The work of
WHO in the Eastern Mediterranean
Region
Annual report of the Regional Director
2019
Annual report of the Regional Director
2019
The work of
WHO in the Eastern Mediterranean
Region
© World Health Organization 2020
Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).
Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”.
Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization.
Suggested citation. The work of WHO in the Eastern Mediterranean Region: annual report of the Regional Director 2019. Cairo: WHO Regional Office for the Eastern Mediterranean; 2020. Licence: CC BY-NC-SA 3.0 IGO.
Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing.
Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user.
General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.
Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed WHO Library Cataloguing in Publication Data
World Health Organization. Regional Office for the Eastern Mediterranean
The work of WHO in the Eastern Mediterranean Region: annual report of the Regional Director 2019 / WHO Regional Office for the Eastern Mediterranean
p.
Arabic edition published in Cairo (ISBN: 978-92-9022-347-4) (ISBN: 978-92-9022-348-1) (online) (ISSN: 9220-1020)
French edition published in Cairo (ISBN: 978-92-9022-349-8) (ISBN: 978-92-9022-350-4) (online)
(ISSN: 1816-2061)
1. Regional Health Planning - Eastern Mediterranean Region 2. Universal Health Insurance 3. Primary Health Care 4. Hospital Restructuring 5. Health Workforce 6. Patient Safety 7. Drugs, Essential - supply & distribution 8. Noncommunicable Diseases - prevention & control 9. Communicable Disease Control I. Title II Regional Office for the Eastern Mediterranean III. Series
(ISBN: 978-92-9022-345-0) (NLM Classification: WA 541) (ISBN: 978-92-9022-346-7) (online)
(ISSN: 1020-9166)
Contents
Introduction ... 4
Expanding universal health coverage ... 8
Addressing health emergencies ... 28
Promoting healthier populations ... 46
Transforming WHO ... 64
I am pleased to present this report on the work of the World Health Organization (WHO) in the Eastern Mediterranean Region during 2019.
WHO undertakes a vast span of activities to support the health and well-being of people in our Member States. Our areas of work include everything from tackling the underlying social determinants of illness, preventing disease and promoting health through to strengthening health systems and tackling health emergencies, while our working methods range from high-level dialogue with government leaders to direct provision of supplies and services in emergency situations.
To coordinate such a wide-ranging programme of work, a clear direction and priorities are essential. My top priority when I took charge as WHO’s Regional Director for the Eastern Mediterranean in 2018 was therefore to lead the development of a new vision that would guide all our work in the Region, ensuring that our activities were focused and linked to measurable results. Vision 2023 was warmly welcomed by Member States in October 2018, and the following year we launched a new strategy aimed at turning our vision into reality.
Introduction
In 2019, WHO started implementing our new
strategy for the Eastern Mediterranean Region.
Vision 2023 is closely aligned to the Sustainable Development Goals and WHO’s global strategy, the Thirteenth General Programme of Work (GPW 13). It is based on the principle of “health for all by all”; in other words, we believe that to achieve the improvements in health and well-being that we seek, everyone – governments, nongovernmental organizations, the private sector, communities and individuals – has a part to play.
It is an ambitious vision, but our strategy identifies concrete steps that WHO will take to help achieve it and specifies the indicators we will use to assess our performance.
This report covers the first year in which we implemented our vision and strategy. It is structured around our four core strategic priorities for the Region: expanding universal health coverage, addressing health emergencies, promoting healthier populations and transforming WHO itself to ensure that it is fit for purpose.
The report highlights our main achievements in 2019 and the major challenges we faced. There are links to further information on many issues, and you will find a wealth of other resources on our website:
www.emro.who.int. In addition, please note that there is a separate update which focuses on progress in implementing our flagship strategic initiatives.
I am proud of the contribution that WHO is making in the Eastern Mediterranean Region. As this report shows, our dedicated and professional staff are achieving notable successes across the Region, including in the most challenging circumstances. But as this report also makes clear, the Organization cannot accomplish anything without strong collaboration from a range of partners, most importantly our Member States. We look forward to further successful collaboration in years to come.
Dr Ahmed Al-Mandhari WHO Regional Director for the Eastern Mediterranean
Expanding
universal health coverage
We are a long way from achieving this ambitious goal in the Eastern Mediterranean Region. According to the most recent global monitoring report, Primary health care on the road to universal health coverage, essential health coverage in the Region is significantly lower than in most other WHO regions. Between 2000 and 2017, the UHC service coverage index (SCI), which measures the availability of essential services, increased globally from 45 to 66 out of 100, but our Region lagged behind with a score of less than 60.
WHO’s global and regional targets on
expanding universal health coverage (UHC) reflect repeated commitments by world leaders to ensure that everyone has access to the
good quality health services they need without
suffering financial hardship.
Access to health is undermined by critical shortages of human and financial resources in many countries of the Region. There are gaps and weaknesses in health systems, with inadequate integration of services, poor or inconsistent regulation, and too little focus on ensuring quality and patient safety. Meanwhile, action to prevent and control diseases is compromised by prejudice, stigma and lack of information as well as more tangible physical and logistical barriers and the disruption and insecurity caused by humanitarian emergencies.
In 2019, WHO worked with our Member States and partners to tackle these challenges through a huge range of activities.
Strengthening primary health care
The cornerstone of an effective health system is primary health care (PHC), and WHO is working with our Member States to support them in developing PHC and ensuring that it is effectively integrated with other elements of the health system.
PHC Measurement and Improvement (PHCMI) is a flagship initiative in the Region which was launched on World Health Day, 7 April 2019, as part of efforts to emphasize the link between PHC and universal health coverage. It offers a step-by-step approach to help countries enhance their PHC provision, beginning with standardized, in-depth assessment of each country’s PHC system to establish a baseline and identify key gaps and challenges. Countries will then be supported to develop strategic, tailored interventions to achieve measurable improvements.
A suite of information products are being developed to support the initiative, notably PHC country profiles and vital signs profiles giving an at-a-glance picture of provision in each country. A consultative meeting in December 2019 brought together 19 countries to discuss their profiles.
Meanwhile, WHO continued working to identify priority benefit packages – the core of essential promotive, preventive, curative, rehabilitative and palliative services that should be available and accessible to all people in the country without risk of financial hardship. A draft regional package of essential services has been developed and will be published in 2020.
