Hon’ble Chair, Dr Mansukh Mandaviya; Vice-Chair, Dr Elia Antonio; Director General, Excellencies, Heads of Delegation, partners and participants,
Good afternoon and welcome to this, my final report on the work of WHO in South-East Asia.
When I spoke to you earlier today, I talked about transformation and highlighted several examples of what has been achieved by our Member States. As ever, the report on our work together over the last year spells out these achievements – country by country – in much greater detail.
Every single country represented here today has much to be proud of. Our annual report provides a lasting record of the hard-fought gains that make up the daily struggle that is our life in public health.
The report is also a testament to the leadership and dedication of ministers, public servants, health professionals and volunteers – in government, in the private sector and across civil society. The achievements we record are yours. The role of WHO is to provide support wherever and whenever it is requested.
I wish to dedicate this report to the devoted and courageous members of WHO South-East Asia who paid the ultimate price during the COVID-19 response:
Mr Widhiyanto Projo, from WCO Indonesia;
Ms Anita Saxena, Mr Ekkadu Rangarajan, and Mr Kuldeep Sharma, from the Regional Office;
And Mr Gagan Sonal, from WCO DPR Korea;
Their memory will be always honoured and remembered.
As we meet here today, I would like to take a moment to step back and look at our achievements collectively. Working together as a Region: can the whole be greater than just the sum of its parts? I really believe it can.
Excellencies,
A decade of health in South-East Asia.
It is almost ten years since the Region was declared polio free. A disease that had haunted humanity throughout history is no longer endemic. We have maintained our polio-free status. And not everyone thought we would.
And now, ten years on we find ourselves hesitantly emerging from a pandemic caused by a virus which was unknown just four years ago.
Polio and covid: two bookends of the last decade.
A year ago, we talked about building back better.
A year on, we are still not out of the woods. We need continued vigilance and more genomic sequencing in the face of emerging covid variants.
And we have to come to terms with the more profound impacts of COVID-19.
The pandemic has caused social, political and economic shock waves across the Region. Health budgets are under intense pressure. People’s lives and livelihoods are threatened. If we are serious about real health security, by which I mean not just protection from communicable diseases, we and our colleagues across governments, still have so much more to do.
Governments across the globe are seeking agreements to prepare for future crises. But fresh from witnessing the limits and fragility of global solidarity – not least when it comes to access to vaccines – we still have no guarantee that the world will act differently when the next pandemic hits.
And if it was not evident before covid, it certainly is now: crises do not happen one at a time. Public health is a battle with multiple front lines.
Excellencies, colleagues,
We are working in a fast-changing environment. The world in which we work has changed fundamentally.
But before we look to the future, let us reflect on what we have achieved together over the last ten years.
Back in 2014 we agreed that we needed clear priorities. Out of multiple demands from all of the countries in the Region, we agreed on seven, later to become eight, flagship programmes. These flagships would not prevent WHO responding to country specific needs as and when they arose, but they would form the core of our work together. In practical terms they account for around 80% of resource allocation.
So what have we achieved?
Today, pregnancy, childbirth, infancy and childhood in our Region are safer than ever.
Between 2015 and 2020, the Region achieved the world’s highest annual rate of reduction of maternal mortality, from 148 to 117 per 100 000 live births.
In 2016, we eliminated maternal and neonatal tetanus as a public health problem.
Five countries of the Region have already achieved the 2030 mortality rate targets for children under-five and newborns. Almost all other countries are on track.
All Member States have initiated hospital-based birth defect surveillance and are implementing national action plans to prevent and manage birth defects.
Across the Region, fewer children suffer from measles and rubella.
Five countries have eliminated measles as well as rubella. Overall, the reported incidence of measles and rubella dropped by 75% and 80% respectively.
We have achieved path-breaking progress on eliminating neglected tropical diseases (NTDs), eliminating more than 20 diseases in one or more countries over the past decade. The number of people in the Region needing treatment for NTDs dropped by 20%, which means around 236 million people.
A few examples:
In 2015 Maldives was certified malaria free, which Sri Lanka achieved in 2016. Both countries eliminated lymphatic filariasis, followed by Thailand in 2017, and Bangladesh in 2023.
In 2016 Thailand became the first country in Asia to eliminate mother-to-child transmission of HIV/AIDS and syphilis, followed by Maldives and then Sri Lanka in 2019.
In 2016, India became the first country globally to gain yaws-free status under the 2012 global roadmap, and in 2018 Nepal eliminated trachoma, which Myanmar achieved in 2020.
Five countries have the potential to eliminate malaria by 2025.
And as I’m sure you’re aware: last week, Bangladesh became the first country globally to be validated for having eliminated kala-azar as a public health problem – a tremendous achievement.
