携手中国 健康非洲
文 | 高力（Gauden Galea） 世界卫生组织驻华代表
图片提供 & 翻译｜世界卫生组织驻华代表处
编辑 | 裴安迪
设计 | 李玉丹
制作 | 黄硕存
导读：
中国的经验告诉我们，建设起一直延伸到社区层面、服务患者的强大的卫生系统至关重要。
● 在非洲建设强大、健康的社区
●建设强有力的公共卫生系统和应急体系
●实现非洲本地化生产
●建设非洲卫生人力队伍
在非洲建设强大、健康的社区
今年5月我就任世卫组织驻华代表，领导一支优秀专业团队为中国的医改和中国增强国际影响力提供支持。在到任后较短时间内，我们有幸两次迎接世卫组织总干事谭德塞博士到访北京：第一次是7月拜访了王岐山副主席和其他多位高层官员，讨论世界卫生组织（下称世卫组织）和中国如何采取重要措施，推动实施2017年签署的建设“健康丝绸之路”的协议；此后又于9月初作为特邀嘉宾参加了中非合作论坛（FOCAC）。
谭德塞博士曾参加过多次中非合作论坛活动，包括在北京举办的首届（和此后的多届）非洲卫生部长会议，探讨如何加强中非卫生合作。时任埃塞俄比亚卫生部长的他以中国的非洲合作伙伴身份参会。之后他又分别以卫生部长和外交部长的身份多次参会，了解在如何建设强大卫生系统的经验方面，中国所能发挥的作用。
谭德塞博士9月作为世界卫生组织总干事重返北京具有重要意义，他决心要确保国际组织更全面地参与日益壮大的中非合作伙伴关系，促进和加速卫生发展。
非洲是世界的未来。非洲有世界最富有的资源，不是指埋藏在地下的矿产，而是指非洲年轻一代的希望和活力；非洲有世界上增长最快的一些经济体，并日益成为创新中心，包括卫生创新中心。 然而，非洲又是世界上不平等现象最突出的地区。有些非洲国家建立起强大的卫生系统，但其他国家的卫生系统或是不堪重负，或是资源短缺，或是在战乱中运行，艰难地保护着公众的健康。同世界其他地区一样，非洲的传染病负担和疫情往往累及那些最脆弱、最贫困和最弱势的群体。
上述危机更多发生在卫生系统、尤其是基层医疗服务最为薄弱、人力资源或监测系统匮乏的地区。
我们所谈的并不仅仅是统计数字，而是遭受疾病折磨的患者，是希望发展和繁荣经济、但需要健康人口去践行的国家。
世卫组织正与所有会员国合作，发展卫生系统和卫生服务，以提高人们的健康水平和福祉。在谭德塞博士的领导下，我们为自己制定了宏伟的全球目标：
• 全民健康覆盖受益人口新增10亿人；
• 面对突发卫生事件受到更好保护的人口新增10亿人；
• 健康和福祉得到改善的人口新增10亿人。
这些是精心制定的宏伟目标。如果按期实现联合国可持续发展目标，我们大家，包括会员国、合作伙伴、社会团体、学术界和私营企业等，一定会在2023年前共同实现这些目标。 2018年7月，谭德塞博士与国家卫生健康委员会马晓伟主任共同签署了《意向书》，商定世卫组织和中国将优先考虑与世卫组织的宏伟计划高度吻合的合作领域。
建设强有力的公共卫生系统和应急体系
首先，我们商定共同支持非洲国家努力建设强有力的卫生系统。中国上世纪60年代初向非洲派出了第一支医疗队，此后就一直和非洲在卫生领域密切合作，并将这一合作不断扩展至基础设施、医疗物资和卫生人力资源领域。 中国的经验告诉我们，建设起一直延伸到社区层面、服务患者的强大的卫生系统至关重要。强有力的卫生系统是新药和医学突破的保障，它能使创新转化为人们在生活的社区就能获得的服务。预防、诊断、治疗、转诊至专科医疗等等服务，都有赖于强有力的社区服务，我们称之为初级卫生保健。 我们还商定要合作支持疾病监测及应急响应能力的提高。我们要双管齐下，在对应急防范和响应进行投入的同时，还要加强卫生系统以预防突发事件和减轻其影响。这意味着我们要共同努力，建立监测系统，改善实验室、信息共享系统等等，还包括协调我们对建设非洲疾病控制中心的支持工作。
突发事件给非洲区带来沉重的负担，但同时也提高了我们的应对能力。继2014年的埃博拉疫情后，世卫组织进行的改革之一就是对不同国家技术熟练的紧急医疗队（EMT）进行认证。世卫组织制定了临床队伍的一系列最低标准，协调同行评议和质量保证工作。这意味着当政府请求帮助时，紧急医疗队要做好准备，迅速到达，并在东道国政府的协调下、在世卫组织的支持下展开工作。
国内应急队伍当然是快速响应的不二人选，他们讲本地语言，了解本地人群的文化背景。但在国家需要更多支持时，世卫组织随时准备着从其他国家动员紧急医疗队。中国迅速行动起来，有三支紧急医疗队通过了世卫组织的认证，既可应对国内的卫生威胁，也可合作参与全球应对工作，包括需要时在非洲展开工作。
实现非洲本地化生产
其次，我们商定提高质量可靠的医药产品在非洲的可及性。药品价格在卫生总费用中占有相当大的比重，很多人因为高昂的药价而因病致贫。任何人都不应该在治病还是果腹、手术还是上学、投资未来还是保命之间被迫做出取舍。为使更多的国家达到世卫组织规定的的自费比例不超过15%的目标，世卫组织和中国共同致力于探索提高低成本优质药品可及性的途径。
对于疟疾和血吸虫病等某些疾病，中国提供的药品和消灭疾病的经验将使非洲国家获益。疟疾曾在中国广泛流行，中国上世纪70年代初曾报告了近2500万病例。2010年，中国与世卫组织合作，采用一体化的方法实施国家疾病消除规划。到2017年，中国不再有本土病例的报告。 但在世界其他地区，疟疾负担一直在增加。非洲的疾病负担占全球疟疾负担的90%。 世卫组织致力于与中国合格的厂家合作，借助世卫组织的预认证程序提高抗疟疾药和抗血吸虫病药等药品的可及性，并确保以较低的成本为非洲提供药品。
此外，谭德塞博士在上次访华期间会见了高层官员，希望更加重视中国对非洲本地化生产的投入。世卫组织非洲会员国明确希望增加非洲的本地化生产，世卫组织则支持合格的投资方助力实现这一目标，以此提高安全、有效和负担得起的医药产品的可及性。 中国对本地化生产的投入，有助于振兴非洲的药品产业。这不仅能保证可负担的、优质基本药品的可靠来源，也可增加就业和推动经济增长。中国公司已着手投入进行本地化生产，我们期待着不久的将来能有更多的投入。
建设非洲卫生人力队伍
最后，在建设非洲卫生人力队伍方面，世卫组织和中国也大有可为。据世卫组织预计，如不采取行动，到2030年，世界将面临1800万医务人员的缺口。这一缺口不仅让人们的日常卫生需要无法得到满足，也给防范疫情和其他突发事件的非洲防线留下巨大隐患。 因此，对医务人员进行培训，不仅是投资非洲的健康，还是投资非洲的安全。中国有很多成熟和卓有成效的培训项目，培养心脏病学、神经外科、眼科等领域的专科医生。更重要的是，将这些干预措施与患者所在的基层医疗服务及专科医疗相联系，并结合社区医疗和随访服务，可以惠及全体人群。世卫组织致力于与中国合作提高非洲的健康和卫生系统水平。通过携手合作，支持国家发展计划和重点工作，可以通过务实的改革措施，实现更好的健康目标，让更多的人群获得健康。
英文版：
How are WHO and China working together in Africa?
