ปาฐกถา ณ ฐ ภมรประว ต คร งท ๒๖

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1 ปาฐกถา ณ ฐ ภมรประว ต คร งท ๒๖ ASEAN Health Community: Opportunities and Challenges นายแพทย ครรช ต ล มปกาญจนาร ตน ผ แทนองค การอนาม ยโลก ประจ าประเทศอ นโดน เซ ย 1

2 Ten Member States: Brunei Darussalam Cambodia Indonesia Ten Member States: Brunei Darussalam, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Singapore, Thailand and Viet Nam

3 Focus of the presentation I. Briefing on Global Health Agenda II. Key Regional Health Issues in ASEAN III. Knowing ASEAN IV. Opportunities and Challenges

4 And There Are Many Navigational Challenges Country Politics UN Mandates Changing economic performance Social Determinants ALLIANCES Counterpart PARTNERSHIPS Capacity NETWORKS UN Reform Global Initiatives Integration System

5 On a very crowded and demanding partnership scenario at country level GTZ CIDA UNAIDS WHO 3/5 INT NGO Norad USAID PEPFAR GFATM RNE CF Sida HSSP UNICEF WB T MAP UNTG DAC GFCCP MOH SWAP PRSP MOF PMO MOEC CCM NCTP NACP CCAIDS CTU GOVERNMENT CIVIL SOCIETY PRIVATE SECTOR Source: Mbewe, WHO

6 Global Health Agenda 1. Universal Health Coverage

7 Global Health Agenda WHO Assembly 2012 DG Acceptance Speech, 23 May 2012 Universal coverage is the single most powerful concept that public health has to offer Universal coverage is the hallmark of a government s government s commitment, its duty, to take care of its citizens, all of its citizen

8 Global Health Agenda Dfiiti Definition embodies specific aims (universal coverage objectives) Access (reduce gap between need and utilization); Quality (sufficient to make a difference); and Financial protection for all

9 2. Global Health Agenda

10 Global Health Agenda The Millennium Development Goals (MDGs) summarize the commitments and have been commonly accepted as a framework for measuring development progress

11 Global Health Agenda MDGs in Summary MDGs have improved QOL of people A global benchmark for countries and many agencies Countries and development partners has combined efforts in these achievements with much progress Many countries such as Africa and South Asia have challenges in achieving MDGs More efforts and resources are necessary to make further progress by 2015 More efforts from next generation are needed beyond 2015 to maintain and make it better.

12 Global Health Agenda Post 2015 Development Agenda Beyond 2015 is a global campaign aiming to influence the ecreation of a post development framework that succeeds the current UN Millennium Development Goals. Beyond 2015 brings together over 380 civil society organisations in over 80 countries around the world.

13 3. International Health Regulations (IHR 2005) Global Health Agenda International Health Security IHR(2005), a paradigm shift From diseases list to all threats From control of borders to containment at source From preset measures to adapted response

14 Public Health Events of International ti lc Concern (PHEICs) Global Health Agenda Assess public health events decision instrument at Annex 2 Mandatory notification of four diseases (single case of smallpox, wild type poliovirus, new subtype Human influenza and SARS) Any events with serious public health impact,, unusual or unexpected, risk of international spread and risk of international travel and trade restriction

15 Climate change introduces huge unknowns Global Health Agenda 4. Climate Change and Human Health

16 Global Health Agenda nd 6 62 WHA May WHA, M 2009 Resolution Related to Climate Changes and d Health H lth Advocacy and Awareness Engagement in Partnership Work Plan with 4 Objectives Promoting g and supporting the generation of scientific evidence Promoting g and supporting the generation of scientific evidence

17 Global Health Agenda Decade of Action 5. Injury and Violent Prevention (IVP) & Disability and Rehabilitation (DAR)

18 5 D d fa ti 5. Decade of Action for Road Safety

19 Global Health Agenda Injury and Violence Prevention (IVP) & Disability and Rehabilitation (DAR) To prevent peve tthe eoccurrence ce of injury through violence & injury risk factor control in three areas: road traffic injury, domestic violence & disability prevention through good management of first health response together with inter sector & cross sectoral partnership.

20 6. NCD U UN High-level Meeting on NCDs New York, September 2011

21 Global Health Agenda Global Action Plan Alcohol

22 Our Mandates to date 2000 Global Strategy for the Prevention and Control of Noncommunicable Diseases 2003 Global Strategy on Diet, Physical Activity and Health 2004 Action Plan on the Global Strategy for the Prevention and Control of NCDs Global Strategy to Reduce the Harmful Use of Alcohol WHO Global Status Report on NCDs 2011 Political Declaration on NCDs Realizing the commitments made in the Political Declaration

23 "This is the second health issue ever to be addressed at a special meeting of the United Nations General Assembly. We should all work to meet targets to reduce NCDs. WHO's best buys serve as excellent guidance" Ban Ki moon UN Secretary General 19 September 2011

24 7. GlobalStrategyto to Global Health Agenda Counter Tobacco Epidemic Effort to Address Tobacco Epidemic

25 Global Health Agenda The Global Strategy World No Tobacco Day, 31 May WHO Framework Convention on Tobacco Control (FCTC), adopted d at WHA May 2003 MPOWER, the effective six component strategy to control tobacco use, February 2008.

