Report of the Regional Director

2 18

The Work of WHO in the South-East Asia Region

1 January–31 December

SEA/RC72/2

The work of WHO in the South-East Asia Region

Report of the Regional Director

1 January–31 December 2018

The Work of WHO in the South-East Asia Region, Report of the Regional Director,

1January–31December 2018 ISBN: 978 92 9022 717 5
© World Health Organization 2019
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Contents

List of Acronyms

iv

Part I

from the regional director

1

Part II

the work of WHO in countries
15

15

Bangladesh Bhutan

23
Democratic People’s Republic of Korea
31

India
41

Indonesia

Maldives Myanmar

Nepal

55

67 77

87
Sri Lanka

Thailand

Timor-Leste

99
111 121

Part III

delivering on the regional flagship priorities and beyond
131

List of acronyms

ACT

artemisinin-based combination therapy

ADB

Asian Development Bank

AEFI

AFP

adverse events following immunization

acute ﬂaccid paralysis

AIIMS AMR ANM APA

APQN

APL
All India Institute of Medical Sciences antimicrobial resistance auxiliary nurse midwife annual performance agreement

Asia Paciﬁc Quality Network

assistive product list

ART

antiretroviral therapy

ARV

antiretroviral

ASEAN bOPV CBHC CCS CERF CRS
Association of Southeast Asian Nations bivalent oral polio vaccine community-based health care (WHO) country cooperation strategy Central Emergency Response Fund congenital rubella syndrome

CSO

civil society organization

CVD

cardiovascular disease

DFAT

DFID DHIS DPT

Department of Foreign Aﬀairs and Trade

Department for International Development District Health Information System diphtheria–pertusis–tetanus
DPR Korea EID
Democratic People’s Republic of Korea emerging infectious disease

EMT

emergency medical team

EMTCT EOC elimination of mother-to-child transmission emergency operations centre

EPI

Expanded Programme on Immunization

emergency response to artemisinin resistance early warning alert and response system Food and Agriculture Organization WHO Framework Convention on Tobacco Control Framework of engagement with non-State actors Field Epidemiology Training Programme Family Health Bureau
ERAR EWARS FAO FCTC FENSA FETP FHB fIPV FP fractional inactivated polio vaccine family planning
Gavi GHSA GIS

GISRS

GLAAS GLASS GLP
Gavi, the Vaccine Alliance Global Health Security Agenda Geographical Information System

WHO Global Inﬂuenza Surveillance and Response System

UN Global Analysis and Assessment of Sanitation and Drinking Water Global Antimicrobial Resistance Surveillance System Global Leprosy Programme

iv

THE WORK OF WHO IN THE SOUTH-EAST ASIA REGION

GMS GPW HEOC HiAP HIS
Greater Mekong Subregion General Programme of Work (of WHO) health emergency operations centre Health in All policies health information system

HIV/AIDS

HMIS HNAP HNPSDP HPV

human immunodeﬁciency virus/acquired immune deﬁciency syndrome

Health Management Information System health national adaptation plan Health, Nutrition, and Population Sector Development Plan human papillomavirus
HRH ICC icddr,b ICT IDA IEC IEHK IHIP IHR human resources for health Interagency Coordination Committee on Immunization International Centre for Diarrhoeal Disease Research, Bangladesh information and communications technology ivermectin, diethylcarbamazine citrate and albendazole information, education and communication interagency emergency health kit Integrated Health Information Platform International Health Regulations (2005)

inﬂuenza-like illness

ILI

ILO IMF
International Labour Organization International Monetary Fund
IMNCI IPC IPD
Integrated Management of Newborn and Childhood Illnesses infection protection and control (WHO) Immunization Preventable Disease Programme

inactivated polio vaccine

IPV

IT

information technology

ITAG IVD JE
Immunization Technical Advisory Group Immunization and Vaccines Development Japanese encephalitis

JEE

joint external evaluation

JMM

LF

joint monitoring mission

lymphatic ﬁlariasis

LLIN M&E MCK MCV MDA MDG MDR-TB MDT mhGAP mhGAP-IG MMR MNT MoA MoF MoH MoHFW long-lasting insecticidal net monitoring and evaluation medical camp kit measles-containing vaccine mass drug administration Millennium Development Goals multidrug-resistant TB multidrug therapy WHO Mental Health Gap Action Programme WHO Mental Health GAP Intervention Guide measles–mumps–rubella maternal and neonatal tetanus memorandum of agreement Ministry of Finance Ministry of Health Ministry of Health and Family Welfare

v

MoHNIM MoHP MoHS MoPH MoU MPDSR MR
Ministry of Health, Nutrition and Indigenous Medicine Ministry of Health and Population Ministry of Health and Sports Minisity of Public Health memorandum of understanding maternal and perinatal death surveillance and response measles and rubella

