The session’s Co-Chair,
Maria Minna,
Minister for International Cooperation of Canada, said healthy people were
productive people, yet the idea that health was part of productivity was slow
to catch on. Today’s session could help
explain that connection. It was also
important to mobilize resources to fight such diseases as AIDS, tuberculosis
and malaria. Only effective global
partnerships could prevail over global diseases.
Co-Chair, Aleke Banda,
Minister of Health and Population of Malawi, said the question was how to
stimulate additional resources to improve the health situation in least
developed countries. The key role
of ministers for finance should be
examined to see how proper budgets could be ensured to provide for adequate
health care.
During a lively
interactive session with wide participation, nearly all speakers agreed that
the HIV/AIDS pandemic was one of the greatest challenges in Africa today, which
needed to be urgently addressed. It was
also stressed more than once that the epidemic highlighted the unfinished
agenda in the LDCs, whose health-care systems were underdeveloped. Also mentioned was the role of multilateral
trade rules on health in many countries.
Several speakers underscored the need to make drugs more available and
affordable in the LDCs.
Among other issues raised
in the debate were maternal and child mortality, gender health issues, market
access to medical supplies and equipment, availability of doctors in rural
areas, the problems of the older people, and the relationship between the
traditional and modern medicine.
Other panellists for this morning’s interactive
session were: Martino Dgedge, Deputy
National Director of Health, Mozambique; Philippe Busquin, European
Commissioner for Research; Philippa Saunders, OXFAM International, United
Kingdom; and Poul Nielson, European Commissioner for Development and
Humanitarian Aid.
Rubens Ricupero, Secretary-General of the
United Nations Conference on Trade and Development (UNCTAD), also spoke.
The Conference will meet again at 3 p.m. to hold an
interactive thematic session on education for all.
Thematic Session: Enhancing Productive Capacities -- the Role
of Health
Opening
the session, co-Chair MARIA
MINNA, Minister for International Cooperation of Canada, said healthy
people were productive people, yet the idea that health was part of
productivity was slow to catch on. Poor
people could not afford to be healthy.
That was a vicious circle -- the poorer people got, the less productive
they became, and the less productive they became, the poorer they got. Social policies were needed to address that
problem and, in Canada, emphasis was being placed on such measures as providing
basic nutrition, fighting AIDS and ensuring children’s health.
Today’s session would help provide understanding of
the connection between health and productivity, she continued. The active participation of all stakeholders
was needed, and resources must be mobilized to fight such diseases as AIDS,
tuberculosis and malaria. Global partnerships
were needed to prevail over global diseases. The timing was crucial, for about one month
from now a special General Assembly session would be held for HIV/AIDS, which
was expected to work on an overall action framework, which could determine
future efforts.
RUBENS RICUPERO, Secretary-General of the
United Nations Conference on Trade and Development (UNCTAD), said that health
was not only a human condition, but an investment in development. He hoped that participants would not only
take part in the discussion, but concentrate on “deliverables”. Interactive debates were among the
innovations introduced during this Conference.
By not being confined to prepared texts, participants would be able to
concentrate on meaningful interaction, trying to extract practical ideas for translating
general ideas into action. There were
great expectations that the Conference would face up to the credibility gap
regarding efforts to help the LDCs.
ALEKE BANDA, Minister of
Health and Population of Malawi, also a co-Chair of the session, said
that the poor health of people in LDCs was a serious problem. Malnutrition, high maternal mortality rates,
emerging and re-emerging diseases were among the issues that needed to be
addressed. The health systems of LDCs
were so weak that they could not respond to the challenges. The lack of essential medicines and poor
infrastructure contributed to the problem.
In addition to knowing
what was needed, he continued, the LDCs knew that resources currently available
were inadequate. Pleas were being made
to donors, but needed resources were still not forthcoming. The question was how to stimulate additional
resources to improve the health situation in LDCs. The key role of ministers for finance should be examined, to see
how proper budgets could be ensured to provide for adequate health care.
In opening remarks, A. ASAMOABAAH, Executive
Director of the World Health Organization (WHO), said that the greatest tragedy
was the great divide between the rich and the poor, and ill-health continued to
contribute to such a divide. Each year,
30 million people in the developing world died of diseases that in developed
countries had been all but forgotten.
Tackling health problems should be part of the economic equation, for
that could help developing countries achieve sustainable economic
progress.
Health should be viewed as an investment, he
said. Healthy workers were physically
and mentally more productive. Better
health could also lead to better education.
As people lived longer, society invested more in social protection
schemes, generating domestic savings.
Access to resources, health infrastructure and technologies were
required, which required a greater commitment by the international
community. Better health provided
people with opportunities, which would enable them to rise from poverty.
In a keynote address, K.Y.