26 Global Health Agenda MPOWER MPOWER strategy as recommended by WHO, can effectively counter the tobacco epidemic. The six policies of WHO s MPOWER Monitor tobacco use and prevention policies. Protect people from tobacco smoke. Offer help to quit tobacco use. Warn about the dangers of tobacco. Enforce bans on tobacco advertising, promotion and sponsorship. Raise taxes on tobacco.

27 Global Health Agenda 8. Social Determinant of Health The social, economic, political, cultural and environmentalconditions in which people are born, grow, live, work and age encompass health determinants collectively known as Social Determinants of Health (SDH)

28 Achievements of MDGs Regional Health Issues Population Changes and Aging Public health emergencies events disasters both natural and manmade Emerging Infectious Diseases : Zoonotic Diseases and other Communicable Diseases Food Security & Food Safety Universal Health Coverage Non Communicable Diseases : Tobacco Control Migrant Health Others : Urban Health, Human Resources in Health, Other factors as a result of economic rapid growth

29 Average life expectancy at birth in southeast Asia, Regional Health Issues

30 MDGs Achievement Ahi tin ASEAN Southeast Asia has sustained substantial reductions in maternal, neonatal, and child mortality since 1990, but this progress has been uneven and started long before the MDGs developed in Disparities in intervention coverage are most acute in countries with the low intervention coverage. There is a need for stronger regional cooperation through ASEAN Nations to support to countries that need to accelerate progress to meet the MDGs.

31 Population & Aging in ASEAN Countries, 1980, 2000 & 2020

32 Regional Health Issues PVMBG : Center for Volcanology and Geological Hazard Mitigation id/ Level II: Vigilant, Low activity. (Mt Ibu, Mt Lli Lewotolo, Mt Talang, Mt Sinabung, Mt Kerinci, Mt Anak Krakatau, Mt Papandayan, Mt Semeru, Mt Dukono, Mt Marapi, Mt Gamalama, Mt Gamkonoro, Mt Bromo) Level III: Ready, Possibility of major eruption within weeks. (Mt. Karangetang, Mt Sangeangapi, Mt Lokon, Mt Ijen, Mt Soputan, and Mt Rokatenda)

33 Disaster in ASEAN The 2004 Asian tsunami that devastated the coastlines of Thailand and Indonesia Cyclone Nargis in Myanmar drew attention to the region s vulnerabilities New models of disaster management partnerships between governments, multilateral agencies, and nongovernmental organisations.

34 Emerging ginfectious Diseases and Zoonotic Diseases Regional Health Issues The severe acute respiratory syndrome (SARS) epidemic emphasised need to strengthen regional health collaboration. The Mekong Basin Disease Surveillance project. The emergence of influenza A H5N1 and H1N1 outbreaks led to efforts to strengthen epidemiological surveillance and stockpiling of antiviral drugs. ASEAN i ll b ti l l ith WHO t ASEAN is collaborating closely with WHO to implement IHR (2005) utilizing APSED

35 CD HIV/AIDS, Malaria ATFOA has committed to Zero new infection, Zero deaths due to HIV/AIDS and Zero discrimination strategy in selected cities in each country AHMM has declared malaria drug resistance as a AHMM has declared malaria drug resistance as a major regional public health problem.

36 Food Security & Food Regional Health Issues Safety Southeast Asia has several major exporters of food and agricultural products, with implications for global food security and safety. Examples: Melanine contaminated milk products E. coli food poisoning i in EU followed by ban of seafood from SEAR Avian influenza and ban of poultry products

37 Regional Health Issues Universal Health Coverage Countries in southeast Asia, home to 8 7% of the world s population and have a fast economic growth and a moderate poverty level of 14 6%, have a high potential to accelerate protection from financial risks and achieve universal coverage of health care. National experiments in expansion of health equity and universal coverage PhilHealth in the Philippines, Vietnam s health fund for the poor Health Equity Funds in Cambodia and Laos, and Thailand s universal health coverage scheme provide innovative models for equitable financing that have attracted global interest.

