Remarks by WHO Regional Director for Africa, Dr Matshidiso Moeti
Thank you, Chair, and my gratitude to all the illustrious previous speakers who have so ably set the stage for tonight’s event to showcase the achievements of the ambitious Transformation Agenda of the WHO African Region over the past decade.
My special thanks to our co-sponsors: Dr Austin Demby, the Honourable Minister of Health of Sierra Leone. Your pioneering innovation in accelerating positive impact on the people’s health has been inspirational.
And to the Bill & Melinda Gates Foundation: You have been a key partner in the African region’s fight against polio, other priority areas, and on transformation.
Welcome Excellencies, partners, colleagues, and friends. I deeply appreciate you making time in your demanding schedules to mark this milestone with me and my colleagues, as my 10-year term as WHO Regional Director for Africa draws to a close.
The Transformation Agenda was born out of a very difficult period characterized by weak health systems in most of our Member States, and poor health outcomes - evidenced by the inability of our Member States to attain the health-related MDGs.
When I took office in February 2015, the African region was responding to the biggest Ebola outbreak in history, struggling to contain the wild poliovirus outbreak, as well as facing down increasingly negative sentiments related to overall management and the lack of accountability and compliance with WHO rules.
To reignite trust and pride in the Organization, the need for reform and new priority-setting was urgent.
The Transformation Agenda, which resulted from extensive consultations, including with some of our harshest critics, who I invited to the table, provided the roadmap.
The Transformation Agenda Roadmap focused on setting up a robust system for improving the efficiency and accountability of the African region secretariat. This was supported by consistent monitoring of our administrative, financial, and human resources management. The roadmap was also focused on ensuring quality support for our Member States’ progress in key technical areas, and improving health outcomes.
I was determined that my colleagues and I would never again have to explain poor audit reports to regional and global WHO governing bodies.
Now, 10 years on, it is time to provide feedback.
WHO African Region’s restructuring of and investment in Country Offices to be fit-for-purpose; the establishment of Multi-country Assignment Teams (MCATs) to support country action; and the huge investment in management improvement helped deliver the achievement we are presenting today.
To effectively monitor the secretariat’s performance, managerial Key Performance Indicators (KPI) were developed and introduced in all Country Offices and the Regional Office departments. The KPIs were linked to corrective action where gaps were identified. The region can now boast of improved audit outcomes and better management of donor resources provided to us. We are pleased that our KPIs have inspired the approach to accountability in WHO’s global transformation.
Improving gender parity, especially among senior and middle-level staff, was one of the Transformation Agenda priorities. Ten years later, we have more senior women managers leading the work of WHO in the African Region than at any time in our history. Through the UN Volunteers partnership, we attracted over 200 UNVs, 80% of whom are young female public health experts, thus further improving the pipeline for gender parity.
We also invested in improving leadership skills among our staff. The WHO African Region pathway to leadership program informed the global WHO leadership program and has been used to build leadership capacity in other WHO regions. We have partnered with academic institutions on the continent as a way of making the program widely available beyond WHO and ensuring sustainability. I am also proud that this program has been offered to senior health managers in several of our Member States.
Investing in our human resource also entailed staff signing up to the values of the organization and regularly communicating the need to create a respectful and fair work environment through town hall meeting and other platforms. A full time Ombudsman is now available to help timely resolve conflicts in the region.
These changes, would not have been possible without the unwavering commitment of our Member States who have fronted the process, supported by our dedicated partners, many of whom are with us this evening.
Our shared vision of health security, equity and universal health coverage for all people in Africa has stood strong ¬– despite the many challenges we have faced such as multiple disease outbreaks and emergencies, not least of which was COVID-19; climate change-related natural disasters; and the re-emergence of imported polio as a health threat.
The successes have been many and varied, as have the lessons learned. Of course, there is still much to do – in some areas, progress has certainly not matched our ambitions.
In relation to our technical work, I will highlight some of the good news, which I have grouped according to priority programmatic areas.
One of the biggest pushes has been to enhance public health emergency prevention, preparedness and response capacity; with the pandemic, and multiple outbreaks of Ebola, Marburg, Yellow Fever and cholera, among others, absorbing much of the focus.
Significant reduction has been achieved in the average time for detection of outbreaks, from 14 days in 2017 to only four days now, reflecting optimal management of these events.
WHO supported the training of 3,700 first responders, who have been key in the response to a range of emergencies, including COVID-19. We have also leveraged our genetic sequencing and laboratory expertise from across disease programmes, to rapidly scale up the country capacity to contribute to knowledge on the evolution of COVID-19 and other pathogens.
The sub-regional emergency operation hubs are proving their value. For example, emergency supplies can now be delivered in as little as four days – down from 45 days previously. We intend to reduce this further.
My visits to many affected countries and communities, for example, Angola, DRC, Madagascar, and Mozambique, left me heartened that our support is having a real impact in terms of lives and livelihoods saved.
Efforts to control and eliminate communicable diseases have also seen meaningful success, with millions of people in Africa vaccinated against COVID-19 against significant odds; and the introduction into routine immunization of the new vaccine against malaria in Ghana, Kenya, Malawi and Cameroon.
We are very encouraged by the progress made against Neglected Tropical Diseases (NTDs), and know that our Expanded Special Project for the Elimination of NTDs, a small, lean but extremely effective team within the NTD programme, has played a central role in this.
The first data, which includes interactive dashboards, maps and datasets, is already proving invaluable, informing actions including through national NTD master plans and annual work plans, and partners’ support.
The results speak for themselves: By the end of 2023, 19 Member States had eliminated at least one NTD, and Togo had become the first country worldwide to eliminate four NTDs.
Marked progress was also made towards controlling HIV. The elimination of mother-to-child transmission in Botswana, Namibia and Eswatini is a special cause for collective celebration.
