Day Seven at the 64th WHA

Improvement of health through sound management of obsolete pesticides and other obsolete chemicals (resolution WHA63.26)
The issue was discussed in Committee B. Member states speaking were Morocco, Slovenia, Lesotho (on behalf of the 46 AFRO region countries), Bangladesh and China.  Slovenia encouraged the WHO to continue to support countries in the situation analysis, needs assessment and development of national action plans, going beyond the 13 countries that have been supported up to now (African countries were prioritized). Slovenia also stressed the need for more financial support and donors’ mobilization to address this issue. Next, Lesotho, speaking for the African countries, stated that this is a very big problem in Africa, the region has been facing mass exposures. Challenges being faced by African countries are capacity building and more participation of the health sector. Bangladesh then reported on the ban of 25 pesticides and chemicals. However, many of them, like endosulfan are still being produced and largely used in neighbouring countries. Therefore, international cooperation is needed to prevent cross boundaries removal of pesticides. The interventions were followed by a brief comment by the Secretariat, which stated that this is a good opportunity to influence multisectoral actors and to expand actions to more countries. And what about chemicals and pesticides that are not obsolete but are toxic and hazardous to population and nature? Nothing said about that.

Improvement of health through safe and environmentally sound waste management (resolution WHA63.25)
Committee B. Countries intervening were Thailand, Botswana (on behalf of 46 Afro countries), Bangladesh, China and Iraq. Thailand and Botswana recognized the declarations produced in Libreville (2008) and in Luanda (November, 2010), which bring commitments closer to African countries. Thailand stressed the importance of a more general approach of strengthening national health care policies.  Botswana, on behalf of African countries, claimed on the inequities in allocation n allocation of resources. Challenges for African countries are: inadequate legislation, lack of technical expertise, and diverse political and economic interests limiting implementation of actions to address this issue. Despite Africa’s disadvantaged situation, the establishment of a regional working group is encouraging. They urge the DG to continue at the leadership of WHO to continue the effort. Bangladesh recognizes the serious consequences for health and health workers and stated that this is one of the most important issues to be addressed in the next 5 years. Bangladesh urged the WHO to provide technical support to meet the training needs of health workers to deal with the management of waste. China brought up the need of supporting action on this issue in the context of emergency situations. Iraq highlighted the importance of including action on waste management in the framework of primary health care and to link it with MDG 6. After the interventions, the Secretariat’s comment was a very brief one, basically acknowledging countries’ contributions.

Working towards universal coverage of maternal, newborn and child health interventions (resolution WHA58.31)

This progress report was discussed in Commitee B. Countries intervening were: Holland, Bangladesh, Rwanda (on behalf of the 46 AFRO countries), Thailand, Malaysia, Nigeria, UK, Iraq and Algeria. Holland and UK advocated for more work on gender equality and women’s empowerment, warning that WHO’s strategy on gender equity has made slow progress. Holland stressed that maternal health is a very critical issue to be addressed, for it’s the one showing least progress. Therefore, the implementation of the recommendations of the Commission on Information and Accountability for Maternal and Child Health is crucial, and more reliable and evidence based data are required. They also called strongly for the elimination of female genital mutilation. Bangladesh, Malaysia and African countries reported on the progress of maternal and child health indicators in their countries. Bangladesh reported a significant reduction  in maternal and child deaths and stated that they’re on track with MDGs 4 and 5. Nevertheless, the fact that many countries are still not on track is of great concern.  Challenges brought up by Bangladesh were: shortage of health workforce and of skilled birth attendants as a major limitation for scaling up interventions, continuity of care in the post natal period, and increase in institutional deliveries. Successful outcomes for Bangladesh include social mobilization, women employment and education, family planning, and promotion of safe abortion. Moreover, Bangladesh has recently introduced a new monitoring program for vital statistics with use of information technology (IT). On behalf of African countries, Rwanda expressed great concern for the slow progress of MDGs 4 and 5 in Africa. Despite that, some progress have been made and a big campaign for the acceleration of child mortality in Subsaharan Africa has been launched. Investment in family planning and its important role has been emphasized. Challenges for the African region include: lack of access to health care, violence against women, STDs, and unsafe abortions. Insufficient funding for the region, lack of human resources for health and lack of medicines need to be addressed. Thailand highlighted the need to link maternal and child health issues with NCDs prevention and control. Malaysia reported on many interventions that have contributed to achieving 100% coverage for maternal and child health services in the country. A reliable vital registration system was established, enabling the detection of reductions in maternal and child mortality rates. For Malaysia, intersectoral cooperation, NGOs and the private sector must continue to play an important role. Nigeria, aligning with Rwanda, reported on the reduction of under-5 mortality rates. They are using the MBB approach (Marginal Budgeting for Bottleneck ) to implement interventions to reduce infant and maternal mortality. One of the strategies they mentioned is training of volunteer community workers to be agents of change. (Watcher comment: very unlikely if they are unpaid). Iraq emphasized the importance of including maternal and child interventions in the primary health care system. Iraq also mentioned particularly the need to continuously promote breastfeeding.
Basically, all member states welcomed the work of the Commission on Information and Accountability for Maternal and Child Health and are looking forward for concrete support for  action and results in each country. African and Southeast Asia countries called for stronger financing mechanisms.
The Secretariat then acknowledged that WHO is working close to UNICEF, UNAIDS, WB, UNFPA (in the H4+ initiative) and assured to member states that they will continue to support in order to achieve MDGs 4 and 5.

