Sustain. Accelerate. Innovate

A Transformative WHO in the South-East Asia Region

When in September 2013 I came before the WHO South-East Asia Region’s Member States as a candidate for the post of Regional Director, I outlined my vision of how WHO’s Regional Office could best fulfill its mandate of supporting the Region’s Member States and the health of the Region’s people – who account for one-fourth of the global population. In doing so I presented my 'One by Four’ vision and strategy. The ‘One’ referred to my resolve to build a responsive, accountable and inclusive WHO in the Region. The ‘Four’ referred to four strategic imperatives. These were:

1. First, addressing persisting and emerging epidemiological and demographic challenges.
2. Second, promoting universal health coverage and building robust health systems.
3. Third, strengthening emergency risk management for sustainable development.
4. And fourth, articulating a strong regional voice in the global health agenda.

From vision to results

As my term in office began, intense collaboration with Member States led to the identification of seven Flagship Priority Programmes through which the Regional Office would derive measurable results. In 2017 an eighth Flagship Priority was added. Since their launch, the Flagship Priorities have prioritized WHO’s technical support to Member States; promoted a strong focus on results and accountability; and inspired sustainable and result-oriented national efforts. So much so that 80% of the Regional Office’s resources – both technical and financial – have been focused on them.

Rapid, inclusive and sustainable gains have followed. In 2014 the Region was certified polio-free. Not a single case of wild poliovirus has been recorded since. In 2015 Maldives was certified malaria-free. Sri Lanka soon achieved the same. In 2016 the Region became the second WHO region to eliminate maternal and neonatal tetanus. In the same year Thailand became the first country in Asia – and the first globally with a large HIV epidemic – to eliminate mother-to-child transmission of HIV and syphilis.

Bhutan, Maldives, DPR Korea and Timor-Leste have eliminated measles. Bangladesh, Bhutan, Maldives, Nepal, Sri Lanka and Timor-Leste have controlled rubella. Maldives, Sri Lanka and now Thailand have eliminated lymphatic filariasis. India is yaws-free; Nepal has eliminated trachoma. Bangladesh, India and Nepal are on the cusp of eliminating kala-azar.

The health of women and children Region-wide has never been stronger. Between 1990 and 2015 the global maternal mortality ratio decreased by 44%. The South-East Asia Region went above and beyond that, achieving a remarkable 69% reduction in maternal mortality. Between 1990 and 2017, under-five mortality has also been reduced by 70%. Momentum has continued. DPR Korea, Indonesia, Maldives, Sri Lanka and Thailand have already achieved global Sustainable Development Goal (SDG) targets for neonatal and under-5 mortality. Maldives, Sri Lanka and Thailand have done the same for maternal mortality.

To tackle the tsunami of non-communicable diseases (NCDs), all 11 Member States have set national NCD targets for 2025. They have developed multi-sectoral action plans aimed at developing a whole-of-society approach to address the problem. In the Region’s pursuit of universal health coverage, access to safe, good-quality medicine is being enhanced through the South-East Asia Regulatory Network, which was launched in November 2016. Our decade for strengthening human resources for health, embarked on in 2014, continues.

The Region has adopted a road map for reversing antimicrobial resistance, with countries embarking on multi-sectoral national plans. Emergency risk management for diseases of pandemic and epidemic proportions has been vigorously fortified. Ten of 11 countries have conducted periodic assessments on capacities for emergency risk preparedness. The strength and efficiency of the Region’s preparedness and response mechanisms have been decisively demonstrated. The response to Nepal’s 2015 earthquake, and to the many floods, earthquakes and cyclones that occur across the Region every year are witness to that. The South-East Asia Regional Health Emergency Fund (SEARHEF) is of critical value to all Member States. SEARHEF has supported 37 emergency operations in nine of the Region’s 11 Member States, disbursing a total of USD 5.95 million.

Member State commitment to end TB by 2030 was confirmed at the Ministerial Meeting on TB in March 2017, which led to the establishment of the Region’s eighth Flagship Priority. At the Delhi End-TB Summit in March 2018, all countries pledged to fast-track their efforts. At the UN General Assembly’s high-level meeting on ending TB in September of the same year, they likewise unanimously endorsed the Political Declaration on the Fight against Tuberculosis. In Regional and Country offices, significant progress has been made to improve governance, including on compliance, transparency, accountability and risk management. Regular management and administrative reviews have meanwhile been held at least once in each country annually to ensure value for money in budget implementation.

Each of these remarkable achievements were Member State-led. They were also WHO-supported. Together we could reach many milestones.

Confronting barriers, embracing change

Challenges, as always, remain – some social, political and economic; others technical, biological and natural. Over 800 million people in the Region still lack access to essential health services. Every year 65 million or more are pushed into extreme poverty due to catastrophic health care costs. Our environment is meanwhile changing, threatening health, life and livelihoods. For some countries it threatens their very existence. And while urbanization brings with it many blessings, it can also create living conditions that compromise health, from increasing sedentary lifestyles to severe pollution. Notably, we also face a mounting (and disproportionate) toll of death and disability on our roads. Populations Region-wide are ageing, requiring us to rethink how best to meet changing needs.

