120Th Session of the WHO Executive Board

NNA BRIEFINGS

120th Session of the WHO Executive Board

The 120th session of the WHO Executive Board was held 22-30 January 2007 under the Chairmanship of Dr Antezana Aranibar, Ministry of Health, Bolivia. The Executive Board is composed of representatives from 32 WHO Member States and is mandated to implement the decisions and policies of the World Health Assembly, to advise it and generally to facilitate its work. The Board meets twice a year.

Key agenda items addressed at this session included:

Tuberculosis control;
Avian and pandemic influenza;
Prevention and control of noncommunicable diseases;
Gender, women and health;
Workers’ health; and
e-health.

Other issues addressed included: malaria, health systems including emergency care system, health promotion, public health innovation and intellectual property, and essential health technologies.

In her opening report, the newly elected Director General (DG) of WHO, Dr Margaret Chan, outlined the pressing issues facing WHO, reviewed major events that occurred last year, and identified actions to be taken in the future. She affirmed that the focus of WHO will be on women and the people of Africa who suffer most with the heavy burden of disease. The DG noted these were optimistic times for health and outlined achievements in measles control; polio eradication;activities and services to control malaria; de-worming children to keep them at school; producing evidence to measure outcomes; refocusing health systems to PHC; and strengthening of health systems to tackle challenging health problems. Dr Chan cautioned that the world must not let its guard down against Avian influenza.

Highlights of the EB discussions included:

Tuberculosis control: EB members expressed concern about the growing numbers of TB cases and the increasing numbers withmultidrug resistant TB (MDR-TB). More recently the emergence of extremely resistant TB (X-DR-TB) has presented new threats to public health. There was concern about the generally low detection rates of TB, low coverage with Directly Observed Treatment, Short Course (DOTS) and low cure rates. The overlapping epidemics of TB and HIV need concerted efforts to achieve better outcomes to tackle both diseases. The concerns certainly underscore the need for the ICN initiative.

Avian Influenza: EB members indicated that it is only a question of when the influenza pandemic will happen and urged global preparedness and adherence to the International Health Regulations as rally points to stem the global threat. The need for vigilance, strengthening early warning systems, capacity building and combating fatigue in preparedness were key themes. It was noted that pharmaceutical companies have displayed good corporate socialresponsibility in improving access to medicines and vaccines.

Prevention and control of noncommunicable diseases (NCDs): The growing prevalence of NCDs represents a “silent epidemic” that must be tackled with information and health education to all age groups. In some regions NCDs account for about 52% of disease burden and up to 80% of hospital bed occupancy, yet the risks are preventable or modifiable. The need for creating supportive environments for health and reducing inequalities was highlighted as a key element in controlling NCDs. Although NCDs are erroneously perceived as diseases of rich countries, the evidence shows the “double burden” of NCDs and infectious diseases in developing countries. Some expressed concern that NCDs are not receiving attention to the same extent as TB, HIV/AIDS and malaria. The three main factors of tobacco use, poor diet and lack of physical activity account for about 50% of the disease burden. Some EB members called for integrating health and wellness programmes in workplaces.

ICN’s intervention under this item expressed concern about the major risk factors for NCDs and highlighted nursing’s key role in promoting health and reducing health risks and called on governments and WHO to fully deploy the nursing workforce in prevention and control of NCDs. (ICN intervention attached)

Gender, women and health: EB members praised the WHO DG for programming women’s health as a priority in the work of WHO. There was concern about the “feminisation” of HIV infections and a call for sex-disaggregated data. It was noted that gender refers to both men and women and that men’s health should also receive due attention. The importance of gender sensitive outcome indicators was emphasised.

