THE 13TH GENERAL PROGRAMME OF WORK (GPW13) OF WORLD HEALTH ORGANIZATION; THE WHO DIRECTOR-GENERAL KEYNOTE SPEECH TO THE 72ND WHA: A MISSING MAJOR PROGRAMMATIC MATTER
THE 13TH GENERAL PROGRAMME OF WORK (GPW13) OF WORLD HEALTH ORGANIZATION; THE WHO DIRECTOR-GENERAL KEYNOTE SPEECH TO THE 72ND WHA: A MISSING MAJOR PROGRAMMATIC MATTER
The NHS Workforce is in crisis with 8% Posts vacant according to the Nuffield Trust Report and it is part of a growing Global Shortage in Healthcare Workforce necessitating the return of ‘The Modern Firm’: ‘Panoply of the best for Workers by Modern Firms’ [1] with a ‘Paradigm Shift’: attracting, training, supporting and retaining workforce. The ‘Workforce Shortage’ obstructs the march towards ‘1 Billion more people benefiting from Universal Health Coverage (UHC)’; One of the 2018 WHO’s GPW13 ‘Triple Billion’ Targets. This is the nexus with the Keynote Speech by WHO Director-General to the 72nd WHA held 20th to 28th May 2019! The ‘Keynote Speech’ was a ‘2018 GPW13 Score Card’ and the ‘Way Ahead’ [2]! There was, however and disturbingly so, a ‘Missing Major Programmatic Matter’!!
The ‘GPW13 Score Card’ disposed 2018 an ‘Incredible Year’ for WHO [2]. After 71 years, the WHO should create a Healthier, Safer and Fairer World and ‘Participants’ were requested to ‘Listen’ more to ‘Themselves’, ‘Younger Voices’ and the ‘Real and Most Vulnerable Voiceless Non-Participants’! The ‘2018 Milestones’ were crystallized with several ‘Identified Personal/ Country Situational Narratives’ distilling the WHO’s GPW13 ‘Fundamentals’: Promote Health, Make the World Safer and Serve the Vulnerable and denominated in the WHO ‘Triple Billion’ 2030 Targets: i) 1 Billion more people benefit from UHC, ii) 1 Billion more people protected against Global Emergencies and iii) 1 Billion more people enjoy Better Health and Well-being.
Specifically for 2018, the ‘Landmark Achievements’ included for UHC:
i. Great progress towards UHC
ii. Declaration of Astana by all 194 Members: ‘No UHC without PHC’
iii. Strong Health Workforce Working in Teams; Global 18 million Health Workforce Shortage and hence the relevance of the NHS Workforce Crisis [1]!
iv. Right to Health including Sexual and Reproductive Health and Reproductive Rights. Prevent, Detect and Treat NCDs. Prevent, Detect and Stop Outbreaks spreading to Epidemics and Treat Vaccine-Preventable Diseases with PHC at the Heart of Immunization Agenda 2030! ‘No Health for All without Vaccines for All’!
v. Stronger Health Systems now in several Countries
vi. Historic Milestones outside Clinical Trials: World 1st Malaria Vaccine launched in Malawi and Ghana
vii. Draft Global Strategy for Elimination of Cervical Cancer with HPV Vaccination.
