Chair, Excellencies, distinguished guests and participants, ladies and gentlemen,
It is my pleasure to introduce you to the 2019 Annual Report of the work of WHO in the South-East Asia Region.
My report this year is different from previous years.
It was written six months into a global pandemic that has deeply affected us all and is causing unprecedented damage to countries in the Region.
It was written at a time of continuing uncertainty.
In many countries the numbers of people infected and the numbers who have died from COVID-19 are still increasing.
The number of those who have lost their livelihoods and the size of the investments being made by government to help mitigate the economic shock are becoming clear.
Important lessons are already emerging from the response that can help guide our efforts towards recovery.
Looking at what we have learned so far and anticipating future challenges and how they relate to our regional priorities are the main themes of this year’s report.
The other parts of the report remain as in previous years. The country and flagship reports in Parts 2 and 3, which cover the year 2019, and which were prepared before the pandemic, remind us of the range of WHO’s work.
They also underscore the Region’s ongoing progress, which I take this opportunity to highlight.
In 2019 the Region celebrated five years of polio-free certification.
Sri Lanka eliminated measles.
Maldives and Sri Lanka eliminated mother-to-child transmission of HIV and syphilis.
Bangladesh, Bhutan, Nepal and Thailand achieved hepatitis B control.
Progress on each of the Region’s eight Flagship Priorities continued.
By year-end all countries were administering two doses of measles and rubella-containing vaccine and had at least one proficient national laboratory to support measles and rubella case-based surveillance.
Bhutan, DPR Korea, Maldives and Timor-Leste sustained their measles elimination status.
Bangladesh, Bhutan, DPR Korea, Maldives, Nepal, Sri Lanka and Timor-Leste sustained rubella control, which all countries are now striving to eliminate as per the 2023 target.
On preventing and controlling noncommunicable diseases, the Region continued to leverage high-impact “best buys”.
Five of the Region’s Member States – namely, India, Nepal, Maldives, Thailand and Timor-Leste – are now among the world’s top ten countries with the largest graphic warnings on tobacco packaging.
Bangladesh, India and Indonesia made substantial increases in tobacco taxation, while Myanmar began developing a new and comprehensive tobacco control law and policy.
Seven Member States are pursuing national targets on reducing exposure to household air pollution.
Most Member States have developed mental health policies which they have been integrating into national health policies.
The Region continued to accelerate reductions in maternal, neonatal and under-five mortality.
Almost all countries have developed a national quality improvement strategy to ensure maternal and child health services meet expectations and needs.
All countries are now implementing maternal death surveillance and response, in addition to maternal perinatal death surveillance and response, which will help reduce stillbirths – a key area of focus.
Commendably, the Region is on track to achieve the GPW target of a 30% reduction in maternal and child mortality by 2023.
The Region’s steady progress towards universal health coverage (UHC) continued.
Trend data from this year’s annual progress report shows that service coverage improved throughout 2019.
The quality of Member State data on UHC is now stronger than before, with data on financial protection becoming a point of focus, in addition to capturing and quantifying foregone care in regular household surveys.
The Region continued to build national capacity to prevent and combat antimicrobial resistance.
All countries in the Region actively participated in World Antibiotic Awareness Week, making the South-East Asia Region the world’s only region in which all countries took part.
Ten of the Region’s 11 countries are now participating in the Global Antimicrobial Resistance Surveillance System, which is more than two-and-a-half times the proportion of countries taking part globally.
The Region continued to be the only WHO region where all Member States carried out the Tripartite AMR self-assessment exercise.
Member States made timely progress to scale up emergency risk management.
All countries reported IHR capacity using the State Parties Annual Reporting tool. The Region’s reported preparedness index rose to 61%, up from 56% in 2018.
In March the Region launched its South-East Asia Regional Knowledge Network of National IHR Focal Points. The innovative mechanism is designed to facilitate peer-to-peer learning and the dissemination and uptake of best practices across the Region.
Thailand became the first country in the Region to receive WHO classification for its emergency medical team.
All countries adopted the Delhi Declaration on Emergency Preparedness, reflecting the high-level importance that Member States have given to this crucial area of work for many years now.
The Region’s momentum on finishing the task of eliminating neglected tropical diseases and other diseases on the verge of elimination gathered pace.
Myanmar has been validated for the elimination of trachoma. Nepal achieved this in 2018.
Timor-Leste became the first country in the Region to successfully implement the first round of the new triple-drug IDA therapy for lymphatic filariasis (LF) country-wide and is on track to eliminate the disease by 2024.
