Why the world needs global health initiatives
Dr Margaret ChanDirector-General of the World Health OrganizationHonourable Mayor of Venice, honourable President of the Veneto Region, honourable ministers, colleagues from the United Nations system, representatives of global health initiatives, researchers and academics, civil society, ladies and gentlemen,
First, let me thank the city of Venice for hosting this event, and thank the government of Italy for its support .Let me thank the many contributors from around the world who have so generously given their time, their findings, and their thoughtful insights.
I think we can now let a long-standing and divisive debate die down. This is the debate that pits single-disease initiatives against the agenda for strengthening health systems.
As I have stated since taking office, the two approaches are not mutually exclusive. They are not in conflict. They do not represent a set of either-or options. It is the opposite. They can and should be mutually reinforcing. We need both.
This is one of the jobs, I believe, of this high-level dialogue: to craft policies and best practice that help the two approaches work together, in harmony, in ways that reduce waste and duplication, and improve efficiency.
We need them to work together to facilitate what I believe we all agree is the most important goal: to save lives and improve health outcomes. The Positive Synergies report has its limitations, which the co-authors readily admit. But it does give us the most solid ground yet for taking stock of where we stand today and establishing informed policies for the future.
Ladies and gentlemen,
Global health initiatives were established with a strong sense of purpose and great ambition. They set out to save lives, on an emergency basis, even though not everything was known at the start about everything that needed to be done, or the best way to do it.
There were risks, and there were missed opportunities, which better planning might have prevented. But there was also courage, or to use words from the report, “an invigorating sense of ambition and purpose.”
And there was a clear moral imperative to act. The AIDS epidemic demonstrated the relevance of equity and universal access in a substantial way. With the advent of antiretroviral therapy, an ability to access medicines and services became equivalent to an ability to survive for many millions of people.
This is the essence of the equity argument: people should not be denied access to life-saving interventions for unfair reasons, including an inability to pay.
These global health initiatives have gathered knowledge along the way, and in so doing, they have shed light on a cause of much ill health in this world: weak and inequitable health systems.
Weak health systems are wasteful. They waste money, and dilute the return on investments. They waste money when regulatory systems fail to control the price and quality of medicine.
They waste training when workers are lured away by better working conditions or better pay. They waste efficiency when needless procedures are performed, or when essential procedures are precluded by interruptions in the supply chain.
They waste opportunities for poverty reduction when poor people are driven even deeper into poverty by the costs of care or by the failure of preventive services.
Above all, weak health systems waste lives.
Weak health systems are almost certainly the greatest impediment to better health in the world today. They are the central obstacle that blunts the power of global health initiatives.
The tuberculosis community clearly states the problem. The emergence of drug-resistant TB represents not just a failure of the control programme, but a failure of the entire health system in which that control programme operates.
In looking for ways to get beyond this impasse, we can take lessons not just from the evidence set out in the report, but also from history.
One reason for the success of smallpox eradication was a constant use of research to guide increasingly refined strategic operations. The smallpox campaign had a built-in capacity to respond, adapt, and shift gears as new evidence emerged.
The campaign to eradicate malaria did not. Of the many reasons put forward for the failure of this campaign, one is particularly relevant to today’s high-level dialogue. It is this: even the best-funded and managed initiatives will fail in the absence of basic infrastructures and services needed to sustain routine case detection and treatment.
The history of the onchocerciasis control programme provides another instructive example. At its start, this was the most vertical control programme imaginable: helicopters dropping insecticides from the sky.
As the burden of disease came down, the programme evolved. It brought us the strategy of community-directed distribution of a broadened range of interventions. This strategy is now an important tool for extending primary health care.
Ladies and gentlemen,
It is time to start listening to the evidence, and not to anecdotal reports or to praises or criticisms founded on ideology rather than on evidence. Let me highlight four points that I personally find important.
First, these initiatives have unquestionably done great good. They have saved or prolonged millions of lives. This was the overarching purpose. I do not need to say more.