viii. Release of the 11th Edition of the International Classification of Diseases
ix. 200 Products Pre-Qualified including Heat-stable Rotavirus Vaccine
x. First Essential Diagnostics List released
xi. Special Programme on Human Reproduction/ New Drug for Postpartum Haemorrhage
xii. 1st UN High-level Meeting on Tuberculosis/ ‘End TB’
xiii. New Framework for Quality Midwifery Education/ Reducing MMR and U5MR
xiv. New Strategy on Snakebite Envenomation
xv. Global Status Report on Road Safety
xvi. Global Action Plan on Physical Activity
xvii. 1st Guidelines on Dementia and Cognitive Decline
xviii. 1st Guidelines on Digital Health
xix. Fight against Antimicrobial Resistance/ Report of the Interagency Coordination Group on Antimicrobial Resistance to the UN Secretary-General
For the 2nd ‘1 Billion Target’/ ‘Global Emergencies’:
i. WHO responded to 481 Emergencies and Potential Emergencies in 141 Countries
ii. WHO controlled Ebola in Western Province of Equateur in DRC within 3 months! Apart from Fighting a Virus, also Fighting Insecurity, Violence, Misinformation, Mistrust and Politicization
iii. WHO response to Cholera in Yemen, Diphtheria in Cox’s Bazaar, Humanitarian Crisis in Syria
iv. Global Polio Eradication Integration focused on Afghanistan and Pakistan
v. New Division of Emergency Preparedness to Prevent Emergencies
For the 3rd ‘1 Billion Target’/ ‘Better Health and Well-being’:
i. 1st Global Conference on Air Pollution and Health/ Two-thirds Reduction in Air Pollution-Deaths by 2030
ii. Secretary-General Climate Action Summit scheduled for September 2019
iii. New Initiative on Climate Change and Health in Small Islands Developing States (Pacific, Fiji and Mauritius)
iv. Protocol to Eliminate Illicit Trade in Tobacco Products in force
v. International Foods and Beverages Alliance Officially Committed to WHO’s Trans-Fat Elimination Target by 2030
vi. High-level Committee on NCDs Report and Recommendations/ Commitments to Political Declaration at 2018 UN High-level Meeting. Also, several Countries on Risk-Factors for NCDs e.g. Taxes on Sugary Drinks
These commendable ‘2018 Landmark Milestones’ accrue from a ‘Transformed WHO’: ‘Key to WHO Successes’! The ‘5 Reforms’ are: New Strategy, New Processes, New Operating Model, New Culture and New Partnerships Approach. The 2018 WHA approved the WHO GPW13 and the 2019 WHA earmarked for ‘Programme Budget’ Approval!
For the ‘Way Ahead’, the ‘3 Priorities’ to guide the 72nd WHA into the future:
i. Health is about Political Leadership
ii. Health is about Partnerships
iii. Health is about People. Participants were to ensure their decisions ‘Took Root’ in their Countries!
Now, the ‘Missing Major Programmatic Matter’:
A Preamble to the 2018 WHO GPW13 Adoption was ‘15, 000 Under-Fives deaths per day in 2016’! Malnutrition is a ‘Major Determinant’ of U5MR and an ‘Undergirding Contributor’ in over 50% to ‘Other Determinants’ of U5MR. Inappropriate Infant and Young Child Feeding (IYCF), including ‘Low Breastfeeding Rates’ and associated ‘Health Challenges’, are linked to Inappropriate Marketing of Breastmilk Substitutes and ‘Related Products’ with the consequent Adoption and Implementation of ‘The Code’: 1981 Code and ALL Subsequent Relevant WHA Resolutions. In 38 years of ‘The Code’, only 35 of 194 Countries have ‘National Legislations’ with nearly ‘Full Code Provisions’ and 58 Countries are ‘Without Any Legislation’ [3]! ‘Code Violations’ are ‘Pervading’, ‘Systemic’ and ‘Systematic’! ‘Health Professionals-Industry Funding Conversation’ and ‘Conflicts of Interest’ rage on with the ‘2016 WHA 69.9/ WHO Guidance’ [4] to the rescue but with continued stiff resistance from the ‘Health Professionals-Industry Dyad’.
The RCPCH bold decision to decline ‘Industry Funding’ [5,6] and The BMJ discontinuing ‘Code Products Advertisement’ [7-10] are laudable ‘Landmark Milestones’ but are not uniformly embraced by all concerned! There are ‘Issues’ with a ‘Major Programmatic Misstep 9’ in the ‘2018 Revised Ten Steps to Successful Breastfeeding’ with a call for ‘Revisit, Review and Reversal’ [11]! The ‘DG Keynote Speech’ called ‘Participants’ to listen to, and address, the ‘Real and Most Vulnerable Voiceless’ and yet, ‘NOT A WORD ON BREASTFEEDING, IYCF AND THE CODE’ in the ‘2018 WHO Score Card’ and the ‘Way Ahead’! This is the disturbing ‘Missing Major Programmatic Matter’ and needs to be rectified timeously!!
REFERENCES
1. Godlee F. The Modern Firm. BMJ 2019; 365:l4173
2. WHO. 72nd WHA Keynote Speech. https://www.who.int/dg/speeches/detail/world-health-assembly of 20th May 2019
3. WHO. Marketing of Breastmilk Substitutes: National Implementation of the International Code; Status Report 2018. WHO, UNICEF, IBFAN. Geneva WHO 2018
4. WHO Sixty-ninth WHA. Ending the inappropriate promotion of foods for infants and young children. WHA 69.9. http://apps.who.int/gb/ebwha/pdf files/WHA69/A69 R9-en.pdf; 28th May 2016. Accessed 24th February 2017
5. https://www.rcpch.ac.uk/news/news-events/news/rcpch-statement-relationsh...
