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World Health Organization
Fifty-Seventh World Health Assembly
17-22 May 2004, Geneva, Switzerland
Every year, the World Health Assembly (WHA) gathers high ranking representatives from all WHO member states, in most cases
including the Ministers of Health themselves, and representatives from the accredited Non-Governmental Organizations (NGO) such as
IFMBE. The WHA, bringing the 192 Member States of the World Health Organization (WHO) together, is set to consider critical
health and health care issues. The decisions regarding the WHO global health policy are prepared in different Committees in-between
the Assemblies and at the Assembly most of them pass with little or no changes in the content. Therefore, at many smaller meetings
around the WHA, official and private, there are a lot of discussions on the future policy and action items for the next year(s).
A flood of documents, resolutions and proposals is produced by professionals working for the WHO, the national delegations
and by consultants from the NGOs. Therefore, IFMBE presence at the General Assemblies is essential for the development of
relationships between the Federation and the WHO, the national delegations and other NGOs, and for taking part in preparing
those decisions that are of global importance for health and the biomedical engineering profession.
The most important issues for the WHO in the previous years and in the future are best expressed in the address of the WHO
Director-General, Dr. Lee Jong-wook, that he gave at the opening of the fifty-seventh WHA in May of 2004. Lee
Jong-wook took office and started his five-year term as Director-General of WHO on 21 July 2003. He received a Medical Doctoral degree
(M.D.) from Seoul National University and a Master of Public Health degree from the University of Hawaii. He has worked for the
WHO at a regional level and HQ level for many years in technical, managerial and policy positions. He was one of leading
personalities in the fight against tuberculosis and vaccine preventable diseases of children. He was heading the WHO Global
Programme for Vaccines and Immunizations and in 2000 he became Director of Stop TB, a group of more than 250 international
partners including WHO member states, non-governmental organizations, industry, donors, and different foundations.
In his speech at the Opening Ceremony, Jong-wook devoted a large amount of time to the actions the WHO shall carry out in the
forthcoming years. These actions and their priorities are directly related to the number of people suffering under different
hardships in today's world:
- 2.8 billion people are living on less than two dollars a day;
- 480 million people are living in areas of conflict, fearing for their lives;
- 1.2 billion people are struggling to find clean water;
- 40 million women, men and children are living with HIV/AIDS;
- over half a million women die in childbirth every year;
- 1.3 billion people smoke, exposing themselves to illness and premature death;
- 1.2 million people are killed in road traffic incidents every year.
"The amount of disease, suffering and death in the world can be overwhelming. There is a notorious saying that:
"when one person dies it is a tragedy, but when a million die it is a statistic". For those exposed to danger and suffering,
it is impossible to see things this way. They cannot be indifferent" said Jong-wook. He also mentioned the impact of technology:
"Advances in technology have profoundly changed the ways in which we live and work. They have brought many improvements, but our
capacity to enhance health is matched by our capacity to damage it. The gap between rich and poor has widened and, in spite of
surpluses, hunger and thirst remain widespread." However, said Lee, "The increase in development assistance for health over
the last few years is also a welcome sign. This went up by an average of 1.7 billion dollars a year between 1997 and 2002.
Much of this increase has been caused by growing awareness of the devastation being caused by HIV/AIDS."
AIDS remains one of the biggest challenges for the WHO and the world health community. Access to information has to be enabled
for the whole world population, so the WHO "… set up a Strategic Health Information Centre at WHO headquarters. It consists
of the most rapid and powerful information and communication facilities currently available for the management of crises and
outbreaks. This technology will enable individuals, teams and Member States to take more effective action in emergencies.
The Centre will also provide ongoing support for information management and dissemination. At the technical level, it is
important to be sure that there is no hole in the global outbreak alert and response network."
Mohammed Nasir Khan, Federal Health Minister of the Republic of Pakistan, was elected President of the World Health Assembly,
the administrative and policy arm of the World Health Organization. At the Plenary Session, Khan also spoke of the huge task
ahead of the WHO in dealing with overwhelming health challenges aggravated by poverty, conflict and war. He spoke of the huge
global problem of HIV/AIDS.
The 57th World Health Assembly had several distinguished delegates. Two former Presidents, South Koreas' Dr Kim Dae Jung and
the US' President Jimmy Carter, have addressed the assembly. Read more about the health program of the
Carter Center also in this issue of the News.
The complete Agenda of the 57th WHA was published in the May 2004 Issue of the News. In this issue, a number of items of
interest for the Federation will be highlighted.
Patient Safety
In May 2002 the World Health Assembly passed resolution WHA55.18, which urged countries to pay the greatest possible attention to
patient safety and requested the Director-General of WHO to carry out a series of actions to promote patient safety, including:
- development of global norms and standards;
- promotion of evidence-based policies;
- promotion of mechanisms to recognize excellence in patient safety internationally;
- encouragement of research;
- provision of assistance to countries in several key areas.