Climate Change
Countries appear to be all aligned with the WHO department of Public Health and Environment, whose vision was expressed in a side event. In the discussion, every member state prizes and thanks the WHO for drawing the global attention on the health effects of climate change during the 16th United Nations Climate Change Conference held in Cancun and for the preparatory work done towards the next events of Durban and Rio De Janeiro. Solutions, countries say, should be found in both reducing the impact of climate change on health (adaptation), and contrasting greenhouse gas emissions (mitigation). WHO can play a crucial role together with countries in the adaptation strategy, strengthening health systems, building capacity, producing evidence-based guidelines in the management of the environmental risks. Moreover an intersectoral and interregional coordination is needed. On the mitigation side, countries were very vague, but on the consensus on the green economy (strongly supported by UK) promoted as a sustainable growth-based solution (all the details are explained in the report of the side event “Climate change, vulnerable population protection and sustainability: from Cancun to Durban and Rio”). The Secretariat refers to have done an assessment on how to reduce carbon footprints from the WHO’s activity and bases, a detailed report will be presented in the upcoming months.

Poliomyelitis: mechanism for management of potential risks to eradication (resolution WHA61.1)

Polio eradication was pointed out as priority by all countries. Outbreaks occurred in the last year – was said – show that attention is still needed and WHO is committed to strengthen routine immunization in order to eradicate polio by 2012. Furthermore WHO is preparing itself to the “post eradication era”, focusing its interests on stock piles. Research on antiviral drugs is in phase 1 trial.  
Nevertheless, a large funding gap remains and is one of the main concern of both member states and Secretariat. Many countries, particularly those from Africa where some recent outbreaks have been detected, demanded to keep the political momentum and thanked expressively WHO, GAVI and Gates foundation for funding efforts. The DG ensured fully support to the polio eradication programme. She said to have taken incredible measures and written directly to head of states. She acknowledged leadership of Gates foundation and contribution of UK. 
Some countries (China, Bangladesh) referred to Polio as a national problem of security, since they are worried about possible imported infections. Hence, they underlined the need to block migration of cases. 
Interesting the short intervention of Gabon: according to the country, management at the district level and strong health system are the most important measure to eradicate polio.
Progress in the rational use of medicines (resolution WHA60.16)
The discussion was very fast because of time constraints. All member states appreciated and supported WHO’s report. There was general agreement regarding the main key issues outlined by WHO:
-More than 50% of all medicines are prescribed, dispensed or sold inappropriately, and half of all patients fail to take medicines correctly.
-The overuse, underuse or misuse of medicines harms people and wastes resources.
-More than 50% of all countries do not implement basic policies to promote rational use of medicines.
-In developing countries, less than 40% of patients in the public sector and 30% in the private sector are treated according to clinical guidelines.
-A combination of health-care provider education and supervision, consumer education, and an adequate medicines supply is effective in improving the use of medicines, while any of these interventions alone has limited impact.
Moreover, was stressed by many that the rational use of medicines not only improves health outcomes, but also reduces costs. However there was some regional specificities: African countries prioritized building capacity of training professionals and community involvement. Almost everybody stressed the relevance of promoting rational use of medicines in contrasting antibiotic resistance. 
International Pharmaceutical Federation (FIP), said that frontline professional are committed to advocate for rational use of medicines in NCDs. 
The Netherlands announced that a ministerial summit on the rational use of medicines, organised by the government in collaboration with the International Pharmaceutical Federation (FIP), will be host in Amsterdam in October 3rd 2012. WHO promised to collaborate. 

