People-centered primary care must be the foundation of our efforts to achieve universal health coverage


 WHO Director-General’s addresses to the Executive Board

People-centered primary care must be the
foundation of our efforts to achieve
universal health coverage

UHC is not only the best investment in a healthier world, it is also the
best investment in a safer world-
Dr. Tedros Adhanom Ghebreyesus

GENEVA: The Year 2018 is a special year in many ways. It’s a year of opportunities. First, it’s whose 70th birthday – an opportunity to celebrate past successes and rethink our future. It’s also the 40th anniversary of the Alma Ata Declaration – an opportunity to reaffirm that people-centered primary care must be the foundation of our efforts to achieve universal health coverage. And it’s the 100th anniversary of the Spanish flu pandemic – an opportunity to remember the devastating potential of outbreaks if we are unprepared for them. As you know, Spanish flu 100 years ago killed more people – 50 to 100 million – than the First World War. These views were expressed by Dr. Tedros Adhanom Ghebreyesus Director-General of the World Health Organization while addressing the WHO Executive Board here on
22 January 2018.

However, this is also a year of opportunity for WHO. It’s the year that will determine what WHO looks like in the future. For the past six months, my team and I have been working every day to strengthen the foundations of the Organization. We have worked tirelessly to develop the General Programme of Work. Many of us didn’t even take a break during the long vacation We have developed a plan to transform WHO and we have begun work on revamping resource mobilization.

Dr. Tedros further stated that we have built a strong leadership team, with enormous talent and experience. For the first time, we have achieved gender parity in whose top ranks, with women outnumbering men, and with more geographical diversity than ever before. This is very historic. Of course, all this work is closely connected. We cannot implement the GPW without transforming WHO, or without resources, or without strong leadership. That’s why I say we’re laying the foundations. That’s what we’ve been doing the last six months.

The GPW, the transformation, resource mobilization, strong leadership: these are the foundations. But even as we have strengthened the foundations, we’ve been getting on with the day-to-day work of the Organization, he remarked.

Speaking about the communicable diseases, the WHO DG said that we have built strong political momentum on non-communicable diseases and TB, which will both have high-level events at the United Nations General Assembly later this year. We have established a new High-Level Commission on NCDs. We have launched a new initiative to combat the health effects of climate change in Small Island Developing States. We’ve signed new agreements with the World Bank, UN Environment, the United Nations Framework Convention on Climate Change and others. We have started a new process of engaging with civil society organizations to amplify our collective voices. It’s the collective voice that is more potent than the fragmented one. And we finished the year with the UHC Forum in Tokyo, where we witnessed unprecedented political commitment in support of our vision of health for all.

He particularly thanked the government of Japan and His Excellency Prime Minister Abe, not only for hosting that important meeting, but for their commitment to spend $2.9 billion advancing UHC globally. The UHC monitoring report, launched in Tokyo, also reminds us of the task at hand. At least half the world’s population still lacks access to essential health services. And almost 100 million people are pushed into extreme poverty every year because of out-of-pocket health spending. This must end .But there are signs of hope.

About 12 days ago I had the honour of meeting President Uhuru Kenyatta in Nairobi, Kenya. He has recently announced that affordable healthcare would be one of the four pillars of the Kenyan economy for his second term in office. He wants whose support. In our meeting, he asked me to help his government to identify the best financing model to achieve his vision. And he wants it fast -- he gave me just three months! That shows his commitment. It was the same story in Madagascar, where the government has just created a National Health Solidarity Fund, which it is now starting to roll out in three districts. And it was the same story in Rwanda, where I visited the Maryanne Health Centre, just outside Kigali. In that area, all pregnant women deliver in the health center. All children are vaccinated. And everyone is enrolled in the community-based health insurance scheme. These rates are rare, even in countries that are far wealthier than Rwanda.

My time in these three countries, Dr. Tedros Adhanom Ghebreyesus stated reminded me that universal health coverage is not a pipedream. It is a reality in many places. Each country I visited was at a different point in its journey. But they have a common destination. This year, universal health coverage will be the theme both for World Health Day and the World Health Assembly, as you know. I’m pleased to announce that we will celebrate World Health Day in Sri Lanka, which is also celebrating its 70th birthday. There is no more fitting place for this event. As you know, Sri Lanka has a long history of providing free healthcare for its people.

Speaking about future plans, he said that this year we also plan to issue a challenge to all countries to take at least three concrete steps towards universal health coverage.

I am more convinced than ever that UHC is not only the best investment in a healthier world, it is also the best investment in a safer world as universal health coverage and health security are two sides of the same coin.

In the past six months, WHO has responded to 50 emergencies in 48 countries, including 9 grade 3 emergencies – the highest level? I now receive a daily briefing note summarizing all ongoing emergencies, and our response to them. We have set up a dashboard with near-real time data on outbreaks and emergencies. We have established the Health Security Council in WHO, a fortnightly meeting co-chaired by Peter Salama, my Deputy Director-General and myself, which reviews all emergencies in detail. No single day passes actually without me focusing on emergencies. We’re trying to run emergencies as a national security council runs. It’s a daily business.

Preventing Emergencies

If we are truly to make the world safe, we must shift towards a greater emphasis on preventing emergencies, rather than merely reacting to them. Prevention – we have to strike first. We shouldn’t wait until the beast strikes. And when outbreaks do strike, we must be ready. That’s why we are now mapping the capacities of all countries to contribute to a global “health reserve army” that can be deployed rapidly to respond to emergencies. We must ensure that each country has the resources, the tools and the permission to do their jobs to the best of their ability – strong delegation of authority. We must give them the right people, in the right jobs, with the right resources to deliver on the “triple billion” target.

We must remember that with increased responsibility comes increased accountability, and we will ensure that our country offices are kept to high standards of performance and accountability. But if we are to achieve any of this – if we are to advance universal health coverage; if we are to address emergencies; if we are to put countries at the center – WHO must change. In the past six months, I have made a priority of developing a plan to transform WHO into the Organization that the world needs it to be. Our goal is clear - to make WHO a modern organization that works seamlessly to make a measurable difference in people’s health at country level. Reaching this goal requires a shared vision, mission and strategy. We have to be aligned on those. Most importantly, it requires a change of culture. A change of mindset.

Dr. Tedros Adhanom Ghebreyesus further stated that recently we asked all 9000 staff globally to complete a survey to help us “take the temperature” of the Organization. What came back was encouraging. But it also highlighted several areas requiring major improvement. It showed that we must do better at communicating our vision and strategy throughout the Organization, and involve staff in setting goals. At the same time, there must be more accountability for performance. More work is needed to motivate staff to do their best - they need more ownership, and opportunities for training and career development. And we need to create a culture of transparency and collaboration that empowers our staff.

The transformation process in WHO will be targeted and time-limited. The transformation team will then itself transform into a unit that drives continuous improvement within WHO and moves us from an organization that simply “serves” to one that “serves and thinks”.

Here too we need your support. If we are to truly change the way WHO operates, we need as much flexible and un-earmarked funding as possible. There is now growing support from many of you. If we continue to operate under the same funding restrictions, we will produce the same results, he added.

No organization can succeed when its budget and priorities are not aligned. I know the trust deficit we have between WHO and the Member States. We will do everything to address the trust deficit we have. But we would like you to help from your side.

In his address the WHO Director General also referred to the tragic death of polio workers in Quetta along with a mother and her sixteen years old daughter and said, such terrorists activities will not deter us from our resolve the eliminate polio from the world.

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