Maternal, reproductive and child health

Maternal and child mortality remains a major public health problem in the Region. Several overarching factors contribute to the high burden of maternal and child mortality that exists in some countries. These include lack of sustained commitment to child and maternal health; weaknesses in health systems and in managing maternal and child health programmes; manmade and natural disasters and political upheaval; and suboptimal use of already limited human and financial resources. The health system challenges referred to in the previous section have an acute effect on delivery of health care for mothers and children. Insufficient numbers in the health workforce, maldistribution, inadequate training and high turnover at all levels are major challenges in countries with high child and maternal mortality. Other major challenges are non-functioning or inadequate referral systems, the lack or poor quality of emergency care for mothers and children at the referral hospitals, and the limited availability of essential medicines which is directly linked to the accessibility and quality of services.

Recognizing the need to strengthen the efforts of governments, partners and donors to respond to maternal and child health needs in the Region, WHO, UNICEF and UNFPA, in collaboration with Member States and other stakeholders, jointly embarked on a regional initiative on saving lives of mothers and children to accelerate progress towards MDGs 4 and 5. The basic strategic approaches adopted in this initiative were to give priority to countries with high maternal and child mortality, to focus on proven, high-impact interventions implemented in primary health care and to strengthen partnerships

The initiative focuses on the following high-burden countries: Afghanistan, Djibouti, Egypt, Iraq, Morocco, Pakistan, Somalia, South Sudan[1], Sudan and Yemen. It was launched in a high-level meeting in Dubai, United Arab Emirates, in January 2013, which concluded with the Dubai Declaration. The Declaration provides impetus and a way forward for all Member States.

Country profiles were developed for each of the high-burden countries, together with an estimation of the likely health impact, and progress towards the MDG 4 and 5 targets, of scaling up the coverage of key interventions, and an estimation of the financial resources required to achieve such scale-up. WHO provided technical support to countries concerned, in collaboration with UNICEF and UNFPA, to develop maternal and child health acceleration plans. This included a meeting of partners, and monitoring of the process of developing the plans and initiating steps for launching the plans in countries. By the end of 2013, plans had been launched in four countries.

Maintaining the momentum created by the high-level meeting, the Regional Committee adopted a resolution (EM/RC60/R.6) endorsing the Dubai Declaration and urging the high-burden countries to: strengthen multisectoral partnership in order to implement their national acceleration plans; allocate the necessary national human and financial resources; and work on mobilizing additional resources from donors, partners and development agencies. The Regional Office allocated US$ 2.6 million to kick-start the implementation of these plans, and funds were distributed to all MDG 4 and 5 priority countries.

The Regional Office maintained close follow-up of and support for the implementation of the roadmaps of the Commission on Information and Accountability for Women’s and Children’s Health in the priority countries. Seven such roadmaps (Afghanistan, Djibouti, Iraq, Morocco, Pakistan, Somalia and Yemen), were verified with WHO headquarters and catalytic funds were disbursed accordingly.

WHO will monitor progress in implementing the regional initiative on saving the lives of mothers and children, in line with the recommendations outlined in the accountability framework of the Commission on Information and Accountability for Women’s and Children’s Health, and will report annually to the Regional Committee on the progress of the initiative. The outcome of the acceleration plans will be evaluated in collaboration with partners. In the meantime, WHO’s work will have to be scaled up in order to provide adequate technical support to the high-burden countries.

Nutrition

The estimated prevalence of stunting and underweight among children under 5 years of age decreased from 40.4% and 22.6% in 1990 to 27.2% and 14.4% in 2011, respectively with the biggest improvements in the countries of the Gulf Cooperation Council, Islamic Republic of Iran, Jordan, Lebanon, Palestine and Tunisia. The estimated prevalence of wasting increased from 9.6% in 1991 to 10.1 % in 2011, an increase attributed to disasters, food insecurity and political instability in Afghanistan, Djibouti, Iraq, Pakistan, Syrian Arab Republic, Somalia, and Yemen.

Micronutrient deficiency (iron, vitamin A and iodine) continues to be an important health problem. Studies conducted in 2012–2013 show four countries (Bahrain, Jordan, Saudi Arabia and United Arab Emirates) are now free of iodine deficiency, while ongoing surveys in three further countries (Kuwait, Oman and Qatar) are expected to show similar results, together changing the map of iodine deficiency. Clinical vitamin A deficiency is largely under control, thanks to the ongoing supplementation and fortification programmes. Mandatory flour fortification, with iron and folic acid in almost all countries, to address anaemia is still a  challenge but positive impacts are reported in Bahrain and Jordan.