Youth and Health Risks (A64/25 and WHA64.28)

Under this item the report by the secretariat (A64/25) summarizes the social, economical and cultural determinants of youth health, and actions to be taken (for further comment see Global Health Watch website for Youth And Health Risks).

The draft resolution (in Fourth Report of Committee B, Draft A64/60) acknowledges several important aspects of adolescence and youth like right to health of adolescent and youth, socio-economic factors such as education, employment, all kind of discrimination, access to health care and information in particular reproductive and mental health services. It emphasizes first six of the eight Millennium Development Goals (MDGs) and importance of promoting healthy life-styles. The resolution urges Member States providing youth friendly services including health workforce development; age and sex specific data collection systems; providing access to reproductive health, mental health and trauma care services; promoting collaboration across several actors like education, employment, media and private sector; inclusion of young people into policy shaping processes. Director General (DG) is requested to collaborate with UN organizations, civil society and private sector, promote research to identify knowledge gap that will facilitate age and gender appropriate programs. Although the resolution is quite comprehensive there must more emphasize on occupational hazards for working adolescents and youth. There is a need for a more detailed emphasis and recommendations on discrimination in terms of gender and sexual orientation. The resolution should have strong recommendations from Member States and WHO to take actions addressing unemployment by acknowledging the determinants of unemployment nationally and globally.

During the discussions of this agenda item and the draft resolution there were 32 interventions of which 30 came from Member States, one from observer country Chinese Thaipei, and one from NGOs. The first speaking country was Tunisia who defined the youth and health risks as a long time neglected area which now is nearly overtaking the child mortality in some parts of the world. Almost all countries emphasized the importance of unhealthy lifestyles, importance of reproductive health in particular adolescent pregnancies and unsafe abortions and STDs affecting the youth health. The focus on poverty, access to education as an underlying cause and structural determinants of both the unhealthy behaviors and general health of the youth is strongly addressed by USA and Brazil. Ghana highlighted the employment policies by introducing the employment scheme for youth in their country. Thailand put more emphasis on the role of environment and adults that the delegate described as providers of risks for the youth. They drew special attention on the marketing strategies by using a metaphor of mosquito’s role in dissemination of malaria.

Member States addressed health systems as an essential element to contribute to the health of youth. Brazil drew attention on the importance of universal coverage and benefits of immunization for youth while Ghana, Nigeria, Tunisia mentioned the youth-friendly service provision to fulfill the needs. Iraq and Iran put an emphasis on the data collection role of health care services and on a national database to provide evidence relating to youth. Health education was emphasized by several countries (Nigeria, Ghana, Iraq, Finland, Germany) as an important way for youth health promotion. Brazil emphasized the role of peer education carried out by youth, while Ghana mentioned the need to benefit from technological developments and the importance of country level policies and strategies to provide access to mental health and reproductive health services.

Nigeria, on behalf of 48 African countries, highlighted the role of early marriages, social exclusion, unwanted pregnancy, unsafe abortions, STD´s, increased maternal mortality, lack of comprehensive knowledge on HIV/AIDS on youth health. They pointed out the challenges and gaps in implementation at government and local levels, as well as the lack of collaboration among all sectors. Tunisia, Mexico and Malaysia too emphasized the need for a multisectoral approach. Oman and Mexico also mentioned the involvement of CSOs.

Both China and Thailand commented on WHO’s work. China requested WHO to be more proactive and provide Member States information for best actions, technical assistance by mobilizing resources. Although they supported the draft resolution, they requested an explanation for the need of extra staff. Thailand pointed out the lack of policies to regulate alcohol, nutrition, and commodities. They also brought an older resolution into question addressed to the DG that if it was difficult to implement the resolution, they would never remind it forever.

IFMSA emphasized the importance of technology such as social media and the relevance of including young people (such as medical students) in health promotion via peer education.

The Secretariat’s response focused on the budget which was considered sufficient to cover the future expenses. However additional resources are welcome. They also pointed out the need for regional staff dedicated to this age group. In response to Thailand’s comments, secretariat emphasized the work done by WHO in the last several years.