Partners for Health in South-East Asia

Conference Report

New Delhi, India 16–18 March 2011 WHO Library Cataloguing-in-Publication data

World Health Organization, Regional Offi ce for South-East Asia. Partners for health in South-East Asia: conference report.

1. Public-Private Sector Partnerships. 2. Health Services Administration. 3. Delivery of Health Care. 4. Health Status. 5. Maternal Mortality. 6. International Cooperation. 7. Health Planning. 8. Health priorities. 9. Communicable Diseases.

ISBN 978-92-9022-405-1 (NLM classifi cation: WA 530)

© World Health Organization 2011

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Printed in India Contents

Foreword v Acronyms and abbreviations vii Executive summary ix Recommendations xiv Introduction xxi Objectives xxii 1. Opening ceremony 1 2. Special address 10 2.1 Partnerships in Health 10 3. Plenary sessions 14 3.1 Millennium Development Goals: the progress so far and opportunities ahead 14 3.2 The challenge of noncommunicable diseases 18 3.3 Building health system capacity 22 3.4 Health partnerships and collaboration: the imperatives of collective responsibility to address the health of the poor and vulnerable 29 3.5 Partnerships in action: reporting from the fi eld 37 4. Best practices: parallel sessions 46 4.1 Addressing child and maternal mortality 46 4.2 Ensuring universal access to health services 48 4.3 Revitalizing primary health care – addressing health inequities 50 4.4 Integrated approach to prevention and control of noncommunicable diseases 52 4.5 Health for the urban poor – the way forward 54 4.6 Protecting health from climate change 56 4.7 Public–private partnerships in health 58 4.8 Financing for universal coverage 60 4.9 Opening new frontiers and innovative opportunities for collaboration in the health sector: South–South and beyond 62 4.10 Perspectives and roles of stakeholders in health development in the Region 65 5. Refl ections on the roles of stakeholders in health development in the Region 77 6. Closing session 84 6.1 Delhi Call for Action on Partnerships for Health 84 6.2 Closing remarks 88 Annexes 90 Annex 1: Programme 91 Annex 2: List of Participants 105 Annex 3: Delhi Call for Action - Drafting Committee 126 Annex 4: Regional Director’s address 128 Annex 5: Millenium Development Goals 130 Annex 6: Fact Sheet – Child and maternal mortality in South-East Asia 131 Annex 7: Fact Sheet – Millenium Development Goal 6: Fighting HIV/AIDS, Malaria and Tuberculosis in South-East Asia Region 139 Annex 8: Fact Sheet – Health Systems Strengthening 143 Annex 9: Fact Sheet – The growing crisis of noncommunicable diseases in the South-East Asia Region 147 Foreword

The Conference of Partners for Health in ity were the subject of South-East Asia held in New Delhi from the several interventions, 16-18 March 2011 was a resounding success. as was the growing This was primarily due to the high-level par- burden to health sys- ticipation and engagement of a wide array of tems and society, of partners representing governments, multi- noncommunicable diseases such as cardio- lateral and regional intergovernmental orga- vascular diseases, cancer, diabetes, chronic re- nizations, nongovernmental organizations, spiratory diseases and conditions like mental foundations, the private sector, media as well illness, injuries and disabilities. The heavy as research and academic institutions. burden of infectious diseases and neglected tropical diseases was similarly addressed in In plenary and parallel thematic sessions, various sessions. partners engaged in lively discussions on the health priorities for the Region, as well as the The meeting culminated in the “Delhi Call roles and responsibilities of each in advancing for Action on Partnerships for Health”, a these priorities. Participants from all over the commitment to, amongst other things, create, world shared invaluable insights on the chal- revitalize and sustain partnerships through lenges and opportunities for effective collabo- aligned and integrated action in consonance ration in health, elaborated best practices and with national development priorities. The lessons learnt and explored innovative ways participants also rededicated themselves to of working together to accelerate the achieve- achieving better and equitable health for the ment of health development goals. people of the South-East Asia Region and accelerate efforts to achieve the Millennium The Conference was held at a particularly Development Goals through community important juncture for health development empowerment and revitalization of primary globally as well as in the South-East Asia Re- health care. gion. Underpinning the three-day discussions was the acknowledgement by a myriad of The principles embodied in the Delhi Call for Action and the deliberations summarized partners of the threat to health development in this Report are representative of the com- in the South-East Asia Region as a result of bined efforts, resources, knowledge, commit- the global food, fuel, economic and climate ment and passion which are vital to help pre- change crises. vent the unnecessary suffering, morbidity and Throughout the proceedings, particularly in mortality and thereby promote the health of their recommendations, partners were mind- the peoples of South-East Asia. ful that the 11 Member States of WHO’s South-East Asia Region hold more than one quarter of the world’s population and bear a disproportionate share of the global burden of disease. The unacceptably high rates of Dr Samlee Plianbangchang maternal and child mortality and morbid- Regional Director

Acronyms and abbreviations

ADB Asian Development Bank ALMA African Leaders Malaria Alliance ASEAN Association of Southeast Asian Nations BGMEA Bangladesh Garment Manufacturers and Exporters Association BPL below poverty line BRAC Bangladesh Rural Advancement Committee BRICS Brazil, Russia, India, China and South Africa CDC Centers for Disease Control and Prevention CSO civil society organization CSR corporate social responsibility DFID Department for International Development (UK) DOTS directly observed therapy – short course GAVI Global Alliance for Vaccines and Immunization GDD the Global Disease Detection (network) GDP gross domestic product GIPA greater and meaningful involvement of people living with HIV/AIDS Global Fund Global Fund to fi ght AIDS, Tuberculosis and Malaria H4+ Agencies UNAIDS, UNFPA, UNICEF, WHO and the World Bank HPP healthy public policy HRH human resources for health IHP+ International Health Partnership Plus IIM Indian Institute of Management ILO International Labour Organization IMR infant mortality rate MDGs Millennium Development Goals MMR maternal mortality ratio MOU Memorandum of Understanding MoVE-IT monitoring of vital events using information technology MSM men who have sex with men NCD noncommunicable disease NEPAD New Partnership for Africa's Development NGO nongovernmental organization NHC National Health Commission (Thailand) NHCO National Health Commission Offi ce (Thailand) NRHM National Rural Health Mission NTP National TB Control Programme ODA Offi cial Development Assistance PEN Package of Essential NCD (interventions) PPM public–private mix R&D research and development RBM Roll Back Malaria SAARC South Asian Association for Regional Cooperation SBA skilled birth attendant SEA South-East Asia SEAPIN South-East Asia Primary Health Care Innovations Network SWAp sector-wide approach TB tuberculosis TFR total fertility rate TRP target rating point UN United Nations UNAIDS Joint United Nations Programme on HIV/AIDS UNDP United Nations Development Programme UNEP United Nations Environment Programme UNFPA United Nations Population Fund UNIC United Nations Information Centre (UNIC) UNICEF United Nations Children’s Fund WHO World Health Organization WONCA World Organization of Family Doctors Executive summary

The World Health Organization (WHO) extend well beyond polio. The message of conference, “Partners for Health in South- Mr Yohei Sasakawa, Chairman of the Nippon East Asia”, was held in New Delhi from 16 Foundation and WHO Goodwill Ambassa- to 18 March 2011. It was organized with a dor for Leprosy Elimination highlighted the view to strengthen regional collaboration for activities of the Nippon Foundation in uti- health, encourage effective and sustainable lizing partnerships to end leprosy. Ms Erin partnerships between stakeholders, share Soto, USAID Mission Director, India, iden- best practices and highlight partnerships in tifi ed fi ve challenges facing the health sector. action. The objectives were to review pro- Dr Analjit Singh, Chairman, Max India gress in achieving health-related interna- Limited, raised the issue of challenging the tionally agreed development goals, inclu- “conventional wisdom” of demand crea- ding the Millennium Development Goals ting surplus, and noted that an increase in (MDGs), in the South-East Asia Region, and supply can lead to an increase in demand. discuss collaborative efforts to address chal- He expanded on the important role of the lenges and bottlenecks; identify priorities private sector in health, and the success of for common action in the South-East Asia many Public-Private Partnerships in India. Region; identify roles and responsibilities of Dr Samlee Plianbangchang, Regional Direc- partners in addressing countries’ health pri- tor, WHO South-East Asia Region, pointed orities; and leverage partner commitment to out that many noteworthy achievements in foster better collaboration. health are now under threat because of sev- eral global crises. Countries of this Region are The conference had over 350 high-level par- still struggling with a large burden of commu- ticipants from the 11 Member States of the nicable diseases as well as neglected tropical Region, donor countries, multilateral and diseases, even as the problem of noncommu- intergovernmental organizations, civil soci- nicable diseases (NCDs) becomes larger. His ety, foundations, the private sector, media as Excellency Mr Ghulam Nabi Azad, Union well as research/academic institutions. Minister of Health and Family Welfare, India, pointed to the impressive gains made by the Dr Poonam Khetrapal Singh, Deputy Re- Government of India in improving the health gional Director, WHO South-East Asia status of the population, largely through Region, welcomed the participants. Mr Kalyan health systems strengthening. Banerjee, President-Elect of the Rotary Foun- dation of Rotary International, USA, spoke Mr Arun Maira, Member of Planning Com- about Rotary International’s many years of mission of India and Former Chairman of support for polio eradication efforts and said the Boston Consulting Group, India de- that the partnerships created for this would livered a special address on Partnerships in x | Conference Report 2011

Health. He stressed the importance of think- agendas of Heads of State and Government. ing out of the box, and listed localization, NCDs are preventable, and cost-effective so- lateralization and learning as three key areas. lutions are available. Innovative approaches to While partnerships are already working, they their control are needed. can and must work better, to meet both old and emerging challenges. The session on “Building health system ca- pacity” recognized that better health depends The plenary sessions viewed partnerships in on equitable access to the health system. terms of specifi c issues. Progress towards the Among the challenges in the Region are frag- Millennium Development Goals (MDGs) mented systems, diffi culty in reaching disad- has been slow and inequitable in the Region, vantaged and marginalized populations, and especially MDG 5 (improving maternal a critical shortage of the health workforce in health), although some innovative public– some countries of the Region. At a deeper private partnerships have worked well such level, there is a very basic knowledge gap that as the Chiranjeevi Yojana Gujarat, India. inhibits evidence-based decision-making due Such schemes could be adopted elsewhere in to inadequate and underutilized health in- the Region to improve access to life-saving formation systems. In many cases, data, es- maternal and neonatal services. The reasons pecially on civil registration, such as births for the slow progress toward MDG 5 include and deaths, is simply not available to inform poverty, inadequate funding of the health policy- and decision-making and planning. system and gender inequality. The Health Metrics Network attempts to remedy this situation and has innovative WHO’s role in setting standards and norms partnerships that are active in this area. was recognized as an important element in contributing to the joint efforts towards Countries below a certain threshold of health achieving MDG 5. Global and regional worker density are highly unlikely to achieve partnerships play a critical role in support- an acceptable level of service coverage. The ing national governments and advocating for South-East Asia Region has six countries commitments from all. that do not have the required health worker density, though attempts are under way to The Region currently faces a double burden remedy the situation. The Global Code of of communicable diseases as well as NCDs. Practice on International Recruitment of To combat NCDs, the social determinants of Health Personnel creates an unprecedented health need to be addressed. Various govern- opportunity for countries to work within a ment interventions are also needed, such as mi- common framework and collaborate in tack- cro- and macroeconomic interventions, urban ling challenges related to health workforce development, and harnessing the help of the migration. media. The Regional Framework for Preven- tion and Control of NCDs targets the main “Health partnerships and collaboration: the modifi able NCD risk factors and focuses on imperatives of collective responsibility to ad- surveillance, health promotion and primary dress the health of the poor and vulnerable” prevention. NCDs should be included in the identifi ed some innovative partnerships and Partners for Health in South-East Asia | xi alliances that are working well. These include universal access to health services” suggested The Wellcome Trust, the Roll Back Malaria that prevention of road traffi c accidents and Partnership, the Global Alliance for Vaccines NCDs must be put on the national health and Immunization (GAVI) and the World agenda of countries. The problems of alco- Bank. Many different approaches to reach- hol and tobacco need to be urgently attacked ing the poor and vulnerable were discussed, to reduce the burden of NCDs. Education such as reducing taxes and tariffs, working in of women should be targeted as a key fac- areas with the highest chances of success, and tor for the improvement of health outcomes. balancing innovation with cost reduction. “Revitalizing primary health care” empha- An example of best practice was the control sized that decentralization can address health of the HIV epidemic in India through focus- inequities and is dependent upon achie- ing on those most at risk. ving good governance, forming productive partnerships at all levels of the community, Examples of successful partnerships at ground implementing a comprehensive approach to level were discussed in “Partnerships in ac- pro-poor growth, improving public services tion: reporting from the fi eld”. It brought in and coordination among stakeholders, and perspectives from diverse groups such as the addressing the social determinants of health. Centers for Disease Control and Prevention Health should be viewed as an investment (CDC), the Bangladesh Garment Manufac- and not an expenditure. The South-East Asia turers and Exporters Association (BGMEA), Primary Health Care Innovations Network the Joint United Nations Programme on (SEAPIN) was established in August 2010 HIV/AIDS (UNAIDS), the World Orga- to strengthen health systems in the Region nization of Family Physicians (WONCA), through the primary health care approach Department for International Development and helps countries to “bootstrap” them- (DFID) and the Salaam Baalak Trust. Each of selves. these has different kinds of partnerships with different kinds of communities: the corporate “Integrated approach to prevention and con- sector to sex workers to the family doctor. trol of NCDs” concluded that prevention and Public health, particularly preventive health control of NCDs should be “piggy-backed” care, should be strengthened – this is especial- onto existing systems and included in school ly important for developing countries. health programmes, instead of creating par- allel systems. The Package of Essential NCD Parallel break-out sessions discussed best (PEN) interventions has been implemented practices in diverse areas. The session on in Sri Lanka and could be duplicated in other “Addressing child and maternal mortality” countries. Innovative approaches to tobacco recommended that different constituencies taxation (“sin” tax) can help in promoting (government, UN agencies, private sector health, as seen in Thailand. NCDs should and academia) should work to reduce child also be included in the MDGs so that they and maternal mortality in the South-East Asia are prioritized. The session on “Health for Region through a coordinated approach that the urban poor” suggested that urban slum addresses several areas of concern. “Ensuring clusters be mapped and listed. Speakers from xii | Conference Report 2011

Indonesia and India shared their experiences However, all resources should not be used for in the area. Active community partnerships fi nancing universal coverage; some should be and empowerment would go a long way in kept aside for emergencies. addressing the unique problems of the urban poor and help reduce health inequities. “Opening new frontiers and innovative op- portunities for collaboration in the health sec- Another break-out session addressed the issue tor: South–South and beyond” highlighted of “Protecting health from climate change”. examples of collaboration in the health sector During extreme events of climate change, in developing countries. South–South Co- health is directly linked with food, water, operation is based on equal partnerships and sanitation and livelihood crises. Partnerships the principles of solidarity, mutual benefi t, may be the solution to some of our present- capacity building and technological transfer, day climate-engendered problems. More evi- with a focus on equity in health within and dence needs to be created in the health sec- between countries. However, partnerships tor for convincing ministries of fi nance and should be sensitive to the global economic donors to allocate funds to combat climate climate, even if they are not dependent on change-related problems. external funding. An operational framework is needed for implementing South–South “Public–private partnerships in health” was Cooperation such as the New Partnership discussed by a range of panelists representing for Africa’s Development (NEPAD). global alliances, academia, the government and corporate sector. Innovative public– Several stakeholders discussed their perspec- private partnerships are critical for service tives on and roles in health development in delivery of health, product development, the Region. Stakeholders included the pri- fulfi lling corporate social responsibilities and vate sector and foundations, NGOs and civil research with academia. They should aim society, governments, UN/intergovernmen- at empowering and engaging communities. tal organizations and the media. Partnerships The community itself is a partner and is key that are sustainable begin with sharing the to delivering interventions, such as spreading most important resource, which is informa- health messages, advocacy, and monitoring tion. Information needs to be shared in order the progress of interventions. to properly intervene in communities – from conceptualization of initiatives to monitor- “Financing for universal coverage” brought ing and evaluation. Current and emerging in discussions on the role of partnerships health challenges cannot be addressed by the in fi nancing, the options for South-East State and private sectors alone. More recog- Asia and public fi nancing. The Thai experi- nition and responsibility should be given to ence was highlighted as an example of best credible organizations, and mechanisms cre- practice. To attain universal coverage, there ated for better cooperation and collaboration. needs to be political commitment, a legal Building stronger aid partnerships based framework, greater democracy and creation on aid effectiveness principles is the mutual of a fi scal space. There is also a need to raise responsibility of recipient and donor govern- funds, reduce risk and improve effi ciencies. ments. The key aid effectiveness principles of Partners for Health in South-East Asia | xiii national ownership, alignment, harmoniza- The key messages from the break-out ses- tion, managing for results and accountability sions were encapsulated in a plenary on must be adhered to. Joint advocacy from UN “Refl ections on the roles of stakeholders in agencies on health-related issues is important health development in the Region”. to enhance access to affordable and suitable medicines and health care. The draft “Delhi Call for Action on partner- ships for health” generated a lively discussion The media roundtable chaired by Dr Shashi and the suggestions which achieved consen- Tharoor, Member of Parliament, India, for- sus were incorporated. mer UN Under-Secretary-General for Com- munications and Public Information, gener- Dr Poonam Khetrapal Singh delivered the ated great interest. Though the media can closing remarks on behalf of the Regional convey public health messages effectively, Director, WHO South-East Asia Region, there needs to be greater interaction between Dr Samlee Plianbangchang. She emphasized spokespersons and journalists to build mutu- that at the centre of all partnerships and al understanding and respect for each others’ initiatives are the people themselves, who needs and pressures. Public health messages should be tapped as partners. H.E. Lyonpo can be of interest to the editor and reader – it Zangley Dukpa, Minister of Health, Bhutan is a matter of how they are packaged. declared the conference closed. Recommendations

Partnerships in health • The Chiranjeevi Yojana in Gujarat is • People on the frontline should be a successful, innovative public–private empowered. partnership to improve access to life-saving maternal and neonatal • Localization is important for the success services. These interventions could be of programmes and capacity building adopted elsewhere in the Region with must be done for this. amendments to fi t the local context.

• Lateralization is also important but The challenge of should not be forced; instead, it must be noncommunicable diseases individualized for the best results. • NCDs are preventable, and cost-effective • Learning should be much faster. One solutions are available. They should can learn from the various collaboration be addressed through surveillance, models already in existence, such as prevention and control. “South–South learning”. • Innovative approaches should be Millennium Development Goals: used to control NCDs, and the social the progress so far and opportunities determinants of health addressed. ahead • Global and regional partnerships, such • Taxation on tobacco products (“sin” tax), as United Nations (UN) H4+ agencies alcohol and energy-dense foods should be (UNAIDS, UNFPA, UNICEF, WHO increased. and the World Bank) and the Global • Government interventions should Strategy for Women’s and Children’s include microeconomic measures such as Health, play a critical role in supporting microfi nancing and community health national governments and advocating insurance, as well as health industry for commitments from all. Partnerships regulation; should continue with the South Asian urban development; and spreading Association for Regional Cooperation awareness through the media and (SAARC), Association of Southeast Asian marketing strategies. Nations (ASEAN), parliamentarians and the private sector, and also engage a • NCDs should be included in the agendas broader spectrum of actors for increased of Heads of State and Government, resource allocation for reproductive with multisectoral involvement and health, focusing on equity and quality of accountability, and by engaging the services. development sector to invest in NCDs. Partners for Health in South-East Asia | xv

Building health system capacity workforce and improve the health of • The knowledge base for reporting needs women and children. to be improved. • Health-care costs must be contained and • For health systems to function well, good catastrophic expenditure avoided. health data are needed. • Best practices in the Region (such as the • Attempts must be made to get policy- case of reduction in the HIV burden in makers to recognize the value of and India) should be replicated. accept the evidence that comes from • Challenges such as control of malaria research institutions. and new and emerging diseases must be • New opportunities such as the MoVE-IT tackled through partnerships with clear initiative should be used to collect and defi nition of the roles and responsibilities compile data to ensure that all births of partners. are recorded and certifi ed, and progress • Monotherapy with artemether and toward MDGs 4, 5 and 6 monitored. substandard medicines for malaria must • Promising practices such as scaling up be avoided to prevent the emergence skilled birth attendance by Bangladesh of drug-resistant strains of the malaria should be replicated in other countries. parasite. • The Global Code of Practice on • Accessibility to health care must be International Recruitment of Health improved throughout the Region through Personnel creates an unprecedented the use of innovative practices such as opportunity for countries to work within barefoot doctors. a common framework and collaborate • Drugs should be made affordable through in tackling challenges related to health innovative means and measures enforced workforce migration. to control the production of spurious Health partnerships and drugs. collaboration: the imperatives of Partnerships in action: collective responsibility to address reporting from the fi eld the health of the poor and vulnerable Communities must be mobilized to • Advocacy and funding are needed to • strengthen immunization programmes and demand better services and improve their introduce new and underutilized vaccines. outcomes. • The nutritional status of children below • The corporate sector should be used as a two years must be improved to ensure partner in controlling tuberculosis (TB), that children reach their full potential HIV and other diseases. and lead productive lives as adults. • Public health, particularly preventive • Reducing maternal mortality and high health care, should be strengthened, fertility rates will build the female especially in developing countries. xvi | Conference Report 2011

• Laws and regulations that prevent Ensuring universal access to most-at-risk populations from accessing health services services for HIV infection must • Prevention of road traffi c accidents and be revised, and a supportive, non- NCDs must be put on the national stigmatizing environment provided. health agenda. • Harm reduction approaches have been • Countries of the Region need to seriously shown to be successful at controlling attack the problems of alcohol and drug use and reducing the spread of HIV. tobacco, which are responsible for a Best practices in the Region should be major share of the NCD burden. replicated for the prevention and control of HIV. • Educational and health initiatives go Addressing child and hand in hand; in particular, education for maternal mortality women should be targeted as a key factor for the improvement of health outcomes. • Different stakeholders such as government, community and religious Revitalizing primary health care – organizations, UN agencies, private addressing health inequities sector and academia) can play a The success of decentralization is signifi cant role in reducing child and • dependent upon achieving good maternal mortality in the South-East Asia Region through a coordinated approach governance, productive partnerships at all that addresses several areas of concern. levels of the community, implementation of a comprehensive approach to pro-poor • Stakeholders can forge stronger growth, partnerships that also need to be made improving public services, improving sustainable. coordination among stakeholders, and • Best practices such as the Janani Suraksha addressing the social determinants of Yojna in India (in which demand-side health. fi nancing through conditional cash • Health should be viewed as an transfers has shown a signifi cant increase investment and not an expenditure. in the use of services, and a decline in maternal mortality) could be replicated in • The role of medical colleges is vital, the Region. as they are the “think tanks” and help • Greater advocacy is needed for in researching problems. Involving reproductive health, particularly with politicians is also important as they play a parliamentarians and the media. central role in health. • Role of the family and the community • Market mechanisms have to be considered needs to be strengthened, to ensure in this era of globalization. Health should effective interaction between the not be put in the marketplace as the ethics communities and the health system. of health will suffer. Partners for Health in South-East Asia | xvii

Integrated approach to and bodies formed with responsibility to prevention and control of look after various areas. noncommunicable diseases • The community should be empowered • Expertise, experience and systems are in to identify their needs and a budget place. Instead of creating parallel systems, provided to them. the control of NCDs should be “piggy- backed” onto existing systems. • A public–private partnership approach can be used to address health needs in • The Package of Essential NCD (PEN) urban slums. interventions has been implemented in Sri Lanka and could be duplicated in • The urban poor can act as active agents other countries. of change. • Civil society has played a very important Protecting health from role in changing sexual and drug-use climate change behaviour for the control of HIV/AIDS; • Partnerships may be the solution to some similar measures should be applied for of our present-day climate-engendered control of NCD risk factors. problems. People in need should be • Prevention and control of NCDs prioritized, with special attention to should be integrated into existing health women and children. programmes such as school health • More evidence needs to be created in the programmes. health sector for convincing ministries • The Framework Convention on Tobacco of fi nance and donors to allocate funds Control must be implemented more for combating climate change-related strongly. problems. • Innovative approaches to tobacco • Renewable energy sources need to be taxation can help in promoting health, as piloted and scaled up. seen in Thailand. Public–private partnerships in health • Member States should explore alternative • Private sector enterprises should fi nancing for health promotion with a be encouraged to create supportive focus on prevention and control of NCDs. workplaces for HIV, TB and malaria • NCDs should be included in the MDGs. prevention/treatment/care, preferably within broader occupational health Health for the urban poor – measures for workers and their families. the way forward • Innovative public–private partnerships • Spatial mapping should be done to are critical for service delivery of health, include poverty clusters that are not product development, fulfi lling corporate listed. social responsibilities and research with • Urban slum guidelines should be created academia. xviii | Conference Report 2011

• Public–private partnerships should also the principles of mutuality, equity, take an active role in preventive health transparency and sustainability. care as this will improve performance of • Initiatives for cooperation in the health the workforce. sector are modest. This is recognized as • The government should encourage a nascent area of work where concerted partnerships for health research in order action needs to be taken. to scale up discovery and development of An operational framework is needed for new medical products. • implementing South–South Cooperation • Public–private partnerships in medical such as the New Partnership for Africa's technology need to be formed in order to Development (NEPAD). adopt/adapt technologies appropriate for Partners in health should assist in countries of the Region. • mapping/documenting successful Financing for universal coverage examples of South–South Cooperation across regions. • Some resources should be kept aside for emergencies. All public health • The South–South Cooperation in health money should not be used for fi nancing should focus on ensuring equitable universal coverage. access to pharmaceuticals, building country capacity to produce low-cost WHO and the international community • quality drugs and vaccines, transfer of can advocate for public fi nancing with appropriate technologies among countries governments and stimulate them to with similar contexts, health innovation, spend more on health. use of information technology especially • Agreement on and understanding of for telemedicine, training of human universal coverage is limited. Data should resources, research and medical care. be collected to fi ll the information gaps • All opportunities have to be seized to in order to facilitate public fi nancing for mainstream health in foreign policies. universal coverage. Perspectives and roles of Opening new frontiers and stakeholders in health development innovative opportunities for in the Region collaboration in the health sector: South–South and beyond Private sector/Foundations Technology for health needs to be • South–South Cooperation is new and • brought to grass-roots users. should be explored further. • Best practices need to be documented • Mechanisms such as South–South and disseminated so that good work can Cooperation and Triangular Cooperation be communicated and replicated. can play a role in shaping and infl uencing the new world order according to • Some models can be institutionalized and Partners for Health in South-East Asia | xix

mechanisms/working groups/follow-up • Increased synergy with and involvement workshops organized so that discussions of civil society and non-State actors needs are taken forward. to be developed. Joint planning and monitoring and evaluation need to be NGOs and civil society conducted regularly. • Current and emerging health challenges cannot be addressed by the State and • The gap between global political private sector alone. Better recognition commitments and country-level realities and responsibility should be given to in the area of aid effectiveness should be credible organizations. Mechanisms bridged. Funds should be pooled, fl exible should be created for better cooperation and not earmarked. and collaboration (from policy level • Governments must be innovative in down to implementation). utilizing funds at the country level, for • The voluntary sector should continue example, by scaling up interventions in to improve their accountability and NCDs with funding from the Global governance. Fund to fi ght AIDS, TB and Malaria, by highlighting linkages between tobacco, • To strengthen health services, it is cardiovascular diseases, diabetes and TB. necessary to encourage, enable and Similarly, funding for malaria control can recognize the formation of associations, be used to prevent other vector-borne networks of membership-based neglected tropical diseases. organizations and NGOs. UN/Intergovernmental organizations • The role of civil society in policy and • UN agencies can optimize resources by programme review of the health sector using each others’ auditing services, offi ces should be strengthened. and have common initiatives to reduce Governments costs and prevent duplication of efforts. • Despite global commitment to the • Private practitioners should be asked principles of the Paris Declaration on Aid to prescribe drugs using their non- Effectiveness, there are gaps in proprietary names. understanding and implementation at In India, adolescent health, especially sexual country level, particularly in terms of • and reproductive health, should receive donor harmonization and alignment with more attention than at present. Advocacy is national development priorities. needed to stop early childbearing. • Greater predictability of funds should be • Joint advocacy from UN agencies ensured. on health-related issues is important • Technical assistance without adequate to enhance access to affordable and skills transfer can create dependency. suitable medicines and health care. Joint There should be a clear road map for programmes have an impact and need to national capacity enhancement. be planned and executed collectively. xx | Conference Report 2011

