Regional Committee Committee Regional Asia for South-East Report of the Seventy-second Session Report of the Seventy-second 2–6 September 2019 , , WHO

WHO Regional Committee for South-East Asia Report of the Seventy-second Session SEA-RC72-23 The WHO Regional Committee for South-East Asia is the World Health Asia is the World for South-East Regional Committee The WHO It has representatives Asia Region. body in the South-East governing Organization’s in meets The Regional Committee in the Region. its 11 Member States from all in the Region, health development progress in every year to review September States, and review past on health issues for Member formulate resolutions of World Health Assembly considers the regional implications resolutions. It also others. resolutions, among Session of the the discussions of the Seventy-second This report summarizes in New Delhi, India, for South-East Asia held WHO Regional Committee 2019. on 2–6 September a number of public health Committee reviewed and discussed At this session, the as and ; latent TB infection; issues relevant to the Region, such and climate change; cervical cancer and health emergency capacities; environment Budget matters and past Regional snake-bite prevention; as well as Programme The Ministerial Roundtable featured a Committee resolutions; among others. The Committee also adopted a number discussion on emergency preparedness. issues of importance to the Region. of resolutions and decisions on selected www.searo.who.int SEA/RC72/23

WHO Regional Committee for South-East Asia

Report of the Seventy-second Session New Delhi, India, 2–6 September 2019 WHO Regional Committee for South-East Asia – Report of the Seventy-second Session SEA/RC72/23 © World Health Organization 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial- ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. WHO Regional Committee for South-East Asia – Report of the Seventy-second Session. New Delhi: World Health Organization, Regional Office for South-East Asia; 2019. Licence: CC BY-NC- SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Printed in India Contents

Introduction...... 1

Inaugural session...... 4

Welcome address by Ms Preeti Sudan, Secretary (Health), Ministry of Health & Family Welfare, ...... 6

Address by H.E. Mr Upendra Yadav, Deputy Prime Minister and Minister of Health and Population, Federal Democratic Republic of Nepal...... 8

Address of the WHO Director-General, Dr Tedros Adhanom Ghebreyesus, delivered by Dr Bernhard Schwartländer, Chef de Cabinet, WHO headquarters...... 9

Address by Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia Region...... 10

Address by H.E. Dr Harsh Vardhan, Minister of Health & Family Welfare, Science & Technology and Earth Sciences, Government of India...... 13

Business session...... 16

Opening of the Session...... 16

Credentials of Representatives...... 16

Election of Officebearers...... 17

Adoption of the Agenda...... 18

Key addresses and report on the work of WHO...... 18

Introduction to the Regional Director’s Annual Report on the Work of WHO in the South-East Asia Region covering the period 1 January–31 December 2018.... 18

Address by the Director-General...... 29

Ministerial Roundtable...... 32

Emergency preparedness...... 32

Programme Budget matters...... 40

Programme Budget 2018–2019: Implementation and mid-term review...... 40

Programme Budget 2020–2021...... 43

Report of the Seventy-second Session iii Policy and technical matters...... 47

Annual report on monitoring progress on UHC and health-related SDGs...... 47

Revising the goal for measles elimination and rubella/congenital rubella syndrome control...... 50

Strengthening IHR and health emergency capacities through implementation of national action plans...... 52

Regional Action Plan on Programmatic Management of Latent TB Infection (LTBI) and Global Strategy for TB Research and Innovation...... 55

Regional Plan of Action for the WHO Global Strategy on Health, Environment and Climate Change...... 58

Accelerating the elimination of cervical cancer as a global public health problem.... 63

Regional Plan of Action for Snake-bite Prevention and Control...... 65

Progress reports on selected Regional Committee resolutions...... 67

South-East Asia Regional Health Emergency Fund and Expanding the scope of the South-East Asia Regional Health Emergency Fund (SEARHEF) ...... 68

Antimicrobial resistance...... 70

Patient safety contributing to sustainable universal health coverage...... 72

Challenges in eradication...... 75

Colombo Declaration on strengthening health systems to accelerate delivery of NCD services at the primary health care level...... 76

Traditional medicine: Delhi Declaration...... 80

2012: Year of Intensification of Routine in the South-East Asia Region: Framework for increasing and sustaining coverage...... 81

Governing Body matters...... 83

Key issues arising out of the Seventy-second World Health Assembly and the 144th and 145th sessions of the WHO Executive Board...... 83

Review of the draft Provisional Agenda of the 146th session of the WHO Executive Board...... 86

Elective posts for Governing Body meetings (WHA, EB and PBAC)...... 88

Management and Governance matters...... 89

Management performance and Transformation in the South-East Asia Region...... 89

Evaluation: Annual report...... 90

iv WHO Regional Committee for South-East Asia Status of the SEA Regional Office Building...... 92

Special Programmes...... 94

UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases: Joint Coordinating Board (JCB) – Report on attendance at JCB in 2019...... 94

UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP): Policy and Coordination Committee (PCC) – Report on attendance at PCC in 2019 and nomination of a member in place of Sri Lanka whose term expires on 31 December 2019...... 95

Time and place of future sessions of the Regional Committee...... 96

Adoption of resolutions...... 96

Adoption of the report of the Seventy-second Session of the Regional Committee...... 97

Closing session...... 97

Resolutions and Decisions

Resolutions

SEA/RC72/R1 Delhi Declaration on Emergency Preparedness in the South-East Asia Region...... 101 SEA/RC72/R2 Programme Budget 2020–2021...... 106 SEA/RC72/R3 Measles and rubella elimination by 2023...... 108 SEA/RC72/R4 Regional Plan of Action for the WHO Global Strategy on Health, Environment and Climate Change 2020–2030: Healthy Environments for a Healthier Population...... 111 SEA/RC72/R5 Resolution of thanks...... 146

Decisions

SEA/RC72(1) Review of the draft Provisional Agenda of the 146th Session of the WHO Executive Board...... 147 SEA/RC72(2) Time and place of future sessions of the Regional Committee...... 147

Report of the Seventy-second Session v Annexes

1. Text of welcome address by the Secretary, Ministry of Health & Family Welfare, Government of India...... 148

2. Text of address by the Deputy Prime Minister and Minister of Health and Population, Federal Democratic Republic of Nepal...... 150

3. Text of address by the Director-General of WHO, delivered by the Chef de Cabinet...... 152

4. Text of address by the Regional Director, WHO South-East Asia Region...... 154

5. Text of address by the Minister of Health & Family Welfare, Government of India...... 157

6. Text of introductory remarks by the Regional Director on the Annual Report on the Work of WHO in the South-East Asia Region covering the period 1 January–31 December 2018...... 163

7. Text of address by the Director-General, World Health Organization...... 172

8. Text of concluding remarks at the Closing Session by the Regional Director...... 177

9. Agenda...... 179

10. List of participants...... 182

11. List of official documents...... 199

Vignettes...... 201

vi WHO Regional Committee for South-East Asia 1 Introduction

1. The Seventy-second Session of the WHO Regional Committee for South- East Asia was held at the Hotel Hyatt Regency, in New Delhi, India, from 2 to 6 September 2019. It was attended by representatives of all 11 Member States of the Region, United Nations and other agencies, nongovernmental organizations (NGOs) having official relations with WHO, special invitees as well as Observers.

2. Ms Preeti Sudan, Secretary (Health), Union Ministry of Health & Family Welfare, Government of India, welcomed the participants.

3. Dr Bernhard F. Schwartländer, Chef de Cabinet to the WHO Director- General, Dr Tedros Adhanom Ghebreyesus, addressed the distinguished delegates and delivered the Director-General’s welcome address.

4. In accordance with Rule 13 of the Rules of Procedure of the WHO Regional Committee for South-East Asia, H.E. Mr Upendra Yadav, Deputy Prime Minister and Minister of Health and Population, Ministry of Health and Population of the Federal Democratic Republic of Nepal, who was Vice-Chairperson of the Seventy- first Regional Committee session in New Delhi in September 2018, opened the Session due to the unavailability of the Chairperson of the previous session, Mr J.P. Nadda, the then Union Minister of Health & Family Welfare of India.

5. The Regional Committee unanimously elected His Excellency Dr Harsh Vardhan, Minister of Health & Family Welfare, Science & Technology and Earth Sciences, Government of India, as Chairperson of the Seventy-second Session. The Committee also elected Her Excellency Ms Dechen Wangmo, Minister of Health of the Royal Government of Bhutan, as Vice-Chairperson of the Seventy-second Session.

6. A Drafting Group on Resolutions comprising at least one representative of each Member State of the Region was established, with Dr Viroj Tangcharoensathien, Adviser to the Office of the Permanent Secretary, Ministry

Report of the Seventy-second Session 1 of Public Health, Royal Thai Government, as Convener, and Ms Aishath Samiya, Deputy Director-General, Ministry of Health, Republic of Maldives, as Rapporteur.

7. A Ministerial Roundtable was held with “Emergency Preparedness” as the subject of discussion. H.E. Dr Harsh Vardhan, Union Minister of Health & Family Welfare of the Government of India, chaired the Roundtable.

8. During its Seventy-second Session, the Regional Committee adopted the following resolutions and decisions:

Resolutions  Delhi Declaration on Emergency Preparedness in the South-East Asia Region (SEA/RC72/R1)

 Programme Budget 2020–2021 (SEA/RC72/R2)

 Measles and rubella elimination by 2023 (SEA/RC72/R3)

 Regional Plan of Action for the WHO Global Strategy on Health, Environment and Climate Change 2020–2030: Healthy Environments for a Healthier Population (SEA/RC72/R4)

 Resolution of thanks (SEA/RC72/R5).

Decisions  Review of the draft Provisional Agenda of the 146th Session of the WHO Executive Board (SEA/RC72(1))

 Time and place of future sessions of the Regional Committee (SEA/ RC72(2))

9. The Committee also reviewed the report of the Regional Director on the Work of WHO in the South-East Asia Region covering the period 1 January–31 December 2018.

2 WHO Regional Committee for South-East Asia Report of the Seventy-second Session 3 2 Inaugural session

10. The inaugural function of the Seventy-second Session of the Regional Committee was moderated by international broadcaster Mr James Chau, who is the WHO Goodwill Ambassador for the Sustainable Development Goals and Health since 2016.

11. Mr Chau welcomed all distinguished delegates and honourable ministers, partners, stakeholders and participants, and stated that the day coincided with the Festival of Lord Ganesh (Ganesh Chaturthi) in India. Lord Ganesh is the presiding deity for intellectual pursuit and overcoming obstacles, and this was perhaps a highly appropriate day to begin a WHO Governing Body meeting, he added.

12. One of the overriding objectives of WHO in its seventh decade of existence as the world’s leading specialized agency for health is to secure the health of billions of lives. With nearly two billion people residing in the South-East Asia Region, there are also “a billion opportunities” for the Regional Office and Member States to make a difference in the lives of the people, Mr Chau observed.

4 WHO Regional Committee for South-East Asia 13. The Flagship Priority Programmes of Regional Director Dr Poonam Khetrapal Singh, since their launch in 2014, have shaped the global health architecture, the Goodwill Ambassador said. He congratulated the Regional Director on her re- election for the second term and for making the South-East Asia Region a “results-driven Region”. He also enumerated some of the most significant achievements by Member States during the years of her stewardship: neonatal mortality and maternal mortality have declined across the Region by at least 60% and 70%, respectively; the Region has retained its polio- free status since 2014, and also eliminated maternal and neonatal tetanus; and eight Member States have eliminated one or more of a gamut of communicable and neglected tropical diseases (NTDs), including , , , mother-to- child of HIV and syphilis.

14. Mr Chau stated that, under the leadership of the Regional Director, the WHO

Report of the Seventy-second Session 5 South-East Asia Region has begun to “think ahead of its time”, and set visionary and successful templates on “results, vision and transformation” for others to follow. Speaking of results, several widespread diseases have been eliminated in the Region over the past few years. The Region’s vision is exemplified in areas such as universal health coverage (UHC), antimicrobial resistance (AMR), noncommunicable diseases (NCDs) and the contingency fund for emergencies (South-East Asia Regional Health Emergency Fund or SEARHEF), which is now replicated elsewhere. On transformation, he said that the Regional Director’s science- and evidence-based policies have seen the South-East Asia Region emerge as a “top performer” in the Organization.

15. The inaugural then proceeded with the lighting of the ceremonial lamp in keeping with the traditions of the host nation.

Welcome address by Ms Preeti Sudan, Secretary (Health), Ministry of Health & Family Welfare, Government of India 16. Ms Preeti Sudan, Secretary (Health), Ministry of Health & Family Welfare, Government of India, welcomed the distinguished delegates. She said it was a privilege for India to host, for the second successive year, the Ministerial Roundtable at the Seventy-second Session of the WHO Regional Committee for South-East Asia in New Delhi. She congratulated Dr Poonam Khetrapal Singh on her re-appointment as the Regional Director and termed her “the dynamic lady of India”.

17. Ms Sudan observed that the South-East Asia Region represents a quarter of the world’s population and carries a heavy triple burden of diseases: persisting communicable diseases; rapidly rising incidence of NCDs and emerging infectious diseases; and frequent natural disasters. Consequently, the progress, achievements, initiatives and innovations in the Region will have a significant impact on global health indicators.

18. She expressed confidence that the efforts of Member States, individually as well as collectively, will have the maximum impact on WHO’s “triple billion

6 WHO Regional Committee for South-East Asia target” envisaged in the Thirteenth General Programme of Work (GPW13) 2019–2023. She noted that the topic of “Emergency Preparedness”, chosen for this year’s Ministerial Roundtable discussion, has strong linkages with UHC and the health-related Sustainable Development Goals (SDGs).

19. Ms Sudan stated that India is accelerating the achievement of new milestones in the health-related SDGs under the visionary leadership of the Prime Minister, H.E. Mr , and the decisive actions taken by the Minister for Health & Family Welfare, H.E. Dr Harsh Vardhan, in areas such as immunization; maternal, child and adolescent health; vector-borne disease control; population-based screening for NCDs; and strengthening primary health care through the new health and wellness centres; among others.

20. In the same vein, Ms Sudan referred to the provision of diagnostic, referral and treatment services. These include dialysis; health promotion through emphasis on lifestyle changes and physical activity including yoga; improving the accessibility and affordability of medicines; and institutionalization of disaster preparedness and response. The emphasis on sanitation, hygiene and pollution control is also very important. She particularly mentioned the success of various public health initiatives such as “Ayushman Bharat”, “Fit India”, “Eat Right India”, and “Swachh Bharat”.

21. The Health Secretary noted that the South-East Asia Region has articulated a strong regional voice in the global health agenda, thereby demonstrating its solidarity at various international forums. This has helped shape the global public health agenda. A case in point is the first-ever Regional Statement on “Universal Health Coverage – Leaving no one behind”, which was delivered at the Seventy-second World Health Assembly in Geneva in May 2019.

22. Ms Sudan emphasized that the Regional Committee provides a platform for Member States to further strengthen collaboration in the Region and share experiences for identifying areas of cooperation that will reinforce the common goals and objectives for better health in the Region and the world.

[For the full text of the address, see Annex 1.]

Report of the Seventy-second Session 7 Address by H.E. Mr Upendra Yadav, Deputy Prime Minister and Minister of Health and Population, Federal Democratic Republic of Nepal 23. In his welcome address, H.E. Mr Upendra Yadav, honourable Deputy Prime Minister and Minister of Health and Population of the Federal Democratic Republic of Nepal, who was Vice- Chair of the Seventy-first session of the Regional Committee in New Delhi in 2018, congratulated the Regional Office for organizing the Session. He described the Regional Committee as the “highest political forum in this Region to interact on public health issues and deliberate and share country experiences and determine what needs to be done next”.

24. He expressed pride at the number of ambitious public health milestones achieved by Member States of the Region, where a quarter of the world’s population lives, and which has an even bigger share of the global disease burden.

25. The honourable minister pointed out that each Member State has its own strengths and limitations, and issues and challenges, but also many success stories to share. Emerging infectious diseases and the rise of NCDs are now the biggest challenges posed to health systems. Innovative approaches must be deployed and appropriate and sustained solutions found collectively, he said. The Regional Committee provides a unique opportunity to identify such effective, affordable and acceptable solutions to these common challenges.

26. H.E. Mr Upendra Yadav then outlined the “impressive progress in health outcomes” relative to income levels that Nepal had achieved in the recent past. Life expectancy has steadily improved and great strides have been taken in reducing maternal and child deaths. The recent public health milestones of elimination of trachoma and control of rubella and hepatitis B have demonstrated Nepal’s firm political commitment, the hard work of its frontline health workers, and the unflinching support of WHO and partners.

27. A new National Health Policy was adopted in 2019, with clear goals and targets for the federal, state and local levels of administration. As Nepal is vulnerable to many public health hazards, the minister highlighted the efforts being made to strengthen the country’s national and subnational capacities to better respond to health emergencies.

8 WHO Regional Committee for South-East Asia 28. The honourable Health Minister concluded by congratulating the Regional Director, Dr Poonam Khetrapal Singh, for her visionary leadership, which has guided the Region in achieving a number of public health milestones in recent years. Her dynamic leadership will make it possible to chart many more public health successes in the years ahead, he said. He thanked the honourable Health Minister of India, Dr Harsh Vardhan, and the WHO Regional Office for the excellent arrangements made for the Session.

[For the full text of the address, see Annex 2.]

Address of the WHO Director-General, Dr Tedros Adhanom Ghebreyesus, delivered by Dr Bernhard Schwartländer, Chef de Cabinet, WHO headquarters 29. Dr Bernhard Schwartländer, Chef de Cabinet, WHO headquarters, informed the participants that Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, could not join since he was travelling with the UN Secretary-General to review the Ebola situation in the Democratic Republic of Congo. Dr Schwartländer informed that Dr Tedros would join the meeting later via a video link from Kinshasa. He then delivered the welcome address of the Director-General.

30. On behalf of the Director-General, Dr Schwartländer congratulated Dr Poonam Khetrapal Singh on her reappointment as Regional Director for a second term. Her vision for a more responsive and accountable WHO, and the Regional Flagship Priorities, are showing remarkable results. He commended her outstanding leadership, which is an inspiration not only in the Region but beyond as well.

31. With one quarter of the world’s population, the Region’s successes and challenges have a major impact on global health indicators. He lauded the Region’s long list of achievements in the past five years, including the elimination of polio in 2014, and becoming the second Region to eliminate maternal and neonatal tetanus. Five countries in the Region have eliminated measles and six have controlled rubella.

Report of the Seventy-second Session 9 32. Dr Schwartländer observed that the Region was soon becoming the “disease elimination capital” of the world and listed several other achievements. Thailand was the first country in the world to eliminate mother-to-child transmission of HIV and syphilis; Maldives followed suit in 2019. Maldives, Sri Lanka and Thailand have eliminated ; India is yaws-free; and Nepal has eliminated trachoma. Sri Lanka and Maldives have eliminated malaria and four Member States have controlled hepatitis B.

33. The Chef de Cabinet lauded the Region’s remarkable progress in reducing maternal mortality and under-five mortality. The Democratic People’s Republic of Korea, Indonesia, Maldives, Sri Lanka and Thailand have already achieved the global SDG targets for neonatal and under-five mortality, while Maldives, Sri Lanka and Thailand have achieved the same for maternal mortality. Several Member States have multisectoral plans in place to address NCDs and were moving ahead with the “One Health” approach to combat AMR.

34. Dr Schwartländer expressed satisfaction at the increasing investments in health by Member States and their innovative approaches towards UHC as well as their strong political commitment towards ending tuberculosis (TB). He said that though the Region was no stranger to emergencies of all kinds, it has the capacity to respond to them. It was necessary to strengthen emergency preparedness along with health systems to achieve UHC.

[For the full text of the address, see Annex 3.]

Address by Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia Region 35. Welcoming the representatives of Member States of the WHO South- East Asia Region to the Seventy-second Session of the Regional Committee, Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia, thanked the Government of the Republic of India for hosting the Ministerial Roundtable for the second year in succession. “Your hospitality and your avid interest in health issues are warmly appreciated,” she told H.E. Dr Harsh Vardhan, Union Minister of Health & Family Welfare, Science & Technology and Earth Sciences, Government of India.

36. When the honourable , H.E. Mr Narendra Modi, talks of the need to “strengthen the hands of the poor in pursuit of good health”, he speaks for many in the Region, Dr Poonam Singh said.

10 WHO Regional Committee for South-East Asia 37. At the same time, the Regional Committee is “an occasion to take stock, review progress, discuss and update policies and technical strategies, and to appraise and approve budgets”, she said. But the governance of health, she added, is also about “reaffirming a joint sense of purpose and solidarity between countries”. The Regional Committee’s role as governors of health in this Region requires that “we look beyond our day-to-day concerns, identify emerging challenges and trends, and seek new opportunities to take forward our joint agenda,” she observed.

38. Reminding the distinguished delegates that the world is already five years into the 15-year timeline for the Agenda for Sustainable Development in 2030, she urged Member States to “adopt new ways of working across sectors and silos, if health is to be a real beneficiary and contributor to sustainable development”.

39. Though economic growth brings new opportunities to invest in health, health does not always match the eligibility criteria for external resources. Even in Member States of the Region where external funding represents a small fraction of health spending, priority programmes for immunization, AIDS, TB and malaria often remain dependent on outside sources for funds.

40. “To achieve the triple billion target of the WHO Transformation Agenda, or the UN’s broader reform process, decisive action is needed,” Dr Poonam Singh said. She reiterated the unique challenges that the Region faces across wide- ranging health areas: strengthening the implementation of the International Health Regulations (IHR) 2005; combating NCDs; increasing immunization coverage; the health impacts of climate change; and the Regional Action Plan on latent TB infection (LTBI); among others.

41. Expressing confidence about achieving the deliverables of this agenda, the Regional Director referred to the “solid track record of this Region”. The Flagship Priorities come to the forefront in this context. They have provided targeted

Report of the Seventy-second Session 11 focus and have been responsible for a series of remarkable achievements. These include the advancement of maternal and child health, tackling measles and rubella, and forging ahead with the battle against NCDs, NTDs, TB and AMR. “Updating the Flagship Priorities – which we will do at this Regional Committee – will help ensure continued progress.”

42. Calling the joint regional vision “clear, firm and bold”, Dr Poonam Singh recalled the shared commitment to “sustain achievements, accelerate progress and harness the full power of innovation”, which was reiterated by her during her re-election to the post of Regional Director in 2018. Through this gamut of work to ensure the health and well-being of the people of the Region runs a “golden thread”: “this golden thread, of course, is the pursuit of UHC.”

43. Dr Poonam Singh described UHC as “the defining mission of public health across the world and the bedrock of health policy across the Region”. She congratulated Member States on their significant achievements in its pursuit, including the innovative policies that have enhanced human resources for health, reduced out-of-pocket (OOP) expenditure, strengthened the quality of medical products and services, and increased coverage for all people everywhere.

44. On the Ministerial Roundtable, the Regional Director emphasized that emergency preparedness strengthens health services, and vice versa. The Roundtable would help to grasp the opportunity to accelerate progress as well as boost the potential of innovative mechanisms such as SEARHEF’s emergency preparedness stream.

45. Dr Poonam Singh outlined the principles of continued success in health in the Region. The first is smart and effective governance within the health sector, with a strong emphasis on integrating programmes and services. “Purpose- driven, big-picture thinking must be embraced and applied to even the smallest interventions.” Second, strengthening political commitment beyond the health sector will help achieve UHC better. Third, partnerships have critical importance in moving forward. A majority of health targets and goals can be achieved only when driven by strong and effective partnerships, not only within government but also beyond it. At WHO, the nurturing of partnerships is a key part of the Organization’s work, she added.

46. Dr Poonam Khetrapal Singh concluded by saying that she looked forward to “insightful and productive discussions, and to the rapid advances these will

12 WHO Regional Committee for South-East Asia result in, for the health and well-being of all people across this unique and very diverse Region”.

[For the full text of the address, see Annex 4.]

Address by H.E. Dr Harsh Vardhan, Minister of Health & Family Welfare, Science & Technology and Earth Sciences, Government of India 47. H.E. Dr Harsh Vardhan, Minister of Health & Family Welfare, Science & Technology and Earth Sciences, Government of India, welcomed all delegates and participants saying that this Regional Committee Session was commencing on Ganesh Chaturthi, a very auspicious day for India. He described Ganesh as the “lord of intellect and wisdom and a superspecialist in removing obstacles”. He asked for divine blessings to fight disease and improve health care for all in the Region.

48. H.E. Dr Harsh Vardhan said that India is on the brink of a health-care revolution. The country is firmly committed to achieving UHC as articulated in its National Health Policy, and reaching the target of “Health for All” without compromises.

49. 2014 was a watershed year for public health in India when the Prime Minister H.E. Mr Narendra Modi kickstarted the health-care revolution in the country. The Region was declared polio-free that year. In a country like India with a huge population, this was no small achievement, especially since it had been battling the disease for decades.

50. Health is a top priority for the honourable Prime Minister, Mr Narendra Modi, the minister said. H.E. Mr Modi set the “juggernaut” rolling when he was elected to office and fast-tracked many programmes to set up affordable, inclusive health interventions. In 2018, the path-breaking Ayushman Bharat (“Long Live India”) programme was launched as India’s approach to UHC. The programme aims to address health holistically through its twin components: 150 000 health and wellness centres at the primary level, and the Pradhan Mantri Jan Arogya Yojana (PM-JAY) at the secondary and tertiary levels.

Report of the Seventy-second Session 13 51. More than 20 000 health and wellness centres have already been operationalized across India. These provide an expanded range of primary care services, and access to medicines and diagnostics close to the community. The PM-JAY scheme provides health protection cover to 100 million poor and vulnerable families for secondary and tertiary care, including pre- and post- hospitalization expenses. The scheme provides health coverage of up to Indian Rupee (INR) 500 000 per family per year. So far, over 4.1 million people have benefited from this scheme.

52. The country is continuing efforts to address maternal and child health interventions and improve the quality of care in this area through targeted interventions under the Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) Strategy.

53. Ending -preventable diseases remains another important priority. Immunization coverage is being expanded to 90% of children across the country by intensifying the “Mission Indradhanush” campaign. The range of diseases covered under the Universal Immunization Programme has been increased, with the inclusion of rotavirus, pneumococcal and measles–rubella in routine immunization. India has also intensified efforts towards the elimination of several tropical diseases such as malaria, leprosy, kala-azar and filariasis.

54. The Government of India has taken up several reforms in medical education. A National Medical Commission has replaced the Medical Council of India, which will bring about better standards in medical education. Twenty-one new All India Institute of Medical Sciences (AIIMS)-like institutes are being set up to provide superspecialty tertiary care around the country. In August 2019, another 75 new medical colleges were approved by the Union Cabinet. All these will add several thousand new seats for medical students.

55. In 2018, the Government announced its commitment to end TB by 2025. Several initiatives were launched to accelerate progress towards this ambitious goal. The increase in incidence of NCDs is being tackled through screening, prevention, management and control activities.

56. Malnutrition is a problem in India, caused mainly by unsafe food and poor diets. India is passing through an epidemiological shift from communicable to noncommunicable diseases, and the burden of diet-related diseases – such as diabetes, hypertension and obesity – is rising rapidly. A “food systems approach”

14 WHO Regional Committee for South-East Asia is being undertaken by the Food Safety and Standards Authority of India (FSSAI). A people’s movement called “Eat Right India” – with the tagline “Sahi bhojan, behtar jeevan” (“Eat right for better life”) – has been launched. Indian national Test cricket captain and youth icon Virat Kohli is its mascot.

57. India has begun to leverage digital technology to make health services more accessible. The country is also using artificial intelligence in the health system. On the world stage, India proposed the “Digital Health Resolution” at the Seventy-first World Health Assembly in Geneva in 2018, which was unanimously adopted. India is taking the agenda forward through the Global Digital Health Partnership (GDHP).

58. In August 2019 on National Sports Day, Prime Minister H.E. Mr Narendra Modi launched the “Fit India” movement. This campaign is aimed at encouraging people to include physical activity and sports routinely in their everyday lives. This, along with the “Eat Right India” campaign, will help fight lifestyle diseases such as hypertension, obesity and diabetes effectively.

59. The Indian Council of Medical Research (ICMR) has launched a research platform for emerging and re-emerging diseases. H.E. Dr Harsh Vardhan hoped that other Member States would find the platform useful for sharing research ideas, technical capacities and resources towards the common objective of strengthening research in these areas of health.

60. Recognizing the importance of traditional medicine in the Region, India launched the National AYUSH Mission, of which yoga is an essential component. Prime Minister H.E. Mr Narendra Modi defined yoga as a “free health insurance for all”, he added.

61. The honourable Health Minister concluded by lauding the “personal energy” of the Regional Director, which he said has “contributed significantly” to the health of the people of the Region. He urged the Regional Office to undertake a “mission-mode” approach by not only disseminating policy and technical guidelines but also creating public health success stories from the Region by guiding Member States to better implement their policies and programmes. He invoked an ancient prayer from the Vedas – “Sarve bhavantu sukhinah, sarve santu niramayah” – meaning “let all people be happy and free from disease”.

[For the full text of the address, see Annex 5.]

Report of the Seventy-second Session 15 3 Business session

Opening of the Session (Agenda item 1) 62. In accordance with Rule 13 of the Rules of Procedure of the WHO Regional Committee for South-East Asia, H.E. Mr Upendra Yadav, Deputy Prime Minister and Minister of Health and Population, Ministry of Health and Population, of the Federal Democratic Republic of Nepal – who was Vice-Chairperson at the Seventy-first session of the Regional Committee in 2018 – opened the Seventy- second Session of the Regional Committee due to the unavailability of the Chair of the previous session, Dr J.P. Nadda, former Union Minister of Health & Family Welfare of the Government of India.

63. H.E. Mr Upendra Yadav thanked the Government of India and the WHO Regional Office for South-East Asia for hosting the Ministerial Roundtable and the Regional Committee, respectively. He described the session as “the highest political forum to interact on and share experiences about public health issues in the Region”.

Credentials of Representatives (Agenda item 2) 64. The Committee was informed that in line with Rules 3 and 3bis of the Rules of Procedure of the Regional Committee, the Credentials of the Representatives had been examined by the Chairperson and Vice-Chairperson (of the Seventy- second Session), and that the validity of the credentials of all Representatives of all Member States, including of all alternates and advisers, had been found to be in order. As such, the Regional Committee accepted the credentials of all Member States of the Region as valid.

16 WHO Regional Committee for South-East Asia Election of Officebearers (Agenda item 3) 65. H.E. Dr Harsh Vardhan, Union Minister of Health & Family Welfare, Science & Technology and Earth Sciences, India, was unanimously elected Chairperson, and Her Excellency Ms Dechen Wangmo, Minister of Health of the Royal Government of Bhutan, Vice- Chairperson, of the Seventy- second Session of the Regional Committee.

66. A Drafting Group on Resolutions was also constituted with at least one representative from each of the 11 Member States of the Region to finalize the draft resolutions and decisions for consideration by the Regional Committee. Dr Viroj Tangcharoensathien, Adviser to the Office of the Permanent Secretary, Ministry of Public Health, Royal Thai Government, was appointed Convener of the Group. Ms Aishath Samiya, Deputy Director-General, Ministry of Health, Republic of Maldives, was appointed its Rapporteur.

67. The Chair, H.E. Dr Harsh Vardhan, thanked the distinguished delegates for appointing him Chairperson. He reiterated his government’s commitment to the SDG Agenda and goal “to leave no one behind”. He expressed the hope of Member States of improving the health and well-being of the people of the Region in collaboration with WHO under the dynamic leadership of the Regional Director, Dr Poonam Khetrapal Singh. He welcomed the delegates and partners once again to the Session to deliberate fruitfully on health issues significant to the Region as well as the world.

68. The Director of Programme Management of the WHO South-East Asia Region, Dr Pem Namgyal, then outlined the Agenda for the Session to the distinguished delegates. The Agenda items of the Regional Committee were enumerated. These included the Ministerial Roundtable on emergency

Report of the Seventy-second Session 17 preparedness, and a broad range of policy and technical matters along with progress reports presented on selected Regional Committee resolutions.

69. The Chair invited the delegates to the planned morning physical activity sessions for Tuesday, 3 September 2019, which were to be led by India, and by other Member States on subsequent days. The Committee was also informed that three-minute breaks for mobility exercises would be held every day during the plenary under the theme of “Health for All”. These exercises were to be led by children with special needs from various nongovernmental organizations in Delhi.

Adoption of the Agenda (Agenda item 4, SEA/RC72/1 Rev. 3) 70. The Committee unanimously adopted the Agenda for its Seventy-second Session.

Key addresses and report on the work of WHO (Agenda item 5)

Introduction to the Regional Director’s Annual Report on the Work of WHO in the South-East Asia Region covering the period 1 January–31 December 2018 (Agenda item 5.1, SEA/RC72/2) 71. The Regional Director, Dr Poonam Khetrapal Singh, presented her report on the “Work of WHO in the South-East Asia Region for the period 1 January–31 December 2018”, highlighting the many public health achievements and successes both by the Organization and the Member States during this period,

18 WHO Regional Committee for South-East Asia while reiterating the several challenges and unfinished goals ahead.

72. “We are at a defining moment in public health – globally and regionally. And so, we must also look ahead. The Sustainable Development Goals loom large. We are almost one third of the distance down the road to 2030. WHO’s ‘triple billion targets’ are integral to their achievement,” she said.

73. Under the Transformation Agenda of the Director-General, Dr Tedros Adhanom Ghebreyesus, WHO is putting the principles of the Thirteenth General Programme of Work into practice. With the backing of Member States, the UN Secretary-General’s reforms can transform how the UN system works at the country level, she said, emphasizing that the South-East Asia Region is a committed partner in this endeavour.

74. Moving on to the challenges faced by the Region, Dr Poonam Singh underscored South-East Asia’s crucial role in driving global health successes: “If we are to achieve the goal of a peaceful, prosperous, sustainable and healthy planet, what happens in our Region can make the difference between success and failure.”

75. The Regional Director began her report with one Flagship Priority Programme in particular: UHC. Calling UHC the “bedrock of health policy in all of our countries in this Region”, she said it ensures unity of purpose and an integrated approach to achieving health for all; and it is also an expression of the Region’s concerns for equity, gender equality and human rights. This makes UHC “the single most powerful concept public health has to offer”.

76. Since universality means everyone, including ethnic and religious minorities, migrants and those living on the margins of society, services must be available

Report of the Seventy-second Session 19 and accessible as a right to all, irrespective of gender or sexual orientation. “Leaving no one behind risks becoming no more than a slogan unless we are determined to tackle the toughest issues.” In this context, she added, “new ways of thinking, new ways of acting, hard choices and determined follow-up accompany us on the road ahead”.

77. She first focused on three challenges: to “Sustain, Accelerate, and Innovate”. “While trying to sustain the gains we have made, we must also be wary of reversals: the re-emergence of defeated threats like polio and NTDs; safeguarding precious medicines from antimicrobial resistance; and making sure that people are not forced back into poverty by having to pay for catastrophic health care.”

78. Second, she stressed the importance of “accelerating progress towards the goals and objectives to which we are committed. Interventions need to be scaled up promptly, bureaucratic hurdles that hamper implementation overcome, and partnerships that can turn pilot projects into large-scale social movements nurtured.”

79. Third, there is the need to innovate. Innovation goes beyond harnessing the benefits and mitigating the risks of new technology; it also involves new ways of thinking about familiar problems. “It means abandoning tired ideas that have outlived their utility, devising new and imaginative ways of delivering services; of empowering people to take responsibility for their own health; and of communicating risk at times of crisis.”

20 WHO Regional Committee for South-East Asia 80. Since the needs of Member States in this Region are vast and resources finite, the Regional Director said the Organization has to be “strategic, focusing on where we can make a difference, and catalytic, using our technical and financial resources to facilitate and influence action by others”.

81. The imperative of having choices and being selective defined the eight Regional Flagship Priorities that she announced at the start of her first term as Regional Director in 2014. Elucidating the Flagships, she said: “The Flagships do not cover everything we do, but they focus technical knowledge, convening power and advocacy. They enhance accountability, because we have defined clear-cut deliverables, and they help break down silos, so our work is more effective. Our Flagship Programmes all contribute to the achievement of UHC.”

82. The Regional Director outlined the series of achievements by Member States and the Organization during the period of the review.

83. Victory over polio in 2014 allowed the Region to harness existing infrastructure, including networks of highly skilled health workers, to embark on an ambitious project: eliminating measles and controlling rubella. Rubella vaccine is now part of routine in 10 Member States. By the end of 2018, all Member States had introduced two doses of measles-containing vaccine in their routine immunization programme.

84. In 2018, the Democratic People’s Republic of Korea and Timor-Leste were verified as having eliminated endemic measles. Bhutan and Maldives sustained their elimination status. Sri Lanka then joined this list. Six Member States – Bangladesh, Bhutan, Maldives, Nepal, Sri Lanka and Timor-Leste – are now verified as having controlled rubella and congenital rubella syndrome. Referring to these tangible successes, Dr Poonam Singh expressed confidence that measles and rubella elimination can be added to the Region’s achievements by 2023.

Report of the Seventy-second Session 21 85. Noncommunicable diseases account for around 55% of all deaths in the Region and the figure will increase to 76% in the next decade, with two thirds of these deaths being premature. The commitment to tackle the problem is intense in the Region. The South-East Asia Regional NCD Action Plan has 10 regional targets, each to be achieved by 2025, ranging from a 30% relative reduction in the prevalence of tobacco use in people over 15 years of age to a halt in the rise of obesity and diabetes.

86. The 2016 Colombo Declaration provides momentum by calling for a focus on strengthening health systems to accelerate the delivery of NCD services at the primary level. All Member States have developed multisectoral action plans aimed at implementing a whole-of-society approach to the problem.

87. The WHO Package for Essential Noncommunicable (PEN) Disease Interventions has been implemented in several Member States and is being pursued in others on a pilot basis, Dr Poonam Singh elaborated. The Region is now the global leader in enforcing health warnings on tobacco packs, with Member States such as Nepal and Timor-Leste having the world’s largest graphic health warnings. Almost all of the Region’s Member States are now Parties to the Framework Convention on Tobacco Control. Member States are also increasing taxation on tobacco products, as part of a slew of efforts to address the cancer burden, since tobacco-related cancers account for 22% of all cancer deaths.

