established in 2010, the Division of Pacific Technical Support provides key support to Pacific island countries and areas, building a larger pool of qualified health professionals and developing country- specific approaches to public health issues. WHO streamlines the management of programmes and activities in the Pacific. It made important contributions to the Ninth Meeting of Ministers of Health for the Pacific Island Countries in Honiara, Solomon Islands. The biennial meeting was co-organized by WHO and the Secretariat of the Pacific Community (SPC). Close collaboration with the Pacific Islands Forum Secretariat resulted in the declaration of an NCD crisis.
In Fiji, WHO supported the development of national laboratory quality standards and laboratory legislation. National tuberculosis guidelines were also developed for Fiji, Nauru, Solomon Islands and Vanuatu. WHO also supported Fiji, Kiribati, Samoa and Vanuatu to develop up-to-date food legislation. Strengthening primary health care services for NCDs using the Package of Essential NCD (PEN) services has been initiated in Fiji, Kiribati, the Federated States of Micronesia, Tonga, Samoa, Solomon Islands and Vanuatu as part of the health sector response to mitigate the impact of a severe NCD crisis. Support also was provided to 13 Pacific island countries and areas for applications and implementation of grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria.
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Children perform a traditional dance in Rarotonga, Cook Islands. Leading the way to a healthier future
Health Millennium Development Goals (2012)
Health MDGs scorecard for WHO regions World Africa Americas Eastern Mediterranean Europe South-East Asia Western Pacific
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Under-5 mortality per 1000 live births (2010)
57 85 210 69 63 0.8 12 87 89 63
119 76 480 48 24 4.7 94 80 63 34 Off track
18 93 63 93 75 0.5 0.1 76 96 87
68 85 250 59 42 0.2 2.5 88 85 66
14 95 20 98 71 0.4 0 68 98 92
57 79 200 59 58 0.3 2.9 89 90 43
19 97 49 91 80 0.1 0.2 93 92 69
Measles immunization % coverage (2010)
Maternal mortality per 100 000 live births (2010) 5
Skilled birth attendant % births (2005–2011)
Contraceptive use % married women aged 15–49 (2005–2010)
HIV/AIDS prevalence 6
% adults aged 15–49 (2010)
Malaria mortality per 100 000 population (2008)
TB treatment % success rate (2009) 7
Water % using improved sources (2010)
Sanitation % using improved facilities (2010) On track Insufficient progress
Source: World Health Statistics 2012
The Western Pacific Region scores the highest of WHO Regions in progress towards health MDGs.
Health MDGs scorecard for LMICs* in the Western Pacific Region (with population ≥ 250 000) Cambodia China Fiji Lao PDR Malaysia Mongolia Papua New Guinea Philippines Solomon Islands Viet Nam
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Under-5 mortality per 1000 live births (2010)
51 93 250 71 51** 0.5 0.9 95 64 31
18 99 37 96 85 0.1 <0.1 95 91 64
17 82 26 100 – 0.1 – 94 98 83 Off track
54 69 470 37 38 0.2 0.4 93 67 63
6 95 29 99 – 0.5 0.1 78 100 96
32 98 63 99 66 <0.1 – 88 82 51
61 60 230 40 36 0.9 9.2 72 40 45
29 79 99 62 51 <0.1 <0.1 89 92 74
27 73 93 70 35 – 2.5 88 – –
23 96 59 84 80 0.4 <0.1 92 95 76
Measles immunization % coverage (2011)
Maternal mortality per 100 000 live births (2010) 5
Skilled birth attendant % births (2006–2010)
Contraceptive use % married women aged 15–49 (2005–2008)
HIV/AIDS prevalence % adults aged 15–49 (2009) 6
Malaria mortality per 100 000 population (2010)
TB treatment % success rate (2009) 7
Water % using improved sources (2010)
Sanitation % using improved facilities (2010)
On track
Insufficient progress
* LMICs – Low- and middle-income countries ** Cambodia Demographic Health Survey 2010
There are large disparities in progress both within and between countries.
