- Your Excellency Mr Vice-President of the Republic of Angola, Eng. Manuel Domingos Vicente,
- Honourable Minister of Health of the Republic of Angola,
- Your Excellency the Secretary of State for Foreign Affairs,
- Your Excellency the Vice-Governor of the Luanda Province,
- Honourable Members of the Parliament of Angola,
- Members of Government of the Republic of Angola,
- Honourable Ministers of Health of Member States of the WHO African Region,
- Your Excellencies Ambassadors, Heads of Diplomatic Missions, and Multilateral and Bilateral Agencies accredited to the Republic of Angola,
- Dear Esteemed Friend and Mentor, Mr Agostinho André Mendes de Carvalho “Uanheuga Xitu”, ex-Minister of Health,
- Distinguished Guests,
- Dear Colleagues and Friends,
- Social Communication Members,
- Ladies and Gentlemen,
It is with deep emotion and an immense feeling of pride that I am addressing this august assembly on this occasion of the opening of the Sixty-second session of the WHO Regional Committee for Africa, here in Luanda, Republic of Angola. I have this feeling of pride for the fact that after recently emerging from a situation of war with tragic consequences, Angola has risen up to the challenge of organizing the present session of the Regional Committee and has mobilized substantial resources to that end. The hospitality shown to the delegates of Member States and the representatives of the many partners that have honoured us with their presence is a clear evidence of our mutual fraternity and respect.
The emotion that I am having derives from the fact that Angolans have re-established peace with the result that nowadays the entire country has become a real development project, with tangible results to show from the economic, social and cultural standpoints.
- Your Excellency Mr Vice-President of the Republic of Angola,
- Honourable Ministers,
- Ladies and Gentlemen,
On behalf of the WHO Director-General, Dr Margaret Chan, I would like to pay compliments to the ministers of health and heads of delegations of Member States of WHO. I extend greetings to the representatives of the various health development partners in Africa and to the Resident Coordinator and Heads of Agencies of the United Nations System in Angola and, of course, to my colleagues, WHO staff. I welcome you all to this event.
May I be permitted to express, from this podium, my profound gratitude to the President of the Republic of Angola, His Excellency Eng. José Eduardo dos Santos, and to the Government and the people of Angola for the conditions they have put in place for the holding of the Sixty-second session of the Regional Committee and for the excellent support given to WHO for its work in the African Region.
The agenda of the Sixty-second session of the Regional Committee includes public health matters of priority to the African Region. Notable among the various topics for discussion are the issues of health systems strengthening, under which we shall analyse how Global Health Initiatives can contribute to improving integrated health care delivery to the populations; the opportunities that the new information and communications technologies provide for improving health information systems; research and development financing and coordination for health innovation; and the roadmap for scaling up human resources for health to accelerate progress towards achieving national and international health goals.
This Regional Committee should also address matters related to disease control, specifically updating of the strategies for control of HIV/AIDS, chronic diseases and for health promotion.
Furthermore, the meeting will address WHO corporate matters namely the ongoing reforms, implementation of the WHO Programme Budget 2012-2013, the Proposed Programme Budget 2014-2015 and the priorities of the WHO 12th General Programme of Work 2014–2019. Your Excellencies Ministers, Heads of Delegation, you will also have an opportunity to take part in a working session with major partners on important topics such as the decade of immunization and the control of malaria.
This year traditional medicine will be the subject of a panel discussion to be facilitated by experts invited specifically for that purpose.
- Your Excellency Mr Vice-President of the Republic of Angola,
- Honourable Ministers,
- Distinguished Guests,
This is the second time that Angola is hosting the WHO Regional Committee for Africa. The first time was in 1956 prior to Angola`s Independence.
Referring to the records of the sixth session of the WHO Regional Committee for Africa, held in Luanda in 1956, I noted emphasis on some issues such as maternal and child health, health and environment, control of schistosomiasis, onchocerciasis, leprosy, yellow fever, smallpox and malaria. For the majority of these health issues, there have been favourable developments and in some of the cases the diseases have been controlled or even eradicated. I would like to cite for example the eradication of smallpox, the control of yellow fever and onchocerciasis and the improvement of maternal and child health.