Media sector for engagement should be • Development and health communication considered by the public sector when needs to be well packaged. entering into a partnership. • The vernacular media should be engaged • Public–private partnerships should be and involved to provide a wider reach for looked for and promoted in various health messages. domains and at multiple levels. • The media should be engaged as partners • Civil society can educate the community and sensitized to relevant issues. about schemes by the government for their benefi t. It can build the capacity • Public health offi cials should be trained of participatory committees to increase to be better spokespersons and work with monitoring and accountability of such the media. schemes. Community monitoring tools such as public dialogue should be Refl ections on the roles of developed and put into action. stakeholders in health development in the Region • Disability issues must be taken on board as • Countries must allocate a larger share of a part of health development concerns. the GDP to health. Investments in health • Health is a political and cross-cutting and resources must be increased. issue, and is beyond the responsibility • While partnerships already exist, of only the Ministry of Health. Other coordination, governance, regulation and ministries should also be involved. stewardship need to be improved. • Politicians should be sensitized to health • Money spent on health is not expenditure issues so that they are able to make but an investment in the lives of people. adequate policy decisions, particularly with regard to the allocation of resources for • Political promises at the global and health. national levels must be followed through by providing resources, political space • Meetings such as this should be held at and services to the people. regular intervals (e.g. every two years) to check whether what was proposed has • The incentives needed by the private been achieved. Introduction

The WHO conference “Partners for Health and discuss health priorities for the Region, in South-East Asia”, was held in New and the challenges and opportunities for Delhi from 16 to 18 March 2011. It was advancing these priorities. It also provided organized with a view to strengthen regional an opportunity to share best practices, and collaboration for health, and encourage highlight partnerships in action. effective and sustainable partnerships between stakeholders. With 26% of the The conference had over 350 high-level world’s population and 40% of the disease representatives from governments in the burden, the Region faces multiple challenges Region, donor countries, multilateral in improving the health of its people. The and intergovernmental organizations, conference aimed to provide a forum for civil society, foundations, media, the the 11 Member States of the South-East private sector, as well as research/academic Asia Region and their partners to identify institutions. Objectives

• Review progress in achieving health- • Identify roles and responsibilities of related internationally agreed partners in addressing countries’ health development goals, including the priorities; Millennium Development Goals Leverage partner commitment to (MDGs), in the South-East Asia Region, • foster better collaboration and explore and discuss collaborative efforts to new and innovative ways of working address challenges and bottlenecks; together to accelerate the achievement • Identify challenges as well as of health-related, internationally agreed opportunities and priorities for common development goals, including the action in the South-East Asia Region; MDGs. Partners for Health in South-East Asia | 1

Opening ceremony

Left to right: Dr Poonam Khetrapal Singh, Ms Erin Soto, Dr Analjit Singh, H.E. Mr Ghulam Nabi Azad, Dr Samlee Plianbangchang, Mr Kalyan Banerjee, Mr Keshav Desiraju

Welcome Dr Samlee Plianbangchang, Regional Dr Poonam Khetrapal Singh, Deputy Director, WHO South-East Asia Region Regional Director, WHO South-East Asia H.E. Mr Ghulam Nabi Azad, Union Region Minister of Health & Family Welfare, India

Addresses Vote of thanks Mr Kalyan Banerjee, President-Elect, the Mr Keshav Desiraju, Additional Secretary, Rotary Foundation of Rotary International, Ministry of Health and Family Welfare, USA India Ms Erin Soto, Minister Counselor for International Development and USAID Master of ceremony Mission Director, India Ms Vismita Gupta-Smith, Public Mr Yohei Sasakawa, Chairman, the Information & Advocacy Offi cer, WHO Nippon Foundation and WHO Goodwill South-East Asia Region Ambassador for Leprosy Elimination, Japan Session Coordinator: (read by Ms Chikako Awazu) Ms Nelly-Enwerem Bromson, Ag Strategic Dr Analjit Singh, Chairman and Managing Alliances & Partnerships Offi cer, WHO Director, Max India Limited, India South-East Asia Region The conference started on a sombre note, with all participants expressing their deep sympathies and condolences with the people of Japan, who have been overwhelmed by a powerful earthquake and tsunami.

the people of the South-East Asia Region and for sparing the time to inaugurate the conference. His presence would give an impetus to strengthening partnerships for health. She introduced the dignitaries on the dais -Ms Erin Soto, Minister Counselor for International Development, the United States Agency for International Development (USAID); Dr Analjit Singh, Chairman and Managing Director, Max India Ltd.; Mr Kalyan Banerjee, President-Elect, Rotary International, USA, Dr Samlee Plianbangchang, Regional Director, WHO South-East Asia Region and Mr Keshav Desiraju, Additional Secretary, Ministry of Health and Family Welfare, India. She welcomed the print and electronic media and asked for coverage to advocate for

Dr Poonam Khetrapal Singh welcomed partnerships in health. Mr Yohei Sasakawa, the Ministers of Health and Finance from Chairman, the Nippon Foundation and Member States in the South-East Asia Region WHO Goodwill Ambassador for Leprosy and the other distinguished participants to Elimination could not attend due to the the fi rst conference of Partners for Health disaster in Japan. in South-East Asia. She explained that the aim of the conference was to synergize and The success of any meeting depends on the harmonize the efforts of all partners to quality of the deliberations. The galaxy of improve health and reduce poverty in the eminent national and international experts, Region. She thanked H.E. Mr Ghulam scientists, academia, NGOs, the media and Nabi Azad, Union Minister of Health decision-makers in health attending this and Family Welfare, India, and thanked meeting would ensure that the deliberations him for his commitment to the health of would be most fruitful. 350 000 children per year fell ill with polio. Today, the number is 1000 children per year and 99% of polio has been eradicated. Initial efforts were aimed at immunizing all children, even in areas of confl ict. We have stood at the threshold of a polio-free world for longer than we expected, but the goal is monumental. All but four of the world’s countries have been declared polio-free. The process has not gone as smoothly as might have been hoped, but the success of polio eradication, with the cooperation of all stakeholders, is an amazing achievement. The goal of polio eradication in India is a challenge, but polio is now at historically low levels. Much can be done by working together. Rotary’s success at working with other organizations in combating polio Mr Kalyan Banerjee recounted the history has provided a model for how we might of polio eradication in the world. Polio was work effectively to address the many other eradicated 20 years ago in the Americas, 10 public health and development challenges years ago in the Pacifi c region, and efforts we face as a global community. Rotary’s are ongoing toward eradication in South- strength is in reaching out to people with East Asia. Many countries around the world different backgrounds in over 200 countries with similar challenges as in India have and establishing close links with them. The eradicated polio. In 1985, when Rotary partnerships created would extend well started the immunization campaign, beyond polio eradication. 4 | Conference Report 2011

achievement of the MDGs. This forum provides an opportunity to discuss best practices and reforms among the public and private sectors. President Obama has launched the fi rst-ever Presidential policy for health in September 2010. The US is committed to achieving sustainable development outcomes by making broad- based economic growth and democratic governance top priority. The US is investing US$ 63 billion over six years to help partner countries improve health systems.

Ms Soto identifi ed fi ve challenges facing the health sector: (i) shortage of skilled staff; (ii) limited investment in and utilization of information technology for development; (iii) need for mechanisms Ms Erin Soto said that South-East Asia to ensure operational accountability; has made many improvements in health (iv) fi nancial barriers to health care; and development and towards the MDGs. (v) the need to engage the private sector, However, the trend is not uniform across especially in low- and middle-income and within countries, and hard-to-reach countries. These challenges can best areas and populations are lagging behind. be addressed by strengthening health Equity in, access to, and use and quality systems, which would lead to strengthened of services are varied. These can slow the governance and better performance. Partners for Health in South-East Asia | 5

role has been performed by the Novartis Foundation. Over 16 million people with leprosy have been cured since 1995 and leprosy will soon be eliminated. Partners have ensured that the drugs reach the people who need them.

Although drugs for leprosy are available even in remote places, those for common ailments such as fever, diarrhoea and respiratory illnesses are lacking. A system is needed which allows access to essential medicines by people when they need them. Home medicine kits with traditional medicines could be an answer. The Nippon Foundation launched such a programme in Mongolia, where the population is largely nomadic. Around 60 000 households use Since Mr Yohei Sasakawa could not be the system and it will soon be a part of the present due to the crisis in his country, country’s health policy. Myanmar, Thailand Ms Chikako Awazu read out his message. and Cambodia have adapted the system to She highlighted the activities of the Nippon their needs. This is one approach to ensure Foundation in utilizing partnerships to primary health care to those in remote end leprosy. The goal of freeing the world areas. of leprosy might have seemed impossible at one time. However, the development From elimination of endemic disease, of multidrug therapy in the 1980s offered ensuring primary health care in remote a glimmer of hope. With partnerships areas to recovery from a major disaster, the between foundations, governments, challenges the world faces today are too nongovernmental organizations (NGOs) arduous for a single organization to tackle and other players, the Nippon Foundation and partnerships are needed for this. It is supported free treatment through WHO possible to overcome challenges by working from 1995 to 1999. From 2000, this with all possible stakeholders. 6 | Conference Report 2011

coming forward to ask for these in cities of all types. This in turn improves health outcomes and the health status of the population. Earlier, it was believed that improvement in infrastructure, health care and education was an outcome of growth and development. But now it is commonly believed that improvement and investment in health care, education and infrastructure is a precursor for development. He asked participants to question whether their countries’ health-care strategy was derived from the principle of sound logic and economic rationale, such as public and private investment and participation. In many countries, these strategies are not well founded. This raises the question of the compatibility of models—the “business Dr Analjit Singh raised the issue of logic” of the private sector and the strategies challenging “conventional wisdom” of developed by the government. Ideally, there demand creating supply. He noted that needs to be a partnership for concerted an increase in supply can lead to an action. Public–private partnerships are very increase in demand, as higher capacity, important, and governments should new technologies and less lengthy hospital invite greater participation by the private stays encourage people to seek medical sector. Private organizations need to realize care. The fear of surgical interventions that they have much to contribute, though has now been mitigated and people are they are accountable and work for profi t. Partners for Health in South-East Asia | 7

of fi nding new and innovative ways to tackle the prevailing gaps in under-funded health priorities including health systems’ strengthening. In addition, countries of this Region are still struggling with a large burden of communicable diseases as well as neglected tropical diseases, even as the problem of noncommunicable diseases (NCDs) becomes larger. Unplanned urbanization is a threat to health in a Region where a massive number of people live at close quarters and only 60% have access to proper sanitation. No single government, no single organization can successfully pursue these challenges alone. Global health is a multi-stakeholder process and sustainable partnerships will be key to Dr Samlee Plianbangchang pointed out facing and overcoming the related social, that many noteworthy achievements are economic and environmental factors which now under threat because of several global contribute directly and indirectly to the crises, not least the food crisis, the fi nancial disease burden in the Region and to helping crisis, and the mounting problem of climate prevent unnecessary suffering, morbidity change. He highlighted the importance and deaths. 8 | Conference Report 2011

mortality ratio (MMR). In the area of Safe Motherhood, the Janani Suraksha Yojna has reached women across the country, and was cited by the Lancet as a most promising health initiative.

India has the largest diabetic population in the world. A three-pronged strategy has been put in place to tackle the problem of NCDs under the aegis of the new national programme for the prevention and control of cancer, cardiovascular diseases, diabetes and stroke. However, all initiatives would be unproductive without health systems strengthening. To this end, the federal government has committed US$ 3.5 billion annually to help the states to improve their infrastructure through the National His Excellency Mr Ghulam Nabi Azad Rural Health Mission. In spite of having pointed to the impressive gains made by more than 730 000 doctors and 930 000 the Government of India in improving the nursing personnel, these are concentrated health status of the population; for example, in urban areas, leaving a huge gap in rural efforts toward the achievement of MDG 6. areas. He outlined impressive plans in the The MDGs have infl uenced all bilateral areas of medical education and other fi elds, and multilateral dialogue and the policies particularly aimed at strengthening the of many countries, including India. He system in backward and underserved areas. noted that health systems’ strengthening has He urged Member countries to join hands had a signifi cant impact on reducing the and make the Region free of want and infant mortality rate (IMR) and maternal disease. Partners for Health in South-East Asia | 9

Mr Keshav Desiraju thanked all the speakers for their insightful interventions which brought to light very important issues which he hoped would be further developed during the course of the meeting. He reminded participants that while health care is the primary responsibility of national governments, partnerships are needed to ensure the necessary human, fi nancial and physical resources for health. He concluded by thanking the Regional Director for South-East Asia of the World Health Organization for his leadership in organizing the Conference and bringing together such high-level participants, which he was confi dent would take forward and strengthen partnerships in health in the Region. 10 | Conference Report 2011

Special address - Partnerships in Health

Mr Arun Maira, Member of the Planning Session Coordinator: Commission of India and Former Chairman Dr Nata Menabde, WHO Representative, of the Boston Consulting Group, India India Partners for Health in South-East Asia | 11

which perhaps explains why the outcomes of the plans have not been good. Another possible reason is the existence of walls and silos within the government. Recognizing this, in the development of the 12th Five- Year Plan we were guided by the philosophy of Gandhiji’s Antodaya movement “think of the poorest fi rst”. The government through NGOs and civil society groups therefore asked those who were the poorest and neediest what they needed most, and their suggestions on how these needs could best be met. Twelve questions were given, which represented the 12 challenges faced by India. The government asked these NGOs and civil society groups to provide consolidated and clear recommendations as to what needs to be done. The groups took Mr Arun Maira stressed that India faces up the challenge and recommended to the many challenges. One of these is providing government what it should do. The process acceptable, accessible and affordable health was not without problems. For example, care to its citizens. There is a long way to NGOs which the government had not go in the area of health but one cannot even thought of, emerged in representation afford to take too long in getting there. of marginalized communities such The requirement for health is ongoing and transgender people and others, and were does not wait for one to fi nd solutions. The subsequently involved. Citizens throughout time for action is now, and the question is the country were reached directly through how can partners work together to produce social media such as Facebook and the the desired outcomes? Mr Maira quoted internet, and their suggestions solicited. parts of a famous poem by Nobel Laureate Rabindranath Tagore, Where the mind is The greatest challenge identifi ed was without fear and the head is held high, implementation, due largely to ineffi ciency and corruption. Business groups, civil Where the world has not been broken into society organizations, the government, fragments by narrow domestic walls… academicians, experts and others formed conclaves to decide what should be done What are the fragments in which we live as interaction between various groups and the walls which divide us? could provide new and mutually benefi cial solutions to common problems. The results In India, fi ve-year plans are made, which were surprisingly clear and, at present, should be developed for, by and of the stakeholders are being involved. At one of people, but this has not been done well, the meetings, a participant was surprised to 12 | Conference Report 2011

fi nd how alike the thoughts of these various not usually learn from or listen to. How organizations were, contrary to what was can we act together to produce effective expected. Thus, the stereotypes that we change? He listed localization, lateralization create also lead to walls being built up. and learning as three key areas. It is very important for the development and Where the clear stream of reason has not success of partnerships to expand what is lost its way in the dreary desert sand of dead understood by learning beyond an academic habit… model, to include listening to diverse viewpoints, working with those outside There is a need to step out of silos and to our usual spheres of knowledge and work, think innovatively and with open minds, and creating a new “learning architecture”. not with preconceived ideas. Referring to He suggested that each one at the meeting the Conference logo “inspire, innovate, should step back and allow others to speak, involve, Mr Maira urged participants to be and listen to them to gain new learning. inspired, to get out of their heads and into their hearts, and to think about what they He concluded by saying that this meeting really cared for. He stressed that innovation was a forum for learning from each other stems from involving people one does and fi nding a way forward.

Discussion points be done similarly and those that can • A participant wanted to know how be done differently. There is also a India could think outside silos since need to learn much faster and better, health was a state subject. What is creating a learning architecture for the government doing to get the effective change. states to prioritize and implement relevant programmes? Mr Maira Conclusions and recommendations answered that as the states are • Gauge the people for whom results huge, health is delivered at the are to be produced instead of telling local level. Thus, engagement with them what they have to do. those for whom health care is being delivered is needed. Localization • Empower people on the frontline. is important, as well as capacity Until they want to do something, it building to empower the 1.2 billion will not be done. on the frontline. Lateralization is also crucial. People should learn to • The architecture of implementation cooperate, look for things that can has to be changed. Partners for Health in South-East Asia | 13

• Localization is important for the • Learning should be much faster. success of programmes and capacity One can learn from the various building must be done for this. collaboration models already in existence, such as “South–South • Lateralization is also important but learning”. should not be forced; instead, it must be individualized for the best results. 14 | Conference Report 2011

Plenary I

Millennium Development Goals: Dr Amarjit Singh, Joint Secretary, Ministry the progress so far and opportunities of Human Resource Development, India ahead Innovations in maternal health care: a case study from Gujarat Chair: Session Coordinator: H.E. Lyonpo Zangley Dukpa, Minister of Dr Quazi Monirul Islam Health, Bhutan Rapporteur: Speakers: Dr Akjemal Magtymova Ms Nobuko Horibe, Regional Director, United Nations Population Fund (UNFPA), Thailand Millennium Development Goals: the UNFPA perspective Partners for Health in South-East Asia | 15

highest in the world, and health systems are thus failing to meet the needs of women. The key determinants of the slow progress toward MDG 5 are a lack of availability of family planning services, lack of skilled care at every birth, and lack of emergency obstetric services. Adolescent pregnancy has enormous consequences, and signifi es an unmet need for contraception.

Health fi nancing in the Region is very poor. The South-East Asia Region spends less on health than Africa, and out-of-pocket expenditure is very high. In emergencies, deaths are common because of this. Some governments hope to overcome this problem through cash incentives and vouchers. Ms Nobuko Horibe provided UNFPA perspectives on improving women’s and It has also been observed that in countries reproductive health. She described the with a high MMR, gender inequality is progress on maternal and reproductive deeply entrenched. Promoting gender health in the Region as “slow and equity will need concerted efforts and inequitable” with inequities among and engaging men as agents of change. The within countries, population groups three main causes of increased maternal and socioeconomic quintiles. While the mortality are delay in recognizing danger, maternal mortality ratio (MMR) has delay in reaching facilities and delay in decreased in almost all regions of the receiving treatment. Such weaknesses must world, it remains high in South Asia, and be addressed through partnerships with reaching MDG 5 does not seem possible, intergovernmental agencies to improve the though some countries such as Sri Lanka, health of women. Despite successes, there Thailand and the Maldives are doing well. is no time for complacency. All partners Reaching MDG 5 is pivotal to reaching the must unite and take action to fi nance and other MDGs. The lifetime risk of maternal improve services, so that MDGs 4 and 5can mortality in South-East Asia is the third be reached. 16 | Conference Report 2011

NGOs, the Federation of Obstetricians and Gynaecologists Society of India (FOGSI), and the government. The State Government would take full responsibility in case of death. A package with payment for services was prepared by the Indian Institute of Management (IIM) Ahmedabad. A memorandum of understanding (MOU) was signed and all payments were promptly made, which showed the commitment of the government.

The Chiranjeevi Yojana promoted institutional deliveries in Gujarat and emphasized (1) midwifery education; (2) designing a service package; and (3) ensuring distribution, retention and motivation of skilled staff, including obstetricians/ Dr Amarjit Singh described the success gynaecologists and paediatricians, for of the Chiranjeevi Yojana in the state improving access to skilled care and of Gujarat, which helped to increase emergency obstetric services by those in need. institutional deliveries and bring down the In addition, a transport system was organized IMR. He highlighted the importance of in August 2007 to take pregnant women, skilled birth attendance during pregnancy, especially those below the poverty line, to childbirth and post partum to substantially hospitals during emergencies. This helped to reduce maternal mortality and early neonatal save the lives of many women. deaths. By December 2010, the rate of institutional In 2005 in Gujarat, there were only seven deliveries had gone up to 91.3% from 57% obstetricians in rural areas to handle the in 2004–05, accompanied by a steep decline complications of delivery, and only 30% in the IMR and MMR. The scheme has of health centres had trained auxiliary been extended and 266 paediatricians have nurse midwives. The Chiranjeevi Yojana now been enrolled in the Bal Sakha scheme was launched to address this problem. for the care of newborns and children. The At that time, Gujarat had 1800 private Chiranjeevi Yojana could be replicated in practitioners and it was decided to involve other Indian states, but this has not been them through a consultative process with done so far. Partners for Health in South-East Asia | 17

Discussion points Conclusions and recommendations • The Chair, H.E. the Minister of • WHO’s role in setting standards Health, Bhutan proposed that Gross and norms was underlined and National Happiness be included as recognized as an important element the ninth MDG. for contributing to the joint efforts for achieving MDG 5 on improving • Maternal mortality data are often maternal health. politicized as the fi gures may range • Global and regional partnerships, widely, depending on the sources and such as United Nations (UN) H4+ methodologies. The methodologies and the Global Strategy for Women’s require constant refi nements. The and Children’s Health, play a UNFPA, along with the United critical role in supporting national Nations Development Programme governments and advocating for (UNDP) and United Nations commitments from all. Partnerships Children’s Fund (UNICEF), should continue with the South contribute to the improvement of Asian Association for Regional statistical capacity for the use of Cooperation (SAARC), Association data and development of evidence- of Southeast Asian Nations (ASEAN), based strategies. UN estimates by parliamentarians and the private WHO/UNFPA/UNICEF/the sector, and also engage a broader World Bank are used to make data spectrum of actors for increased more comparable. Disaggregated resource allocation for reproductive data have the capacity to provide health, focusing on equity and quality vital information on the vulnerable of services. groups that need to be targeted with additional programme efforts. • The Chiranjeevi scheme in Gujarat is a successful, innovative public–private • Within the Chiranjeevi scheme, partnership to improve access to monitoring of the health-care life-saving maternal and neonatal facilities was based on a grading services. These interventions could be system and incentives were tailored adopted elsewhere in the Region with specifi cally to the gaps. amendments to fi t the local context. 18 | Conference Report 2011

Plenary II

The challenge of noncommunicable Session Coordinator: diseases Dr Renu Garg Chair: Rapporteur: Dr Lalit M Nath, Former Director, All Dr Dhirendra Narain Sinha India Institute of Medical Sciences, India Speaker: Dr Bela Shah, Senior Deputy Director- General NCD, Indian Council of Medical Research, India Noncommunicable diseases: challenges Partners for Health in South-East Asia | 19

The Chair, Dr Lalit M. Nath set the stage by saying that because of advances in medicine, more people are living longer. In India, NCDs account for 53%–58% of the burden of disease.

The growing burden of NCDs led the United Nations General Assembly to focus on NCDs at a meeting on 13 May 2010. An NCD Summit was held in December 2010 and a conference on Healthy Lifestyles will be held in Moscow in April 2011.

groups and all regions of the world, and are a threat to development. Their chronic nature leads to long-term disability. NCDs are a more expensive global risk than the global fi nancial crisis, with a potential cost estimated between $250 billion and $1 trillion dollars. WHO projects that over the next 10 years, deaths from diabetes, cardiovascular disease, cancer and respiratory disease will increase in all regions of the world. NCDs have tremendous economic consequences and may slow the economic growth of a nation.

NCDs have socioeconomic, cultural, political and environmental determinants. Some common modifi able risk factors Dr Bela Shah in her address said that include an unhealthy diet, physical NCDs account for 60% of deaths globally inactivity, and alcohol and tobacco use, and 80% of deaths in low- and middle- while non-modifi able risk factors include income countries. They affect all income age and heredity. 20 | Conference Report 2011

The South-East Asia Region is going aged 30–59 years in developing countries through various health transitions. These die from NCDs at twice the rate of their include an epidemiological transition, with counterparts in high-income countries. a large burden of communicable diseases Low-income countries have a 30% greater and a signifi cant increase in NCDs. At morbidity from NCDs, possibly due to the same time, the Region also is home weak health systems, which also account for to several neglected tropical diseases. A high and sometimes catastrophic out-of- demographic transition is evident in the pocket expenditure on health. fact that nearly a third of NCD deaths are among those below the age of 60 years. The way forward to meet the challenge The periurban population has an increased of NCDs lies in addressing the social prevalence of NCDs. A nutritional determinants of health. Most importantly, transition is also taking place, due to strengthening health systems focusing substitution of coarse grains with polished on the primary health care approach is cereals, low intake of fruit and vegetables, crucial. and higher intake of fats and sugars. Health-damaging behaviours like smoking, The road map for the control of NCDs is drinking, consuming unhealthy diets, which enshrined in the Regional Framework for are driven by urbanization, technological Prevention and Control of NCDs, which change, market integration and foreign was endorsed by the Regional Committee direct investment, account for the in 2007. The strategy targets the main behavioural transition that is simultaneously modifi able NCD risk factors and focuses on taking place. surveillance, health promotion and primary prevention. Subsequently, the Regional Weak health-care systems worsen the Action Plan (2008–2013) for implementing impact of the epidemic of NCDs. People the Framework was formulated. Partners for Health in South-East Asia | 21

Conclusions and recommendations • Innovative approaches should be used to control NCDs. • NCDs are the single biggest cause of deaths, of which a large proportion is • Taxation on tobacco products (“sin” premature. tax), alcohol and energy-dense foods • They have strong social determinants should be increased. that must be addressed. • Government interventions should • Preventable and cost-effective include microeconomic measures solutions are available. such as microfi nancing and community health insurance, as • NCDs can be addressed by well as health industry regulation; surveillance, prevention and control. urban development; and spreading • Health systems in developing awareness through the media and countries are overwhelmed by the marketing strategies. increasing magnitude of NCDs • NCDs should be included in the and policy-makers are increasingly agendas of Heads of State and asking for technical support, which Government, with multisectoral remains largely unanswered. This is involvement and accountability, and a serious health and development by engaging the development sector problem. to invest in NCDs. 22 | Conference Report 2011

Plenary III

Building health system capacity Dr Carla AbouZahr, Team Leader, Monitoring Vital Events (MoVE-IT), Chairs: Health Metrics Network, Switzerland Dr T. Ravindra C. Ruberu, Secretary, The need for civil registration and vital Ministry of Health, Sri Lanka statistics Dr Jai P. Narain, Director, Department Dr Mubashar Riaz Sheikh, Executive of Sustainable Development and Healthy Director, Global Health Workforce Environments, WHO South-East Asia Alliance, Switzerland (read by Mr Sunil Region Nandraj, WHO Country Offi ce, India) Speakers: Refl ections on the health workforce crisis in South-East Asia Dr Ugrid Milintangkul, Deputy Secretary- General, National Health Commission, Session Coordinator: Thailand Dr Thushara Fernando Healthy public policies: moving towards an Rapporteur: integrated and intersectoral approach to health – Thailand’s experience Dr Prakin Suchaxaya Partners for Health in South-East Asia | 23

The Chair, Dr Ravindra Ruberu highlighted that health outcomes are not satisfactory in our Region. There is inequity among different populations within and between countries. Thus, health delivery is not uniform. We run into obstacles when we try and deliver services. Therefore, health systems are important, especially in reaching the MDGs. The six building blocks of health systems have been defi ned by WHO, but must be tailored to each country’s needs.

with the Ottawa Charter. Thailand began to see health beyond health care.

A paradigm shift in health took place in 1997 when the Constitution was adopted. It emphasized the importance of public participation and reaffi rmed many rights of the people, especially their right to health.

