Report of the Regional Director

2 18 The Work of WHO in the South-East Asia Region Report of the Regional Director 1 January–31 December SEA/RC72/2 The work of WHO in the South-East Asia Region Report of the Regional Director 1 January–31 December 2018 The Work of WHO in the South-East Asia Region, Report of the Regional Director, 1January–31December 2018 ISBN: 978 92 9022 717 5 © World Health Organization 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercialShareAlike 3.0IGO licence (CCBY-NC-SA3.0I<a href="/goto?url=https://creativecommons.org/licenses/by-nc-sa/3.0/" target="_blank">GO; https://creativecommons.org/licenses/by-nc-sa/3.0/ </a>igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. 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Contents <ul style="display: flex;"><li style="flex:1">List of Acronyms </li><li style="flex:1">iv </li></ul>Part I from the regional director 1Part II the work of WHO in countries 15 15 Bangladesh Bhutan 23 Democratic People’s Republic of Korea 31 India 41 Indonesia Maldives Myanmar Nepal 55 67 77 87 Sri Lanka Thailand Timor-Leste 99 111 121 Part III delivering on the regional flagship priorities and beyond 131 List of acronyms <ul style="display: flex;"><li style="flex:1">ACT </li><li style="flex:1">artemisinin-based combination therapy </li></ul><ul style="display: flex;"><li style="flex:1">ADB </li><li style="flex:1">Asian Development Bank </li></ul>AEFI AFP adverse events following immunization acute flaccid paralysis AIIMS AMR ANM APA APQN APL All India Institute of Medical Sciences antimicrobial resistance auxiliary nurse midwife annual performance agreement Asia Pacific Quality Network assistive product list <ul style="display: flex;"><li style="flex:1">ART </li><li style="flex:1">antiretroviral therapy </li></ul><ul style="display: flex;"><li style="flex:1">ARV </li><li style="flex:1">antiretroviral </li></ul>ASEAN bOPV CBHC CCS CERF CRS Association of Southeast Asian Nations bivalent oral polio vaccine community-based health care (WHO) country cooperation strategy Central Emergency Response Fund congenital rubella syndrome <ul style="display: flex;"><li style="flex:1">CSO </li><li style="flex:1">civil society organization </li></ul><ul style="display: flex;"><li style="flex:1">CVD </li><li style="flex:1">cardiovascular disease </li></ul>DFAT DFID DHIS DPT Department of Foreign Affairs and Trade Department for International Development District Health Information System diphtheria–pertusis–tetanus DPR Korea EID Democratic People’s Republic of Korea emerging infectious disease <ul style="display: flex;"><li style="flex:1">EMT </li><li style="flex:1">emergency medical team </li></ul>EMTCT EOC elimination of mother-to-child transmission emergency operations centre <ul style="display: flex;"><li style="flex:1">EPI </li><li style="flex:1">Expanded Programme on Immunization </li></ul>emergency response to artemisinin resistance early warning alert and response system Food and Agriculture Organization WHO Framework Convention on Tobacco Control Framework of engagement with non-State actors Field Epidemiology Training Programme Family Health Bureau ERAR EWARS FAO FCTC FENSA FETP FHB fIPV FP fractional inactivated polio vaccine family planning Gavi GHSA GIS GISRS GLAAS GLASS GLP Gavi, the Vaccine Alliance Global Health Security Agenda Geographical Information System WHO Global Influenza Surveillance and Response System UN Global Analysis and Assessment of Sanitation and Drinking Water Global Antimicrobial Resistance Surveillance System Global Leprosy Programme iv THE WORK OF WHO IN THE SOUTH-EAST ASIA REGION GMS GPW HEOC HiAP HIS Greater Mekong Subregion General Programme of Work (of WHO) health emergency operations centre Health in All policies health information system HIV/AIDS HMIS HNAP HNPSDP HPV human immunodeficiency virus/acquired immune deficiency syndrome Health Management Information System health national adaptation plan Health, Nutrition, and Population Sector Development Plan human papillomavirus HRH ICC icddr,b ICT IDA IEC IEHK IHIP IHR human resources for health Interagency Coordination Committee on Immunization International Centre for Diarrhoeal Disease Research, Bangladesh information and communications technology ivermectin, diethylcarbamazine citrate and albendazole information, education and communication interagency emergency health kit Integrated Health Information Platform International Health