Honourable Minister of Health of the Republic of Cameroon, Chairman of the fifty-eighth session of the Regional Committee for Africa,
Honourable Ministers and Heads of Delegations,
Director-General of the World Health Organization,
African Union Commissioner for Social Affairs,
UNICEF Regional Director for East and Southern Africa,
Representatives of Bilateral and Multilateral Cooperation Agencies,
Representatives of Partners in health development,
Distinguished Guests,
Ladies and Gentlemen,
On behalf of the WHO Secretariat, I have the honour to present document AFR/RC58/2 entitled The Work of WHO in the African Region 2006-2007: Biennial Report of the Regional Director. This document summarizes the activities carried out and the results achieved by the World Health Organization in the African Region during the last biennial period. It comprises an executive summary, an introduction, Part I on implementation of the WHO Programme Budget, Part II on progress towards implementation of Regional Committee resolutions, a conclusion and the way forward.
I would like to recall that the share of the WHO Programme Budget allocated to the African Region in the 2006-2007 biennium amounted to US$ 949.5 million apportioned to 37 Areas of Work and in proportions of 75 % for countries and 25 % for expenditures of the Regional Office and intercountry offices. Eighty-two percent of the approved budget was disbursed.
More than a half of the countries experienced emergency situations. Advocacy coupled with the support provided to the countries for mobilization of funds made it possible to raise over US$ 78 million for emergency relief.
In health systems and policies, support was provided to 12 countries to review their national health policies and to 16 countries to develop their national strategic plans.
A regional health financing strategy was adopted by the Regional Committee. Concerning institutionalization of national health accounts, the number of countries that evaluated their accounts increased from 13 to 20, and studies are in progress in the remaining countries.
Mr Chairman,
Honourable Ministers and Heads of Delegation,
Ladies and Gentlemen,
In communicable disease control, the Regional Office and the African Union collaborated in holding a special Summit of Heads of State on AIDS, tuberculosis and malaria in Abuja in 2006. The Summit issued an appeal for accelerating prevention and treatment to ensure universal access to services concerning these three diseases.
An estimated 1.9 million new HIV infections and 1.5 million AIDS deaths were recorded in sub-Saharan Africa in 2007. These figures suggest a stabilization compared to previous years and even some improvement in some countries of the Region.
A number of countries adopted innovative approaches to intensifying HIV counseling and testing as an entry point to prevention, treatment and care. So far, 60% of health districts in the Region have at least one health facility providing HIV counseling and testing services. Similarly, the number of pregnant women having access to prevention of mother-to-child transmission services increased from 190 000 to 300 000.
Recent years have seen an unprecedented drive to intensify access to antiretroviral therapy. By the end of 2007, nearly 2.12 million people were on antiretroviral therapy, which represents a coverage rate of 35% compared to 17% in the preceding period.
With the support of WHO and other partners, Member States implemented activities to control HIV and tuberculosis infections in order to limit the adverse effects of co-infection. The average proportion of TB patients screened for HIV increased from 2% by the end of 2005 to 14% by the end of 2007, and was up to 75% in a few countries.
Out of the 34 countries with high tuberculosis burden in the Region, those having a case detection rate of at least 70% increased from 4 to 10 in 2007. Likewise, of the countries most affected by TB in the Region, those that involve communities in the implementation of the DOTS strategy in at least 50% of their districts rose from 2 in 2005 to 15 in 2007. Twenty-six countries of the Region reported a total of 8624 multidrug-resistant cases in 2007. Access to second-line TB medicines for treatment of multidrug-resistant or extensively drug-resistant cases is still limited mainly as a result of the high prices of the medicines.
Concerning malaria, by the end of 2007, 41 of the 43 endemic countries had already adopted artemisinin-based combination therapy as a matter of policy but only 25 of them had been able to implement their policy. More than 33 million insecticide-treated nets were distributed. Twenty-five countries incorporated indoor residual spraying in their national malaria control strategies and 16 of them are doing so systematically. Spraying campaigns helped protect more than 20 million people from malaria.
WHO and partners of the Roll Back Malaria Initiative supported countries to draw up proposals for submission to the Global Fund for AIDS, Tuberculosis and Malaria. Twenty-seven of the proposals thus submitted were approved by the Global Fund.
In the control of neglected tropical diseases, 10 countries were certified as free of local transmission. Between 2005 and 2007, the annual incidence of guinea worm disease decreased by 28%. Efforts to eliminate leprosy in the remaining endemic countries resulted in 30% reduction of leprosy prevalence. By the end of 2007, 44 countries of the Region had achieved the leprosy elimination goal.
The downward trend in the annual incidence of human African trypanosomiasis continued in the biennium. A 69 % reduction of incidence was thus recorded in 24 countries. Governments increased their contribution to the African Programme for Onchocerciasis Control (APOC) by 38 %. In 2007, APOC operations helped avert an estimated loss of 960 000 disability-adjusted life years.
As regards vaccine-preventable diseases, 15 countries achieved DPT3 coverage of at least 90%. Following the introduction of yellow fever vaccine into routine immunization regimens, 22 countries achieved immunization coverage of at least 80% for this antigen. Sustained efforts for poliomyelitis eradication helped reduce the number of poliomyelitis cases reported in 2000 by 70% compared to 2006. In 2007, 41 countries met certification standards for acute flaccid paralysis surveillance.