Second, it is wrong to conclude, categorically, that these initiatives have weakened health systems. They were launched at a time when health systems were already weak, sometimes on the verge of collapse, following decades of neglect. The global initiatives may have exacerbated some specific pre-existing weaknesses, but they did not cause them.
The report identifies some problems. Better planning could have prevented the establishment of parallel systems for information and for the procurement and distribution of supplies. As we know, these parallel systems have contributed to duplication, higher costs, and the undermining of national capacities.
The mixed picture revealed by the report is often a function of differences in the capacity of health systems. Stronger health systems have been better positioned to maximize gains from support by these initiatives and to counteract potentially negative effects.
In reality, the momentum and drive of these initiatives have made specific weaknesses in health systems much more visible. This, in turn, has allowed a more precise definition of problems and a more targeted approach to solutions.
My third point is closely related. For me, some of the best news from the report is evidence that global health initiatives can be flexible and responsive.
Part of their “invigorating sense of ambition and purpose” is an ability to solve problems, often in highly innovative ways.
In their drive for results, they are devising solutions to the very problems they have revealed. As the report states quite simply: they are constantly adapting and improving.
My fourth point is a straightforward request to you. The report cites abundant examples of deliberate and successful innovations.
These innovations are helping to bring health staff to rural areas and keep them there, to change legislation so that nurses can prescribe drugs, and to fully engage community health workers and civil society organizations. They are reducing drug prices, rationalizing the switch to second-line treatments, and exploiting advances in information and communication technologies with a speed and efficiency that have defied the sceptics.
Pay close attention to these innovations. They have unquestionably streamlined operations, saved money, and led to great efficiency gains.
They have also improved the quality of care for patients. And this has been a distinctive shared feature of these initiatives: they have upgraded the quality of care with quality-assured interventions and standardized treatment protocols, setting a new benchmark for global health.
Ladies and gentlemen,
We are meeting at a time when the world faces multiple crises on multiple fronts. Global crises like the economic downturn and climate change will hit developing countries the hardest.
As these countries have the greatest vulnerability, they will bear the brunt of the consequences. As these countries have the least resilience, they will take the longest to recover.
As announced earlier this month, the world is at the start of the 2009 influenza pandemic. I firmly believe that this pandemic will reveal, in a highly visible, measurable, and tragic way, exactly what it means, in life-and-death terms, when health needs and health systems have been neglected, for decades, in large parts of the world.
The gaps and inequalities that we are all trying so hard to address are likely to grow even greater. The price of failure will keep getting higher.
We simply cannot afford to be distracted from our central purpose. We cannot let the momentum, the drive, stumble for a moment. We must pursue every possible opportunity to improve efficiency and reduce waste. We are learning as we keep moving on, with an appropriate sense of urgency.
We faced some challenges early on, but we are moving forward, learning, adapting, pulling together, saving lives.
WHO values all its partners in global health, and values their clear contributions to better health. I am proud of these partnerships, and greatly encouraged by the attention being given to health systems.
This is not easy work. This is not glamorous work. But it absolutely must be done.
Thank you.
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Update No. 37 - Duque To Schools: Continue Reporting Any Unusual Rise in Students With Flu
While 23 Previously Confirmed Mild Cases Now Discharged
10 June 2009Health Secretary Francisco T. Duque III today urged school authorities across the country to continue reporting to their respective local government executives any unusual occurrence of flu-like symptoms among their students especially those who travelled last summer to countries affected with the A (H1N1).
”This effort is part of the readiness of the Department of Health (DOH) to shift from containment to mitigation”, Duque said.
Duque made this call as he reported today 23 more confirmed mild A (H1N1) cases that are related to the cluster of schools that have already voluntarily suspended their classes due to the novel virus. These schools include De La Salle University Taft, East Asia College, De La Salle-College of St. Benilde, St. Andrews School Parañaque, and Ateneo de Manila High School. The new cases bring the total to 77 mild A (H1N1) confirmed cases. Twenty-three of these 77 mild cases have been discharged.
Duque said that the increase in cases was due to the relentless contact tracing done by the DOH in the five affected schools. Duque also said that the 23 new confirmed mild cases are responding well to treatments.