India expanded its implementation of the triple-drug therapy from four LF-endemic districts to 19.
Maldives launched an ambitious yet attainable plan to achieve 100 leprosy-free islands by 2023.
Maldives and Sri Lanka maintained their malaria-free status, and Bhutan and Timor-Leste are nearing elimination.
The Region continued to accelerate efforts to end TB.
In the Global TB Report, Myanmar was identified as one of a handful of countries globally to be on track to reach the End TB 2020 milestones.
The Region’s success across all areas of health has indeed been strong and must be recognized as such – not only because of the commitment, determination, effort and capacity that it represents, but also because of what is at stake in the current crisis.
We cannot afford that our progress is halted or reversed.
We must protect and defend our many gains.
In addition to documenting the Region’s achievements in 2019 and WHO’s support to them, the Annual Report contains a special section that provides an overview of all of WHO’s COVID-19-related activities in the Region.
WHO will continue to provide its steadfast support across all nine pillars of the strategic preparedness and response plan, and wherever else requested or required.
Today, I also wish to speak directly to some of the “big picture” issues that the Annual Report addresses with regard to COVID-19 and the future of public health and sustainable development in our Region.
It is only by candidly addressing such issues that we can mitigate them and continue to effectively respond to the pandemic while sustaining and accelerating progress on the Flagship Priorities, WHO’s “triple billion” targets and Sustainable Development Goal 3.
Chair, Excellencies,
COVID-19 is first and foremost a health crisis, but its economic consequences are unprecedented.
Governments and international organizations are having to respond at a scale few could ever have imagined.
Some countries globally have the fiscal firepower to protect employment and livelihoods. Many do not.
Governments in our Region face an unprecedented and complex set of epidemiological, political and fiscal challenges.
I see a number of emerging trends.
First, the choice between life or livelihood.
“Lockdowns” have been effective in slowing the spread of the disease, but when rigorously enforced come at a high economic cost.
In recent months we have seen pressures to ease restrictions, supported by rhetoric that pits health against short-term economic recovery.
Easing containment measures while case numbers and death tolls are still rising is a real and present danger.
But in the long term, we do not have a choice. Life versus livelihood is a false dichotomy.
Effectively containing the virus through good public health measures and a vaccine in the future is the only long-term solution to the economic crisis.
Second, the virus is exposing existing pathologies in our systems of health care, governance and the economy.
Where there are inequities and vulnerabilities, the virus makes them worse.
While higher-income countries are projected to experience the greatest decline in economic growth, lower-income economies have the least resilience to shocks.
This is particularly true for those countries dependent on tourism and garment production or on exports subject to declining commodity prices.
A particular concern for this Region is dependence on remittances from migrant workers.
When unemployment follows lockdown, the result is not just a precipitous loss of income, but a surge in return migration from urban to rural areas, and from migrant-hosting countries to home countries.
This spreads the disease farther and drives poverty and food insecurity in the communities to which migrants return. It also impacts on remittances, which are a major source of national income.
Third, other health conditions are being exacerbated by the pandemic.
Medical and surgical care that has been delayed or cancelled; suspended vaccination programmes; absences of staff and closure of facilities; fear of infection; increases in suicide and intimate partner violence; mental health crises and drug and alcohol abuse under lockdown; and exposure to hostile environments when lockdown and physical distancing are not possible.
The poor face a stark choice: the gamble of infection against the certainty of hunger.
In many places we see discrimination and violence against health care workers by landlords and neighbours, which is totally unacceptable.
But there is an opportunity: health is now seen by heads of state and government as a central and crucial issue.
Another positive: the devastating knock-on effects of a pandemic should mean that we never again have to argue about the links between health and the economy, or the need for health care and financial protection to be universal.
At a practical level, we have seen an unprecedented willingness to spend on measures to address the impact of the crisis. The challenge going forward is to direct this attention toward the longer-term resilience and sustainability of the health sector.
Chair, Excellencies,
Responses to the crisis depend on countries individually, but full recovery depends on countries collectively.
The big risk comes with fiscal contraction. Governments across the Region have committed to unprecedented levels of expenditure in response to the crisis.
For some, this will make their fiscal situation even more precarious. For all, a period of fiscal consolidation or contraction is likely to follow.
Precedents from past crises suggest that whenever fiscal contraction has occurred, health and social spending are the first sectors to be cut. There is no guarantee that just because a health crisis precipitated the situation that health spending will be protected.
The 2008-9 financial crisis had its greatest impact in high and upper middle-income countries. Emerging from the crisis, some chose to implement austerity programmes to rapidly reduce budget deficits. As a result, social care and health services took a major hit.
