This year marks 5 years since the World Health Organization launched its new vision for the Eastern Mediterranean Region. The World Health Organization (WHO) Regional Office for the Eastern Mediterranean launched this 5-year regional vision in October 2018 as an ambitious call for action and solidarity across the Eastern Mediterranean Region to ensure Health for All by All. While this ultimate goal is yet to be realized, the regional vision has achieved success in the face of adversity.

To accelerate progress towards the achievement of major regional and global goals related to health, Vision 2023 set 4 regional strategic priorities: expanding universal health coverage (UHC); addressing health emergencies; promoting healthier populations; and making transformative changes in WHO. The Regional Office developed the vision through extensive consultation with national governments and other stakeholders. In 2019, a regional strategy was defined to support work on the strategic priorities.

Recent years have shown that significant health gains are possible in many health settings. Since 2010, under-5 mortality has decreased by more than 10 per 1000 live births in Afghanistan, Djibouti, the Islamic Republic of Iran, Morocco, Pakistan, Somalia and Sudan; mortality from noncommunicable diseases has dropped by more than 15% in Oman, Qatar and Saudi Arabia; and the UHC Index, which measures health service coverage, has increased by 10 or more points in Egypt, the Islamic Republic of Iran and Qatar.

Yet overall, progress has been limited and the Region is not on track to achieve the health-related Sustainable Development Goals (SDGs) – global commitments that every country must meet for a peaceful and prosperous future.

Large variations persist in income and health system capacity within and between the 22 countries and territories of the Region. Infectious and chronic diseases are still causing morbidity and mortality that could have been avoided through more effective health policies and health care. The scale of the health and humanitarian emergencies faced by the Region was already colossal in 2018 and has since escalated.

All these challenges were exacerbated when the COVID-19 emergency took hold. The global pandemic did, however, highlight that investment in building resilient health systems is essential to ensure global health security. The speed and scale of the pandemic response have shown that success is possible with strong political commitment and leadership.

Highlights of the past 5 years

Efforts to expand UHC were given added impetus in 2018, when every country and territory of the Region signed the UHC2030 Global Compact and endorsed the Salalah Declaration on Universal Health Coverage 2018. WHO has worked with countries to improve every aspect of their health systems – from governance and financing to health workforce capacity, access to medicines, and service delivery.

In line with the regional vision and strategy, countries were encouraged to use an integrated people-centered health services approach. Among many pioneering initiatives, a regional Professional Diploma in Family Medicine was created to address the Region’s chronic shortage of family practitioners; regional frameworks were introduced to guide strategic engagement with the private sector and better integration of hospitals in health systems; and tools were developed to enhance patient safety and overall quality of care in both hospital and primary health care settings.

While the COVID-19 emergency interrupted many essential programs, including national immunization programs and services for HIV, tuberculosis and malaria, WHO worked with many countries to eliminate certain communicable diseases. The elimination of lymphatic filariasis in Yemen in 2019 proves that success is possible even in countries facing severe challenges. To address low vaccination rates, which have led to major life-threatening outbreaks, WHO has been developing a regional framework for implementing the Global Immunization Agenda 2030.

During the term of Vision 2023, the Region faced emergencies on an unprecedented scale. Half its countries and territories experienced ongoing conflicts or sporadic violence. There were 166 disease outbreaks, including COVID-19, and many countries were also hit by major natural disasters, technological disasters, severe economic decline and poverty. Ours is also the only WHO region where wild poliovirus remains endemic. In 2022, 127 million people in the Region needed humanitarian assistance – more than double the number in 2018.

During the five-year period from 2018, WHO documented and responded to 166 new disease outbreaks (including COVID-19) across the Region, with an average of 33 outbreaks per year with 47 outbreaks in 2018 and 45 in 2022. In the same period, the number of graded emergencies that require an operational response by WHO has more than doubled from 10 in 2017 to 22 in 2022.

To meet these challenges, WHO became more agile across all phases of the emergency management cycle. A regional strategic framework was developed to strengthen the prevention and control of emerging and epidemic-prone infectious diseases. While country-level core capacities still fall short of the International Health Regulations (2005), by 2023 every country and territory of the Region had established, among other things, rapid response teams. The number of laboratories with PCR capacities rocketed from fewer than 30 to over 2500, and WHO helped to train more than 50,000 health workers.

Meanwhile, WHO’s logistics hub in Dubai dispatched more than 1500 shipments to 137 countries and territories across all 6 WHO regions between 2018 and 2022. Such efforts helped to secure very positive external evaluations of WHO’s work in some of the Region’s most protracted crises.

Vision 2023 made health promotion a high priority over the last 5 years. At the heart of this work were flagship initiatives to address inequities in the social determinants of health. The regional Healthy Cities Network expanded dramatically, from 64 cities in 11 countries in 2019 to 110 cities in 15 countries in 2023. Countries were also supported to invest in proven cost-effective measures – the Best Buys for noncommunicable diseases. Much remains to be done, however, despite some encouraging progress.

To increase its own positive impact, WHO introduced wide-ranging changes to its structure and operations and leveraged and led various strategic partnerships. The Regional Health Alliance was created to bring together and guide the joint efforts of 16 United Nations agencies to support regional progress on the health-related Sustainable Development Goals.

Such successes establish Vision 2023 as a legacy to build upon. As I prepare to step down as Regional Director, the WHO Regional Committee for the Eastern Mediterranean will nominate my successor. I would like to wish the new incumbent every success in the post and express my hope that the regional vision is extended for a second term, continuing our collective effort to achieve the ultimate goal of Health for All by All.