Opening Remarks of Dr. Matshidiso Moeti, WHO Regional Director for Africa, at the 6th Meeting of Small Island Developing States (SIDS) in the African Region, Victoria, Seychelles

Submitted by teklemariamm on Tue, 26/09/2017 - 09:55

Your Excellency, President Danny Faure, President of the Republic of Seychelles
Honorable Ministers of Health of SIDS and Heads of Delegations
Distinguished guests 
Dear colleagues and friends, ladies and gentlemen 

Let me start by thanking the Government and People of Seychelles for accepting to host the 6th Meeting of the Ministers of Health of the Small Island Developing in the African Region here in beautiful Victoria. This is the second time in the life of this network that Seychelles is hosting this meeting having hosted the inaugural meeting in 2006.

I’d also like to thank the Honorable Ministers of Health of SIDS, Heads of the Delegations, and representatives of UN organizations for participating in this important meeting. 

This forum is celebrating a solid partnership of over 10 years’ service to the people of Small Island Developing States of the African Region. 

These are countries that share common features such as limited land mass, small populations, limited resources, and dependence on international trade. 

As we have witnessed recently in the Caribbean, particularly in Dominica which has suffered “mind-boggling damage” to quote their president, from Hurricanes Irma and Maria, the Small Island Developing States are also known for their vulnerability to environmental deterioration, climate change, natural disasters, high costs of living and continuing loss of skilled manpower.

Since the first meeting in October 2006 in Seychelles where Ministers of Health endorsed the creation of the SIDs Network and for subsequent meetings to be held biannually, there have been several recurring themes. 

These include health system strengthening, noncommunicable diseases, communicable diseases especially HIV and Malaria, health security and emergencies, climate change; and strengthening the SIDS network.

With regard to Health Systems, we have together addressed such as  Primary Health Care, human resources for health, social determinants and health equity, health financing - including financial sustainability of health systems in the SIDS, and Health in All Policies. 

Some achievements in this area include: 

  • the development of HR policies and plans, including country profiles, in Cape Verde, Comoros and Seychelles; 
  • development of pharmaceutical sector profiles for all the SIDS countries; 
  • the establishment of a national health observatory for data and information management in Cabo Verde; 
  • Mauritius and Sao Tome and Principe (STP) have conducted studies on the estimated total and per capita expenditure on health. Cabo Verde, Comoros and Mauritius have also found alternatives for health financing using tobacco taxation. 
  • For example, in Cabo Verde, all excise revenues are used for sports and health, while in Comoros, a portion of the 5% extra tax on tobacco is directed to hospital emergencies, and Mauritius dedicates a portion of tax revenue to fund smoking-related health problems. 
  • Cabo Verde has recently completed an audit of supply chain management, which is meant to introduce efficiency in the procurement and distribution of medical commodities. We will have discussions on this issue during this meeting. 
  • Other areas have focused on developing legislation on the removal, transportation and preservation of human tissue and organs, and blood safety.

Non Communicable Diseases have remained a significant priority in all the SIDS countries. Available data indicate that the burden of NCDs has continued to rise over the past decade, and in some countries like Mauritius, up to 80% of identified medical problems in the population are due to NCDs, specifically, cardiac disease, lung disease, diabetes and cancer.

Work that WHO and countries have done has focused mostly on developing national policies, strategies and integrated NCD action plans for the prevention and management of NCDs. 

For example, Comoros, Seychelles and STP are currently implementing the WHO Strategy for Avoidable Blindness: Vision 2020 - the right to sight. In this strategy, NCDs such as diabetes have been identified as a key contributor to avoidable blindness in these countries. 

Despite this work on NCDs, you will note that more needs to be done.  

  • How can we work with you to obtain better value for money for the costly NCD drugs that you are currently ordering? 
  • How can we support you to reduce child obesity which is emerging as problem with nutrition and subsequent NCDs? and 
  • How can the SIDS countries share the medical specialists in the various NCD areas to improve the management of patients with NCDs. 

I hope this meeting will be able to come up with anwers to these questions.  

The theme on Communicable Diseases has dealt mostly with HIV/AIDS, Human Papilloma Virus, malaria elimination and other communicable diseases linked to the environment. Great progress has been made over the last decade. 

Patients living with HIV/AIDS in the SIDS countries now have better access to treatment and care, and these programmes have matured over the past decade. 
We are seeing stable population rates of HIV, although with increased intravenous drug abuse, there’s a big risk of both reversing these gains, and introducing other diseases such as hepatitis B & C. 