Transforming hospitals in the Region
Building a health system based on PHC is not just a matter of improving primary health care; it is also necessary to reform hospitals to ensure effective integration between different services and different levels within the system.
A new framework for action paves the way for a transformation of the hospital sector in the Region. It proposes interrelated interventions at the system (policy) and facility (hospital) levels to effect a paradigm shift in the model of care aimed at optimizing the role of each hospital in meeting the health needs of its client population (see Fig. 1).
The framework was endorsed by the Regional Committee in October 2019, and a programme of work to support its implementation was set to begin in 2020.
1
Paradigm shift for service delivery
Old paradigm New paradigm
DDiisseeaassee--bbaasseedd NNeeeeddss--bbaasseedd
CCoonnttiinnuuuumm ooff ccaarree AAccuuttee ccaarree
PPooppuullaattiioonn hheeaalltthh
NNeettwwoorrkkss ooff iinntteeggrraatteedd ddeelliivveerryy sseerrvviicceess FFrraaggmmeennttaattiioonn
AApppprroopprriiaattee ccaarree aatt aann aapppprroopprriiaattee lleevveell VVoolluummee ooff sseerrvviicceess
IInnddiivviidduuaallss
Figure 1: Paradigm shift for service delivery in hospitals
Vs
Engaging the private sector
The private sector plays a major role in the financing and provision of health care in the Region. In line with the pioneering framework for action adopted by the Regional Committee in October 2018, WHO is seeking to support countries in engaging with the private sector and harnessing it to help expand health coverage.
A necessary step in this long-term project is intensive work to analyse and understand the private health sector in different countries, since information systems, monitoring and regulatory regimes are often underdeveloped. Seventeen countries have now completed in-depth private health sector assessments using a tool developed by WHO, and the regional team also began preparing a series of eight thematic reports to help identify gaps and priorities going forward.
Further activities include important collaboration with UNICEF and USAID to develop a policy dialogue workshop, and with partners under the Global Action Plan for Healthy Lives and Well-being for All.
Developing the health workforce
Health systems can only function if health professionals are available where they are needed and have all the right skills and competencies to deliver the required health services. However, there are very significant gaps in the health workforce in the Region at present. Research presented to the Regional Committee in October showed the number of doctors, nurses and midwives per 100 000 population is below the Organisation for Economic Co-operation and Development (OECD) average in all countries of the Region, and also below the Sustainable Development Goals (SDGs) target level in most countries (see Fig. 2).
Efforts to develop the health workforce in the Region in 2019 included a strong focus on nursing and midwifery. The Regional Committee passed resolution EM/RC66/R.3 calling on countries of the Region to develop and implement national strategies and action plans to strengthen the nursing and midwifery workforce, aiming to build momentum ahead of global celebrations of 2020 as the International Year of the Nurse and Midwife. Eight countries in the Region joined the Nursing Now Campaign to raise the profile of the profession.
The resolution stresses the need to ensure that nursing and midwifery training and education emphasizes PHC competencies, and to define and expand nurses’ roles and scopes of practice to maximize their contribution within PHC systems.
Another important initiative to enhance health workforce capacity to deliver PHC was the development of a new qualification to boost doctors’ knowledge of family medicine. WHO collaborated with UNICEF’s Regional Office, the American University in Beirut (AUB) and the World Organization of Family Doctors (WONCA) to create the Regional
Professional Family Medicine Diploma as a bridging programme to help reach the regional target of three family physicians per 10 000 people by the year 2030.
Efforts will now turn to helping countries to introduce the programme within their national medical education systems.
Meanwhile, work continued to support countries in addressing their health workforce challenges in a systematic way through well-structured assessments and strategic plans. Progress was made in improving health Figure 2: Density of doctors, nurses and midwives in the WHO Eastern Mediterranean Region, 2017 or latest available date
workforce information and evidence at country and regional levels, and further data were collated through the National Health Workforce Accounts platform. A new health workforce observatory for Palestine was launched.
Ensuring quality and patient safety
Research has shown that 18% of hospital admissions in the Eastern Mediterranean Region are associated with adverse events, 83% of which could have been prevented. WHO’s work to address this problem centres on implementation of the Patient Safety Friendly Hospital Initiative (PSFHI), a tool to support hospital managers and staff in adopting best practice in their institutions.
More than 280 hospitals across the Region have now adopted the PSFHI.
A new edition of the Patient safety assessment manual, which includes detailed criteria and procedures to guide implementation of the PSFHI, is in preparation and will be published in 2020. The substantive content of the manual aligns with the requirements of the International Society of Quality (ISQua) and was validated at a meeting in July 2019.
Work is also ongoing to enhance service quality in other parts of the health system. In 2019, several countries were supported in developing and implementing a national quality policy and strategy. The process involves extensive consultation with stakeholders to articulate a shared
Photo: ©WHO/S. Meyers
vision and priorities which will then inform the selection of evidence- based interventions linked with national health plans.
In addition, four countries were supported to adopt a set of 34 quality indicators specifically for PHC.
Expanding access to medicines and health technologies
Work on expanding access to medicines in 2019 included the
establishment of a regional steering committee for national regulatory authorities. The new committee will help to promote networking, capacity-building and harmonization of standards and practices.
A survey on the status of pharmacovigilance systems in 19 countries was conducted to inform plans to support strengthening pharmacovigilance in the Region. The main strengths and weaknesses identified were discussed in a regional meeting.
Alongside these Region-wide initiatives, extensive technical support was provided to individual countries on a range of issues, including developing national regulatory institutions and systems, strengthening pharmacovigilance, establishing antimicrobial stewardship programmes, undertaking health technology assessment, and implementing the regional strategic framework to improve access to affordable, safe and quality-assured blood and blood products.
Promoting effective health governance
WHO works extensively to foster informed discussion of health-
related issues among legislators in the Region. Partnerships have been established focusing on several specific issues, including reproductive and child health, road safety and tobacco control, and a further landmark was reached with the launch of the Parliamentary Forum for Health and Well-being in June 2019.