Author | Dr Gauden Galea , World Health Organization Representative in China
Design | Li Yudan
Production | Huang Shuocun
● Building Strong, Healthy Communities across Africa
●Building Strong Public Health Systems and Emergency Response
●Increasing Access to Medicine through Local Production in Africa
● Building Health Workforces in Africa
Building Strong, Healthy Communities across Africa
In May of this year I took leadership of the WHO office in China, leading a team of talented professionals providing support to China’s health reforms and growing international role. In that short period of time since I relocated to China, we have been fortunate to welcome the WHO Director General, Dr Tedros to Beijing twice – first in July to meet with Vice President Wang Qishan and several other senior officials to discuss important steps the World Health Organization (WHO) and China can take to advance our agreement signed in 2017 to build a healthy Silk Road; and then again in early September as an invited guest to the Forum of China-Africa Cooperation (FOCAC).
Dr Tedros has of course participated many times in the past in FOCAC events, including at the very first (and many subsequent) meeting of African health ministers in Beijing to explore China-Africa health cooperation. At that time, as minister of health, his involvement was as an African partner to China. In subsequent years his participation as minister of health and later as minister of foreign affairs shaped his understanding of the extent to which China could play a role in sharing its lessons in building strong health systems.
⬆Dr Tedros Adhanom Ghebreyesus, WHO Director-General visited Ebola sites in Africa
It was with special significance then that he returned to Beijing this month, as Director-General of the World Health Organization, determined to ensure that the global community engage more fully in the growing China-Africa partnership in ways that catalyse and accelerate health development.
It is in Africa that our world’s future lies. Home to the world’s richest resources – not the minerals that lie buried under ground, but the hope and vitality of Africa’s young people. Home to some of the world’s fastest-growing economies, and increasingly a hub of innovation, including in health.
However, it is also in Africa that the inequalities of our world are most painfully apparent. While some African countries have built strong health systems, in other countries the health systems are overburdened and under-resourced or operate within conflict zones, and struggle to provide for a strong public health. Like anywhere in the world, the burden of communicable diseases and outbreaks in Africa too often affects the most vulnerable, the poorest and disadvantaged communities.
These crises do not happen in a vacuum. They thrive where health systems – and in particular primary health care – are overstretched with insufficient human resources or surveillance systems.