22 WHO Regional Committee for South-East Asia 88. Mental health is finally coming out of the policy shadows to be recognized as a priority, with a new legislation enacted in Bangladesh being a stellar example. There are also strategies for eliminating cervical cancer, a largely preventable disease.

89. The Regional Director mentioned the immediate goals in the road ahead for combating NCDs: eliminating trans-fats, reducing salt content of food and promoting exercise through health-informed urban development.

90. On the targets for the Millennium Development Goals (MDGs) 4 and 5 on ending preventable maternal, newborn and child deaths, intense focus has led to all but one of the Region’s Member States achieving the MDG 4 target by 2016. In the same period, neonatal mortality has been reduced by 54% in the Region. Globally, only nine countries have achieved a 75% reduction in maternal mortality, three of which are from the South-East Asia Region. The Region has also eliminated maternal and neonatal tetanus, a significant achievement.

91. There is now intense attention on ensuring that every newborn survives the first 28 days of life. The Democratic People’s Republic of Korea, Indonesia, Maldives, Sri Lanka, and Thailand have already achieved the SDG targets for neonatal and under-five mortality. Maldives, Sri Lanka and Thailand have done the same for maternal mortality.

92. Referring again to the overarching goal of UHC, Dr Poonam Singh said about 800 million people across the Region still do not have full coverage of essential health services. About 16% of the population are spending more than 10% of their total income on catastrophic health expenditure and 3% of the population are pushed into poverty every year due to exorbitant out-of-pocket expenditure on health.

93. The Region accords priority to increasing the number, quality and skill-mix of health

Report of the Seventy-second Session 23 workers and enhancing access to essential medicines. The South-East Asia Regulatory Network (SEARN) has helped harmonize regional cooperation on medical product regulation so that all drugs and medical devices produced and sold in the Region are safe and accessible.

94. This Region has been a pioneer in tracking progress towards UHC. Using agreed international norms, three Member States – Bhutan, Sri Lanka and Thailand – are now above the global median level for service coverage and financial protection. Indonesia and Timor-Leste are just below the median for financial protection, but above it for service coverage. Spending more to achieve better health is a political choice, and nine Member States have increased their health budgets recently.

95. The Regional Director referred to AMR as one of the world’s greatest threats to the control of communicable diseases, as well as to overall health security. The Region has been proactive in controlling AMR: as early as in 2011 came the Jaipur Declaration on Antimicrobial Resistance. AMR was made a Flagship Priority in 2014 and the Regional Committee passed a resolution on the prevention and control of antimicrobial resistance in 2015.

96. These joint efforts are paying off. By 2018, all 11 of the Region’s Member States had developed national action plans to address and monitor AMR. Surveillance of AMR has improved with nine Member States enrolling in the WHO-led Global Antimicrobial Resistance Surveillance System (GLASS).

24 WHO Regional Committee for South-East Asia 97. Since the Region is highly susceptible to acute public health emergencies from floods, cyclones and earthquakes, as well as human-induced threats and outbreaks, efforts continue to scale up capacity development in emergency risk management. Over the past decade, the Region accounted for approximately 27% of all global mortality due to disasters.

98. Dr Poonam Singh said that the South-East Asia Regional Health Emergency Fund (SEARHEF), as well as the globally acclaimed “12 Benchmarks for Emergency Preparedness and Response”, have served the Region well. “The creation in 2016 of the WHO Health Emergencies Programme at the global level has complemented and accelerated what we have been able to do. In 2016, a decision was made to expand the Regional Health Emergency Fund to invest in preparedness, not just response,” she said.

99. Ultimately, preparedness and response capacities can truly be tested only in real time. The response to Nepal’s devastating earthquake in 2015, and to the many floods, cyclones and earthquakes that have occurred since then, are testimony to the joint progress in the Region. So too is the ongoing response to the influx in 2017 of hundreds of thousands of vulnerable people into Cox’s Bazar, Bangladesh.

Report of the Seventy-second Session 25 100. Dr Poonam Singh then drew the attention of the distinguished delegates to the many opportunities that can yield cascading gains in public health in the Region. Strengthening epidemiological and laboratory surveillance is one. Emergency medical teams (EMT) are an important part of the global health workforce. Building their capacity is critical; Thailand became the first country in the Region to have a WHO- classified Type 1 Medical Emergency Response Team.

101. Finishing the job on diseases on the verge of elimination comes high on the agenda. Several NTDs – leprosy, visceral leishmaniasis, schistosomiasis and lymphatic filariasis – have been selected for elimination, and yaws for eradication, by 2020. These diseases are included in the Flagship Priorities.

102. In 2016, India was declared yaws- free. Maldives and Sri Lanka eliminated lymphatic filariasis as a public health problem. Thailand was validated for the elimination of lymphatic filariasis. In 2018, Nepal became the first country in the Region to be validated for the elimination of trachoma. By the end of 2018, the elimination target for kala-azar was achieved in all endemic districts in Nepal and most upazilas in Bangladesh, and 93% of blocks in India. Indonesia has meanwhile reduced the prevalence of schistosomiasis to very low levels.

103. Every year, millions of people across the world continue to fall sick and die from TB. The Region accounts for 44% of TB incidence globally and 50% of associated mortality. Drug resistance has emerged as a major challenge. “Since the Flagship Programme on TB was launched in 2017, we have improved notification, decreased mortality and doubled the budget allocation for TB,” she added.

26 WHO Regional Committee for South-East Asia 104. The Region has galvanized political commitment through the 2017 “Delhi Call for Action” and the 2018 “Statement of Action”. It was well represented at the first United Nations General Assembly High-Level Meeting on Tuberculosis. All Member States are now pursuing key targets aligned with the goal of ending TB by 2030. Some are aiming to end TB before that – Maldives by 2022 and India and Sri Lanka by 2025.

105. The Regional Director then drew attention to the three pillars of her policy for overcoming the challenges ahead: “Sustain... Accelerate... Innovate…”. Health services do not stand in isolation from all the other factors that determine whether people live long and healthy lives, she said. The creation and nurturing of partnerships at multiple levels is also important.

106. Dr Poonam Khetrapal Singh, in conclusion, stated that the level of health and well-being of almost two billion people living in the Region “is better now than ever before”. Amid the recurring challenges, WHO will achieve the goals it sets for itself by insisting on strong, responsive leadership and creating partnerships that fuel fresh and innovative thinking about primary health care services, health systems quality and financing strategies.

[For the full text of the address, see Annex 6.]

107. Delegates congratulated the Regional Director for her comprehensive and informative report, which highlighted the remarkable improvements brought about in the status of public health and well-being of the people of the Region at both regional and country levels. They expressed their appreciation, and said that they looked forward to Dr Poonam Singh’s continued commitment and dedication to her clearly outlined priorities for accelerating public health successes in the years ahead.

Report of the Seventy-second Session 27 108. Representatives of Member States unanimously acknowledged the visionary and dynamic leadership of the Regional Director and lauded the successes achieved by her Flagship Priority Programmes since 2014.

109. Member States also highlighted their individual public health achievements and the sustained elimination of several diseases from many countries during 2018.

110. Member States highlighted the successes achieved in specific areas. These ranged from the introduction of human papillomavirus (HPV) vaccine for girls, curbs on tobacco advertising, and building the resilience of health systems to climate change in Maldives; the continued successes of the comprehensive, primary health care-based Saude na Familia programme in Timor-Leste; taxation on alcohol and the national salt reduction strategy in Sri Lanka; promotion of newborn care through the “1000 golden days” initiative and enhanced surveillance for cervical cancer in Bhutan; the extension of comprehensive basic health insurance to more than 200 million people or 80% of the population with the dedicated deployment of more than 23 000 health service providers in Indonesia; and 90% coverage of DPT3 and polio immunization in Nepal; among others.

28 WHO Regional Committee for South-East Asia 111. The distinguished delegate from Bangladesh mentioned a recently launched UHC-based pilot scheme on health risk protection for poor people to reduce out-of-pocket (OOP) spending in that country.

112. India reiterated its government’s strong commitment to the Ayushman Bharat programme to promote UHC holistically through the twin components of more than 150 000 health and wellness centres and a new national health insurance scheme that aims to cover 500 million people and is one of the largest such schemes in the world.

113. The honourable minister from Myanmar lauded the Regional Director’s Annual Report for its comprehensiveness and precision, stating that it would serve as an excellent template for health workers and strategists in his country. He emphasized that the report would be very useful to learn about the many innovative initiatives that Member States in the Region are implementing.

114. The Committee also congratulated H.E. Dr Harsh Vardhan for his nomination as Chairperson and H.E. Ms Dechen Wangmo for her nomination as Vice-Chairperson of the Seventy-second Session of the Regional Committee.

Address by the Director-General (Agenda ítem 5.2) 115. Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, addressed the distinguished delegates via weblink. He said it was “a great honour” to be talking with the delegates and expressed regret for not being there in person. Dr Tedros began by congratulating his “sister”, Dr Poonam Khetrapal Singh, on her re-election for another term as Regional Director of the South-East Asia Region.

116. Dr Tedros appreciated the achievements made by five Member States in the Region – Bhutan, DPR Korea, Maldives, Sri Lanka and Timor-Leste – which have eliminated measles; and six Member States – Bangladesh, Bhutan, DPR Korea, Maldives, Sri Lanka and Timor-Leste – which have controlled rubella. He lauded the fact that, since 2000, vaccination rates have increased significantly across the Region, leading to a 75% reduction in mortality due to measles. “By the end of 2019, an estimated 400 million children will have been protected against measles and rubella by a vaccine,” he added.

Report of the Seventy-second Session 29 117. The Director-General said that Member States of the Region are “leading the way and showing what is possible” at a time when four Member States in Europe have lost their measles elimination status. He said that “instead of eliminating measles and controlling rubella by 2020, this week you will consider a new goal to eliminate both diseases by 2023, which will require you to address challenges including immunity gaps, suboptimal surveillance and inadequate financing”. Dr Tedros said that he himself is a “firm believer in setting ambitious targets that force us to stretch almost to breaking point”. He assured the full support of the Secretariat in working towards a South-East Asia Region that is free of measles and rubella.

118. Dr Tedros also expressed satisfaction with the progress made towards the elimination of cervical cancer as a public health problem, which like measles and rubella is an entirely preventable disease. “In 2018, almost 100 000 women lost their lives to cervical cancer in the Region.” He said that WHO has launched a global initiative to eliminate cervical cancer. He congratulated Bhutan, Maldives, Sri Lanka and Thailand for introducing the HPV vaccine nationally. He said that WHO is committed to working with Member States and vaccine manufacturers to ensure that all women have access to HPV vaccine.

119. Dr Tedros congratulated Member States for the way the Region has responded to emergencies in the recent past, such as Cyclone Fani in India and Bangladesh, earthquakes and tsunamis in Indonesia, floods and landslides in Myanmar, an outbreak of Nipah virus in India, and the ongoing humanitarian crisis in Cox’s Bazar, Bangladesh. He remarked that the “Flagship Priority on emergency risk management initiated by the Regional Director is bearing fruit”, and Cyclone Fani is “a perfect example of this”.

120. The Director-General underlined that “countries that invest in emergency preparedness will save lives and save money”. He said that the resolution on

30 WHO Regional Committee for South-East Asia the Delhi Declaration on Emergency Preparedness adopted by the Regional Committee on 3 September 2019 is a “vital step forward towards making the Region safer for all its people”. Dr Tedros appreciated the progress made on emergency preparedness. He said that “eight of the 11 Member States have completed joint external evaluations, and (their) core capacities under the International Health Regulations have improved significantly over the past decade”. He congratulated Thailand on becoming the first country in the Region with a WHO-classified EMT.

121. Dr Tedros reminded Member States that with “half of all deaths from tuberculosis globally in the Region”, it demands the same urgent response as an outbreak or natural disaster. He said that following the High-Level Meeting on TB at the UN General Assembly in 2018, he wrote to Heads of State and Heads of Government of 48 countries with the highest TB burden, urging them to accelerate country action to meet the End TB targets. He added that the “Regional Action Plan on Latent TB Infection estimates the investments needed to find and treat all those who need it.” He said that with these investments “more than 1.3 million cases of TB would be averted, and more than 84 000 lives would be saved. The long-term gains in terms of treatment costs avoided and increased productivity would be huge.”

122. Dr Tedros pointed out that while there are signs of declining tobacco use, there are rising levels of alcohol consumption, rising levels of obesity, and a projected rise in people with hypertension. He said that WHO is committed to supporting Member States to address each of the challenges faced by them.

123. In conclusion, the Director-General emphasized the following three points: First, he urged Member States to mobilize domestic resources to invest in primary health care, which is not only the foundation for achieving UHC but also the foundation for making progress on measles and rubella; cervical cancer; emergency preparedness; TB and more. He suggested that one of the key ways all countries can mobilize resources is by “raising taxes on tobacco products, alcohol, sugar-sweetened beverages and other products that harm health”.

124. Second, he urged Member States to invest in emergency preparedness. “The joint external evaluations have shown where the gaps are. Now all countries must act decisively to close those gaps. And we call upon the international community to provide support in closing the gaps.”

Report of the Seventy-second Session 31 125. Third, he reminded Member States that the High-Level Meeting on Universal Health Coverage in New York in September 2019 is “a vital opportunity to catalyse political commitment”. “We need as many Heads of State or Government present as possible. I urge you to do everything you can to make sure your leaders are there in New York to show their commitment to universal health coverage.”

126. Dr Tedros thanked the delegates for their commitment and assured them of his continued support.

[For the full text of the address, see Annex 7.]

Ministerial Roundtable (Agenda item 6)

Emergency preparedness (Agenda item 6.1) 127. The Ministerial Roundtable on Emergency Preparedness was chaired by H.E. Dr Harsh Vardhan, Minister of Health and Family Welfare, Government of India with Dr Roderico Ofrin, Regional Emergency Director at the Regional Office, as moderator. The Chair welcomed everyone to the Roundtable. He mentioned that during the Regional Committee in 2018, deliberations were held on some specific actions related to emergency preparedness in the Region, which resulted in the Regional Committee resolution SEA/RC71/R5 on “Strengthening Emergency Medical Teams in the South-East Asia Region”.

32 WHO Regional Committee for South-East Asia 128. The Chairperson described this as a unique opportunity to discuss emergencies with a larger scope. Building on several successful interventions by Member States to strengthen emergency preparedness and enhance the resilience of populations requires sustained effort and investments. Adequate political and financial commitment to risk-informed development planning is yet to be garnered. It is in these areas that further innovation and action is required for comprehensive preparedness capabilities to be in place. He suggested that this session be used to share experiences and how to move forward.

129. At the invitation of the Chair, Dr Ofrin gave a brief overview with the aid of a video presentation of the situation in this Region of 1.9 billion people, and the challenges they face from natural disasters and outbreaks and associated risks. Added to these are unplanned urbanization and other human-induced disasters. He described the year 2004 as the turning point for emergency preparedness in the Region due to the severity of the tsunami. He gave a snapshot of the lessons learnt and achievements of Member States since then.

130. The moderator then invited the WHO Assistant Director-General for Country Health Emergency Preparedness at WHO headquarters, Dr Jaouad Mahjour, to speak on global efforts in preparedness. Dr Mahjour noted that 100% of Member States from the SEA Region had used the new self-assessment-based State Parties Annual Reporting (SPAR) tool in 2018 to report on their emergency preparedness. He said that globally, only one third of all countries were prepared to face emergencies. Countries with higher national incomes were likely to be better prepared, perhaps due to the availability of increased domestic funding.

131. However, managing health emergencies and preparedness are critical for all Member States, irrespective of their economies. Country capacity for reporting on the IHR, 2005 needs to be improved. More emphasis needs to be placed on

Report of the Seventy-second Session 33 scaling up preparedness. He concluded by mentioning that one of the outcomes of the Thirteenth General Programme of Work was to have one billion people better protected from health emergencies.

132. The moderator explained that the session was divided into three segments to enable the ministers of health to share their country experiences on different aspects of preparedness. First, a short video clip was shown of the announcement of a severe cyclone in a fictitious country by a news anchor. The Health Ministers/ Deputy Health Ministers of Bangladesh, Democratic People’s Republic of Korea and India then presented their experiences of how steps taken for preparedness helped them to tackle cyclones in their respective countries, and how with improved preparedness, whether it be in the meteorological sciences or health systems resilience, they were able to drastically reduce the number of injuries and fatalities.

133. The second segment dealt with disease outbreaks. The Health Ministers/ Deputy Health Ministers of Indonesia, Nepal, Sri Lanka and Thailand described their experiences of battling the after-effects of various outbreaks and lessons learnt from these and consequently the changes that were introduced in their countries.

134. The third segment concerned the issue of rumours. A video clip showed how rumours circulate through social media and cause chaos and misunderstanding. An important lesson from this exercise was that provision of timely and accurate

34 WHO Regional Committee for South-East Asia information is key to preventing such alarm. Correct information should be disseminated by authoritative sources through government websites, the WHO website, government and WHO social media applications, and through newspapers and television. India, Maldives and Myanmar described their experiences in dealing with rumours at such times.

135. The honourable Health Minister of Myanmar suggested that Member States could learn from other countries. During an emergency or immediately after it, representatives from some Member States could go to the affected country and observe or learn from its experience in dealing with such events. He stressed the importance of regular communication on radio and television during emergencies. He mentioned that strengthening the surveillance system was key and synchronized coordination efforts were needed during an emergency. To help health workers in remote parts of the country, Myanmar has distributed several thousand tablet devices on which all guidelines and standard operating procedures are available at the touch of a button.

136. Bhutan and Timor-Leste updated the Committee on how they had integrated emergency preparedness in their respective national development plans.

137. The Committee acknowledged the need to shift focus from “managing public health emergencies” to “managing risks” to make the Region resilient and strengthen emergency preparedness. There is a need to ensure political support for and financial commitment to emergency preparedness in the Region.

138. Member States expressed concern over the menace of adverse effects of climate change and their impact on the epidemiological patterns of vector- borne diseases, zoonoses, emerging and re-emerging diseases, and on food safety in the Region.

Report of the Seventy-second Session 35 139. Dr Lara Andrews, Assistant Director of the Centre for Health Security, Department of Foreign Affairs and Trade, Government of Australia, mentioned the efforts made by her government to understand how Australia could contribute to the Region’s agenda. Australia is finalizing funding for projects across the Region and for applied research on health systems strengthening. The country is also working at the global level for outbreak response and providing funds for the WHO Health Emergencies Programme.

140. Dr Meghna Desai, Country Director for India of the US Centers for Disease Prevention and Control (CDC), Atlanta, spoke about CDC’s global health security efforts in the Region. CDC has provided a four-month public health management training at its headquarters in Atlanta for fellows in various countries of the Region. In 2012, it established the Epidemic Intelligence Service Programme in India. CDC is providing direct support to UN and national agencies to build public health management operational capacities and help India build capacity at points of entry.

141. The Chef de Cabinet, Dr Bernhard Schwartländer, lauded all the work done in the Region that would help to keep the world safe. The proposed Delhi Declaration on Emergency Preparedness has emphasized the need for very strong political commitment in the Region. He added that preparedness for airborne outbreaks presented another big challenge since these could spread around the world very rapidly. It is important to consider cultural beliefs when dealing with communities. Communities should be informed, educated on and involved to

36 WHO Regional Committee for South-East Asia prepare for an outbreak during the time when there is no outbreak or emergency, he said. It is equally, if not more, important to invest funds on preparedness efforts.

142. In response to the discussion, the Regional Director noted that two issues were very clear. The Region had a range of public health emergencies, and it also had a lot of experience in this. All Member States could share knowledge and learn from each other. Lessons learnt exercises are organized after every disaster and experts are called to offer advice and assistance. She suggested that guidelines be condensed to one-page essentials so that they could be easily consulted at times of emergencies. The second issue is understanding the importance of risk communication and addressing it.

143. The Region has moved forward a great deal since the 2004 tsunami. The Regional Director highlighted the important role played by SEARHEF in dealing with the immediate aftermath of an emergency. It has helped to tide over 39 emergencies since its inception in 2008. She explained why she had made emergency health management a Flagship Priority.

Report of the Seventy-second Session 37 144. Dr Poonam Singh said that she considered each emergency as an opportunity to learn. She gave a few examples of such instances and how they had helped during an emergency. After the Nepal earthquake, the retrofitted hospitals were still standing, while the other health facilities had collapsed. The Region was now trying to sustain the gains made and she appreciated the commitment shown by Member States. The thrust was to ensure that every country is prepared. This could be assessed through the benchmarks, which have been universally accepted, including in other regions.

145. For outbreaks, IHR (2005) is the key. Self-assessments have been done by all Member States, and joint external evaluations have been completed in eight. She appreciated the camaraderie between countries and looked forward to more innovation in the Region.

146. The Chairperson then moved the Delhi Declaration on Emergency Preparedness for adoption. The motion was carried unanimously. A unique signing ceremony followed, in which all delegates pressed a button together and an electronic copy of the “Delhi Declaration on Emergency Preparedness in South-East Asia Region” appeared on the screen with their digital signatures.

147. The moderator then invited the Chairperson, Vice-Chairperson, Regional Director and Chef de Cabinet to launch a publication titled INVISIBLE, The Rohingyas: The crisis, the people and their health. Photographs from the

38 WHO Regional Committee for South-East Asia publication were displayed on the screen and all delegates were ceremoniously handed a copy each.

148. The Regional Director and the Chef de Cabinet then presented Thailand with an award for becoming the first WHO-certified Type 1 Emergency Medical Team (EMT). This team can now be deployed internationally.

149. The Chairperson concluded the Ministerial Roundtable by giving an overview of what India had achieved in this field since the tsunami of 2004. He said that climate change is leading to extreme weather events and sudden onset of natural disasters. The earlier concept of disaster risk mapping is rapidly getting blurred with large sections of hitherto unexposed population becoming vulnerable to natural and human-induced hazards. This calls for requisite system strengthening. For India, a country of huge magnitude, addressing the multiplicity of hazards is a critical challenge.

150. Stating that SEARHEF has been an example of fostering solidarity among Member States in the Region as seen in many emergencies, and responding to the request for further budgetary support, H.E. Dr Harsh Vardhan, on behalf of the Government of India, announced a contribution of US$ 200 000 towards the preparedness stream of SEARHEF. He welcomed Member States to utilize the fund through WHO to further strengthen risk reduction initiatives that need to be put in place to make this Region’s population less vulnerable to hazards.

151. H.E. Dr Harsh Vardhan presented all delegates with a copy of his book A tale of two drops, which is the story of in India. He recalled that he had first dreamt of a polio-free India in 1993 when he had assumed the office of Minister of Health in the Government of the Union Territory of Delhi.

Report of the Seventy-second Session 39 152. With the discussions concluded, the Chairperson moved to adopt the Delhi Declaration on Emergency Preparedness in the South-East Asia Region. The motion to adopt the Declaration was carried unanimously. A formal signing ceremony followed with all the distinguished delegates in attendance affixing their electronic signatures. The Director-General and Regional Director also added their signatures on behalf of WHO.

153. The Committee adopted resolution SEA/RC72/R1 on “Delhi Declaration on Emergency Preparedness in the South-East Asia Region”.

154. With this, and with appreciation for the active participation of the honourable Ministers, the Chair declared the Ministerial Roundtable closed.

Programme Budget matters (Agenda item 7)

Programme Budget 2018–2019: Implementation and mid-term review (Agenda item 7.1, SEA/RC72/4, Inf. Doc. 1) 155. The Committee thanked the Secretariat for a comprehensive report on the “Programme Budget 2018–2019: Implementation and mid-term review”, and appreciated the significant health achievements made in the Region in various technical programmes, particularly in polio eradication, NCDs, communicable diseases and emergencies.

156. The Committee was also informed that the subject of Programme Budget 2018–2019, its implementation and mid-term review, had been extensively

40 WHO Regional Committee for South-East Asia deliberated upon during the High-Level Preparatory (HLP) Meeting and the Meeting of the Sub-Committee on Policy and Programme Development and Management (SPPDM) in New Delhi in July 2019. The HLP and SPPDM meetings had made recommendations for the consideration of the Seventy-second Session of the Regional Committee. The Committee accepted these recommendations of the HLP and SPPDM meetings.

157. The Committee expressed satisfaction that the SEA Region is the first among the regions in terms of utilization against allocated Programme Budget (75%) and utilization against distributed resources (82%). Considering that this is the last quarter of this biennium, several Member States urged the Secretariat to continue to accelerate efforts towards sustained implementation while ensuring quality.

158. The Committee also noted the collaborative efforts between the Member States and WHO country offices to implement and translate the new strategy and the Thirteenth General Programme of Work into concrete plans of action.

159. The Committee was pleased to note the full funding of the approved Programme Budget 2018–2019, due to sustained resource mobilization efforts in the Region. The Committee acknowledged the support extended to Member States by the Regional Office by increasing allocation of total resources to the WHO country offices to 77%, while retaining only 23%.

160. The Committee appreciated the Secretariat’s efforts on sustained monitoring and evaluation leading to strong compliance with respect to indicators. The Region reported that 98.6% of the Top Tasks were on track for achievement by the end of the biennium. Some Member States shared the joint monitoring practices with the WHO country offices along with efforts to ensure that there were no overdue DFCs.

Report of the Seventy-second Session 41 161. The Committee applauded the steady progress in the eight Regional Flagship Priority Programmes and suggested a holistic review of the WHO health programmes while harnessing the advantages of digitization and technology.

162. Noting the concern expressed by a Member State on its low level of implementation owing to various factors resulting from the sanctions imposed by the United Nations, the Committee recommended the need for realistic planning and implementation.

163. Commending their collaborative efforts, the Secretariat assured Member States of concerted monitoring and implementation efforts guided by the principle of “value for money”. This has been evident from the progress made since the reporting at the SPPDM Meeting in July 2019. The Region has been performing well above global averages, it was observed.

164. The Secretariat informed that despite prevailing factors, viz. government transitions, decentralization and UN sanctions on one Member State, there has been an endeavour to constantly improve technical and financial performance. The Secretariat also informed Member States that only 33% of the Region’s expenditure is attributed to staff costs, which is less than the global average.

165. The Secretariat expressed its appreciation for the cooperation extended by Member States in ensuring timely and quality implementation of various health-related programmes and their strong pursuit in monitoring agreed results as well as financial compliance. The Secretariat assured full support to ensure “value for money”. There was close monitoring on how much is being spent and on what, and it was expressed that this will help in better reporting. While implementation rates are well above average in the Region, close attention was also paid to the quality of implementation.

166. The Committee requested the WHO Secretariat to provide information on how much money was allocated for the following: research, health information systems, capacity-building of health workers, the Flagship Priorities and inter-country activities. In this connection, the Committee was informed that the implementation reports and mid-term reviews show utilization against available resources classified by Programmatic Categories and budget centres. Furthermore, allocation and utilization of resources against country priorities and regional Flagships are monitored. To date, more than 80% of the technical

42 WHO Regional Committee for South-East Asia and financial resources are devoted to the Flagship Priorities to drive impact at the country level with a focus on the “value-for-money” approach.

167. The Committee noted that there was a need for the Regional Office and Member States to continue to work closely, be sensitive to time limitations and ensure adequate coordination with new and existing donors, to sustain the high levels of financial implementation of the Programme Budget.

Programme Budget 2020–2021 (Agenda item 7.2, SEA/RC72/5, Inf. Doc. 1, Inf. Doc. 2, Inf. Doc. 3) 168. The Committee was informed that the Programme Budget 2020–2021, approved by the Seventy-second World Health Assembly in May 2019, is the first Programme Budget that fully articulates the implementation of GPW13 and marks a major step forward in the Transformation of WHO. It provides a framework for WHO’s action to achieve the “triple billion” targets of GPW13 and address the health-related targets of the SDGs.

169. The overall approved Budget for 2020–2021 is US$ 4840.4 million, of which US$ 388.5 million was approved as the Base Budget for the South-East

Report of the Seventy-second Session 43 Asia Region (with a US$ 99.7 million increase compared with Programme Budget 2018–2019). In line with the GPW13’s integrated, health systems and results-oriented approach, the allocation of the Budget for 2020–2021 is at the strategic priority level.

170. Programme Budget 2020–2021 presents the new WHO Results Framework, which outlines how results will be monitored and measured from outputs to impact. As requested in the Seventy-second World Health Assembly appropriation resolution for the Programme Budget 2020–2021, the GPW13 Results Framework will be finalized in consultation with Member States for presentation to the Executive Board in February 2020.

171. Member States appreciated that the focus of the GPW13 and Programme Budget 2020–2021 is on results and Member States, and the integrated and systems approach required to achieve GPW13 and SDG targets. They also appreciated the collaborative approach used by the Secretariat to develop Programme Budget 2020–2021 with Member States, including prioritization and joint planning exercises. Member States recommended early approval of workplans to start implementation as soon as the new biennium begins and committed themselves to continue working with the Secretariat to finalize the draft workplans.

44 WHO Regional Committee for South-East Asia 172. Member States noted the considerable increase in the Budget allocated to the Region and commended the same. It was pointed out that continued collaboration with Member States, synergy among the three levels of the Organization, and resource mobilization for agreed priorities are key to implementing the new Programme Budget. Member States also appreciated the specific Budget allocation to improve country capacity in data and innovation. They reiterated the importance of this area and the need to strengthen capacity in metrics and data analysis. The need to secure financing for emergencies was also highlighted.

173. On the GPW13 Results Framework, Member States acknowledged the progress made and welcomed the focus on impacts and outcomes as well as the new balanced scorecard for the measurement of outputs. They emphasized the need to define realistic indicators and to avoid duplication in monitoring and reporting. Concerns were also expressed about the proposed annual reporting. Member States appreciated the opportunity to provide inputs and stressed the need to participate actively in the finalization of the GPW13 Results Framework. Some Member States expressed their interest in testing the Results Framework in their countries, including the new proposed UHC index, which incorporates measurement of effective coverage.

174. The Secretariat thanked Member States for their continued engagement in the development of Programme Budget 2020–2021 and their recommendations and commitment to ensure that a robust GPW13 Results Framework is developed. Member States were informed about the next steps to finalize the GPW13 Results Framework prior to presenting it to the Executive Board in February 2020. These steps included discussions with SEA Region Member States on the sidelines of the Regional Committee at a Side-event on 4 September, a consultation with country technical experts from across WHO in October, and a briefing with Member States in November 2019.

175. Dr Poonam Singh highlighted that joint planning and identification of priorities with Member States has been a “tradition” in the SEA Region. Identifying country needs and defining WHO’s work based on these needs has been an essential component of the planning mechanism of the Regional Office. For Programme Budget 2020–2021, in addition to the individual country consultations, the planning focal points of the ministries of health, WHO

Report of the Seventy-second Session 45 Representatives and technical staff in the Regional Office were brought together at a regional meeting to ensure that country needs were optimally reflected in the country support plans (CSPs).

176. The Regional Director informed the Committee about the advanced stage of workplans for 2020–2021 and efforts to ensure that they are approved and funded before end-December 2019. She stressed the importance of the need to strengthen country offices and pointed out that besides the increased Budget to countries, funds from the regional Budget are also used to assist Member States.

177. The Committee adopted resolution SEA/RC72/R2 on “Programme Budget 2020–2021”.

178. Mr Sampath De Seram, Regional Representative to the UN from the International Organisation of Good Templars (IOGT), welcomed the new focus in the Region on country delivery and impact, and commended Member States for the priority given to preventing and reducing health risk factors such as alcohol and tobacco. Given that the relative contribution to death and disease in the Region from such risk factors will only increase in the coming years, awareness of this health and development threat is a necessary start, he said, noting that risk factor reduction is a priority programme in the Region.

179. IOGT called upon Member States to (i) prioritize action on health risk factors across all three “triple billion” targets; (ii) ensure adequate funding to address alcohol and other health risk factors in the light of evidence showing that for every US$ 1 invested in alcohol prevention best buys brings a return of US$ 9; and (iii) strengthen technical capacity at the country level to protect against alcohol industry interference.

46 WHO Regional Committee for South-East Asia Policy and technical matters (Agenda item 8)

Annual report on monitoring progress on UHC and health-related SDGs (Agenda item 8.1, SEA/RC72/6) 180. The Committee was informed that at its Seventieth session in 2017, vide Decision SEA/RC70(1), the Regional Director was requested to “include an annual report on monitoring progress on UHC and health-related SDGs as a substantive Regional Committee Agenda item until 2030”. The latest publication, titled Monitoring progress on universal health coverage and the health-related Sustainable Development Goals in the South-East Asia Region, 2019, highlights the Regionwide progress made on UHC in Member States and the SDGs’ indicator profiles based on the available data. The annual report of 2019 includes a special focus on NCDs. The 2019 report, for the first time, includes a section on primary health care services because of the renewed focus on PHC that emerged with the 2018 Astana Declaration on Primary Health Care. The Declaration commemorated the fortieth anniversary of the historic International Conference on Primary Health Care at Alma-Ata that had led to the Declaration of Alma-Ata in 1978.

181. The Committee commended the annual report of 2019, and noted that in addition to tracking, the South-East Asia Region is the only Region reporting progress towards UHC and the health-related SDGs annually with the best and latest data available.

Report of the Seventy-second Session 47 182. The Committee reiterated the linkages between achieving UHC and progress towards SDG 3 and the GPW13 triple billion targets and emphasized that PHC service delivery is key to success. The overall progress on essential health service coverage was noted, and that Member States have made significant progress on this score since 2010. Financial protection remains an issue with high OOP expenditure being a significant barrier to affordable care.

183. The Committee noted the status vis-à-vis UHC and policies, plans and initiatives under way to accelerate progress in achieving the 2030 targets in the Region. Examples include multiple Member States highlighting their recent health reforms, implementation of essential services packages, use of innovative financing schemes and increased coverage of health insurance, as well as strengthening the availability, accessibility and quality of service delivery at the primary health care level or frontline health services. Several Member States underscored the importance of their UHC monitoring mechanisms in the progress towards SDG 3.

184. Many important health concerns and priorities were raised by the Committee, including the rising epidemic of NCDs, particularly those due to increased tobacco use and alcohol consumption. It was noted that the 2019 report provides additional analysis and emphasizes NCD risk factors, care-seeking behaviour and access to services. The Committee took note of the progress made

48 WHO Regional Committee for South-East Asia in averting mother and child mortality as well as steps towards eradication of diseases, including the goal of several Member States to end TB ahead of the regional target deadlines.

185. The Committee stressed that achieving UHC and the SDGs requires collaboration with all sectors/ministries and that political support was critical. Wider involvement of stakeholders, including NGOs, and working effectively with WHO, were equally important. Member States in the Region should be prepared to actively engage in the UHC event at the highest levels during the United Nations General Assembly on 23 September 2019.

186. The Regional Director said it was very encouraging to see the progress being made across all Member States on UHC. She informed the Committee that the Region has developed a forecast of the levels of coverage of essential services that Member States are projected to achieve by 2030. She reiterated the importance of reducing OOP expenditure, improving the quality of health care, addressing NCDs with greater resolve, and continuing with the gains being made with reproductive, maternal, neonatal, child and adolescent health (RMNCAH) and infectious disease initiatives.

187. Dr Chandrakant S. Pandav, Regional Coordinator of the Iodine Global Network (IGN), pointed out that though there has been steady progress in iodized salt coverage in the SEA Region, there is a need to “sustain, accelerate and innovate” the ongoing progress towards universal salt iodization.

188. He emphasized that to ensure “last mile” coverage and sustainability, universal salt iodization may be implemented as part of an evolving national food fortification strategy. Regulatory monitoring of universal salt iodization must be integrated into a broader food safety and standards control system. He added that, as endorsed by the Sixty-sixth World Health Assembly, salt iodization and salt reduction are compatible public health interventions. He also informed that 10 of the 11 Member States of this Region have achieved adequate iodine intake as per standard parameters and are on the verge of eliminating iodine deficiency disorders.

189. Dr Ratna Devi, Chair of the Board of Trustees (South-East Asia Region) of the International Alliance of Patients Organizations (IAPO) – an international alliance of over 260 patients’ organizations with members in over

Report of the Seventy-second Session 49 70 countries – drew the attention of the delegates to the projections of essential service coverage for 2030 based on the rates of progress since 2010. Only five Member States are likely to achieve more than 80% universal health coverage by 2030 at current rates unless there is significant acceleration, she observed. Member States were urged to accelerate progress towards 100% coverage of safe, quality and accessible UHC by 2030.

190. Mr Sampath De Seram, Regional Representative to the UN from IOGT, presented a statement at the end of the discussions on this Agenda item. He offered three suggestions towards reaching UHC and the health-related SDGs for all by 2030 in the Region: (i) institute a pivot for prevention of health risk factors; (ii) enable the provision of early identification and comprehensive care packages addressing co- and multi-morbidities; and (iii) consider health spending as an investment.

191. Mr De Seram said that alcohol and tobacco adversely affect health systems with respect to the parameters expressed in 13 of the 17 SDGs. Thus, prevention should be emphasized to reach UHC and achieve the health-related SDGs. Secondly, health workers should be empowered to identify, help and support people affected by co- and multi-morbidities. Thirdly, health spending should be considered an investment in human capital, which will build community resilience and strengthen societies and their economies.

Revising the goal for measles elimination and rubella/congenital rubella syndrome control (Agenda item 8.2, SEA/RC72/7) 192. The Committee was informed that at its Sixty-sixth session in 2013, it had adopted resolution SEA/RC66/R5, in which the Region had committed itself to the goal of measles elimination and rubella/congenital rubella syndrome (CRS) control by 2020. A Strategic Plan for Measles Elimination and Rubella/ CRS Control in the South-East Asia Region 2014–2020 had been developed for providing strategic technical guidance to achieve the goal. The Committee appreciated that since then, five Member States in the Region had eliminated measles while six had controlled rubella and CRS.

193. The Committee endorsed the recommendations of the high-level consultation on measles and rubella (March 2019), the Regional Immunization Technical Advisory Group meeting (July 2019) and the Regional Verification Commission (2018) to revise the goal to “measles and rubella elimination by

50 WHO Regional Committee for South-East Asia 2023” and recommended this for adoption as a resolution and endorsed the “Strategic Plan for Measles and Rubella Elimination in WHO South-East Asia Region: 2020–2024”.

