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Carol
Bellamy,
Kunio Waki,
Members of
CCH,
Ladies and
Gentlemen,
It is a particular pleasure to address you today:
members of Executive Boards and colleagues from three sister agencies.
The setting may be new, but there is a good feeling of familiarity
about this Committee. We work together on so many key issues; it is
useful periodically to take stock and to make sure we are really
pulling together. The Coordinating Committee on Health is about
coordination and collaboration in the service of health development.
This is not just helpful in our work – it is essential to the new
way of working in the UN system.
The importance of working together was emphasized
during the series of United Nations conferences of the 1990s. Member
States and UN-system agencies, regional bodies and Bretton Woods
institutions, donors, NGOs and civil society came together to generate
a ground-breaking international consensus around a series of
strategies, goals and targets.
The unprecedented global consensus crystallized in
the Millennium Summit Declaration, endorsed by 149 Heads of State.
This will set the framework for our future collaboration in the United
Nations system. WHO is proud to be an active partner – all the more
so, as such a large part of the Millennium Declaration relates
directly or indirectly to health. Reduction of infant and child
mortality, maternal mortality, HIV/AIDS and increased access to
reproductive health care services: all are among the key objectives
for priority attention.
As we stand at the hopeful beginning of a new
century, we have unequalled opportunities to address the health
problems of the world’s poor. Health is acknowledged to be not only
an end in itself, and an important component of human rights, but also
a key factor in poverty reduction and development.
During 2000, WHO has examined how to scale up the
response to the health problems – including malaria, tuberculosis,
HIV, maternal and childhood conditions and diseases associated with
tobacco use B that
contribute to deepening the poverty of the world’s poorest people:
more than 2.5 billion who live on less than $2 per day. It has done so
in cooperation with national governments, other UN-system
organizations, and a broad range of development partners.
Scaling-up means catalysing popular movements for
health, involving stakeholders from civil society and different
sectors of government. It necessitates the development of reliable
systems for assessing progress, monitoring results and evaluating
impact. It requires effective government stewardship for more
effective health systems. A sustained increase in external support
through poverty reduction strategies is often crucial, together with
sector-wide approaches, bilateral projects or emergency assistance,
and development of human capacity at local and national levels.
During 2000 several intergovernmental bodies have
committed to a long-term increase in their support for better health
outcomes, including reduced incidence of HIV among poor people. These
include the OAU Heads of State, the G8 Heads of State and the European
Commission, through an initiative of the President and five European
Commissioners. WHO will work with these and other bodies to encourage
the provision of additional resources for effective action at the
country level during the next decade.
Coming together in CCH represents another
contribution to these global level partnerships. We have a
wide-ranging and complex agenda before us that addresses both the
health challenges of the past and new emerging issues that demand our
attention. Over twenty years ago, the Primary Health Care movement
sought to address many of these same issues, but its momentum was
stifled by the emerging economic crisis of the 1980s. There were
growing concerns that the money being spent on providing services was
having little real impact in terms of health outcomes. This led to a
tendency to provide aid in the form of projects. But while projects
could be controlled and monitored, they often lacked sustainability or
ownership by the intended beneficiaries.
The thrust for sector-wide approaches or SWAps
arose out of these developments. SWAps start from nationally developed
policies, strategies and budgets, jointly financed by government and
development partners. Donors give up the right to specify how their
funds will be used – but gain a voice in developing policies and
monitoring performance. Many governments in both aid-providing and
aid-receiving countries are increasingly adopting sector-wide
approaches to development cooperation in health. It is therefore
important that we, the UN agencies active in health should have this
on our agenda today.
The pattern of development cooperation is changing.
We are all working together to reduce poverty and inequality. We all
recognize that ill health is both cause and consequence of poverty. We
are all interested in ensuring that spending on health by government
and its development partners is pro-poor.
Over the last few months, there have been
significant and promising developments in our renewed efforts to bring
issues of health and poverty to the attention of the international
community. New mechanisms for ensuring that global initiatives benefit
the poorest countries are being developed. These mechanisms will need
to observe and safeguard the principles underlying the concept of a
comprehensive development framework and of sector-wide approaches.
Building on our collective experience, today’s
discussion of sector-wide approaches for health development will help
us examine very carefully how to attain optimum synergy and
effectiveness in our work with governments and people, particularly in
the poorest countries.