The Forum brings together parliamentarians from across the Region with technical support from WHO. The aim is to strengthen their engagement in advancing health and well-being and facilitate a more holistic, whole- of-government approach to health issues. In so doing, it should support policy-makers in achieving their national goals while also encouraging
Just a few months later, in October 2019, WHO coordinated the first annual meeting of the regional chapter of the Health Systems Governance Collaborative, which brings together a wide range of stakeholders, including parliamentarians and other policy-makers, practitioners, civil society representatives, academics and researchers.
These initiatives were complemented by ongoing efforts to support improvements in health system governance and financing and build capacity within countries. Extensive technical support on institutionalizing health accounts was provided to 11 countries; professionals from seven countries received training on measuring financial health protection; and work began on developing a framework to enable the systematic analysis of health system governance at national and subnational levels in the Region.
Tackling communicable diseases
As well as strengthening health systems, expanding universal health coverage means implementing effective interventions to fight diseases.
Millions of lives in the Region are blighted by communicable diseases.
More people are chronically infected with viral hepatitis B and C here than in any other WHO region; cases of HIV are rising faster than anywhere else in the world; and vector-borne diseases such as malaria and leishmaniasis are re-emerging in some areas.
But success is possible despite all the challenges. In 2019, many countries of the Region celebrated major achievements, supported by WHO and partners. Highlights included the elimination of measles and rubella in several countries and a major campaign against hepatitis C in Egypt.
And in August 2019, Yemen became the second country in the Region to be validated as having eliminated lymphatic filariasis as a public health problem, demonstrating that countries can achieve significant health impacts even during complex emergency situations.
Improving immunization programmes
Routine immunization is the backbone of efforts to prevent and control communicable diseases. Coverage of the third dose of
pertussis, diphtheria and tetanus (DTP3)-containing vaccine increased to 82% in 2018 (the latest reported year) – meaning a year-on-year decrease of about 6% in the number of infants unvaccinated for DTP.
Fourteen countries in the Region have maintained the achieved target of DTP3 vaccine coverage above 90%, and routine immunization services continued to be provided in fragile and conflict-affected countries.
Meanwhile, more new vaccines were introduced in countries of the Region in 2019, including pneumococcal conjugate vaccine (PCV) in Tunisia and human papilloma virus (HPV) vaccine in United Arab Emirates.
Pakistan became the first country in the world to introduce typhoid conjugate vaccine. Currently, Haemophilus influenzae type B (Hib) and inactivated polio (IPV) vaccines are in use in the national Expanded Programme on Immunization (EPI) in all countries, pneumococcus-
containing vaccine in 17 and rotavirus vaccine in 15 countries. In addition, a national policy and decision to introduce rotavirus vaccine was taken in the Islamic Republic of Iran, and preparations for its introduction are underway. The national immunization technical advisory group (NITAG) in Yemen has recommended introduction of a booster dose of DTP vaccines and birth dose of hepatitis B vaccine.
Controlling measles and rubella
Encouraging milestones were recorded in the fight against measles and rubella. The overall reported incidence of measles in the Region fell from 54.2 cases per million in 2017 to 22.5 per million in 2019, and the regional verification commission for measles and rubella elimination declared that measles and rubella had been eliminated in Bahrain, the Islamic Republic of Iran and Oman. Another six countries now have an incidence rate of fewer than 0.5 cases per 100 000 population.
Underpinning these successes were strong efforts in surveillance and immunization. Measles and rubella case-based surveillance was initiated with the support of WHO in 2004 and is now fully functioning in 20 of the Region’s 22 countries. It is supported by a network of WHO-accredited national measles and rubella laboratories and three regional and
subregional reference laboratories. System performance indicators show 17 countries meeting the main elimination surveillance standards.
To boost population immunity, around 90 million people between the ages of 6 months and 14 years in nine countries were vaccinated against measles through vaccination campaigns in 2018–2019, with an average coverage rate of around 96%.
Strengthening health laboratories
Health laboratories also play a critical role in the prevention, detection, and control of diseases, but laboratory staff in leadership and
management positions often lack the education and training they need.
To effectively address this gap, WHO joined five other international organizations to develop the Global Laboratory Leadership Programme (GLLP).
The GLLP takes a “One Health” approach covering both human and animal health, and aims to support laboratory leaders in developing nine core competencies for disease prevention and control, as set out in the Laboratory Leadership Competency Framework.
In 2019, seven laboratory professionals from both the human and veterinary health sectors in Pakistan successfully completed the first of three in-country validation phases addressing the leadership and communication competencies. Phase 2 will take place 2020.
Facilitating access to HIV diagnosis and treatment
In 2019, Pakistan experienced an unprecedented outbreak of HIV affecting more than 1000 children in Sindh province, mainly through substandard health care injections. WHO coordinated technical support to investigate and respond to the outbreak, including infection control, supply of diagnostics and medicines, as well as delivery of quality diagnosis and treatment services.
More generally, the regional team focused efforts on interventions to increase access to HIV diagnosis and treatment. Regional as well as national activities in the Islamic Republic of Iran, Morocco and Pakistan helped to expedite the introduction of HIV self-testing (HIVST) as a strategic approach to increase access to HIV testing services. Client- centred approaches using integrated and differentiated service delivery models were supported in the Islamic Republic of Iran and Pakistan to improve linkage to treatment services after diagnosis and to enhance retention in treatment, particularly for key populations at increased risk of HIV. Other efforts to provide HIV services for refugees and other displaced persons included supporting the mobilization and implementation of resources from the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Hepatitis elimination in high-burden countries
WHO estimates that 15 million people are living with hepatitis C virus (HCV) in the Eastern Mediterranean Region, only 33% of whom have been diagnosed and only 26% treated. Finding and treating the hidden cases is therefore a priority.
There were heartening successes in this regard in 2019. Egypt, the worst affected country in the Region, conducted a national campaign to eliminate hepatitis C during which 60 million people were tested and 3.7 million received treatment. Crucially, the campaign was accompanied by a reduction in the prices of direct-acting antivirals (DAAs) through encouragement of competition among different companies that had registered their generic medicines in the country.
The same approach to price reduction was used in Pakistan, leading to some of the lowest prices reported worldwide, but testing and treatment activities are only just beginning. On 28 July 2019, World Hepatitis Day, the Prime Minister pledged to test 140 million people in the coming five years and to treat all those infected. A model elimination programme
is being rolled out in one district in Punjab with the support of WHO to refine the service delivery model to be used.
