|
Distinguished Ministers,
It is a great pleasure for me to be invited to join
you here tonight.
As many of you know, I came into my current
position with a strong belief that good health and environment is
inseparably linked to development. In my first year, I set up the
Commission on Macroeconomics and Health to provide the evidence base
for these links and for developing strategies on how health can play a
constructive role in the development process. We expect its report at
the end of the year.
An early opportunity to discuss these issues came
in London in May, two years ago, when Claire Short kindly hosted a
conference of heads of developing agencies named "World Health
Opportunity - developing health, reducing poverty".
Looking back, that conference set in motion a
process which over the past two years has gained momentum. It joined
other streams of thought and energy and now they together have grown
into a formidable river.
The issues that we discussed in London have by now
become widely accepted realities: major diseases, such as HIV/AIDS,
malaria and TB directly affect the poorest countries' ability to
develop. They function as a drag on economic growth and they
perpetuate poverty. Childhood illnesses and maternal conditions also
hamper efforts to give the poorest a chance to get out of the vicious
cycles of deprivation and despair.
In addition, changing lifestyles, linked to growing
urbanization, pollution and the onslaught of tobacco marketing in
developing countries, give these nations a double burden of disease to
cope with - a burden their under-funded national budgets and weak
health sectors can ill afford. Investing in poor people's health is a
pre-requisite for other development-spurring activities.
The European Union has played an significant role
in this - with the energetic guidance of Commissioner Poul Nielson and
his colleagues. Through the Communication on communicable diseases,
adopted last year by the Council of Development Ministers, which in
turn led to an EC Programme for Action for the five year period
leading up to 2006, you have marked up a route to pursue, in order to
reach the internationally agreed targets of halving malaria and TB by
2010 and reducing new HIV infections by 25%.
The strong link between the three main elements of
the planned action is particularly important: ensuring optimal impact
from existing interventions; increasing the affordability of key
pharmaceuticals; and increased investment in research and development.
Over the past year, the renewed public concern over
HIV/AIDS and the devastation it is bringing on large parts of the
developing world has brought the link between disease and development
onto the global political agenda. The progress we are seeing towards a
new fund to fight HIV/AIDS, TB and malaria is impressive and
heartening. It is also an extraordinary and trail blazing process.
Governments from industrialized and developing
countries alike are coming together with a coordinated United Nations
family to produce a new and path-breaking mechanism for action against
diseases that perpetuate poverty.
But before I say more about the proposed Global
AIDS and Health Fund, let me say a few words about the context within
which it is being created.
Over the past few months, we have seen a growing
commitment to a new international framework which links the
availability of new resources to the ways in which they are used.
The first element of this framework is that there
really is a steep increase in resources. The United Nations
Secretary-General has spoken of an additional US$ 7 billion
per year for HIV/AIDS. I believe we should be looking toward a
progressive increase in funding - from all sources, both national and
international - toward a total of about US$ 10 billion a
year to cover the investments needed to tackle HIV, tuberculosis and
malaria.
The second element is ensuring that essential
global functions take place, such as programmes of strategic research
for, and development of, necessary drugs and vaccines and strategic
partnerships to bring down medicine prices in order to improve access
in poorer communities.
But we also will need schemes for the efficient
purchase and equitable distribution of critical commodities, obviously
in ways that respect intellectual property, that build on existing
international trade agreements and that show how to take advantage of
the new advances in biotechnology. The Trade Commissioner, Pascal Lamy,
has played a key role in working to this end.
The third element in this framework is innovative
and urgent action to secure the effective operation of health
systems even when they are seriously under-funded. This means
improving the capacity of a variety of different provider groups to
deliver essential services and goods through a diversity of private,
voluntary and public channels. The emphasis must be on stewardship by
governments, even in complex emergencies. Effective stewardship calls
for the strengthening of human resource capacity through development
of leadership and public health skills, coupled with efforts to retain
critical staff. This would be backed by focused investment in
essential infrastructure, fair systems for health financing, logistics
for storing and distributing medicines and other vital commodities,
functioning laboratory services, and - importantly - monitoring the
quality and coverage of all services.
The overall goal would be to ensure that health
systems are able to deliver services that are as effective, responsive
and fairly financed as possible given the resources available.
The fourth element is to ensure the independent
authoritative monitoring and review of results, relating these
to investments, accompanied by rapid reporting and public relations -
in order to sustain long-term involvement.
The fifth element is to catalyse intense and social
mobilization at country and global levels, through a credible and
upbeat programme of advocacy with political leaders and key public
figures. It would work through governments, NGOs, and the media. It
would be based on the theme of working together to "make the
forces of globalization work for the secure future of humanity ".
Last, but not least, we need an effective, fast
mechanism for moving money. This brings us to the proposed Fund.
