Annual report of the Regional Director for the year 2018
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1) The document discusses the WHO Regional Director for the Eastern Mediterranean's annual report, focusing on expanding universal health coverage, addressing health emergencies, and promoting healthier populations. 2) Key goals discussed are enabling 1 billion more people to benefit from universal health coverage, better protection from health emergencies, and better health and well-being. 3) Challenges facing the region include lower essential health coverage than other world regions, rising rates of communicable diseases like HIV and hepatitis C, and high maternal and child mortality. The region is working to strengthen health systems, implement emergency response plans, and promote prevention of noncommunicable diseases.
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Annual report of the Regional Director for the year 2018
- 1. Tehran, Islamic Republic of Iran 14 –17 October 2019 Introduction of the Annual Report 1 Dr Ahmed Al Mandhari WHO Regional Director for the Eastern Mediterranean Agenda item 2(a)
- 2. 2
- 3. Working together for greater impact in countries 3 Our goal is clear – to make WHO a modern organization that works seamlessly to make a measurable difference in people’s health at country level.
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- 20. Expanding universal health coverage 1 billion more people benefiting from universal health coverage 1 billion more people better protected from health emergencies 1 billion more people enjoying better health and well-being 20
- 21. Stepping up action to achieve UHC 21
- 23. Our Region is lagging behind Essential health service coverage is lower in the Eastern Mediterranean Region than on other parts of the world 23
- 24. Health service coverage index 2017 24
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- 35. Primary Health Care Measurement and Improvement Initiative 35
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- 37. Evidence-based policy-making Evidence- informed policy- making Knowledge translation Health technology assessment Guideline development and adaptation Routine data, health information systems National surveys Ad hoc studies, monitoring & evaluation 37
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- 39. The hospital sector needs to be transformed 740 000 hospital beds in the Region (80% in the public sector) Range: 3.932/10 000 population Bed utilization In sub-district and rural areas <30% Destroye d hospital s Syrian Arab Republic 46% Treatable at PHC level Overcrowded large hospitals 80% Direct access to emergenc y units Non- emergency cases 60% Hospital expenditu re 50 80% Advers e events Inpatients Up to 18% 39
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- 41. No UHC without nurses Nurses make up more than 50% of the health workforce 41
- 42. Framework for action Strengthening nursing and midwifery in Region 66th Regional Committee Resolution to strengthen nursing workforce in Region Global strategic directions For strengthening nursing and midwifery 20162020 2008 2011 2016 2017 2019 2020 WHA resolution RC55 resolution Framework for action Health workforce development in Region Year of the Nurse NURSING NOW CAMPAIGN Global and regional momentum to strengthen nursing 42
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- 44. WHO’s Eastern Mediterranean Region has highest rate of hepatitis C viral infections 7 10 11 14 14 15 0 2 4 6 8 10 12 14 16 AM SEA AF EUR WP EM Estimated number of persons living with hepatitis C virus (millions) by WHO region 44
- 45. Estimated malaria cases (millions) by WHO region, 2017 The number of malaria cases in the Region increased from 3.9 million in 2015 to 4.4 million in 2017. Six countries account for more than 99% of cases in the Region. 45
- 46. The HIV infection rate is rising, treatment rates are low 59 76 18 54 50 63 0 10 20 30 40 50 60 70 80 AFR AMR EM EUR SEAR WPR ART Coverage by WHO Region (%) 46
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- 55. Rubella In 2018, more than 70 million people were vaccinated with measles- containing vaccines 55
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- 60. Protecting people from emergencies 1 billion more people better protected from health emergencies 1 billion more people benefiting from universal health coverage 1 billion more people enjoying better health and well-being 60
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- 64. WEEKLY SIGNALS AND EVENTS TOTAL NUMBER OF GRADED EMERGENCIES 39 1 1 18 3 Grade 3 8 Grade 2 2 Grade 1 15 Signals Detected Signal Followed- up New Events Ongoing Events 0 Protracted 3 2 Protracted 2 0 Protracted 1 Total number of graded emergencies and events 64
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- 72. 72 The Dubai Hub: a game changer 14 000m2 temperature- controlled space Rapid response and large volumes Medical supplies to 24 countries across three WHO regions Strategic forecasting to enhance preparedness Supply chain dashboard
- 73. Point of entry training 18 countries of the Region have now completed the joint external evaluation process 73
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- 76. 76 Providing essential medicines to manage NCDs in emergency settings
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- 80. 80 Eastern Mediterranean Region polio situation and risk categories 20192020 Endemic countries: Afghanistan and Pakistan Countries with outbreaks and at very high risk: Somalia, Syrian Arab Republic, Yemen Countries at high risk: Djibouti, Iraq, Libya, Sudan
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- 89. Promoting healthier populations 89 1 billion more people benefiting from universal health coverage 1 billion more people better protected from health emergencies 1 billion more people enjoying better health and well-being 1 billion more people benefiting from universal health coverage