The urgency of finding ways to strengthen the
response of health systems to the challenges ahead is nowhere more
acute than in relation to HIV/AIDS. Looking back over the past two
decades of experience with HIV/AIDS, we must openly acknowledge that
past efforts have largely failed to contain the epidemic. Over 36
million people are already HIV-infected and in need of care and
support. So that the health sector can respond to these needs,
resources must be substantially increased and management capacity
enhanced.
Addressing this challenge is a central component of
the Global Health Sector Strategy which WHO is now developing. The
Strategy will pay particular attention to the importance of ensuring
that complementary prevention and care interventions are delivered by
health systems, working through the public and private sectors, in an
intersectoral approach, and with a wide range of partners.
In the light of the experience we have accumulated
over the past few years, and as we look forward to the future, there
are some key issues which require our urgent attention and increased
efforts, I will mention just three of them - the health of the new
born; HIV and young people; and violence, especially violence against
women. These three issues represent a continuation of our past work in
the areas of maternal health, adolescent sexual and reproductive
health and gender. They also represent a way of refocusing and
revitalising our efforts for the future.
We have long stressed that when we address the
health needs of the woman, we are also addressing those of the infant.
This is of particular importance given what we know about trends in
infant mortality. Targeted, selective interventions such as
immunization and oral rehydration therapy have resulted in substantial
reductions in post-neonatal mortality. But we are increasingly aware
that improvements in the health and survival of the youngest infants -
those aged less than one month old - have not kept pace. Every year,
over 3.5 million such babies die, most of them during the critical
first week of life. Most of these deaths are a consequence of the poor
health and nutritional status of the mother, coupled with the
inadequate care she receives before, during and after delivery.
Further advances in reducing infant mortality will depend critically
on being able to address mortality during the first critical days of
life. We must, therefore, redouble our efforts to meet the health
needs of women during pregnancy and childbirth and to address the
major causes of new born mortality.
At this moment, one in five of the world's
population is between the ages of 10 and 19 years, making a total
of 1.2 billion young people. Globally over half of all new HIV
infections occur among young people. The juxtaposition of these two
facts presents us with a challenge, an opportunity, and a risk.
A challenge, because if we are to make any
impact on the course of the epidemic, if we are to contain it, let
alone reverse it, we must address the needs of young people for
information, skills, support and services that will enable them to
protect themselves from HIV infection.
We have a unique opportunity to do so
because we have made great strides in our understanding of what works
in primary prevention. We must now scale up our efforts to ensure that
effective prevention interventions among young people are available to
all.
The risk is that our efforts to halt the
rising tide of HIV infections will come to nothing unless we are able
to meet the needs of young people. The price of failure will be paid
by individuals, families, communities and, indeed, society as a whole.
WHO is increasing its efforts in those areas most
likely to threaten healthy adolescent development: sexual and
reproductive health, including HIV; substance use, especially tobacco
and alcohol; and mental health.
Violence, in all its many manifestations,
represents one of the major risk factors for poor health and for
premature mortality. Of particular concern is violence directed
against girls and women which subjects them to physical and emotional
trauma and makes them vulnerable to HIV infection, to adverse
pregnancy outcomes. Such violence is the most egregious sign of gender
inequity and is known to exist in all societies, across all age-groups
and among all socio-economic groups.
WHO will further strengthen its ongoing work in
relation to violence. A multicountry study is under way to identify
the incidence and impact of domestic violence against women in
different settings and to develop ways of reducing both. Domestic
violence was once regarded as a private affair, not amenable to
interventions. We now know that there is much that can be done both to
prevent violence and to care for those who are its victims. We now
need to identify ways of addressing other forms of violence such as
sexual abuse of women and children and the violence that all too often
accompanies war and civil strife.
The unprecedented global consensus exemplified at
the Millennium Summit creates additional stimulus for accurate
monitoring of progress towards the attainment of our common goals,
globally and in countries. At the same time, it is crucial to avoid
overloading health information systems with excessive demands for
data, and to ensure consistency in definitions, approaches and
methodologies used to generate the indicators. In response to these
challenges, WHO looks forward to working with you to enhance national
capacities to generate feasible, understandable and useful
reproductive health indicators that can be used to improve programmes
and deliver better health to those in need. |