6. Eregie C.O. ‘Health Professionals-Industry Funding Conversation’: The RCPCH now truly Leading the Way in Children’s Health. https://www.bmj.com/content/364/bmj.1544/rr-0 of 16th February 2019
7. Godlee F. No more infant formula advertising in the BMJ. BMJ 2019; 364:L1279 of 21st March 2019
8. Eregie C.O. There is no Breastmilk Substitute (Including Infant Formula) and Prohibition of its Advertisement is Propgrammatically Appropriate for Optimal Child Health. https://www.bmj.com/content/364/bmj.l1279/rr-4 of 28th March 2019
9. Godlee F. Let’s talk about sex and relations with industry. BMJ 2019; 365:l2093 9th May 2019
10. Eregie C.O. More Talk on the ‘Health Professional Associations-Industry Conversation’; Conflicts of Interest are better avoided: A Proactive Role for ‘Medical Socioeconosophy’. https://www.bmj.com/content/365/bmj.l2093/rr-3 of 22nd May 2019
11. Eregie C.O. A Major Programmatic Misstep in the 2018 Revised Ten Steps to Successful Breastfeeding. https://www.bmj.com/content/363/bmj.k5146/rr-7 of 16th January 2019
Professor Charles Osayande Eregie,
MBBS, FWACP, FMCPaed, FRCPCH (UK), Cert. ORT (Oxford), MSc (Religious Education),
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria,
Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria,
UNICEF-Trained BFHI Master Trainer,
ICDC-Trained in Code Implementation,
*Technical Expert/ Consultant on the FMOH-UNICEF-NAFDAC Code Implementation Project in Nigeria,
*No Competing Interests.
Competing interests:
No competing interests
18 June 2019
CHARLES OSAYANDE EREGIE
MEDICAL DOCTOR
Professor of Child Health and Neonatology, University of Benin and Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria. Also, UNICEF-Trained BFHI Master Trainer and ICDC-Trained in Code Implementaion. Also a Technical Expert/ Consultant on FMOH-UNICEF-NAFDAC Project on Code Implementation in Nigeria
Institute of Child Health, University of Benin, PMB 1154, Benin City, Nigeria
Rapid Response:
THE 13TH GENERAL PROGRAMME OF WORK (GPW13) OF WORLD HEALTH ORGANIZATION; THE WHO DIRECTOR-GENERAL KEYNOTE SPEECH TO THE 72ND WHA: A MISSING MAJOR PROGRAMMATIC MATTER
The NHS Workforce is in crisis with 8% Posts vacant according to the Nuffield Trust Report and it is part of a growing Global Shortage in Healthcare Workforce necessitating the return of ‘The Modern Firm’: ‘Panoply of the best for Workers by Modern Firms’ [1] with a ‘Paradigm Shift’: attracting, training, supporting and retaining workforce. The ‘Workforce Shortage’ obstructs the march towards ‘1 Billion more people benefiting from Universal Health Coverage (UHC)’; One of the 2018 WHO’s GPW13 ‘Triple Billion’ Targets. This is the nexus with the Keynote Speech by WHO Director-General to the 72nd WHA held 20th to 28th May 2019! The ‘Keynote Speech’ was a ‘2018 GPW13 Score Card’ and the ‘Way Ahead’ [2]! There was, however and disturbingly so, a ‘Missing Major Programmatic Matter’!!
The ‘GPW13 Score Card’ disposed 2018 an ‘Incredible Year’ for WHO [2]. After 71 years, the WHO should create a Healthier, Safer and Fairer World and ‘Participants’ were requested to ‘Listen’ more to ‘Themselves’, ‘Younger Voices’ and the ‘Real and Most Vulnerable Voiceless Non-Participants’! The ‘2018 Milestones’ were crystallized with several ‘Identified Personal/ Country Situational Narratives’ distilling the WHO’s GPW13 ‘Fundamentals’: Promote Health, Make the World Safer and Serve the Vulnerable and denominated in the WHO ‘Triple Billion’ 2030 Targets: i) 1 Billion more people benefit from UHC, ii) 1 Billion more people protected against Global Emergencies and iii) 1 Billion more people enjoy Better Health and Well-being.