We need to think about how to avoid the same mistakes. This means identifying spending priorities that both contribute to economic recovery and growth and keep UHC on track.
The Asian financial crisis in the late-1990s took place at a time when the choice for many when they were ill was either to forego treatment or to finance it through debt or selling precious assets.
For many people in the Region, this remains the case.
In several countries an expanding middle class sought to mitigate this risk through household savings. But the currency devaluations that followed the crisis meant that much of the value to these savings was lost.
The consequences were serious. But the crisis created a political opportunity and a vocal constituency for social safety nets – including financial protection for health – to which governments had to respond.
The countries in the Region most affected by the crisis started work on different forms of social health insurance in its immediate aftermath.
By contrast, in countries relatively untouched by the crisis health policy remained fundamentally unchanged, and under-funded.
The key question now is how COVID-19 will change financial protection for health and how will governments respond?
While overall levels of Official Development Assistance held up in the immediate aftermath of the global financial crisis, the way in which it is provided has changed, often due to public pressures in donor countries.
Flexible health sector and budget support has been replaced by tightly specified budgets linked to an externally defined results agenda.
For bilateral agencies, one-off transactions to single purpose global funds deflect risk from the donor and are increasingly attractive in the face of reductions in staff head counts. Support to the UN system has continued to decline.
We must ask ourselves: will these trends continue, or will the crisis provide an opportunity to re-think the role of external support and debt relief?
As the present crisis unfolds, we are reading more and more about the “new normal”.
But we must be realistic. We cannot assume that the pandemic will transform the world, or national health systems, for the better.
It will require that difficult choices be made, that deliberate actions be taken, and it will take time.
Above all it will require firm, clear and empathetic political and technical leadership, and a steadfast commitment to not only sustain present health spending, but to also accelerate it.
The good news is that the priorities we have already decided to pursue in this Region require only limited adjustment.
As this crisis unfolds, the way the health sector responds will be critical.
Given the depth of the economic crisis, the damage that could ensue due to a major contraction of health spending could result in losing many of the hard-fought gains we have achieved in recent decades.
Our first challenge therefore is to sustain and scale up current health spending.
We must strengthen the economic and political argument for sustaining health investment as a pre-requisite for recovery.
The concept of universality also reminds us of the equity gaps that have been so cruelly exposed by the pandemic.
Universality must include everyone: migrants, refugees, slum dwellers, those in remote areas and all those other groups so clearly at risk of being “left behind”.
Increasing the strength of the health workforce and enhancing access to safe and affordable medicines, vaccines and all other forms of medical technology must continue to focus our efforts – yes, throughout the pandemic response, but also beyond it.
It is only by doing so we can continue to achieve our “Sustain. Accelerate. Innovate” vision and build a healthier, more health-secure and sustainable Region and world moving forward.
Let me end with three suggestions that can hasten the Region’s onward momentum.
First, national leadership linked to local decision making.
National leadership – by which I mean the readiness to act decisively, and in ways that build trust and compliance – is vital.
At the same time, what works for containment in one area may not be applicable elsewhere.
We have seen in our Region that effective national leadership not only sets the overall tone and framework for managing the pandemic but also leaves space for local administrations to apply their experience and detailed knowledge.
Second, effective communications. Leadership, trust and the ability to communicate clearly are indispensable in any crisis – even more so when risks to life and health are at stake.
Local and national responses must be owned by people and not just experts.
As and when we start to roll-out a COVID-19 vaccine, the ability of health personnel to communicate effectively and sensitively can make the difference between success and failure.
Widespread acceptance of a new vaccine is not guaranteed; rejection by a significant proportion of the population is a real danger.
Expectations are high. But we have to explain that not all vaccines are 100% effective; that we cannot be sure how long protection will last; but that all precautions have been taken to ensure safety.
We must communicate the need for priority setting.
Effective engagement of communities requires clarity, empathy and attention to detail. It is a vital component of political leadership but is equally important at all levels of the health system.
Third, learning to manage uncertainty. Emerging from the pandemic will raise difficult questions about recovery that have the potential to influence all aspects of national life and international interaction.
We have to prepare for a wide range of possible futures.
Each country will seek its own answers to the questions they face. But health leaders must be looking ahead for early signals as to what is happening and what the consequences for peoples’ health will be.
One thing is certain: we cannot sit back and expect it will all turn out the way we want.
Chair, Excellencies,
Together we must continue to push ever harder for a future that is not only healthier, but also more health secure.
Together we must continue to drive sustained progress towards achieving health for all.