Brazzaville, 10 February 2012
- Excellency Minister of Health and Population of the Republic of Congo;
- Excellency Ambassador, Representing the Minister of Foreign Affairs of Congo;
- Advisers at the Office of the President of Congo;
- Excellency Ambassador of Central African Republic, Dean of the Diplomatic Corps;
- Excellencies Ambassadors and the Heads of Diplomatic Missions;
- Resident Coordinator of the United Nations System;
- WHO Deputy Regional Director for Africa;
- Excellences Representatives of Bilateral and Multilateral Cooperation Organizations;
- Vice-President of the WHO Regional Staff Association;
- Dear Colleagues;
- Members of the Press;
- Ladies and Gentlemen;
It is a great honour and a privilege for me to welcome you to the WHO Regional Office for Africa on the occasion of the annual briefing meeting between WHO and the diplomatic missions accredited to the Republic of Congo. For this year, we have the immense pleasure to have in our midst several representatives of diplomatic missions of African countries accredited to the United Nations Office in Geneva to whom I would like to express warm welcome. But, first and foremost, permit me to express to you and your respective families my best wishes for the new year 2012.
Today, like on the previous occasions, the purpose of our meeting is to share with you information concerning the health situation in the African Region. I will give an overview of the progress made towards achieving the Millennium Development Goals particularly those related to health. I will briefly address the WHO regional strategic directions for the period 2010-2015. The bedrock of these strategic directions is to focus the efforts of the WHO Secretariat towards achieving outcomes contributing to improving the performance of health systems and the health status of the people of Africa. The strategic directions are six in number, namely:
- Continued focus on WHO's leadership role in the provision of normative and policy guidance as well as strengthening partnerships and harmonization;
- Supporting the strengthening of health systems based on the primary health care approach;
- Putting the health of mothers and children first;
- Accelerated actions on HIV/AIDS, malaria and tuberculosis;
- Intensifying the prevention and control of communicable and noncommunicable diseases;
- Accelerating response to the determinants of health.
Based on these strategic directions, I would now like to give you an overview of some priority public health issues in the WHO African Region.
- Excellencies;
- Distinguished Guests;
- Ladies and Gentlemen;
At the dawn of the twenty-first century, drawing upon the lessons learnt in the preceding century, 193 UN Member States and 23 International Organizations adopted the Millennium Development Goals in New York and agreed to achieve the goals by 2015. As you know, the goals, eight in number, concern the major challenges facing humankind today, such as reduction of extreme poverty; maternal and infant mortality; control of several diseases including AIDS; access to education; gender equality; and promotion of sustainable human environment.
I will limit my address to the progress made towards achieving MDGs 4, 5 and 6 related to health while acknowledging that the other MDGs are also important for a holistic approach to development.
The most recent data show that infant mortality has been reduced from 165 to 118 deaths per 1000 live births. Even so, the extent of progress varies from one country to another. For example, although substantial progress has been noted in 27 countries, 12 countries have made no progress at all.
In order to accelerate progress towards achieving MDG4, WHO proposes to Member States four major strategies focusing on (i) newborn care; (ii) integrated management of childhood illnesses; (iii) scaling up the expanded programme on immunization including the introduction of new vaccines and; (iv) a balanced infant and the young child feeding.
In MDG5 aiming at reducing maternal mortality by three-quarters by 2015, countries of the African Region have made some progress. Latest statistics show a ratio of 620 deaths per 100 000 live births. But this progress is still inadequate.
In order to contribute to achieving MDG5, health systems should be more responsive to the specific needs of women, while the socioeconomic conditions of women should be promoted by guaranteeing equal opportunities throughout the life cycle.
- Excellencies;
- Distinguished Guests;
- Ladies and Gentlemen;
I would now like to address MDG6 related to prevention and control of HIV/AIDS, malaria and other diseases. From the onset of the HIV/AIDS epidemic, great importance was given to surveillance of the disease. To that end we supported all countries of the African Region to establish surveillance sites especially in antenatal care services in order to monitor the trends and magnitude of the epidemic among pregnant women.
Since the emergence of the HIV epidemic more than 30 years ago, sub-Saharan Africa has unfortunately continued to be the most affected region. WHO and UNAIDS estimates show that in 2010 sub-Saharan Africa, accounting for only 12% of the world population, is home to about 68% of people living with HIV. Again in 2010, the number of people living with HIV in the African Region was estimated at 22.9 million, the number of people newly infected with HIV was 1.9 million and the number AIDS-related deaths was 1.2 million. Prevalence studies in the general population during demographic and health surveys have shown a decline in HIV prevalence from 5.8% in 2001 to 5% in 2009. As regards the treatment of people infected with HIV/AIDS, very remarkable progress has been recorded. Our region which, in 2003, had 2% coverage of treatment of people living with HIV attained an average coverage of about 49% in 2010.
