Director-General's Office

Opening speech for the Sixty-ninth session of the WHO Regional Committee for the Western Pacific

Dr Tedros Adhanom Ghebreyesus

Manila, Philippines
8 October 2018

Sir Puka Temo, chair of the sixty-ninth session of the WHO Regional Committee for the Western Pacific,

My brother Dr Shin, WHO Regional Director for the Western Pacific,

Excellencies, heads of delegation, honourable delegates, colleagues and friends,

It’s an honour to be with you in Manila today for this historic session of the Regional Committee.

A lot has happened since I stood before you in Brisbane a year ago.

It’s been a busy but productive year.

We’ve approved a new 5-year strategy to make WHO more focused on delivering a measurable impact, with the ambitious “triple billion” targets at its heart;

We’ve continued to overhaul our work on emergencies, and have responded quickly and effectively to numerous outbreaks and other crises;

We’ve launched a transformation project to make WHO more agile;

We established a high-level commission to identify new solutions for noncommunicable diseases;

Just two weeks ago we hosted not one, but two high-level meetings at the UN General Assembly, on tuberculosis and noncommunicable diseases;

We’ve launched a new initiative on climate change in small island developing states;

We’ve committed to eliminating cervical cancer;

We’ve committed to eliminating trans fats from the global food supply;

We’re in the process of launching a new initiative to end malaria;

The Protocol to Eliminate Illicit Trade in Tobacco Products has entered into force;

We’ve worked with Google to launch a new version of the Google Fit app based on WHO guidelines;

Germany, Ghana and Norway have asked us to develop a Global Action Plan to deliver SDG3, which is almost ready;

We have continued to build political commitment for universal health coverage;

And we’ve launched WHO’s first investment case, which estimates that a properly-resourced WHO could save 30 million lives and add 100 million years of healthy living to the world’s population over the next five years.

I would like to say thank you to all of you for your support over the past 15 months.

And I would especially like to say thank you to my brother, Dr Shin.

Whoever you elect as your new Regional Director tomorrow will have a hard act to follow.

I will say more about Dr Shin later, but I know you need no convincing of his formidable achievements, and the imposing legacy he leaves.

As you know, one of his key priorities has been to make the work of the Regional Office more directly focused on supporting countries.

We are now seeking to transform WHO to make countries the centre of what we do everywhere around the world.

But in truth, Dr Shin has been doing it for a decade.

There is abundant evidence of the success of this approach.

In the Western Pacific over the past 10 years,

Maternal mortality has fallen by one-third.

Under-five mortality has fallen by almost two-thirds.

TB deaths are down 29 percent.

Action against hepatitis B has saved 7 million lives;

The 10 malaria-endemic countries in the region are on track for elimination;

And core capacities for emergencies have improved dramatically.

The region is also making impressive progress towards universal health coverage.

Government expenditure has increased to 56% of all health spending.

Since 2005, the number of people being pushed into extreme poverty by out-of-pocket health spending in the Western Pacific has almost halved, from 37 million to 19 million.

This is great news.

But at the same time, the number of people spending more than 10% of their household income on health has increased slightly.

In other words, people are getting wealthier, but a greater proportion of their income is spent on health.

That means some families have to make hard choices between health care and other life necessities.

I urge all governments to pay careful attention to this trend.

I urge you to use every tool at your disposal to ensure your people receive the health services they need, without encountering financial hardship as a reason.

One of those tools is the law. I’m pleased to see that among the issues you’re discussing this week is an action agenda on legal frameworks for health.

As you know, I am a vocal advocate for political commitment to UHC. But without laws, political commitment can remain an empty promise.

Laws are the means by which political commitment becomes meaningful change.

Many aspects of health policy simply can’t be implemented without laws – like ensuring access to services, safeguarding the quality of products and services, and ensuring financial risk protection.

Addressing many of the determinants of health also requires a strong legal underpinning.

The framework calls on every country in the region to review, prioritise, and strengthen its own legal frameworks for health, and to cooperate across borders to address the determinants of health in trade and environment.

I urge you to endorse the framework, and to implement its recommendations.