AMOAKO, Executive Secretary, United Nations Economic Commission for Africa
(ECA) and member of the WHO Commission on Macroeconomics and Health, said there
was an emerging consensus on the importance of health to development. That consensus also pointed towards the need
for radical, imaginative thinking. “The
time for business as usual is past”, he said.
The work of the Commission on Macroeconomics and Health revealed that
the current health crisis in the LDCs was more than just an impediment to
development; it was a fundamental obstacle.
And health and education were not just components of development. They were, jointly, the keys to development.
He said many LDCs were not on target to meet basic
goals for child survival and life expectancy.
The situation was worse in those countries most severely affected by the
HIV/AIDS pandemic. Millions of people
were being lost in the poor countries.
The economic cost of poor health was high. In fact, one of the most compelling conclusions of the research
undertaken by the Commission on Macroeconomics and Health was that “poor health
was far more economically costly than we have ever appreciated”. That insight needed to be incorporated into
every aspect of development planning.
“To meet our goals, we need more money and better
systems”, he continued. In LDCs, a
minimum expenditure on health of about $45 to $60 per head, per annum was
needed. That represented a major
increase over current levels of spending, which now averaged approximately $5
to $10 per head, per annum from government funds, matched by a comparable
expenditure from household themselves.
While LDCs could, by themselves, mobilize more resources, the
international community would need to shoulder the greater part of the burden.
He said that meeting the international development
and Millennium Summit goals needed a major new global commitment. The total finance needed was estimated at
$15 billion to $24 billion for the 600 million people in the LDCs. Those figures excluded HIV/AIDS. Combating the pandemic in sub-Saharan Africa
alone would require an additional $5 billion to $10 billion annually. Those amounts were small by global standards. But, gauged against total official
development assistance (ODA) of $55 billion, it represented a steep increase
indeed, which revealed “just how far we need to reach to provide basic health
to most of the world’s poor”. The
unfortunate reality was that, even if the money were available, it could not be
spent effectively. In some countries,
even existing limited budgets remained unspent. Systemic capacity-building and health-sector reform was needed.
He said poor countries needed to maximize the
efficient use of the resources that they already had. Their basic resource was people.
Leadership, social mobilization and multi-sectoral strategies were
needed. A theme now recognized by
African leaders and the United Nations was that HIV/AIDS demanded the same
level of mobilization as fighting a war.
The second precondition for LDCs was to improve the quality of their
national health systems. While systems
could not be built upon the lines of the resource-rich United States, there was
still much to be learned from Chile and China, which have delivered very
impressive health improvements at a reasonable cost.
Research and development in health was
overwhelmingly concentrated on the diseases of the rich, he said. The health problems of 90 per cent of the
world’s populations attracted only 10 per cent of global funding for research
and development. The key killer
diseases of tropical countries attracted just a fraction of the bio-medical and
epidemiological research that could deliver breakthroughs. Investment in research in poor countries’
health problems should, therefore, be considered a high priority for
intergovernmental partnerships.
He went on to say that no accurate figures were
currently available, but it was likely that the value of services rendered by
LDC-trained health professionals in developed countries exceeded the
health-related ODA to LDCs. That issue
warranted a detailed study by the WHO and the International Labour Organization
(ILO). He also called for bolder and
more effective international partnerships in the field of public health. Such partnerships must be home grown, and
ownership must reside in the poor countries themselves. The current focus on health was long
overdue. Now was the time for decisive
action.
Panellists
MARTINO DGEDGE, Deputy
National Director of Health of Mozambique, said there was a vicious
circle linking poverty, health and production that had to be broken. Strategies
must be designed to fight such diseases as HIV/AIDS, malaria and tuberculosis,
since alleviating those diseases would have a significant impact on poverty eradication. While the three diseases were significant
challenges to human development, they all had one thing in common -- they were
preventable.
He said achieving high
productivity required a multi-dimensional approach consisting of improving
incomes, life expectancy and nutrition.
Fertility rates had to be controlled, while health education and
sanitation infrastructures had to be enhanced.
The equitable distribution of a country’s resources had to be
considered, as well. In Mozambique, his
Government had established a policy aimed at increasing productivity and family
income. Also, regional collaboration
was needed to effectively integrate and harmonize the different strategies. That would also help strengthen efforts to
fight HIV/AIDS and defray treatment costs.
While his country accepted
the proposal of a global fund for HIV/AIDS, such a fund should make clear the
contributors and beneficiaries. How
much would be needed for the fund to have an impact? Africa alone needed $1 billion to control the pandemic. The fund should also be simple and
transparent. Now was time to define
steps and start distribution of the funds that were already available.
PHILIPPE
BUSQUIN, European Commissioner for Research, emphasized the importance of
research as a means of finding solutions.