Specifically for 2018, the ‘Landmark Achievements’ included for UHC:
i. Great progress towards UHC
ii. Declaration of Astana by all 194 Members: ‘No UHC without PHC’
iii. Strong Health Workforce Working in Teams; Global 18 million Health Workforce Shortage and hence the relevance of the NHS Workforce Crisis [1]!
iv. Right to Health including Sexual and Reproductive Health and Reproductive Rights. Prevent, Detect and Treat NCDs. Prevent, Detect and Stop Outbreaks spreading to Epidemics and Treat Vaccine-Preventable Diseases with PHC at the Heart of Immunization Agenda 2030! ‘No Health for All without Vaccines for All’!
v. Stronger Health Systems now in several Countries
vi. Historic Milestones outside Clinical Trials: World 1st Malaria Vaccine launched in Malawi and Ghana
vii. Draft Global Strategy for Elimination of Cervical Cancer with HPV Vaccination.
viii. Release of the 11th Edition of the International Classification of Diseases
ix. 200 Products Pre-Qualified including Heat-stable Rotavirus Vaccine
x. First Essential Diagnostics List released
xi. Special Programme on Human Reproduction/ New Drug for Postpartum Haemorrhage
xii. 1st UN High-level Meeting on Tuberculosis/ ‘End TB’
xiii. New Framework for Quality Midwifery Education/ Reducing MMR and U5MR
xiv. New Strategy on Snakebite Envenomation
xv. Global Status Report on Road Safety
xvi. Global Action Plan on Physical Activity
xvii. 1st Guidelines on Dementia and Cognitive Decline
xviii. 1st Guidelines on Digital Health
xix. Fight against Antimicrobial Resistance/ Report of the Interagency Coordination Group on Antimicrobial Resistance to the UN Secretary-General
For the 2nd ‘1 Billion Target’/ ‘Global Emergencies’:
i. WHO responded to 481 Emergencies and Potential Emergencies in 141 Countries
ii. WHO controlled Ebola in Western Province of Equateur in DRC within 3 months! Apart from Fighting a Virus, also Fighting Insecurity, Violence, Misinformation, Mistrust and Politicization
iii. WHO response to Cholera in Yemen, Diphtheria in Cox’s Bazaar, Humanitarian Crisis in Syria
iv. Global Polio Eradication Integration focused on Afghanistan and Pakistan
v. New Division of Emergency Preparedness to Prevent Emergencies
For the 3rd ‘1 Billion Target’/ ‘Better Health and Well-being’:
i. 1st Global Conference on Air Pollution and Health/ Two-thirds Reduction in Air Pollution-Deaths by 2030
ii. Secretary-General Climate Action Summit scheduled for September 2019
iii. New Initiative on Climate Change and Health in Small Islands Developing States (Pacific, Fiji and Mauritius)
iv. Protocol to Eliminate Illicit Trade in Tobacco Products in force
v. International Foods and Beverages Alliance Officially Committed to WHO’s Trans-Fat Elimination Target by 2030
vi. High-level Committee on NCDs Report and Recommendations/ Commitments to Political Declaration at 2018 UN High-level Meeting. Also, several Countries on Risk-Factors for NCDs e.g. Taxes on Sugary Drinks
These commendable ‘2018 Landmark Milestones’ accrue from a ‘Transformed WHO’: ‘Key to WHO Successes’! The ‘5 Reforms’ are: New Strategy, New Processes, New Operating Model, New Culture and New Partnerships Approach. The 2018 WHA approved the WHO GPW13 and the 2019 WHA earmarked for ‘Programme Budget’ Approval!
For the ‘Way Ahead’, the ‘3 Priorities’ to guide the 72nd WHA into the future:
i. Health is about Political Leadership
ii. Health is about Partnerships
iii. Health is about People. Participants were to ensure their decisions ‘Took Root’ in their Countries!
