The 69th World Health Assembly of the World Health Organization held between the 23rd and 28th of May in Geneva. It had a very heavy agenda and is reported to have had its largest attendance ever. We may have contributed to this, given it was our first WHA. High on the agenda was WHO reform, the response to public health emergencies, the lack of new antibiotics to address bacterial resistance, global shortages of vaccines and medicines, the fight against substandard drugs, and then there was the “small” matter of starting the process of electing a new WHO Director General. Every year, a guest speaker is invited to address the Assembly, and this year it was the fiery Christiana Figueres, the executive secretary of the UN Framework Convention on Climate Change, who pulled off the Paris Agreement late in 2015.
This was the first time NHW was attending the event, just like we did for the National Council of Health meeting in Sokoto. Our motive is simple — we believe that knowledge is power. The more Nigerians know about what goes on at these meetings, and how well they are represented, the better they will get at holding their representatives to account. That is the essence of democracy.
Below are our five highlights:
It was the Minister’s first WHA – From the point of view of having an articulate Minister of Health, able to hold his own on different topics, at different forums, this was a very good outing for Professor Adewole. Prof. Adewole was invited to lots of events, not surprising given the burden Nigeria carries with most of the public health challenges of our time. As we have become accustomed with him, there were lots of promises, and pronouncements. On the opening day, every Minister of Health who seeks the opportunity is given five minutes to make a statement. Professor Adewole delivered an articulate statement, which included some surprises for the Nigerian health sector – stating that we had moved to a “Test –and – treat” policy for HIV. This would be a major (and welcome policy shift) to enable access to ARVs to all those with HIV, as recommended by WHO. Immediately we heard this, we reached out to colleagues in National Agency for the Control of AIDS (NACA) and the Network of People living with HIV in Nigeria, and while they welcomed it, it was also news to them. There were several more promises, the biggest one for us was a commitment that Nigeria would make the SDG goals, five years ahead of the target date! Given thatwe did not attain any of the MDGs this would be nothing less than a miracle.
Although Nigeria still had a large delegation at 31 (for comparison South Africa had eight), we had a much smaller team than previous outings. The Heads of NPHCDA, NCDC, NAFDAC (acting), and NHIS (acting) attended many sessions. The full list of attendees from all countries including Nigeria can be found here.
The DG’s speech – A major event at every WHA is the speech by the Director General, and this was the penultimate one for the current DG Margaret Chan. She started her annual speech optimistically, listing some of the successes of the global health community, including getting 15 million people on ARVs. Following the criticism of WHO’s response to the Ebola response, she highlighted progress that had been made in reforming WHO, especially on the creation of a new Health Emergencies Programme. Most of the focus (and funding) for this new programme is planned to strengthen the regional and country levels, especially the African region. The annual budget for this will be close to $500m, of which $160m is new funding. This will be a fundamental shift by WHO, which is transforming, in the case of health emergencies, from an organisation that primarily only gave advice and guidance to one with new operational responsibilities in responding to outbreaks and humanitarian emergencies. To take full advantage of this, in strengthening local capacity, Nigeria must sort out the status of its NCDC. It was clear from proceedings, that despite the challenges with the WHO’s Ebola response, Member States reaffirmed the central role of the WHO in coordinating emergency response to outbreaks and humanitarian emergencies. The process for electing the next Director General of the WHO has begun and will take a year to complete. There is a strong African candidate, Dr Tedros, in a field of other strong candidates. His candidature appears to be backed by the African Union. It will be an interesting year. Dr Chan ended her speech with a stern warning – “The world is not prepared to cope with what appears to be a dramatic increase in new and reemerging infectious disease threats”. She will complete her tenure as DG in June 2017, just after the next WHA where the voting will actually take place.
The launch of ESPEN – We were at the launch of a new Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN). ESPEN will be hosted and managed by the WHO Regional Office for Africa to reduce the burden of the five most prevalent neglected tropical diseases (NTDs) that are responsive to preventive chemotherapy on the African continent. These diseases are lymphatic filariasis, trachoma, schistosomiasis, soil transmitted helminthiasis and onchocerciasis. The precursor for this was the African Programme for the Control of Onchocerciasis (APOC), which was coincidentally led, very successfully by a Nigerian – Professor Uche Amazigo. Professor Adewole promised to ensure that very soon, the five diseases will no longer be neglected in Nigeria, and called for a partnership approach in the response to it. He made this promise while sitting between the DG of WHO and Dr. Matshidiso Moeti, Regional Director for Africa, WHO AFRO. As always, we will be holding him to his promise.
Commonwealth meeting – While in Geneva, the Commonwealth Health Ministers Meeting (CHMM) held, and was attended by the Honourable Minister of Health. Common health issues and opportunities for working together in the future were discussed. This year’s meeting was titled ‘Health Security and Access to Universal Health Coverage’, two issues high on the agenda of the Nigerian Minister. As always, we heard strong words by the Minister of Health – who said that, “There is no health security when you depend entirely on outside funding”. In response to Professor Adewole, during the question and answer session, Margaret Chan, DG of WHO agreed with the Honourable Minister, saying that if Nigeria could manage corruption, it would not need donor support. Listen to all the keynote addresses at the meeting here. So its over to us now…
Just being here – For a first timer – this is an unusual conference. If you are used to the vibe and excitement of normal large public health conferences, you will find this very frustrating. Unlike the meritocracy that guides scientific conferences, the WHA is guided by the principle that every country is equal, and has a right to be heard, so you end up in prolonged sessions half-listening to depositions from delegates of many countries waiting for the occasional spark of interest. Most representations are boring and self-serving. Having said this – it is great to observe how the bureaucracy of international health policy moves. The grounds of the “Palais”, where the United Nations is based in Geneva is awe-inspiring.
We attended many sessions, that we thought were of relevance to our challenges in Nigeria. In some, we were well represented, in others we were not. Being the first WHA for the Nigerian Minister of Health, he could get away with making promises, from next year he will be asked, not what he intends to do, but what he is doing or has done. As always, we will be there to bring it to you. For now – we are leaving the serenity of Switzerland for the comparatively harsher reality of life in Nigeria…