SG Slade's Remarks at the Pacific Heads of Health Meeting

SG Slade's Remarks at the Pacific Heads of Health Meeting, Nadi

Pacific Heads of Health Meeting
Sheraton Denarau, Nadi
29 April 2013

Opening Remarks by Secretary General, Tuiloma Neroni Slade, Pacific Islands Forum Secretariat

Heads of Pacific Health Systems
Director General, SPC, Dr Jimmie Rodgers
Representatives of the World Health Organisation
Representatives of development partners
Representatives of the Pacific Plan Review Team, Mr Redley Killion and
Dr Nick Poletti
Distinguished participants

Mr Convenor/Chairperson,

I understand that this may well be the first such gathering of Heads of Health Ministries. The occasion is thus of considerable significance, and I feel privileged being able to play a part in this meeting.

2. I would commence therefore with words of congratulations and appreciation to the Director General and the Secretariat of the Pacific Community for taking the important initiative to call this meeting. Initiative alone though would not have assured the presence of so many, and so we want also to acknowledge and thank the Government of Australia through AusAID for its kindness in providing generous funding support.

Meeting objectives

3. Regional meetings are valued for the exchange of experiences, their ultimate worth being what participants gain from their professional and personal interactions. But there is structured purpose for this meeting, for, as prescribed in the Agenda, a principal objective is to enable Heads of Health Ministries to have an effective dialogue opportunity with representatives of the Pacific Plan Review Team who are present, and for that purpose for Heads of Health to consider existing and future potential regional functions and governance arrangements to inform the dialogue. A related objective is for Heads of Health to discuss optimal processes for regional health development, including a possible regional health framework to help define a holistic approach to health issues in the region.

Global and regional factors

4. As Heads of Health Ministries you, of course, are the specialists, the initiators and implementers of national health policy-making. I’m sure you would agree though that in the discharge of your national mandates and responsibilities you would be best placed if you were aware of and informed by relevant global and regional processes. In that respect I would note, for example, that in the Rio+20 Outcomes of last year Pacific Leaders, along with other Leaders of the international community, had signed on to important statements regarding health issues:

in the recognition, for example, that health is a precondition for and an outcome and indicator of all three dimensions of sustainable development – that is, the social, economic and environmental dimensions;

that the goals of sustainable development can only be achieved in the absence of a high prevalence of debilitating communicable and non-communicable diseases, and where populations can reach a state of physical, mental and social well-being; and that action on the social and environmental determinants of health, both for the poor and the vulnerable and for the entire population, is important to create inclusive, equitable, economically productive and healthy societies;

the emphasis on communicable diseases like HIV and AIDS, malaria and tuberculosis as still serious global concerns, and commitment of world Leaders to redouble global efforts to fight these diseases; and

in the acknowledgement that the global burden and threat of non-communicable diseases constitutes one of the major challenges for sustainable development in the twenty-first century.

5. Global statements and pledges of this nature match the health situation of the Pacific, for there is cause for major concern at both the national and regional levels.

Commitments by Forum Leaders

6. Over the years, Forum Leaders at the regional level have raised and discussed at their annual sessions major health challenges. In 2003, for example, Leaders were alarmed at the transmission rate of HIV/AIDS in Forum island countries. Seen as a developmental issue, they acknowledged that HIV/AIDS could have a devastating impact on the economies, societies and the security of the region.

7. Leaders affirmed that strong government leadership generated the most effective responses to HIV/AIDS and committed to implementing their national HIV/AIDS strategies by addressing some of the constraints faced by national programmes. They reinforced the critical importance of the development of national Plans of Action through a consultative process, and an effective partnership amongst countries and territories, regional agencies and development partners, in mobilising resources to implement regional health strategies.

8. The idea for a regional funding mechanism, such as the establishment of a Pacific Health Fund has been raised in the past and, in fact, agreed by Forum Leaders at their meeting in Madang in 2005. But, as is known, a Pacific Health Fund was never brought in to effect. The idea was for Pacific islands countries and territories to utilise such a Fund for financial support to address health challenges, including HIV/AIDS, TB, malaria, emerging ‘outbreak’ diseases such as SARS and avian influenza, as well as an emergency response capacity to diseases. The possibility of such a regional Fund, no doubt to be subject to the highest governance and accountability standards, could be part of the health framework suggested in one of the papers submitted for discussion at this meeting,.

9. At the same Forum meeting in 2003, Leaders noted the significant social and economic burden of NCDs in the region. Leaders supported the need for Ministries of Health to take a stewardship role in addressing NCDs and to create an enabling environment for healthy lifestyles and for ongoing surveillance of NCDs in Pacific island countries.

10. Over 10 years later, following the Honiara Declaration on the Pacific NCD Crisis issued by Health Ministers on 30 June 2011, Leaders were again to be seized of the continuingly serious NCD problem. The death rate of 75% attributed to NCDs, especially among economically-productive adults, was a particular cause of concern. Last year at their meeting in the Cook Islands, Leaders continued to highlight the on-going threat of non communicable diseases to the economic and social fabric of the region.

11. The risk posed as a result of a possible worldwide epidemic or pandemic caused by the highly pathogenic Avian Influenza A/H5N1 exposed the vulnerability of Pacific countries and their state of general unpreparedness and lack of capacity to deal with and mitigate the impact of such a pandemic.

