GENERAL ASSEMBLY OPENS TWO-DAY DEBATE AIMED AT SPURRING PROGRESS TOWARDS ACHIEVING GLOBAL DEVELOPMENT GOALS BY 2015
GENERAL ASSEMBLY OPENS TWO-DAY DEBATE AIMED AT SPURRING PROGRESS TOWARDS ACHIEVING GLOBAL DEVELOPMENT GOALS BY 2015
|Department of Public Information • News and Media Division • New York|
Sixty-second General Assembly
Thematic Debate on Millennium Development Goals
AM & PM Meetings
GENERAL ASSEMBLY OPENS TWO-DAY DEBATE AIMED AT SPURRING PROGRESS
TOWARDS ACHIEVING GLOBAL Development GOALS BY 2015
Secretary-General Says Gains Made, but Many Countries ‘Off Track’;
Panel Discussions Address Goals on Poverty and Hunger, Education, Health
While noting mixed progress in achieving the ambitious Millennium Development Goals, United Nations Secretary-General Ban Ki-moon this morning said they would not be reached by the 2015 target date without a major scaling up of financing and technical support, particularly for agriculture and environmental conservation, and greater efforts to achieve gender equality and promote women’s rights.
“Clearly we have made a real difference. Yet we are falling short of what I know we can do. Just past the halfway point of the race to achieve the MDGs, many countries remain off track,” he said, during an address toa high-level thematic debate at Headquarters on “recognizing the achievements, addressing the challenges and getting back on track to achieve the Millennium Development Goals by 2015”.
Compared to 2000, 3 million more children now survived annually, 2 million more people received treatment for AIDS, and millions more children were in school, he continued. Measles-related deaths across Africa had dropped by 75 per cent thanks to initiatives supported by the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO), and many least developed countries were fast reducing extreme poverty thanks to strong Government leadership and public investment, private investment and productivity growth coupled with external financing and technical support.
However, he added, the recent rise in food prices threatened to undo the gains already achieved in fighting hunger and malnutrition and a slowing world economy exacerbated developing countries’ immediate challenges to mitigating climate change. “That is why I have already called for 2008 to be a year devoted to addressing the needs of the poorest of the poor, and I have made the MDGs a central priority of my term as Secretary-General,” he said.
Echoing those sentiments, General Assembly President Srgjan Kerim, said the international community faced “a race against time” and that 2008 provided a critical “window of opportunity” to expedite progress by translating commitments into concrete deliverables on the ground. One third of sub-Saharan Africa’s population was malnourished and, if current trends continued, one in six people globally -- almost 1 billion -- would still live on less than $1 a day in 2015. Without action, the goal to ensure primary education for all children would at best be met by 2100, but not by 2050. “We must not be remembered as the generation that betrayed rather than honoured our commitments; irrevocably undermining trust in the multilateral system,” he said.
Many Government, business and civil society leaders were heeding that warning and were rallying behind the Secretary-General’s call to action and the Special Millennium Development Goals event on 25 September, he said. The International Finance Facility for Immunization -- backed by the Gates Foundation, six European Governments, Brazil and South Africa -- was frontloading $4 billion to vaccinate 500 million children and save at least 5 million more lives by 2015. The $81-billion-plus debt of more than 20 countries had been fully cancelled, helping to provide free health care and build new classrooms and hospitals. He urged all countries to translate their international commitments into practical plans and donors to issue country-by-country timelines for increasing aid, so partner Governments could plan for essential investments in services.
Matti Vanhanen, Finland’s Prime Minister, agreed, saying the global community faced a “development emergency” that required immediate action. Despite gains in East Asia, more efforts were needed in South Asia and sub-Saharan Africa. Vast inequalities in income, asset distribution, employment opportunities, access to information and political participation still existed in many regions. National ownership, foreign aid and strong partnerships to support national efforts were essential for achieving sustainable development. With the help of trade, economic dependence could be broken and a higher level of economic development attained. Despite challenges, Finland was doing its part to eradicate world poverty and hunger, as well as to improve education and health, he said, noting that his country was on track to provide 0.7 per cent of gross domestic product for official development assistance.