Other countries in the Region are now encouraged to take advantage of the availability of generic medicines to initiate similar activities. While 12 countries have strategies which aim to eliminate hepatitis, few have started implementation.
Ending tuberculosis
Work to tackle tuberculosis (TB) sought to build on global momentum following the first-ever High-level Meeting on the Fight to End TB of the United Nations General Assembly and its landmark Political Declaration in October 2018. WHO’s regional team advocated to obtain corresponding commitments from Member States to accelerate progress to end TB by 2030.
The President of Pakistan declared the Pakistan TB-free Initiative in 2019 and the Ministry of Health of Morocco announced a National Initiative for Ending TB. Both countries redoubled efforts to involve non health sector partners in the fight against TB, in line with the global multisectoral accountability framework.
The regional TB team also worked with countries and partners to enable rapid adaptation and use of new WHO guidelines on the treatment of isoniazid-resistant TB and updated guidelines for the treatment of multidrug- and rifampicin-resistant TB (MDR/RR-TB), with 17 countries plus other partners attending a workshop in May. Afghanistan, Iraq, Lebanon, Pakistan and Qatar were supported to develop national strategic plans, while Jordan, the Syrian Arab Republic and Yemen were supported to update their national guidelines.
Combating malaria and other vector-borne diseases
More countries in the Region achieved or moved closer to malaria elimination in 2019. WHO provided support to the Islamic Republic of Iran and Saudi Arabia so that they could validate elimination. We also supported malaria-free countries in the Region to prevent re- establishment of local malaria transmission, and proper malaria case
management and preparation for certification of malaria-free status in Egypt and Oman.
There was also encouraging evidence that detection is improving in those countries where malaria is still endemic. Staff from all three levels of WHO have been coordinating work on this with ministries of health and other partners, including the Global Fund, UNICEF, the United Nations Development Programme (UNDP), the International Organization for Migration (IOM) and academic partners.
Increased access to rapid diagnostic tests (RDTs) at the community and lower health facility level led to an increase in the malaria confirmation rate in endemic countries, particularly Afghanistan and Pakistan. In 2016 fewer than 50% of reported malaria cases were confirmed in Afghanistan;
by 2019, the rate had risen to 100%.
Long-term progress and experience in tackling malaria can provide the basis for a strong integrated system for surveillance and control of malaria and other vector-borne diseases. The Regional Office and country offices coordinated support to respond to outbreaks of vector-borne diseases, including dengue fever, chikungunya and leishmaniasis in Afghanistan, Djibouti, Pakistan, Oman, Somalia, Sudan and Yemen. In the Islamic Republic of Iran, support was provided to respond to flood emergencies and prevent vector-borne diseases.
However, additional logistical and technical support is required in countries experiencing unprecedented levels of malaria (for example, Djibouti and Sudan) and other vector-borne diseases, particularly Aedes- borne diseases (Djibouti, Pakistan, Somalia, Sudan and Yemen), due to
man-made and/or natural disasters and massive population movement.
The response to the malaria outbreak in Djibouti was multisectoral and involved many organizations, particularly UNDP.
Tackling antimicrobial resistance
There was evidence of strong political commitment to tackling
antimicrobial resistance (AMR) in 2019. Fourteen countries of the Region officially endorsed and submitted their national AMR action plans to WHO’s platforms with full engagement of all relevant government sectors, nongovernmental organizations and international tripartite organizations, including WHO regional and country offices and the Food and Agriculture Organization of the United Nations (FAO). A further five countries
completed their plans pending endorsement by ministers of health.
There was also encouraging progress in developing surveillance data, with subregional data on antimicrobial use being generated for the first time in the Region. Seven countries in the Region, including 127 hospitals, conducted point prevalence surveys to measure physicians’ prescribing practices for antibiotics among hospitalized patients using a standardized methodology. Findings indicated a prevalence ranging between 30% in Tunisia to more than 85% in Iraq and Sudan. The data generated provide evidence for countries to design and implement quality improvement
projects to improve their antibiotic prescribing practices with a special focus on national and facility-level antimicrobial stewardship programmes.
Jordan is so far the only country to utilize the subregional data to design and select priority interventions for implementation.
Enhancing NCD surveillance systems
Noncommunicable diseases (NCDs) such as cancer and cardiovascular disease and mental disorders account for around two thirds of all deaths in the Region and pose a heavy burden of chronic disease.
Effective surveillance systems are crucial to prevent and manage NCDs.
WHO is working to support countries in implementing and integrating NCD monitoring and tracking within their national health information systems. The WHO Global Monitoring Framework identifies three pillars for NCD surveillance: 1) monitoring of mortality (with a specific focus on premature mortality from cardiovascular diseases, cancer, diabetes and chronic respiratory disease) and morbidity (cancer incidence); 2) monitoring of risk factors; and 3) monitoring of national system response (a core component of which is health system response and capacity). In 2019, attention was given to scaling up existing sources of data collection on mortality and morbidity, risk factors and health system response.
The resulting information will help countries in setting priorities and developing targeted interventions to reverse the NCD epidemic.
Meanwhile, agreements and memoranda of understanding were renewed with the United States CDC and the CDC Foundation to continue
implementation of the Global Tobacco Surveillance System in the Region, specifically the Global Youth Tobacco Survey, the Global Adult Tobacco Survey and Tobacco Questions for Surveys. Collaboration continued with the International Agency for Research on Cancer (IARC), WHO’s sister agency, to strengthen cancer surveillance and capacities in the area of research on cancer.
Data on progress made in tackling NCDs at country level were featured in a new regional report, Assessing national capacity for the prevention and control of NCDs. The survey aims to further support countries by identifying progress to date and remaining gaps, highlighting lessons learned and recommending opportunities for improvement.
Scaling up mental health provision
Mental, neurological and substance use disorders are highly prevalent in the Region, and are major contributors to disease, premature death and disability. They are also frequently associated with high levels of stigma and human rights violations, particularly in low- and middle-income countries.
There have been some welcome signs of progress in recent years. For example, suicide rates have fallen significantly (see Fig. 3). Unfortunately, however, there is still a large gap between the resources available and the resources urgently needed to address the burden of mental disorders.