The National Health System Report in 2000 declared that in fact Thai people still suffered from preventable illnesses. The health-care services were focused on curative services, which caused a high expenditure on health care, but gave low returns on health. The National Health System Reform Dr Ugrid Milintangkul reported that Commission was established in 2000 with the process of building healthy public the responsibility of drafting the National policies in Thailand started in 1980 Health Act as a new tool to reform the health through numerous Acts. In 1986, Thailand system. The National Health Act, 2007 shifted its health development strategy to envisages health as having four components: emphasize health promotion in accordance physical, mental, social and spiritual. 24 | Conference Report 2011

In Thailand, many organizations and Health Impact Assessment complements networks at the national and local levels the 2007 Constitution and the National work hand in hand with the Ministry Health Act. The right to health of the of Public Health. Thus, this Ministry people is reaffi rmed in this Act. The three is not solely in charge of everything on key elements of the Health Assembly are health. Health organizations also work public participation (government, academia closely with the National Economic and and the community), knowledge-based Social Development Board. There is good information and consensus. networking from top down. A controversial issue is the medical hub The National Health Commission (NHC) policy, one of the resolutions from the is a cross-sectoral mechanism to support 2010 National Health Assembly, to boost policy coherence. It is chaired by the Prime medical tourism. While this would promote Minister and comprises three sectors – economic growth, it would create inequity government, academic and civil society. in health care between urban and rural areas. The NHC is managed by the National Other problems that may result with this Health Commission Offi ce (NHCO), an policy are brain drain and shortage of health autonomous body that plays a synergizing professionals in rural areas. The government role to facilitate the development of has been asked to reconsider this. participatory healthy public policies (HPP). Despite the considerable progress made, The tools and processes for participation some challenges remain. Meaningful on HPP under the National Health Act, and inclusive participation requires time 2007 include the Health Statute, Health and patience. Knowledge generation and Impact Assessment and Health Assembly. management are required throughout The Health Statute developed in 2009 the process. Policy to action can only be serves as a framework for all sectors to achieved if there is a sense of ownership apply their policies, strategies and action among all stakeholders along the process of plans, and is revised every fi ve years. HPP. Partners for Health in South-East Asia | 25

For public health decision-making at both the national and local levels, data should provide a reliable refl ection of the patterns of mortality among different groups and across regions. They should also be continuous and complete.

At present, 85 countries with 66% of the world’s population do not have reliable cause-of-death data. Each year, 40 million births and 40 million deaths go unregistered. This is because the data are inaccessible, lost or not compiled in a user-friendly fashion. Civil registration, if functioning well, generates continuous data for the whole population, is nationally owned and implemented, and benefi ts both national and individual users and policy- Dr Carla Abou Zahr informed that the makers. It requires the partnership of the Health Metrics Network, started in 2005, is community, those who register, statisticians, a global partnership of producers and users legal authorities and public health of health information. The goal was to stakeholders. It is a national endeavour enhance the availability and use of timely which involves multiple stakeholders. In and reliable health information. It is hosted the South-East Asia Region, Sri Lanka by WHO with funding largely from the and Thailand have good civil registration Bill and Melinda Gates Foundation, and systems. brings together representatives of health and statistical constituencies. The MoVE-IT initiative aims to move away from a paper-based system. It uses informa- Most current measurements are estimates, tion technology (IT) to collect and compile which have a weak empirical base. There data to ensure that all births are recorded and is heavy reliance on household surveys certifi ed, and helps to better monitor progress for monitoring mortality, but these toward MDGs 4, 5 and 6. It also serves as a have limitations. They are conducted platform for tracking NCDs, causes of death occasionally, give retrospective estimates, and health system performance. have wide margins of uncertainty, and limited usefulness for cause-of-death data. MoVE-IT has a three-pronged approach: it In addition, they are not suitable for local- contributes to regional and country policy or district-level monitoring, where action processes; provides standards and tools needs to be taken. They are also externally for assessment and quality control; and funded. generates evidence of what works. In Asia, 26 | Conference Report 2011 several partners are working together to The three themes of the meeting can be generate and use data. applied to civil registration.

It was suggested that the Delhi Call for Inspire: Civil registration is a prerequisite Action should include the statement from the Prince Mahidol Award Conference in for development. 2010 in relation to 90% completeness of Innovate: Use IT to improve strategies. birth and death registration and improved cause-of-death data by 2020. Involve: Involve all sectors.

worker availability and health outcomes, pointing to the fact that without suffi cient health workers, countries are unlikely to achieve the health MDGs and other health development objectives.

In 2006, WHO estimated that 57 countries fell below the minimum required threshold of health workers. Of these countries, six are in the South-East Asia Region (Bangladesh, Bhutan, India, Indonesia, Myanmar and Nepal). In addition, there is urban–rural maldistribution due to poor management of the workforce. Some of the human resource issues are: most countries do not have a costed workforce plan; there is non-availability of national data on human resources for health (HRH); diffi culty in Dr Mubashar Riaz Sheikh’s presentation retaining the workforce in rural areas; and was given by Mr Sunil Nandraj, who migration of the workforce from developing stressed that the health workforce is the to developed countries. main building block of health systems, and there is a direct relationship between At the First Global Forum on Human availability of health workers and coverage Resources for Health held at Kampala, of essential health services. Countries Uganda in 2008, the Kampala Declaration below a certain threshold of health worker and Agenda for Global Action was adopted density are highly unlikely to achieve an as an overarching framework to address acceptable level of service coverage. There the global health workforce crisis. This is a similar correlation between health framework comprises six interconnected Partners for Health in South-East Asia | 27 strategies to bolster the health workforce: retain workers in underserved areas. While strengthening leadership, better use of data on international migration are not evidence, scaling up training, improving consistently available, several countries in retention in rural areas, managing the Region, such as Indonesia, are severely international migration and increasing affected, exporting large numbers of health investments for health workers. workers to other countries in the Region and globally. Other countries, such as India, are In the lead-up to the Second Global also large net exporters of health workers. Forum, held in Bangkok, Thailand in 2011, the Global Health Workforce Alliance Countries have been working to improve conducted a survey to review progress in their workforce situation. Bangladesh each of these six areas in the 57 priority has scaled up the number of skilled countries affected by severe health worker birth attendants (SBAs) to 17 000; India shortages. With regard to leadership under the National Rural Health Mission and stewardship for health workforce (NRHM) has increased the number of posts development, while most priority countries in public health facilities, offered incentives, in the South-East Asia Region (fi ve out of locality-specifi c recruitment, recruited a six) have an HRH plan or strategy, only two new cadre, and added more than 80 000 of these were actually being implemented, health workers. Nepal used community and only one had an associated budget or health workers to reduce pneumonia among cost estimate. children below the age of fi ve years, and the country is on track to achieve MDG 4. Less than half of the countries reported having an institutional mechanism, such A few opportunities have recently opened as a health workforce observatory, to serve up at the global level: a Global Code of as a platform for sharing information and Practice on International Recruitment evidence with policy-makers. Only one of Health Personnel was approved at the country (Bhutan) in the South-East Asia World Health Assembly in 2010. This Region reported the existence of such a creates an unprecedented opportunity mechanism. All the six priority South-East for countries to work within a common Asia Region countries reported having framework and collaborate in tackling implemented strategies such as increased challenges related to health workforce salaries, allowances or benefi ts to attract and migration. 28 | Conference Report 2011

Discussion points Conclusions and recommendations • There is substantial underreporting • The knowledge base for reporting in the civil registration system even needs to be improved. in developed countries. Though • For health systems to function well, systems are in place in many good health data are needed. countries, these have not been used effectively. However, reporting can • Attempts must be made to get be improved in a short span of time policy-makers to recognize the value as shown by Sri Lanka and South of and accept the evidence that Africa. Sometimes, data are either comes from research institutions. underreported or missing, especially • New opportunities such as the those on maternal mortality. This MoVE-IT initiative should be may be related to the diffi culty in taken to collect and compile data to identifying the cause of death. Civil ensure that all births are recorded registration is about recording births and certifi ed, and monitor progress and deaths, not disease notifi cation. toward MDGs 4, 5 and 6. • Healthy public policies should be • Promising practices such as scaling based on evidence, not opinion. up skilled birth attendance by Civil registration can play a part Bangladesh should be replicated in in this process. However, it is other countries. hard to get policy-makers and the • The Global Code of Practice on community to recognize evidence International Recruitment of Health that comes from research institutions. Personnel creates an unprecedented Underscoring the importance of opportunity for countries to work health data will lead to better health within a common framework and outcomes. Endorsement of the collaborate in tackling challenges Health Information Charter available related to health workforce on the web should be encouraged. migration. Partners for Health in South-East Asia | 29

Plenary IV

Health partnerships and Mr Paul Kelly, Director, Country collaboration: the imperatives of Programmes, Global Alliance for Vaccines collective responsibility to address and Immunization (GAVI), Switzerland the health of the poor and vulnerable Dr Mariam Claeson, Programme Chairs: Coordinator, HIV/AIDS, Human H.E. Dr Farooq Abdullah, Union Minister Development, South Asia Region, The for New and Renewable Energy, India World Bank, India Mr Hussain Niyaaz, Additional Secretary, Session Coordinator: Ministry of Foreign Affairs, Maldives Ms Nelly Enwerem -Bromson Panelists: Rapporteur: Dr Bina Rawal, Head of Medical Affairs, Dr Kathleen Holloway The Wellcome Trust, UK Dr Thomas Teuscher, Deputy Executive Director, Roll Back Malaria Partnership, Switzerland 30 | Conference Report 2011

The Chair, H.E. Dr Farooq Abdullah spoke about issues close to his heart. He emphasized the need to reach out to the vulnerable and marginalized, particularly the poorest of the poor. Referring to development, he stressed that growth should not merely be measured in terms of GDP but by the health status of the people. He requested the participants to think creatively about the challenges to health including governance, drug resistance, safe drugs and emerging and re-emerging diseases.

million per year. It supports researchers to develop their ideas, and supports people to implement them. The strategic plan for 2010–2020 has three focus areas: it supports outstanding researchers; accelerates the application of research; and explores the historical and cultural contexts of medicine. It faces fi ve challenges: maximizing the health benefi ts of genetics and genomics; understanding the brain; combating infectious diseases; investigating development, ageing and chronic disease; and connecting the environment, nutrition and health.

The Trust has major overseas programmes and funds seven projects in India. It has three divisions and funds a range of Dr Bina Rawal said that Henry Wellcome technologies in six areas. It funds early- left all his fortune including his pharma- stage research and development, and plugs ceutical company to the Wellcome Trust. funding gaps for projects that benefi t the This amounts to GBP 6–7 hundred public. Since July 2010, it has partnered Partners for Health in South-East Asia | 31 with the Department of Biotechnology, versus drug discovery. The venture tries to Government of India and announced balance innovation with cost reduction. A funding of GBP 45 million to support joint venture with Merck, India plans to the development of affordable health-care develop affordable vaccines in a sustainable products. Keeping affordability in mind, manner, starting with rotavirus vaccine. a joint venture with the Government of Funding for this is GBP 140 million over India has discussed issues such as prevention seven years. Many issues have to be decided, versus treatment in health in areas with the e.g. policy development and priority setting, greatest need, working in areas with the analysis of markets, target product profi les, highest likelihood of success, and devices cost of goods, formulation and delivery.

control malaria were not harmonized and were duplicative. It aimed to reduce poverty and enhance development.

Many lessons were learnt from the global effort at eradication in the 1950s. An intervention rolled out globally could work; people are passive recipients but could be more active; and public–private partnerships could be used to deliver care particularly to remote and hard to reach populations.

Thus, RBM was launched with WHO, the World Bank and other partners and includes in its Partnership Board: South Asia and Asia Pacifi c malaria endemic countries represented by India and China, Dr Thomas Teuscher explained that a respectively, bilateral donors, foundations, global effort to tackle the problem of NGOs, the private sector, other United malaria led to the Roll Back Malaria (RBM) Nations organizations, the research and initiative in 1998. RBM harmonizes development (R&D) industry, academia action in support of the fi ght against and the capacity-building sector. Some new malaria. RBM was launched because players involved in RBM are the Global (1) the Director-General of WHO heard Fund and UNITAID. that it was a common disease clogging up beds, (2) malaria had been identifi ed as a The African Leaders Malaria Alliance major determinant of slow socioeconomic (ALMA) was launched in 2009. It is close development, and (3) donor efforts to to the Offi ce of the UN Secretary-General’s 32 | Conference Report 2011

Special Envoy on Malaria. It seeks to be a resistance. One of the causes of wide-scale high-level problem solver and advocates resistance is the use of monotherapy with for leadership and funding to overcome artemether and substandard medicines. obstacles to achieving the 2010 and 2015 These threaten the positive effects of the goals. It is supportive in reducing taxes fi ght against malaria. ALMA is also trying and tariffs. It supports the RBM effort, to change laws and taxes, and registration which has invested US$ 20 billion over the of drugs to stop single-dose artemether and past ten years in the fi ght against malaria. substandard drugs. This funding might evaporate due to drug

Immunization is one of the most cost- effective ways to improve health in the long term and reduce the burden on already stretched health systems. Expanding and maintaining immunization coverage in developing countries depends on strong partnerships between the private and public sectors. GAVI has a business model to develop innovative ways to increase immunization in developing countries, contributing to reduced child mortality, and helping to achieve MDGs 4 and 5. It has committed US$ 6 billion and has prevented fi ve million deaths by increasing access to immunization in poor countries.

GAVI has four strategic objectives in which the various partners play lead roles: Mr Paul Kelly informed that the Global Alliance for Vaccines and Immunization (1) To accelerate the use of underused and (GAVI), established in 2000, is a creative new vaccines: WHO and UNICEF and effective partnership with UN agencies, help with this by ensuring the governments, the vaccine industry, the Bill availability and use of programmatic and Melinda Gates Foundation and other and epidemiological data. They also philanthropic organizations. Within the past stimulate the demand for vaccines in year, 8.9 million children died of vaccine- countries. preventable diseases before their fi fth birthday, accounting for over 90% of all child deaths. (2) To strengthen the capacity of integrated One quarter of these deaths could have been health systems to deliver immunization prevented by available vaccines. by resolving health system constraints: Partners for Health in South-East Asia | 33

Consistent with the Paris Declaration countries to co-fi nance vaccines, and for Aid Effectiveness, the Alliance works include budgets for vaccines in their with the Global Fund to fi ght AIDS, national plans so that in time they can Tuberculosis and Malaria (Global do without GAVI support. Fund), the World Bank and WHO through countries. (4) To shape vaccines markets: GAVI works with partners to reduce vaccine (3) To increase the predictability of global prices. It works with governments fi nancing and improve the sustainability and UNICEF to develop demand of national fi nancing for immunization: forecasts and engage industry to This includes raising public and private promote competition and ensure an fi nancing, and developing innovative adequate supply of vaccines. GAVI also options to access new and predictable works with civil society to strengthen funding sources. For example, the their capacity to organize and deliver pneumococcal vaccine has been sustainable health immunization available for a long time, but is not services. affordable by developing countries. An initiative is available which further Partnerships are at the centre of the develops vaccines to make them GAVI Alliance Board, which includes affordable by developing countries. representation of all partners. The For the pneumococcal vaccine, which opportunity to achieve MDGs 4 and 5 from is priced at US$ 70 per dose, the cost GAVI’s standpoint is real. The demand per dose in developing countries will from countries is also high, and they realize be US$ 3.50. This initiative makes the importance of vaccines in reducing vaccines available 15–20 years earlier child deaths and contributing to economic than otherwise at a price that countries development. The reality is that more can afford. GAVI also encourages fi nancial resources are needed. 34 | Conference Report 2011

capacity and future productivity. Water, sanitation, education, social protection and agriculture impact on nutrition. The private sector and partnerships can play a role in improving nutrition. At the present rate, none of the countries is likely to achieve MDG 4.

Third, continually identify and respond to leading public health concerns through stronger public health systems and sustained efforts.

Fourth, contain health-care costs and ensure that spending gets value for money. The focus should be on NCDs (which have an increasing health burden), out-of-pocket expenditure, equity, implications of ageing, changing disease patterns and reduced Dr Mariam Claeson clarifi ed that the key household income due to disability and mandate of the World Bank is poverty reduction and economic development. The early mortality. One of the best practices in World Bank engages in the health sector the Region is in Tamil Nadu, where there because of its economic and development is cervical cancer screening, hypertension perspective. Only by building health systems clinics, and community-based risk factor can one have sustainable health development. awareness. This shows that even a poor state What are the imperatives for making a can manage such initiatives. difference to the poor and vulnerable ? Fifth, fi nd ways to pay for health care First, do not let a large number of pregnant without catastrophic spending, including women and children die. Although some risk sharing and pooling, and payment countries may meet the MDGs, there are of incentives to providers, employers substantial differences within countries. and health-care workers. This too can be Some countries may meet this goal without achieved through partnerships. actually decreasing poverty. It also involves reduction in high fertility because this The case of HIV control in India is an affects per capita income, reduces the female example of best practice. India has workforce and reduces the health of women managed to curb the epidemic because and children in the home. of the focus on those most at risk, and by investing in prevention among Second, improve the nutritional status of vulnerable populations. This needed strong children less than two years of age because government leadership, wide partnership, it irreversibly impacts on their learning investment in the most vulnerable sector of Partners for Health in South-East Asia | 35 society where there is much stigma, and a successes in global health include successful strong civil society. partnerships, with clarity on the roles and Partnerships are a means to an end; proven responsibilities.

Discussion points many young women in a hospital • A participant noted the Minister's in India died recently due to concern with access to health care. contaminated IV fl uids. The problem is whether to focus on Conclusions and recommendations the determinants of health or health- care delivery as a way to improve • One quarter of childhood deaths can access to health care. How does one be prevented by the use of available fi nd a balance for this in the context vaccines. of basic health care? • Advocacy and funding are needed • Basic health care means the ability to strengthen immunization to provide clean drinking water. programmes and introduce new and This would prevent many diseases. underutilized vaccines. Easy accessibility to health care is important, i.e. travel short distances • Monotherapy with artemether and to get care. Barefoot doctors/ teachers substandard medicines for malaria should be given training in basic must be avoided to prevent the health care so that when a child goes emergence of drug-resistant strains of to school s/he could be educated on the malaria parasite. the treatment of simple ailments and • The nutritional status of children could then educate her/his parents. below two years must be improved to This would result in avoidance of the ensure that children reach their full current practice of bypassing primary potential and lead productive lives as care facilities to go to tertiary adults. hospitals. If this training could be done by the World Bank and Asian • Reducing maternal mortality and Development Bank, it would reduce high fertility rates will build the the load on bigger hospitals. female workforce and improve the health of women and children. • Drugs should be made cheaper. Fortunately, drugs are cheap in India • Health-care costs must be contained but we have to control spurious and catastrophic expenditure drugs, which can kill. As an example, avoided. 36 | Conference Report 2011

• Best practices in the Region (such • Accessibility to health care must as the case of reduction in the be improved throughout the HIV burden in India) should be Region through the use of replicated. innovative practices such as barefoot doctors. • Challenges such as control of malaria and new and emerging diseases must • Drugs should be made affordable be tackled through partnerships through innovative means and with clear defi nition of the roles and measures enforced to control the responsibilities of partners. production of spurious drugs. Partners for Health in South-East Asia | 37

Plenary V

Partnerships in action: reporting Mr Steven J Kraus, Director, Regional from the fi eld Support Team for Asia and the Pacifi c, Chairs: UNAIDS, Thailand H.E. Professor Dr Syed Modasser Ali, Dr Preethi Wijegoonewardene, Regional Health Adviser to the Prime Minister, President, World Organization of Family Bangladesh Physicians (WONCA) – South Asia, Sri Lanka Ms Tine Staermose, Director, International Labour Organization (ILO), India Mr William Stewart, Senior Health Adviser, Department for International Speakers: Development (DFID), India Mr Ken Earhart, Director, Global Disease Mr Sanjoy Roy, Managing Trustee, Salaam Detection Program, U.S. Centers for Baalak Trust, India Disease Control and Prevention (CDC), India Session Coordinator: Dr Md. Shafi ullah Talukder, Project Ms Nelly Enwerem-Bromson Coordinator, TB Control Programme, Rapporteur: Bangladesh Garment Manufacturers and Exporters Association (BGMEA), Dr Supriya Bezbaruah Bangladesh 38 | Conference Report 2011

In his introductory remarks, the Chair H.E. Professor Dr Syed Modasser Ali said that partnerships in the Region constitute those who have plenty as well as those who have very little. All fi ve fi ngers are not of the same size, but they work as a team.

ILO brings health to the workplace. Many work in the informal sector where working hours are longer and working conditions worse than in the formal sector. Promoting healthy workplaces that do not harm the physical and mental health and fundamental rights of workers is extremely important. A healthy workforce is a productive workforce.

ILO works with the public and private sectors, private organizations, enterprises, and with governments and research institutions in areas such as HIV/AIDS, occupational safety and health, micro health insurance and factory improvement programmes. The Factory Improvement Programme combines workshop training The Co-Chair Ms Tine Staermose with in-factory consultation in Sri Lanka, emphasized that for the International India and Viet Nam, and will soon be Labour Organization (ILO), developing expanded. This helps to improve quality, new partnerships is most important. boosts productivity and improves work Partners for Health in South-East Asia | 39 practices, thereby creating a collaborative health and safety checklist that was available workplace culture. Tailored advice is to a health and safety committee consisting provided to participating enterprises so of workers and managers. They put these that practical improvement can be made procedures on every work fl oor. They to increase overall competitiveness. One looked at the costs of these improvements example is that of a factory in Viet Nam and the required fi nancial resources were with 420 staff, which makes electrical made available. Finally, the company motors. It had many safety hazards, due to the use of paint, infl ammable material, reduced working hours, and therefore workers wearing thin cotton masks exposure to toxic materials, without during painting, and inadequate personal reducing productivity and salaries. The protective equipment. The ILO team made challenge is to introduce such changes in recommendations and prepared a detailed the vast informal sector.

CDC has a Global Disease Detection Program since 2004 whose mission is to build a network through collaboration with ministries of health, multilaterals, and US agencies; establish and connect regional centres; integrate activities such as surveillance, training, pathogen discovery and outbreak response; and strengthen global public health systems. There are currently eight centres and the most mature are in Thailand and Kenya. The most recent are in Bangladesh and India.

The value of global disease detection is health protection for the entire global community. The Global Disease Detection (GDD) network rapidly detects, accurately identifi es and promptly contains emerging Mr Ken Earhart explained that the infectious diseases and bioterrorist threats mandate of the Centers for Disease Control internationally. The focus is on laboratory and Prevention (CDC) is healthier, strengthening and surveillance of emerging safer and more productive lives through diseases. Usually this is done through prevention. strengthening existing surveillance and the public health system within the country. CDC works by forming technical About 40 new pathogens have been partnerships with public health agencies. discovered. Training in epidemiology and 40 | Conference Report 2011 diagnostics helps to ensure a more timely country. Though CDC has many partners and accurate response to threats and such as NGOs and academic organizations, enhanced compliance with the International at the core is the relationship with countries Health Regulations. The future of global and WHO. It bears thinking about whether health security lies with individual NCDs could also be incorporated into the countries and the capacity within each global health platform.

The Bangladesh Garment Manufacturers and Exporters Association (BGMEA) is also a partner in TB control. Youngone, a South Korea-based group, was the fi rst company to provide directly observed treatment, short-course (DOTS) since 2002, as well as diagnosis and management of patients. The NTP provides guidelines, logistics, drugs and training. Youngone provides the manpower. In 2009, an MOU was signed by the BGMEA with the NTP. Individual garment industries provide management support and employees’ time. The Bangladesh Rural Advancement Committee (BRAC) provides technical Dr Md Shafi ullah Talukder informed support. that the National TB Control Programme (NTP) of Bangladesh is a good example of The BMGEA workforce employs 3.6 partnerships for health. The NTP follows a million workers, comprising 80% women, public–private mix (PPM) approach, with who are being empowered and involved a memorandum of understanding (MOU) in decision-making. As a result, the total used to formalize these partnerships. The fertility rate and MMR are decreasing partners collaborating in TB control include and female literacy is increasing. Twelve the government, municipalities, NGOs, health centres have been established, where medical colleges and universities, government medicines are provided free of cost. The and private hospitals, the corporate sector. BMGEA is now poised to establish two Individual health-care providers include 150-bedded hospitals in which all treatment specialist medical practitioners, graduate will be free for garment workers. BMGEA private practitioners, non-graduate private has invited international organizations practitioners, village doctors and community (UNFPA) to partner with it, and welcomes health workers. more partnerships. Partners for Health in South-East Asia | 41

UNAIDS is working in three areas:

1. Revolutionizing HIV prevention: There has been a 20% reduction in new infections in Asia in the past 10 years. However, there is an urgent need to revolutionize HIV prevention as for every person treated, two get new infection. At this rate, one can never win. There is evidence in the Region that three key populations contribute to HIV; these are men who have sex with men (MSM), sex workers and drug addicts. These have to be involved in the partnership. India, Nepal and Thailand have reduced HIV infections by 50% by focusing on these populations. In Asia, 75 million men buy sex from 10 million Mr Steven J Kraus reminded the audience women. These 75 million men are also that 2011 marks 30 years of the AIDS in intimate relationships with 50 million epidemic. The work at UNAIDS will women. These 50 million women be guided by the new UNAIDS strategy must be protected. Thus, these groups 2011–2015, which aims to advance have to be addressed. This can be done global progress in achieving country- either in a legal or illegal environment. set targets for universal access to HIV In 20 countries of Asia, it is illegal for prevention, treatment, care and support, men to have sex with men. Thirty-nine countries regard commercial sex as and to halt and reverse the spread of illegal. Eight countries have the death HIV and contribute to the achievement penalty for people who use drugs. Asia of the MDGs by 2015. UNAIDS has has some of the best examples of harm ten co-sponsors from the UN system. It reduction, needle–syringe exchange and works with governments and civil society opioid substitution therapy. Civil society organizations, key bilaterals (PEPFAR can be of great help. “Nothing about us, and the US government), which brings without us”; if programmes are designed validity, legitimacy, accountability, reality for at-risk populations but not with and credibility to the response. Partnership them, they fail. in the AIDS response and the principle of greater and meaningful involvement 2. Catalysing the next phase of treatment, of people living with HIV/AIDS (GIPA) care and support: Ten years ago, the cost underpin the philosophy and approach of of treatment for AIDS was $10 000 UNAIDS. per year. Today, it costs $116 per year 42 | Conference Report 2011

(99% reduction in price). This has been is a need to improve sexual and achieved by governments and key civil reproductive health and access to society partners. However, this can be treatment. Various surveys in many undone by free trade agreements and countries have shown that the most loss of generics, which are being bought common source of stigma against by big pharmaceuticals. At present, 15 populations most at risk for HIV million people need access to treatment. comes from the health-care sector. The challenge is to energize the next State-sponsored discrimination is round of treatment. greatest for sex workers. Therefore, clear, compassionate and genuine 3. Advancing human rights and gender partnerships with civil society are equality for the HIV response: There needed.

general practice/family medicine at WHO. WONCA advocates for improvements that make a difference to people’s lives at a regional and global level.

In 2009, at the World Health Assembly, adopted a resolution urging countries to invigorate the primary healthcare system. The resolution puts the primary health care workforce, including family doctors, at the centre of every health system. As examples of partnerships that have been working, the South Asia primary care research network trains general practitioners in South Asia to conduct research in primary care. The Member of the Royal College of General Practitioners (MRCGP) international degree is provided to South Asian countries Dr Preethi Wijegoonewardene stated that through collaboration between the Royal the World Organization of Family Doctors College of General Practitioners (RCGP), (WONCA) brings the family doctors of UK and South Asian countries. Yet another the world together (>250 000 doctors in partnership is that between the Post 116 nations). It advocates and supports, Graduate Institute of Medicine, Sri Lanka through its member organizations, the and the Indian Medical Association. These highest standards of clinical care, education, partnerships will elevate the quality of training and research, and represents family medicine. Partners for Health in South-East Asia | 43

on how comprehensive community-based approaches can improve health outcomes. Traditionally, programmes in DFID have been in vertical streams. At present, these are more from the perspective of the life cycle, especially of young women and girls, to deliver comprehensive services.