194. The Committee urged all Member States, donors and partners to mobilize political, societal and financial support for full implementation of the proposed strategies outlined in the Strategic Plan.

195. The Committee urged WHO to provide high-quality, focused technical support to Member States to develop and implement measles and rubella elimination policies and strategies, support mobilization of the required resources for measles and rubella elimination, and to report to the Regional Committee every year until 2023 on the status of progress. The importance was highlighted of a focused involvement of the existing resources available for national polio surveillance in Member States, which could be used to provide intensive support for achieving measles and rubella elimination.

196. The Regional Director congratulated Member States on the progress made and highlighted the accelerated increase in coverage of the first dose of measles-containing vaccine from 63% in 2000 to 89% in 2018 and the second dose of measles-containing vaccine from 3% to 80% during the same period. The Regional Director complimented Member States for vaccinating an unprecedented number of 366 million children with measles and rubella vaccine

Report of the Seventy-second Session 51 all over the Region since January 2017. She appreciated that all Member States in the Region have at least one proficient national laboratory to support measles and rubella case-based surveillance. The measles–rubella laboratory network has expanded from 23 laboratories in 2013 to 50 in 2018 with 41 laboratories accredited as “proficient” for measles and rubella testing.

197. The Regional Director mentioned that she was aware of the requirement for additional financial resources and expressed confidence that the Region would be able to deliver on the revised goal. She assured Member States of technical support to accelerate progress towards achieving the goal. The Regional Director emphasized the central role of respective governments both at the national and subnational levels to ensure political will, programmatic support and domestic resource mobilization to achieve the target of measles and rubella elimination by 2023.

198. At the end of the session, a publication titled Measles Elimination and Rubella Control in the WHO South-East Asia Region was launched.

199. The Committee adopted resolution SEA/RC72/R3 on “Measles and Rubella Elimination by 2023”.

Strengthening IHR and health emergency capacities through implementation of national action plans (Agenda item 8.3, SEA/RC72/8 Rev.1) 200. The Committee noted the progress made in the implementation of the IHR (2005) in the Region. Since 2016, there has been 100% compliance with the

52 WHO Regional Committee for South-East Asia use of the SPAR tool, eight Member States have completed their joint external evaluations (JEEs), five Member States have completed after-action reviews (AARs), seven have developed national action plans for health security (NAPHS) and two Member States have conducted simulation exercises (SimEx).

201. The Committee noted the weak areas in which IHR core capacities need to be strengthened: zoonoses, food safety, health service provision, risk communication, points of entry (ports, ground-crossings and airports), and preparedness for and management of chemical, biological and radionuclear (CBRN) events.

202. The Committee also noted that the five-year Regional Strategic Plan to Strengthen Public Health Preparedness and Response (2019–2023) will serve as a guide for strategies and national action plans of Member States to be aligned with country-specific priorities for achieving health security. The Regional Knowledge Network of IHR national focal points (NFPs) and domain experts will provide an enabling online environment for continuous building of health emergency capacities through peer-to-peer learning and knowledge-sharing.

203. The Committee urged Member States to continue building the capacity of IHR NFPs through strengthening and interlinking them with new and existing networks (for example, Regional Knowledge Network of IHR NFP+, Global Outbreak Alert and Response Network, Public Health Emergency Operations Centre Network and Rapid Response Teams Network).

204. It was also emphasized that to accelerate improvement in IHR implementation and further strengthen health emergency capacities, Member States should allocate adequate resources for their national action plans, and engage stakeholders within the country to mobilize funds for preparedness.

205. The Committee sought support for and commitment to the “One Health” approach to ensure multisectoral collaboration for minimizing health risks before these become threats to humans, animals and plants. This could be achieved by organizing national bridging workshops on IHR Performance of Veterinary Services pathways.

206. The Committee appreciated the support provided by WHO and looked forward to its continued guidance in improving the implementation of the IHR

Report of the Seventy-second Session 53 monitoring and evaluation framework with a focus on uptake of voluntary tools as well: AARs, SimEx and JEEs for more objective assessments of IHR core capacities. It was also observed that the JEE, being voluntary, is not a part of the IHR (2005).

207. The Committee urged WHO to mobilize resources, garner the support of and foster partnerships with the key IHR stakeholders in the Region for implementation of the Regional Strategic Plan (2019–2023) and establish a “core group” of representatives from Member States to support governance and sustenance of the Regional Knowledge Network.

208. It was emphasized that effective implementation of national action plans requires sufficient resources, a strongly networked and strengthened community of IHR NFPs, and ready-to-be deployed national EMTs and rapid response teams. This would help improve IHR implementation, reduce the national and regional burden of infectious disease outbreaks, and make the Region more resilient and prosperous.

209. Professor Taslim Uddin of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, representing the International Society of Physical and Rehabilitation Medicine, pointed out that in disaster management, there has been greater focus on health-related rehabilitation services. However, there is an unmet need: (i) to strengthen rehabilitation capacity at the national level; (ii) to foster an environment of self- empowerment of EMTs and local health services; and (iii) to develop well-defined coordination mechanisms in disaster-affected areas for rehabilitation work.

54 WHO Regional Committee for South-East Asia 210. At the end of the session, two publications by the Regional Office were launched. These were the Five-year Regional Strategic Plan to Strengthen Public Health Preparedness and Response (2019–2023), and Risk Communication Strategy for Public Health Emergencies in the WHO South-East Asia Region: 2019–2023.

Regional Action Plan on Programmatic Management of Latent TB Infection (LTBI) and Global Strategy for TB Research and Innovation (Agenda item 8.4, SEA/RC72/9, Inf.Doc.1) 211. The Committee recognized that the WHO South-East Asia Region bears nearly half the global burden of incident TB cases and more than a third of the LTBI burden. This is starkly disproportionate to the population of the Region, with only about 26% of the global population living here. The current response to the TB situation in the WHO SEA Region needs to be accelerated urgently if significant progress is to be made towards achieving the End TB targets.

212. The Committee reiterated that “Accelerating efforts to End TB by 2030” is a WHO SEA Regional Flagship Priority. To make a substantial dent in the TB epidemic, preventive treatment needs to become a key priority, in addition to accelerating TB case-finding. To align with the global commitments made by Member States at the UN High-Level Meeting on TB in September 2018, the SEA Region needs to reach and treat at least 10 million people with LTBI by 2022. This will require urgent and rapid scaling up of access to preventive treatment.

213. The Committee noted that the Regional Office, in consultation with Member States, technical partners, community representatives and experts, has drafted a Regional Action Plan for scaling up the programmatic management of LTBI.

214. The Committee observed that an estimated 15 million people were eligible for preventive treatment in the Region as per the WHO guidelines on LTBI (as of 2018). They are those who were likely to be recently infected and had the highest probability of going on to develop active TB disease. It was felt that treating this pool of people living with recently acquired TB infection will help to reduce the incidence of TB by an additional 12%–15% per year. If the coverage of this intervention is rapidly scaled up within the next three years, it will prevent more than 1.3 million new TB cases in the Region and avert more than 2.3 million

Report of the Seventy-second Session 55 disability-adjusted life years (DALYs) by 2025. The Committee recognized that, with cost reduction of new and safer drugs, preventive treatment will become highly cost effective, with less than US$ 400 per DALY averted.

215. The Committee noted that activities have been scaled up to improve detection, prevent TB and achieve the respective country targets in alignment with the targets of the End TB Strategy by 2030. Updated WHO guidelines have been adopted, taking into consideration e country-specific issues, including feasibility and economic benefits.

216. Member States requested WHO to continue providing technical support for adapting the guidelines to the national context. These guidelines need to advocate TB control and prevention measures, overcome clinicians’ reluctance to prescribe drugs and remove the perception of a high pill burden by patients.

217. Capacity-building in Member States will be required along with advocacy aimed at demand generation. WHO support was requested for access to affordable and quality-assured anti-TB drugs, including those needed for the preventive treatment of LTBI. Member States emphasized the need for health systems strengthening and multi-stakeholder engagement, including community members, for successful implementation of new endeavours.

218. Member States said that while LTBI is one of the strategic priorities, additional resources would be needed from WHO for preparing advocacy documents and materials to further the cause. Commensurate resource mobilization would be required from the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and other sources.

219. The Committee acknowledged the need to focus preventive treatment on people living with HIV/AIDS, children under five years of age, and other household contacts.

220. The Committee expressed the need to identify the gaps as well as other factors such as strengthening health systems to promote a holistic approach to reach all TB-infected people and provide early intervention.

221. The Committee reiterated that laboratory capacity, active case detection and management, and multisectoral coordination should continue to be improved. Continued technical support for this was requested by Member States.

56 WHO Regional Committee for South-East Asia 222. The importance of conducting nationwide TB campaigns and active case-finding was stressed. Member States emphasized the need for an uninterrupted supply of medicines for preventive treatment, drug-susceptible TB and drug-resistant TB (DR-TB). The Committee also suggested that there could be collaboration with research institutions to develop affordable alternatives to drugs for DR-TB. Member States were committed to establishing regional research and data-sharing platforms to address the issues of emerging and re- emerging diseases such as TB.

223. The Committee endorsed the Regional Action Plan and urged that its tenets be included in national TB control plans and strategic action plans.

224. The Committee expressed satisfaction that the draft “Global Strategy for TB Research and Innovation” has undergone an open consultation process, inviting comments from Member States, civil society and other partners, and the comments have been duly incorporated. The Committee then endorsed the draft “Global Strategy for TB Research and Innovation”. This Strategy aims to support efforts by Member States to accelerate TB research and innovation by setting clear objectives and priorities for advancing the science required to end TB.

225. An animation film on the importance of preventive treatment that emphasized the human angle was screened. Following this, the publication titled South-East Asia Regional Action Plan on Programmatic Management of Latent TB Infection was launched.

Report of the Seventy-second Session 57 Regional Plan of Action for the WHO Global Strategy on Health, Environment and Climate Change (Agenda Item 8.5, SEA/RC72/10) 226. The Committee noted that significant progress has been made in the WHO SEA Region in addressing the environmental determinants of health, particularly relating to improvements in drinking water and sanitation, strengthened advocacy and engagement for addressing the health impacts of climate change. These determinants are underpinned in the Malé Declaration on Building Health Systems Resilience to Climate Change adopted by the Seventieth session of the Regional Committee in 2017.

227. The Committee acknowledged that by taking a more urgent, cohesive and integrated set of actions, more than one quarter of all premature deaths and DALYs in the Region can be averted, which can be attributed to environmental risks (3.8 million or 28% of all deaths and 24% of all DALYs).

228. The Committee acknowledged that the Region faces a double burden of threat to health from the environment and climate change. Traditional and newly emerging environmental risks, each with specific vulnerabilities, are both serious risks. Such risks may increase with social and economic development and, if unaddressed, may erode the substantial public health gains made in the control of vector- and waterborne diseases, NCDs, among others.

229. A new WHO Global Strategy on Health, Environment and Climate Change was announced by the Seventy-second World Health Assembly in May 2019. Consistent with and amplifying the themes of GPW13, the Global Strategy sets out an integrated approach covering all relevant environmental determinants and provides the framework for the transformation needed to improve lives and well-being through healthy environments.

230. The Committee noted that a Regional Plan of Action to implement the Global Strategy on Health, Environment and Climate Change has been developed for consideration following a series of regional consultations. The Regional Plan of Action does not intend to duplicate the Global Strategy but to operationalize it, focusing on those actions that are needed from the national and regional perspectives of the SEA Region.

231. All Member States welcomed the proposed Regional Plan of Action and the leadership shown by the Regional Director in its formulation. The Plan was

58 WHO Regional Committee for South-East Asia endorsed as presented, with the additional inclusion of drought in Section C1.1.5. The Committee was informed that the Regional Plan would be amended as per the suggestions made.

232. The Committee expressed the need for transformational change in the way that environmental risks are tackled. The need for strengthening the capacity and leadership of the health sector was widely acknowledged to fulfil its key role in developing strong public health standards for natural resources such as clean air and water, as well as for safe, health-promoting built environments. These include workplaces, homes and communities. The need to support health protection and promotion for workers and consumers and promote healthier lifestyle choices for all was also highlighted. Collaborating with other sectors was necessary to ensure evidence-based assessments of health risks and health benefits of plans and polices. It was also necessary to ensure that health and well-being are optimized in all development choices.

233. The four strategic actions of the Regional Plan of Action, namely, (i) scaling up primary prevention; (ii) building cross-sectoral action, governance, political and social support; (iii) strengthening the health sector; and (iv) enhancing the evidence base and risk communication; were welcomed by the Committee.

234. The Committee highlighted the need for partnerships and interdepartmental and intersectoral cooperation in activities such as those using the One Health approach on AMR; NTDs and water, sanitation and hygiene (WASH); infection prevention and control and WASH; and environmental and chemical aspects of emergencies and the IHR (2005) being given as examples of areas where initiatives are ongoing.

235. The Committee underscored the special features of the Region, which helped to determine the priorities for action, particularly to reduce the vulnerability of the health system to climate change and to protect vulnerable populations such as the informal sector workforce, children and outdoor workers, and the health-care workforce itself.

236. Member States informed that they would use the Regional Plan of Action to help develop their own national plans of action for health, environment and climate change. In doing so, continued technical support from WHO would be needed, particularly in areas such as risk communication, situational

Report of the Seventy-second Session 59 analysis, vulnerability assessment and in establishing coordination mechanisms; intercountry cooperation and resource mobilization. The need for tools to strengthen the evidence-base was highlighted, particularly for embedding environmental risks in integrated disease surveillance systems, and for linking environment, health and climate data, and technical assistance for green, healthy and resilient health-care facilities.

237. Member States requested WHO’s support in health systems strengthening and building capacity for situational analysis, health vulnerability assessment for various environmental risk factors, development of model “Green Hospitals” and appropriate plans to combat climate-sensitive diseases.

238. The Committee unanimously adopted resolution SEA/RC72/R4 endorsing the “Regional Plan of Action for the WHO Global Strategy on Health, Environment and Climate Change 2020–2030: Healthy Environments for a Healthier Population”.

239. The Regional Director released the publication SDG3 and beyond: healthier environments for healthier populations in the Sustainable Development Goals. The publication provides a snapshot of progress and challenges in, and case studies from, the Region to demonstrate how action on the health-related aspects of six key SDGs that lie outside the health sector’s traditional purview is essential for good health and well-being.

60 WHO Regional Committee for South-East Asia 240. The Chairperson reiterated the importance of a whole-of-government, cultural and societal awareness of the links between environment and health and drew attention to an initiative in India designed to improve “Green Social Responsibility” by promoting daily “Green Good Deeds, Practices and Behaviours”, which could be implemented at individual and societal level to help sustain and fuel the transformative change needed. Before the agenda item ended, three Bodhi tree saplings were presented to the Regional Director.

241. The Chairperson informed the Committee that these saplings would be planted in the grounds of the new WHO Regional Office Building. “The Bodhi tree is also called the tree of enlightenment and, as these saplings grow into trees, they will signify our commitment to continue contributing towards global and regional efforts to mitigate the effects of climate change,” he added.

242. Dr Subhash Chander Bhan, of the Indian Meteorological Department, speaking on behalf of the World Meteorological Organization (WMO), commented on global warming and the effects of greenhouse gas, and re- affirmed the need for accelerated actions on this front. He complimented WHO’s leadership role to address climate change and environmental health risks through the Regional Action Plan. Dr Bhan informed that a new five-year workplan developed jointly by WMO and WHO on climate, health and environment will enhance relevant research, weather and climate service delivery, and capacity for global health applications, which will complement the Regional Action Plan.

243. Dr Bhan also highlighted the collaborative opportunities across the Region to strengthen early warning systems, extreme weather and climate events, improved air quality monitoring and forecasting, capacity-building and health applications that will help national meteorological services and ministries of health to strengthen climate resilience.

244. Mr Atul Bagai, Head of the India Country Office of the UN Environment Programme (UNEP), said that the world was not on track to achieve international agreed environmental targets of the SDGs. Transformative changes were required by formulating and implementing integrated policies. Air pollution was a leading cause of NCDs.

245. Mr Bagai informed that UNEP had joined the WHO Regional Office on the “Healthy Environments for a Healthier Populations – Regional Plan of Action” with

Report of the Seventy-second Session 61 the commitment to establish an expanded regional ministerial forum on health and environment for the Asia-Pacific region. This forum was agreed upon at the fourth Ministerial Meeting of the Regional Forum for Environment and Health in South-East and East Asian countries. These issues of global significance call for concerted and decisive action from both the health and environment sectors. There was a need to continue to strengthen the collaboration beyond ministries and agencies, since this was the thread that tied SDGs together, he said.

246. Dr Arundati Muralidharan of Water Aid International welcomed the focus on access to safe WASH to reduce mortality rates in the Region, and the emphasis on improving WASH in communities and institutions, including health-care settings. Water Aid supported strong monitoring systems, promoted climate-resilient health-care systems, scaled-up action on the quality of water supplies and ensured safely managed sanitation and hygiene to support sustained health outcomes. Member States and WHO were urged to further develop political and social support for the issue and also to ensure that the indicators were designed to track action for the most vulnerable populations.

247. Ms Louise Baker of the United Nations Convention to Combat Desertification (UNCCD) in a written statement said that humans obtain more than 99% of their food calories from land, and therefore desertified and degraded land poses a high risk of malnutrition from an overall reduction in food supply and nutritional value of food because of micronutrient depletion in the soil. Lack of diversity in food production and consumption from monocropping, and soil and water pollution from excessive use of pesticides are among the challenges of modern times, with 820 million people undernourished globally and two billion affected by micronutrient deficiency.

248. Ms Baker added that there are problems associated with airborne pollutants, especially resulting from desertification/drought-induced sand and dust storms or wildfires. Action to protect health is needed at every stage. The provision of essential ecosystem services should be assured and sustained. At the same time, public health systems will need to adapt to a changing world and to the reality of shifting disease burdens caused by climate change, desertification, land degradation and drought if they are to support human health and well-being.

62 WHO Regional Committee for South-East Asia Accelerating the elimination of cervical cancer as a global public health problem (Agenda Item 8.6, SEA/RC72/11) 249. The Committee noted that cervical cancer is a significant public health problem in the WHO SEA Region, and is the third most common type of cancer. The Committee highlighted that cervical cancer elimination is a priority under the Regional Director’s Flagship Programme of “Prevent and control noncommunicable diseases through multisectoral policies and plans with a focus on best buys”. The Global Call to Action towards the elimination of cervical cancer as a public health problem reflects the importance accorded to this issue by the WHO Director-General.

250. The 144th session of the Executive Board requested the WHO Director- General to draft a global strategy to accelerate cervical cancer elimination for the period 2020–2030 for consideration by the 146th Session of the Executive Board and the Seventy-third World Health Assembly in 2020.

251. The Committee noted that the draft Global Strategy on Elimination of Cervical Cancer proposed that the elimination threshold is the age-adjusted incidence rate of less than 4 per 100 000 women-years. This is possible only by the end of the century. The interim targets are: 90% of girls are fully vaccinated with the HPV vaccine by 15 years of age; 70% of women are screened with a high-precision test at 35 and 45 years of age; and 90% of women identified

Report of the Seventy-second Session 63 with cervical cancer receive treatment and care by 2030. It is feasible for the Region to achieve these targets.

252. The Committee noted that significant progress has been made by Member States in the Region towards the elimination of cervical cancer as a public health problem and achievement of the interim global targets by 2030.

253. Member States highlighted the importance of an uninterrupted supply of the vaccine to ensure that two doses of the vaccine can be provided to the target age groups. Issues of availability and affordability of the HPV vaccine were also raised, as there are only two manufacturers of the vaccine worldwide. Member States planning to introduce the HPV vaccine were urged to take a decision on the timing of introduction of the vaccine at the earliest to allow sufficient lead time for manufacturers to supply the required quantities. Gavi-eligible countries need to submit applications at the earliest. Member States transitioning from Gavi support can obtain the vaccine at the Gavi-negotiated price from the United Nations Children’s Fund (UNICEF), which is less than the market price.

254. Screening and treatment of pre-cancerous lesions have been initiated in all Member States of the Region and screening has been included in essential service packages or UHC packages in several countries. Member States are using cytological tests (Pap smear) and visual inspection of the cervix with acetic acid (VIA) for screening of cervical cancer in national programmes. A few Member States are using an HPV DNA test for screening.

255. The Committee highlighted that the HPV DNA test is too expensive for a population-based screening programme. Therefore, the Committee requested WHO to consider pooled procurement of screening test kits at an affordable cost.

256. The Committee also noted the necessity of updating regional implementation of guidance on the prevention and management of cervical cancers. It emphasized linkage to relevant national plans by strengthening focus on primordial, primary, secondary and tertiary preventive strategies to address cervical cancer control as an integrated, comprehensive plan that includes prevention through vaccination, early detection and management.

257. Member States proposed pooled procurement of the vaccine, which would be beneficial for long-term sustainability and ensure a reduction in the

64 WHO Regional Committee for South-East Asia cost of the vaccines. The Secretariat informed the Committee that, apart from Gavi-funded UNICEF procurement, the only example of pooled procurement is that by the Pan American Health Organization (PAHO) of vaccines for routine immunization in the Americas. Such a mechanism has not been tested in the SEA Region but could be explored to see its feasibility. In the current situation of limited availability of the vaccine, priority for receiving the vaccine should be given to girls.

258. In a written statement, the Union for International Cancer Control (UICC), representing 61 cancer organizations across the South-East Asia Region, appreciated the proactive commitment of the Region to cervical cancer elimination and recognized the leadership role of WHO in this endeavour. The growing burden of cervical cancer in the Region makes action imperative.

259. UICC urged Member States to integrate cervical cancer prevention and control with other key services, such as those for HIV and sexual and reproductive health, and ensure that cervical cancer services are included within national UHC service packages. It emphasized the role played by civil society organizations in strengthening the implementation of cervical cancer programmes and services, and offered to support national action in this area in the Region.

Regional Plan of Action for Snake-bite Prevention and Control (Agenda Item 8.7, SEA/RC72/12) 260. The Committee noted that snake-bite is responsible for substantial mortality and morbidity in developing countries, including in Member States of the WHO South-East Asia Region.

261. Recently, WHO added snake-bite to its list of neglected diseases to enhance advocacy and request Member States to initiate appropriate steps to mitigate the impact of this preventable condition. It is an important medical emergency and cause of hospital admission.

262. In 2018, the Seventy-first World Health Assembly adopted resolution WHA71.5 on “Addressing the burden of snake-bite envenoming”, while on the sidelines of the Seventy-second World Health Assembly in May 2019, “Snake-bite Envenoming – A strategy for prevention and control” was launched.

Report of the Seventy-second Session 65 263. At the High-Level Preparatory Meeting in July 2019, Member States requested the Regional Office to develop a “Regional Plan of Action on Snake- bite Prevention and Control” to help them strengthen their capacity to prevent, control and effectively manage snake-bites. It would be based on the Global Strategy but focus on regional needs.

264. The WHO SEA Region is one of the world’s most affected regions due to the widespread agricultural activities, presence of numerous venomous snakes, lack of community awareness and fragmented health-care services, especially in peripheral and hard-to-reach areas. Owing to the Region’s large population, which is a little over a quarter of the world’s population, its many farming communities and the presence of venomous snakes, snake-bite envenoming is the cause of tens of thousands of deaths every year.

265. The Region started working in this area from 1999, when a special issue of the South East Asian Journal of Tropical Medicine was published on the management of snake-bites. This was revised and published as an independent document in 2016 with new technical advances in this area of work. The Queen Saovabha Memorial Institute (QSMI) in Thailand is the WHO Collaborating Centre on snake venom and toxicology. The Regional Office has supported Member States in strengthening their capacity and providing snake antivenom, characterization of biological products, molecular cloning of venom and studies on haematology, with the help of the WHO Collaborating Centre.

266. All Member States appreciated the proposal for drafting the evidence- based Regional Plan of Action on Snake-bite Prevention and Control in line with the WHO Global Strategy (2019). Member States expressed their commitment to the Plan and their concern regarding the absence of data to assess the magnitude of the problem for preparation of national plans of action.

267. Member States also emphasized the inclusion of snake-bite in the curriculum of medical staff. Some Member States have the capacity to meet their requirement of snake antivenom but others need help to build local capacity and ensure that adequate snake antivenom is stockpiled. In addition to the availability of snake antivenom, there is a need for ancillary treatment, training of medical staff and necessary facilities such as equipment and medicines based on needs.

66 WHO Regional Committee for South-East Asia 268. Member States reiterated the need for transfer of technology and sharing of success stories to improve the coverage of hard-to-reach populations and provide them with the best possible treatment to reduce the mortality and morbidity caused by snake-bites. Lack of awareness among communities and the use of traditional treatment causes more harm than good. Thailand shared its success story in controlling the problem and reducing the mortality from snake-bite to zero from over 2000 snake-bites as per the most recent data.

269. The Regional Plan of Action on Snake-bite Prevention and Control will cover advocacy, awareness, community empowerment, appropriate and accessible treatment for snake-bite victims, strengthening of health-care services at each tier of the health services, and collaboration among various stakeholders as mentioned in the global “Snake-bite Envenoming – A strategy for prevention and control”.

Progress reports on selected Regional Committee resolutions (Agenda item 9, SEA/RC72/13, Add.1 and Add.2) 270. The attention of the Committee was drawn to the eight Progress Reports on Regional Committee resolutions that were on the Agenda. These were:

(i) South-East Asia Regional Health Emergency Fund (resolution SEA/ RC60/R7) (Agenda item 9.1); (ii) Expanding the scope of the South-East Asia Regional Health Emergency Fund (SEARHEF) (resolution SEA/RC69/R6) (Agenda item 9.2); (iii) Antimicrobial resistance (resolution SEA/RC68/R3) (Agenda item 9.3); (iv) Patient safety contributing to sustainable universal health coverage (resolution SEA/RC68/R4) (Agenda item 9.4); (v) Challenges in polio eradication (resolution SEA/RC60/R8) (Agenda item 9.5); (vi) Colombo Declaration on strengthening health systems to accelerate delivery of NCD services at the primary health care level (resolution SEA/RC69/R1) (Agenda item 9.6); (vii) Traditional medicine: Delhi Declaration (resolution SEA/RC67/R3) (Agenda item 9.7); and

Report of the Seventy-second Session 67 (viii) 2012: Year of Intensification of Routine Immunization in the South- East Asia Region: Framework for increasing and sustaining coverage (resolution SEA/RC64/R3) (Agenda item 9.8).

271. The Chairperson drew the attention of the distinguished delegates to the Working Paper on this Agenda item numbered: SEA/RC72/13, SEA/RC72/13 Addendum 1 and SEA/RC72/13 Addendum 2.

272. The Committee also noted that the HLP Meeting in July 2019 had discussed all these items individually and made recommendations on each of the Progress Reports through its report SEA-PDM-41 for consideration by the Seventy-second Session of the Regional Committee.

South-East Asia Regional Health Emergency Fund (Agenda item 9.1, SEA/RC60/R7) and Expanding the scope of the South-East Asia Regional Health Emergency Fund (SEARHEF) (Agenda item 9.2, SEA/RC69/R6) 273. The Committee appreciated the concept, management and implementation of SEARHEF, established in 2008. It reiterated that the Region is vulnerable to emergencies caused by various hazards. The Committee noted that the Secretariat had supported an external evaluation of the utilization and impact of SEARHEF. The key findings of the evaluation – covering the first 10 years – highlighted the pivotal role of the Fund in providing immediate financial support (money released within 24 hours) for the first three months following a disaster occurring in a Member State to meet urgent health needs, support emergency field operations and fill in critical funding gaps.

274. The Committee endorsed the recommendations of the external evaluation, particularly the development of a monitoring and evaluation framework for SEARHEF. The Committee also took note that since its inception, the Fund has provided an immediate and flexible response to 39 emergencies in nine Member States of the Region.

275. In the current biennium (2018–2019), SEARHEF has supported four emergency operations: (i) to establish a laboratory in Cox’s Bazar, Bangladesh, for undertaking basic diagnostics for the displaced Rohingya population; (ii) to provide support towards the establishment of mobile clinics in Rakhine State, Myanmar; (iii) to provide essential health services to the affected population

68 WHO Regional Committee for South-East Asia and to address the health needs of the flood-affected population in North and South Hwanghae provinces in DPR Korea; and (iv) to support deployment of mobile clinics and provide snake antivenom for flood-affected populations in Myanmar. Till date, SEARHEF has disbursed a total of US$ 6.07 million.

276. The Committee appreciated the voluntary contribution of US$ 200 000 by India to the preparedness stream of SEARHEF, established by resolution SEA/RC69/R6, and sought further contributions from Member States. Member States already in receipt of funds from the preparedness stream appreciated the catalytic effect of these funds to fill critical gaps in disease surveillance, build capacity for rapid response teams and put in place emergency operations centres. Member States reaffirmed their active role in the SEARHEF Working Group to support the efficient management of the Fund.

277. The Secretariat also thanked Member States for their appreciation of the SEARHEF initiatives. SEARHEF became a success because it was guided by a vision and Member States deserved all the credit for its success. Member States needed to work together in solidarity to help countries facing disasters. The Secretariat expressed satisfaction at the added focus on preparedness. In this context, the Secretariat acknowledged with appreciation India’s announcement of providing US$ 200 000 to the SEARHEF preparedness stream and urged all Member States to contribute generously to this Fund.

Report of the Seventy-second Session 69 Antimicrobial resistance (Agenda item 9.3, SEA/RC68/R3) 278. The Committee recognized that the SEA Region has been at the forefront of the movement to combat AMR. In 2010, the WHO Regional Committee for South-East Asia adopted resolution SEA/RC63/R4 on the prevention and containment of AMR. In 2011, the Health Ministers of Member States of the Region adopted the “Jaipur Declaration on Antimicrobial Resistance”. In 2014, AMR was selected as one of the Regional Flagship Priorities by the Regional Director. In 2015, the World Health Assembly, through its resolution WHA68.7, adopted the Global Action Plan (GAP) on AMR and urged Member States to prepare their national action plans (NAPs).

279. The Sixty-eighth Session of the WHO Regional Committee for South-East Asia adopted resolution SEA/RC68/R3 on AMR, which, among other actions, directed the Regional Office to report on progress achieved in implementing this resolution at its sessions in 2017 and 2019. In 2016, the United Nations General Assembly adopted resolution 71/3, “Political declaration of the High- Level Meeting of the General Assembly on Antimicrobial Resistance”. In May 2019, the Seventy-second World Health Assembly adopted resolution WHA72.5 on AMR, which reiterated global agreement on combating AMR with continued high-level political commitment.

280. All Member States of the SEA Region have NAPs in place and are also reporting to the tripartite AMR country self-assessment survey (TrACSS). Ten of eleven Member States have enrolled in Global Antimicrobial Resistance Surveillance System (GLASS). The Regional external quality assurance scheme (EQAS) has been established and national reference laboratories are participating to generate good-quality data in all Member States. The extended-spectrum beta-lactamase project is being piloted in three Member States.

281. The Committee noted with satisfaction the progress made by Member States in implementing the five strategic objectives of the Global Action Plan on AMR in their NAPs. Member States highlighted the importance of strengthening integrated surveillance of AMR and underscored the importance of involving the environmental sector, in addition to the animal and agricultural sectors, in combating AMR. The need for stronger regional collaboration and sharing of best practices was reiterated. It was emphasized that scaling up the implementation of

70 WHO Regional Committee for South-East Asia NAPs should include increased political commitment, increased budget allocation, effective regulation and formulation of strategic directions.

282. The Committee stressed the importance of scaling up implementation of NAPs by ensuring political commitment, adequate budget allocation, effective regulation and formulation of strategic directions. Member States were assured of WHO support in implementing all five pillars of the Global Action Plan on AMR, including monitoring and implementation as well as documentation and sharing of national experiences and best practices.

283. Dr Chaitanya Kumar Koduri of the United States Pharmacopeial Convention (USP), stated that substandard and falsified (SF) antimicrobials primarily drive pathogen resistance through the creation of subtherapeutic dosing conditions. He congratulated WHO for the adoption of resolution EB144.R11 on AMR. He said that ensuring the quality of antimicrobials is a critical component of achieving the stewardship goals set forth in this resolution.

284. He urged Member States (i) to conduct post-marketing surveillance of antimicrobials and take appropriate action to eliminate SF antimicrobials; and (ii) to enhance cooperation at all levels for concrete action towards combating AMR, which includes: health systems strengthening; capacity-building in research and regulatory systems; and technical support, including, where appropriate, twinning programmes that build on best practices, emerging evidence and innovation.

Report of the Seventy-second Session 71 Patient safety contributing to sustainable universal health coverage (Agenda item 9.4, SEA/RC68/R4) 285. The Committee acknowledged that patient safety is the core of the high- quality health systems needed to achieve UHC. Poor safety and quality of care reduces trust in services and discourages their use, wastes scarce resources and imposes high costs. Progress towards UHC will be seriously constrained without improvement in the quality and safety of both primary health care services and inpatient care. Adequate quality and safety, especially in frontline services, can improve public trust in health services and lead to increased use by those in need, reducing the pressure on secondary and tertiary care facilities.

286. Member States outlined the broad range of national initiatives taken to institutionalize health-care quality and safety, and highlighted a number of successes, signalling the growing political commitment towards this agenda. These include the development of national strategies, frameworks and guidelines, as well as quality assurance or minimum service standards for primary, secondary and tertiary care facilities and accreditation systems based on standard-setting. Several Member States are making efforts to improve WASH and prevent and control infections in health-care facilities. Member States underlined the advantage of implementing low-cost interventions as representing “low-hanging fruit”.

287. The Committee noted the measures taken across Member States to improve quality and safety reporting and monitoring systems, including adverse events such as health-care-associated infections. Implementation and accountability mechanisms such as national- and facility-level committees have also been set up. Training programmes have been established to build the needed health workforce competencies.

288. The Committee expressed support for the Regional Strategy on Patient Safety and appreciated WHO’s efforts in emphasizing the importance of this agenda and supporting Member States in advancing it. The Committee called on WHO to continue collaborating closely with Member States and other partners and stakeholders and sharing successful experiences and good practices. With regard to strengthened monitoring of patient safety and quality, the Committee emphasized the importance of all health facilities reporting and analysing information on adverse events to inform remedial actions that would prevent

72 WHO Regional Committee for South-East Asia harm to patients. The Committee requested WHO to support Member States in shifting from process to impact and outcome indicators.

289. The Committee noted that the upcoming first-ever World Patient Safety Day on 17 September 2019 presents a new opportunity to strengthen awareness and commitment, and prepare for and launch key national initiatives.

290. The Committee noted the minimum service standards that have been developed for all levels of health-care facilities by many Member States, and expressed satisfaction on their success with strengthening capacity to report on adverse events.

291. Member States were congratulated on their strong commitment, consistent efforts and the progress made since the previous review. It was observed that there is reason to believe that the Region will be in an even better position at the time of the next two-yearly review. Some successes by Member States were underscored, such as high levels of political commitment demonstrated with the national patient safety implementation framework 2020–2025; establishment of primary care and hospital accreditation; surveillance and integrated patient care through improved hygiene and sanitation measures and WASH in health-care

Report of the Seventy-second Session 73 facilities; quality assurance standards; and quality measurement and regulation to guide facilities and development mechanisms.

292. Dr Chaitanya Kumar Koduri of the United States Pharmacopeial Convention (USP) stated that according to the 2017 report of the WHO Global Surveillance and Monitoring System for Substandard and Falsified Medical Products, one in 10 medical products fails to do its job. Besides causing treatment failure, poor-quality medicines compromise patient safety and can result in failure to stop the spread of an epidemic, increase drug resistance and erode public confidence in health-care systems.

293. Dr Koduri applauded WHO for supporting initiatives to protect patient safety from poor-quality medicines by identifying major needs and challenges, make policy recommendations, and develop tools for prevention and detection methodologies, and control of substandard and falsified medical products, to strengthen national and regional capacities.

294. Dr Ratna Devi, of the International Alliance of Patients’ Organizations, urged Member States to take note of the WHO Director-General’s Report A72/26 on patient safety and to implement World Health Assembly resolution WHA72.6. She said patient safety is a central pillar of sustainable, compassionate and

74 WHO Regional Committee for South-East Asia effective health care. Putting patient safety first in UHC will reassure communities that they can trust health-care systems to keep them and their families safe.

295. She also thanked Member States for keeping the momentum going on patient safety by attending the Global Ministerial Summits on Patient Safety in London, Berlin, Tokyo and Jeddah. She invited delegates to join IAPO on 17 September 2019 to mark the first World Patient Safety Day.

Challenges in polio eradication (Agenda item 9.5, SEA/RC60/R8) 296. The Committee acknowledged the progress report on challenges in polio eradication in the Region. Despite being polio-free for more than eight years, all Member States in the Region continue to be at risk of importation of wild from currently infected countries and at risk of emergence of outbreaks due to circulating vaccine-derived poliovirus (VDPV) in areas with low routine immunization coverage.

297. The Committee noted the initiatives being taken by Member States to mitigate the risk of spread of wild poliovirus following an importation and to minimize the risks and consequences of potential VDPV emergence. These actions include ensuring high routine immunization coverage, maintaining surveillance and outbreak response capacity and implementing poliovirus containment activities as per Global Action Plan III. The Committee acknowledged the expansion of environmental surveillance for poliovirus detection as a supplement to acute flaccid paralysis (AFP) surveillance in the Region.

298. The Committee noted the recent measures taken by Indonesia and Myanmar in response to the occurrence of circulating VDPV type 1 outbreaks in these two Member States. The Committee also noted the commitment of Member States to maintain and further strengthen actions required to maintain the polio-free status of the SEA Region until global polio-free certification is achieved and beyond.

299. The Committee noted that polio-funded assets that include human workforce, infrastructure, equipment and systems have been established in five Member States, viz. Bangladesh, India, Indonesia, Myanmar and Nepal. The Committee acknowledged that these polio assets have not only contributed to the elimination of polio and the implementation of the polio endgame strategies but have also been increasingly involved with other health activities in the Region

Report of the Seventy-second Session 75 related to other health goals. The Committee also expressed satisfaction with the country-centric approach being adopted by Member States to develop polio transition plans with these assets.

300. The Committee urged Member States to implement the Global Polio Eradication Initiative (GPEI) Endgame Strategy: 2019–2023 by maintaining essential polio activities until global certification is achieved. It also called upon Member States with significant polio-funded assets to endorse and implement their transition plans in a timely manner.