12. The need for regional pandemic preparedness and response plan would be for you Heads of Health to assess as a technical matter. From a policy perspective, it would appear to be an important aspect of any regional health framework which I have referred to.

13. Currently, I understand that different types of dengue fever are circulating in the region, with worrying incidences of dengue serotype 3 (DEN-3) in the Solomon Islands and French Polynesia, and with DEN-1 confirmed in New Caledonia, French Polynesia, Fiji and Wallis. Current vulnerability to a DEN-3 outbreak demonstrates once more the need for adequate preparedness and readiness to combat such an outbreak.

14. The link between health and education, and the role of the media and public awareness strategies, are clear and critical, particularly in terms of building capacity and mechanisms for community outreach programmes to local and isolated communities. These, too, would be essential components of any discourse on a proposed regional health framework.

Health and Climate Change

15. Those of you who are familiar with the work and pronouncements of Forum Leaders will understand the seriousness with which they regard the dangers of climate change. As we all know, climate change threatens every aspect of the environment, social and economic development, and political and human security. The nature of many Pacific countries – small and sparsely populated land areas in a vast ocean – renders them highly vulnerable to the already manifested effects of climate change.

16. From a health perspective, climate change and climate variability directly affect people’s health through changes in weather patterns and impacts of temperature increases, sea level rise, flooding, cyclones and droughts. There are also impacts on basic determinants of health, such as water, food security, housing and economies.

The Forum Compact

17. One issue that Leaders have regularly considered since 2009 is development effectiveness, aimed at and achieved through the Forum Compact on Strengthening Developing Coordination in the Pacific. In my view, there is a wealth of experience emerging from the Forum Compact implementation that is of relevance to the health sector. While much of the work has focused on national efforts and systems, clearly a similar approach could be applied to other sectors. Issues such as strong national leadership, alignment of efforts, reduced fragmentation and more effective planning and budgeting apply equally to the health sector.

18. A key part of the Compact focuses on supporting the efforts of Pacific countries to strengthen institutions and systems of national planning, budgeting, public financial and aid management. This in turn empowers Pacific governments to take stronger leadership and ownership of national development agendas and directing development partners around national priorities and use of national systems to improve service and programme delivery and ultimately development outcomes.

19. However, country leadership and strong country health plans, systems, capacities and coordination mechanisms while all critical, will not of themselves be definitive in results without collaborative and supportive development partners that align their programming and systems to national and regional health needs and country systems. Given the small public administrations in most Pacific countries, development partners can assist government efforts to improve the effectiveness of health aid delivery by reducing duplicative initiatives, engaging more in sector wide programming, use and strengthen country and health systems rather than setting up parallel project and programme management and financial reporting systems and coordinate better their capacity building and country visits.

Taking advantage of the Pacific Plan Process

20. I have alluded to the importance of this meeting taking place right now. I believe that a major opportunity to consider reform of the health sector in the broader regional context is provided by the review of the Pacific Plan, now currently underway. The Review has a wide brief to consider the political and economic drivers of regionalism, which are embodied in the Pacific Plan as the region’s master strategy for integration and cooperation. I understand from the meeting programme that we will have an opportunity in the course of this meeting to discuss the Review process with the Team members and perhaps go in to the details then.

Regional Health Architecture

21. In your discussions over the next two days, I would encourage you to consider how other sectors have tackled the issue of greater regional alignment. The regional education sector, for instance, has undergone some significant changes over the past few years. Education Ministers and their officials have led a significant program of reform and changed the way that they do business ? including the development of a single regional strategy which we now know as the Pacific Education Development Framework. This Education Framework has strengthened the linkages between the national education officials, Education Ministers and the Leaders of the Pacific Islands Forum to ensure that they can track performance based on funding that is addressing real needs. It is important that Leaders have oversight of these sectors and that the work being undertaken is on-track.

22. For example, it might be appropriate to consider a single, unified strategy for regional health initiatives, which could address the balance between national and regional efforts. This will allow for stakeholders to better determine the nature of health as a regional public good, and accordingly provide a clear platform for more effectively financing regional health initiatives. It could also provide a clear framework for monitoring and evaluating regional health interventions – while recognising that the bulk of efforts and financing is likely to remain at the national level, given the varying contexts across countries. The monitoring could be linked to reporting of performance to Leaders under the framework of the Pacific Plan.

23. While member countries and CROP agencies will have to lead any reform agenda in the health sector, it is equally important that development partners and other sources of support also get behind this effort, at the strategic level and especially through financing. Based on our experience with the Forum Compact, many Forum island countries have completed assessments on the expectation of greater budget support. If we are to consider making changes to the health sector to improve its effectiveness and efficiency, then it must be a partnership of all the key players, not just the Pacific countries alone.

Concluding remarks

24. For the Pacific, the fact is that the causes of major health challenges are not of countries or region alone; and the reality is that neither solution nor cure lie within the Pacific health care systems. There is therefore the inevitability of togetherness of close and coordinated collaboration, of cooperative arrangements and of effective partnerships at all levels.

25. As the Secretariat of the Forum we are, of course, closely aligned with the Forum Leaders and their annual gatherings and decision-making. In that capacity the Secretariat is committed to utilising its comparative advantage and prepared to play its part in support of relevant health reform efforts for the region. And thus for this meeting we would encourage and be supportive of innovative, constructive and concrete steps to strengthen the health sector in the Pacific region. And that could be the challenge for us all in this meeting.

Thank you.
 
ENDS

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