Duque stressed that there is still no community spread yet as the new cases were all traced to one case that earlier caught the virus during a travel to an A (H1N1) affected country.
The 23 new confirmed cases include 19 Filipinos and 4 foreigners. There are 18 males and 5 females with an age range of 8-49 years old. Seven of the new confirmed cases have a history of travel. The said cases travelled to the US and Japan.
Since May 1, 2009, the DOH has monitored a total of 667 Cases Under Observation (CUOs). Of these, 77 were positive A (H1N1) cases, 85 have pending laboratory results, and 505 were negative and have been discarded. There were 68 new CUOs today.
In their latest report dated June 8, the World Health Organization has reported 25,288 cases and 139 deaths from 73 reporting countries.
UPDATE NO. 25 - DUQUE REPORTS 4 NEW CONFIRMED CASES OF INFLUENZA A(H1N1)
May 27, 2009
Secretary Francisco T. Duque III announced today that there are four new laboratory-confirmed Influenza A (H1N1) cases in the country today. We have 2 females, aged 1 year and 26 years; and 2 males, aged 13 years and 55 years. The two children had history of travel to affected countries (Hongkong and the United States). Both adults are contacts of the confirmed case from Taiwan. All are currently being observed in health facilities. The 13 year old male has fully recovered while the rest still have cough.
Efforts are being taken to complete contact tracing and to place under quarantine those with known exposure to the confirmed cases. Those who are found ill will be brought to designated health facilities. The results of the monitoring will be shared with affected local governments once they are available so that further spread will be promptly prevented.
The Department of Health is expecting more confirmed cases in the coming weeks due to its intensive contact tracing and heightened awareness among the public. Also, since there is continuous international travel and the number of affected countries continues to increase, the DOH has been preparing for this scenario.
DOH however assures the public that the pandemic preparedness and response plan is in place and that it has expanded its referral hospitals to all DOH Regional Hospitals and Medical Centers.
Duque reiterated that if you have traveled to an Influenza A(H1N1) affected country or have been exposed to a confirmed case of Influenza A(H1N1) and have fever, cough, sore throat or other flu-like symptoms, please consult a health facility immediately. You can also call the DOH Hotline (02) 711-1001 or 711-1002. For the Visayas, you can call the DOH Hotline (032) 418-7636 and (032) 255-1591. For Mindanao, you can call the DOH Hotline (082) 227-2731.
Press Release
May 22, 2009Loren asks DOH: Bombard people with right info on swine flu
Senator Loren Legarda yesterday said that Filipinos must take the first confirmed case of swine flu infection in the country calmly, while taking sanitary precautions like the frequent washing of hands and the use of face masks if applicable.
"The Department of Health must seek the help of media - radio, television and newspapers - to disseminate precautionary guidelines and on what should be done when swine flu infection is suspected," said Loren.
"This is one instance when the people wouldn't mind being bombarded with information by DOH. There's no such thing as information overload when it comes to swine flu. But the important thing is that our people are getting the right information."
The chair of the Senate Committee on Health and Demography, Loren added that Filipinos must also work to improve their immune system by exercising, having a balanced diet and getting plenty of rest.
"Being healthy certainly helps in view of reports that most of the 80 deaths worldwide associated with swine flu arose from complications with other ailments," she said.
As the symptoms of swine flu are very similar to common flu cases, Loren said that all Filipinos who feel feverish must immediately seek medical attention.
"The important thing is for us not to disregard symptoms as just a case of the common cold. It's better to err on the side of caution on this matter."
"But what are the symptoms? What should people do, step by step, if they suspect possible infection? The DOH must inform the people because false information can sow panic and complicate our efforts to contain the spread of the virus."
Loren said that the Philippines dealt well with the SARS and avian flu scare, but that health authorities must double their efforts against swine flu.
The senator said health officials must note how the virus quickly spread in Japan from just four confirmed cases to over 200 cases at present in at least three major cities.
