Выступление на церемонии открытия Сотрудничающего центра ВОЗ по работе с уязвимыми группами населения в Центральной Европе

21 February 2019, High Tatras, Slovakia

Honourable ministers and delegates, esteemed colleagues and dear guests,

I am happy to join Her Excellency the Minister of Health, Dr Andrea Kalavská today, in welcoming you to the official inauguration of the WHO Collaborating Centre Working with Vulnerable Population Groups in Central Europe.

In recent times, we have achieved precious progress towards our shared goal of a world free of tuberculosis (TB): in our Region, during the last five years, TB mortality rates have fallen on average by 10% per year, which is the fastest decline observed in the world; the European Region has also documented the fastest decline in TB incidence among all WHO regions. Screening practices for TB contacts and vulnerable groups are being made more efficient and inclusive. Diagnostics has been strengthened, even in the face of the technical challenges brought by multidrug resistant-TB (MDR-TB); new drugs and regimens are being rolled out; and better clinical and management practices for latent TB and TB in children are being put in place.

At the same time, we are not going fast enough to achieve the targets set out in the Sustainable Development Goals, WHO’s End TB Strategy and the Tuberculosis Action Plan for the WHO European Region 2016–2020. While in some countries, including eastern European countries, the MDR-TB rates are decreasing in absolute numbers, the WHO European Region still carries about 23% of the global MDR-TB burden. This urgently requires stronger and more efficient action.

Because of its strong association with conditions that weaken the immune system, like HIV; as well as social determinants, such as poverty, unemployment, imprisonment and migration; and noncommunicable conditions, such as the harmful use of alcohol, diabetes and tobacco use, TB often takes a toll on the health of marginalized groups, whose sense of belonging and well-being may already be at risk. Guaranteeing equal opportunities for health and well-being for all, comes with challenges for both public health systems and societies as a whole.

To face these challenges while making sure we leave no one behind, stronger and expert partnerships are much needed. We acknowledge the leadership taken by the Slovakian government and institutions for more inclusive public health systems, both through interventions on the ground and through high-level political commitments.

During the first high-level meeting on TB at the United Nations General Assembly last year, we co-organized the launch of the “United Nations common position on ending HIV, TB and viral hepatitis through intersectoral collaboration”. Building on this initiative within the Issue-based Coalition on Health and Well-being, calling for more and better collaboration beyond the health sector, we aim to tackle the social determinants and cross-cutting issues that impact the lives of people at risk of acquiring HIV, TB and/or viral hepatitis.

The innovative TB programmes established in Slovakia, empowering health mediators and coordinators in Roma communities to work with health-care providers and municipal governments to voice and address unmet needs, are an extraordinary example of how inclusive programmes can foster better health outcomes. Through a strengthened health system, and universal health coverage, we will be able to provide people-centred TB prevention and care, alleviate avoidable suffering, reduce transmission and ameliorate TB treatment outcomes. Slovakia has led the way in showcasing collaboration between different stakeholders and at different levels in the health system, whether public–public or public–private, and has a high-quality education and capacity-building system on TB involving relevant players at different levels from complementary institutions. Your successful collaboration with WHO in strengthening cross-border care and our common efforts towards ending childhood TB also show how political commitment is meaningful only when followed by prompt action.

Our collaboration is rooted in the shared acknowledgement that we must act to address all health determinants to promote healthier lives, and that we should reach those most vulnerable first. Interventions reducing social, gender, environmental, economic and other inequities have been proven to bring about better health outcomes for all.

In New York last year, Member States also committed to promoting equal access to health services without discrimination of any kind, recognizing the need to address human rights and social and economic determinants to break the cycle of ill-health and poverty. This includes prioritizing, through an integrative health system strengthening approach, the involvement of communities and civil society, high-risk groups and populations in vulnerable situations, and recognizing that without their engagement TB elimination will not be possible. Women, men and children, indigenous peoples, health-care workers, the elderly, migrants, refugees, internally displaced people, prisoners, people living with HIV, people who use drugs, miners, the urban and rural poor and under-served populations – exclusion or discrimination have no place if we are to eliminate TB and MDR-TB.

With the goal of supporting and advocating for interventions to eliminate TB in vulnerable groups and to foster a better understanding of the needs and conditions of these groups, we are proud to officially welcome our colleagues from the National Institute for TB, Lung Diseases and Thoracic Surgery of Vyšné Hágy into the international collaborative network of WHO.

We trust our partners to continue sparking real change, working with WHO to end TB and avoidable health inequities, and to help drive action for sustainable, better health together.

Thank you very much for your attention.