The health systems reforms that followed the independence of African countries provided better opportunities for health sector development and countries of the African Region have no doubt made progress in health in recent decades.
The progress has resulted from the implementation of more equitable health policies based on what used to be called Primary Health Care, now called Basic Health Care. The primary health care approach at the 1978 Alma Ata Conference was an actual revolution in public health. The approach allowed increased community participation in health care organization, in training and in posting of health professionals as well as better access to health technologies including the provision of essential medicines and vaccines.
Despite the progress, tuberculosis, malaria, some recurrent epidemics and maternal and child mortality will continue to be a concern. Meanwhile in the early 1980s the HIV/AIDS epidemic emerged.
The United Nations Millennium Declaration of 2000 has provided a new opportunity and defined a frame of reference that puts health at the core of our human development ideas and objectives.
If we should compare the main health indicators worldwide, we can appreciate the extent of disparity from country to country, within countries and among populations subgroups, e.g. between the rich and the poor, and between urban areas and rural areas.
According to the latest WHO statistics, life expectancy at birth worldwide is 68 years, varying between 54 years in the African Region and 76 years in the Region of the Americas for example. The African Region, with around 12% of the global population, accounted for 18.6% of deaths that occurred in 2008.
As regards disease control in Africa, I should start by saying that communicable diseases accounted for 63% of the total of deaths in the African Region. HIV/AIDS, diarrhoeal diseases, malaria, tuberculosis and child diseases cause 88% of these deaths. HIV/AIDS alone accounts for 15.6% of the total of deaths in the African Region. Despite these realities, the Region has made progress in HIV/AIDS prevention and control. Coverage of interventions to reduce vertical transmission has increased. Coverage of antiretroviral treatment has also increased from 100 000 people in 2003 to 6.2 million people in 2011.
Even so, the annual incidence of HIV infections remains high, estimated at 1.7 million new cases in 2011. Concerning malaria, 12 countries of the African Region have recorded about 50% reduction of related morbidity and mortality. Control of malaria in Africa has good opportunities and prospects in coming years.
The African Region continues to face up to numerous health emergencies including diseases of epidemic potential that have a devastating impact on the economic and social fabric of countries. The majority of these events are of infectious origin and cholera, meningitis and viral haemorrhagic fevers are among the most frequent. Cholera has claimed 1231 lives in the past 12 months.
As regards the global poliomyelitis eradication initiative, the African Region recorded 66% reduction of wild poliovirus cases. Angola has been polio-free for the past 16 months and the Democratic Republic of the Congo for at least the past 10 months. Poliovirus transmission in Chad has declined considerably in the past 12 months. Unfortunately, in Nigeria, the only endemic country in our Region, the number of cases of polio has doubled, prompting polio international partners to strengthen their support to the Government of Nigeria.
Meningitis epidemics to which nearly 500 million people in countries of the Sahel were exposed annually is now being battled with a powerful control weapon, namely the new conjugate vaccine against meningococcal meningitis type A. Last week we launched in the Republic of Benin the immunization campaign that brought together 100 million people immunized in Africa.
Concerning the Millennium Development Goal 4, i.e, reduce under-five mortality, it is worth noting that under-five mortality has continued to decrease in the African Region from 159 per 1000 live births in 2000 to 109 per 1000 in 2010. Even so, current statistics show that nearly 40% of deaths among children aged below five years occur in the first month of life, which suggests a weak attention to newborn care.
With regard to Millennium Development Goal 5, i.e. reduce maternal mortality by three quarters, maternal mortality decreased on average from 720 deaths per 100 000 live births in 2000 to 480 deaths per 100 000 live births in 2010. The African Region has made progress in improving maternal health but the progress is not sufficient to achieve MDG 5.
As regards other public health problems, chronic diseases including mental disorders and injuries represent nearly 60% of the current burden of diseases at the global level. Worldwide, nearly 37 million deaths are attributed to noncommunicable diseases. The burden of chronic diseases which is increasing rapidly also affects poor and needy populations. The majority of chronic diseases are associated with risk factors such as smoking, unhealthy diet, lack of exercise and alcohol abuse. There is no gainsaying the need to strengthen health promotion in order to reduce the exposure of individuals and populations to this risk factor.
