Integration and chronic conditions on the WHO agenda

Is jumping in at the deep end really the best way to learn? Dr Margaret Chan should know, as less than three weeks in new job as WHO Director-General she opens her first meeting of WHO’s Executive Board today in Geneva.

In what she referred to as “optimistic times for health” she gave some clues about how her priorities might have evolved during her first 19 days in the job. Here are a few snippets I tuned in to in particular as I read her speech – you can get the full version of her address on the WHO site.

Not surprisingly, Dr Chan flagged integration of health services as high on her agenda. (Who wasn’t talking about that as a priority in 2006?) Citing the recent attainment of Measles Initiative targets, she highlighted the ability of the initiative to also deliver a “bundle” of interventions, including bed nets, vitamin A, de-worming tablets, as well as polio and tetanus vaccines.

“I view this initiative as a model of what can be achieved through integrated service delivery,” she said. “This is a value-added approach that amplifies the power of public health.”

That might work for measles and other child-related services, but it is not clear how the ‘model’ would translate into integration of TB and HIV services, for example, or the bringing together HIV and other sexual and reproductive health services.

The theme of integration also surfaced later in her address, in relation to health system strengthening, when she talked about the unprecedented number of partnerships, initiatives, and funding agencies now devoted to public health. Without referring directly to any American philanthropists cum technology giants in particular, Dr Chan emphasised the need for working together and to align with country priorities and capacities.

“Single-disease initiatives have their place, but we need to pursue every opportunity to find synergies that bring multiple results,” she said.

She added: “I further believe that when we use an integrated primary health care approach, we will find ways to inter-relate programme activities, and thus amplify our impact.”

She gave further clues of what is on her mind when she summed up the essence of one of WHO’s dilemmas, drawing attention to the ‘multiplicity of health initiatives focused on delivering outcomes’, and their common requirement for a functional health system.

“Yet strengthening health systems is not the core purpose of these initiatives,” she emphasised. “We need a common approach to service delivery.”

Possibly signalling an imminent (and long overdue) shift away from acute care paradigms that dominate much of WHO’s work and many health systems, the new DG made it clear she is fully aware that tools and strategies for taking action on chronic care prevention and management lay waiting in the wings.

“As the report on chronic diseases makes clear, we have many excellent opportunities for prevention and a broad range of interventions that are cost-effective in all our regions,” she reminded the Board. “For these diseases, prevention is by far the best option. WHO must continue to convince health leaders in all regions that chronic diseases are part of the development agenda.”

Finally, the new DG indicated that she is also on the case when it comes to WHO’s role at the interface of public health and free-market forces, and willing to consider new thinking in this area. Focusing on fixed-dose drugs for children suffering from AIDS, tuberculosis, and malaria, she recognised that such drugs are often not available because industry has no strong market incentive.

“As you know, we are developing a strategy and action plan addressing public health, innovation and intellectual property.”

The Executive Board (EB) is composed of 34 individuals technically qualified in the field of health, each one designated by a Member State elected to do so by the World Health Assembly. Member States are elected to the EB for three-year terms.

Dr Margaret Chan is from China