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- 94. The Eastern Mediterranea n Region has the highest rate of neonatal mortality in the world 94
- 95. Regional situation 9 5 26 deaths/ 1000 live births 47 deaths/ 1000 live births 109 deaths/ 100 000 live births 1019 years Under 5 years Newborns 59 years 115 deaths/ 100 000 live births Second highest region for mortality rates across all age groups
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- 97. Maternal mortality ratio per 100 000 live births 97
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- 106. Health in All Policies approach “Ensuring that health issues are factored into all government decisions, not just ministry of health policies” 10 6
- 107. The Region has the third highest road traffic fatality rate in the world 10 7
- 108. Health leaders 10 8
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- 111. Probability of dying from cardiovascular disease, cancer, diabetes, chronic respiratory disease between the ages of 30‒70 in countries of the Region Source: World Health Organization. Global Health Estimates 2015: Deaths by Cause, Age, Sex and Country, 2000-2015. Geneva, WHO, 2016. 111
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- 115. Translating commitments into action To support countries to achieve food security, end all forms of malnutrition and improve nutrition throughout the life course by 2030 11 5
- 116. Rheumatic heart disease • A significant public health burden in the Region • Strongly associated with overcrowded living conditions • Eminently preventable 11 6
- 117. What is new in the updated framework? NCD investment case High-level multisectoral mechanism GOVERNANCE Reduce exposure to air pollution* A system to monitor air quality Estimations of health impact PREVENTION AND REDUCTION OF RISK FACTORS NCD integration in PHC in stable and emergency settings Implementation of regional framework on cancer HEALTH CARE Population-based cancer registry SURVEILLANCE, MONITORING AND EVALUATION * In line with Plan of action for the regional implementation of the roadmap to enhance the global response to the adverse health effects of air pollution 2017–2021 117
- 118. Screening and brief intervention in only 3 countries Receive evidence-based treatment 1 medication for detox 1 medication for maintenance No specialized facilities Outreach services for people who inject drugs Harm reduction programmes 11 8
- 119. Global meeting to accelerate progress on SDG target 3.4 11 9
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- 123. CEHA 12 3
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- 130. Scaling up contributions by WHO collaborating centres WHO supported establishment of a new WHO collaborating centre on ethics in Karachi, Pakistan 13 0
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- 135. Thank you 13 5
Editor's Notes
- UHC is a priority to the Eastern Mediterranean Region (EMR) and the region is facing major challenges in responding to the consequences of protracted emergencies, and the burden of communicable and noncommunicable diseases increasing the demand on health services and stretching the already strained health systems with implications on availability, skill mix, roles and competencies of nurses.
- The need to strengthen nursing in order to achieve UHC has been well articulated in global and regional WHO resolutions and evidence based strategic directions to guide MS’s efforts to address challenges facing nursing workforce. Having nursing on the agenda of this RC also highlights the importance of strengthening nursing in achieving the regional vision health for all by all More recent efforts include the three-year Nursing Now campaign (2018–2020) which has been initiated to raise the profile and status of nurses worldwide. Nursing Now rolled in eight countries,
- Narrative: A number of other countries in the Region are at high risk of outbreaks caused by importation of WPV1 or development of vaccine-derived poliovirus: Djibouti, Iraq, Libya, Sudan, Syrian Arab Republic and Yemen. All are experiencing varying degrees of complex emergency and have access or security constraints that hamper efforts to maintain high population immunity and sensitive surveillance
- This image beautifully demonstrates how all of the units within the regional programme interact to have an impact. This is an image taken from an environmental collection site in Mogadishu, Somalia, in July this year. This was the first formal documentation of environmental surveillance in Somalia. To get this shot, it took coordination between the External Relations team, the Laboratory and Surveillance teams, the country support team. From this, we have developed a guidance video on environmental surveillance and collection which will be an important tool for the programme as environmental surveillance expands in the Region, and globally. This work is also really important in highlighting the real value of maintaining such close collaboration with the technical team in Amman. Materials are developed based on a need determined by the country teams with the technical guidance of the people in this room.
- About 50% of countries either do not have any specialized treatment facilities or these are only available in the capital city. Fewer than one in 7 people with a substance use disorder worldwide receive evidence-based treatment, while in countries of the Eastern Mediterranean Region only one in 13 receives treatment. Screening and brief interventions are only available in < 10% of primary health care services in three countries. Only 1/3 of countries have needle/syringe exchange programmes and condom distribution programmes. Outreach services for injecting drug users are available in only 25% of countries. 63% of countries have at least one medication available for detoxification treatment. 50% of countries report the availability of at least one medication for maintenance treatment (either methadone, buprenorphine or buprenorphine/naloxone).