The battle against noncommunicable diseases (NCDs) continues. But the probability of dying from cardiovascular diseases, cancers, diabetes and chronic respiratory diseases between the ages of 30 and 70 years is just two percentage points lower than a decade ago.
The Region is currently on track to achieve the WHO NCD Global Action Plan target of a 30% relative reduction in tobacco use prevalence between 2010 and 2025.
Six countries have strengthened food labelling policies, five have strengthened taxation of sugar-sweetened beverages, and three have adopted regulations to eliminate trans fats, covering more than 1.6 billion people.
Nine countries are now implementing the WHO PEN, which helps integrate NCD services at the primary level.
Over the past five years, 10 million more people with hypertension have accessed protocol-based management, almost doubling the rate of control, from 26 to 47%.
Eight countries have population-based cancer registries, and five countries have introduced nation-wide HPV vaccination.
Antimicrobial resistance (AMR) continues to be a major public health and development threat and the Region remains an AMR hot spot. But the basics are in place.
Since 2018, all Member States have been implementing national action plans to address AMR and our Region is the only one in which all countries carry out annual self-assessment surveys.
Most Member States continue to implement national monitoring systems for resistant pathogens and antimicrobial consumption, and all Member States are enrolled in the Global Antimicrobial Resistance Surveillance System.
Strengthening emergency risk management has always been an outstanding concern in this Region:
Based on State Party Annual Reporting, between 2018 and 2020, countries increased IHR core capacities from 56 to 63%.
Nine countries have conducted Joint External Evaluations, and eight of them have implemented a multi-year national action plan.
Most countries continue to implement national action plans for disaster risk management, and all have begun to implement the Region’s Strategic Roadmap for health security and health system resilience for emergencies 2023–2027.
TB was a belated addition to our flagship priorities. It remains a stubborn challenge. Progress in this Region determines whether and when the goal to end TB worldwide will be realised.
The South-East Asia Region accounts for more than 45% of global TB incidence, more than half of TB-related deaths, and more than 38% of the of drug-resistant TB cases.
We do not lack declarations of commitment: at the high-level country-led meeting in October 2021; in the unanimous adoption of a new Regional Strategic Plan towards ending TB 2021–2025; in the adoption of the Gandhinagar Declaration in August, and at the second UN General Assembly High-level Meeting on TB last month.
Several high-burden countries have initiated more people on treatment in 2022 than in 2019.
But the challenge remains: if we are honest, ending TB is almost as elusive now as it was ten years ago.
Excellencies,
Universal health coverage (UHC) underpins all the other flagships and SDG health targets.
So let’s start with the big picture: of the 270 million people projected to be covered by UHC over the course of the 13th GPW, 110 million – more than 40% – are from our Region.
What does this mean in practice?
First, more people with access to health care: the index which we use to measure overall service coverage across the Region has increased from 54 to 62.
And less financial hardship: Out-of-pocket spending as a share of total health spending decreased from 43 to 38%, coinciding with a modest increase in domestic public health spending, from 42% in 2014 to 49% in 2020.
Between 2015 and 2017 alone, the number of people impoverished due to out-of-pocket health spending halved – from 12 to 6%.
In 2021, the South-East Asia Region became the first to adapt the WHO-UNICEF Operational Framework for PHC, to reorient health systems towards quality, accessible, affordable and comprehensive PHC to achieve UHC, health security and the health-related SDGs.
In this Region, we also agreed that we had two specific areas where we wanted to focus as part of the UHC agenda: human resources for health and access to medicines.
The Region’s Decade for Strengthening Human Resources for Health 2015-2024 has catalysed lasting gains: the density of doctors, nurses and midwives in the Region has increased by over 30%.
Reforms to enhance the quality and relevance of health workers now focus on transformative education geared to UHC.
On access to medicines, all Member States have updated National Medicines Policies, with a focus on ensuring equitable access to quality medical products.
All countries now regularly update national Essential Medicine Lists, which guide health care resource allocation and rational medicine usage.
In this Region, policies and training that ensure safe, effective and evidence-based traditional medicine are a critical element of UHC.
In March 2022, WHO and India launched the Global Centre for Traditional Medicine, and in August 2023, we co-hosted the first ever Global Summit on Traditional Medicine, which was a tremendous success.
Excellencies,
This short summary shows that we have much to be proud of.
Over the last ten years – working together, across the Region – we have made a difference. A difference which translates into longer, happier and healthier lives.
But we cannot shy away from the fact that progress in some areas that we all deemed to be a priority has been modest at best.
Too many health systems in the Region are still funded primarily through out-of-pocket spending. In half of the Region’s countries more than a third of health spending comes directly from individual households – driven by spending on medicines, especially by the poor. It is not acceptable that those who can afford the least still need to pay substantially more.
When it comes to government health spending, there has been a small overall increase of 0.8% in the proportion of government budgets allocated to health.
Had it been more, the Region’s strategic and technical excellence, world-leading research and medical institutions, and dedicated health professionals would have achieved more.