301. The Committee emphasized the need for Member States to continuously mobilize domestic resources for long-term sustainability of these assets as well as the engagement of additional donors in immunization to provide time- limited “bridge” funding to maintain essential polio functions and contribute to strengthening immunization systems and to help achieve coverage and equity goals.

Colombo Declaration on strengthening health systems to accelerate delivery of NCD services at the primary health care level (Agenda item 9.6, SEA/RC69/R1) 302. The Committee acknowledged that the Colombo Declaration highlights renewed commitment by Member States to accelerate NCD service delivery

76 WHO Regional Committee for South-East Asia through a people-centred primary health care approach. The aim is to realize the Global and Regional Voluntary Targets for NCD prevention and control, which include achieving 80% availability of essential NCD medicines and technologies in health facilities and ensuring that 50% of high-risk populations receive drug and counselling therapies to prevent heart attack and stroke by 2025.

303. The Committee noted that since the endorsement of the Colombo Declaration, there has been commendable progress in mainstreaming NCD management in the primary health care system and overall NCD prevention and control in Member States of the Region.

304. The Committee expressed satisfaction that all Member States have now adopted the multisectoral action plans (MSAPs) for NCD prevention and control with targets, taking into account the regional voluntary targets, and active multisectoral coordinating mechanisms for NCD prevention and control, which have been established at the national level. The Committee observed that there is rapid scale up of NCD services at the primary health care level in all Member States, particularly in adapting the WHO package of essential noncommunicable disease (PEN) interventions within the national context.

305. The Committee expressed satisfaction that several notable innovations and initiatives have been taken for strengthening NCD service delivery in Member

Report of the Seventy-second Session 77 States. These include: special NCD clinics, improving the availability of essential drug supplies, electronic monitoring and tracking of essential medical supplies, mobile applications for PEN, referrals of laboratory samples, community outreach and a patient record system. A few Member States have added new cadres of health workforce to respond to the increased scope, responsibilities and expectation of the primary health care services. New financial protection schemes for coverage of major NCDs have been included in some Member States.

306. The Committee noted that while Member States are expanding NCD services across health systems, several challenges remain. These include geographical terrain affecting coverage of services, difficulty in procurement of essential medicines and diagnostics due to economies of scale for nations with small populations, inadequate primary health care workforce capacity to effectively deliver NCD services and ability of health systems to cope with the increasing demand for NCD services. More financial resources are needed to achieve national coverage of NCD prevention and control through the primary health care approach.

307. The Committee urged Member States to prioritize strengthening of primary health care systems focusing on capacity-building through development of effective multitasking of the primary health care workforce and building additional cadres to respond to the increased scope and expectation of people- centred NCD prevention and control services.

78 WHO Regional Committee for South-East Asia 308. The Committee suggested that Member States strengthen health-care delivery systems to provide essential NCD services to vulnerable and hard-to- reach populations to achieve UHC. Member States need to expand the scope of services that include NCD-related complications, such as providing timely care to people with stroke and disabilities as well as palliative care services. There is a need to mobilize resources to address NCDs, including identifying fiscal space for NCD prevention and control activities from domestic resources. This can be done through policy advocacy and exploring innovative financing mechanisms such as co-funding by local governments and dedicated taxation on tobacco, alcohol and sugar-sweetened beverages, etc. The progress on these aspects will be reported to the Regional Committee in 2021.

309. Ms Monika Arora, on behalf of the World Heart Federation, supported by the NCD Alliance, Healthy India Alliance, NCD Alliance Lanka and the Myanmar NCD Alliance, congratulated Member States on the progress on the commitments made under the Colombo Declaration, and urged Member States to prioritize prevention and better management of NCDs through strengthening health systems. She emphasized the importance of supporting primary care for NCDs, such as rheumatic heart disease. She suggested that frontline physicians and health-care workers must be provided with the necessary infrastructure and training to diagnose NCDs at an early stage. She urged Member States to support implementation of cost-effective interventions for the prevention and control of NCDs as well as to strengthen support to people with NCDs, young people and marginalized populations.

310. Mr Sampath De Seram of IOGT, welcomed the progress report on the Colombo Declaration and called for measures to “build a generation of NCD managers and leaders in multisectoral agencies equipped with state-of-the-art knowledge about the myths and realities of NCDs risk factors”. He called on WHO and Member States to partner with civil society in ensuring literacy about risk factors and their corporate drivers. Expressing concern about the challenges of “low financing” and “inadequate budgets” for prevention and control of NCDs, he urged Member States to make resources available through leveraging health promotion taxes as Thailand has demonstrated.

Report of the Seventy-second Session 79 Traditional medicine: Delhi Declaration (Agenda item 9.7, SEA/RC67/R3) 311. The Committee acknowledged the universal recognition of the integration of traditional medicines into conventional health-care delivery systems to facilitate the achievement of UHC. It highlighted the importance of preservation of traditional medical knowledge as part of a nation’s cultural heritage. Traditional and complementary medicine has the potential to contribute to health, wellness and people-centred health care.

312. Member States outlined the key initiatives and progress made in terms of policy development, regulation and service delivery, including integration of traditional systems of medicine into the health system with emphasis on health promotion and disease prevention since the endorsement of the Regional Committee resolution SEA/RC67/R3. All Member States agreed to adapt, adopt and implement the WHO Traditional and Complementary Medicine Strategy 2014–2023 and the Delhi Declaration on Traditional Medicine.

313. Member States were informed that the progress made across the Region included the development of national policies and deployment of traditional and complementary medicine practitioners in the public health sector, particularly at the grassroots (primary health care) level, focusing on health promotion and disease prevention. Member States were also apprised of the ongoing efforts to integrate traditional medicine services into national health systems.

314. The Committee noted the challenges that persist, including human resources for traditional medicine, service delivery infrastructure, financial mechanisms for traditional medicine services, lack of well-functioning health information systems to monitor the performance of traditional and complementary medicine systems, and the creation of a regulatory system to ensure the safety, efficacy and quality of traditional medical services.

315. The Committee also acknowledged that continued efforts are required to strengthen national capacity for appropriate integration of traditional and complementary medicine into national health systems; enhance regulatory systems to ensure the safety of traditional and complementary medicines; and strengthen systems for monitoring and supervision.

316. The Committee requested WHO for support in implementing the WHO Traditional and Complementary Medicine Strategy 2014–2023 and the

80 WHO Regional Committee for South-East Asia Delhi Declaration in accordance with each country’s priority, legislation and circumstances. Support was also requested to build national capacity for appropriate integration of traditional and complementary medicine into national health systems, regulatory system strengthening and for the standardization of traditional medicine treatment.

2012: Year of Intensification of Routine Immunization in the South-East Asia Region: Framework for increasing and sustaining coverage (Agenda item 9.8, SEA/RC64/R3) 317. The Committee expressed satisfaction on the progress in intensifying routine immunization in the Region. Member States contributed to this effort by incorporating plans on reaching hard-to-reach areas and high-risk population groups. The Committee noted that the overall coverage with three doses of diphtheria, tetanus and pertussis vaccine (DPT3) had increased from 84% in 2011 to 89% in 2018. Eight Member States have achieved the goal of more than 90% coverage with DPT3 nationally and four Member States have achieved more than 80% coverage in all districts.

318. The Committee noted the efforts made by Member States to increase routine immunization coverage, which has helped to maintain polio-free status,

Report of the Seventy-second Session 81 sustain elimination of maternal and neonatal tetanus, achieve measles elimination in five countries and increase access to new and underutilized vaccines. However, a significant number of children in the Region remain unvaccinated or partially vaccinated, leading to cases of measles, diphtheria and pertussis among pockets of unimmunized children and to occasional outbreaks of these diseases, especially among migrant populations.

319. The Committee noted the several innovative approaches that have been implemented by Member States to improve routine immunization coverage with special focus on identification and vaccination of children and women in high-risk and underserved areas. One significant challenge faced by countries is the increasing hesitancy towards vaccines, which is driven by social media. Proactive measures need to be initiated to counter these messages and reinforce the importance of vaccination.

320. The Committee acknowledged that efforts are needed to ensure equitable subnational coverage of routine immunization by all Member States by increasing the effectiveness and efficiency of national immunization programmes to achieve UHC. Adequate financial and human resources need to be allocated for immunization programmes according to national priorities, considering the ongoing polio transition, Gavi transition and well-documented information on the economic benefits of immunization.

321. The Committee noted that it will be critical to continuously monitor and review immunization coverage nationally and at the subnational level to identify geographical areas and populations with low immunization coverage and to take appropriate actions.

322. The Committee also emphasized that, to sustain the gains in the Region, immunization partners need to support critical needs, including human resources, till the transition to the government health system. Member States highlighted that WHO support is required for identifying gaps in routine immunization coverage, strengthening surveillance of vaccine-preventable diseases, taking appropriate actions in areas with low coverage, and strengthening the capacity of national technical advisory groups.

323. In response to the observations made by Member States on the progress reports on selected Regional Committee resolutions, the Secretariat expressed satisfaction at the range of activities and efforts undertaken by Member States.

82 WHO Regional Committee for South-East Asia 324. The Secretariat highlighted that the Region has been a pioneer in adopting the use of fractional dose of the inactivated poliovirus vaccine (IPV), a dose- sparing strategy that enables the vaccine to reach more children across the world. The Secretariat acknowledged the current shortage of IPV and said that all efforts are being made to improve IPV supply; the situation is expected to ease from 2020 onwards.

Governing Body matters (Agenda item 10)

Key issues arising out of the Seventy-second World Health Assembly and the 144th and 145th sessions of the WHO Executive Board (Agenda Item 10.1, SEA/RC72/14) 325. The Committee noted the significant and relevant resolutions adopted, decisions endorsed and Agenda items discussed, from the perspective of the SEA Region, at the Seventy-second World Health Assembly in May 2019 and the 144th and 145th sessions of the WHO Executive Board in January and May 2019, respectively. These resolutions, decisions and Agenda items relate to a gamut of health matters and to programme, budget and other financial matters. These were deemed to have significant implications and merited follow-up action by both Member States and WHO in the SEA Region.

Report of the Seventy-second Session 83 326. While reviewing the summaries of resolutions on technical matters that have significant implications for the SEA Region, and considering the implications of the resolutions/decisions and actions already taken and to be taken, the Committee was also informed that the HLP Meeting in New Delhi in July 2019 had reviewed and noted this Working Paper (SEA/RC72/14).

327. The Committee appreciated WHO’s efforts in convening briefings for Member States of the Region before the Executive Board sessions and the World Health Assembly, and the daily “morning briefings” held to discuss and finalize the Regional One Voice statements. These aim to assist the fostering of regional solidarity and articulating a strong regional voice on global issues. These morning briefings of the delegations were lauded by the Committee as “very effective” in helping to finalize the Regional One Voice as well as in evolving regional positions on the text of resolutions that were proposed by other Member States or regional delegations.

328. The Committee appreciated – as “impressive, significant and promising” – the successful delivery of 13 Regional One Voice interventions and the first Regional Statement during the general discussions at the plenary on the theme of “Universal health coverage: leaving no one behind” at the Seventy-second World Health Assembly.

329. The attention of the Committee was drawn to building health diplomacy capacity among competent young public health leaders from the Region, which was described as “a key regional social capital to prepare the new generation of global health leaders from the Region”.

330. Member States elucidated on the need to strengthen regional capacities in “global health diplomacy” to bring it on a par with high-income countries so that regional interests can be safeguarded, capacity of delegates strengthened, and competent new generations of public health professionals trained.

331. The attention of the Committee was invited to the annual Global Health Diplomacy workshop in Sampran, Thailand, which is being organized for the past 15 years to bolster global health diplomacy capacity of technical staff who attend the World Health Assembly. Invitations have been extended to Member States from the South-East Asia and Western Pacific regions of WHO for a “Training of Trainers” workshop in November 2019, and Member States have

84 WHO Regional Committee for South-East Asia been encouraged to participate in the same. The Regional Office’s continued support was requested for the ongoing regional initiatives on Global Health Diplomacy to strengthen and sustain such capacity in the Region.

332. Member States raised the issue of updating the WHO Global Code of Practice (GCP) on the International Recruitment of Health Personnel. Member States were apprised of the results of the third round of national reporting that was included under Agenda WHA 12.3 with the background document A72/24 “Global Strategy on Human Resources for Health: Workforce 2030” for deliberations at the Seventy-second World Health Assembly. Greater attention to this subject was requested by Member States in the context of the Second Review Meeting on the relevance and effectiveness of the GCP by the WHO Expert Advisory Group (EAG), which was held on 18–20 June 2019 at WHO headquarters in Geneva.

333. Member States observed that the international recruitment of health personnel is important in ensuring equity and ethics between Member States in the matter of human resources for health (HRH). Member States called for further discussions on the effectiveness of GCP implementation that was raised by the EAG. This includes the revision of the reporting instrument, strengthening of monitoring and evaluation, capacity-building and leadership training of Member States, disaggregated data for health workers, and bilateral agreement information.

334. The Committee was informed that Indonesia, as a Member of the WHO Executive Board, was proposed and elected as co-Chair at the EAG Meeting representing low- and middle-income countries. The Committee noted the baseline for data on health personnel in the World Health Report 2006. According to the report, 57 countries are listed as having critical shortages of doctors, nurses and midwives. These include Member States from the SEA Region such as Bangladesh, India and Indonesia. Member States called for the urgent updation of these data as many of them have vastly improved their position in human resources for health since this report of 2006. The report negatively impacts countries that may be interested in sending their surplus health workers to support the health-care needs of other countries.

335. The Committee urged Member States to implement the related provisions of the select resolutions endorsed by the Seventy-second World Health Assembly

Report of the Seventy-second Session 85 and the 144th and 145th sessions of the WHO Executive Board, which merit follow-up actions. It requested the Secretariat to take appropriate follow-up actions at the regional and country levels to support them in the implementation of actionable provisions of the World Health Assembly and Regional Committee resolutions.

336. Mr Sampath De Seram delivered a statement on behalf of IOGT, which is part of the premier global network for alcohol prevention and control. Calling alcohol a global epidemic, the harm from which destroys people, families and communities, he welcomed the priority accorded by Member States of the Region to prevent and reduce health risk factors such as alcohol and tobacco. He thanked WHO for the alcohol policy that was articulated at the Seventy- second World Health Assembly in May 2019.

337. Reiterating the need for momentum and high-level attention on the review process of the WHO Global Alcohol Strategy, he urged the global community for stronger instruments, more resources and better protection against the alcohol industry. Since the Global Alcohol Strategy has not been adequate in turning the tide on alcohol globally, he called for the adoption of a “Framework Convention on Alcohol Control” on the lines of the similar convention on tobacco.

338. Mr Sampath De Seram informed that 19 member organizations of IOGT from five countries of the South-East Asia Region expressed concern over the recent findings in leading medical publications that projected further increases in alcohol consumption across the Region. This implied that alcohol’s relative contribution to death and disease in the Region will only consequently increase. He called for accelerated action to reduce alcohol and related harm, urging Member States to prioritize and mainstream action on health risk factors across the “triple billion” targets.

Review of the draft Provisional Agenda of the 146th session of the WHO Executive Board (Agenda Item 10.2, SEA/RC72/15) 339. The Committee was informed that the 146th Session of the WHO Executive Board will be held at WHO headquarters in Geneva on 3–8 February 2020. Any proposal from a Member State or Associate Member of WHO to include an item on the Agenda should reach the WHO Director-General not later than 12 weeks after the circulation of the draft Provisional Agenda or 10 weeks before

86 WHO Regional Committee for South-East Asia the commencement of the Session of the Executive Board, whichever is earlier. Proposals should, therefore, reach the Director-General by 18 September 2019.

340. Following its noting by the HLP Meeting, the draft Provisional Agenda of the 146th Session of the WHO Executive Board was placed before the Committee for its review, comments and adoption as appropriate. The Committee noted the draft Provisional Agenda of the 146th Session of the WHO Executive Board.

341. The Committee also thanked Member States for their support to the proposal for inclusion of the additional Agenda item on “Strengthening the control of harmful use of alcohol” in the draft Provisional Agenda of the 146th Session of the Executive Board. It noted that alcohol contributes to more than 200 diseases, injuries and other health problems, resulting in substantial burden and cost to the health-care system as well as economic losses. The social cost of alcohol is enormous. The International Agency for Research on Cancer (IARC) classifies alcohol as a Group I carcinogen and there is clear evidence that “there is no safe limit of alcohol use”.

342. Recalling the adoption of the WHO Global Strategy to Reduce the Harmful Use of Alcohol in 2010, the Committee observed that the year 2020 is an ideal time to revisit the alcohol issue through a substantive Agenda item on alcohol, which will ensure the continuity of commitment and further actions. The Committee reaffirmed support to the proposed submission of an additional Agenda item on “Strengthening the control of harmful use of alcohol” to the WHO Director-General before the deadline of 18 September 2019.

343. The Committee was informed that, following the adoption of Resolution WHA71.7 on Digital Health, the WHO Director-General had created a Division of Digital Health in WHO headquarters as part of his Transformation Agenda. The division in turn has also come up with a draft Digital Health Strategy, which is under discussion. However, the Committee noted that data on health informatics are being treated separately from digital health, which is an anomaly.

344. Requesting the Secretariat to develop an action-oriented workplan and timelines for deliverables in furtherance of the resolution on digital health by Member States, the Committee urged that all components of digital health be brought together for effective coordination and results. Digital health has the potential to achieve the SDGs by making heath facilities affordable as well as

Report of the Seventy-second Session 87 accessible by supplementing health care through artificial intelligence-enabled clinical decision support systems and by serving as a monitoring tool.

345. Recalling the adoption of World Health Assembly resolution WHA72.6 on “Global Action on Patient Safety”, the Committee noted that “World Patient Safety Day” is to be observed every year on 17 September. Noting the expressed need for a common definition of patient safety and a roadmap for its implementation, the Committee supported the proposed inclusion of an additional Agenda item for the consideration of the 146th Session of the WHO Executive Board.

346. Upon review of the draft Provisional Agenda of the 146th Session of the WHO Executive Board, the Committee decided to endorse the proposal by Member States to include additional Agenda items on: (i) “Strengthening the control of harmful use of alcohol”; (ii) “Integrated People-Centred Eye Care”; and (iii) “Patient Safety” in the Provisional Agenda of the 146th Session of the WHO Executive Board [Decision SEA/RC72(1)].

347. The Committee decided to support the proposals submitted by Member States of the SEA Region to reach the Director-General by 18 September 2019 with an explanatory memorandum for the consideration of the officers of the Executive Board.

Elective posts for Governing Body meetings (WHA, EB and PBAC) (Agenda Item 10.3) 348. The Committee was informed that a number of elective posts for Governing Body meetings were due to be filled by Member States of the SEA Region.

349. For the Seventy-third World Health Assembly in May 2020, the posts of Vice-President, Vice-Chairperson of Committee A, Rapporteur of Committee B, Member of the General Committee, and Member of the Committee on Credentials are available to be filled on a rotational basis by countries of the Region.

350. The Committee unanimously accepted the proposal that Thailand be nominated for the post of Vice-President of the World Health Assembly, Sri Lanka for the post of Vice-Chairperson of Committee A, Bhutan for the post of Rapporteur of Committee B, Nepal for the post of Member of the General Committee and Timor-Leste for the post of Member of the Committee on Credentials.

88 WHO Regional Committee for South-East Asia 351. For the 147th Executive Board meeting in May 2020, one of the three posts that are allocated for Member States from the SEA Region will become available, along with the post of Chairperson. It was proposed that India be nominated as one of the Member States from the SEA Region in place of Sri Lanka whose term ends in May 2020, and that India be nominated as Chairperson for the 147th Executive Board Session. The Committee accepted these proposals unanimously.

352. Two Member States of the Region – Bangladesh and Indonesia – are current members of the Programme, Budget and Administration Committee (PBAC), with their terms due to expire in May 2021 and May 2020, respectively. The proposal to nominate India for a two-year term in place of Indonesia was unanimously accepted by the Committee.

Management and Governance matters (Agenda item 11)

Management performance and Transformation in the South-East Asia Region (Agenda item 11.1, SEA/RC72/16, Inf. Doc. 1) 353. The Secretariat provided the Committee with an overview of the progress made in advancing the Region’s attainment of the priorities of the Transformation Agenda and the Regional Director’s Flagship Programmes.

354. The Committee congratulated the Regional Director for her continued commitment and strong leadership in furthering the public health agenda in the Region as well as supporting Member States.

355. The Committee acknowledged that the regional priorities and the eight Flagship Priority Programmes are in alignment with the Thirteenth Global

Report of the Seventy-second Session 89 Programme of Work “triple billion” outcomes and will contribute greatly to their achievement.

356. Noting that transformation is not a radical change, the Committee suggested that best practices from the past should be adapted and the underlying principles of “Sustain, Accelerate and Innovate” should guide technical and financial implementation.

357. The Committee expressed its appreciation for the noticeable progress and tangible growth by the Region in various administrative and finance key performance indicators, as well as the clear alignment demonstrated with GPW13 and the Transformation Agenda.

358. The Committee recognized the successful efforts made to strengthen the capacity of WHO country offices to work with implementing partners to deliver on country and global public health priorities.

359. The Secretariat assured the Committee that country capacity strengthening and support remain the main focus of work in the Region. This is in keeping with the Regional Director’s Flagship Programmes and her vision for the second term to “sustain the achievements, accelerate public health efforts in the Region, and innovate and seek new science and technology in WHO’s work in public health”.

360. The Region is geared towards implementation of country priorities. Efforts have been made to streamline all major administrative processes among the country offices. This has greatly improved overall compliance, accountability and transparency levels in the SEA Region.

361. The Secretariat appreciated the close collaboration and trust of the ministries of health with WHO country offices through regular reviews. The feedback from these provides valuable inputs to the efforts being made towards increasing “value for money” initiatives and efficiency gains.

Evaluation: Annual report (Agenda item 11.2, SEA/RC72/17) 362. The WHO South-East Asia Region recognizes the importance of, and is committed to, advancing the culture of “Evaluation”, as outlined in the WHO South-East Asia Regional Framework for Strengthening Evaluation for Learning and Development and the South-East Asia Region Evaluation Workplan for 2018–2019.

90 WHO Regional Committee for South-East Asia 363. The Region has made considerable progress in implementing the South- East Asia Region Evaluation Workplan for 2018–2019. As of mid-June 2019, two evaluations have been completed, eight are ongoing and two have been initiated. In addition, two evaluations started in 2017 have been completed. The Region has collaborated with the Global Evaluation Office to improve the process of evaluations in line with the Global Evaluation Policy and the Regional Evaluation Framework to ensure objective and quality evaluations.

364. Member States appreciated the progress made in implementing the Region’s Evaluation Workplan 2018–2019 and expressed support to the evaluation of the Regional Flagships Priority Programmes. An evaluation of the Regional Committee resolutions was proposed for inclusion in future evaluation workplans.

365. The importance of regional and country evaluations for learning and improving performance was highlighted. The dearth of evaluation experts in the Region and importance of involving evaluators from the Region, who know the regional and country culture and context, was noted. Member States also noted that four evaluations have been postponed.

Report of the Seventy-second Session 91 366. Member States highlighted the importance of disseminating the findings and lessons learnt from evaluations to avoid repeating mistakes. Member States also acknowledged that, in addition to serving to improve WHO programmes, the findings of evaluations could be used by programmes of ministries of health. It was stressed that the recommendations of the evaluation should be reviewed, actions taken and followed up.

367. The Secretariat apprised the Committee that while the Regional Office had an ambitious target of 16 evaluations for 2018–2019, significant progress has been made since the presentation of the annual evaluation progress report to the Regional Committee in 2018. Currently, there are two completed evaluations and eight ongoing compared to only three evaluations that were ongoing in September 2018. The funds allocated by the Regional Director for the evaluations helped in progressing with regional- and country-level evaluations.

368. The Committee was informed that, in line with recommendations of the HLP Meeting and SPPDM and global practice, reports of four of the completed evaluations have been posted on the SEA WHO website. Further, the results of evaluations are being used to improve strategies and plans, as evidenced during the recent review of the Regional Flagship Programmes.

369. The Secretariat stressed that evaluations take time and resources – comprehensive evaluations in the Region have taken, on average, 12 months and cost between US$ 50 000 and US$ 200 000. Finding the right mix of subject and evaluation experts was a challenge. It was further clarified that the main reasons for postponing evaluations included changes in context, resources and scheduling challenges, and avoiding duplication with ongoing reviews related to the proposed topics for evaluation. The need to ensure a realistic evaluation workplan for the future was stressed. In this regard, evaluation topics should be prioritized based on relevance, feasibility and “value for money”.

Status of the SEA Regional Office Building (Agenda item 11.3, SEA/RC72/18) 370. The Secretariat described the background leading to the decision to reconstruct the Regional Office Building and provided an update to the Committee about the ongoing work. The Committee acknowledged that the

92 WHO Regional Committee for South-East Asia WHO South-East Asia Regional Office in New Delhi, India, was and indeed will remain an important landmark of the city.

371. The Committee appreciated the progress made so far in the reconstruction project, which includes the signing of the Tripartite Agreement between His Excellency the acting through the Ministry of Health & Family Welfare, Government of India; the World Health Organization for the SEA Region; and the NBCC (India) Limited, the project management consultant. A Bilateral Agreement was also signed between the Ministry of Health & Family Welfare of the Government of India and the NBCC (India) Limited.

372. The Secretariat expressed appreciation of the generous contribution of US$ 35.4 million made by the Government of India towards the Regional Office Building Reconstruction Project and the financial support pledged by DPR Korea, Maldives, Sri Lanka, Thailand and Timor-Leste amounting to US$ 1.34 million.

373. The Regional Director acknowledged the sentiments of the staff, Member State representatives and others associated with the old Regional Office Building that was an admired landmark in Delhi for more than five decades, and informed the Committee that a coffee-table book was being prepared as a pictorial memoir of the building to serve as a repository of such sentiments for posterity. This book will be launched at an opportune time coinciding with a definitive stage in the development of the iconic new Regional Office in the presence of the honourable ministers of health of the SEA Region.

374. The Secretariat informed that the artwork and artefacts gifted by Member States to the Organization over the past 50 years since the old building was inaugurated – including the famous mural by legendary artist M.F. Husain depicting the history of medicine from antiquity till modern times that adorned the Conference Hall – have been carefully dismantled and preserved for reinstallation in the new building.

375. The Committee was also informed that three important studies were conducted by experts before the decision to move to the temporary swing spaces and reconstruct the Regional Office Building was taken in consultation with the Regional Committee. The staff of the Regional Office have been involved at every step and they were kept informed of the decisions taken and progress made.

Report of the Seventy-second Session 93 376. A Project Monitoring Committee for the SEA Regional Office Building redevelopment project comprising officials from WHO, the Union Ministry of Health & Family Welfare, Government of India, and NBCC has been set up. This Committee meets regularly to review the progress of the project, according to the agreed terms and conditions. It was also informed that work on the new building is progressing on schedule.

Special Programmes (Agenda item 12)

UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases: Joint Coordinating Board (JCB) – Report on attendance at JCB in 2019 (Agenda item 12.1, SEA/RC72/19) 377. The Joint Coordinating Board (JCB) of the WHO Special Programme for Research and Training in Tropical Diseases Research (TDR) acts as the governing body of the Special Programme and is responsible for its overall policy and strategy.

378. The Committee was informed that currently Myanmar represents the WHO SEA Region, under Paragraph 2.2.2, as a member of the JCB for a four-year period starting from 1 January 2019 to 31 December 2022.

379. The Committee also noted the membership of Sri Lanka under Paragraph 2.2.3 for a period of four years from 1 January 2019 to 31 December 2022.

380. The Committee was informed that the 41st session of the JCB took place at WHO headquarters during 25–26 June 2019 and was attended by all the JCB members. It deliberated on the reports of JCB 40 and 41 as also the follow-up actions taken on the decisions and recommendations of JCB 41.

381. Important decisions taken included approval of the annual report, the result and risk management reports, the programme performance overview and financial reports. The objective was to provide strategic input and advice on implementing the TDR/research capacity-strengthening, 2019–2020 work programme and planning for the 2021–2022 work programme in the context of the TDR strategy 2018–2023.

382. The Committee was informed that TDR’s vision had been translated into specific goals for impact that were contributing to the achievement of the SDG

94 WHO Regional Committee for South-East Asia targets. These impact goals built on the programme strength and provided flexibility to draw on innovations such as:

 Increasing access to health interventions by populations with a high burden of infectious diseases, through generation and use of knowledge arising from quality research on implementation;

 accelerating the development of innovative tools, solutions and implementation strategies essential for disease control and their elimination through research and partnerships;

 building a critical mass of researchers in disease-affected countries through training and mentorship to conduct, lead and further develop research; and

 engaging a broad global community to facilitate the role of research and development, and advocate the use of quality evidence to inform policy.

UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP): Policy and Coordination Committee (PCC) – Report on attendance at PCC in 2019 and nomination of a member in place of Sri Lanka whose term expires on 31 December 2019 (Agenda item 12.2, SEA/RC72/20) 383. The Committee considered Agenda item 12.2 on the attendance at the Policy and Coordination Committee (PCC) of the Special Programme of Research, Development and Research Training in Human Reproduction (HRP) in 2019 and nomination of a member in place of Sri Lanka whose term expires on 31 December 2019. The PCC acts as the governing body of the UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.

384. The Committee was informed that one Member State was to be elected for the three-year term effective 1 January 2020. The HLP Meeting in July 2019 had recommended that Maldives replace Sri Lanka, whose term of office was due to expire on 31 December 2019.

385. The Committee unanimously accepted the proposal for the nomination of Maldives to be a member of the PCC for three years effective 1 January 2020 and requested the Regional Director to inform WHO headquarters accordingly.

Report of the Seventy-second Session 95 Time and place of future sessions of the Regional Committee (Agenda item 13, SEA/RC72/21) 386. The Regional Committee was informed of the invitation extended by H.E. the Deputy Prime Minister and Minister of Public Health of the Royal Thai Government, Mr Anutin Charnvirakuln, vide the formal communication dated 29 August 2019 from his government, to host its Seventy-third Session in the Kingdom of Thailand in September 2020.

387. Accordingly, the Committee decided to hold its Seventy-third Session in Thailand from 7 to 11 September 2020 [Decision SEA/RC72(2)].

388. The Secretary, Ministry of Health and Population of the Government of the Federal Democratic Republic of Nepal, extended an invitation on behalf of His Excellency Mr Upendra Yadav, Deputy Prime Minister and Minister of Health and Population, to the Committee at the plenary to host the Seventy-fourth Session in Nepal. The Committee noted with appreciation the invitation to hold its Seventy-fourth Session in Nepal in September 2021.

389. Concurrently, Her Excellency Ms Dechen Wangmo, Minister of Health, Royal Government of Bhutan, also extended an invitation on behalf of her government to the Committee at the plenary to host the Seventy-fifth Session in Bhutan. The Committee noted with appreciation the invitation to hold its Seventy-fifth Session in Bhutan in September 2022.

Adoption of resolutions (Agenda item 14) 390. The Committee considered and adopted the following five resolutions and two decisions prepared by the Drafting Group on Resolutions.

Resolutions  Delhi Declaration on Emergency Preparedness in the South-East Asia Region (SEA/RC72/R1)

 PB 2020–2021 (SEA/RC72/R2)

 Measles and Rubella Elimination by 2023 (SEA/RC72/R3)

96 WHO Regional Committee for South-East Asia  Regional Plan of Action for the WHO Global Strategy on Health, Environment and Climate Change 2020–2030: Healthy Environments for a Healthier Population (SEA/RC72/R4)

 Resolution of thanks (SEA/RC72/R5)

Decisions  Review of the draft Provisional Agenda of the 146th Session of the WHO Executive Board (SEA/RC72/(A))

 Time and place of future sessions of the Regional Committee (SEA/RC72/(B))

Adoption of the report of the Seventy-second Session of the Regional Committee (Agenda item 15) 391. The draft report of the Regional Committee was taken up for consideration and adoption. As suggested by the Chairperson, it was considered item by item by the distinguished delegates.

392. During the discussions the Committee observed, in relation to Agenda item 8.3, that joint external evaluations, being voluntary, are not a part of the IHR Framework and self-assessment of country capacities as per the tool provided by WHO is a sufficient and comprehensive mechanism for monitoring IHR core capacities. This was accepted by consensus.

393. The report of the Seventy-second Session of the Regional Committee was adopted, after incorporating the minor amendment proposed.

Closing session (Agenda item 16) 394. The Chairperson, H.E. Dr Harsh Vardhan, Honourable Minister of Health and Family Welfare, India, invited participants to make statements before the Regional Director, Dr Poonam Khetrapal Singh, delivered her concluding remarks.

395. In their closing remarks, Member States thanked the Government of India for hosting the Ministerial Roundtable, and the WHO Regional Office for South- East Asia for hosting the Seventy-second Session of the Regional Committee. They deeply appreciated the warm hospitality and excellent arrangements. They expressed satisfaction with the insightful deliberations and appreciated the

Report of the Seventy-second Session 97 efficiency of the resolutions drafting group. They mentioned that the Region had come together in solidarity to solve not just regional but also global health problems.

396. Member States thanked the Regional Director for her deep commitment to strengthening emergency preparedness in the Region, which is highly vulnerable to all types of disasters. They appreciated the Ministerial Declaration on Emergency Preparedness. Many of them requested support for further strengthening emergency preparedness. The achievements by some Member States in this area were lauded. All Member States felt that emergency preparedness was a key area, as were the other Flagship Priority Areas.

397. Member States valued the opportunity provided by the Regional Committee to work together in harmony and the high quality of commitment. They expressed appreciation for the work of the Secretariat in organizing the event and thanked the Chair and Vice-Chair for steering the meeting successfully.

398. The Regional Director, Dr Poonam Khetrapal Singh, thanked the participants for successfully concluding an intense five-day meeting. She expressed satisfaction at the opportunity to review policies relating to technical items, review managerial issues, reflect on the implementation of PB 2018–2019 and the opportunity to look at PB 2020–2021, and the impressive increase in budget of almost US$ 99.7 million.

399. Dr Poonam Singh appreciated the in-depth discussions at the end of which five resolutions were passed and two decisions made. The resolution on emergency preparedness recommended the launch of technical interventions to scale up emergency preparedness and response. She stressed the importance of working together to identify risks, invest in people, implement plans and interlink success and people.

400. Member States had identified their own priorities and committed to learning from one another. She commended them for being willing to walk the talk and their enthusiasm for the morning exercises organized as also the “3 by 3” sessions in the afternoon.

401. Dr Poonam Singh expressed gratitude to His Excellency, Dr Harsh Vardhan, Honourable Minister of Health & Family Welfare, Government of India, for the

98 WHO Regional Committee for South-East Asia efforts made towards hosting the event successfully. She also complimented him for the launch of the “Eat Right India” campaign and wished it all success. She stated that the initiative is part of the WHO agenda too as far as NCDs is concerned. She hoped that all the good initiatives, such as the yoga and physical activity sessions and cycling, would continue. She also thanked the Vice-Chairperson for successfully chairing a number of important sessions and leading the aerobic exercises. She thanked the Chef de Cabinet and others from the WHO headquarters team who helped with the various agenda items and brought new energy and ideas to the Regional Committee. She thanked the various NGOs and INGOs that participated in the meeting.

402. She thanked the ministers and delegations from each Member State for their involvement and engagement in the meeting and inputs on several agenda items. She also thanked the Secretariat for their hard work in ensuring a seamlessly productive meeting. She appreciated the work put in by the staff of Hotel Hyatt Regency for ensuring a pleasant and comfortable stay. She assured Member States that the WHO team was ready to take forward the constructive inputs on each agenda item and that it was the out-of-the-box thinking that had made the meeting successful.

403. She concluded by saying that she looked forward to the Seventy-third session of the Regional Committee to be held in Thailand and appreciated the invitation from the Governments of Nepal and Bhutan to host the Seventy-fourth and Seventy-fifth sessions, respectively

[For the full text of the Regional Director’s concluding remarks, see Annex 8.]

404. The Director of Administration and Finance at the Regional Office, Mr David Allen, also informed the Committee through a brief presentation about the success of the continuing efforts to “green” the sessions. The Committee noted that the Secretariat had raised the bar yet again, with the Seventy-second Session being the “greenest” thus far since the “less-paper” initiatives were begun in 2017.

405. The mobile app was used by a record number of active users (187, against 162 at the previous session) this year to receive relevant information about the plenary and other events, and provided easy and paperless access to all meeting- related documents and working papers. A total of 50 notifications through the

Report of the Seventy-second Session 99 mobile app helped disseminate information to participants and delegates, further eliminating the need for paper notices. No working paper or edition of the daily sessions journal was printed during the Session. In all, less than eight reams of paper were used during the entire five-day Session, which is equivalent to less than half of a standard-sized tree. The corresponding figures for the Regional Committee sessions in 2018, 2017 and 2016 were 12, 25 and 150 reams, respectively. In another green initiative, the use of approximately 3500 single- use plastic waterbottles was avoided by using glass bottles for drinking water.

406. The Chairperson, H.E. Dr Harsh Vardhan, honourable Minister of Health & Family Welfare, Government of India, thanked the delegates on behalf of India for support to the “Eat Right India” campaign. He thanked delegates for the very useful and in-depth discussions held in an atmosphere of mutual understanding and commitment. He appreciated the work of the Resolutions Drafting Group and the rapporteur and said that the adoption of resolutions and decisions was done in a spirit of cooperation and cordiality.

407. Dr Harsh Vardhan thanked participants for their support to him and the Vice-Chair. He also expressed his gratitude to the Director-General, Dr Tedros, Chef de Cabinet, Dr Bernhard Schwartländer, staff of WHO headquarters, other UN agencies, NGOs and others for their valuable contributions to the Regional Committee. He appreciated the hard work and dedication of the WHO Secretariat, and conveyed the gratitude of the Regional Committee to the Regional Director, Dr Poonam Singh for effectively guiding the work of the Region and the Flagship Programmes. He said that this Meeting had helped to further solidarity in the Region. He hoped that the delegates had had a comfortable stay and wished them all a safe journey back home. He hoped everyone would return with even greater determination next year. He then declared the Seventy- second Session of the Regional Committee closed.