NAP

national action plan

NAPHS NATA NCDC NCD
National Action Plan for Health Security National Authority on Tobacco and Alcohol National Centre for Disease Control (India) noncommunicable disease
NGO NHAs NHI nongovernmental organization National Health Accounts national health insurance

NIP

National Immunization Programme

National Immunization Technical Advisory Group National Malaria Control Programme National Medicine Regulatory Authority

National Pandemic Inﬂuenza Preparedness and Response Plan

nurse practitioner in midwifery National Polio Surveillance Project National Regulatory Authority
NITAG NMCP NMRA

NPIPP

NPM NPSP NRA NSACP NSP national STD/AIDS control programme national strategic plan

NTD

neglected tropical disease

NTP

national TB programme

OIE OOP
World Organisation for Animal Health out of pocket
PCV PEN Penta

PIP PIPP

PKDL PLHIV PM-JAY PMTCT

POCQI PPE

pneumococcal conjugate vaccine Package of Essential NCD Interventions pentavalent vaccine

pandemic inﬂuenza preparedness pandemic inﬂuenza preparedness plan

post-kala-azar dermal leishmaniasis people living with HIV Pradhan Mantri Jan Arogya Yojana prevention of mother-to-child transmission

point-of-care quality improvement personal protective equipment

pre-exposure prophylaxis

PrEp

RCV

rubella-containing vaccine

RGoB RMNCAH

RO

Royal Government of Bhutan reproductive, maternal, newborn, child and adolescent health

Regional Oﬃce (of WHO)

RRT

rapid response team

SDGs SEA
Sustainable Development Goals South-East Asia (Region of WHO)

vi

SEA-RVC

SEA Region SEARHEF SEARN SHOC SIA

South-East Asia Regional Veriﬁcation Committee

South-East Asia Region (of WHO) South-East Asia Regional Health Emergency Fund South-East Asia Regulatory Network Strategic Health Operations Centre supplementary immunization activity Sri Lanka Accident Data Management System

surveillance medical oﬃcer

SLADMS

SMO

SOPs SRHR SSB standard operating procedures Sexual and Reproductive Health and Rights (Policy) sugar-sweetened beverage
STAG STI
Strategic Technical Advisory Group sexually transmitted infection
STEPS STH
WHO STEPwise approach to surveillance soil-transmitted helminthiasis

TAG

technical advisory group

TB

tuberculosis

TCV

typhoid conjugate vaccine

Td

tetanus–diptheria

TT

tetanus toxoid

TWG

technical working group

UHC

universal health coverage

UNCERF UNDAF UNDP UNEP UNFPA UNGA UNIATF UNICEF UNIDO UNSDF USAID US CDC VBD
United Nations Central Emergency Response Fund United Nations Development Assistance Framework United Nations Development Programme United Nations Environment Programme United Nations Population Fund United Nations General Assembly UN Interagency Task Force on NCDs United Nations Children's Fund United Nations Industrial Development Organization United Nations Sustainable Development Framework United States Agency for International Development United States Centers for Disease Control and Prevention vetor-borne disease

VL

visceral leishmaniasis

VPD

vaccine-preventable disease

WAAW WASH WFME WFP
World Antibiotic Awareness Week water, sanitation and hygiene World Federation for Medical Education World Food Programme
WHE WHO WSP
WHO Health Emergencies Programme World Health Organization water safety plan

XDR

extensively drug resistant

YLL

years of life lost

vii

The WHO Regional Director for South-East Asia, Dr Poonam Khetrapal Singh, on a visit to the maternity ward at the Government Health Facility, Naypyitaw

FFrroomm tthhee RReeggiioonnaall DDiirreeccttoorr

Part I

Universal health coverage: The road ahead

This report of the work of WHO in the South-East Asia Region provides an overview of what the Organization and its Member States and partners have achieved in the past year. I will follow a similar line in this introduction, with a focus on the Region’s Flagship Priority Programmes, and on our progress in recent years.

But I will also look ahead, providing depth to a conversation that has already begun, and which will continue to mature. That conversation is about universal health coverage (UHC), the pursuit of which is central to WHO’s work in the Region and beyond.

When discussing UHC, I usually focus on two components – human resources for health and access to medical products. We will examine recent achievements in both areas shortly. But before we do, let us widen the scope and consider the subject more broadly.