Notwithstanding the progress, the AIDS pandemic remains quite serious in the region, requiring sustained efforts.
HIV prevention and control starts with determining the serological status of each individual, HIV testing being an entry point to case prevention and treatment. In prevention of mother-to-child transmission of HIV, notable progress has been recorded in sub-Saharan Africa in recent years. Even so, performance levels vary from one subregion to another. In central Africa, HIV screening among pregnant women is 21%; in west Africa, the corresponding rate is 27%; in east and southern Africa the rate is 61%. However, substantial efforts should be made to achieve universal coverage and central Africa should make increased effort in this area. I should acknowledge, though, that significant progress has been made in putting pregnant women on antiretroviral treatment in recent years. One of the means of prevention of HIV infection recommended in the past few years is male circumcision. It has been observed that, in parts of our Region where male circumcision is common, the number of HIV/AIDS cases is lower than in areas where circumcision is not practised. Some studies have shown that male circumcision reduces HIV transmission from women to men by about 50%. Based on the outcomes of scientific studies, male circumcision has been adopted as an innovative measure for preventing HIV/AIDS transmission.
A disease often associated with HIV/AIDS is tuberculosis. About 46% of TB patients are HIV-positive and 76% of people living with HIV and TB are found in our Region. It is very important therefore that closer and more effective collaboration be established between HIV/AIDS control programmes and TB control programmes.
Malaria continues to be a major public health problem in the African Region. An estimated 81% of malaria episodes and 91% of malaria deaths worldwide occur in the African Region. Furthermore, malaria mortality is very high among children and pregnant women and therefore has an impact on MDGs 4 and 5. Scaling up malaria control interventions has resulted in 50% reduction of malaria morbidity and mortality in 13 countries. In central Africa, the number of malaria cases and deaths has been either stable or on the increase in some countries.
In order to reduce the adverse effects of malaria in the African Region, WHO recommends: (i) prevention through using of insecticide-treated bednets; (ii) intermittent preventive treatment of malaria in pregnancy; (iii) diagnosis and treatment with Artemisinin-based combination therapy; (iv) malaria surveillance, monitoring and evaluation.
- Excellencies;
- Distinguished Guests;
- Ladies and Gentlemen;
It should be recalled that financing of MDGs in Africa has, so far, covered only 50% of needs. That is why I would like to conclude my address on this subject by appealing to governments of African countries to meet the Abuja commitment to allocate at least 15% of national budgets to the health sector. I appeal also to cooperation agencies to increase their contributions, matching them to needs, in order to sustain the gains and help improve health outcomes.
Still regarding financing, I would now like to address, Excellencies, Distinguished Guests, Ladies and Gentlemen, an initiative called African Public Health Emergency Fund (EPHEF). As you know, countries of the African Region are grappling with many epidemics and other public health emergencies that pose serious threats to the safety of the populations. The epidemics and emergencies also have an adverse impact on economies, tourism and trade among countries. In 2011 for example, a total of 103 public health events were reported to the Regional Office by countries of the Region. The majority (87%) of the public health events was of infectious origin; others were events due to noninfectious causes such as the consequences of natural disasters. Examples are floods in southern Africa, drought and famine in the horn of Africa. Others are man-made disasters such as wars; and there are occurrences of poisoning (e.g. lead poisoning in Zamfara State in Nigeria and bromide poisoning in Angola).
Among infectious diseases involving a high number of cases and causing many deaths are cholera, meningitis and viral hemorrhagic fevers. In this regard, in 2011, 25 out of the 46 countries of the Region reported 105 222 cholera cases with 2912 deaths.
Strengthening cholera prevention and control actions will significantly reduce the number and the magnitude of epidemics. These actions should comprise, among others, improving the conditions of hygiene; increasing access to safe drinking water; ensuring adequate case management; involving all strata of society; and multisectoral coordination of preventive action.
Epidemics, natural and man-made disasters, and complex humanitarian crises result not only in considerable loss of human lives but also in substantial economic losses. It is against this background that ministers of health decided to establish the African Public Health Emergency Fund (APHEF).
The purpose of the Fund is to mobilize, manage and disburse additional financial resources from Member States to respond rapidly and effectively to public health emergencies of national or international dimension. The resolution establishing the Fund was adopted by the Regional Committee in 2010.
I am continuing advocacy among Heads of State to endorse the resolution passed by ministers of health in Yamoussoukro and it is my pleasure to inform you that some governments have already taken a decision to pay their contribution to the African Public Health Emergency Fund. For his part, the President of the African Development Bank has responded favourably by accepting to play the role of managing the trust fund.