100 WHO Regional Committee for South-East Asia 4 Resolutions and Decisions

Resolutions

SEA/RC72/R1 Delhi Declaration on Emergency Preparedness in the South-East Asia Region

The Regional Committee,

Having considered the Delhi Declaration on Emergency Preparedness in the South-East Asia Region;

 ENDORSES the Delhi Declaration on Emergency Preparedness in the South-East Asia Region, annexed to this resolution; and

 REQUESTS the Regional Director to report on progress on the implementation of the Declaration to the Committee every two years until 2030.

Report of the Seventy-second Session 101 Delhi Declaration Emergency Preparedness in the South-East Asia region

We, the Health Ministers of the Member States of the WHO South-East Asia Region, participating in the Seventy-second Session of the WHO Regional Committee for South-East Asia in New Delhi, India,

Concerned that health risks posed by emerging and re-emerging diseases, outbreaks caused by high-threat pathogens, epidemics, , natural and man-made disasters are increasing and that the population, in particular, of the Region is highly vulnerable to these,

Aware of the fact that member states of the South East Asia Region need to be well prepared to respond to major epidemics, pandemics and natural disasters, increase investment in disaster risk management, emergency preparedness to keep pace with the increased emerging risks and the need for effective multi- sectoral responses,

Acknowledging that drivers of these risks such as rapid unplanned urbanization, ease of travel and massive international movement of people, and most of all, threat of climate change are increasingly global and unprecedented in scope and scale,

Recognizing the need for accelerating progress in the implementation of various instruments, in response to these threats, such as the International Health Regulations (IHR) (2005), Sendai Framework for Disaster Risk Reduction (2015–2030), Paris Agreement (2015), and the Global Health Security Agenda 2024,

Recalling that strengthening emergency risk management in countries has been identified as a priority under the Regional Flagship Programmes of the WHO South-East Asia Region since 2014,

Confirming that disaster risk management and emergency preparedness, in parallel with effective multi-sectoral response systems, are important to achieve health security, and to protect and sustain health development gains in the Region,

102 WHO Regional Committee for South-East Asia Appreciating the fact that the International Health Regulations (2005) core capacities have significantly improved in the South-East Asia Region over the last decade, but noting that certain core capacities in areas such as zoonoses, food safety, health service provision, risk communication, points of entry, chemical, biological and radionuclear events preparedness and management, need further strengthening,

Acknowledging that accelerating of implementation of IHR (2005) through wider use of mandatory and voluntary optional tools under the IHR Monitoring and Evaluation Framework will strengthen and sustain the IHR core capacities and is the foundation for health security in the Region,

Noting that the WHO South-East Asia Region has developed a ‘Five-Year Regional Strategic Plan to Strengthen Public Health Preparedness and Response (2019–2023), a Regional Risk Communication Strategy (2019–2023), and the Regional Knowledge Network of IHR National Focal Points (NFPs) and relevant experts,

Prioritizing multi-hazard approaches to disaster risk reduction, preparedness and operational readiness for favourable outcomes of risk management and recognizing that implementing all aspects of disaster risk management and emergency preparedness are urgently required by the Region,

DO HEREBY agree to the following:

Reaffirming our continued commitment to the people of the Region for disaster risk reduction through the application of multi-hazard approach and emergency preparedness, commit to:

IDENTIFY risks

(i) Take cognizance of the existing identified, assessed and mapped risks, natural and cyclical hazards, and vulnerabilities for more evidence informed planning and implementation of activities for disaster risk reduction, preparedness and operational readiness; INVEST in people and systems for risk management

(ii) Continue the momentum to strengthen IHR core capacities including strengthening IHR National Focal Points through establishing and

Report of the Seventy-second Session 103 sustaining the Regional Knowledge Network, compiling and sharing IHR-related best practices, and other technical documents by creating a regional knowledge repository; (iii) Encourage, facilitate and promote the building and strengthening of resilient health systems and infrastructure through safety assessment of health facilities in line with local prevailing hazards and risks, ensure their functionality in emergencies by: (a) addressing structural and non-structural gaps, (b) ensuring essential health services delivery through health workforce development in all areas of emergency risk management, and (c) ensuring that the logistic and supply chain management of health products is intact before, during and after emergencies; (iv) Continue building surge capacity through strengthening of national emergency medical teams- as adopted in the Resolution SEA/RC71/ R5 of the Seventy-first Session of the WHO Regional Committee for South-East Asia - and national rapid response teams; (v) Continue our support as appropriate to sustain the preparedness stream of the South-East Asia Regional Health Emergency Fund as adopted in the Regional Committee resolution SEA/RC69/R6; IMPLEMENT plans

(vi) Develop, implement and monitor national action plans on disaster risk management, emergency preparedness and response through allocating sufficient resources; (vii) Test these plans regularly for the assessment of operational readiness; (viii) Advocate, develop and implement contingency and business continuity plans and conduct simulation exercises to test the operational readiness; and INTERLINK sectors and networks

(ix) Develop, support and implement intersectoral coordination mechanisms following the ‘One Health’ approach and bridging the gap among diverse sectors including human, animal, environment, for the prevention and control of emerging and re-emerging diseases, and reducing the adverse impact of climate change;

104 WHO Regional Committee for South-East Asia (x) Encourage, promote and facilitate engagement of other sectors – nongovernmental organizations, academic institutions, philanthropic foundations and private sector entities, through collaborative partnerships in areas of applied information technology, logistics and supply chain management in emergencies, research and innovations for strengthening emergency preparedness;

We, the Health Ministers of the Member States of the WHO South- East Asia Region, welcoming and appreciating the support of the WHO Director-General and the Regional Director for South-East Asia Region to scale up capacities in disaster risk management and emergency preparedness in South-East Asia, urge them for continued leadership and technical support in further strengthening these capacities, as well as in forging stronger partnerships across sectors, development partners, UN and other international agencies, as well as civil society, to jointly work towards a safer and more secure Region.

Adopted in New Delhi, India, on the Third Day of September, Two Thousand and Nineteen.

Report of the Seventy-second Session 105 SEA/RC72/R2 Programme Budget 2020–2021

The Regional Committee,

ACKNOWLEDGING that World Health Assembly resolution WHA72.1 approved the WHO Programme Budget 2020–2021 as the instrument for the implementation of the Thirteenth General Programme of Work (GPW13),

NOTING that the approved WHO Programme Budget 2020–2021 is the first programme budget to be prepared in line with the GPW13 and WHO’s triple billion strategic priority approach,

WELCOMING the results, integrated and systems approach to drive impact in countries,

ALSO NOTING that the Programme Budget is based on a bottom-up planning process and identification of Member State priorities,

FURTHER WELCOMING the work being conducted to identify efficiencies across the entire Organization, while reaffirming the need for the normative and enabling functions to be adequately financed across all levels,

AFFIRMING WHO’s leadership of a Transformative Agenda that supports countries in their efforts to reach all health-related Sustainable Development Goal targets,

RECOGNIZING the ongoing work to develop the GPW13 Results Framework in consultation with Member States, including through the Regional Committees, for being presented to the 146th Session of the Executive Board,

WELCOMING that the South-East Asia Region has received a Programme Budget increase of US$ 99.7 million in the Base Budget for 2020-2021, with a total approved Budget of US$ 388.5 million, of which allocation of US$ 277.9 is for country level and US$ 110.6 million is for the regional level,

NOTING the US$ 99.7 million increase, which is distributed to polio transition (US$ 69.9 million), increase in country capacity (US$ 19 million) and for data and innovation (US$ 10.8 million),

106 WHO Regional Committee for South-East Asia REAFFIRMING that emergencies remain a concern in the South-East Asia Region and that the South-East Asia Region Health Emergency Fund (SEARHEF) is vital in providing immediate financial support during emergencies requiring health sector response,

ENDORSING the report and the recommendations of the Twelfth Meeting of the Subcommittee on Policy and Programme Development and Management,

1. URGES Member States: a. to further collaborate with WHO Country Offices in order to finalize the WHO country workplans in line with national priorities while contributing to regional and global priorities and improve the efficiency of utilization of available Programme Budget resources; b. to strengthen collaborative programme management for effective programme implementation; 2. REQUESTS the Regional Director: a. to allocate the approved Budget to the Budget Centres while retaining a 5% reserve of the total budget to be distributed during the biennium based on needs and implementation status of WHO country offices; b. to ensure efficient budget management, through consultations with Member States and allocate resources in a timely manner; c. to support mobilization of Voluntary Contributions, especially to countries and programmes that have been unable to achieve full funding of their workplans; d. to continue efforts, in collaboration with Member States, to strengthen programme management, monitoring and evaluation capacities of WHO programmes with the objective of improving the efficiency and effectiveness of programme implementation; and e. to submit regular reports to Regional Committee on the status of financing and implementation of the Programme Budget, including a mid-term results report and recommendations therein for corrective measures.

Report of the Seventy-second Session 107 SEA/RC72/R3 Measles and rubella elimination by 2023

The Regional Committee,

RECALLING the World Health Assembly resolution WHA65.17 on “Global Vaccine Action Plan” which targeted the elimination of measles and rubella in five WHO regions,

FURTHER RECALLING its resolution SEA/RC66/R5 on “Measles Elimination and Rubella/Congenital Rubella Syndrome Control”,

APPRECIATING the progress made towards achieving the goal of measles elimination in five countries and rubella control in six countries of the South- East Asia Region,

RECOGNIZING the fact that the South-East Asia Region has experienced a 75% reduction in mortality due to measles in 2017 compared with 2000,

COGNIZANT of the fact that the South-East Asia Region bears the highest burden of the congenital rubella syndrome, a preventable birth defect due to rubella virus, estimated at 52 000 cases per year in the Region out of the 105 000 cases per year globally,

NOTING that all WHO regions have set a measles elimination goal and three WHO regions have set a rubella elimination goal with 82 (43%) countries verified for measles elimination and 76 (39%) countries verified for rubella elimination globally as of May 2019,

CONCERNED with the conclusion of the mid-term review of the “Strategic Plan for Measles Elimination and Rubella and Congenital Rubella Syndrome Control in the South-East Asia Region: 2014–2020” conducted in 2017 that stated that the goal of measles elimination and rubella/CRS control by 2020 is unlikely to be achieved,

RECOGNIZING that various health system challenges, notably sustaining a high level of routine immunization coverage in the context of other public health priorities that compete for limited resources, need to be addressed,

REITERATING that strengthening routine immunization in the presence of a well-performing surveillance system is the cornerstone for success and that

108 WHO Regional Committee for South-East Asia high-level advocacy and intense social mobilization, coupled with health systems strengthening, contribute to demand generation for immunization services,

REAFFIRMING and taking pride in the demonstrated capacity of the Region to deliver on global challenges related to immunization systems such as polio eradication and maternal and neonatal tetanus elimination,

CONSIDERING the recommendations from the Midterm review that Member States of the Region consider adopting a regional rubella elimination goal, synchronized with the existing regional measles elimination goal, in order to leverage the momentum and political will for measles elimination also for the elimination of rubella,

NOTING the recommendation made by the “Third Meeting of the South- East Asia Regional Verification Commission for Measles Elimination and Rubella/ Congenital Rubella Syndrome Control” in 2018 that the Region should adopt the goal of rubella elimination,

CITING the results of the March 2019 “WHO South-East Asia Regional High-Level Consultation on adopting the revised goal of measles and rubella elimination” held with Member States in New Delhi, India, on the feasibility of establishing a rubella elimination goal and aligning the measles and rubella elimination goals, and the recommendations of the Tenth Meeting of the “South- East Asia Regional Immunization Technical Advisory Group”,

NOTING that the ‘Proposed Strategic Plan for measles and rubella elimination in the WHO South-East Asia Region 2020–2024’ was reviewed during the Regional High-Level Consultation with Member States in New Delhi, India,

1. DECIDES to adopt the goal of measles and rubella elimination in the South-East Asia Region by 2023; 2. ENDORSES the ‘Strategic Plan for measles and rubella elimination in the WHO South-East Asia Region 2020–2024’; 3. URGES Member States to: a. strengthen immunization systems for increasing and sustaining high-level of population immunity against measles and rubella at both national and subnational levels through adequately funded plans and their effective implementation;

Report of the Seventy-second Session 109 b. achieve and maintain highly sensitive laboratory supported case- based surveillance systems to monitor progress and for high-quality epidemiological assessments to inform policy and planning of strategies to interrupt transmission of measles and rubella viruses; c. develop national and subnational strategies, as appropriate, to achieve measles and rubella elimination in line with the Regional Strategic Plan; d. strengthen preparedness and effective response to measles and rubella outbreaks; and e. mobilize political, societal and financial support to ensure the achievement of measles and rubella elimination by 2023; and 4. REQUESTS the Regional Director to: a. provide quality technical assistance to Member States in their efforts to develop and implement elimination policies, strategies and plans; b. mobilize the required resources, build on existing partnerships, and foster collaboration with new partners in support of measles and rubella elimination efforts; and c. report to the Regional Committee annually until 2023 on the status of progress towards measles and rubella elimination targets synchronized with resolution SEA/RC64/R3 on “2012: Year of Intensification of Routine Immunization in the South-East Asia Region: Framework for Increasing and Sustaining Coverage”.

110 WHO Regional Committee for South-East Asia SEA/RC72/R4 Regional Plan of Action for the WHO Global Strategy on Health, Environment and Climate Change 2020–2030: Healthy Environments for a Healthier Population

The Regional Committee, RECOGNIZING the increasing body of evidence on the direct and indirect adverse impacts of environmental risks on human health and health systems, which pose a serious burden to sustainable development, ACKNOWLEDGING the leadership of Member States of the WHO South- East Asia Region and development partners to address the challenges posed by environmental risks and climate change, WELCOMING the decision of the Seventy-second World Health Assembly, WHA72(9), noting the “WHO Global Strategy on Health, Environment and Climate Change”, RECONFIRMING the commitment made on implementing the Male’ Declaration on Building Health Systems Resilience to Climate Change, HAVING CONSIDERED the draft Regional Plan of Action for the WHO Global Strategy on Health, Environment and Climate Change 2020–2030: Healthy Environments for a Healthier Population, 1. ENDORSES the Regional Plan of Action for the WHO Global Strategy on Health, Environment and Climate Change 2020–2030: Healthy Environments for a Healthier Population (annexed to this resolution); and 2. REQUESTS the Regional Director to, a. provide technical assistance to Member States on implementation of the action plan, while strengthening environmental health information systems, in particular the availability, coverage and accuracy of baseline information required to track progress in implementing this Regional Plan of Action for the WHO Global Strategy on Health, Environment and Climate Change, as well as the Male’ Declaration on Building Health Systems Resilience to Climate Change; and b. submit reports on progress achieved in implementing the Regional Plan of Action to the Regional Committee sessions in 2022, synchronized with the progress report on the implementation of the Male’ Declaration (SEA/RC70/R1), and in 2025 respectively.

Report of the Seventy-second Session 111 Regional Plan of Action for Implementing the WHO Global Strategy for Health, Environment and Climate Change, 2020–2030: Healthy environments for a healthier population

1. Background The objective of the World Health Organization (WHO) is “the attainment by all peoples of the highest possible level of health”. One of the stated functions to achieve this objective is “to promote, in cooperation with other specialized agencies where necessary, the improvement of nutrition, housing, sanitation, recreation, economic or working conditions and other aspects of environmental hygiene”. In addition, it states the need “to promote maternal and child health and welfare and to foster the ability to live harmoniously in a changing total environment”,1 recognizing that environmental factors do not affect everyone equally.

The past few decades have seen important progress in the WHO South- East Asia (SEA) Region in health-related development indices such as increasing universal health coverage (UHC), reducing poverty, increasing life expectancy, and reducing infant mortality rates. Progress in addressing a number of the environmental determinants of health has been demonstrated, notably in relation to improvements in drinking water and sanitation coverage through the sustained and coordinated efforts of WHO and partners. The Region has shown tangible leadership in addressing the health impacts of climate change, particularly through the adoption of the Malé Declaration on Building Health Systems Resilience to Climate Change by ministers of health at the Seventieth Session of the WHO Regional Committee for South-East Asia in Maldives in 2017.

Despite the progress achieved, recent estimates of the environmental impact on health show the considerable number of preventable deaths and morbidity in the Region, which faces a combination of long-standing environment issues together with newer and emerging ones. Household and ambient air pollution now accounts for the largest combined burden of disease of all environmental risks and is a leading contributor to the noncommunicable disease (NCD)

1 The Constitution of the World Health Organization. Geneva: WHO; 1946(https://www.who.int/governance/ eb/who_constitution_en.pdf, accessed 25 July 2019).

112 WHO Regional Committee for South-East Asia epidemic. Emerging global threats, such as inadequate waste management, biodiversity loss, desertification and antimicrobial resistance (AMR) are increasing, posing new challenges to health. Without taking urgent, concerted and cohesive multisectoral preventive health actions, the magnitude of the environmental risks is such that significant health gains achieved in other areas are in danger of being eroded.

The rapid acceleration in human activities and resulting impacts on the environment witnessed since the 1950s in many parts of the world and more recently in the WHO SEA Region, threaten to overwhelm society’s capacity to respond. Such a situation calls for a more holistic approach to environmental health consistent with safeguarding “planetary health”, the interdependence of the health of human civilization and the state of the natural systems on which it depends.2 Traditionally, health and environment actions aim to change the conditions that make people sick in the first place. If, for example, the change in climate is beyond the ability to respond and recover, addressing these conditions will not be possible. The recognition that business as usual and acceleration of current initiatives are not sufficient in a changing planet is fundamental to the success of this Regional Plan of Action.

The WHO Global Strategy on Health, Environment and Climate Change, approved by the Seventy-second World Health Assembly in May 2019,3 calls for a transformation in the way we live, work, produce, consume and govern, with actions on the upstream determinants of health, and on the emerging threats of climate change. The Global Strategy proposes six strategic objectives for the transformation needed:

 primary prevention: to scale up action on health determinants for protection and improvement in the 2030 Agenda for Sustainable Development;

 cross-sectoral action: to act on determinants of health in all policies and in all sectors;

2 Whitmee S, Haines A, Beyrer C, Boltz F, Capon AG, de Souza Dias BF et al. Safeguarding human health in the Anthropocene epoch: report of the Rockefeller Foundation–Lancet Commission on planetary health. Lancet. 2015;386(10007):1973–2028 (https://www.thelancet.com/journals/lancet/article/PIIS0140- 6736%2815%2960901-1/fulltext, accessed 25 July 2019). 3 Health, environment and climate change. In: Seventy-second World Health Assembly, 2019. Geneva: WHO; 2019 (http://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_15-en.pdf, accessed 25 July 2019).

Report of the Seventy-second Session 113  strengthening the health sector: to strengthen health sector leadership, governance and coordination roles;

 building support: to build mechanisms for governance, as well as political and social support;

 enhancing evidence and communication: to generate the evidence base on risks and solutions, and to efficiently communicate that information to guide choices and investments;

 monitoring: to guide actions by tracking progress towards the Sustainable Development Goals (SDGs).

The actions proposed in the Global Strategy are themselves aligned to the three strategic priorities of WHO’s 13th General Programme of Work 2019–2023 (GPW13): Achieving universal health coverage; Addressing health emergencies; and Promoting healthier populations. Addressing the environmental determinants of health will contribute to all three priorities but is expected to have the biggest impact on promoting healthier populations. GPW13 is itself also strongly linked to the 2030 Agenda on Sustainable Development. The SDGs recognize the central importance of multisectoral action in achieving the 2030 Agenda, because of the broad range of determinants that act on people’s health. Several environmental determinants resulting from policies in sectors other than health, notably agriculture and nutrition, climate, transport, housing, finance, education, and water and sanitation, are widely recognized as important for achieving healthier populations.

The WHO South-East Asia Regional Plan of Action for implementing the Global Strategy for Health, Environment and Climate Change is a 10-year set of actions for realizing the Global Strategy at the regional level. It is fully aligned with the Global Strategy but tailored to the priorities, situations and contexts of Member States in the Region. It considers advances made in the Region and the challenges that remain. It draws upon successful interagency initiatives operating at global and regional levels as well as earlier work and the scope for new alliances.

The Plan of Action builds upon the following:

 the Malé Declaration on Building Health Systems Resilience to Climate Change endorsed at the Seventieth session of the WHO Regional

114 WHO Regional Committee for South-East Asia Committee for South-East Asia (Maldives, 2017). The Declaration recognizes the adverse impacts of climate change on human health and health systems, the potential for extreme weather events to overwhelm the health sector’s response capacity, and the health threats that such events pose to vulnerable populations. In the Malé Declaration, ministers of health agreed, inter alia, to continue to raise public and policy awareness of climate change across whole societies and encourage the leading role of the health sector in addressing such impacts;

 the Framework for Action in Building Health Systems Resilience to Climate Change in WHO South-East Asia Region 2017–2022 provides the operational guidance for implementing the Malé Declaration and identifies six building blocks of the health system (leadership and governance, health workforce, health information system, essential medical products and technologies, service delivery and financing) as the important starting points for building resilience to climate change;

 discussions at the Thirty-second Meeting of Ministers of Health of the WHO SEA Region in Dhaka, Bangladesh, 2014, which considered environmental health and climate change, and some of the practical interventions needed to address the current challenges faced in the Region;

 the eight Regional Flagship Priority areas for achieving health imperatives in the Region, particularly those for which there is a strong link to environmental factors. These are NCDs, AMR, UHC; maternal, adolescent and newborn health; emergencies and neglected tropical diseases;

 resolutions adopted at the World Health Assembly, particularly over the past decade, on air pollution, climate change, sound management of chemicals, Minamata Convention, workers’ health, water, sanitation and hygiene (WASH) as well as the related resolutions on patient safety, chemicals and radiological safety in the International Health Regulations (2005) (IHR), AMR and global initiatives such as WASH and neglected tropical diseases, WASH and vaccine-preventable diseases;

 the commitment to establish an expanded regional ministerial forum on health and environment agreed upon by the fourth Ministerial meeting of the Regional Forum for Environment and Health in Southeast and East

Report of the Seventy-second Session 115 Asian Countries.4 The renamed Asia-Pacific Regional Forum on Health and Environment will provide a platform for the health and environment ministers of 51 countries to collectively identify and address health and environment issues that require international actions, and as a forum to facilitate dialogue, and exchange knowledge and best practices to promote sustainable development.

The 2030 Agenda for Sustainable Development provides the important context and driver for tackling the environmental determinants of health and for monitoring progress. All the SDGs directly or indirectly impact on health and are essential to achieving SDG 3: “Ensure healthy lives and promote well-being for all at all ages”. The following are particularly relevant to health, environment and climate change in the Region:

 SDG 1: End poverty in all its forms everywhere.

 SDG 2: End hunger, achieve food security and improved nutrition and promote sustainable agriculture.

 SDG 6: Ensure availability and sustainable management of water and sanitation for all.

 SDG 7: Ensure access to affordable, reliable, sustainable and modern energy for all.

 SDG 8: Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all.

 SDG 11: Make cities and human settlements inclusive, safe, resilient and sustainable.

 SDG 12: Ensure sustainable consumption and production patterns.

 SDG 13: Take urgent action to combat climate change and its impacts.

2. Regional situation analysis The 11 Member States of the WHO South-East Asia Region (Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Nepal, Maldives, Myanmar, Sri Lanka, Thailand, Timor-Leste) have a combined population of

4 All Member States of the WHO South-East Asia Region and Western Pacific Region and all Member States of the United Nations Environment, Asia-Pacific Region.

116 WHO Regional Committee for South-East Asia just over a quarter of the world’s total, i.e. 1.9 billion or 26.2%. They vary in size and population. Life expectancy at birth ranges from 68.9 to 79.9 years for females and 64.6 to 77.2 years for males, and the regional average for the Region for both sexes is 69.5 years. Healthy life expectancy for both males and females ranges from 58.4 to 69.8 years, with a regional average of 60.4 years. The average under-five mortality rate (per 1000 live births) is 38.9, with large differences among countries, ranging from 8.5 to 50.8.5

The most recent estimates of the environmental impact on health in the Region come from the WHO report Preventing disease through healthy environments: a global assessment of the burden of disease.6 Globally, 12.6 million deaths, or 23% of all deaths, and 22% of all disability-adjusted life years (DALYs) are attributable to environmental risks each year. This fraction is higher in children under 5 years, at 26%, with an estimated 1.7 million deaths. In summary, it is estimated that in the WHO SEA Region, 3.8 million deaths (representing 28% of all deaths and 24% of all DALYs in the Region) could be averted by tackling environmental risks.

By far the largest set of diseases impacted by the environment are NCDs, which account for approximately 62% of all deaths, including from ischaemic heart disease, stroke and chronic obstructive pulmonary disease, all related to ambient and household air pollution, as well as some occupational risks and specific cancers related to environmental and occupational exposure. Environmental risks contributing to infectious, parasitic, neonatal and nutritional conditions are estimated to be accountable for 21% of the total proportion of deaths. The infectious diseases responsible for the largest number of deaths are diarrhoeal diseases, related to WASH; and lower respiratory tract infections, related predominantly to household air pollution. The remaining 17% is linked to injuries for which the largest death toll comes from road traffic accidents.

2.1 Air pollution Awareness of the pervasive impact of air pollution on health and its significant contribution to NCDs has grown significantly, particularly over the past five years.

5 World Health Statistics 2018: monitoring health for the SDGs. Geneva: WHO; 2018 (https://www.who.int/ gho/publications/world_health_statistics/2018/en/, accessed 25 July 2019). 6 Preventing disease through healthy environments: a global assessment of the burden of disease. Geneva: WHO; 2016 (https://www.who.int/quantifying_ehimpacts/publications/preventing-disease/en/, accessed 25 July 2019).

Report of the Seventy-second Session 117 Air pollution affects all settings, urban and rural areas, and all socioeconomic and age groups. The most vulnerable groups are children, the elderly and those with underlying disease. Substantial inequities in impact are seen, with women and children disproportionately affected, particularly from household air pollution. This has a significant bearing on the fact that acute respiratory infection remains the biggest single cause of death in under-5 children in the WHO SEA Region.

WHO burden of disease estimates released in 2018 show that the WHO SEA Region is the most highly impacted of all regions from the combined effects of household and ambient air pollution, with 165.8 age-standardized deaths per 100 000 population, and 2.4 million deaths overall. By country, estimates of age-standardized deaths from air pollution per 100 000 population range widely, from 25.6 to 207.2. Household air pollution predominates in the majority of countries in the Region but ambient air pollution is also growing, such that 99% of people in the Region breathe air at concentrations higher than that recommended in WHO guidelines; in a number of cases, many times greater. Sixty per cent of urban populations in the WHO SEA Region are witnessing increased air pollution trends.

Almost two thirds of the population (63%) still rely on polluting fuels for cooking, resulting in the predominant household air pollution problem in the Region with only two Member States largely using clean fuel for cooking purposes – Thailand and Maldives. While some important gains have been made and commitments have been included in all multisectoral action plans to reduce NCDs, trends in reduction of use of polluting fuels in households across the Region have not shown a convincing or dramatic decline over the past 15 years. Accelerating conversion to clean energy and improved cooking technologies is the single most important action that could be taken to address air pollution in the Region, which would contribute to lowering ambient air pollution by up to 30% in some situations.

The main sources of ambient air pollution include emissions from the burning of coal and other carbon fuels, industrial facilities, deforestation, motor vehicle exhausts, and the open burning of waste material. These are the same sources responsible for accelerating climate change. Urgent combined actions on air pollution and climate change are therefore warranted.

118 WHO Regional Committee for South-East Asia Following the landmark adoption of resolution WHA68.8 on addressing the health impacts of air pollution, WHO has been at the forefront of increasing actions to reduce air pollution. Member States in the Region participated strongly at the First WHO Conference on Air Pollution and Health held in October 2018, and many made commitments to strengthen their actions. The UN Secretary- General will host a Climate Action Summit in September 2019, which will further advocate for action on air pollution and health. Within the Region, countries belonging to the Association of Southeast Asian Nations (ASEAN) are developing plans or collective action on climate change and air pollution, the Asia Pacific Regional Forum on Health and Environment has identified the significance of transboundary air pollution in the Region, and several Alliances such as the Climate and Clean Air Coalition have committed to protecting the climate and improving air quality.

2.2 Water, sanitation and hygiene Experience has shown that to successfully address widespread environmental problems, large investments of social and financial capital and coordinated multisectoral action over many years are needed. Efforts to improve WASH over the past decade have been possible only because of such commitments. Success has led to the lowering of the mortality rate to 15.4 deaths per 100 000 population in the Region, ranging from 0.3 to 19.8.5

Major improvements have been seen in access to basic water services, which increased from 80% in 2000 to 92% in 2017.7 Access to basic sanitation also increased significantly, from 27% in 2000 to 63% in 2017. Despite these improvements, some 163 800 diarrhoea deaths were estimated in 2016 due to inadequate drinking water, 153 000 deaths due inadequate sanitation and 56 400 due to inadequate handwashing practices.8 The decline in diarrhoeal deaths in the Region attributable to causes related to WASH between 1990 and 2012 was 55%.9 Despite these improvements, significant challenges still remain to developing safely managed water and sanitation services in the Region.

7 Updated estimates available for household drinking water, sanitation and hygiene. In: WHO/UNICEF. JMP [website] (www.washdata.org, accessed 25 July 2019). 8 Global Health Observatory. In: World Health Organization [online database] (https://www.who.int/gho/ en/, accessed 17 July 2019). 9 Preventing diarrhoea through better water, sanitation and hygiene: exposures and impacts in low- and middle-income countries. Geneva: WHO; 2014 (https://www.who.int/water_sanitation_health/publications/ gbd_poor_water/en/, accessed 25 July 2019).

Report of the Seventy-second Session 119 The Regional Office has provided notable support to Member States on drinking water safety through the institutionalization of water safety plans (WSPs) and by developing the capacity to implement them. More than five thousand urban and rural WSPs have been implemented in the Region over the past 12 years, with sustainability of achievements backed by improvements in regulatory frameworks and technical capacity.10 Sanitation and hygiene promotion has continued through the support provided by WHO in developing national sanitation policies, sharing good practices, building capacity, and through regional sanitation forums such as the South Asian Ministerial Conference on Sanitation and the East Asian Ministerial Conference on Sanitation.

Health-care settings are environments with a high prevalence of infectious disease agents and the inclusion of WASH as an integral part of patient safety initiatives is recognized as a key part of achieving UHC. The first-ever global assessment jointly conducted by WHO and the United Nations Children’s Fund (UNICEF) in 2015 found that of 60 000 health-care facilities, 40% lacked water, 19% were without adequate sanitation and 35% lacked materials for hand hygiene. Furthermore, 40% did not safely manage health-care waste.11 Patients, staff, carers and neighbours at health-care settings face increased risks of infection if environmental conditions such as safe and sufficient water, basic sanitation, adequate management of waste, and appropriate knowledge and application of hygiene are not available. In 2018, the United Nations Secretary- General issued a global call for action on WASH in health facilities to call attention to this issue of fundamental importance to health and development.

Improving WASH in health-care facilities is a core component of the Framework for Action in Building Health Systems Resilience to Climate Change in South-East Asia. In collaboration with partners, the Regional Office has started to implement the Water and Sanitation for Health Facility Improvement Tool (WASH FIT), a capacity-building instrument to help health facilities assess and plan improvements to reduce potential drivers of infection and AMR. Nationally representative data on WASH in health-care facilities is not yet available in all

10 Sutherland D, Payden. Observations and lessons learnt from more than a decade of water safety planning in South-East Asia). WHO South-East Asia Journal of Public Health. 2017;6(2) (http://www.searo.who.int/ publications/journals/seajph/issues/seajph2017v6n2p27.pdf?ua=1, accessed 25 July 2019). 11 WASH in health care facilities: global baseline report 2019. Geneva: WHO and UNICEF; 2019 (https:// www.who.int/water_sanitation_health/publications/wash-in-health-care-facilities-global-report/en/, accessed 25 July 2019).

120 WHO Regional Committee for South-East Asia Member States of the Region and efforts are needed to improve the inclusion of WASH information in health management information systems (HMIS).

2.3 Urbanization The WHO South-East Asia Region is a hub of social and economic development and is becoming increasingly urbanized. In 2015, 53.9% of the world’s population lived in cities. In the Region, the urban population ranges from 18.3% to 61.3%, with Indonesia and the Democratic People’s Republic of Korea having the highest proportion of urban population. Although the proportion of city dwellers in the Region is still relatively small by global standards, it is rapidly increasing and is expected to reach more than 970 million by 2030. The size and speed of change is remarkable.

Of the expected 30 largest cities in the world in 2020, six are in the SEA Region with a combined population of 109 million.12 Five of the largest agglomerations in the world can be found in the Region, with Delhi ranked second only to Tokyo. Rapid and increased urbanization poses enormous challenges for the continued provision of water, sanitation, energy, transport and health care. Unplanned and lopsided development of towns and cities pose additional challenges for waste management and air quality. Cities are generally huge consumers of energy and producers of emissions that lead to climate change. Internal migration of people to towns and cities from rural areas can create additional environmental pressures due to overcrowding and lack of affordable housing.

Waste management is a growing and largely unaddressed challenge facing the Region and its rapidly urbanizing metros. Solid waste is commonly haphazardly disposed of at dumpsites within or outside city boundaries with limited systems for sorting and segregation into different waste streams. Fires at these dumpsites are commonplace, adding considerably to poor air quality in and around cities, and pollution of water courses. People scavenging on dumpsites for materials to recycle face considerable health risks.

In addition to municipal solid waste, the Region’s rapid economic growth has led to the production of “niche” wastes such as electronic waste, construction

12 UN DESA 2018; World Urbanization Prospects 2018. In: Un DESA/Population Division [website] (https:// population.un.org/wup, accessed 25 July 2019).

Report of the Seventy-second Session 121 and demolition waste, and plastic waste, each with its own health risks to those people handling it, who are often among the most impoverished and vulnerable groups in society. Seven SEA Member States have a dedicated policy on biomedical waste management; however, safe disposal of health-care waste remains low in practice, with less than half of health-care facilities reporting having a system for safely collecting, disposing of and destroying the waste they generate.

2.4 Work settings The work setting is one of the most important sources of exposure to environmental risk factors, particularly in South-East Asia, where almost two thirds of workers are engaged in agriculture and an estimated 60% are employed in the informal sector. These situations can expose people to a wide and severe range of risk factors, including exposure to highly hazardous pesticides, high temperatures, poorly regulated working conditions and limited access to basic needs such as safe drinking water and sanitation. Although a large proportion of workers in the Region work outdoors, the impact of occupational exposure to air pollution outdoors remains largely unaddressed. Most Member States in the Region have developed policies and regulations for occupational health and safety; however, these are generally implemented in larger and more formalized workplaces. Workers in the informal sector are generally reliant on the public health system for meeting their occupational health needs. Accordingly strengthening health systems so that they can provide essential interventions and basic health services for the prevention and control of occupational and work-related diseases is being increasingly considered as a necessary part of UHC in many Member States of the Region. Policies and programmes to improve the occupational health and safety of health-care workers are missing in many Member States of the Region.

2.5 Sound management of chemicals Employment in the Region is still predominantly in the agricultural sector, but industrial growth is increasing. The chemicals industry is one of the world’s fastest-growing and largest industrial sectors globally. Countries in Asia in particular are rapidly increasing their production and use of chemicals. At the same time, awareness about the dangers of exposure to toxic chemicals and pesticides remains low. Many Member States lack the necessary capacity for

122 WHO Regional Committee for South-East Asia conducting chemical risk assessment and risk management. Attainment of the capacity to deal with chemical events of public health significance, as defined by the IHR (2005), remains one of the lowest of all core capacities in the Region. Continued high use of chemicals considered obsolete and no longer used in most countries of the world is a concern in the Region. The high and still growing rate of asbestos use, the use of lead in decorative paints and continued use of pesticides classified as highly hazardous are notable examples.

Resolution WHA67.11 passed by the Sixty-seventh World Health Assembly on the public health impacts of exposure to mercury and mercury compounds focuses attention on the role of WHO and ministries of public health in implementing the Minamata Convention, which will see the phasing-out of all medical instruments containing mercury, such as thermometers and sphygmomanometers by 2020. Four Member States are currently Parties to this Convention and eligible for financial and technical support to assist implementation. Several Member States in the Region have established multisectoral coordination mechanisms among the relevant ministries to address the sound management of chemicals but more remains to be done.

WHO continues to support Member States in understanding and strengthening the evidence for action, enhancing the role of the health sector in the sound management of chemicals, establishing and strengthening poisons centres and accelerating the implementation of regional and international priorities by working with other sectors and United Nations (UN) agencies through existing instruments such as the Strategic Approach to International Chemicals Management (SAICM).

The WHO Chemicals Road Map13 approved by the Seventieth World Health Assembly identifies the actions where ministries of health have a lead or key role to play in the sound management of chemicals. The Road Map is accompanied by a workbook, which facilitates the development of national implementation and engagement plans depending on national circumstances. The WHO Global Chemicals and Health Network has been established to facilitate implementation of the Road Map. Increasing the participation of SEA Member States in this

13 Road map to enhance health sector engagement in the Strategic Approach to International Chemicals Management towards the 2020 goal and beyond. Geneva: WHO; 2017 [WHO/FWC/EPE/17.03] (http:// www.saicm.org/Portals/12/Documents/WHO%20-%20Chemicals%20Roadmap%20Brochure%20Final%20 31Aug%202017.pdf, accessed 25 July 2019).

Report of the Seventy-second Session 123 Network would help build and strengthen networks and partnerships within and beyond the Region.

2.6 Climate change Perhaps nowhere is the interlinkage and interdependence of health and environment more dramatic than when considering the impact of climate change on health. Climate change is a significant and emerging threat to public health. WHO has an active and long-standing programme on protecting health from climate change, guided by a World Health Assembly resolution (WHA61.19) and a resolution of the Sixty-second session of the Regional Committee for South-East Asia (RC62/R2).

Despite the work of the UN Framework Convention on Climate Change (UNFCCC), the evidence from the Intergovernmental Panel on Climate Change, and growing concerns for the health of the people and the planet, greenhouse gas emissions have not yet decreased sufficiently to limit global warming and avert severe consequences to public health in the Region. Although there has been an overall increase in emissions in all SEA Member States, they are all still below the world average at the capita level. In 2017, the world emitted 4.91

tonnes of CO2 per capita. Member States of the Region had emissions ranging from 0.28 to 4.07 tonnes per capita in the same year. Total emissions for the Region were 9.25% of the total. This represents a substantial increase from 1990, when this fraction was 4.48%.