Regulations (2005) <ul style="display: flex;"><li style="flex:1">influenza-like illness </li><li style="flex:1">ILI </li></ul>ILO IMF International Labour Organization International Monetary Fund IMNCI IPC IPD Integrated Management of Newborn and Childhood Illnesses infection protection and control (WHO) Immunization Preventable Disease Programme <ul style="display: flex;"><li style="flex:1">inactivated polio vaccine </li><li style="flex:1">IPV </li></ul><ul style="display: flex;"><li style="flex:1">IT </li><li style="flex:1">information technology </li></ul>ITAG IVD JE Immunization Technical Advisory Group Immunization and Vaccines Development Japanese encephalitis <ul style="display: flex;"><li style="flex:1">JEE </li><li style="flex:1">joint external evaluation </li></ul>JMM LF joint monitoring mission lymphatic filariasis LLIN M&E MCK MCV MDA MDG MDR-TB MDT mhGAP mhGAP-IG MMR MNT MoA MoF MoH MoHFW long-lasting insecticidal net monitoring and evaluation medical camp kit measles-containing vaccine mass drug administration Millennium Development Goals multidrug-resistant TB multidrug therapy WHO Mental Health Gap Action Programme WHO Mental Health GAP Intervention Guide measles–mumps–rubella maternal and neonatal tetanus memorandum of agreement Ministry of Finance Ministry of Health Ministry of Health and Family Welfare THE WORK OF WHO IN THE SOUTH-EAST ASIA REGION vMoHNIM MoHP MoHS MoPH MoU MPDSR MR Ministry of Health, Nutrition and Indigenous Medicine Ministry of Health and Population Ministry of Health and Sports Minisity of Public Health memorandum of understanding maternal and perinatal death surveillance and response measles and rubella <ul style="display: flex;"><li style="flex:1">NAP </li><li style="flex:1">national action plan </li></ul>NAPHS NATA NCDC NCD National Action Plan for Health Security National Authority on Tobacco and Alcohol National Centre for Disease Control (India) noncommunicable disease NGO NHAs NHI nongovernmental organization National Health Accounts national health insurance <ul style="display: flex;"><li style="flex:1">NIP </li><li style="flex:1">National Immunization Programme </li></ul>National Immunization Technical Advisory Group National Malaria Control Programme National Medicine Regulatory Authority National Pandemic Influenza Preparedness and Response Plan nurse practitioner in midwifery National Polio Surveillance Project National Regulatory Authority NITAG NMCP NMRA NPIPP NPM NPSP NRA NSACP NSP national STD/AIDS control programme national strategic plan <ul style="display: flex;"><li style="flex:1">NTD </li><li style="flex:1">neglected tropical disease </li></ul><ul style="display: flex;"><li style="flex:1">NTP </li><li style="flex:1">national TB programme </li></ul>OIE OOP World Organisation for Animal Health out of pocket PCV PEN Penta PIP PIPP PKDL PLHIV PM-JAY PMTCT POCQI PPE pneumococcal conjugate vaccine Package of Essential NCD Interventions pentavalent vaccine pandemic influenza preparedness pandemic influenza preparedness plan post-kala-azar dermal leishmaniasis people living with HIV Pradhan Mantri Jan Arogya Yojana prevention of mother-to-child transmission point-of-care quality improvement personal protective equipment <ul style="display: flex;"><li style="flex:1">pre-exposure prophylaxis </li><li style="flex:1">PrEp </li></ul><ul style="display: flex;"><li style="flex:1">RCV </li><li style="flex:1">rubella-containing vaccine </li></ul>RGoB RMNCAH RO Royal Government of Bhutan reproductive, maternal, newborn, child and adolescent health Regional Office (of WHO) <ul style="display: flex;"><li style="flex:1">RRT </li><li style="flex:1">rapid response team </li></ul>SDGs SEA Sustainable Development Goals South-East Asia (Region of WHO) vi THE WORK OF WHO IN THE SOUTH-EAST ASIA REGION SEA-RVC SEA Region SEARHEF SEARN SHOC SIA South-East Asia Regional Verification Committee South-East Asia Region (of WHO) South-East Asia Regional Health Emergency Fund South-East Asia Regulatory Network Strategic Health Operations Centre supplementary immunization activity Sri Lanka Accident Data Management System surveillance medical officer SLADMS SMO SOPs SRHR SSB standard operating procedures Sexual and Reproductive Health and Rights (Policy) sugar-sweetened beverage STAG STI Strategic Technical Advisory Group sexually transmitted infection STEPS STH WHO STEPwise approach to surveillance soil-transmitted helminthiasis <ul style="display: