- Your Excellency Mr Blaise Compaoré, President of the Republic of Burkina Faso,
- Your Excellency Mr Prime Minister of the Republic of Burkina Faso,
- Your Excellency Dr Manto Tshabalala-Msimang, Minister of Health of South Africa and Chairperson of the Bureau of the African Union Conference of Ministers of Health,
- Honourable Minister of Health of Burkina Faso,
- Honourable Ministers of Countries of the WHO African Region,
- Distinguished Country Delegates,
- Honourable Deputies,
- Mayor of the City of Ouagadougou,
- Your Excellencies Ambassadors, Members of the Diplomatic Corps and Representatives of Bilateral and Multilateral Cooperation Agencies,
- Dear Colleagues from Agencies of the United Nations System and International Financing Institutions;
- Members of the Scientific Committee of this Conference;
- Distinguished Guests and Participants representing Civil Society, Nongovernmental Organizations, Academic and Research Institutions, Professional Bodies and other Health Actors;
- Ladies and Gentlemen,
It is a pleasant duty and a great honour for me to welcome you to the International Conference on Primary Health Care and Health System in Africa.
The WHO Director-General, Dr Margaret Chan, has been unable to attend this Conference as she is participating in a WHO Statutory meeting currently underway in Geneva. She has therefore asked me to convey to you her apologies and her best regards. In this context, I am honoured to deliver to you this statement whose content she fully endorses.
On behalf of WHO and the co-organizers of this Conference, namely United Nations Children’s Fund, United Nations Population Fund, UNAIDS, World Bank and African Development Bank, I sincerely wish to express our profound gratitude to His Excellency, President Blaise Compaoré, to his Government and to the People of Burkina Faso for their kind hospitality and their immense contribution to the organization of this Conference. In effect, no effort has been spared to make our stay in this charming city of Ouagadougou as productive and pleasant as possible.
I wish also to acknowledge here the personal commitment of His Excellency President Blaise Compaoré to the cause of public health in Africa, as evidenced by the mobilization of resources on the occasion of the global forum of partners for the control of neglected tropical diseases, his advocacy at the last Summit of African Heads of State for more adequate response to the meningitis epidemic currently rife in some countries of the Sahel, the co-sponsorship for the production of the new conjugate vaccine for meningitis and the substantial investment made by the Government of Burkina Faso to create the conditions enabling Ouagadougou to host the WHO Intercountry Support Team for West Africa.
Your Excellency Mr President,
Ladies and Gentlemen,
The adoption in 1978 of the Alma-Ata Declaration on Primary Health Care triggered a true revolution in public health worldwide.
Today’s conference that was strongly recommended by Ministers of Health at the 57th Session of the WHO Regional Committee for Africa is taking place in the context of the 30th Anniversary of the Alma-Ata Declaration and the 60th Anniversary of WHO. It is also taking place midway towards 2015, the target year for achieving the Millennium Development Goals.
The Conference aims to take stock of our delivery on our commitments in regard to Health for All in Africa and to redefine this commitment in the light of the lessons learnt and the changes and developments that have taken place on the epidemiological, demographic, economic, institutional , social, political and ecological fronts since 1978.
These changes are absolutely necessary for us insofar as they pose challenges to public health. The challenges include:
- Globalization and its impacts on the epidemiological profile;
- Poverty among the majority of the population ;
- Food crisis which is currently taking its toll on Africa;
- Environmental degradation;
- Health hazards posed by dangerous handling of biological agents;
- Political and economic constraints; and
- HIV/AIDS pandemic and its devastating socioeconomic and health impacts.
Your Excellency Mr President of Burkina Faso,
Ladies and Gentlemen,
By responding in so large numbers to our invitation, you have shown your willingness to support efforts to strengthen health systems, using the primary health care approach.
I would like to thank, in particular, the ministers of health and the other members of governments who did not hesitate, despite their very busy schedules, to come here to make their much-need contribution to deliberations at this Conference. This forum will provide an opportunity to share experiences regarding good practices as well as the difficulties and the challenges.