In the 50 years between 1966 and 2015, there were 8518 climate-related disasters (floods, storms and droughts) globally, which resulted in over 1.8 million deaths. The number of events in the eleven Member States of the SEA Region accounted for 14% of all global events, and 10% of all economic costs. They had a much larger human cost, however, with 44% of all deaths, 37% of all injured persons and 40% of all affected persons recorded for the SEA Region.14

Member States of the Region are particularly vulnerable to extreme weather events and climate change. Dependence on agriculture, with a preponderance of small-scale and marginal farmers, large rural populations, expanding urban populations including slum dwellers, large proportions of the population living in

14 EM-DAT: The International Disaster Database [online database] (https://www.emdat.be/, accessed 25 July 2019).

124 WHO Regional Committee for South-East Asia mountainous and low-lying coastal areas and island communities are particular factors influencing the climate vulnerability of the Region. The pre-existing and high burden of climate-sensitive diseases, including malnutrition, vector-borne and air pollution-related diseases creates additional vulnerability. Awareness of the impact of climate change and health is at a mature level in all Member States.

All Member States of the Region have identified the key health vulnerabilities to climate change and have started work to integrate these into national climate change programmes. However, much remains to be done and at a faster pace. The Malé Declaration is a bold initiative by health ministers of the Region to help achieve this, putting emphasis on building health systems resilience to climate change, greening the health sector, strengthening health information systems and developing health national adaptation plans. Further work needs to be done to integrate the surveillance of climate-sensitive diseases, development of early warning systems, climate-resilient WSPs and tools for the integrated monitoring of air quality and health data; inclusion of climate risks in planning and implementing disease programmes and greater mobilization of resources for adaptation and mitigation measures.

Freshwater depletion, land degradation and desertification, biodiversity loss and climate change are some of the environmental changes that are already starting to impact human health. These changes magnify existing risks such as from zoonoses and vector-borne diseases; flood, droughts, heatwaves, storms and other extreme climate events may reduce agricultural yields and cause displacement of populations and result in further health consequences from loss of livelihoods.

In summary, the threats to health from climate change are different, more varied, more complex and larger than encountered by the health sector in its normal day-to-day activities, requiring the sector to rethink the way it responds to environmental determinants and the way it scales up its actions. Considering the enormity of the challenge, the health sector must also effectively advocate for actions to mitigate climate change, while working to build resilient health systems and health-care facilities.

Report of the Seventy-second Session 125 3. Vision and objectives The Regional Plan of Action for WHO South-East Asia Region is guided by the vision of the Global Strategy of “a world in which sustainable development has eliminated almost one quarter of the disease burden caused by unhealthy environments, through health protection and promotion, good public health standards, preventive action in relevant sectors and healthy life choices, and which manages environmental risks to health. Key sectors fully integrate health into their decision-making process and maximize societal welfare.”

From a regional perspective, we adopt the same vision. Our goal is:

Healthy environments for a healthier population

4. Strategic areas The goal calls for actions in four strategic areas:

1. Scaling up primary prevention

Primary prevention aims to prevent disease or injury before it occurs by preventing exposure to the hazards that cause disease or injury or by altering unsafe behaviours. A transformation in the way we address health determinants is essential to reduce one quarter of the deaths and substantial morbidity linked to the environment. To address the current challenges, there should be a focus on addressing the root causes of the problems rather than treating individual diseases, or merely reducing exposure. Better integrated approaches, including embedding environmental health actions in key policies and approaches used by sectors other than health, are needed to ensure health protection.

2. Building cross-sectoral action, governance, and political and social support

It is clear that the health sector can never resolve the problems that result from other sectors by acting alone. There must be strong commitment to work across sectors to systematically address health risks through approaches such as “health in all policies”, health impact assessment and community engagement. Cross- sectoral action is also needed to encourage investments in common goods for health, such as clean air and water, and for evaluation of the health benefits of policy actions across governments.

126 WHO Regional Committee for South-East Asia The 2030 Agenda for Sustainable Development calls for working across sectors and building partnerships to address complex problems. Governance mechanisms, agreements and political will should include interdepartmental and intersectoral cooperation as well as political movements and enabling agreements. New and existing partnerships and collaborations that enable an increased and sustainable response to current and emerging problems and reduce health impacts and inequities should be put in place.

3. Strengthening the health sector

Health leaders need to play a pivotal role in driving transformation towards an equitable and sustainable world, a world where the health of the environment and the health of people are jointly prioritized and addressed with full political and social support. To achieve this, the capacity of the health sector needs to be strengthened. It should have the skills and resources to engage in cross- sectoral dialogue and provide guidance to establish the necessary frameworks for the assessment of health impacts and health benefits. Ensuring that essential environmental services are provided in health-care facilities, that the occupational health of health-care workers themselves is protected and that initiatives and movements such as “greening the health sector” are promoted are critically important to ensure that the health sector leads by example and ensures that its own actions do no harm. Building health systems resilience to climate change by understanding, monitoring, anticipating, communicating and preparing for climate-related health risks is vital.

4. Enhancing the evidence base and risk communication

Sufficient evidence-based information should be available to act on all critical environmental health problems. There may be knowledge gaps and incomplete evidence regarding some risks to health, particularly those regarded as new or emerging such as electronic waste, nanoparticles, microplastics and mixtures of different chemicals and these will need to be resolved through ongoing research. Knowledge gaps regarding the best, most efficient and cost-effective interventions should be prioritized for filling.

Communication gaps need to be addressed urgently, in areas where knowledge of environmental health problems may not be acted upon because of insufficient information and awareness, and there are difficulties in compiling

Report of the Seventy-second Session 127 relevant information at the national level. In many SEA Member States, the infrastructure for monitoring and health surveillance should be strengthened and linked with environmental monitoring systems. All channels of communication and information provision, including social media, should be utilized. Monitoring of progress towards the health-related SDGs and other relevant indicators of health, environment and climate change will help to prompt timely availability of data and assessments for action.

5. Strategic actions For each strategic area of the Regional Plan of Action, two sets of actions are identified: “Actions by Member States” and “Actions by WHO”. The first set contains recommended interventions, mostly at the national level, for consideration by Member States. The second set covers activities to be conducted by WHO, with contribution from all three levels of the Organization and in collaboration with Member States and partners.

5.1 Area 1: Scaling up primary prevention

Under this strategic area, the actions of the health sector will be scaled up to tackle the environmental determinants of health, with specific attention to ambient and household air pollution, WASH, chemicals, radiation and climate change. This will take place in several settings, including workplaces, schools, cities, housing and health-care facilities.

Strategic Action 1.1: Enhance the implementation of a culture of disease prevention to target the environmental determinants of health

Reducing the 3.8 million deaths, which represent 28% of all deaths linked to the environment in the Region, will require a shift in actions, human resources and financing towards the reduction of environmental risks. This transformational change in the health sector will result in reduced morbidity and mortality with reduced costs to the sector.

Actions by Member States

C1.1.1 Systematically engage with relevant sectors to integrate action on the environmental determinants of health into key health programmes.

128 WHO Regional Committee for South-East Asia C1.1.2 Establish effective systems for surveillance of the health impacts of priority environmental determinants of health, particularly air pollution, chemicals and climate-sensitive diseases. C1.1.3 Advocate for co-benefits to health by promoting climate change mitigation strategies. C.1.1.4 Reduce vulnerability to climate change by providing early warning systems for heat waves, disease outbreaks and natural disasters. C.1.1.5 Ensure that infrastructure, such as water supply and sanitation systems, and health-care facilities are resilient to drought, floods, cyclones and earthquakes.

Actions by WHO

W.1.1.1 Develop tools to monitor and raise awareness on climate change risks in various climate-sensitive disease programmes and support Member States in developing/updating health risk maps for climate- sensitive diseases. W.1.1.2 Develop and promote the use of tools for linking data from monitoring of the environmental determinants with health data. W.1.1.3 At the regional level, strengthen inter-programmatic coordination, dialogue and activities to accelerate the integration of climate action in all health/disease programmes. W.1.1.4 Support climate change mitigation efforts by promoting actions that reduce carbon emissions and simultaneously yield co-benefits to health. W.1.1.5 Develop roadmaps specifically to guide Member States on actions to reduce air pollution.

Strategic Action 1.2: Urgently renew and revise programmes and policies on health and environment and accelerate action towards the SDGs for health protection

This action will assist Member States in systematically identifying the health and environment issues that need sustaining, accelerating or innovating and will support capacity-building within and outside the health sector.

Report of the Seventy-second Session 129 Actions by Member States

C1.2.1 Review and update the mandate of environmental health programmes as necessary to ensure integrated coverage of health, environment and climate change, and strengthen governance and coordination with the relevant sectors.

C1.2.2 Promote universal access to safely managed water and sanitation and basic handwashing facilities in all settings.

C1.2.3 Promote the adoption of clean household energy solutions, including through innovations in financing and business models; and prioritize fuels and technologies that offer substantial health benefits during the transition to clean energy.

C1.2.4 Scale up and innovate actions to reduce and substantially eliminate household air pollution under multisectoral NCD action plans.

C1.2.5 Support the relevant sectors to develop or strengthen and implement regulations to control the environmental determinants of health.

C1.2.6 Develop or strengthen capacity to monitor progress towards the health and environment-related SDG targets.

C1.2.7 Strengthen programmes to address work-related environmental risks such as heat, cold, air pollution, chemicals and pesticide exposure and solar radiation among vulnerable groups, such as workers and children.

Actions by WHO

W1.2.1 Provide policy, strategy, technical support and training to Member States to build national capacity to accelerate and sustain environmental interventions addressing air pollution, WASH, chemical and radiation safety, workers’ health, environmental emergencies and others.

130 WHO Regional Committee for South-East Asia W1.2.2 Support Member States in monitoring and reporting on the SDG health- and environment-related indicators and strengthen national capacities to track progress towards relevant national targets.

W1.2.3 Provide guidance to protect vulnerable groups from environmental hazards.

W1.2.4 Support Member States in sustaining and accelerating health and environment interventions based on settings such as workplaces, cities, housing and health-care facilities through tailored intervention packages.

5.2 Area 2: Building cross-sectoral action, governance, and political and social support

Actions in this area will support Member States in building partnerships and implementing work across the different sectors whose actions impact on health. They will also assist in monitoring and implementing actions in the context of the 2030 Agenda for Sustainable Development and the SDGs.

Strategic Action 2.1: Support current partnerships and build new ones where required to ensure all sectors and stakeholders are active participants in the implementation of health protection actions

This action requires the development of strategies to strengthen engagement with all relevant sectors. This includes developing mechanisms to share information between ministries in Member States, between local and national governments, and among countries. Important work can be achieved through the full participation and engagement of all Member States in the Asia-Pacific Regional Forum on Health and Environment.

Actions by Member States

C2.1.1 Scale up training and education and develop competencies to address the environmental determinants of health in collaboration with cross-sectoral partners.

Report of the Seventy-second Session 131 C2.1.2 Actively contribute to national monitoring and reporting on the SDG indicators beyond SDG 3 that are most relevant for health, environment and climate change in collaboration with cross-sectoral partners. C2.1.3 Scale up the use of practical tools for addressing the environmental determinants of health in health-service delivery (e.g. WASH FIT for health-care facilities and the HealthWISE tool for improving work conditions, occupational health and safety for health workers15). C2.1.4 Integrate workers’ health into national health security plans, including the IHR (2005).

Actions by WHO

W2.1.1 Together with partners, scale up the availability of norms, guidance, tools and materials for implementing actions to protect health within and outside the health sector. W2.1.2 Together with partners, scale up training, education and competency development to support implementation of actions to protect health within and outside the health sector. W2.1.3 Engage with cities and other local government bodies to stimulate and support cross-sectoral actions to protect health at the local level. W2.1.4 Support Global Health Cluster partners in monitoring and improving WASH in health-care facilities in emergencies.

Strategic Action 2.2: Strengthen cross-sectoral action based on the implementation of the health and environment-related SDGs, targets and indicators

This action aims to support Member States in implementing health protection actions in key SDGs, targets and indicators relevant to health, environment and climate change. This requires interagency and intersectoral arrangements,

15 HealthWISE – Work Improvement in Health Services. In: International Labour Organization [website] (https:// www.ilo.org/sector/Resources/training-materials/WCMS_250540/lang--en/index.htm, accessed 25 July 2019).

132 WHO Regional Committee for South-East Asia given that those SDG indicators in health, environment and climate change are collected by sectors other than health.

Actions by Member States

C2.2.1 Strengthen governance mechanisms to promote health in all policies relating to health, environment and climate change. C2.2.2 Promote transdisciplinary research on the environmental determinants of health and relevant policy solutions.

Actions by WHO

W2.2.1 Support implementation at country level of global and regional initiatives such as the roadmap for enhanced global response to the adverse health effects of air pollution, the WHO Chemicals Road Map, the Global Action Plan for Pneumonia and Diarrhoea, the Global Strategy on Neglected Tropical Diseases, the Global Action Plan on Antimicrobial Resistance and initiatives on patient safety, infection prevention and control and improving the quality of care for mothers and newborns. W2.2.2 Develop, update and disseminate norms, guidance, packages, tools and training materials on ambient and household air pollution, water, sanitation and hygiene, and other risk factors. W2.2.3 Build health sector capacity at country and regional levels to facilitate the use of clean household energy, implement climate-resilient WSPs, improve WASH in health-care facilities, scale up sanitation safety planning, and strengthen air and water quality surveillance and monitoring programmes. W2.2.4 Monitor and report on the health and environment-related SDGs and strengthen Member States’ capacities to track progress towards national targets. W2.2.5 Improve sharing and access to knowledge and information through mechanisms such as global knowledge platforms, health observatories and databases. W2.2.6 Raise awareness of the risks of ambient and household air pollution to health through global communications campaigns, such as BreatheLife, and provide support for national awareness-raising programmes.

Report of the Seventy-second Session 133 5.3 Area 3: Strengthening the health sector

This area will support health leadership in Member States, and build the necessary political and social support to effectively respond to environmental determinants of health.

Strategic Action 3.1: Implement strategies to strengthen health systems in Member States to build the required expertise, including through innovative ways, to address current and emerging health and environment risks

This action will improve information for health leaders, particularly on subjects in which the health sector is less engaged, such as climate change, equipping them with the latest evidence to better influence the policies of other sectors and effectively contribute to high-level engagements and participation in international conventions and agreements.

Actions by Member States

C3.1.1 Develop the capacities of the primary health workforce to better identify, assess, monitor and manage environmental and work- related injury and disease. C3.1.2 Strengthen national institutional capacities within ministries of health to address the environmental determinants of health, including incident and emergency response. C3.1.3 Integrate health and environment issues in the curricula of medical and allied health sciences and periodically update and include these in continuing professional education. C3.1.4 Establish and strengthen poison centres for the prevention and control of poisoning. C3.1.5 Build national capacity to implement the IHR (2005), specifically to respond to chemical and radiation incidents and emergencies.

Actions by WHO

W3.1.1 Provide policy, strategy and technical support to Member States to build national capacity to promote innovative solutions such as integration of clean household energy interventions in public health programmes, implementation of risk-based approaches to water

134 WHO Regional Committee for South-East Asia quality management, sanitation safety planning, mitigation and adaptation to climate change. W3.1.2 Provide training to national climate change and health focal points. W3.1.3 Identify experts to support Member States in analysing health, environment and climate data for developing and strengthening early warning systems.

Strategic Action 3.2: Promote health-care facilities that are climate-resilient, green and healthy

This area focuses on environmental health services as a part of achieving UHC. Health-care facilities must be properly equipped with safely managed WASH services and facilities and reliable energy supplies. Actions to green the health sector, support low-carbon health care, mitigate greenhouse gases and make the health sector environmentally sustainable and climate-resilient are mutually supportive. WHO and partners have developed extensive methods and tools for implementing climate-informed health early warning systems, building climate resilience, and strengthening the environmental sustainability of health-care facilities. There is a need to strengthen the role of the health sector in promoting health co-benefits of climate change mitigation and present the evidence for action to those sectors most responsible for global warming.

Actions by Member States

C3.2.1 Periodically monitor improvements in climate resilience and in reducing the environmental impact of health-care facilities. C3.2.2 Implement climate-resilient and sustainable health systems by ensuring that health-care facilities have reliable energy and WASH services, are resilient to extreme weather, and reduce their environmental impact, including their carbon footprint, and mitigating the production of greenhouse gases. C3.2.3 Improve chemical and radiation safety measures and medical waste management in health-care settings. C3.2.4 Institutionalize systems of occupational health and safety and well- being for health-care workers.

Report of the Seventy-second Session 135 Actions by WHO

W3.2.1 Provide policy, strategy, technical support and training to Member States to build national capacity for climate resilience in the health system and to promote climate resilience in health-determining sectors. W3.2.2 Document and disseminate good practices in the SEA Region on promoting climate-resilient health-care facilities and reducing carbon emissions by the health sector. W3.2.3 Support Member States in strengthening and implementing standards for WASH in health-care facilities, and in accessing and using tools for assessing and improving WASH services in these facilities. W3.2.4 Assess gaps in WASH services and ensure access to clean and sustainable sources of energy in health-care facilities. W3.2.5 Include climate risks in the risk reduction plans and programmes of the Regional Office. W3.2.6 Stimulate action at regional and country levels to respond to the UN Secretary-General’s global call to action for WASH in all health-care facilities. W3.2.7 Develop a guidance tool for assessing the vulnerability of health-care facilities to climate change. W3.2.8 Provide advice and guidance on electrical power demands for essential health-care services and energy-efficient medical devices for resource-constrained settings.

5.4 Area 4: Enhancing the evidence base and risk communication

This area seeks to enhance the evidence base on health, environment and climate change by fully leveraging existing information and generating new evidence where needed and by creating additional infrastructure for monitoring and health surveillance. A platform will be created for risk communication and awareness-raising.

Strategic Action 4.1: Estimate and communicate the burden of disease, cost of inaction and the benefits of policy-based options based on a co- benefits approach

This action promotes the use of evidence-based norms and guidance to support action at the national level. This includes supporting Member States to perform

136 WHO Regional Committee for South-East Asia risk assessment, burden of disease estimates and strengthen communication for the environmental determinants of health. Where knowledge of the national burden of disease from environmental risks is lacking, decision-making on priority actions can be challenging, impeding the availability of accurate cost estimates of interventions and hindering action.

This action also seeks to improve the presentation of information on health, environment and climate change in a more easily accessible form for decision-makers. WHO will work with Member States to produce information for communication both within and beyond the health sector, including for awareness-raising. The best use will be made of new and emerging communication technologies. Greater availability of health, environment and climate profiles for Member States with the aim of triggering action and investment are needed. Support will be given to Member States to strengthen the monitoring of health, environment and climate change within national policies as well as with international conventions and agreements on the environment.

Actions by Member States

C4.1.1 Compile and improve the availability of existing data and evidence on burden of disease estimates, particularly for high-priority issues such as air pollution and WASH. C4.1.2 Implement effective communication strategies to raise awareness among the public and among decision-makers and stakeholders on the health benefits of policy interventions. C4.1.3 Develop national guidelines for estimating the burden of disease, costs of inaction and the benefits of policy-based interventions based on a co-benefits approach to environmental risk factors. C4.1.4 Harness new technology to help the public visualize environmental health problems and increase dissemination of information, including to mainstream social media and other interactive platforms.

Actions by WHO

W4.1.1 Strengthen national capacities to estimate the burden of disease and costs due to environmental risks to health in air pollution and WASH. W4.1.2 Conduct global communications campaigns and support their implementation at national and local levels to raise awareness among

Report of the Seventy-second Session 137 the public and at political levels on the health and economic impacts of environmental risks to health, including climate change.

Strategic Action 4.2: Strengthen the network of WHO collaborating centres and other centres of excellence for building capacity in Member States, conducting research, and national and regional health, environment and climate change assessments

This action seeks to continue the strong contributions made by WHO collaborating centres and other centres of excellence. Strengthening existing centres and identifying new ones in health, environment and climate change will help the generation and dissemination of evidence, including on the effectiveness of interventions. These centres could assist in developing and implementing a regional research agenda; estimating the costs of climate change impacts on health; building health systems resilience to climate change; identifying and addressing knowledge gaps, and helping to build research capacity; and strengthen health- and environment-related information and surveillance systems.

Actions by Member States

C4.2.1 Establish and sustain networks of research centres and centres of excellence that address the environmental determinants of health. C4.2.2 Engage in the Asia-Pacific Regional Forum on Health and Environment to share information, and advocate for stronger support for policies and actions on environment and health issues, including those of a transboundary nature. C4.2.3 Engage centres of excellence and other relevant institutions to conduct research to fill gaps in knowledge and evidence on the environmental determinants of health.

Actions by WHO

W4.2.1 Develop and promote a regional research agenda and support Member States in developing national research agendas in support of regional and national health, environment and climate change objectives. W4.2.2 Facilitate collaboration among WHO collaborating centres, national centres of excellence, extra-regional research centres, and global networks such as the WHO Chemical Risk Assessment Network and the WHO Radiation Emergency Medical Preparedness and Assistance Network (REMPAN).

138 WHO Regional Committee for South-East Asia W4.2.3 Develop at least one institute in the Region as a WHO collaborating centre on climate and health. W4.2.4 Develop and support an SEA Region climate change and health research network. W4.2.5 Facilitate regional cooperation on climate and health research and exchange of experiences. W4.2.6 Encourage WHO collaborating centres to support the filling in of gaps in knowledge and evidence on the environmental determinants of health.

6. Implementation The success of this Regional Plan of Action for Implementing the WHO Global Strategy on Health, Environment and Climate Change will depend in large part on strengthening collaboration with new and existing partners and increasing inter-programmatic collaboration within the health sector itself.

6.1 Working with partners, including new alliances

Strengthening long-standing alliances between WHO and key UN partners, and new WHO–UN alliances will provide additional support and momentum for implementing the Regional Plan of Action. There are many examples of new initiatives at both the global and regional levels reflecting the interest of partners in supporting work on health and environment. WHO and UN Environment (UNE), for example, have long collaborated on a range of health and environment issues and, in 2016, formalized a new collaboration to step up joint actions to combat air pollution, climate change and AMR as well as improving coordination on waste and chemicals management, water quality and food and nutrition issues. WHO, the Food and Agriculture Organization (FAO) and the World Organization for Animal Health (OIE) are spearheading action against AMR, speaking as one voice and taking collective action.

In 2018, WHO, UNE and WMO launched a global coalition on health, environment and climate change, focusing initially on air quality. Together, the Climate and Clean Air Coalition, WMO, WHO, the World Bank and UNE support the global communications and networking campaign for BreatheLife, aiming to mobilize cities and individuals to protect health and the planet from the effects

Report of the Seventy-second Session 139 of air pollution.16 WHO and the International Labour Organization (ILO) also share a long history of collaboration on occupational health and safety issues.

At the regional level, priorities for WHO–ILO collaboration include occupational exposure to toxic chemicals and other hazardous substances and strengthening occupational health services in primary care settings. WHO and UNICEF have worked in partnership for many decades through the Joint Monitoring Programme on Water Supply and Sanitation, WASH in schools and health-care facilities, and other WASH initiatives. More recently, UNICEF has initiated efforts to implement a cross-cutting strategy on environmental sustainability that opens new opportunities for collaboration on research and data analysis to expand knowledge and deepen understanding of priority issues, needs, policy options and interventions.

At the regional level, a newly launched ASEAN–UN joint activity “Using Environmental Health Data and Tools to Advance the SDGs in ASEAN” can also be an additional vehicle for supporting the implementation of the Regional Plan of Action. This vehicle should be used to demonstrate the effectiveness of policies and preventive actions; the importance of cross-sectoral cooperation; and the need for integrated solutions.

New initiatives at the highest levels of the UN, such as those emanating from the UN General Assembly resolutions on NCDs, the Secretary-General’s Climate Action Summit in September 2019, the launch of a new Health and Energy Platform and the Secretary-General’s global call to action on WASH in all health-care facilities provide further political momentum and a sense of urgency for action, particularly on air pollution, WASH and climate change.

6.2 Working with the Asia-Pacific Regional Forum on Health and Environment

The Asia-Pacific Regional Forum on Health and Environment provides a platform for health and environment ministries to jointly identify and address priority health, environment and climate change issues that require regional action and to share knowledge, information and best practices that promote sustainable development, to engage in policy discussions on critical cross-sectoral issues,

16 Breathelife: a global campaign for clean air (www.breathlife2030.org, accessed 25 July 2019).

140 WHO Regional Committee for South-East Asia and to collaborate in capacity-building activities. Proceedings of ministerial and high-level official meetings stimulate and support policy development and joint programme planning at the national level, with WHO and UNE jointly providing secretariat support.

The Regional Forum advocates for continued strengthening of interministerial collaboration and outreach to health-determining sectors such as agriculture, energy, industry, housing, transport, urban development, and others. The new WHO Global Strategy on Health, Environment and Climate Change may be an agenda item for discussion in upcoming high-level and ministerial meetings. The present Regional Plan of Action can be an important activity to follow up and report on in the Forum’s 2025 and 2030 ministerial meetings.

6.3 Mainstreaming into health programmes

Increasingly, evidence points to environmental risk factors as major causes of disease and injury, but much remains to be done to fully integrate such evidence into health programmes. In 2016 in the SEA Region, 3.8 million total deaths (representing 28% of all deaths and 24% of all DALYs) were linked to environmental risks. Heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory tract infections – all related to air pollution – are among the leading causes of preventable death and illness in the Region.

Exposure to certain chemicals in air, food, water and in workplaces contributes to some cancers, another leading cause of preventable death and illness. Meanwhile, lack of access to safely managed drinking water and sanitation, and adequate handwashing facilities contributes to diarrhoeal disease, the Region’s leading cause of preventable deaths due to infectious disease. Climate change is expected to exacerbate disease trends in the Region and is already thought to be contributing to increases in extreme weather events and resulting injury, illness, loss of life and damage to property. Implementation of this Regional Plan of Action will improve the integration of environmental interventions and embed them in key disease prevention health programmes.

To mention a few examples, interventions to reduce air pollution and those to prevent exposure to harmful chemicals will be integrated in programmes for the prevention and control of NCDs, WASH interventions will be integrated into UHC, interventions to strengthen climate resilience of the health sector will be

Report of the Seventy-second Session 141 integrated into emergency preparedness programmes and the elimination of neglected tropical diseases. The strengthening and integration of environmental monitoring and disease surveillance will be a key transformative action, allowing health authorities to monitor the impact of environmental interventions on health and to better target interventions.

7. Monitoring and reporting on progress Progress on the implementation of the Regional Plan of Action will be monitored against indicators defined for each strategic action and targets, as shown in Annex 1, and incorporate those of relevant SDGs. During 2020, WHO will work with Member States to identify the baseline for each indicator.

Recalling the decision of the World Health Assembly (WHA72/9) to request the Director-General to report back on progress in implementing both the WHO Global Strategy on health, environment and climate change and the Plan of Action on Climate Change in Small Island Developing States to the Seventy- fourth World Health Assembly in 2021 and also recalling the decision of the Regional Committee for WHO South-East Asia (SEA/RC70/R1) requesting the WHO Regional Director for South-East Asia to report on progress in implementing the Malé Declaration on Building Health Systems Resilience to Climate Change to the Seventy-fifth session of the WHO Regional Committee for South-East Asia in 2022.

It is suggested that a progress report on implementation of the present Regional Plan of Action also be made to the Seventy-fifth session of the WHO Regional Committee for South-East Asia in 2022, synchronized with the progress report on implementation of the Malé Declaration. Setting priorities for action by focusing on those to be achieved over five years by 2023 could be subjected to a mid-term evaluation of progress, with further periodic reporting. WHO will continue to regularly disseminate information and work to support Member States to access available financial resources and grants to support implementation of this Regional Plan of Action.

142 WHO Regional Committee for South-East Asia Annex 1 Proposed indicators for each strategic action

Strategic action Indicator 1. Scaling up primary prevention 1.1 Enhance the Percentage reduction of the burden of disease implementation of a culture based on the following SDG indicators: of disease prevention to target the environmental • SDG 3.9.1 Mortality rate attributed to determinants of health. household and ambient air pollution • SDG 3.9.2 Mortality rate attributed to unsafe water, unsafe sanitation and lack of hygiene (exposure to unsafe WASH for all services) • SDG 3.9.3 Mortality rate attributed to unintentional poisoning 1.2 Urgently renew and revise Number of countries with health, environment programmes and policies and climate change action plans or equivalent on health and environment developed and implemented and accelerate action towards the SDGs for health protection. 2. Building cross-sectoral action, governance, and political and social support 2.1 Support current Number of countries with established partnerships and build functional health and environment partnerships new ones where required with health-determining sectors to ensure all sectors and stakeholders are active participants in the implementation of health protection actions.

Report of the Seventy-second Session 143 Strategic action Indicator 2.2 Strengthen cross-sectoral Number of countries reporting on the following action based on the SDG indicators: implementation of the • SDG 1.4.1 Proportion of population living in health and environment- related SDGs, targets and households with access to basic services indicators. • SDG 2.2.2 Prevalence of malnutrition • SDG 6.1.1 Proportion of population using safely managed drinking water services • SDG 6.2.1 Proportion of population using safely managed sanitation services, including a handwashing facility with soap and water • SDG 8.8.1 Frequency rates of fatal and non-fatal occupational injuries, by sex and migrant status • SDG 7.1.2 Proportion of population with primary reliance on clean fuels and technology • SDG 11.1.1 Proportion of urban population living in slums, informal settlements or inadequate housing • SDG 11.6.2 Annual mean levels of fine particulate matter (e.g. PM2.5 and PM10) in cities (population weighted) • SDG 12.4.2 Hazardous waste generated per capita and proportion of hazardous waste treated, by type of treatment • SDG 13.1.1. Number of deaths, missing persons and persons affected by disaster 3. Strengthening the health sector 3.1 Implement strategies to Number of countries where the health strengthen health systems sector is an active participant in national and in Member States to build international platforms for health, environment the required expertise, and climate change including innovative ways to address current and emerging health and environment risks.

144 WHO Regional Committee for South-East Asia Strategic action Indicator 3.2 Promote health-care Number of countries reporting nationally facilities that are climate- representative data on WASH in health-care resilient, green and healthy. facilities 4. Enhancing the evidence base and risk communication 4.1 Estimate and communicate Number of countries with completed burden- the burden of disease, cost of-disease assessments on ambient and of inaction and the benefits household air pollution, water and sanitation, of policy-based options which are effectively used for advocacy based on a co-benefits approach. 4.2 Strengthen the network Number of assessments on health, of WHO collaborating environment and climate change performed centres and other centres by WHO collaborating centres or other WHO of excellence to support partners capacity-building in Member States, conduct research and national and regional health, environment and climate change assessments.

Report of the Seventy-second Session 145 SEA/RC72/R5 Resolution of thanks

The Regional Committee,

Having brought its Seventy-second Session to a successful conclusion,

THANKS His Excellency Dr Harsh Vardhan, honourable Union Minister of Health & Family Welfare, Science & Technology and Earth Sciences of India, for inaugurating the Session and for his inspiring address;

THANKS the WHO Director-General, Dr Tedros Adhanom Ghebreyesus, for his thought-provoking address through web-link;

CONVEYS its gratitude to His Excellency Dr Harsh Vardhan, honourable Union Minister of Health & Family Welfare, Science & Technology and Earth Sciences of India, members of the National Organizing Committee, staff of the Union Ministry of Health & Family Welfare, and other national authorities for their efforts in ensuring the success of the Session; and

CONGRATULATES the Regional Director and her staff for their efforts towards the successful and smooth conduct of the Session.

146 WHO Regional Committee for South-East Asia Decisions

SEA/RC72(1) Review of the draft Provisional Agenda of the 146th Session of the WHO Executive Board

The Regional Committee,

Considering the proposals from Member States for additional Agenda items on ‘Strengthening the control of harmful use of alcohol’, ‘Integrated People- Centered Eye Care’, and “Patient Safety” for inclusion in the Provisional Agenda for the 146th Session of the WHO Executive Board, decides to:

ENDORSE the proposals by Member States for agenda items on ‘Strengthening the control of harmful use of alcohol’, ‘Integrated People-Centered Eye Care’, and “Patient Safety” for inclusion in the Provisional Agenda of the 146th session of the WHO Executive Board;

REQUEST Member States to support Indonesia, Sri Lanka and Thailand in submitting proposals with an explanatory memorandum on behalf of the South-East Asia Region in a timely manner for consideration by the Officers of the Executive Board; and

REQUEST the Regional Director to communicate the additional Agenda item(s) proposals to the Director-General on behalf of the Regional Committee.

SEA/RC72(2) Time and place of future sessions of the Regional Committee

The Committee welcomed with appreciation the invitation from the Royal Thai Government and decided to hold its Seventy-third Session in the Kingdom of Thailand from 7–11 September 2020.

The Committee noted with appreciation the invitation from the Government of the Federal Democratic Republic of Nepal to host its Seventy-fourth Session in September 2021 in the Federal Democratic Republic of Nepal.

It also noted with appreciation the invitation from the Royal Government of Bhutan to hold its Seventy-fifth Session in September 2022 in the Kingdom of Bhutan.

Report of the Seventy-second Session 147 Annex 1 Text of welcome address by the Secretary (Health), Ministry of Health & Family Welfare, Government of India

It gives me immense pleasure to extend a very warm welcome to all of you to the inaugural programme of the Seventy-second Session of the WHO Regional Committee for South-East Asia.

It is a privilege for India to host you for the second successive year at the Ministerial Roundtable at this Regional Committee Session in Delhi, the capital city of India, with a rich culture, history and heritage.

The WHO South-East Asia Region, with its 11 Member States, represents a quarter of the world’s population and carries a heavy triple burden of disease: persisting communicable diseases, a rapidly rising incidence of noncommunicable diseases and emerging infectious diseases, and frequent natural disasters.

Due to this population and disease burden, the progress, achievements, initiatives and innovations in countries of the South-East Asia Region will have a significant influence on global health.

I am sure the efforts being made in our individual countries as well as the collaborative regional efforts will have the maximum impact on achieving WHO’s “triple billion target” that forms the core of the Thirteenth General Programme of Work 2019–2023.

Moving towards achieving the triple billion target, the topic of “Emergency preparedness” chosen for discussion at the Ministerial Roundtable this year is not only significant globally but is also of utmost importance to all of us in the Region. This roundtable provides us a unique opportunity to discuss preparedness with a larger scope and breadth. Emergencies, and preparedness specifically, have very strong linkages with universal health coverage (UHC) and the health- related Sustainable Development Goals (SDGs).

It is a matter of satisfaction for us that India is accelerating the achievement of new milestones in the health-related SDGs. In the recent past, India has taken several remarkable initiatives spanning a gamut of public health areas under

148 WHO Regional Committee for South-East Asia the visionary leadership of the honourable Prime Minister and with the decisive actions of the honourable Union Minister of Health & Family Welfare.

We are happy to see progress in almost all areas, be it immunization coverage; maternal, child and adolescent health; vector-borne disease control; population- based screening for noncommunicable diseases; strengthening of primary health care through health and wellness centres; provision of diagnostic, referral and treatment services, including dialysis; health promotion through stress on lifestyle changes and physical activity including yoga; improving accessibility and affordability of medicines; institutionalization of disaster preparedness and response; and, very importantly, the stress on sanitation, hygiene and pollution control through innovative nationwide schemes in mission mode.

I am pleased to note that by articulating a strong “regional voice” in the global health agenda, the South-East Asia Region has been working together and demonstrating its solidarity in various international forums to help shape the global public health agenda. In fact, this year the first-ever Regional Statement on “Universal health coverage: leaving no one behind” was delivered during the general discussion on this theme at the Seventy-second World Health Assembly.

The Regional Committee Session provides a platform to further strengthen collaboration in the Region, share our experiences, and identify areas of mutual cooperation to reinforce our common goals and objectives of better health for our countries, our Region and the world.

With such rich experience and expertise gathered here, I am sure the Agenda items included in this year’s Regional Committee Session will invoke meaningful and insightful discussions on key health issues and challenges facing the Region. I look forward to the deliberations and the outcomes at this Regional Committee Session and take this opportunity to express my and my team’s support and willingness to provide any assistance you may require during this week.

Let me again wish you all successful deliberations and sincerely hope that your stay in Delhi will be comfortable and productive.

Report of the Seventy-second Session 149 Annex 2 Text of address by the Deputy Prime Minister and Minister of Health and Population, Federal Democratic Republic of Nepal

Warm greetings to all of you from the beautiful country of Nepal.

First of all, I would like to congratulate the WHO Regional Office for organizing these Regional Committee sessions in order to provide a political forum at the highest level to interact on common public health issues that prevail in this Region. Such meetings allow us to deliberate and share our experiences, and find out what needs to be done next.

We are proud to have achieved and sustained a number of ambitious public health milestones collectively by the countries of the Region, which have more than 26% of the world’s population and an even higher proportion of disease burden.

Today, I am happy to join all fellow ministers, the Director-General, the Regional Director, and delegates and representatives from Member countries who have gathered to review the past and identify the future health priorities for the Region.

This Region is full of diversity, not only in sociopolitical, economic, environmental and cultural aspects, but also in their diverse health systems, which are at varying stages of progress. Each country in the Region has its own strengths and limitations, issues and challenges, but there are also many common issues and successes to share. Emerging infectious diseases and rising noncommunicable diseases are putting further pressure on our health systems. We, as a collective team, must find innovative approaches and appropriate solutions to our problems in a sustained way. This forum provides us a unique opportunity to identify effective, affordable and acceptable solutions to these common problems.

I am proud to share that Nepal has made impressive progress in health outcomes relative to its income level. Life expectancy has been steadily improving and Nepal’s progress in reducing maternal and child deaths has been lauded internationally. Building on these successes, we have recently achieved additional public health milestones of trachoma elimination, rubella control and hepatitis

150 WHO Regional Committee for South-East Asia B control. All this demonstrates the government’s firm political commitment, the hard work of frontline health workers, and the support of WHO and other development partners. Nepal has successfully maintained all public health achievements made in the past and is working hard to accelerate progress and find new ways of doing business to improve the health status of the people in the country.