Polio, meanwhile, is an important success story for the African region. It is impossible not to recall Dr Chris Elias’s comment to me when I took office. He told me, “You have a lot of catching up to do, and a large number of (unaffordable) long-term contract polio staff. What are you going to do about it?”
In response to this challenge, I reorganized the polio response program and placed the unit under the direct coordination and oversight of the Regional Director. We worked with partners to introduce innovative technology such as GIS to support response.
We have worked very hard to achieve eradication, being declared free of wild polio virus in 2020. And, earlier this month, experts confirmed that the WPV1 polio outbreak in Southern Africa, following an imported case in 2021, had been successfully interrupted.
This is thanks to a robust, collaborative sub-regional outbreak response, which is also contributing to good progress towards addressing circulating vaccine-derived poliovirus (cVDPV) in many countries.
Interrupted by COVID-19 and slowed down by insecurity in some countries, the polio eradication effort is regaining momentum, with a significant drop in cases enabled by widespread simultaneous multi-country vaccination campaigns, and management of contributory factors, such as water contamination.
The real lesson to us has been the power of collaboration, as we engaged everyone from politicians to community members, combining evidence, science, innovation, and implementation to protect our children from this devastating virus.
The health of Africa’s mothers and children takes precedence in everything we do. I am pleased to be able to share that WHO’s support to our Member States to develop, resource and implement high-impact integrated interventions is yielding results.
The statistics reflect the real lives saved: Seven countries have achieved the relevant SDG 3 targets, while 13 countries reduced their maternal death rates by more than half in the two years to 2020.
But there is much to do about equity. Maternal and neonatal deaths remain highest in protracted humanitarian crises, rural areas, and peri-urban slums. We are adapting our strategies.
Turning now to Universal Health Coverage, we started by supporting our Member States to develop UHC roadmaps. The Health Coverage Service Index which combines several indices that track UHC doubled – from 23 in 2000 to 46 in 2019. Although our progress has been modest, it is encouraging that more people in the African region can now access essential health services.
We also report the threefold increase in the number of health workers in the region (from 2013 to 2022). Notwithstanding the challenges that remain—in terms of migration to wealthy countries or unemployment of qualified staff—this growth has contributed to improved service coverage.
In March 2024, we launched a pioneering health workforce investment charter, a first for the African region, with the aim of consolidating efforts to drive up investment to counter the critical health worker shortages that remain, despite the progress. The charter is a critical complement to the deserved focus on trained, remunerated community health workers, with career prospects.
This excellent example of governments, partners and different stakeholders working and investing together should stand as a reminder to us all of the multi-faceted responses that are crucial to maintain and accelerate the gains.
To increase access to quality medicines, WHO supported countries to build their capacity for regulation. National regulatory authorities in four countries in our region have achieved maturity level 3, and we expect this number to increase to at least seven by 2025.
Our Member States in the region still face health financing challenges. WHO working with partners has supported at least 36 countries to introduce some form of health insurance schemes as a way of mobilising additional domestic resources to drive their national health agendas and reduce catastrophic out of pocket expenditure on health.
On our efforts to address the determinants of health, I made a brief reference earlier to our work to counter the impacts of climate-related emergencies. At COP26, our Member States signed on to the health commitments of climate change. We are beginning to build a cohort of health experts as climate negotiators as part of our mitigation endeavours.
Road safety and tobacco use are both areas in which we have seen good results. In the past 10 years, 17 African Region countries have halved the number of road-related deaths, while 22 out of the 56 countries globally on track to reduce tobacco use by 30% by 2025 are in Africa.
In the area of innovation for health, more broadly, we pioneered an initiative aimed at encouraging young people to create new ideas, solutions, or technologies for health through an Innovation Challenge that attracted over 2,400 applications. This yielded many innovations, and action to support emerging ecosystems in countries. One notable innovation was the portable device that uses AI to verify drug authenticity. The innovator was honored by Forbes 30 Under 30 in 2020.
Returning now to the factors that have enabled our successes since the launch of the Transformation Agenda, I want to stress again that this has been a collective effort.
Together with my team, I have deeply appreciated the close collaboration and partnership with our Member States, partners, other stakeholders, including frontline health workers, civil society, and community members.
We have aligned WHO work with the health goals of the African Union 2063 Agenda. We have also worked closely with the African Union commission, its specialized agencies, such as the Africa Centres for Disease Control, AUDA-NEPAD, and the African Medicines Agency and the Regional Economic Commission. Our partnership with the African Union through the Africa CDC, on implementation of a Joint Emergency Action Plan, is already delivering remarkable results.
Looking beyond the 10 years of the Transformation Agenda, I can confidently say that the WHO African Region has built a robust system for ensuring continuity and an accountable secretariat that focuses on a person-centred approach, to deliver more effective results in an integrated way, with more efficiency and synergy, with Member States’ priorities.
The progress to date would not have been possible without political will at the highest level, and the power of partnerships at multiple levels. We need to celebrate and accelerate these collaborations to move the continent forward.
Although I will be watching your progress from the side-lines, I anticipate the following: that there will be continued growth in our regional partnership with global health players, including the diaspora; that innovation and use of technology in health will increase and result in more efficient delivery of services; that private sector role in health on the continent will expand and supplement that of governments; and that more investment and financing for UHC will continue to grow for our Member States to fully attain UHC by 2030.
WHO will, of course, continue to stand ready to support our Member States and work with continental organizations, and partners in every way possible to improve the health of people in our region.
Thanks to every one of you who helped set the Transformation Agenda 10 years ago, and who have worked tirelessly alongside me to fulfil our fundamental goal of empowering our Member States to deliver optimal health care to all Africans.
It has been an honour and a privilege to serve you.