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Info Service on Health Issues (May19/10) Geneva, 21 May (Kanaga Raja) – “Primary health care is where the battle for human health is won and lost,” said Dr Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organisation (WHO), at the opening of the World Health Assembly (WHA) on Monday. In his address to the 72nd session of the World Health Assembly, whose them e for the general debate this year is “Universal health coverage: leaving no- one behind”, Dr Tedros said that strong primary health care is the front-line in defending the right to health, including sexual and reproductive rights. It is through strong primary health care that countries can prevent, detect and treat non-communicable diseases, he added. [Health as a fundamental human right and Primary Health Care (PHC) as essential health care to be promoted by all nations, was first affirmed in the Alma-Ata Declaration at the International Conference on Primary Health Care (6-12 September 1978) held at Alma-Ata (in the former USSR). [That conference defined PHC as “essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.” [The 1978 Alma-Ata Declaration asked all governments to formulate national policies, strategies and plans of action to launch and sustain primary health care as part of a comprehensive national health system and in coordination with other sectors. To this end, the Declaration said, it will be necessary to exercise political will, to mobilize the country’s resources and to use available external resources rationally. [That Conference, and the PHC concept pioneered by then WHO Director-General, Dr. Halfdan Mahler, was held in those heady days of the New International Economic Order. Dr. Mahler, who had been a doctor at a missionary hospital in India, brought that experience of his on health care and problems in poor countries to the WHO as its DG. [Soon after, the global pharmaceutical industry (PhRMA) regrouped, got the support of the advanced countries, and infiltrated the WHO secretariat thro ugh donor-funded programs, resulting in PHC rarely getting the attention originally intended. [The huge and burgeoning costs of health care, and the astronomical costs of medicines has now forced attention back to PHC, which was reaffirmed at the Global Conference on Primary Health Care in Astana, Kazakhstan in October 2018. SUNS] In his address to the WHA now in session, Dr. Tedros noted that the Declaration of Astana, endorsed by all 194 Member States last year, was a vital affirmation that there will be no universal health coverage (UHC) without primary health care (PHC). The Director-General described the achievements of the past year, according to each of the “triple billion” targets in the WHO’s General Programme of Work. [According to WHO, the “triple billion” targets that are at the heart of its strategic plan for the next five years are: one billion more people benefiting from universal health coverage (UHC); one billion more people better protected from health emergencies; and one billion more people enjoying better health and well-being.] In his address, Dr Tedros said that 2018 was an incredible year, in that firstly, the world has made great progress towards universal health coverage. In this context, he referred to Kenya’s ambitious plans to implement a new UHC scheme, with support from the WHO, saying that last December, he was with President Kenyatta for the launch of that programme in Kisumu. “It’s already producing results,” he said. The WHO chief gave the example of Immaculate Otene, a 33-year-old mother of four, who is unemployed, and her husband often goes without work. But thanks to Kenya’s new UHC plan, designed with support from WHO, her family can now access free health services. The DG cited her as saying: “Just knowing we can access treatment anytime has removed the worry and anxiety that my husband and I used to have.” “My whole family is now registered, and I can take any one of my four children to hospital without hesitation.” Dr Tedros also cited the example of Bolu Rambhav Omble, a 65-year-old labourer from Pune, in India, who about ten years ago, began to complain of pain and swelling in his knees. It turned out that he needed a knee replacement that would cost three times more than his entire family earns in a year. Then Bolu discovered that he was eligible for free surgery under India’s new Ayushman Bharat insurance programme, which was launched last year, with support from WHO. A week later, Bolu had the operation and began physiotherapy. He’s now back on his feet and back to work. Dr Tedros also pointed to similar stories from South Africa, which passed a National Health Insurance bill last year, and the Philippines, where the Universal Health Care Act was signed into law in February this year. He also cited the case of Egypt, which last year passed a new Universal Health Insurance Law, to be funded in part by a new tax on tobacco. The DG further highlighted the case of El Salvador, which just a month ago, passed a new law to integrate health services, introduce innovative health financing, increase access to primary health care and improve regulation of the medicines agency. The Director-General also mentioned the case of Pantelis Leousis, an 80-year-old retired musician from Greece, who had cancer twice, with regular visits to public hospitals and private doctors. But thanks to Greece’s health system reforms, he now has a primary health care clinic just 10 minutes from his house, where he pays nothing for care. With support from the WHO, Greece is expanding its network of primary health care clinics, with an emphasis on services for health promotion and prevention. “Primary health care is where the battle for human health is won and lost,” said Dr Tedros. Strong primary health care is the frontline in defending the right to