WHO is working with countries to close that gap and help people with mental disorders get the support they need. In 2019, we produced a set of factsheets in both Arabic and English giving basic information about a range of disorders to raise awareness among the general public. We also worked to scale up the mental health gap action programme (mhGAP), which aims to bridge the treatment gap for priority mental health problems through integration within each country’s PHC system.
Figure 3: Change in age-standardized suicide rates per 100 000 population in the Eastern Mediterranean Region (both sexes)
6 5 4 3 2 1 0
5.5
4.3
5.4
4.8
3.9
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
In 2019, 15 of the 22 countries and territories in the Region faced major emergencies, including three at the highest level, Grade 3. More than 70 million people needed humanitarian assistance, and the Region was both the source of more forcibly displaced people and host to a larger number of forcibly displaced people than anywhere else in the world.
WHO worked with a wide range of partners to respond to these
emergencies, offering direct support to countries in the form of expertise and supplies, and helping partners deliver essential health services. We also worked with countries to help strengthen emergency preparedness and resilience, and to monitor and investigate potential disease
outbreaks and other risks.
Addressing health
emergencies
Outbreaks of infectious diseases, conflict
and natural disasters exert a heavy toll in the
Eastern Mediterranean Region, causing health
emergencies on an unparalleled scale.
Responding to emergencies
WHO’s regional emergency operations team conducted country support missions to 15 countries in the Region during the year totalling 291 person/days, while our operations support and logistics (OSL) team massively expanded the logistics hub in Dubai from 3000 to 14 000 square metres of warehouse capacity. In 2019 alone, the value of imported products reached US$ 26 million while the value of goods dispatched exceeded US$ 11 million.
OSL staff were deployed to Djibouti, Jordan, Lebanon, Libya, Oman and Yemen to support emergency operations in country offices, share best practice and improve supply chain management, and mobile laboratory containment units were deployed to 13 countries across the Region to enhance preparedness for high-risk pathogens.
We signed three agreements with partners to deliver health services to people in need in different parts of the Region. For example, in 2019 we provided more than 210 tonnes of supplies to health partners operating in northeast Syrian Arab Republic who delivered more than 2500
surgeries, provided life-saving interventions to 5500 seriously wounded patients, supported the chronic disease conditions of a population of 630 000 and provided emergency medicines to a population of 558 000.
Maintaining health systems and services
Emergencies increase the demand for health services while
simultaneously disrupting and undermining the systems that deliver those services. WHO strove to maintain and expand health care provision across a wide range of technical areas, even in the most challenging circumstances.
Our noncommunicable diseases (NCD) kit provides a standard package of essential medicines and medical devices to meet the priority NCD health needs of 10 000 people for three months in emergency situations. In 2019, technical support was provided for its procurement and deployment in Afghanistan, Iraq, Libya, the Syrian Arab Republic and Yemen.
Mental health and psychosocial support were provided in countries affected by the Syrian crisis, Iraq, Libya and Yemen, in coordination and collaboration with our partner United Nations agencies, nongovernmental organizations, national stakeholders and academic institutions.
A framework for action for quality health care in extreme adversity was developed to support the implementation of evidence-based policies and strategies to ensure the delivery of quality and safe health care services in fragile, conflict-affected and vulnerable settings. It was pilot tested in Libya and Palestine during the year.
Meanwhile, as part of the recovery phase in Iraq and the Syrian Arab Republic, technical support was provided to strengthen technical capacities in procurement and distribution systems and the rational use of essential medicines, to support the transition from donations and supply systems managed by international organizations to national supply systems.
Improving surveillance and monitoring risks
WHO’s health emergency information and risk assessment team continued working to enhance capacity to detect and manage public health events, assess risks, and inform the national focal points through the event information site (EIS). The team managed 47 events through the event management system during the year, with 15 risk assessments conducted and 33 updates posted on the EIS.
Activities to improve surveillance and risk monitoring included training sessions to help establish the network of geographical information systems in the Region. Standard operating procedures were developed
In Yemen, laboratory staff conduct testing for malaria and
to support event-based surveillance in Morocco, and the surveillance guidelines for Jordan were expanded to include all hazards.
An incident management leadership course at the end of the year brought together 32 WHO staff from country offices and the Regional Office for training in responding to emergencies using the Organization’s incident management system.
Strengthening emergency preparedness
Extensive activities were undertaken to strengthen countries’
preparedness for emergencies. A joint external evaluation (JEE) was conducted in Iraq to assess the country’s public health capacities to deal with all hazards under the International Health Regulations (IHR 2005). This brings to 18 the number of countries in the Region that have undergone JEEs, with evaluations in the Islamic Republic of Iran, Palestine, the Syrian Arab Republic and Yemen set to complete the tally.
JEEs provide the basis for each country to develop a national action plan for health security (NAPHS) tailored to its specific needs. As part of follow-up work in 2019, workshops were organized by WHO and attended by representatives of public institutions and partner organizations, with participants teaming up across 19 technical areas of the IHR to address
the recommendations that came out of previous JEEs. Djibouti, Egypt, Tunisia and the United Arab Emirates developed their NAPHS.
In addition to this support for individual countries, cross-border and regional preparedness were important areas of focus. WHO collaborated with country offices of the FAO and national ministries of public health, animal health and environment to conduct tripartite joint risk assessments for Afghanistan and Pakistan. Staff from national and subnational offices practised shared health threats at the human–animal–environment interface using a One Health approach.
As part of ongoing efforts to support countries in maintaining IHR core capacities at points of entry, WHO collaborated with the United States Centers for Disease Control and Prevention (CDC) and IOM to develop a new Handbook for public health capacity building and cross-border collaboration at ground crossings. This global resource was pilot tested through a comprehensive three-day programme of discussions in Beirut, Lebanon, with national IHR focal points, senior officials working directly with public health issues at ground crossings, participants from relevant sectors, and WHO’s sister United Nations agencies.
Further action on cross-border security included training for personnel from Bahrain, Saudi Arabia and United Arab Emirates on public health capacity-building and cross-border collaboration at ground crossings, and a review of ground crossings in Egypt to ensure preparedness following a Rift Valley fever outbreak in Sudan.