In this journey of public health, we have developed a new National Health Policy in 2019, on the basis of lists of exclusive and concurrent powers and functions of the federal, state and local levels of government, in accordance with the Constitution, policies and programmes of the government as well as the international commitments made by the country. We want to exploit opportunities provided by the federal structure of our governance system, into which we have incorporated the strengths of each tier of governance to advance universal health coverage and achieve the health-related targets.

As Nepal is vulnerable to many public health hazards, we are strengthening our national and subnational capacities to better respond to possible public health emergencies. We are gradually expanding our health emergency operating centres in each province and also expanding hub–hospital networks and their capacity. We are thankful to WHO and partners for providing financial and technical support in this area and building institutional capacity.

On behalf of the Government of Nepal, I would like to express our deep appreciation for the leadership role of the Regional Director, Dr Poonam Khetrapal Singh. Under her leadership, the Region has achieved a number of public health milestones. Considering her active role, I see huge potential to achieve many more goals in the next couple of years. I wish her all the best.

I would like to express my sincere thanks to WHO and other development partners for their continued support to Nepal. I also extend sincere thanks to H.E. Dr Harsh Vardhan and his team and the Regional Director’s team for the excellent arrangements. I wish this Seventy-second Session of the Regional Committee all success and look forward to sharing and interacting with you all.

Report of the Seventy-second Session 151 Annex 3 Text of address by the Director-General of WHO, delivered by the Chef de Cabinet

Namaste! I want to begin by congratulating Dr Singh on her re-appointment as Regional Director for a second term. Her vision for a more responsive and accountable WHO and the Regional Flagship Priority Programmes she has initiated are driving measurable results. But I also want to pay tribute to her outstanding leadership, which always brings the best out in those working with her. She has been a leader and inspiration in global health much beyond the Region. Thank you, Regional Director, and thank you for being such a friend.

With one quarter of the world’s population, this Region’s success and challenges have a major impact on global health indicators. It is heartening to see the Region’s long list of achievements in the past five years. After eliminating polio in 2014, the South-East Asia Region became the second to eliminate maternal and neonatal tetanus. Five countries have eliminated measles, and six have controlled rubella.

At a time when the world is seeing a resurgence of measles, this Region is leading the way in demonstrating how this childhood killer can be overcome. 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. Maldives followed suit this year.

Maldives, Sri Lanka and now Thailand have eliminated lymphatic filariasis. India is yaws-free; Nepal has eliminated trachoma. Sri Lanka and Maldives have eliminated malaria and four countries have achieved hepatitis B control.

I think we can say that South-East Asia is becoming the disease elimination capital of the world!

The Region has also made remarkable progress in reducing maternal mortality, and under-five mortality. DPR Korea, Indonesia, Maldives, Sri Lanka and Thailand have already achieved the global Sustainable Development Goal targets for neonatal and under-5 mortality, while Maldives, Sri Lanka and Thailand have done the same for maternal mortality.

152 WHO Regional Committee for South-East Asia Several Member States have also developed multisectoral plans to address noncommunicable diseases, and are moving ahead with the “One Health” approach to combat antimicrobial resistance. It is encouraging to see countries increasing their investments in health and embarking on innovative approaches towards universal health coverage. We have seen strong political commitment towards ending tuberculosis, and we look forward to seeing that commitment translated into results.

The Region is also no stranger to emergencies of all kinds, from outbreaks to natural disasters and humanitarian crises caused by displacement. You have demonstrated your capacity to respond to these events, although it will be important to increase the emphasis on emergency preparedness. Strong health systems and universal health coverage are the key to keeping the world safe.

You have much to be proud of! We hope to see this momentum build further, and contribute to WHO’s global triple billion goals. This Regional Committee, the first of Dr Poonam Singh’s second term, is an important one, as WHO and Member States consolidate their goals and targets around the Flagship Priority Programmes on their way to achieving the SDGs.

We have a very busy week ahead of us and I wish you a successful session. We look forward to many more public health achievements by the WHO South-East Asia Region.

Report of the Seventy-second Session 153 Annex 4 Text of address by the Regional Director, WHO South-East Asia Region

It is a pleasure to add my welcome to the Seventy-second Session of the Regional Committee. I want to particularly thank the Government of India for hosting us again this year. Your hospitality and your avid interest in health issues, Your Excellency Minister Dr Harsh Vardhan, is warmly appreciated.

The honourable Prime Minister of India, Mr Narendra Modi, speaks for many in the Region when he talks of the need to “strengthen the hands of the poor in pursuit of good health”. We look forward to hearing more about the progress of India’s reforms in the coming days.

The Regional Committee is a time to take stock. To review progress, to discuss and update policies and technical strategies, and to appraise and approve budgets … the practical business of governing global health. But governance is more than this. It is about reaffirming a joint sense of purpose and solidarity between countries. Our role as governors of health in this Region also requires that we look beyond our day-to-day concerns and the immediate horizon to identify emerging challenges and trends; to seek new opportunities to take forward our joint agenda.

The world will not wait. Yes, we are pursuing the Sustainable Development Goals. But let’s not forget that we are already five years into a 15-year agenda to 2030. We know that we need to adopt new ways of working, across sectors and silos, if health is to be a real beneficiary and contributor to sustainable development. But are we really ready to make those changes? I fear we have some way to go. The context in which we work is changing.

Economic growth brings new opportunities to invest in health. But a side-effect is that eligibility for external resources will decrease. Even in those countries in the Region where external funding represents a small fraction of health spending, priority programmes for immunization, AIDS, TB and malaria often remain dependent on outside sources of funds. Are we doing all we can to prepare for this financial transition?

Whether it is WHO’s Transformation Agenda, the achievement of the triple billion target or the UN’s broader reform process, we have much to do. And the environment in which to do it is not getting easier. Decisive action is needed.

154 WHO Regional Committee for South-East Asia As the Regional Committee’s Agenda makes clear, we have our own unique challenges. Strengthening the implementation of the International Health Regulations (2005), combating NCDs, increasing immunization coverage, the health impacts of climate change, and the Regional Action Plan on latent TB … a wide-ranging agenda. I am confident that working together over the next few days we can agree on what is needed if we are to succeed.

My confidence is based on two things. First, we have a solid track record in this Region. The Flagship Priorities have provided targeted focus and been responsible for a series of remarkable achievements.

In advancing maternal and child health, tackling measles and rubella, in the battle against NCDs, neglected tropical diseases (NTDs), TB and antimicrobial resistance (AMR), the Region has performed with skill and determination. Updating the Flagship Priorities – which we will do at this Regional Committee – will help ensure continued progress. Secondly, our joint regional vision is clear, firm and bold. Our approach to supporting countries is strategic and catalytic.

When you renominated me as Regional Director, you did so based on a shared commitment to sustain our achievements, accelerate progress and harness the full power of innovation. We also agreed a golden thread runs through all aspects of our work. That golden thread, of course, is the pursuit of universal health coverage (UHC). With your support, let us also make UHC the thread that binds this Regional Committee together.

UHC has become the defining mission of public health across the world. It has also been your defining mission – the bedrock of health policy across the Region. You are ahead of the game. Each one of you has accrued unique and valuable experience in your pursuit of UHC. You have much to share, yet much to teach.

I look forward to the progress report giving the 2019 update, and seeing how your innovative policies are enhancing human resources for health, reducing out-of-pocket expenditure, strengthening the quality of medical products and services, and increasing coverage for all people everywhere.

Your success will be our success. This Region has much to teach other parts of the world. I look forward to the ministerial roundtable on emergency preparedness. Strengthening emergency preparedness strengthens health services. And the other way around: strengthening health services strengthens emergency preparedness. This is a good example of the golden thread I wish to highlight.

Report of the Seventy-second Session 155 I trust the roundtable will help us grasp the opportunity to accelerate progress, boosting the potential of innovative mechanisms such as SEARHEF’s emergency preparedness stream. I also trust that the principles on which our continued success depends will emerge ever larger, and ever stronger.

First: the value of smart and effective governance within the health sector, with a strong emphasis on integrating programmes and services. In the SDG era, we must embrace purpose-driven, big-picture thinking and apply it to even the smallest interventions. By doing so, we will increase efficiency, while at the same time fill gaps and ensure that all people can access the services they need, when they need them.

Second: the imperative of strengthening political commitment beyond the health sector. But to achieve UHC and the co-benefits it brings, we must increase political resolve at all levels and across all sectors. By finding innovative ways to do that, we will ensure we have the political and financial capital to secure our ongoing success.

And third: the critical importance of partnerships moving forward. Indeed, we cannot achieve the majority of our targets and goals unless we appreciate the value of strong and effective partnerships, not only within government, but also beyond it. At WHO we have made the nurturing of partnerships a key part of our work. We are deeply committed to its force-multiplying effect and believe it should be embraced by the health sector as a whole.

As you appreciate, UHC is both a political choice and a technical process. Good governance is key to exercising that choice and facilitating that process. Indeed, it is my firm conviction that good governance is the unifying principle on which this historic moment rests, and upon which the strength of our golden thread depends. I urge you to hold that conviction close as you participate in this Regional Committee.

On that note, I once again welcome you, and thank H.E. Dr Harsh Vardhan for inaugurating this event. I look forward to a week of insightful and productive discussion, and to the rapid advances it will result in for the health and well- being of all people across our unique and very diverse Region.

156 WHO Regional Committee for South-East Asia Annex 5 Text of address by the Minister of Health & Family Welfare, Government of India

It is a matter of great privilege for me to welcome you all to New Delhi for the Seventy-second Session of the WHO Regional Committee for South-East Asia and address this eminent gathering on behalf of India.

As you are aware, universal health coverage is at the core of SDG 3 and can be a very powerful tool for social, gender and economic equity. India on its part firmly believes in the objective of attainment by all peoples of the highest possible level of health and well-being, where health is a state of complete physical, mental, spiritual and social well-being and not merely the absence of disease or infirmity. We believe this can be attained through preventive and promotive health care and universal access to good-quality health services with the least financial burden.

India has fast-tracked many initiatives aimed at achieving all the core tenets of universal health coverage as outlined in its National Health Policy 2017. The launch of Ayushman Bharat, i.e. “Long Live India”, last year marks a significant landmark in the history of health in India. Ayushman Bharat is India’s road to universal health care and, when fully operational, will ensure universal, accessible, equitable and affordable health care for all. The first component is the creation of 150 000 health and wellness centres (HWCs) by transforming primary health centres to provide comprehensive primary health care. HWCs will enable a focus on wellness and health promotion, and provide an expanded range of primary health-care services, access to medicines and diagnostics, and be delivered close to the community. We have already operationalized more than 20 000 health and wellness centres.

The second component, Pradhan Mantri Jan Aarogya Yojna (PMJAY), was launched under the visionary leadership of the honourable Prime Minister of India, H.E. Mr Narendra Modi. The Government of India provides health protection cover to over 100 million poor and vulnerable families for secondary and tertiary care, including pre- and post-hospitalization expenses. Key features include health cover of up to Indian Rupee (INR) 500 000 per family per year through a network of empanelled health care providers (EHCPs), cashless access

Report of the Seventy-second Session 157 to services, national portability, with no cap on family size, age or gender, and covering all pre-existing conditions. A total of 17 000 hospitals have been empanelled in the country so far. The scheme has gained good momentum and currently 32 states and Union Territories have started implementation. Though in its infancy, I am proud to highlight that so far more than 4.1 million people have been benefited, leading to their saving about INR 120 billion on health expenditure.

The National Health Mission (NHM), which is India’s flagship health systems reform programme, also provides a robust platform for implementation of a range of interventions focused on primary and secondary health care in rural and urban areas.

We have made tremendous improvement in maternal and child survival through the targeted interventions under the reproductive, maternal, newborn, child and adolescent health (RMNCH+A) strategy. Building upon these gains we are now going a step further and emphasizing on improving quality of care through interventions such as Labour Room Quality Control Initiative, LAQShya, to improve the quality of care in labour rooms and maternity operation theatres. India also took the landmark decision to introduce a midwifery cadre. This will also prove to be an important milestone towards providing respectful maternity care and improved maternal and neonatal outcomes.

In order to empower care providers/parents with the required skills and knowledge, we have launched the Ayushman Bhava App that provides simple messages in a user-friendly manner. We are also supporting early childhood development through the home-based Young Child Care Programme that is being rolled out in a phased manner.

Ending vaccine-preventable diseases remains another important priority and we have charted a plan to increase full immunization coverage to 90% though intensification of Mission Indradhanush campaigns. The range of diseases covered under the Universal Immunization Programme has also been increased with the inclusion of rotavirus, pneumococcal and measles–rubella vaccines.

Collaboration with the Ministry of Women and Child Development is being strengthened to deliver on the aim of a malnutrition-free India. The “Poshan Abhiyaan” (Nutrition Campaign) is being supported through interventions such

158 WHO Regional Committee for South-East Asia as Anaemia Mukt Bharat, an intensification of the National Iron Plus Initiative to attain a threefold reduction in anaemia prevalence. Similarly, we also intend to ensure zero deaths due to diarrhoea by 2022 and have embarked on an ambitious “Defeat Diarrhoea Campaign” to do so.

India has further intensified its efforts on phased elimination of malaria, leprosy, kala-azar and filariasis and improved measures for the prevention of vector- borne diseases.

To increase the availability of medical colleges, the Ministry is implementing a centrally sponsored scheme to establish new medical colleges. In the first two phases, 82 medical colleges have been approved. I am happy to inform you that the Cabinet has approved another 75 colleges during the past week. This will add to the ongoing efforts that we are making for the expansion of medical education. We have added more than 28 000 MBBS seats and 17 000 postgraduate seats in the past five years. To bring on regulatory reforms, India has taken a big step in enacting a new legislation: a National Medical Commission will replace the Medical Council of India and will bring about progressive reforms in ensuring better standards of medical education and availability of adequate and qualified medical professionals.

Under the Pradhan Mantri Swasthya Suraksha Yojana, a total of 21 new All India Institutes of Medical Sciences (AIIMS) are being established in the country so as to provide the required super-specialty tertiary care facilities around the country to bridge regional disparities.

The Prime Minister of India, H.E. Mr Narendra Modi, gave a clarion call to End TB in India by 2025, five years ahead of the global SDG target. We have expanded our diagnostics network and made molecular testing available in all districts of the country. We are actively engaging with the private sector with initiatives such as mandatory notification, incentives and projects such as “Joint Efforts for Elimination of TB (JEET)”. We have also extended free diagnostics and drugs to patients in the private sector.

We are now providing treatment from TB with the best quality medicines through the fixed-dose combination daily regimen and newer drugs such as bedaqiline and delamanid. More than 99% of TB patients are now on safer, less toxic and all-oral drug regimens. We are also aggressively working to address the social determinants of TB through initiatives such as “Nikshay Poshan Yojana” under

Report of the Seventy-second Session 159 which nutritional assistance is given to all TB patients for the duration of their treatment.

To address the burgeoning epidemic of noncommunicable diseases we have undertaken screening, prevention, management and control of common NCDs. Unsafe food and poor diet create a vicious cycle of disease and malnutrition, particularly affecting infants, young children, the elderly and the sick. India is passing through an epidemiological shift from communicable to noncommunicable diseases. The burden of diet-related diseases such as diabetes, hypertension and obesity is rising rapidly. We in India also face a silent epidemic of rising childhood obesity coupled with undernutrition and micronutrient deficiencies. While safe food and healthy diet is an easy and inexpensive solution to all of this, there are several challenges in addressing it.

I am happy to share with you that the Food Safety and Standards Authority of India has adopted a food systems approach to ensure that our citizens have access to safe food and healthy diets. This approach judiciously combines e regulatory and capacity-building measures with consumer empowerment initiatives. We have launched a people’s movement called “Eat Right India”. Its tagline “Sahi bhojan, behtar jeevan” – “Right diet leads to better life” – shows India’s commitment to preventive and promotive health care as an important pillar of our health policy.

One very important aspect of achieving universal health coverage is leveraging innovations in the health arena, and India has appropriately inducted Digital Health in its National Health Policy 2017. I am sure that recent initiatives in terms of an architectural framework provided by the National Digital Health Blueprint will impact all ongoing programmes of the Ministry of Health to ensure quality of care in a timely manner. It is envisaged to create longitudinal electronic health records of 1.3 billion citizens of the country, making health services more transparent and accessible. Focus on usage of artificial intelligence and smart wearables in health areas is one of the priorities for the country under Digital India.

India took the world stage and moved the “Digital Health Resolution” during the Seventy-first World Health Assembly in Geneva, which was unanimously adopted. India has also taken up the issue through the Global Digital Health Partnership, which has over 26 countries and WHO as members. India assumed the role of

160 WHO Regional Committee for South-East Asia its Chair in February 2019. I would like to request all of you to join hands and support the South-East Asia Region to stay at the forefront of international policy development on digital health by joining the Global Digital Health Partnership as a Member State.

We recognize that improving health and well-being requires multisectoral interventions and are happy to note that the schemes launched by several other sectors are positively influencing the socioeconomic determinants of health in India. Programmes such as the , Housing for All by 2022, the Nutrition Mission, Ujjwala Yojana, Skill Development Programmes, Smart Cities project and others are making huge inroads in improving the quality of life of the people in India.

On 29 August 2019, National Sports Day, Prime Minister Mr Narendra Modi launched the “Fit India Movement”. It is a campaign aimed at encouraging people to include physical activity and sports as a routine in their everyday life. This, along with Eat Right India, will help us to fight lifestyle diseases such as hypertension, obesity and diabetes effectively.

Recognizing the importance of traditional medicines in health-care delivery, India has launched the National AYUSH Mission with the objective of providing cost- effective services in traditional medicines. India is in the process of identifying 12 500 health and wellness centres across the country to deliver traditional medicinal services at the grass-roots level with special focus on preventive health care. India aims to strengthen its flagship health insurance scheme Ayushman Bharat by integrating traditional medicine therapy with allopathy at the primary health centres to check noncommunicable diseases.

Yoga is an integral component of the preventive health care initiative taken by India. The Prime Minister Mr Modi has described yoga as a free life insurance that everyone can avail to better their health. He has exhorted people to make yoga a part of their lives as yoga not only enlightens the body but also the soul.

The Indian Council for Medical Research hosted the first meeting of the Regional Research Platform for Emerging Infectious Diseases of Public Health Importance in the WHO South-East Asia Region in August 2019 in New Delhi. The meeting called for establishing the Regional Enabler for the South-East Asia Research Collaboration for Health (RESEARCH) Platform on emerging and re-emerging infectious diseases. The RESEARCH platform will address evolving research

Report of the Seventy-second Session 161 priorities as per local and common needs of Member States of the Region, and enable the sharing of resources (human, financial and infrastructural), corpus of learning, information and products for countries in the Region.

The Department of Health Research and the Indian Council of Medical Research are leading the Health Technology Assessment, which would be useful for assessing and costing different technologies, best practices and products to be potentially adopted by the states of India and, in future, the countries of the Region.

I have had occasion to witness the personal commitment and energy devoted by the Regional Director, Dr Poonam Singh, to the programmes run by WHO. The constant engagement with Member States and other stakeholders – whether it is on deciding the Regional Flagship Priorities through consultation or providing needed assistance – has brought about positive reforms in the Region.

Home to over one fourth of the global population, the WHO South-East Asia Region has made remarkable progress in several priority programmes in the past five years. In 2014, the Region was certified polio-free. In 2015, Maldives was certified malaria-free. Sri Lanka soon achieved this status. Bhutan, the Democratic People’s Republic of Korea, Maldives, Sri Lanka and Timor-Leste have eliminated measles. Bangladesh, Bhutan, Maldives, Nepal, Sri Lanka and Timor-Leste have controlled rubella. Maldives, Sri Lanka and Thailand have eliminated lymphatic filariasis. India is yaws-free. Nepal has eliminated trachoma. Bangladesh, Bhutan, Nepal and Thailand have controlled hepatitis B. These achievements highlight the need for sharing best practices and learnings from each other’s experiences.

I really look forward to strongly continuing our collaboration with the Regional Director and Member States as we move forward on attaining the Sustainable Development Goals through universal health coverage. In this regard, I would implore the Regional Office to adopt a mission-mode approach in not only disseminating policy and technical guidelines but also creating public health success stories from the Region by aiding better implementation of policies and programmes in Member States.

As I conclude, allow me to invoke the mantra from the ancient Indian scriptures that guides our efforts: Sarve bhavantu sukhinah, Sarve santu niramayah. This means: “May all become happy, may all become healthy”. Thank you.

162 WHO Regional Committee for South-East Asia Annex 6 Text of introductory remarks by the Regional Director on the Annual Report on the Work of WHO in the South-East Asia Region covering the period 1 January–31 December 2018

It is once again my pleasure to speak to you about the work of WHO and the health of the people in our Region. I am proud to say that the report I present to you this year reflects how far we have come. We are at a defining moment in public health – globally and regionally. And so, we must also look ahead.

The Sustainable Development Goals loom large ... no longer aspirations for the future; we are almost one third of the distance down the road to 2030. WHO’s triple billion targets are absolutely integral to their achievement. Our own organization is changing. The Transformation Agenda of the Director-General, Dr Tedros, is putting the principles of the Thirteenth General Programme of Work into practice. With backing from Member States, the UN Secretary-General’s reforms can transform how the UN system works at country level. And we are committed partners in this endeavour.

Excellencies, you understand only too well the challenges we face. But you know that if we are to achieve the goal of a peaceful, prosperous, sustainable and healthy planet, what happens in our Region can make the difference between success and failure. We have a full agenda. Updating the Region’s Flagship Priorities; preparing to implement the Programme Budget; and working to up our game at the country level, where it matters most. But before highlighting some key achievements, I want to continue our conversation about one Flagship in particular: universal health coverage, or UHC.

UHC is the bedrock of health policy in all countries in this Region. UHC ensures unity of purpose and an integrated approach to achieving health for all. It is a means of achieving better health outcomes for an additional billion people. It is essential to building health security in the face of emergencies and threats. But it is more than this. It is an expression of our joint concerns for equity, gender equality and human rights. You have heard UHC referred to as “the single most powerful concept public health has to offer”.

Report of the Seventy-second Session 163 Indeed, it can be. But only if it inspires governments and their partners to grasp the real obstacles to universal access and financial protection. Let us be clear: universality means everyone, including ethnic and religious minorities, migrants and those living on the margins of society. Care for those at the beginning of life, all the way through to the prevention of suffering at its close. It means services must be available and accessible as a right to all, irrespective of gender or sexual orientation. “Leaving no one behind” risks becoming no more than a slogan unless we are determined to tackle the toughest issues.

Remember, too, that financial protection is not just about insurance and reducing out-of-pocket payments. It is also about facilitating the provision of health care, access to medical education and procurement of medicines. New ways of thinking, new ways of acting, hard choices and determined follow up accompany us on the road ahead.

As we pursue this agenda, let us focus on three challenges: Sustain, Accelerate, Innovate. First: Sustaining the gains we have made. We must be wary of reversals – the re-emergence of defeated threats like polio and neglected tropical diseases (NTDs); safeguarding precious medicines from antimicrobial resistance; making sure that people are not forced back into poverty by having to pay for health care; and preparing, in advance, for when countries are no longer able to access resources from development partners.

Second: Accelerating progress towards the goals and objectives to which we are committed – we take too long to scale up interventions we know to be successful. We need to overcome bureaucratic hurdles that hamper implementation. And we need to nurture partnerships that can turn pilot projects into large-scale implementation and social movements.

And third: We need to innovate. Harnessing the benefits and mitigating the risks of new technology is part of the picture, but there is much, much more. Innovation means new ways of thinking about familiar problems. It means abandoning tired ideas that have outlived their utility. It means devising new and imaginative ways of delivering services; of empowering people to take responsibility for their own health; and of communicating risk at times of crisis.

The needs of countries in this Region are vast and our resources are finite. WHO’s financial contribution is tiny in comparison with the resources of governments, the private sector and civil society. So, we have to be strategic – focusing on

164 WHO Regional Committee for South-East Asia where we can make a difference – and catalytic – using our technical and financial resources to facilitate and influence action by others.

We also have to make choices and be selective. Hence, the eight Flagship Priorities. The Flagships do not cover everything we do, but they focus technical knowledge, convening power and advocacy. They enhance accountability, because we have defined clear-cut deliverables. And they help break down silos, so our work is more effective. Our Flagship Programmes all contribute to the achievement of UHC.

Let us turn first to measles elimination and rubella control. Victory over polio in 2014 allowed the Region to harness existing infrastructure, including networks of highly skilled health workers, to embark on a further ambitious project: eliminating measles and controlling rubella. Rubella vaccine is now part of routine vaccination in ten Member States.

By the end of last year, all Member States had introduced two doses of measles- containing vaccine in their routine immunization programme. Case-based surveillance for measles and rubella is now taking place regionwide. In 2018, the Democratic People’s Republic of Korea and Timor-Leste were verified as having eliminated endemic measles. Bhutan and Maldives sustained their elimination status. Sri Lanka has now joined this list. Six Member States – Bangladesh, Bhutan, Maldives, Nepal, Sri Lanka and Timor-Leste – are now verified as having controlled rubella and congenital rubella syndrome.

I am confident that, by 2023, we can add measles and rubella elimination to our achievements. But to make sure, relentless focus is essential: reaching the unreached and addressing, with skill and understanding, the growing challenge of vaccine hesitancy.

Turning now to noncommunicable diseases. NCDs account for around 55% of all deaths in the Region. In the next decade, that figure will increase by 21%, and two thirds of these deaths will be premature. The fall-out affects not only individuals, families and communities, but also national economies. Unchecked, these will be devastating.

We have seen commitment to tackle the problem globally and regionally. The South-East Asia Regional NCD Action Plan has 10 regional targets; each to be achieved by 2025. The Plan’s targets are bold, from a 30% relative reduction

Report of the Seventy-second Session 165 in the prevalence of tobacco use in people over 15 years to a halt in the rise in obesity and diabetes.

The targets are attainable. The 2016 Colombo Declaration provides momentum by calling for a focus on strengthening health systems to accelerate the delivery of NCD services at the primary level. NCD services are slowly beginning to reach more people than ever, and all Member States have developed multisectoral action plans aimed at implementing a whole-of-society approach to the problem. The WHO Package for Essential Noncommunicable Disease Interventions has been implemented in several Member States and is being pursued in others on a pilot basis.

Our Region is now the global leader in enforcing health warnings on tobacco packs, with countries such as Nepal and Timor-Leste having the world’s largest graphic health warnings, while Myanmar is accelerating its implementation of the WHO Framework Convention on Tobacco Control. Countries are increasing taxation on tobacco products. Almost all of the Region’s Member States are now Parties to the Framework – a significant achievement as the Region strives to address its cancer burden, with tobacco-related cancers accounting for 22% of all cancer deaths.

Mental health is finally coming out of the policy shadows to be recognized as a priority – we applaud the new legislation enacted in Bangladesh. We are also seeing strategies for eliminating cervical cancer, a largely preventable disease.

So yes, in response to all these achievements, we are making progress. But we have so much further to go: to eliminate the use of trans-fats, to reduce the salt content of food and to promote exercise through health-informed urban development in our towns and cities. We have resolutions, political support, multisectoral plans, achievable goals and targets, innovations in service delivery, and much more.

But what I really look forward to is the day when we start our report by talking about real declines in the prevalence of the main NCD killers and risk factors, and not just about the strategies and plans that we hope will make those declines actually happen.

In 2014, several of the Region’s Member States appeared unlikely to reach the targets for MDGs 4 and 5 on ending preventable maternal, newborn and

166 WHO Regional Committee for South-East Asia child deaths. Success required an annual rate of mortality reduction from 4.9% for maternal mortality and 3.9% for under-five mortality. Neonatal mortality remained stubbornly high and progress to reduce it was slow. Focusing our efforts on this unfinished agenda has paid off.

By 2016, all bar one of the Region’s Member States had achieved the MDG 4 target and, in the same period, neonatal mortality was reduced by 54%. Achieving a 75% reduction in maternal mortality has been achieved by only nine countries globally, three of which are from this Region. The Region has also eliminated maternal and neonatal tetanus, a massive achievement that we continue to maintain.

We are now turning our attention to ensuring that every newborn survives the first 28 days of life. Our Technical Advisory Group on Women’s and Children’s Health is guiding governments, partners and other stakeholders on how best to accelerate action. At present, the Democratic People’s Republic of Korea, Maldives, Sri Lanka, Indonesia and Thailand have already achieved the SDG targets for neonatal and under-five mortality. Maldives, Sri Lanka and Thailand have done the same for maternal mortality.

Further progress now requires that we turn our attention to quality. As governments have expanded networks of primary-level facilities, recent studies have shown that poor quality of care is a greater barrier to decreasing mortality than lack of physical access to services.

Which brings us back to UHC. Across our Region, some 800 million people still do not have full coverage of essential health services. As per the latest estimates, 16% of the population are spending more than 10% of their total budget on catastrophic health expenditure and 3% of the population is pushed into poverty due to out-of-pocket expenditure on health.

As part of the broad UHC agenda we have given priority in this Region to increasing the number, quality and skill-mix of health workers – through the Decade for Strengthening Human Resources for Health – and enhancing access to essential medicines. Since 2016, the South-East Asia Regulatory Network has been working to help harmonize regional cooperation on medical product regulation, with the aim of ensuring that all drugs and medical devices produced and sold in the Region are safe and accessible. On affordability, last year’s

Report of the Seventy-second Session 167 roundtable meeting was very productive – your insights on the way forward were immensely valuable.

This Region has been a pioneer in tracking progress toward UHC. Using agreed international measures, three Member States –Bhutan, Sri Lanka and Thailand – now fall above the global median level for service coverage and financial protection. Indonesia and Timor-Leste are just below the median for financial protection, but above it for service coverage.

We have to strengthen health systems to ensure that they deliver more health for the money. But we cannot focus on efficiency alone, ignoring the fact that public spending on health is low, and out-of-pocket spending is still high compared with several other regions of the world.

We have seen important new commitments by governments to spend more. Nine countries have increased their health budgets. Spending more to achieve better health is a political choice, and one that has measurable payoffs in terms of inclusive growth and greater productivity. This is an important message for your ministries of finance.

It is with good reason that antimicrobial resistance (AMR) is often regarded as one of the world’s greatest threats to the control of communicable diseases, as well as to overall health security. Urgent is action is needed. I am proud that we have been proactive in this Region. As early as 2011, the Region’s health ministers called for concerted action against AMR in the Jaipur Declaration on Antimicrobial Resistance. To supplement the Declaration, AMR was made a Flagship Priority. And in 2015, the Regional Committee passed a key resolution on AMR prevention and control.

Our joint efforts are paying off. By 2018, all 11 of the Region’s Member States had developed a National Action Plan to address and monitor progress on prevention of AMR. We have improved AMR surveillance, with nine Member States enrolling in the WHO-led Global Antimicrobial Resistance Surveillance System (GLASS). GLASS enables countries to share information on national AMR trends, and standardizes AMR surveillance globally.

Ongoing advocacy and engagement will be critical to turn plans into action. So too will be efforts to strengthen the “One Health” approach via the regional Tripartite mechanism – a joint collaboration between WHO, the Food and

168 WHO Regional Committee for South-East Asia Agriculture Organization of the United Nations, and the World Organisation for Animal Health.

Across the Region, efforts continue to scale up capacity development in emergency risk management. Our Region is highly susceptible to acute public health emergencies from floods, cyclones and earthquakes, as well as human- induced threats and outbreaks of emerging and re-emerging diseases. Over the past decade, the Region accounted for approximately 27% of all global mortality due to disasters.

Scaling up capacity in emergency risk management has been – and continues to be – a key priority. In recent years, the South-East Asia Regional Health Emergency Fund, as well as the globally acclaimed “12 Benchmarks for Emergency Preparedness and Response”, have served us well. So too have efforts to build strong health systems, while integrating them into wider systems of preparedness and response.

The creation in 2016 of the WHO Health Emergencies Programme at the global level has complemented and accelerated what we have been able to do. The Region will continue to lead from the front. The decision in 2016 to expand the Regional Health Emergency Fund to invest in preparedness and not just response was the starting point. But leveraging the Fund’s promise is dependent on identifying where needs are most pressing and securing investment to fill those gaps.

The fact that almost all Member States have now conducted periodic assessments on capacities for emergency risk preparedness will help us do that. So too will the fact that eight Member States have now conducted joint external evaluations on core capacities for the International Health Regulations (2005). Ultimately, preparedness and response capacities can only truly be tested in real time. The response to Nepal’s 2015 earthquake and to the many floods, cyclones and earthquakes that have occurred since then, are testimony to our joint progress. So too is the ongoing response to the influx in 2017 of hundreds of thousands of vulnerable people into Cox’s Bazar, Bangladesh.

There are many opportunities to make further gains. Strengthening epidemiological and laboratory surveillance, while enhancing buy-in for key cross- sectoral initiatives. Emergency medical teams are an important part of the global health workforce and can reduce suffering and loss at times of crisis. Building

Report of the Seventy-second Session 169 their capacity is critical. And I should pause here to congratulate Thailand for being the first country in the Region to have a WHO-classified EMT. Lastly, while progress in developing national action plans is positive, implementing them will be possible only if they are adequately funded. At present, too many are not.

One issue that reflects the drive to “leave no one behind” is finishing the job on diseases on the verge of elimination. Several NTDs – leprosy, visceral leishmaniasis, schistosomiasis and lymphatic filariasis – have been selected for elimination, and yaws for eradication, by 2020. By including these diseases as Flagship Priorities, they have become national priorities, leading to rapid gains.

In 2016, India was declared yaws-free. Maldives and Sri Lanka eliminated lymphatic filariasis as a public health problem. Not long after, Thailand was validated for the elimination of lymphatic filariasis. This progress has continued. In 2018, Nepal became the first country in the Region to be validated for the elimination of trachoma. By the end of the year, the elimination target for kala- azar was achieved in all endemic districts in Nepal and upazilas in Bangladesh, and 93% of blocks in India. Indonesia has meanwhile reduced the prevalence of schistosomiasis to very low levels.

These accomplishments reflect political commitment and the tireless efforts of those working for national NTD programmes. They also reflect the wisdom of adopting a multifaceted approach to NTDs that addresses marginalization, stigma and poverty, and not just medical interventions.

But as ever, we must be cautious: complacency is not an option. History tells us that NTDs, like measles, rubella and many other diseases, can return with a vengeance if attention lapses. Every year, millions of people across the world continue to fall sick and die from TB. Bold action and an accelerated response are needed if we are to achieve the global End TB targets.

Our Region is at the epicentre. It accounts for 44% of TB incidence globally and 50% of associated mortality. Drug resistance has emerged as a major challenge, bringing with it a whole new set of challenges. Since the Flagship Programme for TB was launched in 2017, we have made significant progress: improved notification, decreased mortality and a doubling of the budget allocation for TB in the Region as a whole.

170 WHO Regional Committee for South-East Asia The Region has shown global leadership in TB control: galvanizing political commitment through the 2017 “Delhi Call for Action” and the 2018 “Statement of Action”. The Region was well represented at the first UN General Assembly High-Level Meeting on TB. All Member States are now pursuing key targets aligned with the goal of ending TB by 2030, in line with the political declaration “United to End Tuberculosis: An Urgent Global Response to a Global Epidemic”. Some are aiming to end TB before that: Maldives by 2022, India and Sri Lanka by 2025.

We have much to celebrate. At the same time, our Region faces myriad challenges that we cannot afford to ignore: the health impacts of climate change, ageing populations and environmental pollution. Cities that choke their inhabitants; roads and vehicles that kill innocent travellers; foods that do little to nourish; commerce that promotes products that kill or maim. One threat vanquished, another takes its place. Public health never stands still.

As we look to the future, two things stand out. First, the roads we travel are interconnected. We can no longer think about health services in isolation from all the other factors that determine whether people live long and healthy lives. Second, WHO brings powerful technical resources to the table, but we cannot work alone. The creation and nurturing of partnerships at multiple levels, for multiple purposes, must increasingly shape the way we operate. I look forward to working with regional and national partners to fuel fresh and innovative thinking about primary health care services, health systems quality and financing strategies.

The level of health and well-being of almost two billion people living in the WHO South-East Asia Region is stronger than ever before. And while every country in our Region faces challenges, I believe that by setting ambitious goals, insisting on strong, responsive leadership, and by creating partnerships that value all contributions, we will achieve the goals that the world expects of us.

Report of the Seventy-second Session 171 Annex 7 Text of address by the Director-General, World Health Organization

Namaste! It is a great honour to be talking with you, and I’m sorry that I can’t be with you in person. I would like to once again congratulate you, my sister Poonam, on your re-election for another term as Regional Director.

Dr Schwartländer summarized some of the Region’s many achievements in his remarks. He listed many of the diseases that have been eliminated in your countries in recent years.

This week you are considering a bold new goal to eliminate measles and rubella by 2023. Five countries in the Region have already eliminated measles – Bhutan, DPR Korea, Maldives, Sri Lanka and Timor-Leste. And six have controlled rubella – Bangladesh, Bhutan, DPR Korea, Maldives, Sri Lanka and Timor-Leste. Vaccination rates have increased significantly across the Region, leading to a 75% reduction in mortality due to measles since 2000. By the end of this year, an estimated 400 million children will have been protected against measles and rubella by a vaccine.

This is a stunning achievement. At a time when four countries in Europe have lost their measles elimination status, you are leading the way and showing what is possible. Your success, rightly, is prompting you to raise the bar.

Instead of eliminating measles and controlling rubella by 2020, this week you will consider a new goal to eliminate both diseases by 2023. This is a bold commitment that will require you to address challenges, including immunity gaps, suboptimal surveillance and inadequate financing. But I am a firm believer in setting ambitious targets that force us to stretch almost to breaking point. Rest assured that you have the Secretariat’s full support in working towards a South-East Asia Region that is free of measles and rubella.

I’m also pleased to see your commitment to accelerating the elimination of cervical cancer as a public health problem. Like measles and rubella, cervical cancer is an entirely preventable disease. There is no reason why any woman should die from it. And yet they do. Last year, almost 100 000 women lost their

172 WHO Regional Committee for South-East Asia lives to cervical cancer in this Region. That’s why WHO has launched a global initiative to eliminate cervical cancer.

