Opening remarks by WHO Regional Director for Africa, Dr Matshidiso Moeti
Your Excellency, José Ulisses Correia de Pina e Silva, Prime Minister of Cabo Verde,
Honourable Minister of Health of Cabo Verde, Dr Arlindo Nascimento do Rosário,
Honourable Ministers of Health of Comoros, Guinea Bissau, Madagascar, Mauritius, Seychelles, and Sao Tome and Principe,
Councillor of Culture of Praia, José António Lopes da Silva,
Heads of delegations,
Distinguished guests, dear colleagues, ladies and gentlemen,
It is my pleasure to welcome you to this Seventh Meeting of Ministers of Health of Small Island Developing States in the African Region.
A special welcome to Guinea Bissau, joining this meeting for the first time – with your participation, all SIDS in the African Region are now represented in this group.
I would like to sincerely thank the Government of Cabo Verde for hosting this meeting and to appreciate the Prime Minister, honourable ministers, city representatives, heads of delegation, and partner organizations for participating in this event.
We know that Small Island Developing States share common health and climate change challenges. Furthermore, the SIDS are unique in their geographically dispersed populations and high life expectancy.
This seventh meeting is an opportunity for us to continue leveraging these similarities to advance our collective efforts towards achieving universal health coverage and the Sustainable Development Goals.
I am pleased to report that all countries now have designated focal points for SIDS. For the period 2017 to 2019, Seychelles is acting as the Secretariat as agreed at our last meeting.
Together, we have made good progress in implementing recommendations from our last meeting: on pooled procurement, NCDs, disaster management and collaboration. We have made some progress on national health accounts and health financing, and we need to do more to implement recommendations on food and nutrition, vector-borne diseases, and illicit drug use.
As you know, WHO's priorities for the next five years will focus on universal health coverage, health security and promoting healthier populations. These priorities resonate very well with those of SIDS Member States.
For example, in relation to UHC, your governments have been working to reduce out-of-pocket payments and to improve access to quality health services. In the area of health security, all your countries have been assessed for readiness and preparedness, and we are continuing to work with you to address the social determinants of health.
I am happy that we are back in Cabo Verde after the successful Second WHO Africa Health Forum. Cabo Verde is leading in promoting physical fitness and reducing the harmful use of alcohol.
According to the UHC index – which we use to measure the availability of health services in countries – Seychelles is the highest scoring country in the African Region. Across the African SIDS, the UHC index varies considerably, from a low of 28 (Madagascar) to a high of 71 (Seychelles), meaning that we need to accelerate action to achieve UHC and to learn from each other on the best ways to do this.
Sustainable financing is central to achieving UHC. In the past year, we have worked with Comoros to develop strategies for innovative financing for UHC, as well as working with Mauritius and Seychelles to produce national health accounts. These accounts show high per capita spending on health in comparison with other countries in the African Region – in Mauritius this was 548 US dollars in 2016 and in Seychelles it was 597 dollars in 2016, compared with a regional average of 108 dollars. This spending translates into higher life expectancy at birth with both countries exceeding 74 years, compared to the regional average of 61 years. In both countries, and across the SIDS, there is room to improve in terms of delivery of quality, people-centred health services – ensuring no population sub-groups are being left behind, such as low-income households, older people and adolescents.
We have a key opportunity during this meeting to create an economy of scale through the SIDS pooled procurement mechanism. By working together to implement this mechanism, we can make medicines more affordable and more readily available.
Countries are already taking positive steps towards pooled procurement: Comoros is updating its national medicines policy and operational plan, Mauritius started to review its standard treatment guides and update the national medicines list to align with the WHO model list. Madagascar carried out a survey on prices and availability, and information on quality and regulatory requirements were collected in all six countries to serve for the call to express interest.
Going forward we will need to look for sustainable financing for the Secretariat of the pooled procurement programme. We will also need to address the drivers of prices, such as taxes, mark-ups and other operational costs. We have started to do this in Comoros through updating the national medicines policy. We should also be cognizant of countries participating in multiple pooled procurement programmes, such as in the Southern African Development Community and the ACAME programme, so that we can learn from other mechanisms and share best practices to increase efficiencies and cost effectiveness.
The secretariat has prepared key documents for the launch of the pooled procurement programme, including a draft strategy, a draft agreement and a list of priority medical products. In developing these documents, we produced evidence on medicines pricing, which has been a major driver for pooled procurement. Experts from your countries, honourable ministers, reviewed these documents during their first technical meeting in Mauritius in July earlier this year.
