The other new Dr WHO

This week, for the 71st time delegates from around the world – ministers, Heads of State, UN agencies, donors and civil society advocates – will meet at the annual World Health Assembly (WHA) in Geneva to set and debate the global health agenda. Seventy years after the World Health Organization (WHO) was established, the institution faces a funding and identity crisis. In part due to its success in work to eradicate polio, the WHO stands to lose a fifth of its funding. In a bid to fill that gap WHO finds itself in the position of having to redefine its role and reassert its relevance in a world where global funds and private donors wield increasing influence.

This year’s WHA will be different. It will be the first one hosted by the new Director-General of the WHO, Dr Tedros Adhanom Ghebreyesus. Elected in 2017, Dr Tedros is working to make his mark as a new kind of Director-General. He has promised greater engagement with civil society and is kicking off the WHA with a group fitness session. At the WHO Executive Board meeting in January, he called on States in attendance to come to the WHA with three pledges to take concrete steps toward achieving Universal Health Coverage (UHC), an unprecedented step he followed up with letters to Heads of State. With the 2030 deadline for achieving UHC fast approaching and half the world’s population still without access to essential health services, this is a welcome push for accelerated action.

Save the Children will be supporting Dr Tedros’s call for pledges and encouraging States to make ambitious, measurable commitments that they can report back on next year. Colleagues from our Australia, Bangladesh, Germany, Norway, Swiss and UK offices and the Scaling Up Nutrition (SUN) Civil Society Network will be attending to advocate for increased and smarter investment in UHC, nutrition and ending preventable child deaths. We will be making the statements to the Assembly, in response to agenda items covering the General Programme of Work 2019–2023, access to medicines, nutrition, adolescent health and early childhood development.

For those of you at the Assembly, please come along to the events we’re supporting:

  • Taking Civil Society Engagement to New Heights to Advance WHO’s 13th General Programme of Work and Advance the “Triple Billion” Targets, 22 May 2018, 6:00-7:30pm, Room IX Palais de Nations.
  • Investing Millions for the Nutrition of Billions, 25 May 2018, 12:30-14:00pm, Salle VII, Palais de Nations.
  • SUN Nutrition Hub – a week of nutrition events, including a film screening, 21–25 May 2018.

If you’re not at the WHA this week, please get involved by following the hashtags #WHA71 and #3pledges4UHC, supporting our messages and sharing your views.

Baby Irfan, born in a maternity clinic in Nepal (photo: Diana Markosian)

Statements:

Provisional Agenda Item 11.1: Draft thirteenth general programme of work, 2019-2023

Save the Children are pleased to join allies at this Assembly, committed to ending preventable child deaths through universal access to essential health services. This requires a focus on the leading causes of under-five mortality including pneumonia, prematurity and birth complications.

These priorities should be strongly reflected in the General Program of Work. Each year, one-million children die from direct complications of prematurity and another 660,000 babies are lost to complications at birth. In 2016, 880,000 children, 2,400 per day, died from just one disease: pneumonia – the biggest infectious killer of children under-five.

One preventable child death is too many. Member States must accelerate implementation of the Every Newborn Action Plan, adopted by this Assembly in 2014, and deliver pneumonia and nutrition action plans as part of comprehensive national strategies for delivering health to all.

We will not achieve Universal Health Coverage (UHC) without equitable and sustainable financing structures built on truly domestic resources. WHO must work with donors and countries to develop and implement health financing systems and be bold in holding governments to account. Global development financing architecture needs to align with today’s needs and those leading innovative approaches like the Global Financing Facility should be supported by member States, donors and leading health institutions.

We are delighted by Dr Tedros’s call for members to take concrete steps towards achieving UHC. We urge all states to make their pledges meaningful and measurable and encourage WHO to hold leaders to account at next year’s World Health Assembly. We look forward to assisting with implementation and reflecting on your progress in 2019.

 

Provisional Agenda Item 11.5:  Addressing the global shortage of, and access to, medicines and vaccines

Ensuring that every child has access to life-saving vaccines is an essential step on the road to Universal Health Coverage. But realising these goals, in the context of shifting population dynamics and disease burdens will require a persistent emphasis on reaching the furthest behind first.