Moctar Ouane, Mali’s Minister for Foreign Affairs, delivering a statement on behalf of his President, said developing countries’ debt loads and their fundamental lack of resources must be redressed immediately. Developing countries could make significant gains in achieving the millennium targets if they had the necessary resources available. It was also important to support developing countries’ private sectors, erase political trade inequalities and speed up implementation of development commitments made at previous international conferences. Mali had developed a 2007 to 2011 national strategy aimed at combating poverty and improving the overall quality of life of its citizens. The country had made some progress in that regard, he said, calling on the international community to join Mali in further efforts.
The day’s session also featured three panel discussions on issues deemed a priority: poverty and hunger; education; and health. The morning panel, on poverty and hunger, was moderated by Kandeh Yumkella, Director-General of United Nations Industrial Development Organization (UNIDO) and included: Paul Collier, Saint Anthony’s College, Oxford University and author of The Bottom Billion: Why the Poorest Countries are Failing and What Can be Done About It; Henrietta H. Fore, Director of United States Foreign Assistance and USAID Administrator; Jayaseelan Naidoo, Chairman of the Development Bank of South Africa and Board Chairman of the Global Alliance for Improved Nutrition; Eckhard Deutscher, Chair of the Organisation for Economic Cooperation and Development (OECD)/Development Assistance Committee; and Steven O. Willoughby, Chief Executive, New Partnership for Africa’s Development (NEPAD).
Opening that panel, Mr. Collier called for more strategic ways to create opportunities in trade and to integrate the world’s poorest people into the manufacturing economy, while taking full advantage of the current commodity boom and post-conflict peace opportunities. At the same time, special invited guest Dr. Jeffery D. Sachs, Director of The Earth Institute at Columbia University, said that agriculture was key in every dimension: it was where the poor lived, it was what people survived on, and it was the way they fought disease. “If you want private sector growth, the agricultural sector was the leading driver of growth,” he said. In closing, he stressed that “the money is there” and there is “no limit to what we can do”.
The afternoon panel on education was moderated by Iftekhar Ahmed Chowdhury, the Foreign Adviser of Bangladesh, and included Nicholas Burnett, Director-General for Education for the United Nations Educational, Scientific and Cultural Organization (UNESCO); Geraldine Bitamazire, Uganda’s Minister for Education; Desmond Bermingham, of the Fast Track Initiative Secretariat; Ann Cotton, Founder and Executive Director of the Campaign for Female Education; and Yuto Kitamura, of Nagoya University, Japan.
Upon opening the discussion, Mr. Chowdhury reminded Member States that education empowered people to participate in their own development and positive gains in education could, therefore, play a catalytic role in achieving other Millennium Goals. Panellists also discussed in depth the challenges to maintaining a high quality of education, as well as gender inequalities in access to education. Other participants expressed their ongoing support for mobilizing domestic and international funds for long-term institutional development to ensure lasting, quality education for all children.
The panel on health, moderated by Dr. Anarfi Asamoa-Baah, Deputy Director-General of the World Health Organization, included Thoraya Obaid, Executive Director of United Nations Population Fund (UNFPA); Dr. Innocent Nyaruhirira, Executive Chairman, King Faisal Hospital, and Former Health Minister of Rwanda; Dr. Jim Yong Kim of the Harvard Medical School and Co-Founder of Partners in Health; Dr. Julian Lob-Levyt, Executive Secretary, GAVI Alliance; and Dean Hirsch, President of World Vision International.
Ms. Obaid called for the health of women to be made a development and financing priority, saying that an estimated $6 billion in additional funding was needed each year to reduce maternal and newborn mortality. Dr. Lob-Levyt said that, in order for public-private partnerships to succeed, organizations had to work together, as well as behind and in support of national strategies. Concerning the role of academic institutions, Dr. Kim said that few people had thought about the complexity of health-care systems. Strong basic science and diagnostic tools were necessary, but the great challenge now would be to build on those systems.
