It has been five years since the World Health Organization announced its new vision for the Eastern Mediterranean. The World Health Organization Regional Office for the Eastern Mediterranean launched this five-year vision for the region in October 2018. It was an ambitious call to action and solidarity across the Eastern Mediterranean region aimed at ensuring “health for all by all.” While this ultimate goal has not yet been realized, this regional vision has succeeded in overcoming several challenges.
To accelerate the pace at which we achieve regional and global health-related goals, “Vision 2023” laid out four strategic priorities: expanding universal health coverage, addressing health emergencies, promoting healthier populations, and making transformative changes within the organization. The regional office developed this vision in consultation with national governments and other stakeholders, and a regional strategy for supporting work on these strategic priorities was drawn in 2019.
Over the past few years, it has become clear that substantial improvements can be achieved in addressing many health conditions. Since 2010, mortality and morbidity among children under five years of age have dropped by more than 10 deaths per 1,000 live births in Afghanistan, Djibouti, Iran, Morocco, Pakistan, Somalia, and Sudan. Deaths from non-communicable diseases have decreased by more than 15% in Oman, Qatar, and the Kingdom of Saudi Arabia. The scores on Universal Health Coverage Index, which measures indicators of health service coverage, of Egypt, Iran, and Qatar, have increased by 10 points or more.
However, progress remains limited overall. The region is not on track to achieving health-related Sustainable Development Goals (SDGs), which are global commitments that every country must fulfill for a more peaceful and prosperous future.
There are vast variations in income, as well as in the capacities of national health systems, within and between the 22 countries and territories of the region. Infectious and chronic diseases continue to cause deaths that could have been prevented with better public health policies and more efficacious healthcare services. The region had been facing a broad array of health and humanitarian emergencies in 2018, when this five-year regional vision was developed, but their scope has expanded since then.
All of these challenges were exacerbated by the state of emergency imposed by the COVID-19 pandemic. Nonetheless, this pandemic also demonstrated that investing in resilient health systems is necessary for global health security. Moreover, the speed and scale of the response to the pandemic showed that we can succeed if there is political commitment and effective leadership.
Regional efforts to expand universal health coverage (UHC) were given added impetus in 2018, when all 22 countries and territories signed the UHC2030 Global Compact and endorsed the Salalah Declaration. The WHO cooperated with the countries and territories of the region to improve every aspect of their health systems - starting from governance and financing, to the capacities of health workers, access to medicine, service provision, active community engagement, and the promotion of a health-conscious culture in all public policy.
In line with this regional vision and strategy, countries were encouraged to adopt a holistic approach to health services provision that puts people at the center. Several pioneering initiatives were launched to this end, like the Regional Professional Diploma in Family Medicine to address the shortage of family practitioners in the region.
In addition, new regional frameworks were introduced to guide strategic engagement with the private sector and better integration of hospitals in health systems, and tools were developed to enhance patient safety and overall quality of care in both hospital and primary health care settings.
The COVID-19 pandemic interrupted many essential programs, including national immunization programs and services for HIV, tuberculosis, and malaria. However, the WHO worked with many countries to eliminate communicable diseases, with the elimination of lymphatic filariasis in Yemen in 2019 proving that success is possible even in countries facing severe challenges. To address declines in vaccination rates, which have led to outbreaks of life-threatening diseases, the WHO is developing a regional framework for implementing the Global Immunization Agenda 2030.
During the term of Vision 2023, the region faced emergencies of an unprecedented scale. Half of the countries and territories of the region have experienced ongoing and protracted conflicts or outbursts of violence. There have been 166 disease outbreaks, including COVID-19. Furthermore, many countries have been hit by major natural and technological disasters, as well as suffering from severe economic decline and poverty.
On top of that, ours is the only WHO region where wild poliovirus remains endemic. In 2022, 127 million people in the region were in need of humanitarian aid, more than double the 2018 figure. Since 2018, the WHO has documented and responded to 166 new disease outbreaks (including COVID-19) across the region, coming out to an average of 33 outbreaks a year. Forty-seven were recorded in 2018 and 45 were recorded in 2022. The number of cases graded emergencies and requiring an operational response by the WHO has more than doubled in recent years, from 10 emergencies in 2017 to 22 in 2022.
To meet these challenges, the WHO became more agile across all phases of the emergency management cycle. A regional strategic framework was developed to strengthen the prevention and control of emerging and epidemic-prone infectious diseases.
While national capacities remain far below the requirements of the International Health Regulations (2005), every country and territory in the region had established rapid response teams by 2023, among other things. The number of laboratories with PCR capacities has increased dramatically, from fewer than 30 to over 2,500, and the WHO helped to train more than 50,000 health workers, and the WHO helped train over 50,000 health workers.
Simultaneously, the Global Logistics Hub in Dubai dispatched more than 1,500 shipments to 137 countries and territories across all six WHO regions between 2018 and 2022. Through Global Logistics Hub, we dispatched medical supplies worth 7 million US dollars 2017, and at the height of the pandemic in 2020, we dispatched medical aid valued at around 60 million US dollars.
These efforts have contributed to making external evaluations of the WHO's work on some of the protracted crises in the region extremely positive.
Vision 2023 has made health a top priority over the past five years. At the heart of this effort were pioneering initiatives to address injustices in the social determinants of health. The Regional Healthy Cities Network has expanded significantly, from 64 cities in 11 countries in 2019, to 110 cities in 15 countries in 2023, and countries were supported to invest in demonstrably cost-effective measures, which have been shown to be the most effective tool for curbing non-communicable diseases.
Despite the encouraging progress that has been made, much remains to be done. To increase the positive impact of the WHO, extensive changes were made to its structure and operations, and it developed and led several strategic partnerships. A Regional Health Alliance was created, bringing together 16 UN agencies to guide joint efforts to support progress on the health-related SDGs.
The successes of Vision 2023 are a foundation that can be built upon. With my term as Regional Director nearing its end, the Regional Committee for the Eastern Mediterranean will appoint my successor. I wish whoever takes on this role all the success, and I hope that the scope of the regional vision will be expanded in their term, so that we may continue our collective efforts toward achieving our ultimate goal of "health for all by all.”