38 Health System Issues Regional Health Issues in ASEAN Decentralization ti and reforms have led the Philippines i and Indonesia to devolve their health care delivery systems. Thailand s declaration on compulsory licensing to produce and import essential medicines Indonesia s refusal to share samples of H5N1 influenza viruses with WHO, sparked major diplomatic debates about balancing bl of national imperatives with global l interests. Pi Private sectors Issues after being one community including Health Tourism, migrant health,

39 Regional Health Issues Non communicable diseases In the poorest populations of the region, NCD already kill more people than do communicable, maternal, and perinatal conditions combined Many of these deaths occurring before old age. Greatly strengthened health promotion and disease prevention strategies are an urgent priority

40 Regional Health Issues Migrant Health Singapore, Malaysia, and Thailand have become a magnet for migrants, both regular and irregular, from neighbouring countries for employment. Health problems can arise among irregular migrants who are at risk for exploitation, poor living conditions, and inadequate health care. Challenges: how to include this group in existing UHC?

41 Regional Health Issues Other issues Urban Health Healthy Cities Human resources in health Other factors: Economic Rapid growth migration, development, counterfeit medicine, smuggling tobacco,

42 ASEAN Vision 2020 Knowing ASEAN "A concert of Southeast Asian nations, outward looking, living in peace, stability and prosperity, bonded together in partnership in dynamic development and in a community of caring societies"

43 Vientianne Action Programme 2004 The Signing of the ASEAN Charter & Singapore Declaration on the ASEAN Charter 2007 TRANSFORMATION OF ASEAN Bali Concord II 2003 ASEAN COMMUNITY 2015 ASEAN Political-Security Community (APSC) ASEAN Economic Community (AEC) ASEAN Socio-Cultural Community (ASCC) Entry into force of ASEAN Charter 15 December 2008 ASEAN Secretariat Jakarta Cha-am Hua Hin Declaration on the Road Map for the ASEAN Community

44 Dialogue Partners 1. Australia 2. Canada 3. China 4. European Union (EU) 5. India 6. Japan 7. Republic of Korea (ROK) 8. New Zealand 9. Russia 10. United States Sectoral Dialogue Partner Pakistan Other External Parties to ASEAN UN & its specialized agencies (WHO is included in this category) GCC SAARC MERCOSUR Rio Group Etc..

45 Knowing ASEAN ASEAN Vision 2020 ASEAN Politico-Security Community (APSC) ASEAN Economic Community (AEC) ASEAN Socio-Cultural Community (ASCC)

46 The ASEAN Charter Knowing ASEAN Signed at the 13 th ASEAN Summit on 20 November 2007 in Singapore It has been ratified by the 10 Member States The ASEAN Leaders celebrated the entry into force of the ASEAN Charter on 15 December 2008

47 ASCC : Strategic objectives Access to healthcare and promotion of healthy lifestyles To ensure access to adequate and affordable healthcare, medical services, and medicine, and promote healthy lifestyle for the people of ASEAN Improving capability to control communicable diseases To enhance regional preparedness and capacity through integrated approaches to prevention, surveillance, and timely response to communicable and infectious diseases

48 ASCC: Strategic objectives Enhancing food security and safety To ensure adequate access to food at all times for all ASEAN people and ensure food safety in AMS Building disaster resilient nations and safer communities to strengthen effective mechanisms and capabilities to prevent and reduce disaster losses in lives, and in social, economic, and environmental assets of AMS and to jointly respond to disaster emergencies through concerted national efforts and intensified regional and international cooperation

49 Institutionalization on ASEAN Health Development ASEAN Health Ministers i Meeting (AHMM) Senior Officials on Health Development (SOMHD) 6 ASEAN Working Groups Ad hoc Task Forces Health and Communicable Diseases Division, ASEAN Secretariat, Jakarta

50 AREAS of ASEAN Cooperation on Health ( ) ( ) Addressed 10 Health Issues Communicable Disease (EID) HIV/AIDS Pharmaceutical Development Food Safetyy Tobacco Control Pandemic Preparedness and Response NCD Mental Health MCH Traditional Medicine Networking/Initiatives ASEAN Plus Three Filed Epidemiology Training Network (FETN) Health Impact Assessment Increase access to healthcare UHC

51 ASCC Blueprint through Strategic Framework on Health Development ( ) Endorsed Work plans Implementation By Lead Countries and Development Partners Report Progress to Higher Levels Identified focal points; ASEAN Secretariat, Jakarta Roles: Coordination, facilitation, Initiation

52 Opportunities Comparative advantages of ASEAN High political commitments Engaging Dialogue Partners Issuance of health related unified policies and initiatives Directions on health cooperation in ASEAN Avenues for handling trans national health related issues Providing regional coordinating platform on health

53 ASEAN COMPARATIVES ADVANTAGES Opportunities Strong policy commitments ASEAN Charter & Blueprints of 3 communities Existing of Dialogue partners Strong partnership ASEAN Secretariat as a coordinating body