In the area of sanitation, DFID does not supply the hardware, e.g. building toilets. Its work involves meeting community demands and supporting communities to understand the linkages between poor sanitation and diahorreal and other diseases. Supporting communities not tolerate open defecation and other practices which impact on their health. India has the largest nutrition programme in the world, but the Mr William Stewart highlighted three delivery is poor, and the biggest gap is a exciting partnerships in which the nutrition strategy for those below the age of Department for International Development, two years, and teaching better infant- and UK (DFID) is involved in “to improve the child-feeding practices to women. health and nutritional status of the poorest and excluded in DFID partner states”. It In India, public health-care services are works with state governments in India to of poor quality so people go to private improve health, nutrition, and physicians, driving up the cost of health care. water and sanitation services, thereby There is little accountability of these services reducing maternal and child deaths, to the community. DFID therefore works undernutrition and unwanted pregnancies. with self-help groups, women’s groups and This is the fi rst time DFID has put water other community organizations to ensure an and sanitation into its health programme. increase in the quantity and quality of supply The second Partnership, which will deliver and demand for essential services, through this platform, is built around community increased use of essential health, nutrition, engagement; empowering communities and and water and sanitation services. working with community organizations to better hold public sector services to account. Evidence in India and globally shows how community approaches can improve The third partnership that is not yet fully maternal and newborn health. Communities functional is the one around the evidence must be mobilized to demand better services for these approaches and the need to and improve their outcomes. DFID is continue to build upon an evidence base building partnerships to further that. 44 | Conference Report 2011

money primarily by selling themselves to international tourists. The Trust then met each hotel owner in the area, telling them to ask questions if a tourist came in with a child, and if the child was molested in that hotel, the police would be called in. It worked; hotel owners cooperated and a partnership was formed.

Next, an HIV testing unit was set up in Safdarjung hospital for these children as they were at high risk for HIV infection. To bring about any kind of change, it was necessary to bring about psychological change in the child. Therefore, a child psychiatrist from Newcastle was called to look at the mental health of the children, and now there is a full-scale mental health scheme. Over the Mr Sanjoy Roy explained that the Salaam past three years, about 9000 children have Baalak Trust started working with street been examined and treated. Fifty-three children 22 years ago. It was a bitter cold children were diagnosed with TB, of whom winter so blankets were distributed to six have died. Several have been treated for children at the railway station. The children scabies, STIs, malnutrition, a few for HIV said they did not need these because if they and many other ailments. used the blankets, someone would molest them. They would rather stuff newspapers The NGO sector is very guarded, and down their chests. The next day, they were should be more transparent, while given sweaters. They said they had no place governments tend to get lost in the to wash or store a second set of clothes. bureaucracy. United Nations and bilateral The Trust then realized that what was organizations need to leverage their needed was not just education but a whole goodwill to bring about dialogue and array of facilities – nutrition, health and change. People should be empowered to mental health. Apart from selling things demand good health. Empowerment is the at the railway station, these children made key to success. Partners for Health in South-East Asia | 45

Discussion points strengthened, especially in developing • This session discussed different countries. kinds of partnerships with different • Nutrition strategies should be kinds of communities: from the formulated for children less than two corporate sector to sex workers to years of age. the role of family doctors. • Laws and regulations that prevent most-at-risk populations from Conclusions and accessing services for HIV infection recommendations must be revised, and a supportive, • Communities must be mobilized to non-stigmatizing environment demand better services and improve provided. their outcomes. • Harm reduction approaches have • The corporate sector can be a useful been shown to be successful at partner in controlling tuberculosis, controlling drug use and reducing HIV and other diseases. the spread of HIV. Best practices in • Public health, particularly the Region should be replicated for preventive health care, should be the prevention and control of HIV. 46 | Conference Report 2011

Best practices: parallel session I

Addressing child and maternal Panelists: mortality H.E. Ms Madalena F.M. Hanjam Moderator: C. Soares, Vice-Minister of Health, Dr Quazi Monirul Islam, Director, Family Timor-Leste Health and Research, WHO South-East Ms Nobuko Horibe, Regional Director, Asia Region United Nations Population Fund (UNFPA), Thailand Speaker: Dr Harshalal R. Seneviratne, Dean and Dr Vinod Paul, Vice-Chair, Partnership for Senior Professor, Faculty of Medicine, Maternal, Newborn and Child health, and University of Colombo, Sri Lanka Head, Department of Paediatrics, All India Institute of Medical Sciences, India Mr Ashok Alexander, Director, Bill and Best practices for addressing child and Melinda Gates Foundation, India maternal mortality: the hype, the reality and Session Coordinator: the hope Dr Neena Raina Rapporteurs: Dr Narimah Awin/Dr Rajesh Mehta Partners for Health in South-East Asia | 47

Discussion points • Need for the application of “business • Countries, as exemplifi ed by Timor- principles” in efforts to scale up Leste, expect a coordinated approach interventions. to external aid and technical support Conclusions and recommendations from agencies and donors. In Timor-Leste, the contribution of the • Different stakeholders such as government, community and private sector is less than 1%, so the religious organizations, UN agencies, government plays a major role in private sector and academia can coordination. play a signifi cant role in reducing • Governments and policy-makers child and maternal mortality in the need to further engage scientists South-East Asia Region through a in their programmes, who can coordinated approach that addresses provide technical advice as well as several areas of concern. introduction/use of tools. • Stakeholders can forge stronger • Delays in deciding to seek care can be partnerships that also need to be reduced by improving women’s status made sustainable. and empowering them, so that they • Best practices such as the Janani can make informed decisions. Suraksha Yojna in India (in which • The common perception is that demand-side fi nancing through the private sector needs to practise conditional cash transfers has shown corporate social responsibility (CSR); a signifi cant increase in the use of however, partnerships would be more services, and a decline in maternal effective if the needs and aspirations mortality) could be replicated in the Region. of both sides are considered. • For partnerships to be sustained, • Greater advocacy is needed for reproductive health, particularly with there is a need to look at a systematic parliamentarians and the media. approach. This means obtaining a “win–win” formula; each partner • Role of the family and the needs to know the components that community needs to be strengthened, are to be delivered/adhered to by to ensure effective interaction the other partner, and trust among between the communities and the partners must be built. health system. 48 | Conference Report 2011

Best practices: parallel session II

Ensuring universal access to health Dr Dirgh Singh Bam, President, Dirgh- services Jeevan Clinic, Nepal Chairs: Community based TB control: lessons learnt from Nepal H.E. Mr Rui Manuel Hanjam, Vice-Minister of Finance, Timor-Leste Dr Viroj Tangcharoensathien, Director, International Health Policy Programme, Dr Ascobat Gani, Health Economist and Ministry of Public Health, Thailand Former Dean, School of Public Health, University of Indonesia, Indonesia Reaching universal coverage in Thailand: what strategic approaches? Speakers: Session Coordinators: Dr T. Ravindra C. Ruberu, Secretary, Dr Ilsa Nelwan and Dr Iyanthi Ministry of Health, Sri Lanka Abeyewickreme Achieving universal coverage in a free health environment: the Sri Lankan scenario Rapporteur: Dr Soe Aung, Programme Adviser/ Director, Dr Leonard Ortega Myanmar Medical Association, Myanmar Community participation in scaling up malaria control Partners for Health in South-East Asia | 49

Discussion points Conclusions and recommendations • Health-care financing is key to • A balance needs to be achieved universal coverage. Even where between government-pooled funds universal coverage1 has been and private insurance schemes. achieved, there may be a shortage A shift toward community-based of services. Out-of-pocket • rather than institution-based human payments remain high. Broadening resources for health would include the tax base and reducing indirect recruiting a health workforce from taxation are important. among teachers, members of religious • There is a need for greater effi ciency, groups and organizations, and other development of master plans, community stakeholder groups. increased accountability and Operational research as well as transparency, and modernization of • laboratory coverage needs to be the health services. strengthened. • Vertical programmes with Prevention of road traffi c accidents a horizontal approach to • and NCDs must be put on the implementation help improve the national health agenda. coverage of interventions. • Countries of the Region need to • To sustain universal coverage, curative seriously address the problems of spending has to be stabilized and alcohol and tobacco, which are should be balanced with public health responsible for a major share of the interventions. This is more cost NCD burden. effective for improving population health, particularly in view of ageing • Educational and health initiatives go populations and the burden of hand in hand; in particular, education NCDs. for women should be targeted as a key factor for the improvement of health outcomes.

1 Universal access to health services implies how much of a population can reach health services. Universal coverage is the output related to utilization and acceptability. 50 | Conference Report 2011

Best practices: parallel session III

Revitalizing primary health care – Mr Alok Mukhopadhyay, Chief Executive, addressing health inequities Voluntary Health Association of India, India Chairs: Community empowerment: means for reducing equity gaps Dr Gado Tshering, Secretary, Ministry of Health, Bhutan Dr Dharma S. Manandhar, President, Mother and Infant Research Activities Dr Amorn Nondasuta, Chairman, The (MIRA) and Head, Department of Foundation for Quality of Life, Thailand Paediatrics, Kathmandu Medical College, Speakers: Nepal Dr Budihardja Singgih, Directorate Community mobilization and community- based health workforce can make a General for Nutrition and Maternal difference and Child Health, Ministry of Health, Indonesia Session Coordinator: Decentralization of health care: can it Dr Sudhansh Malhotra address health inequities? Rapporteur: Dr Boosaba Sanguanprasit Partners for Health in South-East Asia | 51

Discussion points can help in reaching vulnerable and • Decentralization of health care can hard-to-reach populations, as has been address health inequities. It is a shown in Nepal. desirable process for improving health Conclusions and recommendations systems, and should be an integral part of broader health reforms to • The success of decentralization is achieve improved equity, effi ciency, dependent upon achieving good quality and fi nancial soundness. governance, productive partnerships at all levels of the community, • The essence of decentralization is implementation of a comprehensive distribution of authority and resources. approach to pro-poor growth, • To revitalize PHC, the key is the improving public services, improving community itself. coordination among stakeholders, and • Countries should “bootstrap” health addressing the social determinants of programmes to a higher level of health. effectiveness by analysing existing • Health should be viewed as an programmes, and upgrading and investment and not an expenditure. reorienting them. • The role of medical colleges is vital, • The South-East Asia Primary Health as they are the “think tanks” and help Care Innovations Network (SEAPIN) was established in August 2010 to in researching problems. Involving strengthen health systems in the politicians is also important as they Region through the PHC approach. play a central role in health. Innovative approaches are already • Market mechanisms have to be in existence; they only need to be considered in this era of globalization. identifi ed. Health should not be put in the • Implementation of demand-side marketplace as the ethics of health will policies and community mobilization suffer. 52 | Conference Report 2011

Best practices: parallel session IV

Integrated approach to prevention Dr Neelamani Rajapaksa Hewageegana, and control of noncommunicable Provincial Director of Health Services, diseases UVA, Sri Lanka Chairs: Package of Essential Noncommunicable (PEN) Disease interventions for primary Dr Sudha Sharma, Secretary, Ministry of health care in low-resource settings, Health and Population, Nepal Sri Lanka Professor Tint Swe Latt, Rector, University Dr Prakit Vathesatogkit, Executive of Medicine (2), Myanmar Secretary, Action on Smoking and Health Speakers: Foundation, Thailand Dr Mahesh K. Maskey, Chair, Nepal Public Using innovation in tobacco taxation in Health Foundation, Nepal promoting health, Thailand Status of Noncommunicable Diseases in Session Coordinator: South-East Asia and the role of civil society Dr Renu Garg in its prevention and control, Nepal Rapporteur: Dr Nyo Nyo Kyaing Partners for Health in South-East Asia | 53

Discussion points systems, the control of NCDs should • It is important to work with industry be “piggy-backed” onto existing to further the principle of healthy systems. public policies. The tobacco and • The Package of Essential NCD alcohol industry should not be (PEN) interventions has been involved as health partners. implemented in Sri Lanka and could • The media are experts in be duplicated in other countries. communicating with the public, and should be involved in spreading • Civil society has played a very health messages. important role in changing sexual and drug-use behaviour for the • Civil society’s intervention in control of HIV/AIDS; similar containing the NCD epidemic is measures should be applied for NCD vital to effectively tackle the twin risk factors. challenges of NCD prevention and control – changing human behaviour • Prevention and control of NCDs and creating the right physical and should be integrated into existing social environment. health programmes such as school health programmes. • NCDs need to be demystifi ed. Awareness of the risk factors for • Incentives may need to be given NCDs should be raised among the to health workers in remote and community. diffi cult areas.

• The exclusion of NCDs from the • The Framework Convention MDGs is a strong reason for the on Tobacco Control must be weak political commitment and implemented more strongly. defi ciency in funding. • Innovative approaches to tobacco • The Regional Framework on taxation can help in promoting Prevention and Control of NCDs health, as seen in Thailand. should be translated into local languages and widely utilized. Civil • Member States should explore society can play an important role in alternative fi nancing for health each step of the Regional Framework. promotion with a focus on Conclusions and recommendations prevention and control of NCDs. • Expertise, experience and systems are • NCDs should be included in the in place. Instead of creating parallel MDGs. 54 | Conference Report 2011

Best practices: parallel session V

Health for the urban poor – Dr M.H. Basyir Ahmad Syawie, Mayor of the way forward Pekalongan, Indonesia Chairs: City without slums through community- based poverty eradication programme Mr Keshav Desiraju, Additional Secretary, Ministry of Health and Family Welfare, Dr Siddharth Agarwal, Executive Director, India Urban Health Resource Centre, India Dr Genevieve Begkoyian, Regional Health Improving health of the urban poor: experiences from the fi eld and lessons Advisor, Young Child Survival, United learned Nations Children’s Fund (UNICEF), Nepal Session Coordinator: Speakers: Dr Sudhansh Malhotra Dr Abdul Sattar Yoosuf, Assistant Regional Director, WHO South-East Asia Region Rapporteur: Health for the urban poor in the 21st Dr Suvajee Good century: challenges and opportunities Partners for Health in South-East Asia | 55

Discussion points of expertise, information technology • The urban poor constitute the most and funding. rapidly developing segment of the • Many urban poverty clusters are not population in developing countries listed; health vulnerability in these and face demographic, environmental areas is greater than in listed clusters. and health challenges. This inhibits their ability to be active, productive and prosperous members of • To engage people to move out of society. slums, the main challenge is funding and empowerment. Conclusions and recommendations • Spatial mapping should be done to To eradicate slums, • include poverty clusters that are not listed. institutionalization is required at various levels, such as the city, • Urban slum guidelines should be subdistrict and hamlet levels. created and bodies formed with the responsibility to look after various • Urban health is not only about health areas. services but also improvement of infrastructure. • The community should be empowered to identify their needs and a budget • Active partnerships with the provided to them. community and empowerment • A public–private partnership approach can help in identifying those can be used to address health needs in communities which are most in need. urban slums. • Opportunities include democratic • Urban poor communities can act as systems, decentralization, availability active agents of change. 56 | Conference Report 2011

Best practices: parallel session VI

Protecting health from climate Dr Sharad Onta, Professor, Department of change Community Medicine and Family Health, Chair: Tribhuvan University, Nepal Climate change, vulnerability assessment: Mr Young Woo Park, Regional Director experiences from Nepal and Representative for Asia and the Pacifi c, United Nations Environment Programme Mr Yeshey Penjor, Climate Change Policy (UNEP), Thailand Specialist, United Nations Development Programme (UNDP), Bhutan Panelists: Climate change and human health: Dr Iqbal Kabir, Coordinator, Climate adaptation in Bhutan Change & Health Promotion Unit, Ministry of Health and Family Welfare, Dr Bindeshwar Pathak, Founder, Sulabh Bangladesh International Social Service Organisation, Experiences and initiatives to protect human India health from climate change in Bangladesh Impact of climate change on sanitation and health and how Sulabh International has Ms Mabel Rebello, Member of Parliament contributed in addressing the issue, India and Member of Standing Committee of Indian Association of Parliamentarians on Session Coordinator: Population and Development (IAPPD), Ms Payden India Rapporteur: Community-level initiatives to protect human health from climate change Dr Zakir Hussain Partners for Health in South-East Asia | 57

Discussion points document. Nepal has used the • Basic necessities such as food, guidelines to assess the vulnerability drinking water, sanitation and shelter of the health sector to climate change are the fi rst services that are hit by extreme weather events caused by • Sulabh International has provided climate change, and these have a toilet services and has also developed direct impact on health. fi ve new technologies that are water effi cient and environment friendly. Community participation is • It aims to collaborate with the important for addressing the effects Government of India to provide of climate change. toilets to all by 2015. • The Asian Development Bank (ADB) has undertaken a project to address Conclusions and recommendations the impacts on health in other sector • Partnership was identifi ed as one of activities such as water, sanitation the solutions to some of our present- and agriculture. It tries to convince day climate-engendered problems. governments to allocate funds People in need should be prioritized, for health through a cost–benefi t with special attention to women and analysis. children. • Several factors other than climate • More evidence needs to be created change have an impact on health, in the health sector for convincing such as country policies and health ministries of fi nance and donors to systems. These should be considered allocate funds to combat climate while carrying out research to change-related problems. understand the impacts of climate • Co-benefi ts need to be gauged change on human health. through working with other sectors. • WHO is preparing a health • Renewable energy sources need to be vulnerability assessment guidance piloted and scaled up. 58 | Conference Report 2011

Best practices: parallel session VII

Public–private partnerships in health Mrs Penny Grewal Daumerie, Director, Chairs: Global Access, Medicines for Malaria Venture (MMV), Switzerland Mr Prasanna Kumar Pradhan, Special Secretary, Ministry of Health and Family The power of partnerships: accelerating the Welfare, India development and delivery of much-needed medicines Dr Narottam Puri, Advisor, Health Services Committee at The Federation of Indian Dr Harinder S. Sikka, Director, Corporate Chambers of Commerce and Industry, Affairs, Piramal Healthcare Limited, India India and President – Medical Strategy & Discussion on public–private partnerships in Quality at Fortis Healthcare Limited, India health Speaker: Professor S.P. Thyagarajan, Pro-Chancellor Mr Anil Swarup, Director General for (Research), Sri Ramachandra University, Labour Welfare and Joint Secretary, India Ministry of Labour and Employment, India Research partnerships in health …..a journey called Rashtriya Swasthya Bima Yojana Session Coordinator: Dr Manisha Shridhar Panelists: Dr Akram Ali Eltom, Director, Partnerships Rapporteur: Unit, The Global Fund to Fight AIDS, Mr Gautam Basu Tuberculosis and Malaria, Switzerland Country-level opportunities and challenges in public–private partnerships for health Partners for Health in South-East Asia | 59

Discussion points Conclusions and recommendations • Public–private partnerships can be • A quality check of the health used to cover below poverty line insurance scheme of the Rashtriya (BPL) families with health insurance Swasthya Bima Yojana run by the (though smart cards/electronic Ministry of Labour, Government systems). Families can make a choice of India needs to be enforced. The from select private hospitals in the manner of ensuring such quality health insurance scheme of Rashtriya checks is under development by the Swasthya Bima Yojana by the Ministry Ministry of Labour. of Labour, Government of India. • Private sector involvement needs • Private sector enterprises should to be in place for the Emergency be encouraged to create supportive Management Research Institute workplaces for HIV, TB and malaria (EMRI) and Health Management and prevention/treatment/care, preferably Research Institute (HMRI). within broader occupational health measures for workers and their • Effective communication with the private sector is needed on families. the advantages of investing in the • Innovative public–private partnerships health of the workforce. A healthy, are critical for service delivery of robust workforce would contribute health, product development, fulfi lling to a profi table private sector and corporate social responsibilities and productive individuals; hence, public– private partnerships for health should research with academia. be a priority for the private sector. • Public–private partnerships should • Reducing out-of-pocket expenses also take an active role in preventive through risk pooling can be done by health care as this will improve offering direct private insurance or performance of the workforce. participating in joint government/ employer national insurance and/or • The government should encourage community-based insurance schemes partnerships for health research for individuals/communities affected in order to scale up discovery by HIV, tuberculosis and malaria. and development of new medical products. • There is a need for accelerating the development and delivery of much- • Public–private partnerships in medical needed medicines through the power technology need to be formed in of partnerships. order to adopt/adapt technologies • Ethical challenges in public–private appropriate for countries of the partnerships must be addressed. Region. 60 | Conference Report 2011

Best practices: parallel session VIII

Financing for universal coverage Dr Hasbullah Thabrany, President South- Chairs: East Asia Public Health Education Institutes Network (SEAPHEIN) & Former Dean, H.E. Mr Ahmed Asad, State Minister of School of Public Health, University of Finance and Treasury, Maldives Indonesia, Indonesia Dr David Evans, Director, Health Public fi nancing – private delivery to Systems Financing, WHO Headquarters, strengthen health systems Switzerland Dr Phusit Prakongsai, Director, The global situation: health systems fi nancing: the path to universal coverage International Health Policy Program, Ministry of Public Health, Thailand Speakers: Financing for universal coverage: Professor Indrani Gupta, Professor and experiences from Thailand Head of Health Policy Research Unit, Session Coordinator: Institute of Economic Growth, India Dr Sunil Senanayake Universal health coverage: options for South-East Asia Region Rapporteur: Dr Kathleen Holloway Partners for Health in South-East Asia | 61

Discussion points preventive services, and insurance • To attain universal coverage, there is does not cover these. There is a a need to raise funds, reduce risk and need to include prevention and improve effi ciencies. Low-income promotion, which may need a countries may fi nd this diffi cult. The different fi nancing mechanism global community and international from insurance. However, even agencies can be of help. private insurance is now giving risk reduction premiums for people • For universal coverage to be who do some preventive activities. attained, there needs to be political This can also cover screening tests/ commitment, a legal framework, activities under insurance for older greater democracy and creation of a age groups. fi scal space. • Social insurance protects from • The private sector can play a role as social disasters, not natural ones. there is a shortage of skills. However, Catastrophic and out-of-pocket the private sector should be regulated expenditure need to be monitored. and the public sector involved more than the private sector. Conclusions and recommendations • Financing mechanisms should • Some resources should be kept aside be mixed and the poor should be for emergencies. All public health targeted. money should not be used for fi nancing universal coverage. • Chronic diseases and ageing are a major challenge. It will take time • WHO and the international to reach universal coverage of community can advocate for public NCDs. There are three dimensions fi nancing with governments and – the percentage of the population stimulate them to spend more on covered, what services are covered, health. and the percentage of costs covered. • Agreement on and understanding Financing these is a challenge. A of universal coverage is limited. mix of services is needed; preventive Data should be collected to fi ll the actions as well as treatment. information gaps in order to facilitate • Unfortunately, the focus is always public fi nancing for universal on curative services and not on coverage. 62 | Conference Report 2011

Best practices: parallel session IX

Opening new frontiers and Dr Alvaro Matida, Adviser, FIOCRUZ innovative opportunities for Center for Global Health, The Oswaldo collaboration in the health sector: Cruz Foundation, Brazil South–South and beyond Dr Mmathari Kelebogile Mastau, Deputy Chairs: Director-General, Strategic Health Dr Marie-Andree Romisch-Diouf, Programme, Department of Health, Director, Country Cooperation, WHO Government of South Africa Headquarters, Switzerland Dr Antonio Duran, Coordinator, Dr Nata Menabde, WHO Representative, International Health Policy, Andalusian India School of Public Health, Spain Speakers: Session Coordinators: Dr Biswajit Dhar, Director-General, Dr Nata Menabde and Mr Sunil Nandraj Research and Information System for Rapporteur: Developing Countries (RIS), Ministry of Ms Anagha Khot External Affairs, India Dr K.M. Gopa Kumar, Legal Advisor, Third World Network, India Partners for Health in South-East Asia | 63

Discussion points • Partnerships help in technology • South–South Cooperation is an transfer, vaccine development, innovative mechanism based on e-health initiatives, training for equal partnerships and the principles human resources, research and of solidarity, mutual benefi t, capacity medical care, and strengthening building and technological transfer, health systems. with a focus on equity in health within and between countries. • In forming partnerships, there is a need for a perfect fi t, so that both • South–South Cooperation does not parties benefi t from each other. There adopt the traditional “assistance should be a give and take between mode” but is based on developing all those forming a partnership. The effective partnerships that are delicate balance between synergy and evaluated from the recipient’s point individualism should be maintained. of view, applying the principles of the Paris Declaration and the Accra • Multisectoral collaboration should Agenda For Action. not promote health at the cost of other sectors. • Several successful initiatives are under way under the South–South • Partnerships should be sensitive to Cooperation and Triangular the global economic climate, even if Cooperation, and several of these they are not dependent on external involve the BRICS (Brazil, Russia, funding. India, China and South Africa), other emerging economies as well as • Countries such as India have other developing countries in Latin established pharmaceutical America, Africa and South-East Asia. manufacturing plants in some African countries as joint ventures. • South–South Cooperation To move to the next step, new is primarily concerned with products and technologies in health international negotiations in the should be introduced. area of trade and health but is not adequately translated into action. Conclusions and recommendations • Partnerships are required because • South–South Cooperation is new and they transform the imbalance in should be explored further. There is collaboration between the North and huge scope for learning from each South and aim for social equity. other. 64 | Conference Report 2011

• The role of South–South is to ensure that this growth is Cooperation and BRICS is harnessed to address the existing acknowledged, especially in the health sector challenges and translates changing landscape of global into better health for the people. governance and rapid economic • An operational framework is needed growth in several developing for implementing South–South countries. Cooperation such as the New • Mechanisms such as South–South Partnership for Africa’s Development Cooperation and Triangular (NEPAD). Cooperation can play a role in • Partners in health should assist in shaping and infl uencing the new mapping/documenting successful world order according to the examples of South–South principles of mutuality, equity, Cooperation across regions. transparency and sustainability. • The South–South Cooperation in • Initiatives for cooperation in the health should focus on ensuring health sector are modest. This is equitable access to pharmaceuticals, recognized as a nascent area of work building country capacity to produce where concerted action needs to be low-cost quality drugs and vaccines, taken. transferring appropriate technologies • There is need for a renewed focus on among countries with similar implementation, based on learning contexts, health innovation, use of from good practices and success information technology especially stories. for telemedicine, training of human resources, research and medical care. • While there has been unprecedented economic growth in several • All opportunities have to be seized to developing countries, the challenge mainstream health in foreign policies. Partners for Health in South-East Asia | 65

Parallel session X

Perspectives and roles of Dr Jingjai Hanchanlash, Advisor to stakeholders in health development Executive Board & Former Board Member in the Region and Co-Chairman, The Thai-EU Business Council, Thailand 1. Private sector/Foundations Perspectives and roles of private Chairs: sector stakeholders in health Dr Ranjit Roy Chaudhury, Chairman, development in the Region Task Force for Research, Apollo Hospitals Dr Vikram Sheel Kumar, Co-Founder and Educational and Research Foundation, Chief Medical Offi cer, Dimagi Inc., India India Overview of mobile applications (for health) Mr Sushanta Sen, Principal Advisor to the Confederation of Indian Industry (CII), Ms Indrani Kar, Senior Director & Head – India Development Initiatives, Confederation of Indian Industry (CII), India Panelists: Role of private sector and partnerships Ms Sinta Kaniawati Munir, General Manager, Unilever Indonesia Foundation, Session Coordinator: Indonesia Dr Roderico Ofrin Corporate social responsibility: Rapporteur: empowering the community through public health education program Dr Sara Varughese 66 | Conference Report 2011

