Essential public health functions: the experience of the Eastern Mediterranean Region.

Early 2012, the WHO Regional Office for the Eastern Mediterranean (EMR) worked with Member States to reach consensus on the key health challenges that would be the focus of joint work over the course of the next five years. Five strategic priorities were identified and were subsequently endorsed by the World Health Organization (WHO) Regional Committee for the Eastern Mediterranean, which is the WHO governing body at the regional level, at its 59th session in October 2012 (1). These were: health system strengthening, maternal and child health, prevention and control of noncommunicable diseases, health security and the unfinished agenda of communicable diseases, and emergency preparedness and response. In close coordination with Member States, WHO undertook a comprehensive situation analysis for each priority area, in terms of the nature and characteristics of the challenges encountered, gaps and barriers to action, as well as opportunities for intervention. This was followed by identifying what had to be done to address these gaps. This is summarized in the report “Shaping the future for health in the Eastern Mediterranean Region: Reinforcing the role of WHO 2012–2016” (2, 3). In addition to the pre-existing challenges in the five priorities, the past five years witnessed major developments that had a considerable impact on the public health landscape in the Region. Political changes, social and economic crises, civil unrest and emergencies, as well as rapid demographic changes, have had a significant impact on health of the Eastern Mediterranean populations. The same period has also experienced the unfolding crises in Iraq, Libya, Syria, and Yemen, in addition to the ongoing protracted emergencies in countries like Afghanistan, Pakistan, Somalia and parts of Sudan. Today, almost twothirds of Member States in the Eastern Mediterranean Region are directly or indirectly significantly affected by crises resulting in unprecedented massive population movements (4-6). A common gap that was identified for all five priority areas is the limited availability of public health capacity (7). Although there has been some progress in public health capacity in the Region over the last two decades, this has not matched the overwhelming public health challenges the Region faces. In fact, some countries did not appear to have made a significant improvement in public health within ministries of health during this period. It was clear in 2012 that competencies in public health are insufficient in tackling the health priorities in many countries of the Region. Thus, strengthening public health capacity was established as a special initiative of the Regional Director and was given a high priority during his five-year term. This was translated through a number of regional initiatives launched since 2012, including: the Leadership for Health programme, health diplomacy initiative, refocusing the Eastern Mediterranean Health Journal as a regional public health journal, and reinforcing national public health institutes and associations. One key component of this initiative focused on the assessment of Essential Public Health Functions (EPHFs) (8).