WHO stands ready to support each country with evidence-based technical assistance on what works and what doesn’t.

A second tool at your disposal for making progress towards universal health coverage is digital technology.

At the World Health Assembly in May, you and WHO’s other Member States asked us to develop a global strategy on digital health.

The action agenda you are considering this week will help to shape that global strategy.

The increasing use of electronic health records, telemedicine, mobile technologies, big data and artificial intelligence hold enormous potential for overcoming barriers and reaching everyone with the services they need.

The options are endless, which is why the action agenda calls on countries to make a careful assessment and prioritise the use of proven, essential technologies, rather than trying to do everything.

Countries can easily waste a lot of time and money in their enthusiasm to embrace every latest technology.

Many countries in the region have developed or are now in the process of finalizing their national eHealth policy or strategy.

This is very encouraging, although more work is scheduled to support small island developing states.

I urge you to endorse the action agenda on eHealth this week, and to make a priority of harnessing the power of digital technologies for health – especially for primary health care.

In just two weeks’ time we will gather in Astana, Kazakhstan for the 40th anniversary of the Alma-Ata declaration.

Together, we will reaffirm the centrality of people-centred primary health care as the backbone of strong health systems, and the foundation of universal health coverage.

Unfortunately, the vision of Alma Ata remains a distant dream in too many places.

But today, digital technologies give us a vital tool that we did not have 40 years ago.

Ladies and gentlemen,

Although we encourage all countries to invest more in stronger primary care, the fact remains that hospitals are an essential part of every health system.

At some time in our lives, almost all of us will receive care in a hospital.

Hospitals are responsible for the largest share of capital expenditure in health systems, and up to 56% of recurring health expenditure.

The efficiency and effectiveness of every country’s health system is therefore determined in large part by the efficiency and effectiveness of its hospitals.

Too often, performance is affected by weak management, inefficiency and poor quality of care.

The Western Pacific is home to some of the world’s largest and most complex hospitals in massive cities, and small hospitals on remote islands.

Of course, the huge diversity in the region makes it impossible to recommend one-size-fits-all solutions.

But no matter how large and advanced the hospital, there is always room for improvement.

Which is why the action framework on hospital management provides a broad menu of options for every hospital and every country.

Hospitals in advanced economies can focus on controlling costs and improving outcomes by linking payments to performance, and introducing incentives for team-based care.

For transitional economies and small island states, the action agenda suggests improvements in health service planning, quality, accountability, efficiency and the use of resources.

For highly decentralized countries, improvements can be made to governance and information management.

I urge all Member States not only to endorse the action agenda this week, but to take its recommendations to heart, and to take them home.

One of the services that hospitals provide is rehabilitation.

Earlier this year I saw an inspiring video about a young man called Roby Malonzo.

Roby lost his leg in a motorbike accident when he was 14 years old, right here in the Philippines.

But he found out about a medical centre that provides prostheses for people from low-income families.

Roby went along, and a funny thing happened.

He didn’t just get a new leg. He got a job.

Roby now works making prostheses for people just like him.

That’s the power of rehabilitation – it doesn’t just restore movement; it restores hope.

Rehabilitation isn’t just about health; it’s about well-being. It’s about empowering people to live the lives they want to live and do the things they want to do.

Rehabilitation cannot be an afterthought or an addendum to care; it must be an integral part of care, and an integral part of universal health coverage.

As your populations get older and rates of noncommunicable diseases increase, the demand for rehabilitation services in this region will skyrocket.

Which is why the action agenda on rehabilitation you are considering this week is so important.

Its four pillars offer a range of actions for countries to improve the availability of rehabilitation services, to strengthen their governance and financing, to develop a skilled rehabilitation workforce and to strengthen data and research.

I urge you to endorse it and implement it.

Last year I had the honour of being with you to celebrate the elimination of trachoma in Cambodia and the Lao People’s Democratic Republic.

Today I’m delighted to be here to confirm Palau, Viet Nam, and Wallis & Futuna for the elimination of lymphatic filariasis.

Since 2016, a total nine countries in the Region have been validated for eliminating lymphatic filariasis as a public health problem.

