At WHO regional meeting, an urge for better health systems

MANILA — The annual regional meeting of the World Health Organization’s Western Pacific office concluded Friday, with a new regional director, several new regional frameworks and actions plans, and a reminder that amid recent health successes, the region still has much to do to improve health systems and eliminate deadly diseases.

The weeklong meeting in Manila discussed countries’ progress against communicable diseases such as malaria, tuberculosis, and hepatitis. Outgoing WHO Regional Director for the Western Pacific Shin Young-soo highlighted the region’s successes in bringing down hepatitis B infection rates to 1 percent of the population for children under 5.

However, the region is still home to 40 percent of hepatitis B and C patients worldwide. While the cost of drugs for hepatitis B is now relatively cheaper — less than $100 a year, according to the regional director — hepatitis C drugs are still “very expensive.” He hopes hepatitis management and treatment will continue to be a main focus of WHO in the Western Pacific.

Health ministers also gave an update on interventions they’ve introduced to tackle the burden of noncommunicable diseases in the region, and asked for WHO’s guidance in the drafting and implementation of interventions related to tobacco control and obesity reduction, including through taxation.

NGOs meanwhile, raised issues not often tackled in discussions of NCDs, such as the prevention and treatment of rheumatic heart disease, which is common among young people and females, and is prevalent in some Pacific Island states and indigenous communities.

The International Pharmaceutical Students’ Federation highlighted the poor regulation and improper use and disposal of chemicals, and expired or damaged medicines, which can have impacts on people’s health and the environment. The federation also reminded member states of the dangers of “irrational use” of antibiotics, including on livestock and farming, and how it can contribute to devastating antimicrobial resistance.

WHO announced the elimination of lymphatic filariasis — a neglected tropical disease — in Palau, Vietnam, and Wallis and Futuna, a French overseas territory. Malaysia was also confirmed to have eliminated mother-to-child transmission of HIV and syphilis, the first country in WHO’s Western Pacific region to achieve the status.

But concerns remain on health security threats, from the increasing frequency and intensity of natural disasters, such as typhoons that hit countries in the region, to the re-emergence of polio in Papua New Guinea — prior, the country was polio-free for 18 years.

Strengthening legal frameworks for health

A huge part of this year’s discussions centered on hospital management and the use of digital health, such as telemedicine, issues that WHO directors said have clear links to universal health coverage.

E-health, as the directors called it, should be seen as promoting service delivery change, patient quality, and improving patient access to services, so no one is left behind.

WHO Director-General Tedros Adhanom Ghebreyesus noted how discussions on e-health at the regional office could help inform those at headquarters as they develop a global strategy on digital health.

“The future of health care will be influenced by digital health greatly, and it’s a must. And if it’s something we must do, we must really invest consciously. And we must be ahead of the curve. Digital health will be major part of health care,” he said, adding that WHO will be signing a memorandum of understanding with the International Telecommunication Union to look at the potential benefits of artificial intelligence on health.

These issues tie in with health laws, also part of the meeting’s agenda.

Legal frameworks can strengthen health governance, improve health service access, prevent and manage public health risks, and foster multisectoral collaboration to address the different social determinants of health, said the regional office’s acting director on program management.

A number of member states spoke about the need for guidance in developing legal frameworks on issues concerning NCDs, particularly interventions governing taxes. But Peter Cowley, director of WHO’s Western Pacific office health systems division, said guidance can range anywhere from how governments can provide better legal advice on hospital licensing and professional licensing of nurses and physicians to the implementation of a national health insurance program.

“If you were going to implement a national health insurance program or social health insurance, what's the legal framework behind that? Is it mandatory for employers and employees to contribute? Or it could be what do you do with people who are in the informal sector. Do they have to pay a certain fee? Part of that is regulations of the scheme,” he told Devex.

The Western Pacific office is currently the only region with a unit on health law and ethics, he said. And it speaks to the nature of institutions in the region, as countries transition to more developed economies. The demand for such support led the regional office to hire two public health lawyers as staff.

“I think we're looking at how best can we consolidate our response. Is it through working on evidence ... Or is it more in you're trying to share good practices or is it more in helping people frame things up, or is it more to what Dr. Shin [Young-soo] was mentioning, just reaching out to parliamentarians because that is proven to be crucial,” he said.

A new regional director

One of the biggest highlights of this year’s annual meeting of WHO’s Western Pacific office is the election of a new regional director. Takeshi Kasai, the regional office’s director of program management and deputy to the regional director, emerged as the winner in a closed-door voting session last Tuesday.

Kasai is a veteran at WHO, having served for the organization in different capacities since 2000. His election marks the third time a Japanese has taken leadership of the Western Pacific office since 1951. Before Kasai, the regional director position has been led by one Chinese, one Filipino, two Koreans, and two Japanese.

While some argue Kasai’s nomination comes at an opportune time given how Japan has taken a lead role in the push for universal health coverage, it does highlight the limited diversity of leaders who have taken the position.

The Western Pacific office also has not had a woman as regional director, although its senior management currently is gender balanced.

WHO communication

During his opening speech, the WHO director-general Tedros spoke about the need for the organization to be more proactive in promoting its normative and technical products. When Ethiopia was considering to reform its health systems during his time as health minister, he was not aware WHO had “an excellent technical guide on health system design.”

“I had to Google it. WHO must do better than that,” he said.

Increasing member states’ awareness of WHO’s technical guidelines, however, is not solely the responsibility of communications officers. Country representatives, he said, could become the main communications officer in countries.

Tedros also underscored the importance of developing WHO materials in the local language, and not just sticking with just the United Nations’ six official languages.

He also talked about the importance of clear communication to countries and partners: “The things we say could result in public panic.”