As Dr Tedros repeatedly reminds us: it is a political decision to invest in health and we in this Region could do better.
Excellencies, colleagues, friends,
I have the privilege of being able to look ahead, having worked in WHO for over 25 years – first as Executive Director in Geneva and then as the Deputy Regional Director followed by Regional Director in the WHO South-East Asia office. Allow me a few reflections on where we now stand.
Crises do create opportunities, but it is important that we are aware of the magnitude of the challenges we now face.
I alluded before to the fact that coming out of the pandemic, our Region faces major economic and fiscal uncertainties. We have seen the fragility and limits of global solidarity. We have lost ground on shared goals: millions have been pushed back into extreme poverty.
At the halfway point to 2030 nearly all the global SDGs are off track. Food prices remain high. Job recovery has been slow and uneven.
The climate crisis is a real and present danger to health and to our economies, not a distant threat on the horizon.
Geopolitical competition undermines collective action and makes it harder to resolve what may in the past have remained local conflicts.
At the same time, the value and priority people attribute to health and well-being is higher than ever.
This means increased demand for health services. It means calls for a more holistic approach to health and well-being. It means a more joined-up approach to policies that impact on life and livelihood. And it means that health and well-being are no longer just nice-to-have add-ons when preparing government budgets – they need to be seen as key drivers of the national economy.
Looking ahead, let me draw what I see as some key lessons from the last ten years.
First, it is no accident that the two defining events of the last decade were a result of communicable diseases. Eternal vigilance as the price of health security applies to new and emerging health threats, but also those that are still with us.
Second, there is no longer any doubt that NCDs represent a challenge that can undermine much of what we have achieved in public health. A mere two percent decrease in mortality over a decade in this Region should be a cause for grave concern.
We have ample evidence about NCD determinants but a very modest track record when it comes to doing anything about them.
The economic, commercial, political, social and environmental drivers of disease require action on multiple fronts – most beyond the influence of the formal health sector alone. These are political and not just technical challenges. If we are to lead the most important conversation in public health in this Region, we must be prepared to work with and influence those that have the power to bring about real change.
Third, throughout the pandemic, we have seen the power of science and scientific collaboration. One of WHO’s enduring strengths at global, regional and country level is to bring together the best minds to address any technical challenge.
The new frontiers of technology have the potential to revolutionise health policy and practice. But only if they reduce and do not deepen existing inequities. Science must walk hand in hand with access and equity. We must never forget the contrast between the speed of vaccine development and the length of time it took to fairly share the benefits it produced.
Advances in artificial intelligence, robotics, and synthetic biology open extraordinary opportunities to accelerate health and well-being for all. But there is no guarantee that they will result in more efficiency or equitable access unless careful thought is given to how progress is governed – globally, regionally and nationally.
It is my sincere hope that WHO will step up to lead this dialogue.
Fourth, we have become accustomed to working in an increasingly complex and crowded institutional space. The health ecosystem globally, and in this Region, has seen an increase in the number of new players, new partnerships, new platforms and new funds.
We talk about collaboration, but too often we compete – for attention and resources. We must work together, reducing duplication and fragmentation. Our colleagues in other funds, programmes and agencies are allies. We are on the same side.
At country level this means engaging – as one – with key players across government, particularly with ministries of finance. But collaboration cannot depend on country offices alone – we need incentives that ensure it is a global and regional priority if we are to make it part of our working DNA.
And lastly, over the past ten years, we have learned critical lessons about what works and what must remain as constants in our fight for better health. Above all, the central importance of universal access to the services that people need, with financial protection and adequate investment in primary-level care.
To me, what is vital as we go forward is that this remains a practical agenda. Real people dealing with real issues of life and death. “Leaving no-one behind” is a tough political challenge.
But let’s face it: more often than not, we know who is being left behind and why. The challenge is to do something about it. Similarly, “equitable access” means confronting vested interests that will actively resist change. Unless “accountability” has consequences, it has little meaning. These are tough issues: they must not just end up as slogans to be repeated in every new declaration.
My point – and it is a critical one – is that UHC is only the most powerful concept in public health if we take these practical challenges seriously. Matching concepts and good intent with nuts-and-bolts action. That is the way forward.
Excellencies, colleagues, my friends across this Region.
A chapter ends, the book remains. The story is ours to write.
We can be proud of our work together, not just over the last year, or even the last decade, but over the past 75 years, as WHO celebrates its platinum jubilee.
But the work doesn’t stop. It never will. New challenges emerge. Old challenges return.
In public health – as life itself – change is the only constant, and agility our only recourse.
Together, let us put our faith in the future, in new leaders and new challenges. We are in good shape. We are future-ready and self-assured, and so we can look forward to a healthier, more equitable and sustainable South-East Asia Region for all.
I thank you.