At the end of the year, the eighth regional stakeholders meeting brought together more than 140 participants from Member States to review the implementation of the IHR. The meeting provided a platform for the introduction of several new tools and innovations to support IHR implementation, including training packages and tools for NAPHS prioritization, monitoring and evaluation. Recommendations addressed enhancing multisectoral collaboration, determining priority areas, increasing capacity-building activities and continuing knowledge exchange between countries, with WHO reaffirming its commitment to provide ongoing technical support.
Key outcomes of the meeting will feed into the first health security diplomacy meeting, set to take place in 2020, which will provide a high- level forum for continuing multisectoral collaboration and coordination for IHR implementation.
Tackling infectious disease outbreaks
Despite major investment in recent years to strengthen preparedness and core capacities under the IHR, many countries in the Region remain vulnerable to infectious disease threats. Outbreaks of infectious diseases pose a particular risk to internally displaced persons, refugees and other vulnerable groups, and tend to have far-reaching social, economic and environmental impacts.
Epidemics of infectious diseases caused more than 2 million cases of illness and around 10 000 deaths in the Region in 2019. There were new emerging infectious disease outbreaks caused by high-threat pathogens as well as sporadic upsurges of endemic diseases.
WHO took proactive steps to reduce their impact by supporting the implementation of proven interventions focusing on strengthening national capacities to prepare for emergencies, detect public health events early on, monitor their progress to respond effectively and
document impact, and undertake advanced research to fill the knowledge gaps related to emerging infectious diseases.
During the year, a total of 14 outbreaks of emerging infectious diseases with the potential for global spread were investigated and responded to through technical and financial support from the Regional Office. Eight countries reported diseases with outbreak potential, including chickenpox (varicella), chikungunya, cholera, Crimean-Congo haemorrhagic fever, dengue fever, diphtheria, extensively drug-resistant typhoid fever,
hepatitis A, human immunodeficiency virus (HIV), measles, Middle Eastern respiratory syndrome coronavirus (MERS-COV), poliomyelitis and Rift Valley fever.
Cholera outbreaks continued to affect Somalia and Yemen for the third consecutive year. Yemen has been facing the worst cholera outbreak ever recorded, with more than 2.2 million people affected and nearly 4000 lives lost since 2016. In 2019, WHO provided substantial support to both Somalia and Yemen in implementing priority interventions to contain the outbreaks, including enhancing early warning surveillance and laboratory diagnosis, deploying rapid response teams, improving water and sanitation activities, mobilizing communities and implementing oral cholera vaccination campaigns.
We worked with Pakistan and Sudan to rapidly investigate and control one of the worst dengue fever outbreaks in recent years and implemented targeted vector control interventions to reduce vector breeding sites, enhance entomological surveillance and improve health education campaigns targeting vulnerable populations.
Four countries – Oman, Qatar, Saudi Arabia and United Arab Emirates – faced cases of MERS during the year, reporting 223 laboratory-confirmed cases and 56 associated deaths in total. The number of hospital outbreaks decreased significantly during that time due to improved early warning surveillance and detection, as well as infection prevention and control practices.
Meanwhile, Sudan experienced multiple disease outbreaks, but a change in government policy led to all outbreaks being officially declared by the Federal Ministry of Health in line with IHR requirements and information being shared with WHO.
Enhancing EWARN
Many countries in the Region are experiencing protracted humanitarian crises. Early Warning Alert and Response Network (EWARN) surveillance systems were maintained in all countries with complex emergencies in order to rapidly detect, verify and investigate any alerts or signals of priority epidemic-prone diseases.
The EWARN network was expanded to eight countries, with Djibouti joining Afghanistan, Iraq, Libya, Somalia, Sudan, the Syrian Arab Republic and Yemen. WHO continues its support to implement, monitor and evaluate these EWARN systems for their improvement and upgrading.
Work to strengthen the network in 2019 also included the initiation of a process to update the evaluation protocol which is used to identify technical and operational gaps in EWARN systems. WHO held a cross- regional workshop in Amman, Jordan, on 21–24 October 2019 to share and discuss countries’ experiences of using the evaluation protocol.
Strengthening pandemic preparedness
WHO continued to prioritize and support the development of national capacities to detect, prepare for, and respond to pandemic influenza.
A major initiative in this regard was the fifth meeting of the Eastern Mediterranean Acute Respiratory Infection Surveillance (EMARIS) Network, held in conjunction with the Second Scientific Conference on Acute Respiratory Infection in the Eastern Mediterranean in Casablanca, Morocco, in November 2019.
Through the EMARIS network, countries in the Region work together to strengthen and enhance influenza surveillance, improve the use of surveillance data to strengthen disease control programmes and conduct research related to influenza and other respiratory viruses. This latest biennial meeting was organized in collaboration with the United States CDC and focused on the theme of “better data, better policy, better action”, aiming to promote quality data generation from local surveillance systems to enable evidence-informed public health policy-making.
Notable successes in the Region were discussed, including the expansion of the Pandemic Influenza Preparedness Framework, enhanced national rapid response capacities, an increase in the use of the PISA tool
to estimate seasonal influenza severity, improved skills in advanced detection techniques, an increase in surveillance evaluations, a rise in the number of scientific publications and the finalization of pandemic preparedness plans.
Among other efforts to strengthen pandemic preparedness during the year, WHO provided extensive training to enhance influenza capacities, including a regional workshop on developing a protocol for the monitoring and evaluation of sentinel-based influenza surveillance systems, subregional training on influenza disease burden estimation and a meeting of directors of national influenza laboratories in the Region.
Polio – an ongoing threat
The Eastern Mediterranean was the only region worldwide to detect wild poliovirus (WPV) cases in 2019. Wild poliovirus remains endemic in the Region, and the risk of the international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC). WHO’s team and our Member States are strongly committed to eradicating this global threat.
However, 2019 was a difficult year for the polio programme. Wild poliovirus transmission resurged in 2019 in the two remaining polio- endemic countries, Afghanistan and Pakistan, with a total of 176 cases reported (29 in Afghanistan and 147 in Pakistan; see Fig. 4). Patterns of both human cases and environmental positives indicate that circulation of the virus had expanded from known reservoir areas in both countries.
There were also outbreaks of vaccine-derived poliovirus in Pakistan and Somalia.