Within the European Commission, a plan of action had been developed,
which included action in the field of research, giving priority to AIDS,
malaria and tuberculosis. Other
diseases were not neglected, either.
Efforts were being made to make research more consistent and better
coordinated.
He said an amount of up to
130 million euros was devoted to the current programme, which was being
implemented in cooperation with a number of local teams. There was great benefit to be gained from
local participation in the development and application of therapies in various
regions. Close interaction was to be
ensured between the treatment and consistent research. Another framework programme was being
prepared, including a section of clinical trials on malaria and other diseases.
He hoped that interaction
with the countries most affected would be achieved. Dialogue with the pharmaceutical industry was continuing, in
order to provide incentives for the development of products that were not
currently economically viable. The
transfer of technology was also important, while not forgetting human
resources. The European Union was
introducing mobility grants for researchers to encourage mobility. He hoped that the question of research would
not be forgotten, for it constituted a major element in improving health in the
LDCs.
PHILIPPA
SAUNDERS, OXFAM International, United Kingdom, spoke about the outcome of a
recent workshop on health, which had drawn attention to the urgent need for multilateral
funder participation in efforts to meet development targets by 2015. Health-related loans should be converted
into grants. Warning against vertical
programming, the participants of the workshop stated that neglected diseases
should receive the needed attention, and new drugs should be developed for that
purpose. Funds should not be devoted
exclusively to tuberculosis, HIV/AIDS and malaria.
The needs of women needed
to be considered, she said. The
workshop had noted that maternal mortality rates reflected the overall
condition of health services in particular countries. Concern was also expressed about the lack of access to affordable
drugs. In recognition of their special
needs, LDCs should be allowed greater flexibility in their search for
medicines. A recent study of prices of
important drugs had shown that medicines were more expensive in developing
countries than in industrialized ones.
Continuing, she said that
the participants of the workshop had questioned the effectiveness of the World
Trade Organization (WTO) Agreement on Trade-Related Aspects of Intellectual
Property Rights. African leaders
themselves were asking for a closer examination of that agreement. There was a role for tiered pricing in LDCs,
but the schemes should be much clearer.
She welcomed the pharmaceutical companies’ contribution of some drugs,
but donations were sometimes abused in emergencies and hospitals in Africa.
Responding
to comments, Dr. ASAMOABAAH said that 25 countries had been on the LDC list at
the first Conference; today there were 49.
One might say that one way to reduce the number of LDCs was not to hold
any more conferences. Jokes aside,
however, that meant that there were greater expectations for the international
community than ever before.
Today’s presentations had
confirmed a growing international recognition that it was good economics to
invest in health, he said. Not everyone
was convinced, though. The lack of
funds was of key importance, but money was not everything. Not just money -- but “good money.” Relabelled and “recycled” money was “bad
money”. It was important to look for
new sources of funding. For example, an
international health fund could represent “good money”.
A new philosophy and a
reorientation of health systems were required, he continued. For example, more services should be
provided in the rural areas and in the suburban slums, taking into account the
countries’ demographic composition. He
went on to describe problems with donor funds, which often did not reach their
destination, and said that sometimes vaccination campaigns resembled a hostage
situation, with a school being stormed and everyone getting an obligatory
injection. A partnership of mutual
respect should be emphasized. The team
spirit had yet to take root. The
providers of health care for the poor needed to receive recognition and become
part of the policy-making process.
Poul Nielson, European Commissioner for
Development and Humanitarian Aid, said while prevention of diseases remained at
the forefront of all efforts, finding a way to provide access to affordable
treatment for the afflicted was just as important. The economics and priorities of health policies must be based on
the realities of the economics and priorities of LDCs’ health policies. He warned participants about allowing the
issue to be hijacked by the media and public relations arms of the rich
countries. The Conference must send a
message about the fashion-of-the-month approach used by wealthy nations
regarding issues important to poor countries.
He said the programme of action called for new
approaches that would deliver greater resources more efficiently. Last week, health experts from the European
Union member States met to discuss principles related to the proposed global
health fund for HIV/AIDS and other communicable diseases. They wished to fully engage developing
countries, including civil society actors, in the process of devising how the
fund could best be used to improve the health of the poor. Above all, what was emphasized was the
necessity of building strong and effective health systems that targeted the
major communicable diseases.
“We need to make sure that a major health fund is
more than just a stunt by the Group of Eight industrialized countries”, he
warned. Donors should make truly new
resources available over an extended period of time. He did not support single-issue funds and pleaded instead for a
broad-approach fund that would target other diseases. He would also continue to raise and press for countries to have
ownership of funded programmes, systems and projects. The major question was, would the fund improve delivery? There had been enough empty donor-driven
initiatives already. Further, any such
fund could not succeed and would not get support without a commitment from
industry for global tier-pricing systems.