Update No. 22 -PRESS STATEMENT ON THE CURRENT SITUATION OF INFLUENZA A (H1N1) IN THE PHILIPPINES
May 25, 2009As of May 25, the Department of Health has identified ten new Cases Under Observation (CUO), eight of whom are from NCR, one from Region I and one from Region VII. Since May 1, the DOH has monitored 113 CUOs, two of whom were confirmed cases of A(H1N1). Fifteen CUOs still have pending laboratory results, the remaining 96 have been discarded since they are negative for Influenza A(H1N1).
Globally, the World Health Organization reported a total of 12,022 cases and still 86 deaths in 43 countries as of May 24. There are no new countries reporting confirmed cases of Influenza A (H1N1).
Update on the two confirmed cases in the Philippines. Both cases are well and do not have any symptoms. They are still being monitored and will be discharged once their repeat PCR becomes negative for A (H1N1). At present, all their close contacts have not reported any symptoms of flu and are observing home quarantine.
Update on the Taiwanese two nationals. On further investigation, the Department of Health was informed that the Taiwanese nationals did not attend a yoga workshop in the Philippines. However, it was found that this confirmed A(H1N1) case and her daughter did attend a social gathering while visiting the country. The DOH is now in the process of tracing their contacts and will update you as information becomes available.
We would like to reiterate that if you have traveled to an Influenza A(H1N1) affected country or have been exposed to a confirmed case of Influenza A(H1N1) and have fever, cough, sore throat or other flu-like symptoms, please consult a health facility immediately. You can also call the DOH Hotline (02) 711-1001 or 711-1002.
DOH Influenza A(H1N1) Surveillance Progress Report (as of May 25, 2009)
On the Taiwanese national who visited the Philippines, the DOH is continuously investigating the case. We have already coordinated with Taiwan Centers for Disease Control who reported yesterday that the patient has already fully recovered. At present, her daughter only has mild respiratory symptoms and does not have fever anymore. Based on the information we have, the Taiwanese woman fell ill after visiting the Philippines for a short vacation. She did not attend any social gathering in the country, which could have exposed her to the virus while here in the Philippines.
On May 22, 2009, the Central Epidemic Command Center (CECC) confirmed the forth and fifth imported case of influenza A (H1N1) in Taiwan. The forth case is a 30-year-old, Taiwan-born female who traveled to Manila, the Philippines to attend an international yoga workshop with her daughter, elder sister and a friend from May 16 to 20, 2009. The participants in the events were mostly from the United States, Canada and Australia. The case took flight PR896 and arrived at Taiwan at 09:30 on May 20, 2009. Before boarding the plane, the case experienced influenza-like symptoms such as lightheadedness and sore throat, but did not develop fever. Therefore, the case returned home after she arrived in Taiwan and had dinner at a friend’s house. On May 21, 2009, she put on a facemask and sought medical attention at a clinic because her symptoms persisted. Her doctor suspected that she was infected with influenza A (H1N1) and thus referred her to a hospital. At the hospital, she was diagnosed with a fever of 38℃, sore throat, and light cough, and was immediately sent to the negative pressure isolation room for treatment and specimen collection. In the evening of May 21, 2009, the case’s daughter developed fever and was sent to the hospital for treatment at the negative pressure isolation room. The case’s daughter has come into close contact with fiver of her family members. In addition, the public health personnel have visited the kindergarten the case’s daughter attends for epidemiological investigation in order to determine if school closure is necessary.
CECC urged the passengers sitting in the same row and in the 3 rows in front and behind the case and the crew members on flight PR896 (departed from Manila at 07:39 on May 20, 2009 and arrived at Taoyuan at 09:31 on the same day; the case’s plane seat: 23B) to voluntarily report themselves to the Taiwan Centers for Disease Control (Taiwan CDC) through the Communicable Disease Reporting and Consultation Hotline, 1922. After contacting Taiwan CDC, public health personnel will visit them to administer antiviral prophylaxis and request them to conduct self-health management: observe their own health, conduct home quarantine, and measure their body temperature twice a day for a period of seven days. If any of the close contacts develop influenza-like symptoms such as fever and cough during the next 2-7 days, please be sure to contact the local health unit first and refrain from seeking medical attention on his/her own. On the other hand, the passengers on board the same flight with the case should not be overly panicked and are urged to conduct self-health management for seven days or call 1922 for consultation.
