the International Conference On Financing for Development
Mr Chairman, Ministers, Ladies and Gentlemen.
On behalf of the World Organization, I thank you for this opportunity to address the conference on health in relation to financing for development.
Health, particularly the health of poor people, is central to the achievement of the Millennium Development Goals (MDGs), and thus to the success of our endeavours here. Better health is, of course, an important goal in its own right. But, we now know that better health is not just an outcome of economic development and poverty reduction - it is a powerful means of achieving these goals.
Of course health is not the only route to poverty reduction but it is one that has been undervalued - and, the critical point, one that has too long been under-resourced.
The work of the Commission on Macroeconomics and Health, shows that we have for too long under-estimated the economic losses that accrue from ill-health: not just to individuals, but to their families, to societies as a whole, and across generations. The potential pay-off to increased investment is enormous. Eight million lives saved and US$ 360 billion generated within 15 years is an estimate: but it is an estimate of such power that it cannot be ignored.
Dr Brundtland, the Director-General of WHO and Professor Jeff Sachs, Chair of the Commission, will be presenting more detailed information on the findings and recommendations of the Commission for Macro-economics and Health at a side event at lunchtime on Wednesday.
But potentially effective interventions are not reaching those who need them in anything remotely close to the right numbers.
The gap between what is happening and what is needed is, in large part, related to resources. But more money alone is not sufficient. Commitments on the part of governments and donors to make any increase in financing work in the interests poor people are equally essential.
We believe that experience from the health sector offers lessons for other areas of development.
First, we need to set clear and quantifiable goals on which both donors and developing country governments agree. Then, precise estimates must be made for what it will cost to achieve these goals. We need then to be creative in securing investments for these outcomes which add to the current system of bilateral and loan-financed assistance. Performance should be closely measured and countries given clear financial incentives for achieving the agreed goals. We also need to co-ordinate the aid from all donors so that receiving country governments can focus on planning, and can make one comprehensive report to donors - not hundreds of separate ones, as the case often is today.
So far, health is the only area where a detailed costing of needs has been done on a global scale, through the work of the Commission on Macroeconomics and Health. It concluded that tackling the health conditions which cause much of the ill-health in poor populations, including HIV/AIDS, TB and malaria, requires at least $30-40 per capita in the developing countries per year. That compares with total current spending on all aspects of health care of about $13 per person per year in the least developed countries and about $24 dollars per person per year in other low income countries.
This money is needed to cover essential and effective actions for health including medicines and vaccines, and delivery systems that focus on reaching those in need. The Commission estimates that developing countries, on average, should devote an additional 1% of GNP to health over the next five years. But, even with such an increase a gap will remain. To bridge this gap will require a substantial increase in external assistance.
We can make this case for more money because we know how to spend it well. One element of success is to go beyond the government, to include the private sector and civil society. Countries as diverse as Vietnam, Thailand and Uganda have shown us what can be achieved when the public sector, the private sector and civil society work together through well-managed multistakeholder health systems.
In health, we now have concrete goals. Some of these are reflected in the MDGs and Targets. Some diseases, such as polio, leprosy and guinea worm we want to get rid of altogether. Others, like measles, malaria and TB, we want to cut down by half. With HIV/AIDS and tobacco use, we want to see the spread contained. For all these goals and targets we have fixed time limits.
At the same time we want to see governments and donors joining forces to develop the health systems needed to sustain the action required to achieve better health outcomes, especially for the poor.
At the global level, international systems that support scaling up of national health efforts are emerging. Great strides are being made in increasing the availability of global public goods through publicprivate associations such as the Medicines for Malaria Venture, the Global TB Drug Development Facility, the International AIDS Vaccine Initiative and the Tropical Disease Research Programme, to name a few.
Global surveillance systems have been developed - to monitor disease trends and to measure health systems performance. At the WTO negotiations in Doha, last year, we saw the beginning of international trade agreements that allow countries to pursue priority public health objectives. Public-private alliances and venture capital funds provide incentives to promote the development of new drugs, vaccines and diagnostics; and more research aimed at tackling diseases concentrated in developing countries.
Global funding mechanisms, like the Global Fund to Fight AIDS, TB and Malaria and the Global Alliance for Vaccines and Immunization ensure resources to buy medicines and vaccines that the poor countries would otherwise not able to afford, no matter how low a price.
Efforts are also being made to agree on priorities and co-ordinate the assistance among donors. The creation of the Global Fund has not only resulted in increased resources for health, but it has focused the debate about priorities, both among donors and recipients of assistance.
We cannot continue to suspend belief about what is possible with current levels of spending. We have to be realistic real about the costs cf what we are trying to achieve. In the follow-up to the report of the Macroeconomic Commission, WHO will help to bring together development partners with national health and economic authorities to plan investments for the future.
Second: we have to innovate. The system of development finance that we see in health is still characterised by fragmentation, high transaction costs and islands of excellence. Systemic change needs systemic approaches.
Third: we have to show concrete results from our collective endeavours, and let others know that they are being achieved. WHO is committed to supporting those countries that succeed in mobilising more resources from the Global Fund and other sources: establishing the necessary base-lines, ensuring the application of best practice, and monitoring progress. This is the key to building the confidence of national and international investors.
In summary, the building blocks for more effective and sustained action on health are now in place. We are seeing positive impacts on health outcomes already.
If it can be done in health, there are no reasons why other parts of the development agenda cannot achieve the same results.
Statements at the Conference