This resolution was aimed to ensure that the drive for safer health care becomes a worldwide endeavour, in order to bring
significant benefits to patients both in developed and developing countries.
Following the aims of the resolution, the WHO has established work programmes tackling systemic issues such as taxonomy,
estimating hazards, and the development of reporting and learning systems. In order to ensure global patient safety, the WHO
also brought together experts in areas such as blood safety, injection safety, drugs and medicines, and medical devices.
Regarding the medical devices, the WHO, with strong IFMBE support, promotes in particular international standards, performance
specifications, prequalification of suppliers, capacity building in the appropriate use and maintenance of equipment, and
standardized procedures for alerts and recalls. WHO's guiding principles on the regulation of medical devices aim to provide
support to Member States in implementing national regulations.
One year later, in November 2003, at a meeting of senior policy-makers and international experts, organized by the WHO and in
collaboration with the United Kingdom, Sir Liam Donaldson proposed the establishment of an international alliance. Donaldson
has worked in all sectors of healthcare: hospital medicine, general practice, public health, academic medicine, health service
management and central government. In 1998 Sir Liam became the fifteenth Chief Medical Officer for England. Since coming into
post, he has helped to establish a comprehensive framework for assuring and improving the quality of NHS care. That proposal
was supported, and at the meeting it was agreed to establish a number of working groups to consider the potential functions
that the International Alliance for Patient Safety could deliver. It was also planed to formally launch the Alliance before
the end of 2004. IFMBE intends to become a leading member of the Alliance.
At present no single organization or individual has the expertise, funding or research and delivery capabilities to tackle the
full range of patient safety issues on a worldwide scale. It is considered that the WHO is playing a key role in helping countries
develop patient safety policies and practices. There is, however, a pressing need for additional coordination and facilitation of
international expertise and learning in order to reduce duplication of effort and minimize the waste of valuable resources.
IFMBE can play a major role here, too.
During the WHA, in a technical meeting, the representatives of different organizations and experts met to discuss current
development of this initiative and further steps. Sir Liam presented the idea of the Alliance and then introduced the speakers
who prepared background presentations.
In the discussion, many examples of human errors in the health system were presented. However, it is difficult to differentiate
whether, especially in developed countries, the main cause of medical errors lies in weak safety culture or poor technical design
of medical equipment and packaging. All participants in the discussion were in agreement that no physician or nurse wants to hurt
patients, and doctors, nurses, and other health workers are highly trained to be careful and take precautions to prevent mistakes.
Lucian Leape, MD, member of the Quality of Health Care in America Committee, and an Adjunct Professor at Harvard School of Public
Health once said: "Human beings make mistakes because the system, tasks and process of the work were badly designed". Medical
errors are on top of the list of the death causes, near car accidents, breast cancer and AIDS. In particular, it was reported
that the newest data show medical errors to be present in 4.7% of cases in USA, 10% in UK and 16.6% of cases in Australia.
One of the speakers was also Mrs Susan Sheradon, who was representing Consumers Advancing Patient Safety, and who gave testimony
of medical errors that caused sustainable damage to her son and the death of her husband. Ms. Shabnam Undre, Imperial Collage,
London, spoke on the need to establish assessment methods for estimating hazard risk in different environments. She was also a
member of a team that investigated medical errors in developing countries and found that faulty equipment was on the second
place on the list of medical errors.
The IFMBE is certainly an organization whose voice has to be heard more loudly in matters of patient safety. In the very bright
sense of patient safety, from teaching of new generations of students - future biomedical and clinical engineers, then designing
new devices, researching within the biomedical science and testing new methods and devices, developing and implementing new
international standards and being present in multi-professional teams in clinical environment, assessing and managing the
medical equipment and optimizing parts of the health care system: all these are the fields our Federation is representing
presentat the international scene. In separate IFMBE News articles the IFMBE President, Joachim Nagel, will describe the
important role IFMBE is playing within the various WHO initiatives, specifically with regard to patient safety, the developments
of standards, e-health, capacity building, the Civil Society Initiative and new IFMBE initiatives for the promotion of the
biomedical/clinical engineering profession.
In this context, the position of clinical engineers and biomedical engineers whose workplace is within the healthcare system
has to be re-considered. The contribution our colleagues make to everyday safety of patient through assessment of appropriate
medical equipment, its testing and maintenance as well as the knowledge they built in new clinical procedures, earns them a
recognition within the WHO's Human Resources program.
Joachim Nagel
jn@bmt.uni-stuttgart.de
Ratko Magjarevic
ratko.magjarevic@fer.hr
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