This is both a disappointing setback and a grave concern. Thanks to the dedication of donors, governments, health workers and partners, the Region – and the world generally – have made incredible strides against polio in recent decades. But as long as wild poliovirus is circulating anywhere, the virus could come surging back.
2014 2015 2016 2017
2018 2019
500 100150 200250 300350 400
2014 2015 2016 2017 2018 2019 2014 2015 2016 2017 2018 2019
AFG PAK
Number of Isolates
WILD AFP & ENV Isolates
AFP ENV
Wild AFP Case
0 01-19 20-49 50 Plus NetworkNo Proportion of WPV (ES) Isolation
Pakistan & Afghanistan (WILD AFP & ENV Isolates)
Figure 4: Wild poliovirus incidence in Afghanistan and Pakistan, 2014–2019
Note: The figure includes both human cases of acute flaccid paralysis (AFP) and environmental positives (ENV).
Three countries in the Region, Somalia, the Syrian Arab Republic and Yemen, are considered at very high risk for polio outbreaks with another four – Djibouti, Iraq, Libya and Sudan – at high risk (see Fig. 5). All have varying degrees of complex emergency and access or security constraints which hamper efforts to maintain high population immunity and sensitive surveillance. WHO is providing technical and logistical support to these countries to implement supplementary immunization and surveillance activities. Ending polio in Afghanistan and Pakistan, closing outbreaks, and increasing routine immunization is a key regional priority.
Stepping up the fight against wild poliovirus
As case numbers rose, the polio programme began systematically overhauling operations to address programme vulnerabilities and
increase vaccine coverage. The governments of Afghanistan and Pakistan are committed to delivering a polio-free future for their populations, and implemented comprehensive programme reviews during 2019.
Challenges to eradication efforts include gaining access to all populations (which is affected by insecurity and partial bans on immunization in
Afghanistan), quality of immunization campaigns in reservoir areas, population movement and concerns about the safety of frontline workers.
Rising vaccine hesitancy, often related to misinformation spread over traditional or social media, has further complicated efforts to reach every
EMR: Tier Classification
Very High Risk Countries Endemic Countries High Risk Countries
Tier Classification
Low Risk Countries Non-EMR Countries
Figure 5: Countries’ risk status for polio outbreaks in the Region
In response, WHO and partners are implanting transformative changes to turn the tide against the virus, including better programme management, a laser focus on entrenched polio reservoirs, measures to increase
community engagement and working to overcome access barriers.
The polio programme is also committed to collaborating with routine immunization programmes and forming new partnerships with broader health initiatives.
To support country efforts, the polio programme established the
Global Polio Eradication Initiative (GPEI) Hub in Autumn 2019. The Hub, located in Amman, Jordan, is staffed by a dedicated team of experts with decades of experience fighting the poliovirus. They have been brought together specifically to support the Pakistan and Afghanistan teams as the countries overhaul operations and scrutinize areas of operational weakness. The Hub will provide better coordination across the GPEI partnership, enable more rapid deployment of surge support and technical expertise to Afghanistan and Pakistan, and ensure rapid decision-making closer to the ground.
Encouraging news came on 24 October 2019 when wild poliovirus type 3 (WPV3) was certified as globally eradicated by the Global Commission for the Certification of Poliomyelitis Eradication. This was a major achievement, meaning that out of the three wild polio serotypes, only one remains. For the Eastern Mediterranean Region, it was further proof that with investment in skilled workers, innovative tools, and routine immunization, it is possible to achieve a polio-free world.
Combating cVDPV
Concurrent type 2 and type 3 circulating vaccine-derived poliovirus (cVDPV) outbreaks continued in Somalia in 2019, and a type 2 vaccine- derived virus outbreak was detected in Pakistan. A total of 25 cases of cVDPV were reported across the Region in 2019 (22 in Pakistan and three in Somalia).
Patterns of both human cases and environmental positive samples
indicate continued circulation of the virus in known reservoir areas in both countries.
The continued detection of cVDPVs in Somalia reflects a significant population immunity gap primarily due to the large number of inaccessible children in areas controlled by non-state armed groups.
During 2019, the polio programme developed a new global strategy to target cVDPV outbreaks. As part of the strategy, the programme will roll out a new oral vaccine designed to tackle vaccine-derived outbreaks, possibly as early as June 2020. This decision was supported by the WHO Executive Board in February 2020.
Meanwhile, the Syrian Arab Republic remained polio-free a year after the closure of a serious vaccine-derived outbreak in December 2018.
The polio programme alongside regional partners successfully ended an outbreak of cVDPV that had taken hold in conflict-affected areas of the Syrian Arab Republic, paralysing 74 children. Amid ongoing insecurity and huge population movement, the programme worked throughout 2019 to maintain and increase levels of immunity among the under-5 population.
This included running regular vaccination campaigns with the help of United Nations partners in camps of internally displaced populations.
Environmental surveillance continues in the country to test for poliovirus.
Increasing collaboration between polio and other health programmes
The polio programme is committed to collaborating with routine immunization programmes and forming new partnerships with broader health initiatives. In 2019, Gavi, the Vaccine Alliance, was welcomed into the polio partnership to provide expertise to this project, especially in the endemic countries of Afghanistan and Pakistan.
The Polio Eradication Hub has a dedicated function for strengthening services beyond polio in Afghanistan and Pakistan, spearheaded by UNICEF and supported by WHO and other partners. Work so far focuses on strengthening broader immunization services by providing technical support, increasing services in under-resourced areas, and building capacity, including by supporting training for health workers.
In several countries in the Region, staff funded by the polio programme support the WHO Health Emergencies Programme and national EPIs.
A study in Sudan in early 2019 found that national medical officers
supported by the polio programme spent up to 45% of their time working to support other health projects.
Integrating gender into the polio programme
Gender is an important determinant of health, impacting both those delivering and those receiving health services. The polio programme is the first disease-specific programme within WHO to develop a dedicated gender strategy. In 2019, the programme launched its gender strategy and is now working towards integrating a gender lens across all workstreams. At a regional level, this includes collecting gender-disaggregated data on immunization coverage and delivery and conducting analysis to further strengthen the reach of vaccination services. Action plans have been developed to realize gender equality strategic objectives. Within the Region, indicators show that boys and girls under 5 years of age have very similar immunization status for polio vaccination and are generally equally well represented in surveillance.