Discussion points information. The private and • Public–private partnerships should public health sectors need to share aim at empowering and engaging information in order to properly communities. The community is a intervene in communities – from partner in delivering interventions conceptualization of initiatives to such as spreading health messages monitoring and evaluation. and monitoring the progress of • Technology can provide solutions but interventions. A service provision these should be well thought out. It is model should not be applied. important not to automate idealized • Education and behaviour change systems – actual intervention in the remains the best intervention to fi eld is what is more relevant. prevent disease and, in communities, • There are innovative ways for the this can be done successfully only if private sector/industry to be involved they are involved. These initiatives in public health: – Advocacy and should be in synergy with those of awareness in the workplace and the the government. community in areas such as HIV • There is a need to think beyond and TB – Capacity development the usual ways of working with the of workers, civil society and private sector in partnerships for health service providers – Taking health, especially in the following: interventions beyond awareness governance of public health; and the workplace – Private–private building the capacity of civil society; partnerships to support health innovative schemes for managing and health-related needs in health and social insurance; and villages – Knowledge creation and maintaining standards of quality of dissemination of good practices – the health services. Involvement of the private sector in national health commissions, health • Corporate social responsibility authorities or legislation/policy programmes are not about donations development. to hospitals; these schemes should be well thought out as per the • Mutual benefi ts or co-benefi ts should priorities and needs of populations/ be identifi ed/described together by communities, keeping sustainability the private and public sectors so that in mind. partnerships can be sustained. • Partnerships that are sustainable • There is a need to massively scale begin with sharing the most up these private sector models and important resource, which is interventions to make a meaningful Partners for Health in South-East Asia | 67

difference, and this can be done by • Best practices need to be documented working together. Clear roles and and disseminated so that good work responsibilities are necessary so that can be communicated and replicated. every sector can maximize their comparative advantage. • Some models can be institutionalized and mechanisms/working groups/ Conclusions and recommendations follow-up workshops can be • Technology for health needs to be organized so that these discussions brought to users at the grass-roots. are taken forward. 68 | Conference Report 2011

Parallel session X

Perspectives and roles of Dr Vinya S. Ariyaratne, General Secretary, stakeholders in health development Sarvodaya Shramadana Movement, in the Region Sri Lanka Building sustainable civil society 2. NGOs and civil society partnerships for health: challenges and Chair: Mr Azmat Ulla, Head of Regional responses Offi ce, International Federation of Red Dr Mirai Chatterjee, Programme Cross and Red Crescent Societies, India Coordinator, SEWA Social Security, India Speakers: Health action through membership-based Dr Md Akramul Islam, Programme organizations (MBOs) of women: some experiences of the Self-Employed Women’s Head, Health Programme, Bangladesh Association (SEWA), India Rural Advancement Committee (BRAC), Bangladesh (read by Dr Khurshid Alam Session Coordinator: Hyder, WHO SEARO) Dr AP Dash Role of NGOs in health: experience in tuberculosis control in Bangladesh Rapporteur: Dr Khurshid Alam Hyder Partners for Health in South-East Asia | 69

Discussion points needed for the poor to improve the • Focusing primarily on disadvantaged social determinants of health across the groups often inadequately addressed life cycle in the Region. by the government, civil society • Bangladesh is a unique example of organizations have, over the years, government–NGO partnership in played an important role in addressing implementing TB control and working the health needs of the poorer segments on other health-related issues. The key of the population in the Region. areas are participatory planning and joint • While some NGOs in the Region have review, resource mobilization, health been and continue to provide “services” systems strengthening and capacity in the health sector, others such as the building, and advocacy, communication Sarvodaya Shramadana Movement in and social mobilization. Sri Lanka have been working on the • Partnerships enhance performance and “determinants” of ill-health. It believes capacity for rational use of resources, in an integrated approach to health. At provide a platform for civil society, various stages of its evolution, Sarvodaya coordination and oversight strengthened has established partnerships with by joint meetings and fi eld visits, and community organizations, government confl ict resolution and trust building agencies, the private sector, UN through regular communication. agencies and international development organizations. Conclusions and recommendations • Effective partnership-building requires • Current and emerging health challenges sharing a common vision, mutual cannot be addressed by the State and understanding between partners, respect private sectors alone. Better recognition for organizational mandates, and and responsibility should be given to recognizing each others’ strengths and credible organizations. Mechanisms limitations. should be created for better cooperation • Bureaucratic attitudes, procedural and collaboration (from policy level constraints, confl icting interests on down to implementation). issues such as procurement, payments • The voluntary sector should continue for services, etc. often result in serious to improve their accountability and problems that inhibit partnerships. governance. Organizations that work on the determinants of health to address • To strengthen health services, it is inequities are faced with more structural necessary to encourage, enable and issues in building partnerships, recognize the formation of associations, particularly with the State sector. networks of membership-based organizations and NGOs. • Membership-based organizations for self-employed women’s associations • The role of civil society in policy and are key to enhancing bargaining power programme review of the health sector and strength. Partnership alliances are should be strengthened. 70 | Conference Report 2011

Parallel session X

Perspectives and roles of Dr P.B. Jayasundera, Secretary, Ministries stakeholders in health development of Finance and Planning and Economic in the Region Development, Sri Lanka Role of recipient governments 3. Governments Dr Sudha Sharma, Secretary, Ministry of Chair: Health and Population, Nepal H.E. Dr Aminath Jameel, Minister of Health development in Nepal: Government Health and Family Welfare, Maldives of Nepal’s perspectives Panelists: Session Coordinator: Mr Gopal Krishna Menon, Country Dr Jigmi Singay Manager, Australian Agency for International Development (AusAID), India Rapporteur: Role of donor governments Ms Nelly Enwerem-Bromson Partners for Health in South-East Asia | 71

Discussion points Conclusions and recommendations • It is important to strengthen • Despite global commitment to consultative forums between recipient the principles of the Paris Declaration governments and development partners, on Aid Effectiveness, there are gaps as well as reinforce multisectoral in understanding and implementation partnerships at country level to address at country level, particularly in the social needs of the population. terms of donor harmonization and alignment with national development • Aid effectiveness should be assessed in priorities. the attainment of health development outcomes, and ownership of • Greater predictability of funds should development policies and plans by be ensured. recipient countries. • Technical assistance without adequate • Building stronger aid partnerships skills transfer can create dependency. based on aid effectiveness principles is There should be a clear road map for the mutual responsibility of recipient national capacity enhancement. and donor governments. • Increased synergy with and • Key aid effectiveness principles include involvement of civil society and non- national ownership, alignment, State actors needs to be developed. harmonization, management of results Joint planning and monitoring and and accountability. evaluation need to be conducted regularly. • Recipient countries should set clear national development priorities and • The gap between global political have robust health policies and plans commitments and country-level for partners to align with. realities in the area of aid effectiveness should be bridged. Funds should be • Accountability seems to be imposed on pooled, fl exible and not earmarked. recipient governments, but not always followed by donor governments. The • Governments must be innovative in principle of mutual accountability utilizing funds at the country level, for should be kept in mind. example, by scaling up interventions in NCDs with funding from the Global • The sectorwide approach (SWAp) and Fund to fi ght AIDS, TB and Malaria, the example of Nepal’s International by highlighting linkages between Health Partnership (IHP+) were tobacco, cardiovascular diseases, highlighted as models of aid diabetes and TB. Similarly, funding for effectiveness, resulting in improved malaria control can be used to prevent health outcomes, such as a reduction in other vector-borne neglected tropical the MMR. diseases. 72 | Conference Report 2011

Parallel session X

Perspectives and roles of Dr Asheena Khalakdina, Health stakeholders in health development Specialist, United Nations Children’s Fund in the Region (UNICEF), Thailand

4. UN/Intergovernmental organizations Ms Tine Staermose, Director, International Labour Organization (ILO), India Chair: Dr Ram Boojh, Programme Specialist, Ms Caitlin Weisen, Country Director, Ecological & Earth Sciences, United United Nations Development Programme Nations Educational, Scientifi c and (UNDP), India Cultural Organization (UNESCO), India Panelists: Session Coordinator: Dr Nata Menabde, WHO Representative, Dr Narimah Awin India Mr Marc G.L. Derveeuw, Representative Rapporteur: a.i, United Nations Population Fund Dr Prakin Suchaxaya (UNFPA), India Professor Charles Franklin Gilks, Country Coordinator, Joint United Nations Programme on HIV/AIDS (UNAIDS), India Partners for Health in South-East Asia | 73

Discussion points • There is a need to balance the social determinants of health with the • UN agencies and international strengths and potential of the health organizations, having a “bird’s eye system. view” of the situation in countries, are in an opportune position to assist • Adhering to international standards Member States by focusing on major can be a win–win situation for both issues and challenges such as poor enterprises and workers. Workers geographical, social and fi nancial get a healthy workplace, could get access to services; extreme disparities higher wages, face fewer hazards while within countries; weak health systems; enterprises get a healthier workforce poor scaling up of interventions; and higher profi ts. high catastrophic expenditure on health with poor social security; no • Global agencies provide support health and safety net for workers; to countries with bad indicators. environmental pollution from using Support should also be given to cow dung for cooking; and several countries that are doing well. unfi nished agendas such as deaths • In the past four years, UN from pneumonia and diarrhoea. organizations in India are much • Partners also have to use better coordinated, for example, in opportunities such as strong political HIV work or census and gender commitment (e.g. the Janani mainstreaming. However, there are Suraksha Yojna in India), robust areas that need improvement. national plans for the NHRM and the huge pharmaceutical industry in • Support to the government to achieve India, the role of IT in health, and the MDGs will require collaborative the various models for integration and efforts among UN agencies. Both decentralization of services. vertical and lateral approaches are required. Maternal and child health • However, many opportunities can and nutrition are key issues. pose challenges and sometimes do not lead to solutions; for example, • Progress in health is mainly focused the huge pharmaceutical industry in on inputs and not much on outputs India and the IT revolution have not or outcomes. UN agencies are led to equity, and have played no role accountable to assist governments in reducing hunger and malnutrition; in improving on this. With the the high intellectual capital has not information technology that India been able to harness public leadership has, health information, monitoring to allow universal access to safe water and reporting systems can be and sanitation. improved. 74 | Conference Report 2011

Conclusions and recommendations should receive more attention than at present. Advocacy is needed to stop UN agencies can optimize resources • early childbearing. by using each others’ auditing services, offi ces and have common • Joint advocacy from UN agencies initiatives to reduce costs and prevent on health-related issues is important duplication of efforts. to enhance access to affordable and suitable medicines and health care. Private practitioners should be asked • Joint programmes have an impact to prescribe drugs using their non- and need to be planned and executed proprietary names. collectively. • In India, adolescent health, especially sexual and reproductive health, Partners for Health in South-East Asia | 75

Parallel session X

Perspectives and roles of stakeholders Ministry of Health and Family Welfare & in health development in the Region Health Editor, Prothim Alo, Bangladesh Ms Kiran Mehra-Kerpelmen, Director, 5. Media roundtable United Nations Information Centre Chairs: (UNIC), India Dr Shashi Tharoor, Member of Parliament, Ms Paula Alvarado, Regional India, Former UN Under-Secretary- Communications Manager, International General for Communications and Public Federation of Red Cross and Red Crescent Information Societies, India Dr Bindeshwar Pathak, Founder, Sulabh Mr Rajat Ray, Information Focal Point, International Social Service Organisation, UNFPA, India India Ms Sonia Sarkar, Communications Offi cer, Panelists: UNICEF, India Dr Poonam Khetrapal Singh, Deputy Ms Usha Bhasin, Deputy Director-General, Regional Director, WHO South-East Asia Delhi Doordarshan, India Region Ms Abha Bahadur, Senior Vice-President, Ms Damayanti Datta, Deputy Editor, India Sulabh International Social Service Today, India Organisation, India Mr Siddhartha Swaroop, Deputy Country Mr Paresh Tewary, Director, Federation Director, The BBC Trust, India of Indian Chambers of Commerce and Ms Patrlekha Chatterjee, Columnist, The Industry (FICCI), India Lancet, India Ms Vandana Mehra, Communications and Mr Shankar Raghuraman, Associate Editor, Information Offi cer, the World Bank, India The Times of India, India Moderator and Session Coordinator: Ms Arti Dhar, Special Correspondent, Ms Vismita Gupta-Smith The Hindu, India Dr Iqbal Kabir, Coordinator, Climate Rapporteur: Change & Health Promotion Unit, Dr Supriya Bezbaruah 76 | Conference Report 2011

Discussion points to simplify technical messages and • The stage was set with the question make statistics more relatable to the – what would it take for the media common person. to be different and give more space/ • It was felt that public broadcasters coverage to social issues ? Followed often partner better with the UN and by what role the media can play in partners for health by giving more public health. airtime to these issues. The private • It was commented that one’s own news agencies often do not see in- health is always of interest to people. depth health and development stories Once the media believes that, getting as priorities. public health messages out will be • Editors and members of the media easier. strongly recommended “fi eld trips” • It was acknowledged that health organized by agencies to facilitate and development issues get less reporting with human interest stories coverage in the media. While the from the ground. private media is driven by Target Conclusions and ecommendations: Rating Points (TRPs), health and development programming often • Development and health lacks the professional packaging. It is communication needs to be well often perceived as ‘boring’ and not at packaged. par with commercial programmes. • The vernacular media should be • The UN and partner agency engaged and involved to provide a communications experts also wider reach for health messages. expressed that health and • The media should be engaged as development issues need to have a partners and sensitized to relevant human interest angle to make them issues. news worthy. Timely dissemination of public health information to • Public health offi cials should be meet media’s deadlines is also often trained to be better spokespersons a challenge. Partners for health need and work with the media. Partners for Health in South-East Asia | 77

Plenary VI

Refl ections on the roles of Mr Siddhartha Swaroop, Deputy Country stakeholders in health development Director, The BBC Trust, India in the Region Mr Steven J Kraus, Director, Regional Support Team for Asia and the Pacifi c, Chair: UNAIDS, Thailand Mr K Chandramouli, Secretary, Ministry of Dr Akram Ali Eltom, Director, Partnerships Health and Family Welfare, India Unit, The Global Fund to Fight AIDS, Panelists: Tuberculosis and Malaria, Switzerland Dr Budihardja Singgih, Directorate Ms Anuradha Singh, Programme General for Nutrition and Maternal and Coordinator, SEWA Social Security, Child Health, Indonesia India 78 | Conference Report 2011

focusing on primary health care, community empowerment and universal coverage. However, in 2000, most countries did not get even 5% of the gross domestic product (GDP) for the health budget. Thus, selective interventions but with the highest level of care are needed for health development. Even as we move to tackle the challenge of NCDs, health inequities still exist, along with disasters, trauma, mental health, leprosy, maternal and child health and nutrition, among other problems. Climate change and the food and energy crisis also confront the world. The answer is to move ahead in partnership, as no single problem has a single cause. The governments of all countries must Dr Budihardja Singgih recalled the Alma- take the lead. While partnerships already Ata Declaration, wherein governments were exist, coordination, governance, regulation urged to increase fi nancing for public health and stewardship need to be improved.

Can health fi nd its place in a market driven by target rating points (TRPs)? Do facts and fi gures interest the public? News and facts on health should be made interesting and relevant for readers. In India, there is less content and more advertising in the newspapers. Partnerships should be formed with media owners to bring them on board and sensitize them to health issues. Corporate social responsibility within media houses can help in getting free air space for health issues. The vernacular media should be helped to build capacity and be engaged, for example, by taking them on fi eld visits, as they have a wider reach than the English media. Public health Mr Siddhartha Swaroop summarized the experts need regular training to become media roundtable held the day before. better spokespersons and simplify technical Why do health issues fail to capture the issues. Journalists also need training on attention of the media and the public ? health issues. Partners for Health in South-East Asia | 79

to make a difference. Improving health requires more than accepting the status quo. Deliberate, creative acts are needed to change and improve health outcomes.. Over the past few days, there have been many examples of people who are doing just this.

Money spent on health is not an expenditure but an investment in the lives of people. Such investment and political commitment will help in reaching all the MDGs. The systems that are built today are the best investment that can be made for the health of our children and for the future. Mr Steven J. Kraus strongly appreciated the good work done by the WHO Regional Political promises at the global and Offi ce for South-East Asia Region in national levels must be followed through organizing the meeting, where great ideas by providing resources, political space were discussed in an environment of and services to the people. Governments openness and trust, and the Government should be made accountable for their of India for its leadership. Time should promises. Democratization of the health- be taken to refl ect on our successes as well care process and a people-centred approach as our failures and challenges, and think are imperative. If people are mobilized, they about what can be done to improve health can make changes to improve their health. globally. He reminded us of the impressive One should look to the future and decide number of people, many present at the how our objectives can be achieved. We meeting who are actively working together must “be the change we want to see”. 80 | Conference Report 2011

for providing the leadership for public- private partnerships. The Region can become the incubator for such partnerships. Important values and assets from the Region can be harnessed, and concerns shared. Public–private partnerships should be looked for and promoted in various domains and at multiple levels, and is not just a corporate affair. It is imperative that we better understand, learn from the positive practices and reduce the challenges of public-private partnerships. The private sector should be regarded as an ally for improving health, and has been benefi cially engaged in areas such as water and sanitation and Information technology.

Dr Akram Ali Eltom spoke about One of the challenges to public–private partnerships such as the Global Fund, partnerships is managing a balance between STOP TB, RBM, GAVI and others altruism and profi ts. The incentives needed which benefi t from the full potential of by the private sector for optimal engagement public–private partnerships. The South- should be considered by the public sector East Asia Region has signifi cant potential when entering into a partnership.

Ms Anuradha Singh described the role of civil society as an agent of change. Though there are various schemes, these do not have reach and awareness is lacking at the ground level. Civil society can educate the community so that it can benefi t from these. It can build the capacity of participatory committees to increase monitoring and accountability of such schemes. Community monitoring tools such as public dialogue should be developed and put into action. Partners for Health in South-East Asia | 81

challenge to increase fi nancial investment and commitment to health, and improve health indicators. Tackling communicable diseases was a priority in the Region, but now the growing incidence of NCDs has been added to the disease burden. In addition, mental health, neurological disorders and tobacco are other important issues. At the end of the day, health can never be lost sight of as a national priority, as health issues are interlocked with poverty, especially in the South-East Asia Region. These challenges continue to confront governments, communities and individuals. Political will and an adequate share of the Mr Chandramouli summed up the session GDP allocated to health is needed to tackle by describing the roles of stakeholders health problems in the Region. Activities in health development. The Alma-Ata need to be expanded to achieve universal Declaration is one of the best articulations access to health. Communities need to be on health, which subsumes resources and empowered to take care of their own health. other aspects. However, the Region still faces The media is an important ally in ensuring many challenges such as a high IMR, MMR that health messages are disseminated at the and total fertility rate among others. It is a grass-roots. 82 | Conference Report 2011

Discussion points countries but fi ltered to each specifi c • Health professionals, health workers country’s situation. Mathematical and the community must work models and cost–benefi t and cost- together. In times of economic effectiveness analyses are needed to turmoil, health must be the last to make health attractive to politicians be affected. The health workforce, and donors. including hospitals, must be secure and Inequitable development causes many protected. Health professionals must • be united and work as one. problems, such as malnutrition, among others. “Marketization” of • We should learn from the agriculture health should be controlled to make sector, where the farmer takes care of health accessible and affordable. the agriculture. In the case of health, it is largely health professionals and • Health should be looked at in an the family. Communities can take care integrated manner, and should include of their own health and should be social justice, water, sanitation, engaged innovatively as partners. empowerment etc. Why do people lose health? What happens to those • Many participants felt that this was with poor health ? They lose many one of the best and most productive opportunities. Twenty per cent of the meetings they had ever attended. They world’s poor are disabled. The issue proposed that meetings such as this of disability must be confronted, as should be held every two years on a it causes poverty and poor health. regular basis to see whether what is Persons with disability should also be committed today has been put into brought into the mainstream. action. Twenty per cent of the population is • Health is a political and cross-cutting • beyond the reach of health services. A issue, and is beyond the responsibility of only the Ministry of Health. Other way to reach them should be found. ministries should also be involved. For this, large fi nancial resources are Involving the Ministry of Finance not needed; instead, communication, in this meeting is an important step. and education on health and rights are Politicians should be increasingly needed. involved in such meetings so that Conclusions and recommendations they are sensitized to health issues. This will enable them to make better • Countries must allocate a larger share policy decisions, particularly in terms of the GDP to health. Investments of allocation of resources for health. in health and resources must be Lessons should be learnt from other increased. Partners for Health in South-East Asia | 83

• While partnerships already exist, build the capacity of participatory coordination, governance, regulation committees to increase monitoring and stewardship need to be and accountability of such schemes. improved. Community monitoring tools such as public dialogue should be developed • Money spent on health is not and put into action. expenditure but an investment in the lives of people. • Disability issues must be taken on board as a part of health development • Political promises at the global and national levels must be followed concerns. through by providing resources, • Health is a political and cross-cutting political space and services to the issue, and is beyond the responsibility people. of only the Ministry of Health. Other • The incentives needed by the private ministries should also be involved. sector for engagement should be • Politicians should be sensitized to considered by the public sector when health issues so that they are able entering into a partnership. to make adequate policy decisions, • Public–private partnerships should be particularly with regard to the looked for and promoted in various allocation of resources for health. domains and at multiple levels. • Meetings such as this should be held • Civil society can educate the at regular intervals (e.g. every two community about schemes by the years) to check whether what was government for their benefi t. It can proposed has been achieved. 84 | Conference Report 2011

Plenary VII

(Left To Right: Dr Poonam Khetrapal Singh, H.E. Lyonpo Zangley Dukpa And Dr Budihardja Singgih)

Delhi Call for Action on Partnerships Dr Budihardja Singgih, Directorate for Health General for Nutrition and Maternal Chair: and Child Health, Ministry of Health, Indonesia and Chair, Drafting Committee H.E. Lyonpo Zangley Dukpa, Minister of for Delhi Call for Action Health, Bhutan Dr Poonam Khetrapal Singh, Deputy Regional Director, WHO South-East Asia Region Partners for Health in South-East Asia | 85

Adoption of the Delhi Call for Action on Partnerships for Health

Discussion points committee, Dr Budihardjah Singgih. • The drafting committee had After a lively discussion, those prepared a draft of the Delhi Call suggestions that attained consensus for Action, which was read out by were incorporated and the Delhi Call the Chairperson of the drafting for Action was unanimously adopted by the participants. 86 | Conference Report 2011

Delhi Call for Action on promoting laws and policies, a rapidly Partnerships for Health growing and inadequately regulated private sector, occupational health issues, rapid and often unplanned We, the participants in the conference of urbanization, the increasing numbers of Partners for Health in South-East Asia, the elderly, unhealthy lifestyles, and the health consequences of climate change; Recognize that the eleven countries of the WHO South-East Asia Region Are concerned that despite years hold more than a quarter of the world’s of action by a range of partners, population and bear a disproportionate health inequity remains, a signifi cant share of the global disease burden, proportion of the population lacks including a heavy burden of maternal access to quality health care, and the and child mortality and morbidity, Region has the highest out-of-pocket infectious diseases such as malaria, expenditure on health care in the world, tuberculosis, HIV and neglected which contributes to and exacerbates tropical diseases, as well as emergent poverty; threats like SARS and pandemic infl uenza; Consider that rapid economic growth in South-East Asia does not effectively Are concerned that noncommunicable translate into investment for better diseases (NCDs) such as cardiovascular health for all people; diseases, cancer, diabetes, chronic respiratory diseases and conditions like Acknowledge that strong health systems based on the primary health care mental illness, injuries and disabilities, (PHC) approach are the cornerstone which affect the poor as much as of achieving better health outcomes those better off, are placing a further and addressing emerging public health burden on health systems and society, priorities, but that health systems in the and also aware that NCDs account for Region often remain ineffective, too more than half of annual deaths in the focused on curative care, underfunded Region; and fragmented, and are further challenged by diffi culties in training Recognize that both natural and human and retaining health workforce; factors contribute to the Region’s vulnerability, including its susceptibility Believe that health challenges with to natural disasters, rapid demographic social, political and economic and epidemiological transition, limited determinants can only be addressed by and inconsistent political support and a spectrum of partners acting decisively uneven implementation of health- and in concert. Partners for Health in South-East Asia | 87

In cognizance of the foregoing, Resolve to foster South–South we the representatives of national cooperation as an innovative governments, parliamentarians, mechanism for effective cooperation academia, civil society and patients between equal partners, based on the rights groups, NGOs, the private sector, principles of solidarity, mutual benefi t professional organizations, bilateral and equity; and multilateral donors, global health partnerships, development partners, Resolve to collaborate more closely in media and UN organizations: order to align and integrate action, as well as to avoid duplication of effort Rededicate ourselves to achieving better and to fi ll gaps, thereby making more and equitable health for all people of effi cient and effective use of limited the South-East Asia Region, regardless resources in an austere global fi nancial of socioeconomic status, geography, climate; culture, beliefs, gender, sexual orientation, age or disability; Dedicate ourselves to mobilizing resources in a collaborative and Resolve to accelerate our efforts towards coordinated manner to support the achieving key goals and targets outlined development and strengthening of all in the Millennium Development Goals policies that promote health, including (MDGs) in consonance with national national and subnational health development priorities and through policies, and research and evidence for revitalization of primary health care; policy-making; Commit ourselves to capitalize on the momentum generated at global, Commit ourselves to working regional and national levels for collectively to empower our galvanizing action toward prevention, communities so that they can take an care and control of NCDs, as well as active part in health and development; the health effects of climate change; Agree to work together in a spirit of Pledge ourselves to create, revitalize shared effort, responsibility and and sustain partnerships between accountability to meet the existing governments, health and other and emerging health challenges in the sectors, parliamentarians, civil society, South-East Asia Region; nongovernmental organizations, intergovernmental organizations, the Call upon Member States and partners private sector, the media, donors, patients to jointly develop collaborative, rights and other advocacy groups, coordinated and time-bound action academia, global health partnerships, plans to address the commitments development partners, and organizations embodied in this Delhi Call for of the United Nations system; Action. 88 | Conference Report 2011

the rising burden of NCDs, health of the urban poor, climate change and reaching the unreached. What emerged was the interrelatedness of these health challenges. Numerous participants traced the complex relationships between health issues and social and economic determinants of health. Often, improvement in health must come through non-health initiatives. NCDs, for example, can be traced to the use of alcohol and tobacco, unhealthy diets and sedentary lifestyles.