Several targeted nutrition interventions are part of the acceleration plans to achieve MDGs 4 and 5 in high-burden countries. These include supplementation with folic acid and iron and establishment of nutrition stabilization centres for treatment of severe and complex cases of malnutrition in Afghanistan, Pakistan and Yemen. In Iraq about 90% of the severe and acute cases of malnutrition are covered throughout the country. Scale up of nutrition interventions, including capacity-building and training of community and health workers, in coordination with UNICEF, WFP and FAO is working well. WHO provided technical support to Pakistan and Yemen under the Scaling-up Nutrition (SUN) initiative, which mobilizes additional resources from both government and the donor community, while Afghanistan is being supported under the Renewed Effort Against Child Hunger (REACH) initiative.

The low levels of exclusive breastfeeding (less than 34%) and poor feeding practices for infants and children are contributing to the increasing prevalence of overweight and obesity. Some countries like Bahrain are integrating nutrition and growth monitoring in primary health clinics to address obesity at an early stage. Baby Friendly Hospitals have been established in many countries to promote breastfeeding. However, 33 years after endorsement of the International Code of Marketing of Breast-milk Substitutes in 1981, out of 22 countries only 7 (32%) have passed laws reflecting all of the provisions of the Code, while 11 countries have passed laws reflecting some of the provisions. A regional policy statement and action plan were developed to promote full implementation of the Code, and to promote breastfeeding in all countries. Follow up action needs to continue in the years to come.

Ageing and health of special groups

Health-promotion and preventive interventions early in the course of life are cost-effective investments for the health of schoolchildren, working adults and older persons. Support for health-promoting schools continued through developing country profiles and regional databases in seven countries. A regional guide of suggested measures in school health services was finalized and methodologies for institutionalization of mental health promotion in schools were prepared.

As part of regional efforts to implement the global plan of action on workers’ health, technical support was provided to several countries. However, a new vision and a comprehensive strategy on occupational health is needed and will be the focus of work in 2014. As older people become a larger and more visible proportion of the general population in the Region, better strategies for responding to their special health and social needs are urgently needed. Technical support was provided to countries to create enabling environments, health-promoting settings and healthy lifestyles for all age groups. A draft regional training guide on primary health care services for older persons was reviewed in a regional consultation on age-friendly health care services.

Violence, injuries and disabilities

In 2013, implementation of the regional five-year injury prevention plan started, focusing on road traffic injuries and trauma care. With publication of the Global status report on road safety 2013, covering most countries of the Region, the baseline was set for monitoring the Road Safety Decade of Action 2011–2020. The second UN Road Safety Week, on pedestrian safety, was celebrated in many countries, while a pilot instrument to profile trauma systems was also developed. The survey for the global violence prevention report was completed in 88% of participating countries. In 2014–2015, more focus will be placed on supporting ministries of health to fulfil their expected roles within a broader multisectoral response in the areas of violence and injury prevention, as well as disability and rehabilitation.

Based on the Convention on the Rights of Persons with Disabilities, a draft model disability law was developed. A regional United Nations Joint Statement on Disability in Disasters declared commitment to scaling up efforts for the inclusion of persons with disabilities in all policies and programmes aimed at addressing disaster risk reduction and humanitarian situations. Member States contributed to the UN High-level Disability and Development Meeting and to development of the global WHO disability plan of action.

Many countries face challenges in addressing visual and hearing impairment, the most important of these being lack of adequate political support and of financial resources. However, following the endorsement of the global action plan for prevention of avoidable blindness 2014–2019 by the World Health Assembly, four countries developed five-year national eye health plans. A new professional staff experienced in prevention of blindness has recently been appointed in collaboration with IMPACT Eastern Mediterranean Region to strengthen the technical support provided to high-burden countries.

Health education and promotion

Improving the health of the population throughout the life course was the main focus in the area of health education and promotion in 2013, in particular the health of children, women and adolescents and noncommunicable diseases.. A consultation with religious scholars addressing practices harmful to women resulted in an agreement with the International Islamic Centre for Population Studies and Research, Al Azhar University, Egypt and a joint plan of work to be implemented in priority countries of the Region. This will lead in 2014 to a literature review of international and regional experiences in addressing child marriage and gender-based violence, including female genital mutilation, and development of training packages and a curriculum for students of Al Azhar University.