ICN’s intervention under this item pointed out the gender imbalance in WHO and the low representation of nursing posts,which currently represent only 1.5% of staff within WHO (ICN interventionattached)

Workers’ Health: The health of workers is a fundamental right and occupational health services should provide comprehensive services including regular checkups, compensation for injury, access to counselling and testing for HIV and other diseases. One country indicated that fewer people were applying to become nurses and laboratory technicians due to fear of HIV infections in workplaces. Workplace policies should address broad issues including exposure to risks such as asbestos, infectious diseases and injuries.

An intervention by six health professions organisations representing nursing, midwifery, dentistry, pharmacy, medicine and physiotherapy highlighted the key role of the health professions and called for better working conditions. (Intervention attached)

e-Health: standardised terminology: The EB noted that standardised terminology used in e-Health was an important part of the WHO classification systems and should be accessible to all countries just like the International Classification of Diseases (ICD). There was caution against digital and information divide if access is not made widely available to developing countries.

ICN intervened under this item and welcomed the development of e-Health standardised terminology and shared ICN’s experience in developing the International Classification for Nursing Practice (ICNP).(ICN intervention attached)

More information on the 120th Session of the Executive Board is available on the WHO website

Statement of the International Council of Nurses

at the 120th Executive Board (Agenda Item 4.5)

Nurses: Key Partners in Prevention,

Care and Control of Noncommunicable Diseases

On behalf of the International Council of Nurses (ICN), thank you for the opportunity to speak on this important subject. ICN is a federation of national nurses associations (NNAs) in 129 countries. Our mandate is to improve the health of the world’s people by improving standards of nursing practice, education, management and research, and strengthening nurses’ contribution to health systems at all levels.

ICN applauds Dr Margaret Chan, the Director General, and the Secretariat for the global implementation strategy on prevention and control of noncommunicable diseases. ICN is concerned with the major risk factors for chronic diseases namely unhealthy diet, physical inactivity and tobacco and alcohol use. We believe the full and effective deployment of nursing personnel will be key to the strategy’s success and to reducing the major risk factors. The 13 million nurses globally represent an incredible force in the promotion of health, prevention of noncommunicable diseases, and care and rehabilitation of growing populations with chronic conditions.

Effective implementation of the strategy on noncommunicable diseases depends on adequate numbers of appropriately skilled nursing and other health personnel working in health teams and within functioning health systems. To this end we are encouraged by the Director General’s renewed commitment to primary health care and to integrated management of diseases.

In conclusion ICN urges WHO, Governments and others to invest in strengthening the nursing workforce in order to reduce the burden of chronic diseases and to implement the global strategy on prevention and control of noncommunicable diseases.

ICNtakes this opportunity to reaffirm its continued commitment to partnership with WHO and to strengthening nursing’s contribution in improving the health of the word’s people.

120th Session of Executive Board, WHO

Statement of the International Council of Nurses (Agenda Item.4.8)

ICN welcomes the Secretariat Report on Gender, women and health: the draft strategy clearly affirms that gender equality and equity should be integrated into all WHO’s work. ICN notes that some progress has been made in gender equality and equity at WHO, however much remains to be done. A review of the WHO Human Resource Annual Report, 2006 reveals that the percentage of women working at WHO with fixed term is 48.4%; the percentage of women in professional categories is 35%; while the percentage of women in senior management positions is 39.6% in P4; 30.7% in P5; 21% in P6/D1 and; 24.4% in D2.

These low percentages of women in senior positions also translate into very low representation of nurses, who are largely women, within WHO. Currently nurses make up about 1.5% of the professional staff.

While women worldwide are overwhelmingly poorer, more likely to be victims of violence and lacking power in virtually all societies, nowhere is the failure to establish women's rights more tragically evident than in the HIV/AIDS pandemic. Fundamental gender inequalities fuel the epidemic, particularly in sub-Saharan Africa where women and girls now make up over 60% of those living with HIV and 76% of those in the 15-24 years of age group.

We draw attention to the internationally agreed development goals contained in the Millennium Declaration that include the promotion of gender equality and the empowerment of women as effective ways to combat poverty, hunger and disease and to stimulate sustainable development.