The challenges are immense and complex but not unsolvable, as can be seen from the innovative interventions presented such as using the “sin” tax to fi nance health- promoting initiatives and legislations that Closing remarks enable individuals to make better choices Dr Poonam Khetrapal Singh delivered the for health. closing remarks on behalf of the Regional Director, WHO South-East Asia Region, Revitalization of PHC and universal access Dr Samlee Plianbangchang. She thanked are key strategies for improving health in the participants for their sustained interest the Region. These raise issues of in the meeting. access, affordability, public–private sector cooperation, among others. Designing The meeting provided a unique schemes for sustainable funding for opportunity to bring together partners universal access to health services remains a from various sectors – government, civil key concern. In some countries, the delivery society, international NGOs, donors, UN of health care is largely a State concern, agencies, global health partners, the media while other countries have a large private and the private sector. A number of key sector capacity. No one size fi ts all. Not all themes emerged in terms of challenges the gaps identifi ed relate to lack of funding. and successful strategies and solutions in Some have to do with the way partners the area of health. Partnerships are vital, are engaged, sometimes with the most as no single sector can address health vulnerable groups such as sex workers and problems by itself. The meeting discussed drug users. Greater fl exibility and openness how collaboration could be improved. are needed. Pressing health issues were examined, such as enhancing efforts to reach the MDGs, As partnerships are developed, there must reducing maternal and child mortality, be openness to sectors, organizations and Partners for Health in South-East Asia | 89

individuals with different perspectives and decision- and policy-making was focused on experiences. The media can be a powerful by several participants. tool for advocacy for health promotion. The private sector plays an important At the centre of it all are the people role in health delivery but operates with a themselves. Those who are vulnerable and business logic that needs to be understood at risk are also people who can be tapped for successful collaboration. Knowledge, as partners. The development of the Delhi information and technology are key areas Call for Action is itself a good example of for future development and collaboration. partnership and must be carried forward The need to develop health information through follow-up and continued efforts to systems and improve data and evidence for inspire, innovate and involve. 90 | Conference Report 2011

Annexes

Annex 1: Programme

Annex 2: List of participants

Annex 3: Delhi Call for Action - Drafting Committee

Annex 4: Regional Director’s address

Annex 5: Millennium Development Goals

Annex 6: Fact Sheet – Child and maternal mortality in South-East Asia

Annex 7: Fact Sheet – Millennium Development Goal 6: Fighting HIV/AIDS, Malaria and Tuberculosis in South-East Asia Region

Annex 8: Fact Sheet – Health Systems Strengthening

Annex 9: Fact Sheet – The growing crisis of noncommunicable diseases in the South-East Asia Region Partners for Health in South-East Asia | 91

Annex 1 Programme

Wednesday, 16 March 2011 0800 – 0900 1. Registration 0915 – 1015 2. Opening Ceremony Welcome by Dr Poonam Khetrapal Singh, Deputy Regional Director, WHO South-East Asia Region Address by Mr Kalyan Banerjee, President - Elect, The Rotary Foundation of Rotary International, USA Address by Ms Erin Soto, Minister Counselor for International Development and USAID Mission Director, India Address by Mr Yohei Sasakawa, Chairman, The Nippon Foundation and WHO Goodwill Ambassador for Leprosy Elimination, Japan (read by Ms Chikako Awazu) Address by Dr Analjit Singh, Chairman and Managing Director, Max India Limited, India Address by Dr Samlee Plianbangchang, Regional Director, WHO South-East Asia Region Opening Ceremony Address by H.E. Mr Ghulam Nabi Azad, Union Minister of Health & Family Welfare, India Vote of Thanks by Mr Keshav Desiraju, Additional Secretary, Ministry of Health and Family Welfare, India Master of Ceremony: Ms Vismita Gupta-Smith, Public Information & Advocacy Offi cer, WHO South-East Asia Region Session Coordinator: Ms Nelly Enwerem-Bromson 1015 – 1045 Tea/Coffee

1045 – 1145 3. Special Address Mr Arun Maira, Member of Planning Commission of India and Former Chairman of the Boston Consulting Group, India Partnerships in Health Session Coordinator: Dr Nata Menabde, WHO Representative, India Special Address 92 | Conference Report 2011

1145 – 1230 4. Plenary Millennium Development Goals – The Progress so far and Opportunities ahead Chair: H.E. Lyonpo Zangley Dukpa, Minister of Health, Bhutan Speakers: Ms Nobuko Horibe, Regional Director, United Nations Population Fund (UNFPA), Thailand Progress Towards Millennium Development Goal 5

Plenary Dr Amarjit Singh, Joint Secretary, Ministry of Human Resource Development, India Innovations in Maternal Healthcare: A Case Study from Gujarat Session Coordinator: Dr Quazi Monirul Islam Rapporteur: Dr Akjemal Magtymova 1315 – 1400 Lunch

1400 – 1500 5. Parallel Break-out Sessions: Best Practices 5.1 Addressing Child and Maternal Mortality Moderator: Dr Quazi Monirul Islam, Director, Family Health & Research, WHO South-East Asia Region Speaker: Dr Vinod Paul, Vice Chair, Partnership for Maternal, Newborn and Child Health and Head, Department of Paediatrics, All India Institute of Medical Sciences, India Best Practices for Addressing Child and Maternal Mortality – the hype, the reality and the hope Panelists: H.E. Ms. Madalena F.M. Hanjam C. Soares, Vice Minister of Health, Timor-Leste Ms Nobuko Horibe, Regional Director, United Nations Population Fund (UNFPA), Thailand Dr Harshalal R. Seneviratne, Dean and Senior Professor, Faculty of Medicine, University of Colombo, Sri Lanka Mr Ashok Alexander, Director, Bill and Melinda Gates Foundation,

Parallel Break-out Sessions: Best Practices Sessions: Break-out Parallel India Session Coordinator: Dr Neena Raina Rapporteurs: Dr Narimah Awin/ Dr Rajesh Mehta Partners for Health in South-East Asia | 93

5.2 Ensuring Universal Access to Health Services Chairs: H.E. Mr Rui Manuel Hanjam, Vice-Minister of Finance, Timor-Leste Dr Ascobat Gani, Health Economist and Former Dean, School of Public Health, University of Indonesia, Indonesia Speakers: Dr T. Ravindra C. Ruberu, Secretary, Ministry of Health, Sri Lanka Achieving Universal Coverage in a Free Health Environment – The Sri Lankan Scenario Dr Soe Aung, Programme Adviser/ Director, Myanmar Medical Association, Myanmar Community participation in scaling up malaria control Dr Dirgh Singh Bam, President, Dirgh-Jeevan Clinic, Nepal Community based TB control. Lessons learnt from Nepal Dr Viroj Tangcharoensathien, Director, International Health Policy Programme, Ministry of Public Health, Thailand Reaching Universal Coverage in Thailand: what strategic approaches? Parallel Break-out Sessions: Best Practices Sessions: Break-out Parallel Session Coordinators: Dr Ilsa Nelwan and Dr Iyanthi Abeyewickreme Rapporteur: Dr Leonard Ortega

5.3 Revitalizing Primary Health Care – Addressing Health Inequities Chairs: Dr Gado Tshering, Secretary, Ministry of Health, Bhutan Dr Amorn Nondasuta, Chairman, The Foundation for Quality of Life, Thailand PHC Innovation Speakers: Dr Budihardja Singgih, Directorate General for Nutrition and Maternal and Child Health, Ministry of Health, Indonesia Decentralization of Health Care – Can it Address Health Inequities? Mr Alok Mukhopadhyay, Chief Executive, Voluntary Health Association of India, India Community Empowerment – Means for Reducing Equity Gaps Dr Dharma S.Manandhar, President, Mother and Infant Research Activities (MIRA) and Head, Department of Pediatrics, Kathmandu Medical College, Nepal Community Mobilization and Community-based Health Work Force can make a Difference

Parallel Break-out Sessions: Best Practices Sessions: Break-out Parallel Session Coordinator: Dr Sudhansh Malhotra Rapporteur: Dr Boosaba Sanguanprasit 1500 – 1530 Tea/Coffee 94 | Conference Report 2011

1530 – 1615 6. Plenary The Challenge of Noncommunicable Diseases Chair: Dr Lalit M Nath, Former Director, All India Institute of Medical Sciences, India Speaker: Dr Bela Shah, Senior Deputy Director General and Head, Division of NCD, Indian Council of Medical Research, India Plenary Noncommunicable Diseases Challenges Session Coordinator: Dr Renu Garg Rapporteur: Dr Dhirendra Narain Sinha

1630 – 1800 7. Parallel Break-out Sessions: Best Practices 7.1 Integrated Approach to Prevention and Control of Noncommunicable Diseases Chairs: Dr Sudha Sharma, Secretary, Ministry of Health and Population, Nepal Prof. Tint Swe Latt, Rector, University of Medicine (2), Myanmar Speakers: Dr Mahesh K. Maskey, Chair, Nepal Public Health Foundation, Nepal Status of Noncommunicable Diseases in South-East Asia and the Role of Civil Society in its Prevention and Control, Nepal Dr Neelamani Rajapaksa Hewageegana, Provincial Director of Health Services, UVA, Sri Lanka Package of Essential Noncommunicable (PEN) Disease interventions for Primary Health Care in Low Resource Settings, Sri Lanka Professor Prakit Vathesatogkit, Executive Secretary, Action on Smoking and Health Foundation, Thailand Using Innovation in Tobacco Taxation in Promoting Health, Thailand Parallel Break-out Sessions: Best Practices Sessions: Break-out Parallel Session Coordinator: Dr Renu Garg Rapporteur: Dr Nyo Nyo Kyaing Partners for Health in South-East Asia | 95

7.2 Health for the Urban Poor – The Way Forward Chairs: Mr Keshav Desiraju, Additional Secretary, Ministry of Health and Family Welfare, India Dr Genevieve Begkoyian, Regional Health Advisor, Young Child Survival, United Nations Children’s Fund (UNICEF), Nepal Speakers: Dr Abdul Sattar Yoosuf, Assistant Regional Director, WHO South-East Asia Region Health for the Urban Poor in the 21st Century: Challenges and Opportunities Dr M.H. Basyir Ahmad Syawie, Mayor of Pekalongan, Indonesia Dr Siddharth Agarwal, Executive Director, Urban Health Resource Centre, India Improving Health of the Urban Poor: Experiences from the fi eld and Lessons Learned

Parallel Break-out Sessions: Best Practices Sessions: Break-out Parallel Session Coordinator: Dr Sudhansh Malhotra Rapporteur: Dr Suvajee Good

7.3. Protecting Health from Climate Change Chair: Mr Young-Woo Park, Regional Director and Representative for Asia & the Pacifi c Offi ce, United Nations Environment Programme (UNEP), Thailand Panelists: Dr Iqbal Kabir, Coordinator, Climate Change & Health Promotion Unit, Ministry of Health and Family Welfare, Bangladesh Experiences and Initiatives to Protect Human Health from Climate Change in Bangladesh Ms Mabel Rebello, Member of Parliament and Member of Standing Committee of Indian Association of Parliamentarians on Population and Development (IAPPD), India Community level initiatives to protect human health from climate change Dr Sharad Onta, Professor, Department of Community Medicine and Family Health, Tribhuvan University, Nepal Parallel Break-out Sessions: Best Practices Sessions: Break-out Parallel Climate Change, Vulnerability Assessment – Experiences from Nepal 96 | Conference Report 2011

Mr Yeshey Penjor, Climate Change Policy Specialist, United Nations Development Programme (UNDP), Bhutan Climate Change and Human Health - Adaptation in Bhutan Dr Bindeshwar Pathak, Founder, Sulabh International Social Service Organisation, India Impact of climate change on sanitation and health and how Sulabh International has contributed in addressing the issue, India

Best Practices Session Coordinator: Ms Payden Rapporteur: Dr Zakir Hussain Parallel Break-out Sessions: Sessions: Break-out Parallel

1800 Regional Director’s Welcome Reception, Hotel Le Meridien

Thursday, 17 March 2011 0800 – 0845 8. Registration 0845 – 0900 9. Recap of Day 1 Dr Sangay Thinley, Director, Department of Communicable Diseases, WHO South-East Asia Region 0900 – 1000 10. Plenary Building Health System Capacity Chairs: Dr T. Ravindra C. Ruberu, Secretary, Ministry of Health, Sri Lanka Dr Jai P Narain, Director, Department of Sustainable Development and Healthy Environments, WHO South-East Asia Region Speakers: Dr Ugrid Milintangkul, Deputy Secretary General, National Health Commission, Thailand Healthy Public Policies: Moving towards an integrated and intersectoral approach to Health - Thailand’s Experience Dr Carla AbouZahr, Team Leader, Monitoring Vital Events

Plenary (MoVE-IT), Health Metrics Network, Switzerland The need for Civil Registration and Vital Statistics Dr Mubashar Riaz Sheikh, Executive Director, Global Health Workforce Alliance, Switzerland (read by Mr Sunil Nandraj, WHO Country Offi ce, India) Refl ections on the health workforce crisis in South-East Asia Session Coordinator: Dr Thushara Fernando Rapporteur: Dr Prakin Suchaxaya 1000 – 1030 Tea/Coffee Partners for Health in South-East Asia | 97

1030 – 1200 11. Parallel Break-out Sessions: Best Practices 11.1 Public-Private Partnerships in Health Chairs: Mr Prasanna Kumar Pradhan, Special Secretary, Ministry of Health and Family Welfare, India Dr Narottam Puri, Advisor, Health Services Committee at The Federation of Indian Chambers of Commerce and Industry (FICCI) and President – Medical Strategy & Quality at Fortis Healthcare Limited, India Speaker: Mr Anil Swarup, Director General for Labour Welfare and Joint Secretary, Ministry of Labour and Employment, India …. A Journey called Rashtriya Swasthya Bima Yojana Panelists: Dr Akram Ali Eltom, Director, Partnerships Unit, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Switzerland Country Level Opportunities and Challenges in Public Private Partnerships for Health Mrs Penny Grewal Daumerie, Director, Global Access, Medicines for Malaria Venture (MMV), Switzerland The Power of Partnerships: Accelerating the development and delivery of much-needed medicines Dr Harinder S. Sikka, Director, Corporate Affairs, Piramal Healthcare Limited, India

Parallel Break-out Sessions: Best Practices Best Practices Sessions: Break-out Parallel Discussion on Public-Private Partnerships in Health Professor S.P. Thyagarajan, Pro-Chancellor (Research), Sri Ramachandra University, India Research Partnerships in Health Session Coordinator: Dr Manisha Shridhar Rapporteur: Mr Gautam Basu

11.2 Financing for Universal Coverage Chairs: H.E. Mr Ahmed Asad, State Minister of Finance & Treasury, Maldives Dr David Evans, Director, Health Systems Financing, WHO Headquarters, Switzerland The Global Situation – Health Systems Financing : The Path to Universal Coverage Speakers: Prof. Indrani Gupta, Professor and Head of Health Policy Best Practices Research Unit, Institute of Economic Growth, India Universal Health Coverage – Options for South East Asia Region Parallel Break-out Sessions: Sessions: Break-out Parallel 98 | Conference Report 2011

Dr Hasbullah Thabrany, President South-East Asia Public Health Education Institutes Network (SEAPHEIN) & Former Dean, School of Public Health, University of Indonesia, Indonesia Public Financing – Private Delivery to Strengthen Health Systems Dr Phusit Prakongsai, Director, International Health Policy Programme, Ministry of Public Health, Thailand Financing for Universal Coverage – Experiences from Thailand Best Practices Session Coordinator: Dr Sunil Senanayake Rapporteur: Dr Kathleen Holloway Parallel Break-out Sessions: Sessions: Break-out Parallel

11.3 Opening New Frontiers & Innovative Opportunities for Collaboration in the Health Sector: South – South & Beyond Chairs: Dr Marie-Andree Romisch-Diouf, Director, Country Cooperation, WHO Headquarters, Switzerland Dr Nata Menabde, WHO Representative, India South-South Cooperation and Beyond. Some Refl ections. Panelists: Dr Biswajit Dhar, Director General, Research and Information System for Developing Countries, (RIS), Ministry of External Affairs, India Dr K.M. Gopa Kumar, Legal Advisor, Third World Network, India Dr Alvaro Matida, Adviser, FIOCRUZ Center for Global Health, The Oswaldo Cruz Foundation, Brazil South-South Cooperation Dr Mmathari Kelebogile Mastau, Deputy Director-General, Strategic Health Programme, Department of Health, Government of South Africa Dr Antonio Duran, Coordinator, International Health Policy, Parallel Break-out Sessions: Best Practices Sessions: Break-out Parallel Andalusian School of Public Health, Spain Session Coordinators: Dr Nata Menabde and Mr Sunil Nandraj Rapporteur: Ms Anagha Khot Partners for Health in South-East Asia | 99

1200 – 1300 Lunch 1300 – 1400 12. Plenary Health Partnerships and Collaboration: The imperatives of collective responsibility to address the health of the poor and vulnerable Chairs: H.E. Dr Farooq Abdullah, Union Minister for New and Renewable Energy, India Mr Hussain Niyaaz, Additional Secretary, Ministry of Foreign Affairs, Maldives Panelists: Dr Bina Rawal, Head of Medical Affairs, The Wellcome Trust, United Kingdom The Wellcome Trust Dr Thomas Teuscher, Deputy Executive Director, Roll Back Malaria

Plenary Partnership, Switzerland The Roll Back Malaria Partnership Mr Paul Kelly, Director, Country Programmes, Global Alliance for Vaccines and Immunization (GAVI), Switzerland Dr Mariam Claeson, Programme Coordinator, HIV/AIDS, Human Development, South Asia Region, The World Bank, India Session Coordinator: Ms Nelly Enwerem-Bromson Rapporteur: Dr Kathleen Holloway

1405 – 1515 13. Plenary Partnerships in Action: Reporting from the Field Chairs: H.E. Professor Dr Syed Modasser Ali, Health Adviser to the Prime Minister, Bangladesh Ms Tine Staermose, Director, International Labour Organization (ILO), India Panelists: Mr Ken Earhart, Director, Global Disease Detection Program, U.S. Centers for Disease Control and Prevention (CDC), India Global Disease Detection Program

Plenary Dr Md Shafi ullah Talukder, Project Coordinator, TB Control Programme, Bangladesh Garment Manufacturers and Exporters Association (BGMEA), Bangladesh Reporting from Bangladesh Corporate Sector Mr Steven J Kraus, Director, Regional Support Team for Asia and the Pacifi c, UNAIDS, Thailand UNAIDS: Partnership in action 100 | Conference Report 2011

Dr Preethi Wijegoonewardene, Regional President, World Organization of Family Physicians (WONCA) - South Asia, Sri Lanka Partnerships in Action: WONCA Mr William Stewart, Senior Health Adviser, Department for International Development (DFID), India Strengthening multi-sectoral action for health and nutrition

Plenary Mr Sanjoy Roy, Managing Trustee, Salaam Baalak Trust, India Salaam Baalak Trust Session Coordinator: Ms Nelly Enwerem-Bromson Rapporteur: Dr Supriya Bezbaruah 1515 – 1545 Tea/Coffee

1545 – 1715 14. Parallel Break-out Sessions: Best Practices Perspectives and Roles of Stakeholders in Health Development in the Region 14.1 Private Sector/Foundations Chairs: Dr Ranjit Roy Chaudhury, Chairman, Task Force for Research, Apollo Hospitals Educational and Research Foundation, India Mr Sushanta Sen - Principal Advisor to Confederation of Indian Industry (CII), India Panelists: Ms Sinta Kaniawati Munir, General Manager, Unilever Indonesia Foundation, Indonesia Corporate Social Responsibility: Empowering the Community through Public Health Education Program Dr Jingjai Hanchanlash - Advisor to Executive Board & Former Board Member and Co-Chairman, The Thai-EU Business Council, Thailand Perspectives and Roles of Private Stakeholders in Health Development in the Region Dr Vikram Sheel Kumar, Co-Founder and Chief Medical Offi cer, Dimagi Inc., India Overview of Mobile Applications (For Health) Ms Indrani Kar, Senior Director & Head – Development Initiatives, Parallel Break-out Sessions: Best Practices Sessions: Break-out Parallel Confederation of Indian Industry (CII), India Role of Private Sector and Partnerships Session Coordinator: Dr Roderico Ofrin Rapporteur: Dr Sara Varughese Partners for Health in South-East Asia | 101

14.2 NGOs and Civil Society Chair: Mr Azmat Ulla, Head of Regional Offi ce, International Federation of Red Cross and Red Crescent Societies, India Speakers: Dr Md. Akramul Islam, Programme Head, Health Programme, Bangladesh Rural Advancement Committee (BRAC), Bangladesh Role of NGOs in Health: Experience in Tuberculosis Control in Bangladesh (read by Dr Khurshid Alam Hyder, WHO SEARO) Dr Vinya S Ariyaratne, General Secretary, Sarvodaya Shramadana Movement, Sri Lanka Building sustainable civil society partnerships for health: Challenges and responses Dr Mirai Chatterjee, Programme Coordinator, SEWA Social Security, India Health Action through Membership-Based Organisations (MBOs) of Women – some experiences of the Self-Employed Women’s Association (SEWA), India Session Coordinator: Dr A.P. Dash Rapporteur: Dr Khurshid Alam Hyder

14.3 Governments Chair: H. E. Dr Aminath Jameel, Minister of Health and Family Welfare, Maldives Panelists: Mr Gopal Krishna Menon, Country Manager, Australian Agency for

Best Practices Sessions: Break-out Parallel International Development (AusAID), India Role of Donor Governments Dr P.B. Jayasundera, Secretary, Ministry of Finance & Planning and Secretary, Ministry of Economic Development, Sri Lanka Role of Recipient Governments Dr Sudha Sharma, Secretary, Ministry of Health and Population, Nepal Health Development in Nepal: Government of Nepal’s Perspectives Session Coordinator: Dr Jigmi Singay Rapporteur: Ms Nelly Enwerem-Bromson 102 | Conference Report 2011

14.4 UN/Intergovernmental Organizations Chair: Ms Caitlin Weisen, Country Director, United Nations Development Programme (UNDP), India Panelists: Dr Nata Menabde, WHO Representative, India Dr Marc G.L. Derveeuw, Representative a.i , United Nations Population Fund (UNFPA), India Prof. Charles Franklin Gilks, Country Coordinator, Joint United Nations Programme on HIV/AIDS (UNAIDS), India Dr Asheena Khalakdina, Health Specialist, United Nations Children’s Fund (UNICEF), Thailand Ms Tine Staermose, Director, International Labour Organization (ILO), India Dr Ram Boojh, Programme Specialist, Ecological & Earth Sciences, United Nations Educational, Scientifi c and Cultural Organization (UNESCO), India Session Coordinator: Dr Narimah Awin Rapporteur: Dr Prakin Suchaxaya

14.5 Media Roundtable Chairs: Dr. Shashi Tharoor, Member of Parliament, India, Former-UN Under-Secretary-General for Communications and Public Information Dr Bindeshwar Pathak, Founder, Sulabh International Social Service Organisation, India Panelists: Dr Poonam Khetrapal Singh, Deputy Regional Director, WHO South-East Asia Region Parallel Break-out Sessions: Best Practices Sessions: Break-out Parallel Ms Damayanti Datta, Deputy Editor, India Today, India Mr Siddhartha Swaroop, Deputy Country Director, The BBC Trust, India Ms Patrlekha Chatterjee, Columnist, The Lancet, India Mr Shankar Raghuraman, Associate Editor, The Times of India, India Ms Arti Dhar, Special Correspondent, The Hindu, India Dr Iqbal Kabir, Health Editor, Prothom Alo, Bangladesh Ms Kiran Mehra-Kerpelman, Director, United Nations Information Centre, India Partners for Health in South-East Asia | 103

Ms Paula Alvarado, Regional Communications Manager, International Federation of Red Cross and Red Crescent Societies, India Mr Rajat Ray, Information Focal Point, United Nations Population Fund, India Moderator & Session Coordinator: Ms Vismita Gupta-Smith Rapporteur: Dr Supriya Bezbaruah Best Practices Parallel Break-out Sessions: Sessions: Break-out Parallel

1930 Reception – Government of India, Hotel Ashok

Friday, 18 March 2011 1000 – 1015 15. Recap of Day 2 Speaker: Dr Athula Kahandaliyanage, Director, Department of Health Systems Development, WHO South-East Asia Region

1015 – 1115 16. Plenary Refl ections on the Roles of Stakeholders in Health Development in the Region Chair: Mr K. Chandramouli, Secretary, Ministry of Health and Family Welfare, India Panelists: Dr Budihardja Singgih, Directorate General for Nutrition and Maternal and Child Health, Ministry of Health, Indonesia Mr Siddhartha Swaroop, Deputy Country Director, The BBC Trust,

Plenary India Mr Steven J Kraus, Director, Regional Support Team for Asia and the Pacifi c, UNAIDS, Thailand Dr Akram Ali Eltom, Director, Partnerships Unit, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Switzerland Ms Anuradha Singh, Programme Coordinator, SEWA Social Security, India 1115– 1145 Tea/Coffee 104 | Conference Report 2011

1145 – 1230 17. Plenary Delhi Call for Action on Partnerships for Health Chair: H.E. Lyonpo Zangley Dukpa, Minister of Health, Bhutan Dr Budihardja Singgih, Directorate General for Nutrition and Maternal and Child Health, Ministry of Health, Indonesia and Chair, Drafting Committee for Delhi Call for Action

Plenary Adoption of the Delhi Call for Action on Partnerships for Health Closing Remarks by Dr Poonam Khetrapal Singh, Deputy Regional Director, WHO South-East Asia Region Lunch Bilateral Meetings Partners for Health in South-East Asia | 105

Annex 2 List of Participants

SEAR MEMBER STATES India Bangladesh H.E. Mr Ghulam Nabi Azad Union Minister of Health and H.E. Professor Dr Syed Modasser Ali Family Welfare Health Advisor to the Prime Minister H.E. Dr Farooq Abdullah H. E. Mr. Tariq A. Karim Union Minister for New and Renewable High Commissioner Energy India Dr. Shashi Tharoor Ms Nasreen Rukhsana Member of Parliament Joint Secretary Former United Nations Under -Secretary- Ministry of Health General for Communications and Public Dr Iqbal Kabir Information Coordinator Ms Mabel Rebello Climate Change & Health Promotion Unit Member of Parliament and Member of Ministry of Health and Family Welfare Standing Committee of Indian Association Mr. Mohammad Monirul Islam of Parliamentarians on Population and Counsellor Development (IAPPD) High Commission India Dr Anup Saha Member of Parliament Bhutan Mr Arun Maira H.E. Lyonpo Zangley Dukpa Member of Planning Commission and Minister of Health Former Chairman of Boston Consulting Dr Gado Tshering Group Secretary Mr K. Chandramouli Ministry of Health Secretary Dr Gampo Dorji Ministry of Health and Family Welfare Deputy Chief Program Offi cer Dr. Rahul Khullar Non-Communicable Disease Division Secretary Department of Public Health Ministry of Commerce DPR Korea Mr Prasanna Kumar Pradhan H.E. Mr Rim Hae Song Special Secretary Ambassador Ministry of Health and Family Welfare India Mr Keshav Desiraju Mr Hyon IL Kim Additional Secretary First Secretary Ministry of Health and India Family Welfare 106 | Conference Report 2011

Dr Amarjit Singh Dr Andi Saguni Joint Secretary Head, APBN II Division Ministry of Human Resource Bureau of Planning and Budgeting Development Ministry of Health Mr Anil Swarup Dr Ekowati Rahajeng Director General for Labour Welfare & Head, Health Resources Division Joint Secretary Center for Health Research and Ministry of Labour and Employment Development Ministry of Health Mr Sanjay Prasad Director Ms Netty Pakpahan Ministry of Health and Family Welfare Head, Bureau of Organization Legal Service Division Ms Sheyphali B. Sharan Ministry of Health Director (Media Coordination) Ministry of Health and Family Welfare Ms Dr Anggia Ismaini Mr Sam Pitroda Head Subdivision of Multilateral Advisor to the Prime Minister Cooperation Prime Minister’s Offi ce Center for International Cooperation Ministry of Health Dr Sunil D. Khaparde Deputy Director General Dr Wayan Eka Sandiartha National AIDS Control Organization Member of Staff Center for International Cooperation Indonesia Dr Budihardja Singgih Maldives Directorate General for Nutrition and H.E. Dr Aminath Jameel Maternal and Child Health Minister of Health and Family Ministry of Health H.E. Mr Ahmed Asad Dr Tjandra Yoga Adhitama State Minister of Finance & Treasury Director General Disease Control and Environmental Health H.E. Mr Abdul Azeez Yoosuf Ministry of Health High Commissioner India Dr M.H. Basyir Ahmad Syawie Mayor Mr Hussain Niyaaz Pekalongan Additional Secretary Ministry of Foreign Affairs Ms Hendra Henny Andries Minister Counsellor Dr Ibrahim Yasir Ahmed Embassy Director General of Health Services India Ministry of Health Dr Untung Suseno Sutarjo Dr Hassan Hameed Head, Bureau of Planning and Budgeting Vice Chancellor Ministry of Health Maldives National University Partners for Health in South-East Asia | 107

Ms Aishath Shaheen Ismail Mr Samantha Pathirana Dean, Maldives College of Higher Education Counsellor Faculty of Health Sciences High Commission India Myanmar Mr Tun Tun Naing Dr Neelamani Rajapaksa Hewageegana Director General Provincial Director of Health Services, UVA Central Statistical Organization Thailand Ministry for National Planning and Dr Ugrid Milintangkul Economic Development Deputy Secretary General Dr Kyee Myint National Health Commission Deputy Director General (Medical Care) Dr Viroj Tangcharoensathien Ministry of Health Director, International Health Policy Professor Tint Swe Latt Program Rector Ministry of Public Health University of Medicine (2) Dr Phusit Prakongsai Nepal Director, International Health Policy Program Dr Chet Raj Pant Ministry of Public Health Member National Planning Commission Timor-Leste Dr Sudha Sharma H.E. Ms Madalena F.M. Hanjam C. Soares Secretary Vice-Minister of Health Ministry of Health and Population H.E. Mr Rui Manuel Hanjam Mr Bhuban Karki Vice Minister of Finance Under Secretary Mr Agapito da Silva Soares Ministry of Finance Director General of Health Dr Bhim Singh Tinkari Mr Marcelo Amaral Director, PHC Revitalization Division Head, Department for Planning, Ministry of Health and Population Monitoring & Evaluation Sri Lanka Ministry of Health H.E. Mr Prasad Kariyawasam Mr Elmano Manuel Manediak High Commissioner Technical Advisor to Vice Minister Finance India Ministry of Finance Dr T. Ravindra C. Ruberu Ms Cidalia Maria Freitas Secretary Technical Advisor to Vice Minister of Ministry of Health Finance Ministry of Finance Dr P.B. Jayasundera Secretary Dr Avelino Guterres Correia Ministries of Finance and Planning and Technical Advisor Economic Development Ministry of Health 108 | Conference Report 2011