In collaboration with the Centers for Disease Control and Prevention (CDC), Atlanta, WHO extended the implementation of the global school health survey to several new countries and conducted new rounds in others. The surveys provide countries with comparative data on behavioural risk factors among school students which can inform the development of health promotion policy and programmes for school settings. A regional programme to mainstream health promotion in the media was launched which will enhance the capacities of journalists in reporting and networking on health issues. The programme is being implemented in collaboration with Thomson Reuter Foundation and Agence France Press.

Social determinants of health and gender

Poverty and inequitable distribution of resources between urban and rural populations are major social determinants of health in the Region. Vulnerable groups, such as poor, single-household mothers and refugees are more at risk of health inequity than other population groups.

Initiatives to address the social determinants and gender in the health sector continue to be based on vertical rather than integrated programmatic approaches. The challenges also include lack of adequate sex-disaggregated data, the need to sustain intersectoral action, and lack of capacity to mainstream social determinants for health and gender into health programmes, policies and strategies. WHO has collaborated with Member States in several initiatives addressing the social determinants of health but there is, so far, no concrete comprehensive vision for a regional action-oriented plan. A substantial number of countries have decided to give this area of work a priority in the collaborative programme with WHO in 2014 and beyond and work has been initiated to develop the action plan. We hope to report favourably on the outcome of this work in the next annual report.

Health and the environment

Despite the diversity of the Region with regard to income, development, health and environmental conditions, three groups of countries are clearly distinguished. Group 1 comprises the high-income countries with good environmental health services and direct impact of environmental risks on noncommunicable diseases; group 2 comprises middle-income countries with endeavouring environment health services, and a double burden of environmental risks for both communicable and noncommunicable diseases; and group 3 includes low-income countries which do not have adequate environmental health basic services, and where environmental risks have a clear impact, primarily on communicable diseases.

The Regional Committee endorsed a strategy for health and the environment 2014–2019 which provides a roadmap for the three groups aimed at protecting health from environmental risks in the Region. It outlines necessary actions for lowering the huge burden of environmental risk, which is estimated to account for almost 24% of the total burden of disease, including more than 1 million annual deaths regionally. The challenge now is for countries to translate the strategy into national action plans and for WHO to monitor progress.

To reinforce the capacity of WHO in delivering technical support to Member States, an organizational and structural reform mandated the Regional Centre for Environmental Health Action (CEHA) with the overall management of the regional environmental programme in the Region from 2013. Activities were carried out in the areas of drinking-water quality; wastewater reuse and safety management; chemical hazards emergencies; air quality; climate change; health care waste management; environmental health strategies; and environmental health information management. Technical support in environmental health was provided in several emergency situations, the Syrian crisis in particular, and capacities in preparedness and response to chemical events in the Region were strengthened. Support was also provided to enable countries to meet the core capacity requirements for implementation of the International Health Regulations (2005) with regard to food safety, and chemical and radionuclear events.

In response to enquiries from several Member States, CEHA conducted a ground-breaking research study in Jordan to generating scientific evidence on the minimum domestic water requirements for health protection. The study of 2851 households explored the correlation between domestic water consumption and diarrhoea incidence among children under 5 years of age. The findings provide evidence to inform the development of national policies and/or legislative instruments for service targets and subsidy in order to secure the supply of minimum domestic water requirements for health protection. The study should be repeated in different locations to generate further evidence and subsequently a guidance recommendation from WHO.

[1] As of May 2013 South Sudan is a Member State of the WHO African Region.

Regional framework for action

Despite declared political commitment to implement the Political Declaration of the High-Level Meeting of the United Nations General Assembly on the Prevention and Control of Non-Communicable Diseases, many countries are experiencing challenges in moving to concrete action. The response to the 2011 UN political declaration and to the regional framework for action which was endorsed by the Regional Committee in 2012 has been patchy and uneven. Factors responsible for this situation vary from one country to another but generally include inadequate political commitment at the highest level, competing priorities particularly in crisis-stricken countries, weak engagement of non-health sectors whose action is essential in the implementation of key measures, weak health systems including fragmented health information systems, opposing forces including the tobacco industry and the unopposed marketing of unhealthy foods, and the absence of an effective civil society movement.