Asha-Rose Migiro, United Nations Deputy Secretary-General, closed the session by summarizing the day’s discussions.
The General Assembly met today to hold a high-level thematic debate on “recognizing the achievements, addressing the challenges and getting back on track to achieve the Millennium Development Goals by 2015”.
Opening the session, SRGJAN KERIM, General Assembly President, said achieving the Millennium Development Goals was fundamentally a test of the world’s global partnership for development among Member States, the private sector, civil society and the global public. More commitment and dedication were needed to meet most of the millennium targets by 2015. The stakes were high. Achieving the Millennium Development Goals on time would result in lifting 500 million people out of poverty, properly nourishing 300 million and saving the lives of 30 million children. However, it was clear that the current pace to do that was too slow and that if it continued none of the Goals would be met in Sub-Saharan Africa.
“We are facing a crisis -- a development emergency. As the Secretary-General has remarked, ‘millions of lives quite literally hang in the balance,’” he said. “We must not be remembered as the generation that betrayed rather than honoured our commitments; irrevocably undermining trust in the multilateral system.” This year provided a critical “window of opportunity” to expedite progress by translating commitments into concrete deliverables on the ground, he said. Many Government, business and civil society leaders were rallying behind the Secretary-General’s call to action and the Special Millennium Development Goals event on 25 September. “2008 is the year for action,” he said.
There had been significant progress in reducing poverty and hunger, he said. The global proportion of people living in extreme poverty fell from about one third in 1990 to less than one fifth in 2004. The proportion of hungry people was expected to drop from 20 per cent in 1990 to 10 per cent in 2015. Overall, the world was on track to achieve Goal number one. But there was a huge challenge in Africa, where absolute poverty rose over the past decade. In Sub-Saharan Africa, one third of the population was malnourished. If current trends continued, 360 million people would still live in poverty by 2015. One in six people globally -- almost 1 billion -- would still live on less than $1 a day in 2015. Their situation could deteriorate further if energy and food prices continued to rise, increasing food insecurity and hunger for the most vulnerable.
Major progress had been made on Goal number four, which called for reducing infant mortality by two thirds, he continued. At the halfway point to achieving the Millennium Development Goals, 3 million more children now survived each year. But 10 million children under age 5 still died annually, half of them in Sub-Saharan Africa. Every year, more than 500,000 women died needlessly from complications during pregnancy or childbirth. That meant that the goal of reducing maternal mortality by three quarters would not be met by 2015 unless the world acted decisively. Malaria killed 1 million people, tuberculosis 2 million and AIDS 3 million. A special high-level Assembly meeting 10 and 11 June would address HIV/AIDS.
Progress had been made in education since 2000, he said, noting that there were now 41 million more children in school. Net enrolment worldwide had risen to approximately 87 per cent and gender parity had already been achieved in primary schools in 118 countries. However, the quality of education and high student-to-teacher ratios were significant challenges. Without action, the goal to ensure primary education for all children would at best be met by 2100, but not by 2050. “Despite these setbacks, success is not beyond our grasp.” There was reason for hope and inspiration. In the past 20 years, 400 million people had been lifted out of absolute poverty. Smallpox had been eradicated. Since the 2000 Millennium Declaration, 34 more countries were on track to meet the infant mortality goal, 44 more to meet the poverty goal, and 47 more to meet the education goal. In Africa, up to one third of schooling was now provided by churches and faith groups. Businesses and charities were also involved.
Goldman Sachs, working with the non-governmental organization CAMFED and Cambridge University, had just set up a $100 million global initiative to provide business education to underserved women. Their research indicated that closing the gender gap could raise per capita income by 10 per cent to 14 per cent in developing countries, lifting millions out of poverty. The tuberculosis epidemic was declining. Polio, leprosy and neonatal tetanus were on the verge of extinction and 2 million more lives were now saved annually thanks to immunization. The International Finance Facility for Immunization -- backed by the Gates Foundation, six European Governments, Brazil and South Africa -- was frontloading $4 billion to enable 500 million children to be vaccinated and at least 5 million more lives saved by 2015.