Major progress has been made in Pakistan, and some in Afghanistan, with respect to recruiting local female community vaccinators and supervisors to strengthen the capacity to reach every child in house-to-house
immunization activities.
Containing longer term risks of polio spread
Significant progress was made in 2019 to contain type 2 polioviruses, in line with the WHO Global Action Plan (GAP III) to minimize risks associated with poliovirus facilities after type-specific eradication of wild polioviruses and sequential cessation of oral polio vaccine use. All countries that destroyed or removed VDPV2 materials documented the destruction processes.
Three facilities in the Eastern Mediterranean Region have been designated as polio essential facilities. In both countries where the facilities are located (Islamic Republic of Iran and Pakistan), national authorities for containment have been nominated to ensure strict implementation of containment measures. WHO is assisting both countries to prepare for pre-audit within the certification process and to achieve other containment targets.
Meanwhile, several countries across the Region initiated surveillance to detect children with primary immune deficiencies (PIDs), a group of diseases caused by genetic defects of the immune system. Certain types of PIDs are associated with a risk of prolonged excretion of poliovirus, and thus a risk of its spread. This is a real threat for the polio programme after eradication, as population immunity levels will wane after vaccine use is eventually phased out. Sensitive surveillance will allow the timely detection of poliovirus excretion from any PID patient, thereby creating opportunities for preventive public health measures and treatment of patients.
This can be extremely challenging since it requires concerted,
coordinated, long-term efforts across many government departments and sectors. Nonetheless, in 2019 there were significant developments in many areas, including:
• stepping up strategic action to improve the health of newborns, children and adolescents;
• securing high-level commitment for action on NCDs such as cancer and heart disease;
• encouraging progress in the fight against the menace of tobacco; and
• launching a new regional Commission on Social Determinants of Health.
Promoting healthier populations
WHO undertakes a huge range of activities to
tackle the underlying causes of ill health and
promote well-being.
Improving child and adolescent health
Our work to promote effective and timely health interventions received a boost in October 2019 when the Regional Committee endorsed a new regional implementation framework on newborn, child and adolescent health to guide work in this area over the period 2019–2023.
Children and adolescents make up around a third of the entire population of the Eastern Mediterranean Region, and improving their health is an urgent priority. The Region has the second highest mortality rates for newborn children and those under the age of 5 of any WHO region. More than 800 000 children died in the Region before their fifth birthday in 2017, and most of those deaths could have been prevented.
Meanwhile, the death rate among adolescents in the Region has risen significantly since the year 2000, despite falling across the rest of the world.
While ending preventable deaths remains a key objective, the new framework aims to ensure that babies, children and adolescents do not just survive but thrive. There are huge variations within and between different countries of the Region in morbidity and mortality rates for these age groups (see Figs. 6 and 7), and the framework is designed to meet the distinct requirements of different countries. It provides guidance for countries on selecting priority actions, essential interventions and relevant progress indicators. It emphasizes the fundamental need for integrated interventions across the life course and the continuum of service
provision, multisectoral action and partnerships, and also recognizes the specific difficulties facing underserved populations and people in humanitarian emergencies.
Figure 6: Under-5 mortality per 100 000 live births in countries of the Region
Figure 7: Under-5 mortality rates in the poorest and richest population quintiles in selected countries of the Region
140 120 100 80 60 40 20 0
Somal ia Pakistan
Afghanistan SudanDjibout
i
YemenRegion Iraq MoroccoEgypt
Palest ine
Tunisia
Syrian Arab Republ ic
Jordan
Islamic Republ ic of Iran Libya OmanKuwait
United Arab Emirates Saud
i ArabiaLebanonQatarBahrain 122
69 62 60 59 55
47
27 22 21 20
17 17 16 14 12 11 8 8 7 7 7 7
Poorest Richest 120
100 80 60 40 20 0
Afghanistan Djibout i
Egypt Jordan Mor
occo Pakistan Palest ine Sudan
Syrian Arab Republ
ic Tunisia Yemen 108
53 7272
39 17
27 10
36 21
44 107
2114 89
42 60
33 1717
60
33 Source: UN Inter-agency Group for Child Mortality Estimation (2019).
Source: UNICEF (2019).
Strengthening maternal and reproductive health
Family planning was an important area of focus in 2019. Globally, WHO developed a Consolidated guideline on self-care interventions for sexual and reproductive health and rights, and the regional team was keen to support its implementation, to improve the autonomy of even the most vulnerable populations and help make universal health care achievable throughout the Region. Accordingly, the Eastern Mediterranean became the first WHO region to introduce the new guideline to countries, with a consultative meeting and workshop followed by a launch event in Morocco in September.
Two initiatives were also developed at regional level. A project on strengthening sexual and reproductive health policies and practice for better women’s health in the Eastern Mediterranean Region was launched to fulfil women and girls’ rights to achieve positive sexual reproductive
health outcomes and ensure their well-being. Project implementation included national plans of action for Afghanistan, Egypt, the Islamic Republic of Iran, Morocco, Pakistan and Tunisia.
A second project focused on improving family planning practices for promoting maternal and newborn health, and included work to update national standard protocols, build the technical capacity of service providers and raise awareness of the health benefits of family planning in Afghanistan, Egypt, Morocco, Pakistan, Somalia and Sudan.
Supporting healthy ageing
Work to promote healthy ageing in the Region faces serious shortages in both human and financial resources. Responding to staffing needs is critical to meet the health and social needs of older people. A proposed global Decade of Healthy Ageing to begin in 2020 should provide an important opportunity to renew commitments and raise resources.
In the meantime, WHO continued to provide technical support to countries in line with the Global strategy and plan of action on ageing and health. Egypt developed a national strategic plan for promoting the health of older persons, 2020–2024, national strategies on healthy ageing were developed in Qatar and Saudi Arabia and Pakistan succeeded in raising funds to support a national project to protect the rights of older people with disabilities among the Afghan refugees in the country.
WHO also fostered data-generating activities in countries to enable evidence-based planning and management of healthy ageing programmes. We assisted Qatar in reviewing its reporting and
information system on healthy ageing, and set up plans to expand this activity to other Eastern Mediterranean Region countries in 2020.