In 2015, focus continued to be placed on scaling up the implementation of the regional framework for action. Since its endorsement by the Regional Committee, in 2012, the framework has been updated annually and a set of process indicators, intended to guide Member States in measuring progress in implementing the strategic interventions, has been developed.

We continued to hold annual regional meetings on noncommunicable diseases to provide an opportunity for Member States to review the progress made with international and regional experts and to respond to their needs for technical support. In addition the Regional Office continued in 2015 and 2016 to develop concrete technical guidance that will enable countries to implement measures recommended in the four areas of the regional framework (governance, surveillance, prevention and health care) based on evidence, international experience and best practice.

Governance

High-level advocacy was carried out throughout 2015 at various forums, including the World Health Assembly and the Regional Committee, to promote collaboration across sectors outside health and between government and non-state actors. Only six countries now have an operational multisectoral strategy and/or action plan, and four have set targets for 2025 based on WHO guidance. Countries of the Region are at various stages of implementation of their action plans and WHO continues to monitor the situation in collaboration with them, based on the process indicators of the regional framework.

An innovative initiative was the development, in collaboration with the WHO Collaborating Centre at Georgetown University, of a dashboard and policy briefs on best practices in health legislation, based on global evidence. The work provides a guide for countries to take appropriate legislative action to tackle key risk factors in the areas of tobacco control, diet, physical activity and governance. Each of the priority interventions identified is outlined through an individual legal brief that contains tangible recommendations applicable to countries, drawing from global, regional and national experiences, and adaptable to the local economic, social and legal context.

Prevention and control of risk factors

Industry interference with tobacco control policies and the limited involvement of non-health actors continue to be major challenges to operationalizing the interventions in the area of prevention and control of risk factors for noncommunicable diseases. Sixteen countries have adopted a national level target for reducing tobacco use by 30% by 2025 and 17 countries are in the process of implementing taxation increases based on the guidelines to Article 6 of the WHO Framework Convention on Tobacco Control (WHO FCTC). Support was also provided to countries for updating tobacco control legislation, specifically on the aspects of tobacco-free public places, pictorial health warnings, and banning of advertising, promotion and sponsorship.

One of the main activities undertaken was the raising of political awareness on tobacco control issues, particularly on the WHO FCTC protocol and the industry’s influence on tobacco advertising, promotion and sponsorship in drama (TAPS). In this context, six projects were funded for implementation by nongovernmental organizations and completed, tackling different aspects of tobacco use in dramas aired on the regional language networks. Two countries (Yemen and United Arab Emirates) were cited in the WHO Report on the Global Tobacco Epidemic, 2015 as among the highest achieving countries in terms of banning TAPS, and Saudi Arabia was cited as one of the countries that had achieved full compliance with banning tobacco use in public places. Technical support was provided for capacity-building on smoking cessation and ratification of the WHO FCTC protocol in the Gulf Cooperation Council (GCC) countries. Saudi Arabia and Iraq became parties to the WHO FCTC protocol and three new countries joined the highest achieving countries in terms of monitoring (Kuwait, Pakistan and Qatar).

The burden of overweight, obesity and diet-related chronic diseases continues to increase due to nutrition transition, especially in high-income and middle-income countries. Seventeen countries have adopted the International Code of Marketing of Breast-milk Substitutes, and are monitoring its application. Nevertheless the progress on implementation is uneven. A number of policy guidance documents were developed to support the adoption of sustainable multisectoral approaches. These included policy statements and recommended actions for reducing salt, fat and sugar intakes and a protocol for measuring salt intake using 24 hour-urine collection.

Current salt intakes in the Region are very high, with an average intake of 10 g per person per day in most countries. Implementation of salt reduction strategies is progressing in several countries, and multisectoral national committees have been established in some countries with an authority to strategize and monitor implementation of salt reduction activities. Intake estimates for saturated fatty acids are also high, with most countries exceeding the 10% upper limit. Initiatives aimed at reducing total and saturated fat in food products have been undertaken in several countries (Egypt, Iraq, Islamic Republic of Iran and GCC countries). In most countries, industry participation remains voluntary and timid. Food labelling for total fat, saturated fatty acids, transfat and salt in all food imported or locally produced became mandatory in GCC countries. In Egypt, the first steps were taken to reduce palm oil intake with the circulation of a draft standard on subsidized cooking oil. In several countries, private industry moved towards voluntary production of low fat and fat-free dairy products.