The more than $81 billion debt of more than 20 countries had been fully cancelled, helping to provide free health care and build new classrooms and hospitals, he said. However, the final 2006 figures for official development assistance fell in real terms for the first time since 1997 to $104.4 billion, though aid to Africa rose to an all-time high. Not just more aid, but quality aid was needed to impact people’s lives. Each partner country must determine its own priorities, the pace and sequencing of reform. Progress was possible when strong Government leadership and good domestic policies were combined with adequate financial and technical support from the international community, private sector and non-governmental organizations.
The global consensus recognized that, by itself, economic growth was not enough, he said. Inclusive growth must be accompanied by good governance, environmental conservation, social justice, human rights, gender equality and quality public services. At the midway point to achieving the millennium targets by 2015, all international commitments must now be urgently translated into practical plans with systematic follow-through by all countries. Donors must issue country-by-country timelines for increasing aid, so partner Governments could plan for essential investments in services. Attention must also focus on creating a more coherent development agenda, based on the nexus between financing for development, the millennium targets and the challenge of global warming.
“This is the only strategy we can adopt to create a more sustainable, just and equitable future for all,” he said. “But we face a race against time. We must now demonstrate the political will and turn our promises into action.”
BAN KI-MOON, United Nations Secretary-General, said that more than midway to 2015, the Millennium Development Goals’ track record was mixed. Compared to 2000, there had been undeniable progress. Three million more children now survived annually, an additional 2 million more people received treatment for AIDS, and millions more children were in school. Progress had also been made towards individual goals in particular countries and regions.
For example, he continued, primary school enrolment had increased in Ghana, Kenya, the United Republic of Tanzania and Uganda. Senegal was making great strides towards meeting the water and sanitation targets, and many countries were demonstrating how the HIV epidemic could be contained. Impressive progress had been achieved in malaria control thanks to the free distribution of bed nets in the Niger, Togo and Zambia. Another striking achievement was the 75 per cent reduction in deaths across Africa due to measles thanks to initiatives supported by the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO). Since 2000, macroeconomic fundamentals and policy implementation had improved markedly, with growth now averaging more than 5 per cent across Africa alone.
Many countries had proved that rapid and large-scale progress towards the millennium targets was possible, he said. That happened when strong Government leadership and good policies supporting private investment and productivity growth, as well as sound strategies for scaling up public investment, were reinforced by adequate international financing and technical support. In that regard, many Asian countries had led the way with the fastest reduction in extreme poverty in human history. “Clearly we have made a real difference. Yet we are falling short of what I know we can do. Just past the halfway point of the race to achieve the MDGs, many countries remain off track,” he said. That was particularly true across large parts of Africa and for many least developed countries. However, even some of South Asia’s fast-growing countries faced serious challenges in improving and achieving certain other goals, and some of Latin America’s middle-income countries had struggled to wipe out pockets of extreme poverty.
The challenge of meeting the millennium targets was being compounded in the short-term by the recent rise in food prices, which threatened to undo the gains achieved so far in fighting hunger and malnutrition, he said. That situation called for a substantial increase in investment and expenditures in agriculture. It also underscored the importance of pushing for an open trading system in agricultural commodities, which would benefit countries worldwide. A slowing world economy also increased the immediate challenges faced by developing countries. In the longer term, development progress was gravely threatened by the effects of climate change and other major environmental challenges. Developing countries, with limited technological and financial resources, were particularly ill-equipped to adapt to changes in the natural environment that could adversely impact socio-economic development. They needed more assistance and resources to support adaptation efforts, so they could secure existing gains and continue to advance.
More must also be done to achieve gender equality and promote women’s rights, he said, calling on the international community to empower women economically, include them in decision-making at all levels, and combat discrimination and violence against them. “The world’s mixed record on the MDGs and emerging complications like climate change or a global economic slowdown underscore the urgent need for a strong and sustained push towards the Millennium Development Goals. That is why I have already called for 2008 to be a year devoted to addressing the needs of the poorest of the poor, and I have made the MDGs a central priority of my term as Secretary-General,” he said.