Now, the ‘Missing Major Programmatic Matter’:
A Preamble to the 2018 WHO GPW13 Adoption was ‘15, 000 Under-Fives deaths per day in 2016’! Malnutrition is a ‘Major Determinant’ of U5MR and an ‘Undergirding Contributor’ in over 50% to ‘Other Determinants’ of U5MR. Inappropriate Infant and Young Child Feeding (IYCF), including ‘Low Breastfeeding Rates’ and associated ‘Health Challenges’, are linked to Inappropriate Marketing of Breastmilk Substitutes and ‘Related Products’ with the consequent Adoption and Implementation of ‘The Code’: 1981 Code and ALL Subsequent Relevant WHA Resolutions. In 38 years of ‘The Code’, only 35 of 194 Countries have ‘National Legislations’ with nearly ‘Full Code Provisions’ and 58 Countries are ‘Without Any Legislation’ [3]! ‘Code Violations’ are ‘Pervading’, ‘Systemic’ and ‘Systematic’! ‘Health Professionals-Industry Funding Conversation’ and ‘Conflicts of Interest’ rage on with the ‘2016 WHA 69.9/ WHO Guidance’ [4] to the rescue but with continued stiff resistance from the ‘Health Professionals-Industry Dyad’.
The RCPCH bold decision to decline ‘Industry Funding’ [5,6] and The BMJ discontinuing ‘Code Products Advertisement’ [7-10] are laudable ‘Landmark Milestones’ but are not uniformly embraced by all concerned! There are ‘Issues’ with a ‘Major Programmatic Misstep 9’ in the ‘2018 Revised Ten Steps to Successful Breastfeeding’ with a call for ‘Revisit, Review and Reversal’ [11]! The ‘DG Keynote Speech’ called ‘Participants’ to listen to, and address, the ‘Real and Most Vulnerable Voiceless’ and yet, ‘NOT A WORD ON BREASTFEEDING, IYCF AND THE CODE’ in the ‘2018 WHO Score Card’ and the ‘Way Ahead’! This is the disturbing ‘Missing Major Programmatic Matter’ and needs to be rectified timeously!!
REFERENCES
1. Godlee F. The Modern Firm. BMJ 2019; 365:l4173
2. WHO. 72nd WHA Keynote Speech. https://www.who.int/dg/speeches/detail/world-health-assembly of 20th May 2019
3. WHO. Marketing of Breastmilk Substitutes: National Implementation of the International Code; Status Report 2018. WHO, UNICEF, IBFAN. Geneva WHO 2018
4. WHO Sixty-ninth WHA. Ending the inappropriate promotion of foods for infants and young children. WHA 69.9. http://apps.who.int/gb/ebwha/pdf files/WHA69/A69 R9-en.pdf; 28th May 2016. Accessed 24th February 2017
5. https://www.rcpch.ac.uk/news/news-events/news/rcpch-statement-relationsh...
6. Eregie C.O. ‘Health Professionals-Industry Funding Conversation’: The RCPCH now truly Leading the Way in Children’s Health. https://www.bmj.com/content/364/bmj.1544/rr-0 of 16th February 2019
7. Godlee F. No more infant formula advertising in the BMJ. BMJ 2019; 364:L1279 of 21st March 2019
8. Eregie C.O. There is no Breastmilk Substitute (Including Infant Formula) and Prohibition of its Advertisement is Propgrammatically Appropriate for Optimal Child Health. https://www.bmj.com/content/364/bmj.l1279/rr-4 of 28th March 2019
9. Godlee F. Let’s talk about sex and relations with industry. BMJ 2019; 365:l2093 9th May 2019
10. Eregie C.O. More Talk on the ‘Health Professional Associations-Industry Conversation’; Conflicts of Interest are better avoided: A Proactive Role for ‘Medical Socioeconosophy’. https://www.bmj.com/content/365/bmj.l2093/rr-3 of 22nd May 2019
11. Eregie C.O. A Major Programmatic Misstep in the 2018 Revised Ten Steps to Successful Breastfeeding. https://www.bmj.com/content/363/bmj.k5146/rr-7 of 16th January 2019
Professor Charles Osayande Eregie,
MBBS, FWACP, FMCPaed, FRCPCH (UK), Cert. ORT (Oxford), MSc (Religious Education),
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria,
Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria,
UNICEF-Trained BFHI Master Trainer,
ICDC-Trained in Code Implementation,
*Technical Expert/ Consultant on the FMOH-UNICEF-NAFDAC Code Implementation Project in Nigeria,
*No Competing Interests.
Competing interests: No competing interests