A draft nutrient profiling model was developed to guide countries in categorizing foods and beverages into ‘healthy’ and ‘unhealthy’. Support was provided, in collaboration with the WHO Regional Office for Europe, WHO headquarters and Liverpool University, to several countries to develop a provisional roadmap to speed up action on marketing of unhealthy foods through building capacity for legal interventions. A series of sensitization activities culminated in an open forum attended by mainstream media outlets, regional celebrities, media experts and representatives of civil society organizations which resulted in recommendations for non-health sectors to address marketing of unhealthy foods to children.

In order to promote physical activity, capacity development was supported in mass media and social marketing, in partnership with the WHO Collaborating Centre on Physical Activity, Nutrition and Obesity, Sydney, Australia. The first round, in which nine countries participated, resulted in development by representatives of both health and non-health sectors of provisional social marketing and mass media plans. Distance mentoring on implementation was started with four countries (Islamic Republic of Iran, Kuwait, Oman and Morocco). In addition, a toolkit was developed to guide inclusion of physical activity in primary health care.

Surveillance, monitoring and evaluation

The key priority is for Member States to implement the NCD surveillance framework with its three components (monitoring risk factors and determinants, tracking morbidity and premature cause-specific mortality, and assessing health system response and performance). The indicators included under each of the three components will enable Member States to monitor their progress in achieving the targets of the global action plan endorsed by the World Health Assembly.. A training module has been developed and will be offered to countries to build capacity in NCD surveillance and a training course for trainers is expected to be conducted before the end of 2016.

A number of surveys were completed as part of monitoring risk factors. Almost all countries completed the 2015 country capacity survey for noncommunicable diseases, and several countries are engaged at various stages of the STEPS survey to monitor the burden and trends of risk factors, the Global Adult Tobacco Survey and the Global Youth Tobacco Survey. Capacity-building in cancer surveillance was conducted in collaboration with the International Agency for Research on Cancer (IARC), with a focus on establishing population-based cancer registries in countries, while a regional course to further strengthen capacity in surveillance was piloted and is being revised. This was further supported by setting up a standardized assessment tool to identify obstacles and opportunities for countries to scale up surveillance.

Health care

The reorientation of health systems towards the integration of management of noncommunicable diseases into primary health care is a key priority. Building on the recommendations of a regional meeting held in 2014, a guide was developed for assessment of the health systems components underlying effective integration. In addition, a review of global evidence was conducted to support the development of a matrix of policy options, based on WHO health systems building blocks and tailored according to country needs. A core set of quality indicators for management of noncommunicable diseases was developed, as part of a regional initiative on quality measures in primary health care.

A regional situation analysis of care of noncommunicable diseases in emergencies was conducted in five countries focusing on refugees and displaced persons from the Syrian Arab Republic. The findings of the analysis emphasized the importance of a consistent primary health care approach to provision of care, even in emergency contexts. Experiences in the Region have also revealed the need for a standardized set, and timely provision, of core essential medicines and technologies. An emergency health kit for management of noncommunicable diseases was therefore developed, complementing the Interagency Emergency Health Kit.

Country profiles were developed showing where each country stands in addressing the five strategic areas of cancer prevention and control. Work focused on building capacity, first, in establishing or assessing cancer registries, and second, in the development of palliative care. Many countries have invested substantially in organizing nationwide breast cancer screening and public health awareness campaigns. In 2015 WHO provided technical support for the development of screening programmes and for evaluation of public awareness campaigns.

In 2015 the Regional Office led, and played an important role in, advocacy for an accountability framework to measure progress. The contribution of countries was substantial in ensuring that the 10 indicators crafted to measure progress were aligned with the indicators of the regional framework for action. Countries are now better able to monitor and report on progress, and to meet their commitment in implementing the time-bound commitments of Member States: by 2015, to set national targets, and develop/strengthen national multisectoral action plans; and by 2016, to reduce risk factors, and strengthen health systems. 

WHO will continue to work with Member States to accelerate progress, which will be measured by the progress indicators during the next United Nations review in 2018. Focus will be placed on raising political awareness and increasing the level of multisectoral involvement in implementing the provisions of the regional framework through a whole-of-government approach and on providing technical support to countries.