I would like to commend the network of experts who are already sharing information and I am pleased to confirm that the WHO Regional Office will continue hosting the SIDS Pooled Procurement Secretariat for two additional years.
By signing the SIDS Pooled Procurement agreement, you will launch the programme and authorize the Secretariat to move forward with harmonizing requirements and preparing the first call to express interest, in collaboration with staff responsible for medicines procurement in your countries.
This is particularly important for noncommunicable disease medications, as island countries are at the forefront of the crisis of chronic diseases – these diseases already cause more than four in every five deaths in Mauritius and Seychelles. In contexts of limited resources, WHO’s Package of Essential NCD interventions (WHO PEN) is a practical approach that countries can take to integrate NCD prevention and management at the primary health care level – I understand Seychelles has already requested support to implement WHO PEN. We also need to reduce exposure to risk factors, such as unhealthy diets, obesity, physical inactivity, tobacco use and the harmful use of alcohol – including, for example, enacting legislation, as Seychelles is doing with the sugary drinks tax and Cabo Verde has done through increasing tobacco excise tax in the past year. In addition, we need to continue to track trends and monitor progress.
Here, I would like to congratulate Cabo Verde for awards in 2018 and 2019, from the United Nations Inter Agency Task Force on NCDs. The first award was for the country’s actions to fight alcohol and substance abuse, led by His Excellency, the President of Cabo Verde, Jorge Carlos de Almeida Fonseca. This year’s award was for the Healthy Cities Initiative, in recognition of the efforts of His Excellency, Prime Minister of Cabo Verde, José Ulisses de Pina Correia e Silva. This shows your commitment to promoting health, through healthy urban planning, prevention measures in communities, and strong primary health care services.
Creating healthy environments is particularly important in SIDS, as we know that island countries are also on the frontline of climate change, with cyclones affecting Comoros and Madagascar this year.
We need to do more to proactively strengthen health systems to adapt to and to address climate change, and this includes improving resilience to external shocks. On behalf of WHO, I would like to reiterate our commitment to supporting the implementation of the SIDS action plan on climate change from 2019 to 2023 that you developed during our meeting in Mauritius last year.
Preparedness for disasters is a key area for action. As I mentioned earlier, all SIDS have completed joint external evaluations of your International Health Regulations capacities.
In addition, all SIDS submitted your IHR State party annual reports for 2017 and 2018, and we see some key gaps across countries, including needs to enhance multisectoral coordination mechanisms, establish emergency operations centres and rapid response teams, to strengthen the health workforce through training of field epidemiologists, to enhance capacities at point of entry (airports and ports), to strengthen laboratory capacities, as well as capacities to manage chemical events and radiation emergencies. I have directed my technical team to support you in these critical areas.
I would like to specifically commend Comoros, Seychelles and Sao Tome and Principe for moving forward with development of their national action plan for health security, and adapting the revised Integrated Disease Surveillance and Response, or IDSR, guidelines.
Funding for these national action plans remains challenging. At the regional level we are developing a resource mobilization strategy, based on projected needs and a situation analysis of existing and potential funding sources. At the same time, we also need to look to domestic sources and see clearly that national action plans for health security need to be anchored more broadly in the national health plan, towards building resilient health systems for universal health coverage.
In the recent past, SIDS countries have responded well to several outbreaks. For instance, I’m aware that after action reviews were completed in Cabo Verde for malaria and Zika, Sao Tome and Principe for the necrotizing cellulitis outbreak, and Madagascar for plague. These reviews are essential in ensuring countries continuously improve preparedness and response capacities.
These capacities need to be strengthened in an integrated manner as part of the broader strengthening of health systems.
In the area of innovations, SIDS countries have not been left behind. Cabo Verde is leading the way with a broad programme of e-Governance, including a strong telemedicine network. Other countries can learn from this experience.
Together, we can accelerate progress towards universal health coverage and the achievement of Sustainable Development Goal 3 to ensure healthy lives and well-being for all people, at all ages.
The coming three days are a valuable opportunity to share best practices, to advance implementation of the pooled procurement and supply chain mechanism, and to better understand shared priorities across Small Island Developing States.
I look forward to productive discussions during this meeting and to our continued work together to make health a reality for all island communities in Africa.