In conclusion ICN wishes to bring attention to the recent recommendations to the UN General Assembly for the establishment of a women specific UN agency, robustly funded, with operational capacity and headed by an Under Secretary General. On behalf of the 13 million nurses working worldwide, we urge all countries to vigorously support this recommendation.

WHO Executive Board, 120th Session

Agenda Item 4.10 Workers’ Health: Draft Global Plan of Action

Intervention by Six Health Professions:

World Dental Federation, International Confederation of Midwives, International Council of Nurses, International Pharmaceutical Federation, World Confederation for Physical Therapy and World Medical Association

Thank you for the opportunity to speak on behalf of six health professions – dentistry, medicine, midwifery, nursing, pharmacy and physiotherapy – which together represent national associations in more than 150 countries, and the collective views of more than 25 million health professionals. Our organisations work closely with WHO at headquarters and regionally; contributing technical and policy advice, financial and human resources to projects, acting as WHO advocates, and disseminating information on your behalf.

We commend WHO on the draft plan of action for improving the health of workers, a matter of particular importance to the health professions given the evidence that the delivery of safe and efficient health services depends on the competence of workers and a healthy and supportive work environment conducive to excellence in performance. However, the ongoing underinvestment in the health sector, coupled with poor employment conditions and policies (such as exposure to occupational hazards, discrimination, and physical and psychological violence; unfavourable work-life balance; unreasonable work loads, etc.) has resulted in a deterioration of working conditions in many countries. This has had a serious negative impact on the recruitment and retention of health personnel, the productivity and performance of health facilities and, ultimately, on patient outcomes.

We clearly believe that achieving a “better response from health systems to workers’ health” issues requires greater investments in the health sector workforce itself. We therefore strongly support measures that protect, promote and improve the health, safety and well-being of health workers. The work environment must be made safe from occupational hazards. Management practices must support the well-being of workers as well as patient safety. Workforce deployment needs to accommodate manageable workloads and stress levels. We believe such efforts transcend the mandate of any one organisation or country and are the responsibility of all health sector stakeholders.

This year the health professions will launch a multiyear, multistakeholder campaign to promote safe and healthy workplaces for all health workers. Will WHO commit to joining us in this effort to improve the delivery of care and the health status of individuals, families and communities? We hope to hear your affirmative reply today.

Thank you.

120th Session of Executive Board, WHO

Statement of the International Council of Nurses (Agenda Item.4.11)

On behalf of the International Council of Nurses (ICN), a federation of national nurses associations (NNAs) in 129 countries, thank you for the opportunity to speak on this important subject. ICN’s mandate is to improve the health of the world’s people by improving standards of nursing practice, education, management and research, and strengthening nurses’ contribution to health systems at all levels. We do this in several ways, including collecting and comparing data across clinical settings, client populations, geographic areas or time, and by using an array of tools of which none is more important than the International Classification for Nursing Practice (ICNP®).

ICNP® is a unified nursing language system and a compositional terminology for nursing practice. It allows us to globally communicate and compare nursing data to support clinical decision-making, evaluate nursing care and patient outcomes, develop health policy, and generate knowledge through research.

As the author of ICNP®we welcome this report which sets out WHO’s role in the future development of standardized health care terminologies. ICN believes that there is a continued need for development and application of such terminologies. We further believe that the WHO Terminology Network can assist in facilitating harmonization among various terminologies, including the standardized terminology developed for clinical use by ICN. We applaud the intent to support Member States in the development, implementation and management of standardised terminologies.

We are pleased to see WHO lay out its relationship with SNOMED-CT and the newly created International Standards Development Organisation. We have been concerned for sometime about the evolution of SNOMED and its access and relevance to developing nations. Mr Chairman, in concluding, we would ask WHO to share with us the plans for equitable and balanced dissemination of SNOMED-CT among WHO Member States that are not members of the Standards Development Organisation due to cost or other barriers.

Thank you.