The cost of drugs for the poorest countries must be directly related to
their ability to pay.
Interactive Session
During a lively session with wide
participation and intervention coming from a former President of Ghana, Jerry
Rawlins, various agencies and organizations of the United Nations, delegations
and members of civil society, nearly all speakers agreed that the HIV/AIDS
pandemic was one of the greatest challenges in Africa today, which needed to be
urgently addressed. It was also
stressed more than once that the epidemic highlighted the unfinished agenda in
the LDCs, whose health-care systems were underdeveloped.
As various speakers
endorsed the proposed framework for action for promoting health in the LDCs,
one speaker drew attention to the upcoming special session of the General
Assembly on HIV/AIDS. The draft
declaration of commitment outlined areas for action and possible actions, which
included prevention, human rights, vulnerability, research and development,
AIDS in conflict areas and resources.
Once approved, it would form an important set of deliverables.
As HIV/AIDS continued to
dominate the session, a speaker called for the full engagement of governments
and their various partners to prevent the spread of the disease and to care for
those afflicted by it. The important
role of community or local volunteers
in providing help to those living with HIV AIDS was also underscored by a few
speakers, with one forcefully calling for voluntary contributions to be
recognized, supported, promoted and facilitated, if they were to meaningfully
enhance the work of health systems.
Another speaker, who
announced to the session that she was HIV positive, reminded all that that the
diseases of tomorrow would be greater than the diseases of today. If the world did not act now to save Africa,
then that continent’s problems would be the problems of perhaps Europe and Asia
tomorrow. It was also stressed that
there was a critical need to move beyond the numbers game -- statistics and so
on -- and really decide what needed to be done in terms of global advocacy.
A speaker said that it was
important to give health a proper place in the new LDC programme of
action. Financial institutions needed
to be committed to its implementation.
Health and health systems should be fully integrated in the development
programmes.
Great interest was
expressed in the proposed global health fund, which one speaker characterized
as “a breakthrough initiative”. It was
pointed out that the fund should receive support from governments and that it
should have a flexible structure to meet the various requirements of different
countries. The proposed international
fund for HIV/AIDS and other communicable diseases would be a useful tool in
combating various maladies affecting least developed countries, a speaker
said. However, unless financing above
and beyond the existing levels was ensured, the international community would
“be playing a shell game” with resources.
The health situation in
the United States was not comparable to that in Ethiopia or the Great Lakes
region, a speaker said. Armed conflicts
contributed to the deteriorating health situation in many LDCs. They also led to discontinuation of development
assistance, which needed to be resumed as soon as possible. Efforts to improve health in LDCs would be
futile if the issue of conflicts were not properly addressed, another speaker
added. As resources and
capacity-building were a high priority for LDCs, it was important to cancel the
external debt of those countries, for that would allow them to channel
much-needed finance towards health care and the eradication of poverty.
Speakers also addressed
emergency situations encountered by some of the LDCs. Conflicts and emergencies created large flows of refugees, and no
health system could cope with thousands of people flowing to a country from
neighbouring States. Also mentioned in
the discussion was the role of multilateral trade rules on health in many
countries. Several speakers stressed
the need to make drugs more available and affordable in the LDCs.
The WTO Agreement on
Trade-Related Aspects of Intellectual Property Rights had been designed in
support of research and development, a representative of that organization
said. In relation to essential drugs,
differential pricing could and should play an important role in ensuring access
to affordable drugs in the developing countries. Another problem involved actually getting medicines to the people
who needed them. Additional financing
from the international community was required for that purpose, as well.
Among other issues raised
in the debate were maternal and child mortality, gender health issues, market
access to medical supplies and equipment, the availability of doctors in rural
areas, the problems of older people, and the relationship between the
traditional and modern medicine.
In her concluding remarks,
Ms. MINNA said that a real partnership was emerging, with LDCs and industrialized
countries undertaking tangible “deliverables”.
It was reassuring that the creation of a new global fund to focus on
HIV/AIDS, malaria and tuberculosis had received support from the speakers.
Without strengthening the health-care systems, it would be difficult to achieve
the goals set at the Conference.
Research and the availability of doctors were among the important points
made in the debate, as well as links between education and health. The role of sustained financial assistance
was also emphasized, as well as pricing and conflict resolution.
She went on to say that,
as pointed out in the discussion, the dates for reaching established benchmarks
were approaching, but without decisive action on behalf of the international
community they would be hard to achieve.
Health should be regarded not as an expense, but as an important factor
of productivity. For that reason,
ministers of health and finance needed to consider providing sufficient
budgeting for health purposes.