The major public health challenges are associated with health determinants that change unpredictably and are unevenly distributed. I would like to recall and refer to a passage from the 2008 Report of the Commission on Social Determinants of Health: the lack of health care is not the main reason for the high burden of disease in the world. For example, water borne diseases are not caused by lack of antibiotics but by human consumption of unclean water. Likewise, heart diseases are not caused by lack of services specialized in coronary diseases but by the lifestyles of people.
Health systems reforms should therefore be carried out within a broader context that also improves the living conditions and the quality of life of people. We should therefore be prepared to grapple with a broader and increasingly complex public health agenda with new intertwined problems that will emerge as time goes on.
Health financing continues to be a concern since the improvement of the health status of the populations largely depends on it.
The commitment by Heads of State and Government in Abuja to allocate at least 15% of their national budgets to the health sector has been achieved by five countries. Twenty-four African countries have been able to reach the figure of US$ 44 health expenditure per capita per annum as recommended by the Task Force on Innovative International Financing. The average health spending per capita increased from US$ 35 to US$ 82 over the last 10 years. The first-ever conference of ministers of health and ministers of finance held this year in Tunis strengthened the commitment to a strategic alliance between ministries of health and ministries of finance and called for more efficient management of human resources, an increase in health sector investment including innovative financing mechanisms with emphasis on the need for greater transparency and accountability.
We are currently witnessing a trend towards the hospital approach to health services, commercialization of health care and fragmentation of national health systems. It is necessary that countries strengthen the implementation of their policies based on primary health care and pay attention to health determinants. Effective implementation of primary health care will contribute to reaching universal health care coverage. However, aspects of funding should be treated with attention according to the economic and social context of each country.
WHO has been emphasizing the development of national health accounts, more efficient management of the resources available to health and the adoption of prepayment schemes (health taxes or health insurance) that would certainly help prevent impoverishment due to catastrophic health expenditure.
The human resources for health crisis will persist and is, no doubt, one of the factors that weaken health systems. The African Region accounts for about 26% of the global burden of disease but has only 3% of health professionals (2% of the total of 10 million doctors and 4% of the total of 20 million nurses/midwives). Thirty-two countries of the Region are facing an acute crisis of human resources for health. On average, the African Region will need to increase the health workforce by 140% to close the gap. We commend the countries that have decided to increase their capacity to train doctors and other health professionals and we are drawing attention to the need to guarantee the quality of training in accordance with internationally established standards.
As regards health technologies, I would like to point out that access to routine vaccines has improved considerably and there is still need to accelerate the introduction of new vaccines. The access of the populations to quality medicines remains problematic. Some countries have initiated their local production of medicines or strengthened their capacity to do so; the African Union recently drew up a plan to strengthen the pharmaceutical industry in Africa. All these initiatives require more active drug regulation that enables us to prevent the circulation and intake of falsified medicines. It is against this background that we are suggesting the establishment of the African Medicines Agency.
- Your Excellency, Mr Vice-President of the Republic of Angola,
- Honourable ministers,
- Distinguished guests,
If I should sum up what I have said under five points above, I would say that:
- The health status of the African populations has improved in recent years and the trend will continue.
- Economic growth in Africa provides new opportunities for successful reforms but health systems should benefit therefrom.
- Reforms should impact on the least-performing components of health systems, e.g. financing, human resources, health information systems and epidemiological surveillance, health technologies, research and innovation.
- In the decision-making process there is need to take account of the opinions and expectations of communities and grassroots organizations in health matters.
- Intersectoral dialogue for health should be strengthened through the leadership of ministers of health with a view to promoting social determinants of health and the establishment of objective conditions for reducing health inequalities and achieving universal coverage of health care in Africa.
- Your Excellency Mr Vice-President,
- Excellencies,
- Distinguished participants and guests,
I would like to express my gratitude especially to the Minister of Health and the Secretary of State for Health of Angola and to the Government`s interministerial team that worked so hard to make the holding of this event possible. May I also re-iterate my gratitude to His Excellency the Vice-President, Eng. Manuel Domingos Vicente, for his presence at this gathering, which has made us feel so honoured.
For its part, the WHO Secretariat stands ready to make its technical and scientific contribution towards the success of the Sixty-second session of the Regional Committee.
I thank you for your attention.