Welcoming address on behalf of WHO
Mr. Chairman, Honorable representatives of the PRESIDIUM Ladies and Gentlemen Dear Colleagues
It is a great honor for me to address to you in the name of the World Health Organization, General Director Dr. Gro Harlem Brundtland and Regional Director of Europe Dr. Marc Danzon., and personally on behalf of myself in the capacity of the Direqybr of the WHO office in Russia.
WHO is an organization covering 50 countries reaching from the Atlantic Ocean to the Pacific shores of Russian Far East, and from the Arctic to the steppes of Central Asia and to the Islands of the Mediterranean in the South. It has some 870 million inhabitants.
WHO is there in order to provide:
1. Long-term vision and persistence in thinking
2. Direct involvement in all its Members States
3. Guidance for national policies
4. To be relevant to all major groups including doctors, nurses, policy-makers, politicians, administrators and not least the patients and citizens.
The Russian Federation together with its central and eastern European neighbors has experienced an unprecedented health crisis with rising mortality, emerging infectious diseases and difficulties in access of health services. There are already positive signs whereby the lowest bottom has been reached but huge challenges still lie ahead. Furthermore, we should not only stare at the averages, as we know that inequities in health are rapidly increasing. This means that those people who belong to the upper social strata are feeling better than ever, but at the same time the poor and those living under poverty limit are actually still experiencing the deterioration of their health. It has been estimated that approximately one third, if not about the half about-^0 -75 million Russians todayrlive under the officially set poverty line. OffamiUes with children the figure is actually about 60 per cent.
Healthcare reforms is an area which touches all people in Russia, the healthy and the sick, administrators and health professionals, politicians and businessmen. In 1996 WHO held a Ministerial Conference in Ljubljana which came up with 6 fundamental principles that the reformers should take into consideration. Firstly, reforms should be targeted on health. Secondly, they should be driven by values such as human dignity, solidarity, equity and professional ethics. Thirdly, they should be centered on people. Fourthly, they should be focused on quality. Fifthly, they should be based on sound financing and finally they should be oriented towards primary healthcare. When looking at ongoing healthcare reforms in Europe there are very few, which are following these principles, and one can really question whether they deserve to be called healthcare reforms at all. They may be fiscal reforms, they may be cost cutting exercises of the Ministry of Finance or they may be driven by political imperatives such as privatization and decentralization.
WHO has developed a Health for All policy, which forms the guideline for all our nations forming their national health policies. This policy has been renewed already three times in Europe, and the last version of the Health 21 was unanimously approved in 1998 by all Member States. The third target in this Policy focuses on a healthy start in life saying that conditions should be created for a supportive family with wanted children and good parenthood capacity. Furthermore it is explicitly said that the provision of sex education and support to young people, plus ready access to condoms will reduce the risk of unplanned pregnancies and sexually transmitted diseases, including HIV infection.
Here I would like to add a personal note to you as the audience of a Conference focusing on reproductive health. About 30 years ago, when I started my medical career as a General Practitioner in a rural area army native country Finland, one of the big problems was high number of abortions, rising sexually transmitted diseases and difficulties for the population to have access to effective contraception. The gynecologists providing these services were more than 60 kilometers away. We started together with my young colleagues and nurses family planning services through our health center. Information was provided for all population groups starting from kinder-garZens to pensioner-clubs. Against the will of gynecologists we started installing IUDs (intra-uterine-devices), against the complaints of church representatives we gave advise and provide preventive pills to unmarried couples and even teenagers through school health services, and worked together with the social services so that no-one had to abstain from effective family planning because of lack of funds.
Furthermore, the diagnostics of sexually transmitted diseases was set up on the first contact level in the health center and treatment was provided under the supervision of a general practitioner, not a specialist in venerelogy or gynecology. All women, who underwent abortion, were provided empathetic counseling in family planning and we made sure that a suitable method was found. Our principle was that if a women has a repeated abortion it is our fault, not hers. In the same way, every family which had received a new baby, was given advice, including the father, on effective contraception. It is naturally up to the family itself to decide when they want to have more children, but I do not recall one single time during the ten years of my work as a GP that a woman or a man would have wanted to have a new pregnancy immediately after a delivery. Therefore, most women were provided an IUD, which we felt was most suitable, and the cheapest solution for married couples. Neither do I remember a single time that we did not find together with the family or the woman a method that would suit her needs.
The results of our work were good. The ministry of Health supported the activities and a similar system was implemented throughout the country. Gradually the gynecologists who had been against it, realized that abortion rate started to go down, and that they could concentrate on real specialist problems in their area of work. Good collaborative and consultation practices between primary health care and specialist services was created. In 5 years the abortion rate in the whole country was halved being now one of the lowest in Europe.
I also remember how in 1981 I was visiting Moscow for a family planning conference. We explained to our Russian colleagues our work and its results. We were told that it would not be possible in Russia. Only gynecologists would be allowed to prescribe preventive pills or install lUDs. Only venereologists would be allowed to treat sexually transmitted diseases, and for the teenagers - so I was told - they would recommend "poetry and cold showers".
Well —today we know that poetry and cold showers did not work, neither during the soviet times, nor will it work in the present Russian Federation. But I am very glad that we are here today finding the right recipes for Russia today.
Honorable Colleagues!
To conclude, in the name of the World Health Organization I would like to wish you a very successful conference with many interesting ideas and practical recommendations for solving existing problems. We want to be your partner in the building of a happier future for our people.
Special
representative of the General Director of WHO in Russia
Mikko Vienonen