Children in the lowest wealth quintiles continue to fall behind those growing up in wealthy families. Most of the world’s poor now live in middle-income countries, transitioning from donor support and falling behind vaccine coverage targets. Diseases like pneumonia – the biggest infectious killer of children under five – continue to claim lives, in part due to high vaccine prices.

Affordability is key to increasing coverage – in the poorest countries and among the poorest children. WHO has a critical convening role in coordinating multiple fund replenishments and transitions. We call on the WHO to claim that role and on member states, as donors, and as leaders shaping future policy, to work together:

  • to demand more affordable vaccines;
  • to ensure all national immunisation programmes include the life-saving pneumococcal conjugate vaccine;
  • to support and push for greater price transparency;
  • to oppose patents that obstruct market entry by new suppliers; and
  • to invest in innovative financing mechanisms to increase competition for healthy markets, to drive down vaccine prices, accelerate access and save more lives.

 

Provisional agenda item 12.3 Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030): sexual and reproductive health, interpersonal violence, and early childhood development

Save the Children welcomes the overall progress made by States on women’s, children’s and adolescents’ health. However, we are concerned with the increasing proportion of neonatal deaths in the total burden of under 5 mortality, now at 46 per cent, according to WHO. Outside of neonatal causes, pneumonia is the top infectious killer of children under 5, killing an estimated 920,000 children under 5 every year. The battle to end preventable child mortality is far from being won. Member States must invest more on quality health care at the time around birth and include childhood pneumonia in their national UHC plans.

At the same time, we want children to thrive, not just to survive. Nurturing, protecting, promoting and supporting children from pregnancy to three years of age is the foundation for child development. Yet 250 million children globally are at serious risk of not reaching their developmental potential. These children will more likely encounter difficulties throughout their life, resulting in social and economic loss for their communities and societies. This is why we are urging Member States to integrate the Nurturing Care Framework, to be launched this week, in national multi-sectoral plans that support families and reach very young children.

Finally, we cannot forget adolescents. When governments invest in basic packages of essential quality health and nutrition services, they must include adolescent sexual reproductive health services that are free at the point of use. These services have to be provided at the primary health care level and reach the most deprived and most marginalised groups. Governments must create mechanisms to enable child and adolescent participation in all aspects of health and nutrition policies and accountability.

 

Provisional agenda item 12.6: Maternal, Infant and Young Child Nutrition 

Almost half of all deaths in children under five are attributable to undernutrition. Save the Children calls on all States to invest in the nutrition of their people.

The World Bank estimates an additional $7 billion annually is needed to reach WHA2025 targets on anaemia, stunting, exclusive breastfeeding and wasting. Further funding is required across a broader spectrum of issues to end malnutrition by 2030 and achieve SDG2.

Costed scale-up plans for nutrition should be integrated into national UHC strategies. But financing is just part of the solution. States should prioritise provision of an essential package of health and nutrition services for women, children and adolescents with increased health worker and community capacity to deliver nutrition services as they progress towards UHC.

Breastfeeding remains undervalued despite the proven benefits. We urge States to prioritise breastfeeding, including investment in healthcare provision and training, maternity protection and legislation. While there is recognised need for certain infants to be formula-fed, we are concerned that marketing activities of some manufacturers and distributers has led to unnecessary and improper use of infant formula, putting children at risk.

Primary responsibility for that harm rests with governments. They have a duty to protect, promote and support breastfeeding as part of their obligations under the UN Convention on the Rights of the Child. An essential part of that protection is to adopt the International Code of Marketing of Breastmilk Substitutes and all subsequent resolutions into domestic law with investment in independent monitoring free from commercial interest and effective enforcement mechanisms.

Save the Children urges States to commit to achieving good nutrition and UHC by financing national nutrition plans. We urge States to adopt the proposed resolution on maternal, infant and young child nutrition to reaffirm their commitment to breastfeeding.

 

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