Your Excellency, Dasho Dechen Wangmo, Minister of Health, Royal Government of Bhutan; Hon’ble Ministers of Health from countries of the WHO South-East Asia Region; Dr Tedros Adhanom Ghebreyesus, Director-General, WHO; Dr Catharina Boehme, Chef de Cabinet of the D-G; Colleagues from the international community and from across WHO; Representatives of United Nations and Specialized Agencies, inter-governmental organizations and non-state actors; distinguished delegates,
We have heard it said many times before. After financial crises, after natural disasters and civil wars. And now after the COVID-19 pandemic.
“We must Build Back Better”.
I want to look beyond the slogans in our discussions today. And ask: What does building back better after a global pandemic really mean?
How has it changed the political and economic context for health across the Region? How has it changed the way people live and work? How has it changed the choices ministries of finance have to make about the way health is funded?
And let us not forget an important question: what positive lessons can we glean from the experience of the last two and a half years?
First, we have to start with the most important fact about the COVID-19 pandemic: it is not over.
Yes, we are preparing for the future, but the present is still with us. Emergent variants that evade immunity and transmit more easily can still prove catastrophic. We have to keep up our guard.
We have come a long way.
Three billion vaccine doses have been administered across the Region and around 1.5 billion people have been double vaccinated. Three countries have already achieved the 70% coverage target by mid-2022. Five more are on track to do so.
Social and economic life has in many places returned to what it was like before the pandemic. Children are back at school. Offices and markets are open. Industry is back in business. Tourists are beginning to return.
This is all good news. But this is not the time to ignore the needs of the many millions that still remain unprotected.
By now, of course, everyone should have access to tests, treatments and vaccines and every country should have the capacity to carry out laboratory and genomic surveillance.
But they do not.
We still have much to do to enhance emergency preparedness – and to strengthen overall community and health systems resilience.
We should not need a reminder but, in case we do, monkeypox now shows that public health emergencies respect no timetable and can take many forms.
I repeat, we have to keep up our guard.
COVID-19 has changed many things, but our North Star remains the same – building equitable and resilient health systems that provide universal coverage and financial protection.
But let me be very clear: the route to these ideals has become more difficult.
That health is critical to pandemic recovery should go without saying. We have to be strategic and think long-term, but equally we have to act quickly if we are to secure the place of peoples’ health and well-being among what will be fiercely competing interests.
You will see in this year’s report many examples of what can be achieved. The country reports show we can be optimistic.
But dark clouds are looming. We must not ignore the big picture.
As I have said many times before, after the damage caused by the pandemic, nobody can deny the link between health and the economy.
We now have to recognize the full magnitude and complexity of the economic challenges facing governments across the Region and around the world.
It is our job to argue for increasing health spending as a good in its own right and as a priority on the route to recovery. But our colleagues in ministries of planning and financing face tough choices. We need to make the case for health in the most convincing way possible.
Against a backdrop of war in Europe and heightened food insecurity, food and fuel costs have soared, increasing consumer prices.
Controlling the pandemic has been made more difficult by conflict and has added fuel to the fire of economic collapse.
Across the Region, job recovery rates have been highly uneven – especially for women and those with low levels of education.
In the worst-case scenario, food inflation could stay high well into 2023, requiring the expansion of targeted support measures.
Delayed recovery and the removal of social safety nets make it harder for families to cope. This means foregone health care, reduced food consumption, selling of assets, and high-interest loans.
Even in the best-case scenario, large swathes of the Region’s population will continue to face substantial economic pain, despite improvements from the worst days of the COVID-19 crisis.
As I see it, we have two critical challenges:
First, to anticipate and respond to near and medium-term health threats, with a focus on addressing social and economic determinants, leaving no one behind.
And second, to identify and invest in the best means to prepare for and prevent similar crises in future, while at the same time accelerating towards our Flagship Priorities, the Triple Billion targets and health-related Sustainable Development Goals.
This is what we mean by building back better. Addressing present priorities, while seeking a safer and healthier future.
For the first challenge, we have a road map – the Region’s Declaration on COVID-19 and measures to build back better essential health services, which we adopted in September last year.
The way forward along this road is the new Regional Strategy for Primary Health Care (PHC), which aims to help all countries reorient health systems towards strong PHC.
The Strategy is based on the values of universality, equity, solidarity and accountability. It is grounded in the conviction that PHC services must be people-centred, resilient and adaptive, and informed by local knowledge. It is evidence-driven and aligned with the global operational framework for PHC.
The PHC approach is the best approach to deliver on our goals. But there are two very important caveats.
The path to building strong PHC-oriented health systems must take account of each country’s unique social, economic, political and administrative context. We are working with a road map and a strategy, not a prescription.
And while the core values of PHC remain central to our cause, we cannot rely on values alone to convince those that hold the purse strings. We have to make a convincing case for health investment in ways that show its political value and economic return.
We will be under pressure to make hard choices. The economic fallout from the pandemic puts pressure on all aspects of public spending in every country in the world. Setting realistic priorities and sticking to them – if we are not prepared to make tough choices, others will make them for us.