The Secretary-General said that last September he convened the Millennium Development Goals Africa Steering Group to mobilize international financial and development organizations to support achieving the Goals in Africa, which faced some of the toughest challenges to getting on track. The Steering Committee had already identified a first set of initiatives to step up implementation, including launching an African Green Revolution to expedite economic growth and combat hunger, steps to implement comprehensive school feeding programmes using locally produced food and ensuring coverage of micronutrients, and recommendations to make critical infrastructure investments that could help raise productivity and integrate Africa into the global economy. Similar recommendations for concrete action could be prepared for other developing regions.
The General Assembly and the Economic and Social Council (ECOSOC) had significantly oriented their work to achieving the millennium targets, he said. ECOSOC, through its Annual Ministerial Review, was intensifying its focus on Millennium Development Goals implementation, making poverty and hunger concerns the centrepiece of last year’s Review. This year’s focus would be sustainable development and next year’s would be public health. ECOSOC’s approach was broad-based and inclusive. Progress could only be achieved if all actors were energized. United Nations agencies, funds and programmes were also scaling up their support for programmes to reach the millennium targets. The United Nations was expanding internal coordination and streamlining procedures to create more synergies, and was bringing energy, resources and expertise to help countries achieve the goals.
In every country where a United Nations country team operated, the Organization was systematically working with Governments to align the United Nations Development Assistance Frameworks with the Goals, he said. In many countries, the United Nations was playing a central role in supporting the design and implementation of national Millennium Development Goals strategies. “The year 2008 should mark a turning point in progress towards the MDGs,” he said, adding that: “We will take steps to improve the impact of globalization on the poorest people and communities at UNCTAD-XII later this month.” In July, the Development Cooperation Forum would discuss ways to increase the effectiveness of such cooperation to support Millennium Development Goals achievement. And a high-level meeting on Africa’s development needs would be held 22 September.
The Secretary-General said that, building on those events and together with the General Assembly President, he would convene 25 September in New York a special high-level event on the Millennium Development Goals that would bring together world leaders, private-sector representatives and civil society partners to discuss specific ways to energize collaboration. “I expect the meeting will also send a strong message that Governments are ready to rise to the financing for development challenge,” he said.
MATTI VANHANEN, Prime Minister of Finland, said the global community faced a “development emergency” and immediate action was needed in response. According to available data, the eradication of extreme poverty and hunger by 2015 was possible. Globally, there had already been gains in places such as East Asia, but more efforts were needed in Southern Asia and sub-Saharan Africa. In some regions, there were still vast inequalities in income, asset distribution, employment opportunities and access to information and political participation, among others. Gender inequality and social exclusion of some populations made the pattern even more complex and many children still lacked access to health services and education.
Climate change was also a major challenge and 2008 would be a crucial year in terms of building consensus for a global response, he said. The Bali outcome was a breakthrough, but the real challenge lay ahead -- Member States had less than two years to come to an international agreement. All countries had to contribute to the effort, but they needed to help each other and act with urgency. It was clear that, in the long run, climate change could severely undermine efforts to reduce extreme poverty. The world community must ensure that climate change did not throw human development into reverse. The poor, of which 70 per cent were women, were disproportionately affected by negative environmental changes and their full participation was, therefore, essential.
In spite of all the commitments and efforts of the international community, he continued, there were still more than 800 million people suffering from hunger. To improve their quality of life and overall development, it was necessary to examine the links between trade and development. With the help of trade, economic dependence could be broken and a higher level of economic development attained. He added that the challenges of maternal mortality must be urgently addressed. There had been practically no improvement recently, although it was one of the most significant factors causing inequalities between developed and developing countries. Further, the two education-related development goals were of critical importance and Finland’s development policies highlighted the importance of the education of women and girls as the key element of sustainable development.
Sustainable development required national ownership and foreign aid and partnerships should support national efforts, he said. His country was on track to achieve the 0.7 per cent official development assistance target by 2015. Achieving that goal had been a challenging job, but the efforts undertaken reflected the serious commitment and willingness of his Government to help eradicate global poverty and hunger and to improve education and health.