We are not just talking about numbers on a piece of paper. Rather, we are talking about people who suffer from preventable diseases. And we’re talking about countries trying to develop and grow economically, but needing a healthy population to do so.
WHO is working with all our member states to build the health systems and services that will improve people’s health and wellbeing. Under Dr Tedros leadership we have set an ambitious global goal for ourselves:
• 1 billion more people benefitting from universal health coverage;
• 1 billion more people better protected from health emergencies;
• 1 billion more people enjoying better health and well-being.
These are ambitious targets, and deliberately so. These are the targets that we – the Member States, partners, civil society, academia and the private sector – must achieve together by 2023 if we are to stay on track for the U.N. Sustainable Development Goals.
In July 2018, Dr Tedros signed a Letter of Intent with Minister Ma Xiaowei of the National Health Commission. In that agreement, WHO and China prioritized collaboration that very much mirrors WHO’s own ambitious plans.
Building Strong Public Health Systems and Emergency Response
First, we agreed to jointly support African countries in their efforts to build strong health systems.
China and Africa have worked closely in health since the early 1960s when China sent its first medical team to Africa and have continued to cooperate on infrastructure, medical supplies and the human resources for health.
Drawing on the lessons of China, we know it is crucial to build strong health systems that extends all the way to the community level – where the patients are. New medicines and medical breakthroughs rely on a strong health system to ensure those innovations are accessible and available to people where they live, in their communities. Prevention, diagnosis, treatment, referrals to specialty services – these all rely on strong services in the community, what we call primary health care.
We also agreed to collaborate on supporting enhanced capacity in disease surveillance and emergency response. We must do both – strengthen the health systems that prevent and mitigate emergencies, even as we invest in preparedness and response. This means working together to build surveillance systems, better laboratories, systems for information sharing, and others. It also includes coordinating our support to the building of the new African Centers for Disease Control.
The African region bears a heavy burden of the world’s emergencies. But it is also developing the capacities to respond. Following the Ebola outbreak in 2014, one of the reforms WHO put in place was to qualify skilled Emergency Medical Teams (EMTs) in different countries. WHO sets a minimum standard for clinical teams, and coordinates peer review and quality assurance. This means that when a government requests help, teams will arrive better prepared, and work under the coordination of the host Government, with the support of WHO.
National response teams will always be best placed to respond quickly. They speak the local language and understand the culture and context of the local population. But when additional support is required, WHO is prepared to mobilize EMTs from other countries. China has worked quickly to secure WHO qualification of three Emergency Medical Teams – both to respond to their own health threats and to cooperation in global response, including in Africa if requested.
Increasing Access to Medicine through Local Production in Africa
Second, we agreed to promote increased access to quality medical products in Africa. The price of medicines is a significant component of overall health care costs. Too many people are pushed into poverty because of the cost of medicines. No one should have to choose between medicine and food; between surgery and school books; between investing in the future and just staying alive.
In order for more countries to reach the WHO target of no more than 15% out-of-pocket payments, WHO and China are committed to finding ways to increase access to lower cost, high quality medications.
For some diseases, such as malaria and schistosomiasis, China offers medicines and experience in disease eradication that would benefit African countries. Malaria was once widespread in China; in the early 1970s there were nearly 25 million cases reported in China. China adopted an integrated approach through the National Malaria Elimination Programme in 2010, together with WHO. And by 2017 there were no reported indigenous cases in China.
But in the rest of the world, the malaria burden has been increasing; and Africa bears 90% of the global malaria burden.
WHO is committed to working with qualified Chinese manufacturers to increase access to medicines, including those for malaria and schistosomiasis, through the WHO pre-qualification process and thus ensuring medicines are available in Africa at lower costs.
In addition, during Dr Tedros previous visit he had the opportunity to meet with senior officials to increase attention to Chinese investments in local production in Africa. African member states have clearly expressed their goal for increasing local production in Africa, and WHO supports that objective with any qualified investor as a way to improve access to safe, effective and affordable medical products.
Chinese investment in local production can help build a thriving pharmaceutical industry in Africa, which not only provides an affordable, secure source of high-quality essential medicines, it creates jobs and drives economic growth. Chinese companies have started to invest in local production, and we expect to see more in the near future.
Building Health Workforces in Africa
Finally, there is much for WHO and China to do together on building health workforces across Africa. WHO estimates that, without action, the world will face a shortfall of 18 million health workers by 2030. That shortfall not only leaves people without support for their everyday health needs, it leaves a huge hole in the region’s defences against outbreaks and other emergencies.
Investing in health workers is therefore not only an investment in a healthier Africa, it’s an investment in a safer Africa.
China has many well-established and very fruitful training programs, training medical specialists in the field of cardiology, neuro-surgery, ophthalmology and many more. What is important is to link these interventions to primary health care – that is where the patients are and specialty services can only benefit the whole population when they are linked to community-based care and follow up.
WHO is committed to collaboration with China to promote better health and health systems across Africa. Working in support of national development plans and priorities, together we can support ambitious reforms to produce the better health outcomes, and a more healthy population. 