Mr Chairman,
Honourable Ministers and Heads of Delegation,
Ladies and Gentlemen,
The fifty-sixth session of the Regional Committee for Africa adopted the child survival strategy jointly developed by UNICEF, the World Bank and WHO. In terms of achievements, 19 countries expanded IMCI coverage to more than half of their districts; 29 countries developed national strategies for infant and young child feeding; and the Regional Office trained senior staff from 13 countries in the use of the new WHO child growth standards. As part of a WHO/UNICEF/UNFPA partnership, an additional 21 countries developed their national road maps for accelerating the achievement of Millennium Development Goals (MDGs) related to maternal and newborn health, bringing the total of countries with road maps to 37.
Twenty-five of the 37 countries that have road maps were supported to implement their Road Map. Prevention and control of cervical cancer received increased attention in 2006-2007. Training was provided, region-wide, in both visual inspection with acetic acid and cryotherapy.
Concerning sexual and reproductive health, guidelines and training materials were disseminated. The Regional Office contributed to the development of the strategy for integrating gender analysis and actions in the work of WHO, which was adopted by the World Health Assembly in May 2007. WHO gender policy analysis tools were disseminated to countries of the Region and regional economic communities.
Mr Chairman,
Honourable Ministers and Heads of Delegations,
Ladies and Gentlemen,
Further evidence of the heavy burden of noncommunicable diseases was gathered during 2006-2007 through STEPs surveys. The preliminary findings showed a high prevalence of hypertension and diabetes in the Region.
Subsequently, integrated noncommunicable disease control programmes were established in four countries. By December 2007, 35 countries had ratified the WHO Framework Convention on Tobacco Control. The Regional Office supported these countries to draw up and implement legislations and national action plans for tobacco control. In 2007, WHO and the United Nations Economic Commission for Africa sponsored the African Road Safety Conference in Accra. Participating countries adopted the Accra Recommendations and Declaration on Road Safety.
Poverty and other socioeconomic factors particularly affect health. The participants at the fifty-sixth session of the Regional Committee therefore adopted Resolution AFR/RC56/R4 on poverty. The next session of the Committee endorsed the Resolution entitled “Key social determinants of health: a call for intersectoral action to improve health status in the African Region”.
Member States continued to face major challenges regarding food safety and food security. At its fifty-seventh session, the Regional Committee adopted a related Resolution AFR/RC57/R2. Countries received technical support for training in food safety.
Mr Chairman,
Honourable Ministers and Heads of Delegations,
Ladies and Gentlemen,
In June 2007, the WHO African Region published the maiden issue of the African Regional Health Report which is recognized as an unbiased and constructive reflection of the health situation in the Region. It will be followed by a second report focusing on systems of health research, health information and knowledge management in the African Region.
WHO and its partners supported Algeria in successfully organizing and holding the Ministerial Conference on Research for Health in June this year.
Mr Chairman,
Honourable Ministers and Heads of Delegations,
Ladies and Gentlemen,
The report I am presenting also sets out the progress in the implementation of 16 resolutions adopted by the Regional Committee in the areas of macroeconomics and health; prevention and control of HIV/AIDS, tuberculosis and malaria; reproductive health; strengthening national health information systems; occupational health and safety; child health; millennium development goals; avian influenza; knowledge management; and onchocerciasis control.
Generally, Member States showed increased commitment to scaling up proven interventions targeting priority diseases, child survival, and reproductive health. The Secretariat invested significantly in providing technical guidance and tools for policy formulation, development of plans, and programme monitoring and evaluation. The Secretariat also provided direct technical support for capacity building, implementation of proven interventions, and accessing significant financial resources under international financing initiatives.
Specifically, WHO continued to advocate for increased investment in health as an effective means of reducing poverty and to disseminate the recommendations of the Commission on Macroeconomics and Health. In this regard, WHO provided technical support to countries to develop or improve the health component of their Poverty Reduction Strategy Papers.
In the area of child health, WHO, in collaboration with the African Union Commission, developed a framework for achieving MDG 4. The AU ministers responsible of child affairs endorsed the framework at the Second Pan-African Forum on Children held in Cairo, from 27 October to 2 November 2007. Subsequently, WHO, in close collaboration with UNICEF, supported 17 countries to develop national child survival strategies based on the framework I have just mentioned.
Mr Chairman,
Honourable Ministers and Heads of Delegations,
Ladies and Gentlemen,
In conclusion, I wish to express my satisfaction with the overall level of achievement of the objectives and the expected results set for the implementation of WHO Programme budget 2006-2007 in the African Region. The level of implementation of the budget was higher than in the preceding biennial period, increasing to 95% for the regular budget and to 78% for extrabudgetary funds. However, some factors such as late provision, unavailability and uneven distribution of voluntary funds adversely affected the implementation of the Programme Budget. I should also mention the issue of inadequate human resources for health in many countries and of partners’ targeted support to some countries.
The lessons learnt from the 2006-2007 experience guided the preparation and implementation of the 2008-2009 Programme Budget.
All these outcomes would not have been achieved without the commitment of Member States and the support of our partners.
Finally, the roll out of the WHO Global Management System in the African Region is scheduled for November this year. The system will bring about unprecedented changes in WHO’s work. It will streamline and automate most standard management procedures, enhance decentralization through greater delegation of authority, facilitate joint programme planning and implementation, and increase transparency and accountability.
I thank you very much for your kind attention.