Mr Florindo de Jesus Soares German International Cooperation Private Assistant to Vice-Minister of Health (GIZ) Ministry of Health Dr Markus Behrend Mr Antonio Romano Programme Manager Journalist of TV Timor-Leste Nepal OTHER SEAR GOVERNMENT Japanese International Cooperation ORGANIZATIONS Agency (JICA) India Ms Makiko Konohara Project Formulation Advisor Dr Bela Shah India Senior Deputy Director-General Indian Council of Medical Research Ms Aditi Puri Development Specialist Dr Prashant Mathur India Scientist 'D' Mr Syed Fareed Uddin Division of Non Communicable Diseases Consultant - TQM Indian Council of Medical Research India Dr Biswajit Dhar Kreditanstalt für Wiederaufbau Director- General Bankengruppe (KfW) Research & Information System for Developing Countries (RIS) Mr Bertold Rudolf Liche Ministry of External Affairs Programme Coordinator Bangladesh OTHER GOVERNMENTS South African Ministry of Health Australian Agency for International Ms Mmathari K Mastau Development (AusAID) Deputy Director-General, Mr Gopal Krishna Menon Stretegic Health Programme Country Manager Department of Health India Swedish International Development Cooperation Agency (SIDA) Department for International Development (DFID) Ms Yasmin Zaveri Roy Programme Manager Mr William Stewart India Senior Health Adviser India U.S. Agency for International Development (USAID) French Ministry of Foreign and Ms Erin Soto European Affairs Minister Counselor for International Dr Christian Tosi Development Regional Counselor for Health USAID Mission Director Thailand India Partners for Health in South-East Asia | 109

Dr Ronald Waldman ACADEMIA Senior International Health Advisor and Pandemic Preparedness/ All India Institute of Medical Humanitarian Response Team Sciences USA Dr Vinod Paul Vice-Chair, Partnership for Maternal Mr James Browder Newborn and Child Health and Deputy Director, Health Offi ce Head, Department of Pediatrics India India Mr Stephen Solat Dr Chandrakant S. Pandav Deputy Director-Health Professor and Head of Centre for India Community Medicine India Dr Karan Singh Sagar Country Representative Dr Shakti Kumar Gupta Maternal Child Health Integrated Program Head - Dept. of Hospital Administration India & Medical Superintendent India Ms Tanu Chhabra Bahl Dr Lalit M. Nath Communications Specialist Former Director India India Ms Sheena Chhabra Mr Jitendar Kumar Sharma Project Development Specialist-Health Project Offi cer India India U.S. Centers for Disease Control Andalusian School of Public Health and Prevention (CDC) Dr Antonio Duran Dr Ken Earhart Coordinator, International Health Policy Director Spain Global Disease Detection Program Boston University India Ms Amiya Bhatia Dr Pauline Harvey Research Associate Director Division of Global HIV/AIDS Centre for Global Health & Development Center for Global Health USA India B P Koirala Institute of Health Ms Karen Seiner Sciences Public Health Adviser Professor Purna Chandra Karmacharya Infl uenza Division South-East Asia Region Vice Chancellor India Nepal 110 | Conference Report 2011

BSE Training Institute Ltd Maldives National University Mr Sudhakar Rao Dr Hassan Hameed Chairman of the Board Vice-Chancellor And former Member of Public Enterprises Maldives Selection Board for the Government of India Myanmar Medical Association Dr Soe Aung Centre for Medical Education Proramme Adviser/Director Dr Humayun Kabir Talukder Myanmar Associate Professor Bangladesh National Institute of Health & Family Welfare Darul Ihsan University Professor Rajni Bagga Dr Anwar Islam Head, Management Science Vice-Chancellor India Bangladesh Dr Swain Pushpanjali Delhi University Associate Professor Dr Sunita Kaistha India Associate Professor , JMC College National Institute of Immunology India Professor Nirmal Kumar Ganguly Ms Sonal Gupta Distinguished Biotechnology Fellow & PhD Scholar Adviser India India Ms Mahak Sharma Patan Academy of Health Sciences PhD Scholar Professor Arjun Karki India Vice Chancellor Gadja Mada University Nepal Dr Titi Savitri Prihatiningsih Royal Institute of Health Sciences Vice Dean of Academic Affairs Associate Professor, Faculty of Medicine Dr Chencho Dorjee Indonesia Director Bhutan Institute of Economic Growth SEA Regional Association of Medical Professor Indrani Gupta Education Professor and Head of Health Policy Research Unit Professor Anan Srikiatkhachorn India Deputy Dean Thailand Institute for Primary Health Care Innovation Sri Ramachandra University Dr Narongsakdi Aungkasuvapala Professor S.P. Thyagarajan Director Pro Chancellor (Research), Thailand India Partners for Health in South-East Asia | 111

Sulabh International Academy of FOUNDATIONS Environmental Sanitation Action on Smoking and Health and Public Health Foundation Dr Suman Chahar Professor Prakit Vathesatogkit Chairperson Executive Secretary India Thailand The George Institute for Global Health Apollo Hospitals Educational and Dr Pallab K. Maulik Research Foundation Head, Research & Development Professor Ranjit Roy Chaudhury India Chairman, Task Force for Research Tribhuvan University India Dr Sharad Onta Chronical Care Foundation Professor, Department of Community Dr Sita Ratna Devi Medicine and Family Health Chief Executive Offi cer Nepal India University of Colombo Clinton Health Access Initiative Professor Harshalal R Seneviratne Ms Amita Chebbi Dean and Senior Professor, Faculty of Country Director Medicine India Sri Lanka Dr Fabian Toegel Professor Rohini de A Seneviratne Senior Technical Advisor Professor and Head, Faculty of Medicine India Department of Community Medicine Sri Lanka Bill and Melinda Gates Foundation Mr Ashok Alexander University of Indonesia Director Professor Bambang Wispriyono India Dean Dr Devendra Khandait Faculty of Public Health Program Offi cer Indonesia India Dr Ascobat Gani John D. and Catherine T. MacArthur Health Economist and Former Dean Foundation Faculty of Public Health Indonesia Ms Dipa Nag Chowdhury Acting Director Professor Hasbullah Thabrany India President South-East Asia Public Health Education Institutes Network (SEAPHEIN) Lanka Alzheimer's Foundation & Former Dean Dr Hearath B. Tamitegama Faculty of Public Health President Indonesia Sri Lanka 112 | Conference Report 2011

MI International Foundation The Oswaldo Cruz Foundation Dr Vivek Gupta Dr Alvaro Matida Senior Consultant Adviser India FIOCRUZ Center for Global Health Brazil Nepal Public Health Foundation Dr Mahesh K. Maskey The Rotary Foundation of Rotary Chair International Nepal Mr Kalyan Banerjee The Nippon Foundation President-Elect USA Ms Chikako Awazu International Program Department The Wellcome Trust Japan Dr Bina Rawal Pakistan Polio Plus Committee Head of Medical Affairs UK Mr Aziz Memon National Chairman Dr Shirshendu Mukherjee Pakistan Strategic Adviser R&D Initiative India Public Health Foundation of India Dr Hanimi Reddy Modugu Unilever Indonesia Foundation Senior Social Scientist Ms Sinta Kaniawati Munir South Asia Network for Chronic Disease General Manager India Indonesia Dr. Subhadra Menon World Diabetes Foundation Head, Health Communication and Mr Anil Kapur Advocacy India Managing Director Denmark Dr Monika Arora Head-Health Promotion Tobacco Control GLOBAL HEALTH PARTNERSHIPS Adjunct Assistant Professor Global Alliance for Vaccines and India Immunization (GAVI) Dr Preet Dhillon Mr Paul Kelly Senior Scientifi c Offi cer Director Country Programmes South Asia Network for Chronic Disease Switzerland India Mr Farouk Shamas Jiwa The Foundation for Quality of Life Programme Offi cer, Dr Amorn Nondasuta Advocacy and Public Policy, Chairman External Relations Thailand Switzerland Partners for Health in South-East Asia | 113

Global Fund to Fight AIDS, European Union Tuberculosis and Malaria Mr Laurent LeDanois Dr Akram Ali Eltom Attache Director, Partnerships Unit Development Cooperation Switzerland Delegation of the European Commission to India, Bhutan and Nepal Dr Artashes Mirzoyan India Fund Portfolio Manager for Bangladesh and India (TB+Malaria) Dr (Ms) Ute Schumann Switzerland Attache Development Cooperation Dr Werner Buehler Delegation of the European Union to India Fund Portfolio Manager Switzerland International Federation of Red Cross Ms Sylwia Murray and Red Crescent Societies Senior Program Offi cer Mr Azmat Ulla Switzerland Head of Regional Offi ce Health Metrics Network India Dr Carla AbouZahr Dr Lauraelena Pacifi ci Team Leader, Monitoring Vital Events Regional Health and Care Coordinator (MoVE-IT) India Switzerland Ms Paula Alvarado Roll Back Malaria Partnership Regional Communications Manager India Dr Thomas Teuscher Deputy Executive Director Islamic Development Bank Switzerland Dr Tayeb Sadik Global Stop Tuberculosis Partnership Health Expert Mr Anant Vijay Kingdom of Saudi Arabia Coordinator Finance, Resource Mobilization INTERNATIONAL NONGOVERNMENTAL Switzerland ORGANIZATIONS ACCESS Health International INTERGOVERNMENTAL ORGANIZATIONS Ms Annapurna Chavali Consultant - Primary HealthCare Asian Development Bank India Mr Jacques Jeugmans Practice Leader (Health) Bangladesh Rural Advancement Poverty Reduction, Gender Committee (BRAC) Social Development Division Regional and Professor Anwar Islam Sustainable Development Department Director Philippines Bangladesh 114 | Conference Report 2011

CARE Indian Association of Mr Muhammad Musa Parliamentarians on Population and Chief Executive Offi cer Development India Mr Manmohan Sharma Executive Secretary Catholic Relief Services India Ms Katherine Cunliffe Indian Media Center for Journalists Head of Programs Mr Ashutosh Singh India President India Child Fund Mr Dola Mohapatra Indian Public Health Association National Director Dr Madhumita Dobe India Secretary General India Ms Anjali Sakhuja International Diabetes Federation Program Director India Ms Wannee Nitiyanant Vice President Commonwealth Association for Thailand Health and Disability International Network for Cancer Treatment and Research Dr Uday Bodhankar Secretary General Dr Gayatri Palat India Program Director Palliative Care Framework Convention Alliance on India Tobacco Control International Planned Parenthood Mr Shailesh Vaite Federation Regional Coordinator for Ms Anjali Sen South-East Asia Region Regional Director India India

Health Related Information Ms Susmita Das Dissemination Amongst Youth Director - Programmes India Ms Shalini Bassi Head Programms International Union Against India Tuberculosis and Lung Disease Dr Darivianca Elliotte Laloo Ms Radhika Shrivastava Technical Offi cer Deputy Director Partnership for TB Care and Control in India India Partners for Health in South-East Asia | 115

Jhpiego Corporation Population Services International Dr Bulbul Sood Dr. Daisy Lekharu Country Director National Manager-TB Programs India India John Snow Inc. (JSI) Salaam Baalak Trust Mr Andrew Fullem Mr Sanjoy Roy Director of HIV and AIDS Managing Trustee USA India Dr David Hausner Sarvodaya Shramadana Movement County Director for AIDSTAR-One Dr Vinya S Ariyaratne India General Secretary Medical Women's International Sri Lanka Association Save The Children Dr Pattariya Jarutat Dr Rajiv Tandon Vice-President Senior Advisor - Maternal, Newborn, Child Thailand Health Nutrition Medicines for Malaria Venture (MMV) India Ms Penny Grewal Daumerie Dr Seema Pahariya Director, Global Access National Manager - Health Nutrition Switzerland India Mother and Infant Research Activities SEWA Social Security (MIRA) Dr Mirai Chatterjee Dr Dharma S. Manandhar Programme Coordinator President and India Head, Department of Pediatrics Kathmandu Medical College Ms Anuradha Singh Programme Coordinator Nepal India Operation ASHA Sight Savers International Dr Shelly Batra President Ms Elizabeth Kurian India Regional Director India Ms Anne Andrews Strategy Consultant Ms Fahmida Mariam India South Asia Programme Director Bangladesh Ms Sarah Snidal Manager (Development) India 116 | Conference Report 2011

Sulabh International Social Service World Organization of Family Organisation Physicians (WONCA) Dr Bindeshwar Pathak Dr Preethi Wijegoonewardene Founder Regional President - South Asia India Sri Lanka Ms Abha Bahadur World Vision Senior Vice-President India Dr Vijay Kumar Edward Director Health HIV AIDS Mr Roshan Jain India Program Offi cer India Dr Sri Chander Health Adviser The Environmental Consumer Singapore Protection Foundation MEDIA Prof. (Dr.) R.K. Nayak Executive Chairman Aajtak India Mr Balkrishna Third World Network India Dr K. M. Gopa Kumar AIR Legal Advisor Mr Vinayak Dutt India India Urban Health Resource Centre Bartaman Dr Siddharth Agarwal Mr Sandip Swarnakar Executive Director India India BBC Voluntary Health Association of India Ms Pradashana Kaul Mr Alok Mukhopadhyay India Chief Executive India Bharat Media Mr S.K. Singh Women Work Health Initiative India Ms Amita Sahaya Secretary Bharti Express India Mr Alaudin India The World Medical Association Dr Wonchat Subhachaturas Business Standard President Mr Joe Mathur Thailand India Partners for Health in South-East Asia | 117

CNN IBN Freedom for Press Ms Shalini Dr Archana Saxena India India Dainik Bhaskar Gujarat Samachar Mr Pradeep Surin Mr Inder Sawhney India India Dainik Jagran Headlines India (India Today) Mr Brajkrishan Mishra Mr Chiranjib India India Deccan Chronicle/Asian Age Heritage World India Ms Jyoti Verma Mr Atish Mandal India India DD News Hindustan Times Mr Nitendra Ms Nishi Bhat India India Mr Sonu Mehta Mr Rajkumar India India India News Mr C.K. Ashok India Ms Asha Mohini India Delhi Doordarshan Mr Abhay Parashar Ms Usha Bhasin India Deputy Director General India India Vision Mr Sahil eHealth India Ms Divya Chawla India Ms Ragin S India ETV News India Today Ms Ruby Kumari India Ms Damayanti Datta Deputy Editor Express Healthcare India Ms Aashruti Kak Indian Express India Ms Kasturi Das Financial World India Mr Pradip Kumar Mr Ashok Kumar India India 118 | Conference Report 2011

Indian Institute of Mass New Concept Information Systems Communication Pvt. Ltd. Mr Sunit Tandon Ms Taru Bahl Director Senior Communication Consultant India India Indian Journal of Public Health News Bee Dr Sandip Kumar Ray Mr Pradip Kumar Basin Chief Editor India India New Europe Ishaan Times Mr Kanwaljeet Singh Mr Bhanu Seth India India News X INVC Mr Pawan India Mr Zakir Hussain India Ms Sneha India Kanak TV NDTV Dr Naim Akhtar India Mr Ravindra India Lok Manch Pharmabiz.com Ms Shikha Tripathi Mr Joseph Alexander India India Mr Prakash Gupta Pledge Daily India Mr Nasir Mirza Ms Rohini Bhardwaj India India PIB Manorama News Mr Parveen Seth Ms Bina Basil India India Mr S.R. Sharan Mr S. Syamkumar India India Mr Mukul Vyas India Mansar Communication Pvt Ltd. Mr Raju Mansukhani PTI Bhasha Director Mr Vaibhav Maheshvari India India Partners for Health in South-East Asia | 119

Rajasthan Patrika The Tribune Mr Kumarendra Ms Aditi Tandon India India Rashtriya Sahara Ms Ananya Panda Mr Gyan Prakash India India Total TV Sahara TV Mr Shoorvir Mr Ravikant Rai India India Mr Manohar Kesari Mr T.M. Daniel India India TV Today The BBC Trust Ms Urvashi Kapur Mr Siddhartha Swaroop India Deputy Country Director UNI TV India Mr Ajay Yadav Ms. Priyanka Dutt India Associate Project Director India Zee News Mr P. Suresh Babu The Hindu India Ms Arti Dhar Special Correspondent PRIVATE SECTOR India Bangladesh Garment Manufacturers Mr Sandeep Saxena and Exporters Association India Dr Md. Shafi ullah Talukder The Lancet Project Coordinator- TB Control Programme Ms Patrlekha Chatterjee Bangladesh Columnist India Bayer (South East Asia) Pvt. Ltd The Pioneer Ms Ting-Yu Huang (Fiona) Ms Archana Jyoti Project Manager - Government Affairs/ India Health Policy and Communications The Times of India Singapore Mr Shankar Raghuraman Confederation of Indian Industry (CII) Associate Editor India Ms Indrani Kar Senior Director & Head-Development Mr Kounteya Sinha Initiatives India India 120 | Conference Report 2011

Mr Amitabh Vyas Futures Group International Deputy Director India Pvt. Ltd India Dr S. N. Misra Ms Roopali Bhargava Senior Technical Advisor Executive, Health India India KPMG Dr Ramnik Ahuja Ms Janet Geddes Head, Public Health Associate Director India India Mr Sushanta Sen Mr Ryan Figueiredo Principle Advisor Senior Consultant India India Dimagi Inc. Max Healthcare Institute Limited Dr Vikram Sheel Kumar Dr Pervej Ahmed Co-Founder & Chief Medical Offi cer Chief Executive Offi cer and MD India India Dirgh-Jeevan Clinic Mr Ravi Virmani Chief Operations Offi cer Dr Dirgh Singh Bam India President Nepal Dr Shubnum Singh Vice President, Medical Affairs Eli Lilly and Company (India) Pvt. Ltd. India Ms Sunita Prasad Dr Arati Verma Consultant Chief, Medical Excellence Programs India India Enkay Sagar Holdings Pvt. Ltd. Max India Limited Mr N.K. Sagar Mr Analjit Singh Chairman Chairman and Managing Director India India Federation of Indian Chambers of Mr Nitin Thakur Commerce and Industry (FICCI) Head, Communications Mr. Paresh Tewary India Director FICCI – SEDF Ms Neha Daing India Manager, Corporate Development India Dr Narottam Puri Advisor Health Services Committee Nestle India Ltd. President - Medical Strategy & Quality at Dr Sanjeev Ganguly Fortis Healthcare Limited Medical Director South Asia India India Partners for Health in South-East Asia | 121

Mr Gary Tickle UNITED NATIONS AND SPECIALIZED Regional Business Head, Nestle Nutrition AGENCIES India Food and Agriculture Organization of Mr Sanjay Khajuria the United Nations (FAO) Senior Vice President Corporate Affairs Mr Leo Loth India Epidemiologist Ms Anshu Gupta India Manager Corporate Affairs India International Labour Organization (ILO) Pfi zer Inc Ms Tine Staermose Ms Catherine Gurtin Director Associate Director India Singapore Ms Ingrid Chritstensen Mr Siddhartha Prakash Sr. Specialist on Occupational Safety Director and Health India India Ms Jayasree Menon International Organization for Head, Public Affairs Migration (IOM) India Dr Jaime F. Calderon Jr. Piramal Healthcare Limited Regional Migration Health Manager Asia and the Pacifi c Dr Harinder S. Sikka Thailand Director, Corporate Affairs India Joint United Nations Programme on Siemens Ltd HIV/AIDS (UNAIDS) Mr Steven J. Kraus Mr Dhandapany Raghavan Director, Regional Support Team for Asia Executive Vice President Healthcare and the Pacifi c India Thailand The Thai-EU Business Council Professor Charles Franklin Gilks Dr Jingjai Hanchanlash Country Coordinator Advisor to Executive Board & Former India Board Member and Co-Chairman Mr J.V.R. Prasad Rao Thailand Special Adviser to Executive Director India World Economic Forum USA Mr Sumeet Aggarwal United Nations Children's Fund Community Manager and Healthcare (UNICEF) Sector Mr David McLoughlin Global Health Deputy Representative Programmes USA India 122 | Conference Report 2011

Dr Genevieve Begkoyian Dr Ahmed Fahmi Regional Health Adviser, Young Child Programme Specialist, Science Technology Survival India Nepal Dr Ram Boojh Mr Henri van den Hombergh Programme Specialist, Ecological and Earth Chief, Health Section Sciences India India Dr Asheena Khalakdina Health Specialist United Nations Environment Thailand Programme (UNEP) Dr V.K. Anand Mr Young-Woo Park Health Specialist, Child Survival Regional Director& Representative for Asia India and the Pacifi c Thailand Dr Srihari Dutta Dr Subrata Sinha Immunization Specialist Environmental Affairs India Regional Offi ce for Asia and the Pacifi c Ms Sonia Sarkar Thailand Communication Offi cer United Nations Population Fund India (UNFPA) United Nations Development Ms Nobuko Horibe Programme (UNDP) Regional Director Ms Caitlin Wiesen Thailand Country Director India Dr Marc G.L. Derveeuw Representative a.i. Ms Alka Narang India Assistant Country Director HIV& Development Unit Mr Rajat Ray India Information Focal Point India Mr Yeshey Penjor Climate Change Policy Specialist United Nations High Commissioner Bhutan for Refugees (UNHCR) United Nations Education, Scientifi c Dr John Tabayi and Cultural Organization (UNESCO) Public Health Offi cer for Asia and Pacifi c Region Mr Armoogum Parsuramen Director and UNESCO Representative to Nepal Bhutan, India, Maldives and Sri Lanka, United Nations Information Centre India (UNIC) Dr Shankar Chowdhury Ms Kiran Mehra-Kerpelman Programme Offi cer, Education Director India India Partners for Health in South-East Asia | 123

United Nations Military Observer SECRETARIAT Group in India and Pakistan WHO/SEARO and WHO Country (UNMOGIP) Offi ces Major Alexander Reuter Dr Poonam Khetrapal Singh Liaison Offi cer Deputy Regional Director India Dr Abdul Sattar Yoosuf United Nations Offi ce on Drugs and Assistant Regional Director Crime (UNODC) Mr Debashis Mukherjee Dr Jai P Narain Director Research Offi ce Department of Sustainable Development India and Healthy Environments The World Bank Dr Sangay Thinley Dr Mariam Claeson Director Programme Coordinator Department of Communicable Diseases HIV/AIDS, Human Development, South Asia Region Dr Quazi Monirul Islam India Director Department of Family Health Dr Jerry La Forgia and Research Lead Specialist India Dr Athula Kahandaliyanage Director Ms Preeti Kudesia Department of Health Systems Senior Public Health Specialist Development India Ms Dianne Arnold Ms Vandana Mehra Director, Communications and Information Offi cer Administration and Finance India Dr Nata Menabde World Health Organization WHO Representative to India Headquarters and other Regional Dr Lin Aung Offi ces WHO Representative to Nepal Dr Marie - Andree Romisch-Diouf Dr Firdosi Rustom Mehta Director Country Cooperation WHO Representative to Sri Lanka Switzerland Dr Khalilur Rahman Dr David Evans Liaison Offi cer, ESCAP Director Health Systems Financing Switzerland Dr Akinori Kama Liaison Offi cer to RD Dr Sergio Spinaci Associate Director Dr Rui Paulo de Jesus Global Malaria Programme Country Cooperation Strategy & Switzerland Governing Bodies 124 | Conference Report 2011

Session Coordinators and Dr Neena Raina Rapporteurs Regional Adviser – Dr Iyanthi Abeyewickreme Child and Adolescent Health Regional Adviser – HIV/AIDS Dr Sunil Senanayake Dr Narimah Awin Regional Adviser – National Health Regional Adviser – Making Pregnancy Safer Planning & Health Financing (NPF) & Reproductive Health Dr Jigmi Singay Dr AP Dash External Relations Offi cer Regional Adviser – Vector-Borne and Dr Dhirendra Narain Sinha Neglected Tropical Diseases Control Regional Adviser – Surveillance Dr Thushara Fernando Dr Prakin Suchaxaya Planning Offi cer Regional Adviser – Dr Renu Garg Nursing & Midwifery Ag Regional Adviser – Noncommunicable Diseases Dr Sara Varughese Programme Manager – Dr Suvajee Good Disability and Rehabilitation Regional Adviser – Health Promotion and Education Dr Supriya Bezbaruah Disease Surveillance and Epidemiology - Dr Kathleen Holloway Communication Specialist Regional Adviser – Essential Drugs and Medicines Ms Nelly Enwerem-Bromson Ag Tecnical Ofi cer- Dr Khurshid Alam Hyder Strategic Alliances and Partnerships Regional Adviser – Tuberculosis Ms Vismita Gupta-Smith Dr Nyo Nyo Kyaing Public Information and Advocacy Offi cer Regional Adviser - Tobacco Free Initiative Dr Akjemal Magtymova Dr Sudhansh Malhotra Medical Offi cer – Making Pregnancy Safer Regional Adviser – Primary and Community Health Care Mr Bruce Murphy Dr Ilsa Nelwan Reports and Documents Offi cer Regional Adviser – Health Systems Dr A M Zakir Hussain Infrastructure Temporary International Professional - Dr Roderico Ofrin Environmental Health & Regional Adviser – Emergency & Climate Change Humanitarian Action Dr Rajesh Mehta Dr Leonard Ortega Temporary International Professional – Regional Adviser - Malaria Child and Adolescent Health Ms Payden Dr Boosaba Sanguanprasit Regional Adviser – Water, Sanitation and Temporary International Professional - Health Primary and Community Health Care Partners for Health in South-East Asia | 125

Dr Manisha Shridhar Ms Rekha Bettina Gautam Temporary International Professional – Temporary International Professional – Intellectual Property Rights and Trade & Strategic Alliances and Partnerships Health Mr Sudesh K Madanpotra Mr Sunil Nandraj Head, Travel and Central Services Cluster Focal Point for Health Systems Development Mr J.K. Verma WCO India Administration Assistant, Deputy Regional Director’s Offi ce Ms Anagha Khot Focal Person for Human Resource in Health Mr Anuj Mittal WCO India Information Systems and Management Mr Gautam Basu Mr Sharath Babu Assistant (Editorial) Administrative Assistant WHO Country Offi ce Focal Points Mr VJ Mathew Administrative Assistant Dr Reuben Samuel Focal Person for Partnerships Ms Shirin Stephens WCO India Administrative Assistant Dr Somchai Peerapakorn Mr H.C. Sharma Focal Person for Partnerships Travel Assistant WCO Thailand Mr Deepak Walia Dr Chandrakant Lahariya Clerk Routine Immunization and New Vaccines Ms Ritu Agarwal Focal Person Clerk NPSP India Mr Aatish Jain Mr David Selvanayag Clerk India Mr Samsher Singh Mr Chaigyau Mog Information Systems and Management India Mr Shazad Alam Dr Paul Francis Information Systems and Management India Other Members of the Secretariat Mr Paul Carlson Field Security Offi cer and Ag Administrative Services Offi cer 126 | Conference Report 2011

Annex 3 Delhi Call For Action on Partnerships for Health Drafting Committee 17 March 2011

1. Dr Budihardja Singgih (Chairperson) 7. Professor Arjun Karki Directorate General for Nutrition and Vice Chancellor Maternal and Child Health Patan Academy of Health Sciences Ministry of Health Nepal Indonesia 8. Ms Elizabeth Kurian 2. Mr Marcelo Amaral Regional Director Head, Department for Planning, Sight Savers International Monitoring and Evaluation India Ministry of Health Timor-Leste 9. Dr Darivianca Elliotte Laloo Technical Offi cer 3. Professor Ranjit Roy Chaudhury Partnership for TB Care and Chairman, Task Force for Research Control in India Apollo Hospitals Educational and International Union Against Research Foundation Tuberculosis and Lung Disease India India 10. Professor Tint Swe Latt 4. Dr Madhumita Dobe Rector Secretary-General University of Medicine (2) Indian Public Health Association Myanmar India 11. Dr Sudhansh Malhotra 5. Mr Farouk Shamas Jiwa Regional Adviser – Primary and Programme Offi cer, Advocacy and Community Health Care Public Policy, External Relations WHO South-East Asia Region Global Alliance for Vaccines and Immunization (GAVI) 12. Dr Pallab K. Maulik Switzerland Head, Research and Development The George Institute for Global Health 6. Dr Iqbal Kabir India Coordinator Climate Change & 13. Mr Bruce Murphy Health Promotion Unit Reports and Documents Offi cer Ministry of Health and Family Welfare WHO South-East Asia Region Bangladesh India Partners for Health in South-East Asia | 127

14. Dr Gayatri Palat 19. Dr Wonchat Subhachaturas Program Director, Palliative Care President International Network for Cancer The World Medical Association Treatment and Research Thailand India 20. Dr Sangay Thinley 15. Dr Titi Savitri Prihatiningsih Director Vice Dean of Academic Affairs Department of Communicable Diseases Associate Professor, Faculty of Medicine WHO South-East Asia Region Gadja Mada University India Indonesia 21. Dr Bhim Singh Tinkari 16. Professor Rohini de A Seneviratne Director, PHC Revitalization Division Professor and Head, Faculty of Ministry of Health and Population Medicine Nepal Department of Community Medicine University of Colombo 22. Mr Shailesh Vaite Sri Lanka Regional Coordinator for South-East Asia Region 17. Mr Jitendar Kumar Sharma Framework Convention Alliance on Project Offi cer Tobacco Control All India Institute of Medical Sciences India India 23. Mr Anant Vijay 18. Dr Dhirendra Narain Sinha Coordinator Finance, Resource Regional Adviser – Surveillance Mobilization WHO South-East Asia Region Global Stop Tuberculosis Partnership India Switzerland 128 | Conference Report 2011

Annex 4 Address by Dr Samlee Plianbangchang Regional Director, WHO South-East Asia Region

Excellency, Mr Ghulam Nabi Azad, Union Minister of Health & Family Welfare, the Government of India, Excellency, honourable guests and partners, ladies and gentlemen, With great pleasure and privilege, I warmly welcome you all to the WHO’s Regional Conference of Partners for Health in South-East Asia.