54 High political commitments ASEAN Summit with partners Declarations ASEAN Health Ministers Meeting (AHMM) has been conducted every two years Joint Statement ASEAN China Health Ministers Meeting Joint Statement ASEAN Plus Three (China, Japan & ROK) Health Ministers Meeting

55 Political Commitments on HIV/AIDS Opportunities ASEAN Summit in Bali 2011: ASEAN Declaration on Commitment on HIV/AIDS Zero New Infections Zero Death AIDS Rl Related Cases Zero AIDS Zero AIDS Discrimination

56 Engaging Dialogue Partners: ASEAN WHO Collaboration Opportunities MOU ( ) Tobacco Control; NCD; Traditional Medicine; Rational l Use of Drug; ASEAN Dengue Day Drug resistance in Malaria

57 Issuance of health related unified policies and initiatives Opportunities Mutual Recognition Agreement (MRA) ASEAN Events Smoke Free ASEAN Connectivity Plan focusing on three main areas: infrastructure, culture and technology, health services, communicable diseases ASEAN Agreement on Disaster Management and Emergency Response (AADMER) Challenges: In what extent on adoption/implementation g p p of those policies in each Member States???

58 Directions on health cooperation in ASEAN: Recent ASEAN Health Ministers Meeting July 2012, Phuket, Thailand Theme ASEAN Community 2015: Opportunities and Challenges to Health, Issued three Joint Statements Focuses for Continue efforts on EID Non Communicable Diseases Universal Health Coverage Tobacco Control Malaria drug resistance HIV/AIDS Elimination of rabies by 2020 Opportunities

59 Providing Regional Platform on Health and handling trans national health issues: ASEAN EID COMPONENTS (MECHANISM) Opportunities IHR 2005, APSED, One Health ASEAN Resource Center on Risk Communication Minimum i Standard d on Joint Multi sectoral l Outbreak Investigation and Response Antiviral Drugs and PPE Stockpile ASEAN Plus Three FETN FUNDING, COORDINATING MECHANISM???? ASEAN Plus Three EID Website

60 Opportunities ASEAN Agreement on Disaster Management and Emergency Response (AADMER) Signed by ASEAN Foreign Ministers To operate AADMER, ASEAN Coordinating Centre for Humanitarian i Assistance on disaster management (AHA Centre) is established, locates in Jakarta, funded by AMSs

61 Regional Mechanism : Opportunities ASEAN University Network Etblihd Established in November 1995 with participating of 26 universities in 10 AMS MOA was signed by the presidents/rectors/vice chancellors chancellors operated by Secretariat Office located at Chulalongkorn U Identified 5 Thematic approaches In SOMED Meeting in November 2012, a new establishment of thematic network called Medical Network will be considered

62 Challenges KEY CHALLENGES Diversification Coordination Implementation mechanisms & Monitoring Harmonization ( Global/National/Regional) Competing with others development issues

63 Diversification Achievements of MDGs indicates different development stages among ASEAN Member States INITIATIVE FOR ASEAN INTEGRATION (IAI) STRATEGIES FRAMEWORK Effort to assist CLMV in narrowing the gaps IAI Work Plan ( )

64 Challenges Coordination Inter governmental organization, bureaucratic Identification i of Regionality Many of health related declarations have been issues HIV/AIDS Coordination body ASEAN Secretariat staffing with ih overwhelming of work Cross Sectoral coordination among three communities

65 Implementation mechanisms & Monitoring Many of health related declarations/policies have been issues Implementation mechanism has been done through a working group which is comprise of a representative from all ten Member States, every working group meets annually Coordination body ASEAN Secretariat staffing with inadequate resources for monitoring Commitments among ASEAN Member States Resources mobilization

66 Competing with other development issues ASEAN has been founded d from economic and political security reasons Many development belong to ASEAN Economic Community Competing priorities among various health issues Health H l h is not always priorities i i among dialogue partners

67 Summary ASEAN is a region characterised by diversity, including public health challenges. The region is highly susceptible to natural disasters and other Emerging Diseases An inter governmental mechanism benefit for regional cooperation in health development Multi sectoral coordination is vital Prioritization of key regional health issues and capacity building of needed AMSs (CLMV) need to be intensified Harmonization of efforts between key development partners need to be highlighted C i f ASEAN S i d f i h ld b Capacity of ASEAN Secretariat as a nerved function should be strengthened

68 Global Health Agendas Globalization National Health Priorities Regional Health Threats ASEAN (ASCC, AEC, ASPC) PR RIOR RITI IZAT TIO ON CO OOR RDI NAT TIO ON

69 ASEAN: One Vision ii One Identity One Community