The second major challenge is to prepare for and prevent future public health emergencies.
Again, we are prepared – we have a plan: the Strategic Roadmap on Health Security and Health System Resilience for Emergencies.
The Roadmap draws on and reflects the Region’s longstanding focus on strengthening emergency risk management, a Flagship Priority.
It is informed by extensive Member State and expert consultations. It is aligned with and builds on the 2019 Delhi Declaration on Emergency Preparedness. And it supports full compliance with the International Health Regulations.
But if there is one lesson the world has learned from the pandemic, it is that plans without political support and adequate investment do very little – and help to prolong the cycle of panic and neglect.
Of critical importance to both pillars of the Region’s build back better vision is strengthening human resources for health.
We are doing well. Since 2015 the Region has increased the density of doctors, nurses and midwives by more than one fifth.
Almost all countries of the Region have surpassed the original WHO threshold for nurses and midwives. Three countries have now surpassed the revised threshold density of 44.5 doctors, nurses and midwives per 10 000 population.
In all countries, we still need more people to work in health care. But equally we need smarter investments aligned with future health needs and changing health service requirements.
Given that an estimated 70% of all health workers are women, gender-sensitive policies to attract and retain health workers are especially needed, as are family and lifestyle incentives, hardship allowances and grants.
Chair,
We are at a history-defining juncture. Over the past two and a half years, the Region and the world have witnessed immense, transformative change – some good, some bad, and some with as-yet-unknown consequences.
We must now leverage those trends that will accelerate our mission, driving rapid and sustained progress towards universal health coverage, health security and Health for All in the months, years and decades ahead.
First, public health and well-being must continue to be a core fiscal and policy priority.
Although nine out of 10 countries increased domestic government expenditure on health by a factor of 2 or more between 2008 and 2018, in most, private spending per capita remains higher than public spending per capita.
Just two countries allocate 10% or more of domestic government expenditure on health. And only six provide data on primary health care as a percentage of GDP in their national health accounts.
The upshot of all this? Advocacy is going to be essential if we want to sustain spending on PHC. And advocacy is a lot more effective if we have reliable data on which to base it.
Second, I want to highlight the growing importance of public engagement and community empowerment for health.
Throughout the COVID-19 response, decision-makers and influencers have learned the value of working alongside communities to inform, engage and empower.
Without this, mobilizing buy-in and support would have just not been possible.
We now have a chance to harness that momentum to strengthen emergency preparedness and response, and to increase participation and empowerment – particularly among youth – across all areas of health, especially for noncommunicable diseases and neglected tropical diseases.
Third, healthier environments.
Throughout the COVID-19 response, inadequate housing and insufficient access to clean and safe water has facilitated viral spread. Exposure to ambient and indoor air pollution negatively impacts clinical outcomes.
This, in a context in which 1 in 4 people globally lack access to safe drinking water in their homes, and just 50% of health care facilities in low-income countries provide basic water services.
Between 2030 and 2050, climate change is expected to cause an additional 250 000 deaths per year globally from an array of climate-sensitive hazards such as malnutrition, malaria, diarrhoea and heat stress.
Striving for a Region in which clean air, water and food are available to all, where economies promote physical and mental health and well-being, where cities are liveable, and where people have greater control over their health and the health of the planet.
If we are serious about building back better, these issues are not optional extras, they are the issues that will determine our peoples’ health.
Fourth, the collateral damage caused by the pandemic has shown beyond any doubt that where inequities exist, a crisis makes them worse. From wage labourers to women suffering domestic violence.
We have to identify the vulnerable and excluded. Better information systems are necessary but not sufficient. We need to harness all the means at our disposal – health systems, policies and programmes – to break down the barriers to good health.
This is not just about making sure that services and supplies are available. Vaccine hesitancy has shown us the importance of understanding the complex factors that influence demand, and the power of bad actors on social and other media to disrupt it.
We must continue not just to ask but to answer a simple question: Who is missing out and why?
Lastly, strong, inclusive, sustainable, and well-coordinated partnerships will continue to be critical to WHO’s work, and to the Region’s overall efforts to strengthen the COVID-19 response, build health system resilience, and reorient health systems towards strong primary health care.
The WHO-led UHC Partnership, a platform for international cooperation on UHC and PHC, is a good example of how this should be done, with a specific focus on reinforcing national leadership and capacity.
We do not need fragmentation and duplication of effort. We need a unified, cohesive approach aligned with national priorities and plans, and which provides countries flexible yet predictable support.
Excellencies,
A corner has been turned, but our journey continues.
In 2019 when we launched the “Sustain. Accelerate. Innovate” vision to complement the updated Flagship Priorities, we could not have anticipated a crisis of this magnitude.
But amid the COVID-19 response, and the first hopeful-yet-uncertain glimmerings of the recovery, that vision remains very much central to how we as a Region see our future and define our priorities.
Towards that goal, let our vision be clear, our partnership productive, and our progress swift and sustained, for a healthier, more equitable, sustainable, and health-secure South-East Asia Region and the world.
Thank you.