Malaysia has also been confirmed for the elimination of mother to child transmission of HIV and syphilis.

These are indeed cause for celebration. And there are many others.

WPRO is the only WHO Region where the burden of schistosomiasis has been reduced to the point that regional elimination is now within reach.

But as you all know, more work remains to be done to rid this region of neglected tropical diseases.

The draft Regional Framework for the Control and Elimination of NTDs is a vital step towards that goal.

Its four strategic pillars are designed to ensure universal and equitable access to interventions and services for NTDs, particularly in hard-to-reach marginalized and vulnerable populations.

At face value, the five issues I have highlighted are quite separate and distinct.

But I see a clear connection between all of them.

All of them are essential for building strong health systems and achieving universal health coverage.

Legal frameworks and e-health are about enabling better health services.

Hospitals and rehabilitation are about delivering better health services.

And the framework on neglected tropical diseases is about the final result of better health services: infections prevented, people treated and lives saved.

WHO’s role is to support every country with constructive policy dialogue, world-class normative guidance, and astute technical know-how to translate commitment into plans, plans into actions, and actions into results.

Colleagues, ladies and gentlemen,

In the coming weeks and months, you will be hearing more about how WHO is transforming to put countries at the centre of everything we do.

But the clearest example is our Programme Budget for 2020 and 2021.

The budget has been developed based on country priorities, and is designed to strengthen the capacity of our country offices to deliver impact.

As you will hear, we are proposing an almost 30% increase in technical capacity for country offices, while the headquarters budget will stay flat.

We have also committed to almost $100 million of savings at headquarters for 2020 and 21.

This is what it means to put countries first. This is part of our commitment to leaving no one behind.

This region is home to the world’s largest country and the world’s smallest. It’s home to two of the world’s three largest economies, and its five smallest.

But every country is important.

Health for all means health for ALL, including every woman, every child and every man, from Tokyo to Tuvalu.

Some Member States have expressed a concern that our increasing focus on countries means a decreasing focus on our normative and technical work.

Not at all.

It just means we are focused on developing normative and technical products that countries want, and that countries use.

There’s no use writing a guideline if no one wants it. And there’s no use writing a guideline if no one informs the health ministry it’s available.

When I was Minister of Health in Ethiopia and we were reforming our health system, no one from WHO told me that WHO had an excellent technical guide on health system design.

I had to Google it.

WHO must do better than that.

Our aim in strengthening country offices is to make sure that we are more effective in translating political commitment at the global level to tangible results on the ground.

Of course, we understand that WHO must be worth the investment; we understand that we must good value for money.

That’s why two weeks ago we began a process of reviewing and prioritising all of our activities globally. We’re asking every department and office at headquarters and in our regional offices to submit a plan for the normative and technical products they plan to produce during 2020 and 21, and why they’re doing it.

Our aim is to review and analyse everything we’re doing to ensure we’re doing the right things, and to identify gaps.

That’s also why we’ve been working hard for the past year on our WHO Impact Framework – to keep ourselves and our Member States accountable for the commitments we’ve made.

Because to make progress, we must measure progress.

Ladies and gentlemen,

Let me finish with a few words about Dr Shin.

I must admit to having mixed emotions today, as one era closes and another begins.

Over the past year, I have come to appreciate Dr Shin not just as a colleague and peer, but as a brother and a friend.

I have valued his wisdom and advice enormously.

Dr Shin has never been afraid to tell me exactly what he thinks – for which I have great respect and admiration.

His contributions to our Global Policy Group meetings have helped to shape the WHO we are now building for the future.

In that sense, although his term as RD is coming to an end, his legacy will live on.

He is rightly admired and respected throughout the region.

He loves WHO, and he cares passionately about the health of the 1.9 billion people who call the Western Pacific region home.

Under his leadership, those people have benefited greatly.

I look forward to working closely with whoever succeeds him. They have big shoes to fill.

Dr Shin, we will all miss you. I will miss you.

It is my great honour to award Dr Shin Young-soo the WHO medal for the years of service he has rendered to the Western Pacific region of the World Health Organization.

Please join me in standing to honour Dr Shin.