Permit me, at this stage, to share with you my idea of the vision that should – if you permit – guide us in the next three days of deliberation and brainstorming.
Every Member State of the African Region is expected to achieve the health-related Millennium Development Goals by using a well-performing health system with qualified and motivated staff, providing quality and equitable services and focused on the needs of communities including the vulnerable and most needy communities, and with their full involvement.
The underpinnings of this vision are the basic principles of the primary health care strategy which, if I should recall, were defined jointly by WHO and UNICEF as, and I quote, “essential health care based on practical, scientifically sound, and socially acceptable methods and technology, made universally accessible to all individuals and all families in the community with their full participation and at a cost that the community and the country can afford to maintain at every stage of their development and in the spirit of self-reliance and self-determination”. (unquote)
Is this vision realistic today?
Yes, now more than ever, considering that investing in health means investing in development and that health is both a fundamental human right and an indispensable factor for poverty reduction.
Yes, now more than ever, if we would use all the opportunities and initiatives that currently exist in the area of financing and social mobilization.
Yes, now more than ever, if we acknowledge that the political and socioeconomic contexts of today call for more efficient management, unity of purpose and universal mechanisms of social protection.
Your Excellency Mr President,
Ladies and Gentlemen,
There is need to acknowledge the efforts that countries of the African Region have made since 1978 to reduce the areas of non-performance in health by improving infrastructure and implementing ambitious programmes of training in health sciences. In this regard, a number of countries should be commended for acquiring up-to-date technical facilities and for employing health personnel in a wide range of highly specialized areas.
There is also need to mention the efforts of some countries of the African Region to reduce the burden of illness and death from HIV/AIDS, malaria, tuberculosis, onchocerciasis and other endemic diseases, infant and child diseases, and women’s health problems.
In this regard, a decreasing trend has been noted in under-five mortality which fell from 188 per 1000 live births in 1970 to 165 per 1000 live births in 2005. This decrease is, to a large extent, the fruit of intensification of health interventions related to child survival, especially immunization. For example, measles mortality dropped by 91% between 2000 and 2006. Furthermore, whereas all the 46 countries of the Region reported poliomyelitis cases in 1988, today, only one country remains polio-endemic in the Region.
The annual cases of dracunculiasis, otherwise called Guinea-worm disease, decreased from nearly 900 000 cases in 1989 to less than 4000 cases in 2007, which represents a reduction by 99%.
In 1990, as many as 44 countries of the Region were leprosy-endemic. In 2007, only two countries remained leprosy-endemic.
The proportion of AIDS patients on antiretroviral treatment increased substantially from 1% in 2003 to 37% by the end of 2007.
Even so, much remains to be done.
For example, the African Regions bears 25% of the global disease burden. Yet it is home to only 11% of the world population and has only a meagre portion of the global resources allocated to health.
Chronic malnutrition still affects 38% of children under five years of age.
Maternal mortality rate was estimated at 900 per 100 000 live births in 2005, and that is unacceptable. What is worse, it has not shown any clear tendency to decrease. Maternal mortality is therefore an area requiring increased attention and commitment from us all.
More than 68% of HIV infections worldwide and 76% of AIDS deaths are in sub-Saharan Africa.
The emergence of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis has become another major source of concern.
The African Region accounts for 90% of global cases of malaria which is affecting especially the poorest populations, taking its heaviest toll on pregnant women and children.
In a growing number of countries, diseases of epidemic potential are recurrent and emerging diseases are increasing in number and in frequency.
Adding unto the above is the burden of neglected tropical diseases and noncommunicable diseases both of which are not adequately addressed by our health services.
So unfortunately, the present health systems in the Region are unable to perform optimally their function of governance, human resources production and management, health financing and provision of quality care. They are also unable to reduce the inequality of access to care especially for the poor and for people living in remote areas.