Ladies and gentlemen, Global health is a multi-stakeholder process. The organizations, both governmental and nongovernmental, which you represent here today, have an important role to play in global health governance. This meeting is being held at an important juncture in health development worldwide and in the South-East Asia Region. Many of the noteworthy achievements in health attained during the past century are now under threat. This is especially so in the developing countries like many in the South-East Asia Region. The threat from the combined effects of global crises started at the beginning of this century, in particular food, fuel, economy and climate change. As the world strives to address these global challenges, development budgets for health – particularly in developing countries - are being placed under tremendous pressure. New and innovative ways must be found to effectively tackle the prevailing gaps in under-funded health priorities, including: • health systems strengthening; and • control of chronic noncommunicable diseases. Although signifi cant progress has been achieved towards improving health of the people in South-East Asia, we simply must do much more. The South-East Asia Region bears a staggering 40% of the world’s disease burden for 26% of the world’s population, rendering the health challenges facing the Region vast, in both number and magnitude. South-East Asia still struggles with a list of communicable diseases that are now virtually unheard of in many countries of the world. Neglected tropical diseases, such as kala-azar, lymphatic fi lariasis, and yaws still thrive in some countries in this part of the world. The rapid increase of people living in cities with improperly planned urbanization represents a major threat to health where roughly 40% of the urban population lives in slums or shanty towns, exposing itself to many basic health problems. Partners for Health in South-East Asia | 129

Ladies and gentlemen, Disadvantage and ill health are closely linked. So, the urban poor suffer disproportionately from a wide range of health problems. With a massive number of people living at close quarters and only 60% of all people in South-East Asia having access to proper sanitation, the struggle to fi ght communicable diseases lingers on. Diseases such as malaria, tuberculosis, diarrhoea, vector-borne diseases and HIV/AIDS will continue to subsist under these conditions. Progress made thus far in malaria and tuberculosis control is also now being compromised by the emergence and spread of drug resistant pathogens. This burden of communicable diseases is compounded by the growing challenge of NCDs. The Region has about 240 million smokers, a large percentage of adults who do not have adequate physical activity, and at least 80% of the population does not eat suffi cient quantities of vegetables and fruits. The biggest killers in South-East Asia are cardiovascular diseases, diabetes and cancer. Indeed, the Region is facing the double burden of communicable and non-communicable diseases.

Distinguished participants, Despite a high level of government commitment, the South-East Asia Region contributes to one third of maternal deaths world wide. Child mortality shows a declining trend; but it is still unacceptably high in several countries. The challenges in meeting the desired targets for maternal and child mortality reduction are linked to low fi nancing for maternal, newborn, and child health; low coverage of comprehensively evidence-based interventions; and weak health systems infrastructures. The infrastructures of our health care services are fragmented and suffer from huge defi cits in human resources and facilities. Catastrophic expenditures on health-care are recognized as a major cause of impoverishment and poor health. These are only some of the issues and challenges facing SEAR. Through inclusive partnerships, we must collectively address the related social, economic and environmental factors in the most comprehensive manner, the factors that contribute, directly and indirectly, to the double disease burden in South-East Asia. It is our common responsibility to take full advantage of the momentum gained from our past experiences and use it as an impetus to invest more, in both technical and fi nancial terms, in saving lives, and ensuring better health for all people. No single government, no single organization, no matter how resourceful or powerful can successfully pursue such a formidable challenge alone. Health is indeed a cross-cutting area, which must be addressed in the true spirit of partnerships. By bringing together our combined wisdom and efforts, we can make a difference and we can help prevent unnecessary suffering, unnecessary morbidity and unnecessary deaths. Let us join hands and work together to meet the formidable health challenges that lie ahead. The efforts made today to promote and protect the health of all people in SEA will reverberate throughout the Region – and throughout the world – far into the future. With these words, ladies and gentlemen, I wish you all a very successful meeting. Thank you. 130 | Conference Report 2011

Annex 5 Millennium Development Goals

Adopted by world leaders in the year 2000 and set to be achieved by 2015, the Millennium Development Goals (MDGs) provide concrete, numerical benchmarks for tackling extreme poverty in its many dimensions.

The MDGs also provide a framework for the entire international community to work together towards a common end – making sure that human development reaches everyone, everywhere. If these goals are achieved, world poverty will be cut by half, tens of millions of lives will be saved, and billions more people will have the opportunity to benefi t from the global economy.

The eight MDGs break down into 21 quantifi able targets that are measured by 60 indicators.

Goal 1: Eradicate extreme poverty and hunger

Goal 2: Achieve universal primary education

Goal 3: Promote gender equality and empower women

Goal 4: Reduce child mortality

Goal 5: Improve maternal health

Goal 6: Combat HIV/AIDS, malaria and other diseases

Goal 7: Ensure environmental sustainability

Goal 8: Develop a Global Partnership for Development

Available at: http://www.undp.org/mdg/basics.shtml Partners for Health in South-East Asia | 131

Annex 6 Child And Maternal Mortality In South-East Asia

What is the problem? Maternal Under-5 mortality ratio Country mortality rate • Child, newborn and maternal mortality (per 100 000 live (per 1,000) are declining in SEAR countries. There are births) many success stories in the Region to share 340 – making Bangladesh 54 – on track with others. However, this decline has progress been uneven. Overall the Region needs to accelerate progress to achieve MDG 4 and Bhutan 81 – slow 200 – on track MDG 5. 55 – no 250 – insuffi - DPR Korea • Member States of the WHO SEA Region progress cient progress account for 27% of the world’s population 69 – 230 – making India insuffi cient but contribute to a third of global burden progress of child and maternal deaths. progress 240 – making MDG5 (reducing maternal mortality) is Indonesia 41 – on track • progress the MDG that has made least progress 28 – early globally; the average MMR for the SEA Maldives 37 – on track Region for 2008 was 240 per 100 000 achiever live births. Five countries account for 122 – 240 – making Myanmar insuffi cient 80% of these deaths – Bangladesh, India, progress Indonesia, Myanmar and Nepal. progress 380 – making Nepal 51 – on track • The incidence of low birth weight (LBW) progress is still high (30%) in the SEA Region; the prevalence of underweight and stunting in Sri Lanka 17 – slow 39 – achieved children also remains high. 14 – early Thailand 48 – achieved • The major causes of maternal deaths achiever are haemorrhage, ecclampsia, sepsis, Timor- 370 – making 93 – slow unsafe abortion and underlying medical Leste progress conditions. under-fi ve mortality occurs in the neonatal • The major causes of under-fi ve child period, the main causes of neonatal death mortality are acute respiratory infections being LBW and prematurity, infections and diarrhoeal diseases. Above 50% of and asphyxia. 132 | Conference Report 2011

Why is it important and urgent remarkable difference among different to address this problem? population groups. • A large proportion of maternal and child • This inequity of health and survival exists mortality is preventable. because of economic status and social factors like gender, location (rural vs. • Additionally, the high mortality among urban) status of education etc. Addressing children and women and low national health inequity would help ensure the averages of coverage of life saving basic rights of gender and social equality interventions are associated with a in the member countries.

Inequity in MNCH

Use of the basic maternal and child health services by lowest and highest economic quintiles, 50 + countries

Reprinted, with permission of the publisher, from Gwatkin, Wagstaff and Yazbeck (2005). Partners for Health in South-East Asia | 133

Under Five Mortality Rate by Wealth Quintile

Under Five Mortality Rate by Sex

Under Five Mortality Rate by Residence 134 | Conference Report 2011

• Evidence-based and affordable technologies and interventions are available that are applicable across the continuum of care and during specifi c stages of the life course.

Global consensus MNCH interventions & packages

REPRODUCTIVE CHILD BIRTH CARE EMERGENCY NEWBORN AND CHILD CARE

• Post-abortion • Emergency obstetric care (including Ext • Hospital care of newborn and childhood illness care, safe cephalic version, AMTSL, Partogram including HIV care abortion where use, antenatal steroids, antibiotics as • Extra care of preterm babies including kangaroo legal indicated mother care Clinical • Skilled obstetric care and immediate • Emergency case of sick newborns • STI case newborn care (hygiene, warmth, management breastfeeding) and resuscitation, infection prevention • PMTCT/ART for HIV REPRODUCTIVE ANTENATAL POSTNATAL CARE CHILD HEALTH CARE HEALTH CARE CARE • Promotion of • Immunisations, • Family planning • 4-visit focused healthy behaviours nutrition, e.g. Vitamin • Prevention and package • Early detection A supplementation and management of • IPTp and of and referral for growth monitoring STIs and HIV bednets for illness • IPTp and bednets for including ART malaria • Extra care of LBW malaria • Peri-conceptual • PMTCT/ART babies • Care of children folic acid for HIV • PMTCT with HIV including

Outreach/outpatient cotrimoxazole • First level assessment and care of childhood illness (IMCI) FAMILY AND COMMUNITY • Adolescent and • Counselling and • Where skilled Healthy home care including: pre-pregnancy preparation for care is not • Newborn care (hygiene, warmth) nutrition new born care, available, consider • Nutrition including exclusive breastfeeding and • Education breastfeeding, clean delivery appropriate complementary feeding • Prevention of birth and and immediate • Seeking appropriate preventive care STIs and HIV emergency newborn care • Danger sign recogniton and careseeking for illness preparedness including hygiene, • Oral rehydration salts for prevention of warmth and dehydration Family/community early initiation of • Where referral is not available, consider case breastfeeding management for pneumonia, malaria, neonatal sepsis

INTERSECTORAL Improved living and working conditions-Housing, water and sanitation, and nutrition education and empowerment

Pre-pregnancy Pregnancy Birth Newborn/postnatal Childhood Partners for Health in South-East Asia | 135

• However, the coverage of interventions that can save the lives of women and children has been low in the countries in the Region.

Births attended by Skilled Health Personnel (%) in 1990-90 and 2000-08

Proportion of Infants less than 6 Months Exclusively Breastfed 136 | Conference Report 2011

Children 0-59 months with diarrhoea past two weeks given ORS

Children 0-59 months with suspected pneumonia taken to health care provider and received antibiotics

What contributes to this problem determinants such as poverty and • Weaknesses in the health system, several socio-cultural factors like status especially shortage of human resources, of women, education, employment, and access to quality care 24 hours and 7 transport, etc. days a week, are often a determinant of • Adolescent (10-19 years age group) poor maternal and child health survival. pregnancy, because of social practice • Beyond the health system, maternal of early marriage in some countries in and child health has multifactorial the Region, is associated with higher Partners for Health in South-East Asia | 137

maternal mortality, low birth weight and • This underscores the importance a higher newborn and infant mortality. of multisectoral collaboration and partnerships with all relevant • MDG 4 and MDG 5 are infl uenced by stakeholders. all the other Millennium Development Goals, especially poverty, education, • The survival of mothers, newborns and gender equality, HIV/AIDS and children is signifi cantly affected by the malaria, the environment and the role of quantum of national health expenditure, partnership. especially from public funds.

The “Health MDGs”

What is being done to alleviate this track to achieve MDG 4 and MDG 5. problem? has there been progress? As with the global trend, there has been • Member States have put in place signifi cant reduction of maternal and policies, strategies and programmes child deaths in the SEA Region from to improve maternal and child health. 1990 to 2008. While the current maternal and child mortality rates are still unacceptably • WHO and international development high in several countries, some are partners have worked together with making good progress and a few are on Member States in these efforts. 138 | Conference Report 2011

There is a high level of political • Ensure adequate fi nancing and commitment as refl ected by the investment for maternal and child health, Governments in the UN Secretary- and increase public spending on health, General’s initiative for the health of to reach about 5% of GDP to prevent women and children. catastrophic out-of-pocket expenditure.

What else is to be done? • Strengthen the health systems and Member States, in partnership with address the shortage of human resources development partners, civil society and for health to increase the coverage of life- other stakeholders must continue to: saving interventions and ensure access to quality care in order to improve maternal Accord high political commitment and • and child health and survival. visibility to maternal and child health; and this commitment must be manifested • Further enhance intersectoral in terms of increased resources for collaboration to address the socio-cultural maternal and child health. determinants of maternal and child • Eliminate inequities in health between health and survival and decrease barrier the rich and the poor, men and women, of access to quality care. urban and rural areas by increasing access to health services at community level so • Strengthen governance and stewardship that the ‘unreached’ can be reached with and develop a mechanism for life saving interventions. accountability. Partners for Health in South-East Asia | 139

Annex 7 Millennium Development Goal 6: Fighting HIV/AIDS, Malaria and Tuberculosis in the South-East Asia Region

Millennium Development Goal 6 • One in every three patients with TB lives • This goal focuses on combating HIV/AIDS, in the WHO South-East Asia Region, malaria and other diseases. where half a million deaths due to the disease occur every year. Bangladesh, • It has three main targets: India, Indonesia, Myanmar and Thailand are among the 22 countries with the – Target 6A: Have halted by 2015 highest burden of TB, accounting for and begun to reverse the spread of 80% of all TB cases globally. HIV/AIDS. • Globally, an estimated 33.3 million Target 6B: Achieve, by 2010, – people live with HIV/AIDS, and 2.6 universal access to treatment for million were newly infected in 2009. In HIV/AIDS for all those who need it. the South-East Asia Region, 3.5 million – Target 6C: Have halted by 2015 and people are living with HIV/AIDS, largely begun to reverse the incidence of in India, Indonesia, Myanmar, Nepal malaria and other major diseases such and Thailand. In 2009, there were an as tuberculosis. estimated 220 000 new HIV infections, and 230 000 deaths due to AIDS-related Why HIV, TB and Malaria are illnesses in the Region. important • Though HIV, TB and Estimated HIV Burden in South-East Asia malaria are preventable Region, 2009 and TB and malaria are curable, more than 10 million people in the Region suffer from these three diseases with a signifi cant health, social and economic impact. • More than 70% of the population of the South- East Asia Region lives in areas where malaria is transmitted. 140 | Conference Report 2011

Estimated TB prevalence, incidence, mortality and notifi cation rate: SEA Region, 1990-2009

The people who are most vulnerable HIV prevalence among new TB • Pregnant women and under-fi ve children patients is 5.7% but varies widely are biologically high-risk groups for among countries. malaria. Migrant workers in rural areas, MDG 6 and poverty: A “Catch-22” those residing in forested areas or forest situation fringes, and ethnic communities are among the high-risk groups. • The association between poverty, malnutrition and communicable diseases, • Sex workers, men who have sex with including HIV, malaria and TB, are well men, transgenders and injecting drug established. The poor are malnourished, users are more vulnerable to HIV/AIDS. leading to greater susceptibility to infection. • Those who are immuno-suppressed, such as people living with HIV, are also • In children, this combination of more vulnerable to TB. Over 25% of malnourishment and disease could TB is attributable to poor nutrition and have long-term repercussions in terms another 25% to HIV infection. Those of mental development as well as life living in crowded and poorly ventilated expectancy. conditions are more likely to get TB. TB • In adults, absenteeism due to ill health, is also linked to smoking, alcohol use and and the cost of care, leads to further diabetes. erosion of earning capacity, and so the • The South-East Asia Region accounts family sinks deeper into poverty. for nearly 15% of the global burden of • The poor also have the least access to new HIV-positive tuberculosis cases. proper treatment. Partners for Health in South-East Asia | 141

Preventing HIV/AIDS, malaria and Key challenges tuberculosis • Universal access to care is crucial for • Simple measures can go a long way towards fi ghting the three diseases. preventing these diseases. The most important is awareness. For example, the • Newer, better and more cost-effective vast majority of people living with HIV/ drugs and diagnostics are urgently AIDS remain unaware of their infection needed. status. • Stigma and discrimination continue to be • Use of insecticide-treated bednets and use challenges. of mosquito repellents can substantially reduce the risk of malaria. • The underlying social and economic • Awareness of TB and the fact that it is factors that lead to greater vulnerability curable leads to prevention. to the disease also need to be tackled.

Malaria Intervention Status in SEA Region, 2004-2009 Bednet Coverage

Bednet coverage (including untreated) increased from 0.3% in 2004 to 23.8% in 2009. 142 | Conference Report 2011

WHO’s role by WHO, 95 countries have access to • WHO plays a key role in providing quality assured fi rst- and second-line anti-TB drugs. Uninterrupted supply of technical support to Member States. these vital drugs at the service delivery In the case of HIV/AIDS, for example, points and strengthening of procurement WHO has recently produced guidelines and supply management chain are the on the use of antiretroviral drugs focus of attention at all levels and targets for treating pregnant women; and for the programmes. preventing HIV infection in infants could substantially reduce pediatric HIV and Why partnerships are needed improve maternal and child survival rates. • The three diseases targeted by MDG 6 • WHO also plays a strong advocacy role, are too deeply entrenched in society to be especially with governments. WHO is easily effaced. advocating for action to reduce stigma • They are no longer health issues alone and discrimination in health-care settings but also social issues. They cannot, and communities so that vulnerable and therefore, be fought by the health sector high-risk populations can access health- alone. care services without prejudice and fear. • Partnerships are therefore needed from • Through the Global Drug Facility, an every part of society to successfully fi ght arm of the Stop TB Partnership housed these diseases. Partners for Health in South-East Asia | 143

Annex 8 Health Systems Strengthening

A health system consists of all organizations, public health implications, e.g. AIDS, people and actions whose primary intent is tuberculosis and malaria. Immunization, to promote, restore or maintain health. as the most-cost effective intervention for preventing various childhood diseases, Why is health systems strengthening takes similar path. important? Despite many benefi ts that have accrued The Alma-Ata Declaration on Primary from the vertical approach, it has been Health Care (PHC) in 1978 advocated a realized that there are disadvantages. The comprehensive and integrated approach in sustainability of vertical programmes is implementing essential health programmes compromised due to fragmentation of through health systems. It is also known already weak health systems. The approach as comprehensive PHC. The declaration further weakens the already overstretched also promoted the goal of Health for All health systems. Donors under the Global (HFA) by the year 2000. HFA is a social Health Initiatives realize that harmonization goal, aiming at attainment for all people of and alignment of funds are mandatory to the world of the highest health status that enhance the effi ciency and effectiveness of will permit them to lead a socially and their assistance (Paris Declaration and Accra economically productive life. Agenda for Action, 2006). In line with these principles, GAVI, the Global Fund Primary health care requires a change (GF) and the World Bank have agreed on in socioeconomic status, distribution strengthening the health system through of resources, a focus on health system provision of specially earmarked funds. development, and emphasis on basic health services that are public health in nature. Key challenges for health systems Some have considered PHC too idealistic High disease burden: WHO’s South-East and expensive, and many donors preferred Asia Region contains 27% of the global a selectively focused, disease-centred model. population, accounts over 28% of global Thus, they took a shortcut by adopting the disease burden. so-called vertical approach, or selective PHC, to deal with health conditions responsible for Emergencies and disasters: The Region a high disease burden that need quick results. continues to be vulnerable to emergencies and disasters caused by various hazards but This approach continues to be used for primarily by natural ones. For the decade eradication or elimination of certain 1998-2008, 61.16% of global deaths due to diseases, such as polio, measles and disasters caused by natural hazards were in communicable diseases having signifi cant these 11 countries. 144 | Conference Report 2011

Low budget: In the Region, health Health workforce: In most countries expenditure depends on private expenditure too much focus is placed on medical (66.4%). Total expenditure as a percentage care and less on public health, resulting of GDP is only 3.4% and per capita in low priority being accorded to government expenditure on health was community-based health workers and only US$29 in 2006, much lower than the community health volunteers compared to World Health Report 2010 recommendation doctors . of 60 international dollars for essential interventions comprising HIV/AIDS/TB/ The conceptual framework for malaria, childhood infectious diseases, strengthening health systems to accelerate maternal and prenatal conditions, the achievement of the health-related micronutrient defi ciencies and tobacco- Millenium Development Goals is outlined related illnesses. below:

Health systems strengthening conceptual framework

Challenges: National Health Policies Health system • High disease strengthening Strategies and Plans burden: based on PHC: Communicable • Equitable access disease and • Focus on primary Improved non commu- care with referral health nicable disease back-up Increase (including • Emergencies: funding • Affordable MDGs) Epidemics Align and • Public health & natural balance with Improved harmonize disasters medical care health donor funding • People-centred equity • Low health care Social inclusion budget • Use of (including • Health appropriate MDG3) workforce technology Trust and • Good confi dence intersectoral collaboration

The World Health Report 2010 theme is health of the population in a signifi cant “Health Systems Financing for Universal manner due to the following: Coverage”. It must be remembered that achieving universal coverage does not • Many associate Universal Coverage with automatically mean improvement of the coverage of health insurance or social Partners for Health in South-East Asia | 145

security schemes that mainly deal with Reducing unnecessary expenditure on medical care. medicines and using them more appropriately, and improving quality control, could Most public health interventions are • save countries up to 5% of their health provided free by the government or expenditure. Solutions for the other enjoyg high government subsidy. problems can be grouped under the following • Unlike medical care that is a private good, headings: public health is a public good. The private sector is not interested in producing this • Get the most out of technologies and good and the government has to provide health services it free. • Motivate health workers • Few public health specialists that are • Improve hospital effi ciency multidisciplinary and multisectoral in nature to reduce dependency on medical • Get care right the fi rst time by reducing doctors that is expensive to produce. medical errors The report identifi es ways for countries to • Eliminate waste and corruption improve effi ciency: • Critically assess what services are needed 146 | Conference Report 2011

Annex 9 The growing crisis of noncommunicable diseases in the South-East Asia Region

Noncommunicable diseases: • 8 million people die of NCDs each year Why are they important? in the Region. • Four types of noncommunicable diseases • 54% of all deaths in the Region are (NCDs)—cardiovascular diseases, cancers, due to NCDs — far in excess of deaths diabetes and chronic respiratory diseases from communicable diseases, maternal, — contribute to the majority of global perinatal and nutritional causes put mortality. together (see chart). • Four modifi able health-risk behaviours • A 21% increase in NCD deaths is — lack of physical activity, unhealthy projected in the Region over the next 10 diet, tobacco use and excessive alcohol years. consumption — are responsible for much of the illnesses and early deaths related to NCDs affect younger age groups in NCDs. the Region • 30% of NCD deaths in the Region occur These diseases are largely preventable • among adults below 60 years of age. through effective interventions that tackle common risk factors, and are frequently • A sharp rise in NCD deaths is noted after manageable through early detection, the age of 40 years. improved diet, exercise and treatment. • Middle-aged adults (40–60 years) show disproportionately higher death NCDs are the top killers in the Region rates due to NCDs compared with • 22% of the global NCD deaths occur in their counterparts in more developed the South-East Asia Region. countries.

NCDs affect the poor and further Estimated percentage of exacerbate poverty deaths, by cause, SEAR, 2005 • The poor are extensively exposed to the health-harming impacts of the environment and have less freedom and power to make healthy choices. • Loss of household income among the poor occurs from unhealthy behaviours (such as tobacco and alcohol use), loss of productivity (due to disease, disability and premature death) and high Partners for Health in South-East Asia | 147

out-of-pocket health-care expenditure • 80% of heart diseases and stroke, 80% of (on treatment), thus exacerbating poverty. Type 2 diabetes and 40% of cancers can be prevented by eliminating common • 40% of household expenditures for risk factors, namely poor diet, physical treating NCDs in India are fi nanced inactivity and smoking. through household borrowing and sale of assets. • Estimates suggest that a 2% annual reduction in NCD deaths over a decade Major risk factors for NCDs are would save over 8 million lives, the prevalent in the Region majority under the age of 70 years. • 8%–26% of all adults do not meet the recommendations for aerobic physical • 150 minutes of moderate physical activity a week or its equivalent is estimated to activity based on global guidelines. reduce the risk of ischaemic heart disease • Nearly 250 million people smoke in the by 30%, the risk of diabetes by 27% and Region. the risk of breast and colon cancer by 21%–25%. • 80% of the population does not eat suffi cient quantities of fruits and Key challenges in the prevention and vegetables. control of NCDs • Childhood and adult obesity, key • NCD prevention and control determinants of NCDs, are on the rise in programmes remain largely neglected and the Region. underfunded at all levels.

NCDs are increasing health-care • Globalization and economic development demands are fuelling the risk factors for NCDs through the availability of processed/ • NCDs are dominating health-care high-energy foods and lack of needs in most countries in the Region opportunities for physical exercise. as a result of the epidemiological and demographic transition. • NCD prevention and control • Health systems are currently ill equipped programmes are currently not included in the Millennium Development Goals, to tackle NCDs. making them a low priority for national • Lack of access to affordable medicines and international developmental partners. and health-care services are also major causes of premature deaths due to NCDs. WHO’s role in NCD control • Raising the priority of NCDs in NCDs can be prevented health, development plans and • NCDs can be prevented, delayed or initiatives is one of the key priorities alleviated through simple lifestyle of WHO’s work. The Global Strategy changes. for the Prevention and Control of 148 | Conference Report 2011

Noncommunicable Diseases (2000) and Partnerships are key the Global Action Plan (2008–2013) • Many determinants of NCDs lie outside guide the work of WHO at the global the health sector. Addressing these risk level. The work of WHO SEARO in the factors requires the commitment and area of NCDs in the Region is guided by active involvement of the non-health the Regional NCD Framework, endorsed sector, including planning, agriculture, by the WHO Regional Committee in industry, trade, fi nance and education. 2007. Key strategies include: Action is also required by the private sector and civil society. • Advocacy and raising awareness. • Prevention and control of NCDs should • Surveillance to map risk factors for be on everybody’s agenda. NCDs. • NCDs are a serious threat to ALL Member States in the South-East Asia Region. • Primary prevention focusing on health promotion and legislation. • Effective NCD control is cheaper than treatment for both governments and • Early disease detection and early families. Prevention is key. treatment at the primary health care level. • Urgent actions are needed by all partners to prevent and control NCDs. • Evidence building through research.