I congratulate Bhutan, Maldives, Sri Lanka and Thailand for introducing the human papillomavirus (HPV) vaccine nationally. We understand that vaccine shortages and prices are a barrier for many other countries. WHO is committed to working with you and the vaccine manufacturers, to ensure that all women have access to this life-saving tool.

This Region is prone to emergencies of all kinds. Just in the past year you have witnessed the destruction caused by Cyclone Fani in India and Bangladesh, earthquakes and tsunamis in Indonesia, floods and landslides in Myanmar, an outbreak of Nipah virus in India, and the ongoing humanitarian crisis in Cox’s Bazaar. I congratulate you for the way the Region has responded to each of these emergencies. Your efforts have saved lives and prevented suffering.

You have also made good progress on emergency preparedness. Eight of the 11 Member States have completed joint external evaluations, and your core capacities under the International Health Regulations have improved significantly over the past decade. I also congratulate Thailand on becoming the first country in the region with a WHO-classified Emergency Medical Team.

The Flagship Priority on emergency risk management implemented by the Regional Director is bearing fruit. Cyclone Fani is a perfect example. Although 64 people tragically lost their lives, without the early warning and evacuation system, many more people could have died, and the costs could have been much higher.

This underlines a key point: countries that invest in emergency preparedness will save lives and save money. This week you will consider the resolution on the Delhi Declaration on Emergency Preparedness. This is a vital step forward towards making the Region safer for all its people.

Although it is not classified as an emergency, the enormous burden of tuberculosis in the South-East Asia Region demands the same urgent response as an outbreak or natural disaster. Half of all deaths from tuberculosis globally are in this Region, even though it is home to just a quarter of the world’s people.

Following the High-Level Meeting on TB at the UN General Assembly last year, I wrote to Heads of State and Government of 48 countries with the highest TB

Report of the Seventy-second Session 173 burden globally, urging them to accelerate country action to meet the End TB targets. To meet those targets, this Region needs to reach and treat at least 10 million people with latent TB infection by 2022. This will require an urgent and rapid scaling up of access to preventive treatment, which is lower in this Region than any other.

The Regional Action Plan on latent TB infection estimates the investments needed to find and treat those all those who need it. They are not insignificant. But they are investments that would yield a rich reward. More than 1.3 million cases of TB would be averted, and more than 84 000 lives would be saved. The long-term gains in terms of treatment costs avoided and increased productivity would be huge.

Emergency preparedness. Measles and rubella. Cervical cancer. Tuberculosis. Each of the issues I have discussed presents unique challenges that demand a unique response. But the common denominator for addressing each of them is primary health care. In Astana last year, all WHO Member States reaffirmed that primary health care is the bedrock of universal health coverage.

At current trends, fewer than half of your countries will achieve more than 80% coverage of essential health services by 2030. More action is needed to address the burden of noncommunicable diseases, especially key risk factors, including tobacco, alcohol, obesity and hypertension.

Tobacco use remains the biggest cause of preventable morbidity and mortality in the Region. While there are signs of declining tobacco use, all of your countries show rising alcohol consumption, rising levels of obesity, and a projected rise in people with hypertension.

WHO is committed to supporting you to address each of the challenges you are facing. And we are committed to becoming the organization you need us to be. Since we last met 12 months ago, the Regional Directors and I have been hard at work transforming WHO into an agile organization that works seamlessly across all three levels to deliver the Sustainable Development Goals. We now have a new Programme Budget to support the General Programme of Work, which you approved at the World Health Assembly last year.

To build this new Budget, we turned our planning process upside down, so that country needs explicitly drive the work of headquarters and the regions.

174 WHO Regional Committee for South-East Asia For example, for the first time in our history, all three levels of the Organization have worked together to define exactly what WHO headquarters will produce in the coming biennium. As a result, we now have a list of nearly 300 specific “global public health goods” – the technical tools you need to make progress towards the “triple billion” targets.

But we are not just changing what we do, we are also changing how we do it. Our new operating model aligns the Organization at all three levels and will enable us to work together more effectively and efficiently. One of our key priorities was to make sure every single WHO employee can connect their work to the corporate priorities. Today, 75% of staff can link their day-to-day work to the General Programme of Work, compared with only 47% at the start of this year.

We are also committed to increasing diversity across the Organization. We’ve already achieved several quick wins. We have started rolling out 13 new or redesigned processes to harmonize and optimize the way we do business, from the way we develop norms and standards, to recruitment, procurement, communications and more.

And we have announced plans for the WHO Academy, a major initiative to revolutionize health learning globally and train health workers to implement WHO norms and standards. The agreement was signed with the President of France, His Excellency President Emmanuel Macron, and the academy will be in Lyon.

I would like to thank you for your commitment and support. I leave you with three requests. First, I urge you to mobilize domestic resources to invest in primary health care as the top priority for every country. This is not only the foundation for achieving universal health coverage, it’s also the foundation for making progress on all the other issues I have discussed: measles and rubella; cervical cancer; emergency preparedness; tuberculosis and more.

One of the key ways all countries can mobilize resources is by raising taxes on tobacco products, alcohol, sugary drinks and other products that harm health. This is a win–win because it helps to prevent noncommunicable diseases by reducing consumption of products that cause them, and it raises revenue that can be reinvested in health.

Report of the Seventy-second Session 175 Second, I urge you to invest in emergency preparedness. The joint external evaluations have shown where the gaps are. Now all countries must act decisively to close those gaps. And we call upon the international community to support us in closing the gaps.

Third, the High-Level Meeting on Universal Health Coverage in New York later in September 2019 is a vital opportunity to catalyse political commitment. We need as many Heads of State or Government present as possible. I urge you to do everything you can to make sure your leaders are there in New York to show their commitment to universal health coverage.

Thank you once again for your commitment and support. I assure you of mine. I wish you a very productive meeting as we work together to promote health, keep the world safe and serve the vulnerable.

176 WHO Regional Committee for South-East Asia Annex 8 Text of concluding remarks at the Closing Session by the Regional Director

We have come to the close of a successful Regional Committee Session. In the past week, we have reviewed progress on several policy and technical issues, as well as managerial and governance matters. This included taking stock of progress on the Programme Budget 2018–2019 and recognizing the Budget increase of US$ 99.7 million for Programme Budget 2020–2021. In other words, we carried out the practical business of governing global health. In doing so we reaffirmed our joint purpose and shared commitment, which are crucial to delivering on the five resolutions and two decisions adopted at this Regional Committee.

The Ministerial Roundtable’s Delhi Declaration on Emergency Preparedness recommended a range of technical interventions to scale up emergency preparedness and response. It is by working together through innovative mechanisms such as the SEARHEF that we can accelerate progress as per the Declaration’s “Four I’s”: identify risks; invest in people and systems for risk management; implement plans; and interlink sectors and networks. While all Member States committed to identifying their own priorities and developing appropriate solutions, you also committed to learning from one another and adapting best practices to local contexts.

I commend you on your vision and the wisdom it represents, and for being willing to walk the talk, which you demonstrated at several morning physical activity sessions, as well as the “3 by 3” healthy breaks between Agenda items.

As I outlined when introducing the Annual Report, our joint action will allow us to sustain our achievements, accelerate progress and harness the full power of innovation as we continue our journey together, including at the UN General Assembly later in September.

In noting the success of this Regional Committee, I express my sincere gratitude to His Excellency Dr Harsh Vardhan, honourable Minister of Health & Family Welfare, Government of India, for the effort he and his team put into this event. I also commend His Excellency on leading the yoga session, the walk in Lodi Garden, the bicycle ride, and the launch of the “Eat Right India” campaign. I

Report of the Seventy-second Session 177 wish it all success. I thank the Vice-Chair, Her Excellency Ms Dechen Wangmo, honourable Minister of Health, Royal Government of Bhutan, for successfully chairing a number of important sessions and for leading the aerobic exercises.

I thank the Chef de Cabinet, Dr Bernhard Schwartländer, alongside the WHO headquarters team, for the energy and ideas they brought to the Committee, and for their ongoing dedication to driving real change at the country level, including via the GPW Results Framework. I also thank the many nongovernmental and intergovernmental organizations that participated. The challenges to health we face cannot be solved by Member States and WHO alone, but instead require a whole-of-society approach. Your inputs and engagement are much appreciated. I likewise appreciate the Regional Office Secretariat for the hard work they put in to ensuring a seamlessly productive week, as well as staff of the Hyatt Hotel for hosting us.

Finally, and most of all, I thank your Excellencies and each Member State delegation for the time and effort you put in to prepare for this event and for your constructive interventions. It was evident that each Agenda item was planned well in advance, making your inputs of critical value.

It is precisely this dedication to excellence, to innovative, out-of-the-box thinking, and to driving real change at the grass-roots level that leaves me in high spirits as we look ahead to the Seventy-third Session of the Regional Committee in Thailand. I appreciate the invitations from Nepal and Bhutan to hold the Seventy- fourth and Seventy-fifth sessions, respectively.

I once again thank you for your participation and look forward to continuing our journey together for the health and well-being of all people everywhere in the South-East Asia Region. Thank you.

178 WHO Regional Committee for South-East Asia Annex 9 Agenda

1. Opening of the Session

2. Credentials of Representatives 3. Election of Officebearers 4. Adoption of the Agenda SEA/RC72/1 Rev. 3 5. Key addresses and report on the Work of WHO 5.1 Introduction to the Regional Director’s Annual SEA/RC72/2 Report on the Work of WHO in the South-East Asia Region covering the period 1 January 2018–31 December 2018 5.2 Address by the Director-General 6. Ministerial Roundtable 6.1 Emergency preparedness SEA/RC72/3 7. Programme Budget matters 7.1 Programme Budget 2018–2019: SEA/RC72/4, Implementation and mid-term review SEA/RC72/4 Inf. Doc. 1 7.2 Programme Budget 2020–2021 SEA/RC72/5, SEA/RC72/5 Inf. Doc. 1, SEA/RC72/5 Inf. Doc. 2 & SEA/ RC72/5 Inf. Doc. 3 8. Policy and technical matters 8.1 Annual report on monitoring progress on UHC SEA/RC72/6 and health-related SDGs 8.2 Revising the goal for measles elimination and SEA/RC72/7 rubella/congenital rubella syndrome control 8.3 Strengthening IHR and health emergency SEA/RC72/8 Rev. 1 capacities through implementation of national action plans 8.4 Regional Action Plan on Programmatic SEA/RC72/9, Management of Latent TB Infection (LTBI) and SEA/RC72/9 Inf. Global Strategy for TB Research and Innovation Doc. 1

Report of the Seventy-second Session 179 8.5 Regional Plan of Action for the WHO Global SEA/RC72/10 Strategy on Health, Environment and Climate Change 8.6 Accelerating the elimination of cervical cancer SEA/RC72/11 as a global public health problem 8.7 Regional Snake-bite Prevention and Control Plan SEA/RC72/12 of Action 9. Progress reports on selected Regional Committee SEA/RC72/13, resolutions SEA/RC72/13 Add. 1 & SEA/RC72/13 9.1 South-East Asia Regional Health Emergency Add. 2 Fund (SEA/RC60/R7) 9.2 Expanding the scope of the South-East Asia Regional Health Emergency Fund (SEARHEF) (SEA/RC69/R6) 9.3 Antimicrobial resistance (SEA/RC68/R3) 9.4 Patient safety contributing to sustainable universal health coverage (SEA/RC68/R4) 9.5 Challenges in polio eradication (SEA/RC60/R8) 9.6 Colombo Declaration on strengthening health systems to accelerate delivery of NCD services at the primary health care level (SEA/RC69/R1) 9.7 Traditional medicine: Delhi Declaration (SEA/ RC67/R3) 9.8 2012: Year of Intensification of Routine Immunization in the South-East Asia Region: Framework for increasing and sustaining coverage (SEA/RC64/R3) 10. Governing Body matters 10.1 Key issues arising out of the Seventy-second SEA/RC72/14 World Health Assembly and the 144th and 145th sessions of the WHO Executive Board 10.2 Review of the draft Provisional Agenda of the SEA/RC72/15 146th session of the WHO Executive Board 10.3 Elective posts for Governing Body meetings (WHA, EB and PBAC) 11. Management and Governance matters 11.1 Management performance and Transformation SEA/RC72/16, SEA/ in the South-East Asia Region RC72/16 Inf. Doc. 1

180 WHO Regional Committee for South-East Asia 11.2 Evaluation: Annual report SEA/RC72/17 11.3 Status of the SEA Regional Office Building SEA/RC72/18 12. Special Programmes 12.1 UNICEF/UNDP/World Bank/WHO Special SEA/RC72/19 Programme for Research and Training in Tropical Diseases: Joint Coordinating Board (JCB) – Report on attendance at JCB in 2019 12.2 UNDP/UNFPA/UNICEF/WHO/World Bank SEA/RC72/20 Special Programme of Research, Development and Research Training in Human Reproduction (HRP): Policy and Coordination Committee (PCC) – Report on attendance at PCC in 2019 and nomination of a member in place of Sri Lanka whose term expires on 31 December 2019 13 Time and place of future sessions of the Regional SEA/RC72/21 Committee 14 Adoption of resolutions 15 Adoption of the report of the Seventy-second SEA/RC72/22 Session of the Regional Committee 16 Closing session

Report of the Seventy-second Session 181 Annex 10 List of participants

1. Representatives, Alternates and Advisers

Bangladesh

Representative Mr Md Saidur Rahman Additional Secretary Health Services Division Ministry of Health and Family Welfare Government of the People’s Republic of Bangladesh

Alternate Professor Dr Md Iqbal Kabir Director, Planning and Research Directorate-General of Health Services (DGHS) Ministry of Health and Family Welfare Government of the People’s Republic of Bangladesh

Mr Khandokar Zakir Hossain Deputy Secreary Ministry of Health and Family Welfare Government of the People’s Republic of Bangladesh

Bhutan

Representative H.E. Ms Dechen Wangmo Minister of Health Royal Government of Bhutan

Alternate Dr Pandup Tshering Director-General Ministry of Health Royal Government of Bhutan

Adviser Mr Kinley Dorji Chief Programme Officer Ministry of Health Royal Government of Bhutan

Ms Tashi Tshomo Program Officer Ministry of Health Royal Government of Bhutan

182 WHO Regional Committee for South-East Asia Mr Sonam Phuntsho Planning Officer Ministry of Health Royal Government of Bhutan

Ms Pinkey Lhamo Personal Secretary to Hon’ble Minister of Health Ministry of Health Royal Government of Bhutan

Democratic People’s Republic of Korea

Representative H.E. Dr Oh Chun Bok Minister of Public Health Ministry of Public Health Democratic People’s Republic of Korea

Alternates Dr Pak Jong Min Director, Department of External Affairs Ministry of Public Health Democratic People’s Republic of Korea

Dr Choe Suk Hyon Deputy-Director, Department of External Affairs Ministry of Public Health Democratic People’s Republic of Korea

Mr Ri Jang Gon Senior Officer Department of International Organizations Ministry of Foreign Affairs Democratic People’s Republic of Korea

India

Representative H.E. Dr Harsh Vardhan Minister of Health and Family Welfare Ministry of Health and Family Welfare Government of India

Alternates H.E. Mr Ashwini Kumar Choubey Minister of State for Health and Family Welfare Ministry of Health and Family Welfare Government of India

Ms Preeti Sudan Secretary (Health) Ministry of Health and Family Welfare Government of India

Report of the Seventy-second Session 183 Mr Vaidya Rajesh Kotecha Secretary (Ayush) Ministry of Health and Family Welfare Government of India

Mr Sanjeeva Kumar Special Secretary (Health) Ministry of Health and Family Welfare Government of India

Mr Arun Singhal Additional Secretary Ministry of Health and Family Welfare Government of India

Mr Manoj Jhalani Additional Secretary Ministry of Health and Family Welfare Government of India

Ms Vandana Gurnani Joint Secretary Ministry of Health and Family Welfare Government of India

Mr Vikas Sheel Joint Secretary Ministry of Health and Family Welfare Government of India

Mr Manohar Agnani Joint Secretary Ministry of Health and Family Welfare Government of India

Mr Lav Agarwal Joint Secretary Ministry of Health and Family Welfare Government of India

Mr Mandeep Kumar Bhandari Joint Secretary Ministry of Health and Family Welfare Government of India

Mr Nilambuj Sharan Economic Adviser Ministry of Health and Family Welfare Government of India

184 WHO Regional Committee for South-East Asia Mr Abhinav Gupta PS to the Minister of Health and Family Welfare Ministry of Health and Family Welfare Government of India

Indonesia

Representative H.E. Dr Anung Sugihantono Deputy Minister/Director-General of Disease Prevention and Control Ministry of Health Republic of Indonesia

Alternate H.E. Dr Siswanto Deputy Minister of Health for the National Institute of Health Research and Development Ministry of Health Republic of Indonesia

H.E. Dr Ir Subandi Deputy Minister/ Director General for National Development Planning Agency for Human, Community and Culture Development Ministry of National Development Planning Republic of Indonesia

Ir Doddy Izwardi Director, Centre for Research and Development of Public Health Efforts Ministry of Health Republic of Indonesia

Mr Acept Somantri Director for Bureau of International Cooperation Ministry of Health Republic of Indonesia

Dr Pungkas Bahjuri Ali Director of Community Health and Nutrition Ministry of National Development Planning Republic of Indonesia

Mr Ferdinan S. Tarigan Deputy Director of Multilateral Health Cooperation Bureau of Inernational Cooperation Ministry of Health Republic of Indonesia

Report of the Seventy-second Session 185 Dr Tiffany Tiara Pakasi Head of Section of Leprosy Directorate of Communicable Disease Prevention and Control Ministry of Health Republic of Indonesia

Dr Esti Widiastuti Head of Section of Diabetes Mellitus Directorate of Non-Communicable Disease Prevention and Control Ministry of Health Republic of Indonesia

Dr Ermawan Head of Section of Strategic Planning Bureau of Planning and Budgeting Ministry of Health Republic of Indonesia

Dr Setiorini Head of Section of Program, Centre for Health Crisis Ministry of Health Republic of Indonesia

Ms Isnaniyah Rizky Data Analyst for Section Multilateral Bureau of International Cooperation Ministry of Health Republic of Indonesia

Maldives

Representative H.E. Mr Abdulla Ameen Minister of Health Ministry of Health Republic of Maldives

Alternate H.E. Ms Aishath Mohamed Didi Ambassador of the Republic of Maldives to the Republic of India Embassy of the Republic of Maldives in New Delhi

H.E. Ms Nishama Mohamed Deputy Minister of Health Ministry of Health Republic of Maldives

186 WHO Regional Committee for South-East Asia H.E. Ms Aminath Shabeena Minister (Deputy Chief of Mission) Embassy of the Republic of Maldives in New Delhi

Ms Aishath Samiya Deputy Director-General Ministry of Health Republic of Maldives

Mr Ahmed Suzil First Secretary Embassy of the Republic of Maldives in New Delhi

Ms Sarah Jamal Senior Public Health Programme Officer Health Protection Agency Ministry of Health Republic of Maldives

Ms Fathmath Afa Adnan Senior Public Health Programme Officer Ministry of Health Republic of Maldives

Mr Abdulla Aruham Third Secretary Embassy of the Republic of Maldives in New Delhi

Myanmar

Representative H.E. Dr Myint Htwe Union Minister of Health and Sports Ministry of Health and Sports Government of the Republic of the Union of Myanmar

Alternate Professor Thet Khaing Win Permanent Secretary Ministry of Health and Sports Government of the Republic of the Union of Myanmar

Dr Thuzar Chit Tin State Public Health Director State Health Department, Shan State (South) Ministry of Health and Sports Government of the Republic of the Union of Myanmar

Report of the Seventy-second Session 187 Dr Thaung Hlaing Regional Public Health Director Regional Health Department, Magwe Region Ministry of Health and Sports Government of the Republic of the Union of Myanmar

Dr Aye Nyein Regional Public Health Director Regional Health Department, Bago Region Ministry of Health and Sports Government of the Republic of the Union of Myanmar

Dr Aung Soe Htet Deputy Director, International Relations Division Ministry of Health and Sports Government of the Republic of the Union of Myanmar

Nepal

Representative H.E. Mr Upendra Yadav Deputy Prime Minister and Minister of Health and Population Ministry of Health and Population Federal Democratic Republic of Nepal

Alternate Dr Pushpa Chaudhary Secretary Ministry of Health and Population Federal Democratic Republic of Nepal

Dr Bikash Devkota Chief, Policy, Planning & Monitoring Division Ministry of Health and Population Federal Democratic Republic of Nepal

Mr Om Bhandari Second Secretary Embassy of Nepal in India

Sri Lanka

Representative H.E. Dr Rajitha Senaratne Minister of Health, Nutrition and Indigenous Medicine Miinstry of Health, Nutrition and Indigenous Medicine Government of the Democratic Socialist Republic of Sri Lanka

188 WHO Regional Committee for South-East Asia Alternates H.E. Mr Austin Fernando High Commissioner of the Democratic Socialist Republic of Sri Lanka to the Republic of India

Mr Niluka Kadurugamuwa Deputy High Commissioner of the Democratic Socialist Republic of Sri Lanka to the Republic of India

Dr Anil Jasinghe Director-General of Health Services Ministry of Health, Nutrition and Indigenous Medicine Government of the Democratic Socialist Republic of Sri Lanka

Dr (Mrs) S.C. Wickramasinghe Deputy Director-General (Non-Communicable Diseases) Ministry of Health, Nutrition and Indigenous Medicine Government of the Democratic Socialist Republic of Sri Lanka

Dr S. Sridharan Deputy Director-General (Planning) Ministry of Health, Nutrition and Indigenous Medicine Government of the Democratic Socialist Republic of Sri Lanka

Dr Sudath Samaraweera Acting Deputy Director-General (Education, Training and Research) Ministry of Health, Nutrition and Indigenous Medicine Government of the Democratic Socialist Republic of Sri Lanka

Dr H.D.B Herath National Coordinator, Disaster Preparedness & Response Unit Ministry of Health, Nutrition and Indigenous Medicine Government of the Democratic Socialist Republic of Sri Lanka

Dr P.S. Ginige Acting Chief Epidemiologist Epidemiology Unit Ministry of Health, Nutrition and Indigenous Medicine Government of the Democratic Socialist Republic of Sri Lanka

Report of the Seventy-second Session 189 Dr S.A.I.K Suraweera Consultant Community Physician (Environment & Occupational Health Unit) Ministry of Health, Nutrition and Indigenous Medicine Government of the Democratic Socialist Republic of Sri Lanka

Dr S. Subasingha Adviser to the Minister of Health, Nutrition & Indigenous Medicine Ministry of Health, Nutrition and Indigenous Medicine Government of the Democratic Socialist Republic of Sri Lanka

Dr Sujatha Senaratne Private Secretary to the Minister of Health Ministry of Health, Nutrition and Indigenous Medicine Government of the Democratic Socialist Republic of Sri Lanka

Thailand

Representative H.E. Mr Sathit Pitutecha Deputy Minister of Public Health Ministry of Public Health Royal Thai Government

Alternates Mr Somsak Paniengtong Adviser to the Deputy Minister of Public Health Ministry of Public Health Royal Thai Government

Mr Suriya Soucksakit Adviser to the Deputy Minister of Public Health Ministry of Public Health Royal Thai Government

Mr Kanawat Chantaralawan Adviser to the Deputy Minister of Public Health Ministry of Public Health Royal Thai Government

Mr Thanattorn Kangwansongwong Working Team to the Deputy Minister of Public Health Ministry of Public Health Royal Thai Government

190 WHO Regional Committee for South-East Asia Dr Supakit Sirilak Deputy Permanent Secretary Ministry of Public Health Royal Thai Government

Dr Narumol Sawanpanyalert Medical Officer, Advisory Level Department of Medical Services Ministry of Public Health Royal Thai Government

Dr Viroj Tangcharoensathien Adviser to the Office of the Permanent Secretary Ministry of Public Health Royal Thai Government

Dr Walaiporn Patcharanarumol Acting Director, Global Health Division Office of the Permanent Secretary Ministry of Public Health Royal Thai Government

Ms Sirinad Tiantong Policy and Plan Analyst, Expert Level Global Health Division Office of the Permanent Secretary Ministry of Public Health Royal Thai Government

Dr Teerasak Chuxnum Veterinarian, Senior Professional Level Bureau of Epidemiology Department of Disease Control Ministry of Public Health Royal Thai Government

Ms Panita Charoensuk Public Health Technical Officer, Senior Professional Level Health Impact Assessment Division Department of Health Ministry of Public Health Royal Thai Government

Report of the Seventy-second Session 191 Dr Kasemsuk Yothasamutr Medical Officer, Professional Level Lerdsin Hospital Department of Medical Services Ministry of Public Health Royal Thai Government

Ms Narissara Yamsub Public Health Technical Officer, Professional Level Division of Medical Technical and Academic Affairs Department of Medical Services Ministry of Public Health | Royal Thai Government

Dr Orratai Waleewong Pharmacist, Practitioner Level International Health Policy Programme Office of the Permanent Secretary Ministry of Public Health Royal Thai Government

Mr Banlu Supaaksorn Foreign Relations Officer, Practitioner Level Global Health Division Office of the Permanent Secretary Ministry of Public Health Royal Thai Government

Dr Nareerut Pudpong Researcher International Health Policy Programme Office of the Permanent Secretary Ministry of Public Health Royal Thai Government

Dr Supapat Kirivan Reseacher International Health Policy Programme Office of the Permanent Secretary Ministry of Public Health Royal Thai Government

Timor-Leste

Representative Dr Odete da Silva Viegas Director-General for Health Services Delivery Ministry of Health Democratic Republic of Timor-Leste

192 WHO Regional Committee for South-East Asia Alternate Dr Olinda dos Reis Albina Head, Department for Nutrition Ministry of Health Democratic Republic of Timor-Leste

Dr Frederico Bosco Alves dos Santos Head, Department for Non Communicable Diseases Control Ministry of Health Democratic Republic of Timor-Leste

Advisor Dr Sergio Gama da Costa Lobo Principal Adviser to the Ministry of Health Ministry of Health Democratic Republic of Timor-Leste

2. Representatives of the United Nations and Specialized Agenies

UNICEF Dr Asheber Gaym Maternal Health Specialist UNICEF, India UN Convention to Combat Ms Louise Baker Desertification Chief, External Relations and Policy Bonn, Germany United Nations Environment Dr Atul Bagai Programme Head UN Enviroment Country Office, India World Meterological Dr S. C. Bhan Organization Regional Coordinator India Meteorological Department Food And Agriculture Dr Tomio Shichri Organization Country Director/Representative India International Organization for Dr Patrick Duigan Migration (IOM) Regional Migration Health Advisor Bangkok, Thailand

3. Representatives from Nongovernmental Organizations in Official Relations with WHO

International Pharmaceutical Ms Adhani Praderika Nafila Winardi Students` Federation IPSF delegate Netherlands

Report of the Seventy-second Session 193 World Stroke Organization Professor Jeyaraj Pandian WSO Vice-President Geneva, Switzerland Action Contre La Faim Ms Brigitte Tonton International Regional Health and Nutrition Advisor France Rotary International Mr Deepak Kapur Chair, India National PolioPlus Committee New Delhi, India United States Pharmacopeia Dr Chaitanya Koduri Associate Director Hyderabad, India International Pediatric Association Dr Naveen Thacker Representative India World Organization of Family Dr Raman Kumar Doctors President, WONCA South-East Asia Region Ghaziabad, India The International Society for Professor Vikram Datta Quality in Health Care Director, Professor & President Incorporated (ISQua) NQOCN New Delhi, India Iodine Global Network Dr Chandrakant Sambhaji Pandav Regional Coordinator New Delhi, India MSF – Doctors Without Borders Ms Konstantinos Antonopoulos Regional Representative Hongkong Childhood Cancer International Ms Poonam Bagai CCI Asia Regional Leadership Team New Delhi, India International Federation of Medical Mr Po-Chin Li Students` Associations Regional Director for Asia Pacific Denmark International Society of Physical and Professor Taslim Rehabilitation Medicine (ISPRM) Chairman Department of Physical Medicine and Rehabilitation, BSMMU Dhaka, Bangladesh

194 WHO Regional Committee for South-East Asia World Vision International Dr P. Carel Joseph Director, Health New Delhi, India International Union Against Dr Jamie Tonsing Tuberculosis and Lung Disease Regional Director New Delhi, India International Federation of Mr Josh Black Pharmaceutical Manufacturers Associate Vice-President and Associations (IFPMA) Washington DC, USA IOGT International Mr Sampath De Seram Regional Representative to the UN Sri Lanka International Alliance of Patient Dr Ratna Devi Organizations Chair New Delhi, India World Heart Federation Dr Monika Arora Executive Director, HRIDAY New Delhi, India Union for International Cancer Dr Abdul Malik Control (UICC) Co-founder Male, Maldives Public Services International Ms Susana Barria Coordinator India WaterAid International Dr Arundati Muralidharan Manager, Policy India

4 Observers

Sulabh International Social Service Dr N. B. Mazumdar Organization Director General India Department of Foreign Affairs a Dr Lara Andrews and Trade (DFAT), Australia Assistant Director Australia Roll Back Malaria Partnership Dr Richard Nchabi Kamwi E8 Ambassador SADC Malaria Elimination Secretariat Namibia

Report of the Seventy-second Session 195 Indian Public Health Dr Sanghamitra Ghosh Association Secretary-General Kolkata, India Professor Sanjay Rai National President, IPH New Delhi, India Public Health Engineering Dr Indira Chakravarty Department (PHED) Chief Adviser to the Government of West Bengal Kolkata, India Global Coalition Against TB Mr Dalbir Singh President India Clean Air Asia Ms Prarthana Borah India Representative New Delhi AMSA International Ms Rohini Dutta Regional Chairperson India Ms Ke Ying Ng Medical Student Malaysia Ms Istirohatul Ahadiyah Medical Student Indonesia International Pharmaceutical Ms Aprilia Hiumawan Students` Federation IPSF Delegate Netherlands Mr Norman Ramadhan IPSF Delegate Netherlands Ms Florensia Rahati Pujiani IPSF Delegate Netherlands Vital Strategies Ms Namrata Kumar Policy Research Assistant New Delhi, India United States Pharmacopeia Ms Chooai Ruth Lee Associate Director Singapore Mamta Health Institute for Dr Sunil Mehra Mother and Child Executive Director New Delhi, India

196 WHO Regional Committee for South-East Asia IPAS Development Foundation Mr Vinoj Manning Chief Executive Officer New Delhi, India International Federation of Dr Karan Parikh Medical Students Association Maharashtra, India Ms Poorvaprabha Patil Karnataka, India Ms Claudia Mary Josephine Indonesia Dr Tonazzina Hossain Sauda Bangladesh International Alliance for Dr Apoorva Gomber Patients Organizations Policy & Advocacy Officer Dakshayani and Amravati Health & Education New Delhi, India Dr Ajaykumar Sharma Senior Director Organization of Pharmaceutical Producers New Delhi, India Iodine Global Network Dr Anamika Wadhera Director Programmes and Executive Director LAB QA/QC New Delhi, India HRIDAY Ms Tina Rawal Consultant, HRIDAY New Delhi, India Centre for Disease Dyanmics Professor Dr Jyoti Joshi Economics Head-South Asia New Delhi, India Center for Disease Dynamics Professor Ramanan Laxminarayan Economics and Policy Director New Delhi, India Centre for Science and Dr Vibha Varshney Environment Associate Editor New Delhi, India CDC, India Dr Meghna Desai Director New Delhi, India Snakebite Healing and Ms Priyanka Kadam Education Society President and Founder Mumbai, India

Report of the Seventy-second Session 197 Medecins Sans Frontieres Ms Jyotsna Singh Senior Advocacy Officer New Delhi, India IOGT International Mr Suneel Vatsyayam Regional Representative India Rotary International Mr Sandeep Kashyap Coordinator, Polio Plus Programme India Global Health Strategies Mr Raman Sankar Manager India

5. Ambassadors/High Commissioners

Royal Bhutanese Embassy Ms Pema Tshomo Political Counsellor Embassy of the Republic of H.E. Sidharto Suryodipuro Indonesia Ambassdor of Indonesia to India and Bhutan Mr Irvan Fachrizal First Secretary Embassy of the Republic of the H.E. Mr Moe Kyaw Aung Union of Myanmar Ambassador of the Republic of the Union of Myanmar to India Royal Thai Embassy Mr Thirapath Mongkolnavin Charge d’affaires Ms Duangkamon Kiatbumrung First Secretary Birtish High Commission Dr Himangi Bhardwaj Senior Health Adviser Royal Norwegian Embassy Ms Camila Dannevig Counselor Development Cooperation Dr Soffia Osk Magnusdottir Dayal Senior Adviser Health

6. Others in attendance (Special Invitees)

WHO Goodwill Ambassador Mr James Chau Sheung Wan, Hong Kong

198 WHO Regional Committee for South-East Asia Annex 11 List of official documents

SEA/RC72/1 Rev.3 Adoption of the Agenda SEA/RC72/2 Introduction to the Regional Director’s Annual Report on the Work of WHO in the South-East Asia Region covering the period 1 January 2018–31 December 2018 SEA/RC72/3 Emergency preparedness SEA/RC72/4, Programme Budget 2018–2019: Implementation and SEA/RC72/4 Inf. Doc. 1 mid-term review SEA/RC72/5, Programme Budget 2020–2021 SEA/RC72/5 Inf. Doc. 1, SEA/RC72/5 Inf. Doc. 2 & SEA/RC72/5 Inf. Doc. 3 SEA/RC72/6 Annual report on monitoring progress on UHC and health-related SDGs SEA/RC72/7 Revising the goal for measles elimination and rubella/ congenital rubella syndrome control SEA/RC72/8 Rev. 1 Strengthening IHR and health emergency capacities through implementation of national action plans SEA/RC72/9, Regional Action Plan on Programmatic Management SEA/RC72/9 Inf. Doc. 1 of Latent TB Infection (LTBI) and Global Strategy for TB Research and Innovation SEA/RC72/10 Regional Plan of Action for the WHO Global Strategy on Health, Environment and Climate Change SEA/RC72/11 Accelerating the elimination of cervical cancer as a global public health problem SEA/RC72/12 Regional Snake-bite Prevention and Control Plan of Action SEA/RC72/13, Progress reports on selected Regional Committee SEA/RC72/13 Add. 1 & resolutions SEA/RC72/13 Add. 2

Report of the Seventy-second Session 199 SEA/RC72/14 Key issues arising out of the Seventy-second World Health Assembly and the 144th and 145th sessions of the WHO Executive Board SEA/RC72/15 Review of the draft Provisional Agenda of the 146th session of the WHO Executive Board SEA/RC72/16, Management performance and Transformation in the SEA/RC72/16 Inf. Doc. 1 South-East Asia Region SEA/RC72/17 Evaluation: Annual report SEA/RC72/18 Status of the SEA Regional Office Building SEA/RC72/19 UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases: Joint Coordinating Board (JCB) – Report on attendance at JCB in 2019 SEA/RC72/20 UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP): Policy and Coordination Committee (PCC) – Report on attendance at PCC in 2019 and nomination of a member in place of Sri Lanka whose term expires on 31 December 2019 SEA/RC72/21 Time and place of future sessions of the Regional Committee SEA/RC72/22 Adoption of the report of the Seventy-second Session of the Regional Committee SEA/RC72/23 Report of the Seventy-second Session of the WHO Regional Committee for South-East Asia

200 WHO Regional Committee for South-East Asia Vignettes from the Seventy-second Session of the WHO Regional Committee for South-East Asia

Report of the Seventy-second Session 201 1

The Regional Director, Dr Poonam Khetrapal Singh, felicitated six Member States of the WHO South-East Asia Region for a range of public health achievements over the past year. Bangladesh (1), Bhutan (2), Nepal (3) and Thailand (4) were recognized for becoming the first four countries in the Region to control hepatitis B. Maldives (5) was awarded for eliminating mother-to-child transmission of HIV and syphilis, and Sri Lanka (6) for eliminating measles. Thailand (7) was also awarded for becoming the first WHO-certified Type 1 Emergency Medical Team, which can be deployed internationally. The Chef de Cabinet, WHO headquarters, Dr Bernhard Schwartländer, was also present.

202 WHO Regional Committee for South-East Asia 2

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Report of the Seventy-second Session 203 4

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204 WHO Regional Committee for South-East Asia 6

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Report of the Seventy-second Session 205 206 WHO Regional Committee for South-East Asia Report of the Seventy-second Session 207 208 WHO Regional Committee for South-East Asia Report of the Seventy-second Session 209 210 WHO Regional Committee for South-East Asia Report of the Seventy-second Session 211 212 WHO Regional Committee for South-East Asia Report of the Seventy-second Session 213 214 WHO Regional Committee for South-East Asia Report of the Seventy-second Session 215 216 WHO Regional Committee for South-East Asia Report of the Seventy-second Session 217 218 WHO Regional Committee for South-East Asia Report of the Seventy-second Session 219 220 WHO Regional Committee for South-East Asia Report of the Seventy-second Session 221 222 WHO Regional Committee for South-East Asia Regional Committee Committee Regional Asia for South-East Report of the Seventy-second Session Report of the Seventy-second 2–6 September 2019 New Delhi, India, WHO

WHO Regional Committee for South-East Asia Report of the Seventy-second Session SEA-RC72-23 The WHO Regional Committee for South-East Asia is the World Health Asia is the World for South-East Regional Committee The WHO It has representatives Asia Region. body in the South-East governing Organization’s in meets The Regional Committee in the Region. its 11 Member States from all in the Region, to review progress in health development September every year States, and review past on health issues for Member formulate resolutions of World Health Assembly considers the regional implications resolutions. It also others. resolutions, among Session of the the discussions of the Seventy-second This report summarizes in New Delhi, India, for South-East Asia held WHO Regional Committee 2019. on 2–6 September a number of public health Committee reviewed and discussed At this session, the as measles and rubella; latent TB infection; issues relevant to the Region, such and climate change; cervical cancer and health emergency capacities; environment Budget matters and past Regional snake-bite prevention; as well as Programme The Ministerial Roundtable featured a Committee resolutions; among others. The Committee also adopted a number discussion on emergency preparedness. issues of importance to the Region. of resolutions and decisions on selected www.searo.who.int