Mental health

Mental, neurological and substance disorders account for the loss of 7.4% of disability-adjusted life-years, and for 22.9% of the years lived with disability globally. Illicit drug use accounts for 0·9% of DALYs lost globally. The age-standardized prevalence of drug dependence for cannabis (0.19%), amphetamines (0.25%), cocaine (0.10%) and opioids (0.22%) in the Region are similar to global estimates. However, the Region has the highest prevalence of mental disorders, specifically depressive illness and anxiety disorders, of all WHO regions. This is almost wholly accounted for by the complex emergency situations prevailing within the Region. While all countries have made some progress, irrespective of national income level, a huge treatment gap remains, ranging from 76% to 85% for severe mental disorders.

Despite the great burden, mental health continues to have a low political and public health profile while the stigma attached to it cuts across all aspects of mental health care, with widespread discrimination that has major impact on service development, delivery and utilization. Mental health has suffered chronic under-funding and consequently there is a paucity of specialist staff and services. The skills of both general health workers and mental health leaders are largely limited to the delivery of care.

Institutional care is still the dominant model of care in the majority of countries. This constrains the capacity for development of mental health staff and has led to human rights abuses. There is a lack of research evidence and information from within the Region to underpin strategic planning and service development. Nevertheless, mental health and substance abuse are starting to attract more attention, both globally and regionally, and the number of countries experiencing complex emergency situations is driving up the need and demand for support services.

In 2015, the Regional Committee endorsed an evidence-based regional framework which was developed between 2014 and 2015 by the Regional Office in consultation with Member States and top international and regional experts. The aim of the framework is to scale up action on mental health and operationalize the Comprehensive mental health action plan 2013–2020. Four domains of action were identified by the regional framework: governance, prevention, health care and surveillance.

Good progress has been made by some countries. In the area of governance, some countries (Kuwait, Lebanon, Oman, Qatar, Somalia, United Arab Emirates) developed or updated their mental health strategies in accordance with the global targets and indicators. Three countries (Afghanistan, Saudi Arabia and United Arab Emirates) reviewed their mental health legislation and regulations in accordance with provisions of the United Nations Convention for the Rights of Persons with Disabilities (UNCRPD). The curriculum for a regional course in leadership in mental health was developed and the first course was hosted by American University in Cairo (AUC) t in September 2015.

In the area of health care, support was provided in a number of areas. More than half the countries now have functioning mhGAP programmes aimed at bridging the treatment gap for priority mental health problems through integration within primary health care. So far three countries (Afghanistan, Jordan, Libya) have initiated the Quality and Rights project based on the provisions of the UNCRPD to ensure quality of services and observance of patient’s rights in psychiatric facilities. Services for substance use disorders were strengthened in Iraq and Pakistan through capacity-building and support for the setting up of centres, in collaboration with the United Nations Office on Drugs and Crime (UNODC). Opium substitution treatment services were established in Pakistan and expanded in other countries, while a harm reduction protocol was developed in Oman.

Support was provided, in collaboration with WHO headquarters and international nongovernmental organizations, to countries undergoing humanitarian crises in mental health and psychosocial support in emergencies, through strengthening the technical capacities of the country offices, as well as direct support. The Arabic version of a training package for psychological first aid was published, and a psychosocial intervention package to be delivered through non-specialized health workers in emergencies is being field-tested.

In the area of prevention, the Arabic version of the global report on suicide was published and launched in 2014. An assessment of resources and capacities available for diagnosis and management of autism spectrum disorders was conducted in collaboration with the Italian Public health Institute and the organization Autism Speaks. A training package on mental health for schools was finalized and is in the process of piloting in selected countries, while life skills education materials and parenting skills training materials for autism spectrum disorders are also being finalized.

Guidance was published on setting up systems for suicide registration and substance use treatment information. A core set of quality indicators for mental health care in primary health care was developed, as part of a regional initiative on primary health care quality measures.

WHO will strengthen its linkages and collaboration with regional and global partners to implement the provisions of the regional framework for action in the Region and operationalize the provisions of the global action plan 2013–2020. It will enhance its ability to provide support to countries for reviewing and developing national policies and strategies in line with the global action plan and focus on enhancing the specialist and non-specialist workforce for the integrated delivery of quality mental health care. It will also lead the development of a mental health literacy package and campaign to combat the stigma attached to mental health and substance abuse. It will continue to support countries to scale up mental health and psychosocial support in emergencies and will also promote mental health through school mental health, suicide prevention and mental health literacy programmes.