flex;"><li style="flex:1">TAG </li><li style="flex:1">technical advisory group </li></ul><ul style="display: flex;"><li style="flex:1">TB </li><li style="flex:1">tuberculosis </li></ul><ul style="display: flex;"><li style="flex:1">TCV </li><li style="flex:1">typhoid conjugate vaccine </li></ul><ul style="display: flex;"><li style="flex:1">Td </li><li style="flex:1">tetanus–diptheria </li></ul><ul style="display: flex;"><li style="flex:1">TT </li><li style="flex:1">tetanus toxoid </li></ul><ul style="display: flex;"><li style="flex:1">TWG </li><li style="flex:1">technical working group </li></ul><ul style="display: flex;"><li style="flex:1">UHC </li><li style="flex:1">universal health coverage </li></ul>UNCERF UNDAF UNDP UNEP UNFPA UNGA UNIATF UNICEF UNIDO UNSDF USAID US CDC VBD United Nations Central Emergency Response Fund United Nations Development Assistance Framework United Nations Development Programme United Nations Environment Programme United Nations Population Fund United Nations General Assembly UN Interagency Task Force on NCDs United Nations Children's Fund United Nations Industrial Development Organization United Nations Sustainable Development Framework United States Agency for International Development United States Centers for Disease Control and Prevention vetor-borne disease <ul style="display: flex;"><li style="flex:1">VL </li><li style="flex:1">visceral leishmaniasis </li></ul><ul style="display: flex;"><li style="flex:1">VPD </li><li style="flex:1">vaccine-preventable disease </li></ul>WAAW WASH WFME WFP World Antibiotic Awareness Week water, sanitation and hygiene World Federation for Medical Education World Food Programme WHE WHO WSP WHO Health Emergencies Programme World Health Organization water safety plan <ul style="display: flex;"><li style="flex:1">XDR </li><li style="flex:1">extensively drug resistant </li></ul><ul style="display: flex;"><li style="flex:1">YLL </li><li style="flex:1">years of life lost </li></ul>THE WORK OF WHO IN THE SOUTH-EAST ASIA REGION vii The WHO Regional Director for South-East Asia, Dr Poonam Khetrapal Singh, on a visit to the maternity ward at the Government Health Facility, Naypyitaw FFrroomm tthhee RReeggiioonnaall DDiirreeccttoorr Part I Universal health coverage: The road ahead This report of the work of WHO in the South-East Asia Region provides an overview of what the Organization and its Member States and partners have achieved in the past year. I will follow a similar line in this introduction, with a focus on the Region’s Flagship Priority Programmes, and on our progress in recent years. But I will also look ahead, providing depth to a conversation that has already begun, and which will continue to mature. That conversation is about universal health coverage (UHC), the pursuit of which is central to WHO’s work in the Region and beyond. When discussing UHC, I usually focus on two components – human resources for health and access to medical products. We will examine recent achievements in both areas shortly. But before we do, let us widen the scope and consider the subject more broadly. UHC is the bedrock of health policy in each of the Region’s Member States. It provides unity of purpose and an integrated approach to achieving health for all. As outlined in the Region’s Flagship Priorities, and in WHO’s Thirteenth General Programme of Work (GPW), the pursuit of UHC reflects the Organization’s commitment to achieving better health outcomes for all people everywhere. It is also an expression of our commitment to equity and human rights. FROM THE REGIONAL DIRECTOR’S DESK 1I am certain readers of this report will have heard UHC referred to as “the single most powerful concept that public health has to offer”. Indeed, that it may be – but only if it inspires governments and their partners to fully grasp the obstacles to universal access and financial protection. And let us be clear: Universality means everyone, including ethnic and religious minorities, migrants and those living on the margins of society. It also means services must be equally available and accessible as a right to all, irrespective of gender or sexual orientation. Notably, those services include affordable and safe medicines, adequate pain relief and palliative care, as well as long-term care for older persons. We must be similarly clear about how we define financial protection. Yes, financial protection is about providing insurance and reducing