Importantly, as we confront these and other concerns, we must guard against the resurgence of infectious diseases that are currently in retreat, including HIV and malaria. We must also ensure that the aspiration of ending TB epidemic by 2030 becomes reality. The risk of drug-resistant and untreatable strains of TB emerging and becoming commonplace in the Region is particularly high. The Region’s progress has brought new questions to the fore. Sustained economic growth means there will soon be just one low-income country in the Region. The rest will be middle-income, diminishing their eligibility for external resources.

Given the challenges we face, we must do more, better and faster if we are to fully seize the opportunities available. Those opportunities are unprecedented. Region-wide, political commitment to health is high. A significant percentage of national resources are being allocated to health, even if more is needed. Every disease eliminated as a public health problem frees resources that can be invested elsewhere in the pursuit of our public health mission. We are tantalizingly close to conquering health threats that have been with us for centuries.

Machinations at the global level support the Region’s drive. The 2030 Sustainable Development Agenda has been embraced by all countries and has changed the way public health is framed and how those within it are working. Universal health coverage is now a global development priority. Within that, strengthening primary health care has received renewed urgency. The SDG’s as well as WHO’s GPW13 triple billion goals are an impetus to the regional flagships which are in sync with the global priorities. We have a decisive opportunity for health to be front and center of national and global development, and to reinforce and realize what the South-East Asia Region has been working towards.

To make that happen, a resolute and purposeful WHO is needed – a WHO that continues to support its diverse Member States and pushes with single-minded resolve to accomplish the Region’s outstanding tasks and transform health and well-being for each of the Region’s 1.8 billion people.

Sustain. Accelerate. Innovate

In providing me the opportunity as Regional Director to spearhead WHO’s support to its Member States, I acknowledge and thank them for their renewed confidence. In achieving our joint objectives and moving from where we are to where we want to be in five years’ time, together we will marshal a simple though powerful strategy.

First, we will Sustain our achievements. That means ensuring the technical and operational frameworks are in place to protect our accomplishments, including being certified polio-free and eliminating maternal and neonatal tetanus. It also means ensuring we hold fast to our substantial progress in areas such as HIV and malaria – diseases that history shows can return with a vengeance if attention falters.

Second, we will Accelerate progress to complete our unfinished agenda and chart bold advances where possible. That means strengthening services for reproductive, maternal and newborn health. It means fortifying routine immunization programmes and ensuring rapid improvements in coverage are made for all people everywhere. It means continuing our battle against neglected tropical diseases and ensuring no person or community is left behind. It means building on our strategic acumen and fully implementing a range of national action plans, whether to roll back NCDs, tackle antimicrobial resistance, scale up capacity in emergency risk management, or end TB by 2030. And it also means retaining our joint focus on measuring health services coverage and better understanding who is missing out and why.

Third, we will harness the full power of Innovation. Wherever feasible, we will enlarge the scope of our agenda and look for out-of-the-box solutions, including by facilitating research to support evidenced-based policymaking. Notably, as part of this effort – and as a matter of priority – we will intensify cross-sectoral collaboration. Yes, health is now recognized as a ‘whole-of-government’ concern. But there nevertheless remain opportunities that can be leveraged to great effect. That is especially the case when it comes to engaging with grassroots NGOs and other organizations able to act as force multipliers.

Indeed, in pursuing our strategic imperatives we needn’t necessarily expend a greater volume of energy or resources – optimal outcomes can be achieved simply by working more efficiently. Driving impact at the country level will be a core priority of the ‘Sustain. Accelerate. Innovate’ strategy. To this end, the SDGs give clear direction and targets to achieve. So too does WHO’s 13th General Programme of Work.

The Region’s Flagship Priorities will continue to guide the allocation of resources, with country support plans providing an essential medium to integrate and align WHO’s support to each country and its unique health needs, policy commitments and health system infrastructure. At the same time, WHO will work to coordinate the many stakeholders and partners in the Region to avoid programme fragmentation, as well as transaction and management burdens among other concerns. When pursued in synergy, these actions will ensure that ‘country impact’ is, above all, sustainable.

In sum, our Region is blessed with some of the finest health experts, state of the art collaborating centers and universities, most advanced medical facilities and a booming medical technology and pharmaceutical industry. With valued and strengthened partnerships, there is no reason we cannot continue along an arc of progress that is changing lives, and with it the course of human history.

I look forward to working with each of the Region’s Member States as we pursue our common vision – a vision that builds on every country's strengths so that together we ensure healthy lives and promote well-being for all at all ages.

Dr Poonam Khetrapal Singh
Regional Director, WHO South-East Asia

Letter of Representation

Delegation of Authority