Shrinking resources — expanding health needs Two decades ago 65% of our funding came from regular annual contributions from Member States (assessed contributions), and 35% from additional voluntary contributions from a variety of donors and other Member States. Today, that situation is reversed, leaving our work in the Region heavily dependant on donor contributions. This comes at a time when our work across the Region continues to expand, placing greater demands on resources. Today, with the increasing number of health entities in the Western Pacific Region WHO’s coordinating expertise is even more important. Dr Hyeongap Jang with the Korea Foundation for International Healthcare (KOFIH) says fragmentation of various health entities and programmes in the Region makes WHO’s coordinating role essential. Without increased resources important programmes and initiatives are in danger of being scaled back or forced to shut down, making us less able to reach out and help Member States bring better health to those in need. Now, more than ever, we need greater support from donors and partners. With your help, we can do more.
Increased reliance on voluntary contributions
35% 65%
30% 70%
Biennium 1990 – 1991
Biennium 2010 – 2011
Assessed Contributions Voluntary Contributions
300
250
Total implementation in million USD
Voluntary Contributions Assessed Contributions 200
For information on contributing to our work please contact: External Relations and Communications Unit World Health Organization for the Western Pacific P.O. Box 2932, 1000, Manila, Philippines Phone: + (632) 5288001 (trunk line) Fax: +(632) 5262217 E-mail: ERC@wpro.who.int Website: www.wpro.who.int
70% 150
66% 58% 58% 45%
100
38%
50
0 2000-01 2002-03 2004-05 2006-07 2008-09 2010-11
Biennium
Increased reliance on voluntary contributions to support programme expansion in the past ten years.
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Leading the way to a healthier future
Partners who support our work in the Region American Leprosy Missions (ALM) Asia Europe Foundation (ASEF) Asia–Pacific Economic Cooperation (APEC) Asian Development Bank (ADB) Asian Liver Center–Stanford University School of Medicine Association of Southeast Asian Nations (ASEAN) Australian Agency for International Development (AusAID) Bill & Melinda Gates Foundation Canadian International Development Agency (CIDA) Centre for Neglected Tropical Diseases – Liverpool School of Tropical Medicine China Medical Board (CMB) Danish International Development Agency (DANIDA) Department for International Development (DFID) Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH Development and Cooperation - EuropeAid European Commission (EC) Foundation for Innovative New Diagnostics (FIND) GAVI Alliance (GAVI) Global Health Council Government of Grand Duchy of Luxembourg Government of Singapore Government of Macao, China Government of the Netherlands International Tuberculosis Research Center, Korea (ITRC) Japan International Cooperation Agency (JICA) Joint United Nations Programme on HIV/AIDS (UNAIDS) Korea International Cooperation Agency (KOICA) Korean Anti-tuberculosis Association/International Tuberculosis Research Center-Korea (KNTA/ITRC) Korean Centers for Diseases Control and Prevention (KCDC) Korean Foundation for International Health Care (KOFIH) — Dr Lee Jong-wook Memorial Fund Millennium Challenge Account - Mongolia (MCA – Mongolia) Ministry of Environment, Republic of Korea Ministry of Health and Welfare, Republic of Korea Ministry of Health, Labour and Welfare, Japan National Foundation for the Centers for Disease Control and Prevention, Inc. New Zealand Agency for International Development (NZAID) Norwegian Agency for Development Cooperation (Norad) Pacific Islands Forum Secretariat (PIFS) Pacific Leprosy Foundation (PLF) Programme for Appropriate Technology for Health (PATH) Republic of the Philippines Rotary International (RI) Sabin Vaccine Institute Sasakawa Memorial Health Foundation Secretariat of the Pacific Community (SPC) Shinnyo-en, Japan South Asia Field Epidemiology and Technology Network, Inc. (SAFETYNET) South Pacific Applied Geoscience Commission (SOPAC) Southeast Asia Tobacco Control Alliance (SEATCA) Swedish International Development Cooperation Agency (Sida) The Arab Gulf Program for Development (AGFUND) The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) The Nippon Foundation The Rockefeller Foundation The World Bank United Nations Economic and Social Commission for Asia and the Pacific (UNESCAP) United States Agency for International Development (USAID) United States Centers for Disease Control and Prevention (USCDC) United Nations Office on Drugs and Crime (UNODC) United Nations Trust Fund on Human Security (UNTFHS) United Nations Development Programme (UNDP) United Nations Office for the Coordination of Humanitarian Affairs (OCHA)
WHO in the Western Pacific Region
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Leading the way to a healthier future
www.wpro.who.int