out-of-pocket payments. But it is also about improving the provision of health care, in access to medical education and health sector employment, and in the procurement of medicines and equipment. Moving forward, it is imperative we consider and act on ideas in their fullest sense. This is especially true for the concept of “Leaving no one behind” – the guiding maxim of the health and development sector more broadly. Unless we are courageous in identifying and remedying inequities, the phrase will become devoid of meaning. The same is true for UHC. Uncritically aligning all that is going on in health care with UHC is not only mistaken; it also has the potential to undermine an idea that, at its core, calls for bold, dynamic and wellcalibrated policy-making. To harness the potential of both concepts, rather than business as usual, we must pursue business unusual. That requires new ways of thinking and acting. It also requires making hard choices and backing them with steadfast resolve. Member States are poised for progress. As the country briefs in Part II of this report show, political support for UHC across the Region is strong. The same is true at the global level. WHO’s Transformation Agenda, which is at the heart of the Director-General’s reforms, aims to ensure that the Organization is better equipped to support its Member States achieve the path-breaking change needed. To that end, the United Nations’ High-Level Meeting on UHC in September holds great promise, with Thailand representing our Region as one of two co-facilitators. As you review the substantial achievements documented herein – many from 2018, and many made over the past five years – I invite you to join me in looking to the future. This is especially important as we update the Flagship Priorities, contribute to the GPW’s “triple billion” targets, and stay on track to achieve the Sustainable Development Goals (SDGs). To help you do that, I here frame three questions, each corresponding to a core component of the Region’s succinct but powerful vision: “Sustain. Accelerate. Innovate”. ~First: How can we sustain the gains we have made? The re-emergence of polio, maternalandneonataltetanusandarangeofcommunicablediseasesispossible. Vigilance is needed to prevent this happening. We must also protect against antimicrobial resistance (AMR) and guard increases in financial protection. These are but a few examples. The list is potentially very long. 2THE WORK OF WHO IN THE SOUTH-EAST ASIA REGION ~Second: How can we accelerate progress towards the goals and objectives we have agreed upon? What can we do to scale up interventions that we know to be effective? How can we overcome the bureaucratic hurdles that stand in the way of effective implementation? And how can we nurture the partnerships that turn pilot projects into large-scale implementation and ultimately social movements? Each of these questions must be addressed as a matter of priority. ~And third: How can we innovate in ways that will enhance the way we work and the results we achieve? Harnessing the benefits and mitigating the risks of new technology is part of the picture, but there is much, much more to consider. Innovation means new ways of thinking about familiar problems. It means abandoning tired ideas that have outlived their utility. And it means devising new and imaginative ways of delivering services, empowering people to advance their own health and the health of others and finding better ways to communicate risk in times of crisis. Universal health coverage: The road travelled WHO’s work in the Region is guided by the 2030 Sustainable Development Agenda and the achievement of the SDGs, as well as the strategies and targets agreed on by Member States in the GPW. Taken together, these objectives are broad. Member State needs are vast. Our resources are finite. Indeed, WHO’s financial contributions are miniscule in comparison to the combined resources of governments, the private sector and civil society. That requires us to be both strategic and catalytic, including by marshaling WHO’s unsurpassed technical expertise and convening power to support Member States and facilitate and leverage action by others. In doing so, we must make hard choices and be selective. Lighting the inaugural lamp at the celebration of the World Health Day 2018 global event in Colombo

Report of the Regional Director

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