UHC is the bedrock of health policy in each of the Region’s Member States. It provides unity of purpose and an integrated approach to achieving health for all. As outlined in the Region’s Flagship Priorities, and in WHO’s Thirteenth General Programme of Work (GPW),

the pursuit of UHC reﬂects the Organization’s

commitment to achieving better health outcomes for all people everywhere. It is also

an expression of our commitment to equity

and human rights.

FROM THE REGIONAL DIRECTOR’S DESK

1

I am certain readers of this report will have heard UHC referred to as “the single most

powerful concept that public health has to oﬀer”. Indeed, that it may be – but only if it

inspires governments and their partners to fully grasp the obstacles to universal access

and ﬁnancial protection. And let us be clear: Universality means everyone, including ethnic

and religious minorities, migrants and those living on the margins of society. It also means

services must be equally available and accessible as a right to all, irrespective of gender or sexual orientation. Notably, those services include aﬀordable and safe medicines, adequate pain relief and palliative care, as well as long-term care for older persons.

We must be similarly clear about how we define financial protection. Yes, financial

protection is about providing insurance and reducing out-of-pocket payments. But it is also about improving the provision of health care, in access to medical education and health

sector employment, and in the procurement of medicines and equipment.

Moving forward, it is imperative we consider and act on ideas in their fullest sense. This

is especially true for the concept of “Leaving no one behind” – the guiding maxim of the

health and development sector more broadly. Unless we are courageous in identifying and

remedying inequities, the phrase will become devoid of meaning. The same is true for UHC.

Uncritically aligning all that is going on in health care with UHC is not only mistaken; it also has the potential to undermine an idea that, at its core, calls for bold, dynamic and wellcalibrated policy-making. To harness the potential of both concepts, rather than business

as usual, we must pursue business unusual. That requires new ways of thinking and acting. It also requires making hard choices and backing them with steadfast resolve.

Member States are poised for progress. As the country briefs in Part II of this report show, political support for UHC across the Region is strong. The same is true at the global level. WHO’s Transformation Agenda, which is at the heart of the Director-General’s reforms,

aims to ensure that the Organization is better equipped to support its Member States

achieve the path-breaking change needed. To that end, the United Nations’ High-Level Meeting on UHC in September holds great promise, with Thailand representing our Region as one of two co-facilitators.

As you review the substantial achievements documented herein – many from 2018,

and many made over the past ﬁve years – I invite you to join me in looking to the future. This

is especially important as we update the Flagship Priorities, contribute to the GPW’s “triple

billion” targets, and stay on track to achieve the Sustainable Development Goals (SDGs). To help you do that, I here frame three questions, each corresponding to a core component of the Region’s succinct but powerful vision: “Sustain. Accelerate. Innovate”.

~

First: How can we sustain the gains we have made? The re-emergence of polio,

maternalandneonataltetanusandarangeofcommunicablediseasesispossible. Vigilance is needed to prevent this happening. We must also protect against

antimicrobial resistance (AMR) and guard increases in ﬁnancial protection. These

are but a few examples. The list is potentially very long.

2

~

Second: How can we accelerate progress towards the goals and objectives we

have agreed upon? What can we do to scale up interventions that we know to

be eﬀective? How can we overcome the bureaucratic hurdles that stand in the way of eﬀective implementation? And how can we nurture the partnerships

that turn pilot projects into large-scale implementation and ultimately social

movements? Each of these questions must be addressed as a matter of priority.

~

And third: How can we innovate in ways that will enhance the way we work and

the results we achieve? Harnessing the beneﬁts and mitigating the risks of new

technology is part of the picture, but there is much, much more to consider. Innovation means new ways of thinking about familiar problems. It means abandoning tired ideas that have outlived their utility. And it means devising new and imaginative ways of delivering services, empowering people to

advance their own health and the health of others and ﬁnding better ways to

communicate risk in times of crisis.

Universal health coverage: The road travelled

WHO’s work in the Region is guided by the 2030 Sustainable Development Agenda and the achievement of the SDGs, as well as the strategies and targets agreed on by Member States in the GPW.

Taken together, these objectives are broad. Member State needs are vast. Our

resources are ﬁnite. Indeed, WHO’s ﬁnancial contributions are miniscule in comparison to the combined resources of governments, the private sector and civil society. That requires

us to be both strategic and catalytic, including by marshaling WHO’s unsurpassed technical expertise and convening power to support Member States and facilitate and leverage action by others. In doing so, we must make hard choices and be selective.

Lighting the inaugural lamp at the celebration of the World Health Day 2018 global event in Colombo