health, including sexual and reproductive rights. It’s through strong primary health care that countries can prevent, detect and treat non-communicable diseases, he said. It’s through strong primary health care that outbreaks can be detected and stopped before they become epidemics. “And it’s through strong primary health care that we can protect children and fight the global surge in vaccine- preventable diseases like measles.” “That’s why primary health care is at the heart of the Immunization Agenda 2030, our new strategic initiative, which we are designing with you, to maximize the power of vaccines,” Dr Tedros told the WTO Member states at the Assembly. “Because we cannot achieve health for all without vaccines for all.” He underlined that strong primary health care depends on having a strong health workforce, working in teams. Doctors, nurses, midwives, lab technicians, community health workers – they all have a role to play. But the world is currently facing a shortfall of 18 million health workers to achieve and sustain universal health coverage by 2030. “It is imperative that all countries invest in jobs to close that gap and deliver health for all,” said the Director-General. “In addition to WHO’s work supporting stronger health systems, we have also contributed to significant progress against many of the world’s leading causes of death and disease,” he added. “Just last month, we celebrated a historic milestone in the fight against one of the world’s most ancient diseases, with the launch of the world’s first malaria vaccine in Malawi and Ghana, which is being rolled out based on recommendations from WHO’s Strategic Advisory Group of Experts on Immunization.” In this context, he cited the example of Gilimbeta Taziona and her 5-month-old daughter Lusitana, where last month, at the Mitundu Community Hospital in Malawi, Lusitana became the first child in the world to be vaccinated outside a clinical trial with the world’s first malaria vaccine. “But even as we introduce new tools, we are also working to make better use of the tools we have, through the “High Burden, High Impact” initiative, to reinvigorate progress against malaria.” Last year, Uzbekistan and Paraguay were certified as being malaria-free, and at this WHA, Argentina and Algeria will join them. Dr Tedros also highlighted a new initiative that was launched by WHO last year to eliminate cervical cancer, which kills more than 300,000 women every single year. “We have now developed a draft global strategy for elimination, and we have supported the introduction of HPV [human papilloma virus] vaccination in 13 countries, and screening and treatment in 10 countries.” Highlighting how important WHO’s normative work is to Member states, Dr Tedros said in the past year, WHO has produced hundreds of new normative products that are being integrated into health systems all over the world, to protect and promote health. It released the 11th Edition of the International Classification of Diseases, which is ready for adoption at this Assembly, it pre-qualified 200 products, including the first heat-stable rotavirus vaccine, and published the first Essential Diagnostics List. The Special Programme on Human Reproduction published research showing that a new formulation of a drug to prevent life-threatening bleeding after childbirth is as safe and effective as the gold standard, he said. The Director-General also underlined that the first UN High-Level Meeting on Tuberculosis saw unprecedented political commitment from around the world to end the world’s deadliest infectious disease. “As part of our commitment to reducing the global burden of maternal and infant mortality, we developed a new Framework for Action on Quality Midwifery Education.” Dr Tedros also mentioned amongst others the launch by WHO of a new strategy on snakebite envenoming, the Global Status Report on Road Safety, the Global Action Plan on Physical Activity, the first guidelines on dementia and cognitive decline, and WHO’s first guidelines on digital health. “Together with our partners, we’re also stepping up the fight against antimicrobial resistance, one of the most urgent health threats of our time,” he said. Just three weeks ago, WHO had delivered the report of the Interagency Coordination Group on Antimicrobial Resistance to the United Nations Secretary-General. “We are now fully committed to implementing the recommendations of that report with the Food and Agriculture Organization of the United Nations, the World Organisation of Animal Health and other agencies.” The DG also highlighted WHO’s efforts over the past year to keep the world safe. Last year, WHO responded to 481 emergencies and potential emergencies in 141 countries. At the WHA a year ago, Dr Tedros said that he had described his visit to the Democratic Republic of the Congo, where WHO was responding to an Ebola outbreak in the western province of Equateur. That outbreak was controlled in just 3 months. But shortly after it ended, another outbreak started, this time in the eastern part of DRC. “And as you know, it’s still going.” “We can be proud of the fact that so far, the outbreak has not spread outside two provinces in DRC. But I emphasise “so far”. The risk of spread remains very high. Because this outbreak is one of the most complex health emergencies any of us have ever faced.” “We are fighting one of the world’s most dangerous viruses in one of the world’s most dangerous areas. We are fighting with even better tools than we used to extinguish the Equateur outbreak in three months,” he said. Pointing out that WHO so far has vaccinated more than 120,000 people, Dr Tedros said: “And we now have evidence that the vaccine is more than 97% effective in preventing Ebola. We also have 4 experimental treatments that we’ve used to treat 800 patients.” “But we are not just fighting a virus. We’re