Many reasons account for this dysfunction, foremost among which are:
- the political crises, leading to movements of populations;
- the structural adjustments programmes of the 1980s;
- the weight of external debts.
Furthermore, there are factors that are internal to the health sector itself, namely:
- priority setting, often without evidence base, and use of vertical approaches by major programmes;
- fragmentation of external aid and inadequate coordination of the actions of partners;
- inadequate national capacity in planning and management; and
- high attrition, demotivation and weak commitment of health personnel due to their difficult working and living conditions;
This list is far from being exhaustive.
The situation is further compounded by other factors affecting health status, including limited access to safe drinking water, basic sanitation, decent housing, education especially for girls, and conditions fostering women’s empowerment. The fact that the actions needed to correct these determinants are the responsibility of sectors other than health underscores the immense importance of intersectoral collaboration in health development strategies.
Your Excellency Mr President,
Ladies and Gentlemen,
Is the Primary Health Care approach appropriate for health systems strengthening today, while we are at midway to the target year for achieving the Millennium Development Goals?
The answer is “Yes”, because information gathered both in Africa and in other Regions, shows increasingly that the Primary Health Care approach remains an appropriate tool of health promotion.
Since her assumption of office, the WHO Director-General has said, on many occasions, that the health of Africans is her priority; and that sustainable progress in health depends primarily on health systems strengthening.
May I use this occasion to reaffirm the accession of United Nations agencies to the UN Secretary General’s Initiative for Millennium Development Goals in Africa. We are continuing our consultation for enhanced coordination in order to provide to countries the support needed to accelerate efforts to achieve health-related goals.
Your Excellency Mr President,
Ladies and Gentlemen,
Today, the health sector is receiving unprecedented attention and has brought together many actors determined to work in concert and in synergy.
There is a growing number of innovative health financing initiatives. However, to increase impact, all these initiatives should be harmonised and implemented to support national health services and to reach out to the most disadvantaged populations.
At the regional level, a support mechanism has been set up by WHO, UNICEF, UNAIDS, UNFPA, World Bank and African Development Bank to help countries to draw maximum benefit from the various sources of financing. I mean the mechanism called “Harmonization for Health in Africa”.
The sustainability of health system financing remains at the core of our concerns as evidenced both by the commitment made by African Heads of State in Abuja in 2001 to allocate at least 15% of national budgets to the health sector and by the application of the recommendation of the Commission on Macroeconomics and Health to allocate at least US$ 34 per capital to health every year.
Your Excellency Mr President,
Ladies and Gentlemen,
Achieving health goals requires the involvement of all members of the community. Civil society constitutes a force that can advance the cause of health. This Conference is therefore offering to civil society a special space for self-expression. I strongly encourage civil society to share the perceptions and experience it has gained through working with the populations, and to take an active part in the deliberations which should be critical in order to generate fruitful ideas and ensure a better health policy definition for the African Region.
This invitation applies equally to the private sector whose role in health care delivery and health development is crucial and should be considered in our health policies.
Your Excellency Mr President,
Ladies and Gentlemen,
One of the main outcomes expected of this Conference is a declaration, specifically the Ouagadougou Declaration aimed at strengthening health systems in Africa through a renewed approach to primary health care.
I have no doubt that everyone will make their best contribution to the development and formulation of the Declaration. We hope the Declaration will reflect the determination of everyone, and that its implementation will transform our vision into reality and enable Africa to make up for the time it has lost in its process of health development.
Furthermore, without intending to anticipate on the outcomes of our deliberations, I should say that the implementation of the recommendations must take account of the principles of aid effectiveness, harmonization and alignment. I am also expressing a wish for a strategic partnership that would further involve the African Union and subregional economic communities.
For our vision to become reality, we need the courage to make a significant and even radical change especially in translating policy into action.
May this Conference define a cohesive framework for the action of communities, governments and partners to improve the health of the people and thereby earn a place as a milestone in public health in Africa.
Thank you for your kind attention.