21 May 2009
The Department of Health is officially announcing this evening the first confirmed case of Influenza A (H1N1) in the Philippines.
A female traveler arrived in the Philippines on May 18, Monday, from the United States and Canada. A throat specimen was collected, and was tested at the Research Institute of Tropical Medicine (RITM) on May 20, Wednesday, after she developed fever, sore throat and cough.
Today, RITM confirmed that the specimen tested positive for the novel Influenza A (H1N1) on PCR using the primers sent by the US Centers for Disease Control and Prevention (CDC).
She was immediately started on an antiviral, Oseltamivir, and given supportive care. At this time, the patient is continuously being monitored. She no longer has fever or cough, but still has sore throat.
The DOH would like to emphasize that there is no community level outbreak in the country and measures are being done by the government to prevent transmission, starting with the quarantine of household close contacts.
The family of the patient has been informed and advised about the situation. We would like to thank them for their cooperation and willingness to comply with the recommendations of the DOH. They were advised to observe self-monitoring, home quarantine, social distancing, proper hygiene and respiratory etiquette procedures.
We appeal to our media partners and the rest of the nation to respect the privacy and anonymity of the patient and her family. Rest assured that any information vital to protect public health and safety will be appropriately shared to those concerned.
The DOH also stresses that the discovery of this first case of Influenza A(H1N1) in the Philippines is something we have been preparing for and is a result of the collective efforts of both public and private sectors as well as the effective surveillance system which we have put in place.
The DOH has already notified the International Health Regulations (IHR) and will submit its official report in 24 hours.
Influenza A (H1N1) is currently affecting 41 other countries with 11,034 cases and 85 deaths. Thus far, the behavior of the virus is to cause generally mild illness and low mortality (<1%)>
This development only shows the vulnerability of all countries to the threat of Influenza A (H1N1) which indicates that no nation and no government should be complacent. Thus, we continue to strengthen our systems for surveillance, early detection and management and effective response. We are also closely coordinating with the WHO, other agencies of government and the private sector to effectively combat the virus.
Our stockpiles of Oseltamivir is currently sufficient at 1 million capsules and have been distributed in regional hubs all over the country. We would like to remind the public that Oseltamivir may only be dispensed and taken upon the advice of your doctor. Irrational use can result in drug resistance that causes the drug to become ineffective in the future.
We reiterate to the public that government is on top of the situation and everyone is advised to be vigilant. If you have arrived from an affected country and develop flu-like symptoms (or TRANGKASO) such as fever, sore throat and cough, immediately consult a medical professional or call the DOH Hotline at (02) 711-1001 or 711-1002.
This situation is evolving globally. We will give regular updates to the media and the public as information becomes available.
To know more about Influenza A(H1N1), you may go to the DOH Influenza A(H1N1) Website at www.doh.gov.ph/h1n1
MANILA, May 21 (Reuters) - The Philippines has recorded its first case of the new H1N1 flu virus, a 10-year-old girl who had returned from a trip to the United States and Canada, Health Secretary Francisco Duque said on Thursday.The Filipino girl returned on May 18 and was stopped at the airport when found to be suffering from a fever, sore throat and a cough, Duque told reporters. He said the girl was confirmed to be suffering from H1N1 on Wednesday but was recovering. (Reporting by Manny Mogato; Editing by Paul Tait)
Update No. 17 - Influenza A(H1N1) Monitoring
May 21, 2009As of May 21, the Department of Health has identified seven new cases under observation, five of whom were from NCR, one from Region 6 and one from Region 8. All cases had history of travel from Influenza A (H1N1) affected countries. Four of the new cases’ laboratory test results for Influenza A (H1N1), together with three cases reported previously, are still pending. All other previous cases tested negative for Influenza A (H1N1). While the intensive laboratory testing procedures for individuals possibly infected with Influenza A (H1N1) is on-going, the DOH reiterates that influenza-like illness monitoring at the community level is also enhanced. This is to ensure that outbreaks of influenza are detected early and control measures are implemented immediately.
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