Cabo Verde and STP have recorded an increased uptake in malaria interventions, resulting in over 50% reduction in the malaria burden. 
The effects of climate change require the SIDS countries to pay special attention to the spread of vector borne diseases, such as chikungunya, and to implement policies to reduce these vectors. 

In the area of Health Security, SIDS countries have over the past decade worked with WHO and other partners in their efforts to attain the  IHR (2005) core capacities. 
Based on the core capacity assessments conducted in these countries, IHR national implementation plans were developed with WHO supporting areas such as events-based surveillance, intersectoral coordination, case management of common communicable diseases, and public awareness. 

As with most countries in our Region, none of the SIDS countries attained the desired core capacities for IHR by June 2014. 

Because of the above and learning from the experience of Ebola, WHO and partners have introduced joint external evaluations (JEE) as a way of identifying gaps and improving monitoring of countries implementation of IHR.  

So far, Comoros has completed their JEE, and Seychelles plans to do theirs early in 2018. We encourage you to reach out to your Head of WHO Country Offices to indicate the timing for the JEE in your country. 

On the theme of climate change, you will have heard the WHO Director-General speak at the recent Regional Committee about climate change in small-island nations as one of his “fast track initiatives”. We are all reassured that it is getting the prominent attention it deserves. That said some progress has been made to address issues of climate change in SIDS countries: 

For example, Seychelles has undertaken a situation analysis and needs assessment (SANA) to enable implementation of the 2008 Libreville Declaration on Health and Environment in Africa, where African Ministers of Health and Environment committed themselves to jointly address environmental determinants of health and ecosystems integrity. 

Cabo Verde, Comoros and STP have adapted the regional plan on climate change and produced national plans for the public health adaptation on climate change. 
This said, we need to evaluate how we can accelerate actions on climate change, bearing in mind the Paris Declaration of 2015, and the targets of the Regional Strategy on Environmental Determinants of Human Health, adopted at the 67th Regional committee for Africa.

The last decade has also seen recurrent discussion on how we can strengthen the SIDS network in the African Region. , At the last meeting in Mauritius, we agreed to have focal points and a secretariat for SIDS; I have noted movement on this and I look forward to hearing progress on this, and how WHO can better support this network.

Taking stock of all that we’ve done over the past decade, the time has now come for us to agree on a few thematic areas going forward. WHO is currently developing its program budget for the next biennium 2018 to 2019, and this will be good time for SIDs country and WHO to agree on the key priorities that we can together focus on over the next two years as well as include in our program budget.  

We should also as much as possible address all the issues related to SIDS in the context of the SDGs. A framework of action on UHC and the SDGs has been developed for you to use, and to consider how to ensure sustained monitoring for SDG action.  

For the first time, at the Mauritius meeting, we came up with 24 action points that we were to implement together. I’m happy to report that significant progress has been made in 21 of these (±87%) action points.

Unfortunately, we didn’t implement actions related to: Use the SIDS Network website to regularly monitor implementation of actions agreed; Provision by WHO of the price list and prequalified drugs for major NCDs and sharing of information on best practices in procuring affordable medicines and commodities.

In the case of the price list of prequalified drugs for major NCDs, WHO is yet to develop such a list, although a mobile tool for measuring price and availability of NCD medicines has been developed and soon WHO will convene price negotiation and pricing policy workshops to guide countries. 

This has become a top priority, considering the excessive costs that the SIDS countries are paying for NCD medicines. We will discuss this issue further during this meeting, and hope to hear from the experts on how your countries can benefit from pooled procurement and other mechanisms.

Going forward, on my part, the Transformation Agenda sets out the priorities for the region, including the SIDS countries, which are: improving health security, strengthening and investing in national health systems, sustaining focus on health-related SDGs, addressing the social and economic determinants of health; and transforming AFRO into a responsive and results-driven organization. 

In the next few months, a big activity of the TA will be to review the staff profile in WHO country offices to ensure it is tailored to match the priorities of the country.  I encourage you to work with your WRs to ensure that the correct priorities are identified so that the WHO staff profile in your countries are aligned to these.

I’d like to end by stating that WHO will work closely with all the SIDS Ministries of Health and other partners to address these priority health problems, and provide the necessary support for this Network to function even more resolutely as a bloc.  

Thank you.