- Excellencies,
- Distinguished Guests,
- Ladies and Gentlemen,
It is conventional wisdom in all cultures that "prevention is better than cure". From this standpoint, immunization is a powerful tool for disease control. Thanks to the expanded programmes on immunization, several childhood diseases are now in the process of elimination or eradication. Efforts by countries of the African Region have made it possible, for example, to reduce measles mortality by 92% compared with 2000 levels. Efforts are underway to increase the use of new vaccines (Haemophilus Influenzae and pneumococcus type B against pneumonia; Rotavirus against diarrhea; HPV against cervical cancer; and the new vaccine MenAfriVac against meningococcal meningitis A) in order to help reduce more significantly the mortality caused by vaccine-preventable diseases. We are facing a problem of funding for immunization despite its cost-effectiveness and we would need to invest in immunization infrastructure.
As you know, countries worldwide have committed themselves to eradicating wild poliovirus from the globe. Poliomyelitis is a highly contagious disease mainly affecting children.
In the African Region, 347 cases of wild poliovirus were reported in 2011. Nigeria together with Afghanistan, India and Pakistan are the four endemic countries in the world. It is worth noting that wild poliovirus circulates also in Chad, Democratic Republic of Congo (DRC) and Angola. In 2011 for example, Chad and DRC alone accounted for 65% of the total number of cases in the Region.
We should redouble our efforts by interrupting wild poliovirus transmission in 2012.
- Excellencies,
- Distinguished Guests,
- Ladies and Gentlemen,
The final subject I would to address in my statement is the ongoing reform of the World Health Organization. The United Nations system is increasingly recognizing the role of the health sector in sustainable development and the United Nations Secretary-General promotes this growing interest. On 25 January this year, in presenting his plan for the next five years, the Secretary-General outlined priorities on which the world community should focus in order to build the future to which we all aspire. The priorities are sustainable development; conflict prevention and mitigation; respect for human rights; natural disaster preparedness and response; and building a peace-loving world that further taps the talents of women and youths. It is in this perspective that I also see the WHO reform aimed at providing better response to the health challenges of the 21st century.
In the WHO reform, the vision is to bring all peoples to the highest possible level of health. The January 2012 session of the WHO Executive Board, after thoroughly examining the subject, set out a process to facilitate deliberations at the World Health Assembly in May 2012.
The main thrusts of the WHO reform are:
- Priority setting in the General Programme of Work;
- WHO governance by global and regional governing bodies; and
- Administrative reform including new methods of evaluation.
I immensely appreciate the contributions of African States to the ongoing debate and would like to draw attention to the need for indepth and careful analysis of all aspects of the reform to help reach an informed position suited to the interests of Member States and the needs of WHO so that the Organization can provide better response to expectations. The global financial crisis has had a negative impact on WHO capacity in the African Region. We had a funding gap of about US$ 400 million, which compelled us to separate with a sizable number of staff members, thereby reducing our capacity to respond to requests from Members States. We face uncertainties about the future as the crisis persists and I would like to count on the kind support of the international community to take exceptional measures to guarantee adequate funding for the African Region of WHO.
Before I end my address, permit me to express greetings to my very dear brother, the illustrious professor Georges Moyen, Minister of Health and Population of the Republic of Congo and first vice-Chairman of the WHO Regional Committee for Africa. On this occasion, I would like to acknowledge his leadership and say how well we appreciate the ongoing process of accelerated health coverage in Congo. The four components of this health reform, — (i) launching latest, up-to-date medicine in Congo; (ii) strengthening the operational capacity of referral hospitals in social and health districts; (iii) increasing the coverage of integrated health centres; and (iv) achieving universal coverage of primary health care delivery; — correspond to a policy of equity and should contribute to a clear improvement of health indicators in Congo.
I would also like to highlight the initiative of the President of the Republic of Congo, His Excellency Mr Denis Sassosu N'guesso, to declare 2012 as "year of health". It is a decision that confirms the health sector's attributes as driving force and beneficiary of socioeconomic development in Congo. May I assure the Government of Congo of WHO's commitment to support the Ministry of Health and Population in the implementation of strategies and interventions to ensure the success of this new initiative.
Last but not least, I would like to reiterate our thankfulness to the entire Government and People of the Congo for the very favourable conditions provided to the WHO Regional Office for Africa to work from here in this beautiful Djoue estate. The Regional Office and its staff are, no doubt, enjoying a very convivial environment characterized by friendship and fraternity.
While reiterating my best wishes for the new year, I would like to renew my firm commitment and that of WHO staff to continue to strive for better health and quality of life for African peoples.
I thank you.