The purpose of the proposed Fund is to mobilize,
manage and disburse additional and complementary grant resources -
enabling countries to achieve more rapid progress in addressing the
development, economic and human security challenges created by
HIV/AIDS, malaria and TB.
Let me briefly sum up how I see the evolving
consensus. There are 11 points here.
- The Fund should not replace existing financing mechanisms but
should enhance existing efforts.
-
It should support on-going national
development processes, such as poverty reduction strategies,
sector programmes, and national HIV/AIDS strategies.
-
It should increase the effectiveness of
international assistance, and foster convergence between
disease-specific initiatives.
-
It should encourage voluntary and
private sector participation in the management and provision
of services at the country level.
-
It should encourage new ways of working,
including rapid and effective fund disbursement - without
compromising accountability.
-
It should be transparent and flexible:
avoid new and elaborate planning processes. The review criteria
should be transparent and consistently applied.
-
It should decrease transaction costs:
for donors and national governments.
-
It should focus on results, with
clear indicators in all proposals - rewarding good performance.
-
One size does not fit all : operation
of the Fund must be geared to different national contexts.
-
It should have effective but light
governance .
-
It should be consistent with international
agreements and therefore work within the context of TRIPS and
the safeguards included in them.
This weekend, representatives from 43 developing
countries and from donor countries are coming together in Geneva to
discuss how we best can proceed with the Fund. The European countries
individually, but equally the European Commission, will have a crucial
role to play in order to ensure that we end up with a viable,
effective and well-funded mechanism.
We will need to be careful this weekend to build up
the consensus needed on the ways in which the Fund works in countries
and on its governance. We need to agree on the next steps, and on the
key role of the Secretary-General in ensuring that those steps lead to
a viable, well financed and properly managed funding mechanism. We
need to be able to confirm that developing country governments are
comfortable with the process through which the Fund is being taken
forward. We need to be clear that this is an international Fund,
backed by the UN, but driven jointly by governments of developing and
industrialized governments in ways that reflect good development
practice. We need to establish an entity that is seen as an attractive
proposition for those who wish to invest in health and development
outcomes.
A positive outcome from this weekend's meeting will
be a great boost for UNGASS on HIV/AIDS in New York at the end of
June, the G8 in July and the plans being taken forward by the Swedish
and Belgian Presidencies during this vital year. This will set us well
on track for the achievement of International Development Goals by
2015. This means innovative ways of working within the UN system as a
whole, and within WHO in particular. Business as usual is not an
option - for the UN, nor for countries that will call on the resources
within the Fund or the mechanisms used for spending its resources.
Our own work at WHO is changing in this direction.
Through GAVI, though Roll Back Malaria, through Stop TB and other
partnerships, we have built up experience in how to follow through
globally agreed interventions all the way to country action. We see
what can be achieved if additional resources become available for
country level action, especially if the availability of resources is
linked to the achievement of agreed milestones for health outcomes. At
the same time, we are directing research efforts and policy
development in areas where new technologies and approaches are needed
- such as in the development of treatment regimes for people with AIDS
in resource-poor settings.
In countries, WHO's role will be that of a central
partner of the government in planning programmes, in reforming the
health sector and in developing policies. We seek ways to work more
effectively with other UN system agencies, and - of course - with
ongoing programmes for poverty reduction supported by the bilateral
development agencies and development banks.
There have been some recent and promising examples
of ways in which the WHO's country teams can help to promote sustained
success.
In Cambodia, WHO has worked closely with the
Government and civil society to combat HIV/AIDS. Through developing a
national policy for "100% condom use", planning and
executing a well organized health campaign, and ensuring coordinated
action in other sectors, we have seen that HIV infection rates have
shown a declining trend in recent years. For example, the rate of HIV
infections among sex workers below 20 years of age dropped from more
than 40% in 1998 to 23% in 2000.
In Indonesia, WHO has been intimately involved in
the Government's decentralization of the health system, ensuring that
a devolution of responsibility is matched by competence and resources
at local level.
In Nigeria, WHO is working shoulder to shoulder
with the government of President Obasanjo, who, of course taken a
leading role in placing health centrally in his own - and Africa's
development agenda. Our aim is to make WHO an effective partner in
countries' efforts to spur development through making cost-effective
investments in health.
Partnerships have become a central feature of our
strategy to make best use of our strengths and focus on outcomes. The
partnership with the European Commission has developed in a very
constructive way over the past two years - particularly through
country-level action. It has also been heartening to see the way in
which individual members of the Union have been so supportive of the
new agenda. I hope that with the stated European commitment on health
in development, our collaboration will be further strengthened in the
months and years to come.
We have a common task to reduce poverty and
encourage equitable development for all those who so far have been
left behind in the sweeping wave of globalization. I would like the
resources of WHO - at country, regional and global levels, to be used
to their best effect in the pursuit of this vital agenda. I look
forward to working even more closely with you to ensure that this goal
is fulfilled.
Thank you. |
