Introduction
2010 was a year of consolidation. Major work was undertaken in key areas which will have impact over the long term.
One of these key areas is childhood immunization. 2010 saw the launch of the first annual vaccination week in April, in which all countries took part. The commitment and enthusiasm displayed in spreading the message that immunization remains one of the most cost-effective tools in public health was heartening. The awareness raised through this annual campaign will surely strengthen national immunization programmes and have long-term impact on the survival and health of children in the Region.
A number of diseases saw simultaneous gains and setbacks, including poliomyelitis. Sudan joined the 19 poliomyelitis-free countries and polio now remains only in Afghanistan and Pakistan. In Afghanistan, the poliovirus has been contained within a localized area in the south. However, despite significant efforts by the government, supported by WHO and its partners, a way has still not been found to gain sustained access to the children of the south for immunization campaigns. In Pakistan, similar access difficulties continue to hinder control efforts in the border areas with Afghanistan. The managerial and programme performance issues in other parts of Pakistan, on which I reported last year, are being addressed by the government. The President of Pakistan declared an emergency but the subsequent action plan has yet to be implemented in a satisfactory and sustained manner at the peripheral level to achieve overall success. The situation in Somalia is of great concern due to continued lack of access to a very large part of central and southern Somalia for the past two years. A continued risk facing the Region is the large migrant population in the Horn of Africa, which is mobile and underserved by health services and which continues to introduce the virus from neighbouring infected countries. The regional programme has introduced several tools and approaches to ensure quality including use of environmental surveillance, independent monitoring and lot quality assurance. The eradication of poliomyelitis will remain unfinished business in the Region until the very last case is declared and we must all remain vigilant and committed.
Measles too saw gains and setbacks. Measles mortality in the Region has fallen by 93% since 2000 but there are still challenges to be overcome before we can claim elimination of measles. These challenges necessitated revision of the target for elimination from 2010 to 2015. Routine vaccination coverage remains below the key figure of 95% in several countries and outbreaks occurred in Afghanistan and Pakistan.
Vaccine-preventable diseases are responsible for more than 20% of under-5 mortality. Therefore scaling up childhood vaccination is a key strategy for achieving Millennium Development Goal 4 since, at a regional level, under-5 mortality rate has dropped by 30% since 1990. Three countries - Egypt, Lebanon and Oman - have already surpassed the target while six others are on track to achieve it. The Region still has the second highest maternal mortality ratio among all WHO regions, at 360 maternal deaths per 100 000 live births, with only around a 30% reduction since 1990. Based on the current trends, the Region as a whole is expected to remain far below the targets of Goals 4 and 5 relating to reduction of under-five mortality and maternal mortality, respectively. Efforts to achieve the targets are being challenged by many factors, including inadequate political commitment and lack of universal access to quality primary health care services. Health information systems are another major challenge, not only because inadequate information makes it difficult to assess progress towards health targets such as the Millennium Development Goals, but also because it makes it difficult to make decisions that are properly informed by the evidence.
Two countries in the Region have now been certified malaria-free, United Arab Emirates and, in 2010, Morocco, and other countries are working towards certification. A malaria-free Arabian Peninsula is foreseeable. However the challenges to elimination in the region as a whole are still considerable. Principle among these challenges are the lack of security, population movement and weak surveillance and diagnostic systems in countries where malaria is endemic, as well as spreading resistance to insecticides and the key antimalarial, artemisinin.
Outbreaks of dengue fever occurred in several countries, particularly in areas along the Red Sea and Arabian Sea coasts, as well as in Pakistan. This is a re-emerging disease in the Region that has now established itself and must be dealt with. The countries concerned showed great commitment in reporting these outbreaks and in taking action. This transparency is to be commended and will open the door to greater coordination, collaboration and partnership. The means to prevent and control dengue fever and its sequel dengue haemorraghic fever are well know but it is not a disease that can be controlled by the health authorities alone. Other sectors, municipalities and communities must all be involved, led by the Ministry of Health.
Over the years I have highlighted the growing importance of chronic noncommunicable diseases in the Region. These diseases not only represent the majority of the disease burden in the Region, over 60%, with major impact on quality of life, but have long-term impact on national health financing, on socioeconomic development and on family income. Yet, they are preventable to a large extent, and if detected early can be well controlled in the individual patient. There is ample evidence of cost-effective interventions that have proven effectiveness to reduce the burden disease and these now constitute best practice globally. It makes no sense not to put in place strong prevention programmes to raise public awareness, focusing on healthy lifestyles, tobacco cessation, physical activity, balanced diet and frequent timely health checks. While countries are moving towards greater access to appropriate screening, prevention and treatment within a primary-health care based system, this remains a challenge and needs greater prioritization. The global strategy and regional action plan provide clear guidance for countries in this respect.
There is little good news for environmental health in the Region. Neglect of the environment accounts for an estimated 24% of disease burden in the Region, taking into account pollution, poor waste management, water shortage and degradation, and overcrowding. This burden can be expected to rise if the implications of climate change for health are not taken into account in health planning. The environment is not high on national agendas in the Region and the result can be seen around us every day, wherever we are. The impact on human health and development, as well as national development, is not being adequately addressed. Around a third of the countries in the Region still cannot provide more than 90% of the population with sustainable access to safe water and sanitation. Improper disposal of domestic, industrial and health care waste poses a threat to all, and in particular the poor and marginalized, the very young and the elderly. This should be of greater concern to governments.
Publication of The World Health Report 2010. Health systems financing: the path to universal coverage and endorsement of a resolution on health care financing by the Regional Committee at its 57th session were important events. Despite the global financial crisis, countries have taken heed of the need to sustain support for health and education. The strategic directions endorsed by the Regional Committee provide clear guidance on a way forward. Policy-makers now need to take action to reduce the out-of-pocket share of health expenditure and, at the same time, to improve efficiencies in health system delivery.
New WHO premises were formally opened in Tunis, housing the WHO Representative’s office and the WHO Mediterranean Centre for Health Risk Reduction. I thank Tunisia for its support throughout this project. Work is progressing on the construction of the first truly “green” building in our region, which will serve as new offices for the Centre for Environmental Health Activities and the WHO Representative’s Office in Jordan. More important, I hope it will also provide a model for the Region of green building design which, as the impact of climate change really begins to be felt in the Region, takes into account the local environment, the increasing need to conserve energy and water and the need to reduce our “carbon footprints”. I thank the Government of Jordan for its support for this project, including the donation of land. I thank also the Government of Oman which provided the WHO Representative’s office with new premises in 2010. The support of Member States for the work of WHO in the Region benefits both the individual country and the Region as a whole.
As we look to the future in the Region we see a great deal of change taking place in the political, economic and social landscape. This is a time of great hope and of some trepidation. As long as universal human rights, including the rights to health and education for all, remain the principle objective and as long as our core human values of dignity, compassion, tolerance and mutual respect are honoured, there can only be brightness on the horizon.