fighting insecurity. We’re fighting violence. We’re fighting misinformation. We’re fighting mistrust. And we’re fighting the politicization of an outbreak.” In this context, he said that since January, there have been dozens of attacks on health facilities in North Kivu. “Unless we unite to end this outbreak, we run the very real risk that it will become more widespread, more expensive and more aggressive,” Dr Tedros cautioned. Apart from the Ebola outbreak, the Director-General said that the WHO also responded to the largest recorded cholera outbreak, in Yemen, diphtheria in Cox’s Bazaar (Bangladesh), the ongoing humanitarian crisis in Syria and many others that didn’t make the headlines. “And together with our partners in the Global Polio Eradication Initiative, we have launched a new strategy to address the most difficult remaining areas in Afghanistan and Pakistan.” Dr Tedros told the delegates at the WHA that “we have a moral duty to respond urgently and effectively to outbreaks and other emergencies. But it makes no sense either morally or economically to continue spending money responding to emergencies, without investing in preventing them.” “That’s why we have set up a new division of emergency preparedness, in addition to our existing work on emergency response.” “We will save more lives and more money if we support countries to put in place the measures to prepare for and prevent emergencies, instead of waiting for them to happen,” he said. Dr Tedros also highlighted WHO’s achievements with respect to the third of its “triple billion” targets, namely, to see 1 billion people enjoying better health and well-being. In October last year, WHO hosted the first Global Conference on Air Pollution and Health. Dr Tedros pointed out that every year, 9 million people are killed by the air they breathe. At the end of the global conference, leaders from national and city governments made more than 90 voluntary commitments, and set an aspirational goal to reduce the number of deaths from air pollution by two-thirds by 2030. The DG also said that WHO has completed the first phase of its new initiative on climate change and health in Small Island Developing States. “As you know, climate change affects the whole world, but Small Island States are disproportionately affected.” Last year was also an important year in the fight against tobacco, he added. The Protocol to Eliminate Illicit Trade in Tobacco Products came into force, further strengthening the world’s only public health treaty. “This gives us a powerful new tool in the fight against the evil of big tobacco. But the more countries that ratify it, the more powerful it will be,” said Dr Tedros, urging countries that have not yet ratified the protocol to do so. He also noted that in response to WHO’s call to eliminate industrial trans-fat from the global food supply, 28 countries have now introduced limits or bans, covering one-third of the world’s population. The International Food and Beverage Alliance, which represents some of the world’s largest food-producing companies, has officially committed to adhere to WHO’s trans-fat elimination target by 2023. He also noted that the High-Level Commission on Non-communicable Diseases (NCDs) delivered its report, and most of its recommendations were included as commitments in the political declaration at the UN High-Level Meeting on NCDs last year. “We are now working with countries to turn those commitments into action,” the DG said, adding that several countries have also introduced new measures to address risk factors for NCDs, including taxes on sugary drinks. “So as you can see, it has been an extremely productive 12 months,” he said. The DG also noted that in March, WHO had announced some of the most wide-ranging reforms in its history. There are five components to its transformation: a new strategy; new processes; a new operating model; a new culture; and a new approach to partnerships. Referring to the approval of the new General Programme of Work at the Assembly last year, with its emphasis on outcomes and impact, the DG said: “This year we are asking you to approve the programme budget that supports that plan, and we are now developing an operational plan to execute the GPW [General Programme of Work]”. “Our new processes are based on best practices to modernize the organization, cut bureaucracy and make us more responsive. We have already started implementing some of these new processes,” he reported. Dr Tedros also announced the appointments of former President Ellen Johnson Sirleaf of Liberia, as Goodwill Ambassador for Health Workforce; Mr Alisson Becker, goalkeeper for Brazil and Liverpool, together with his wife Dr Natalia Loewe Becker, as Goodwill Ambassadors for Health Promotion; and Ms Cynthia Germanotta, who with her daughter, Lady Gaga, is the founder of the Born This Way Foundation, as Goodwill Ambassador for Mental Health. “The next 12 months will be decisive for global health. We have all the ingredients for success,” said Dr Tedros. He highlighted three priorities that he said must guide the discussions at the WHA this week and throughout the next year: health is about political leadership; health is about partnership; and health is about people. “This week, you will make resolutions and decisions on community health workers, anti-microbial resistance, patient safety, pandemic influenza and much more.” “But the ultimate outcome of our work this week is not resolutions and decisions. We all have a duty to make sure the decisions we make this week take root in our countries and communities,” he told the delegates at the WHA. “This week, I ask you to remember the people, from your family and your country, and from every family and every country, who will be affected by the resolutions you pass and the decisions you make.”
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