MOCTAR OUANE, Minister for Foreign Affairs of Mali, delivering a statement on behalf of his country’s President, said it was encouraging to see some of the recent achievements made in realizing the Millennium Development Goals, but it was obvious that much more needed to be done to honour the commitments made in the Millennium Declaration. The fundamental lack of resources for developing countries needed to be redressed immediately. As long as resources were available, developing countries were able to make significant gains in achieving the Millennium Goals. It was, therefore, necessary to ensure increased public assistance for those countries moving forward. Developing countries also needed to be better integrated into the global economy through increased support for their private sectors and by putting an end to political trade inequalities.
His country had already adopted a national strategy to combat poverty and to improve the overall quality of life of its citizens for the period 2007 to 2011, he said. Already, some progress had been achieved and he invited the international community to join his country in further efforts in the future. The objectives of the Millennium Development Goals were just as relevant now as before, and the international community needed to redouble its efforts and its resolve to ensure rapid implementation. Accelerated implementation of the commitments made at previous international conferences was also essential. He added that rapid and large-scale progress was possible, as long as good policies and technical and financial support was provided by the international community.
The debt of developing countries also needed to be addressed, he added. Working with developed countries, developing countries needed to find better employment for its younger populations and provide adequate health care and medications to all citizens. National efforts alone would not be enough to achieve the Millennium Goals and, as such, his Government would continue to push for a global partnership for development, as described in the Millennium Declaration. At the national level, his Government would host a round-table discussion in 2008 to further detail the policies and strategies needed to ensure rapid progress was made to achieving the Goals.
Panel Discussion on Poverty and Hunger
The panel discussion was moderated by Kandeh Yumkella, Director-General of the United Nations Industrial Development Organization and included: Paul Collier, Saint Anthony’s College, Oxford University; Henrietta H. Fore, Director of the United States Foreign Assistance and USAID Administrator; Jayaseelan Naidoo, Chairman of the Development Bank of South Africa and Board Chairman of the Global Alliance for Improved Nutrition; Eckhard Deutscher, Chair of the Organisation for Economic Cooperation and Development (OECD), Development Assistance Committee; and Steven O. Willoughby, Chief Executive, New Partnership for Africa’s Development.
Introducing the panel, Mr. YUMKELLA, the Director-General of the United Nations Industrial Development Organization, said it was necessary for the international community to address the causes of famine and hunger and not just the symptoms. Giving people incomes matters. Jobs matter. Development was freedom, he said, because it gave people options, possibility and hope.
Mr. COLLIER, St. Anthony’s College, Oxford University, and author of The Bottom Billion: Why the Poorest Countries are Failing and What Can be Done about It, said the international community needed to harness historic opportunities that, in the past, had been missed. Those historic opportunities involved commodity booms and post-conflict peace. Currently, there was great interest in the resources and commodities of developing countries. It was essential for the international community to create and maintain standards that would guarantee the proper management of commodity booms and resources. For example, Governments should ensure the proper capture and management of resource revenues through appropriate taxation and tax distribution on resource extraction.
The second historic opportunity, the spread of peace in regions previously in conflict, was equally important, he added. Rebuilding societies was a long and complex endeavour that needed more than simple “fire-fighting” techniques. The international community had a responsibility to ensure effective peacekeeping and substantial aid over the long-term, while post-conflict Governments, themselves, needed to fully commit to lasting peace. Along with harnessing those historic opportunities, the full integration of the “bottom billion” into the global manufacturing economy was also essential for eradicating poverty and hunger. Due to the difficulties of entering into the manufacturing world, international action was needed to “pump prime” the bottom billion to allow them special access on a temporary basis to break into manufacturing industries. Overall, he concluded, the international community needed to be more strategic in creating opportunities in trade, while taking full advantage of the commodity boom and post-conflict peace opportunities currently on hand.
HENRIETTA H. FORE, Director, of United States Foreign Assistance, and USAID Administrator, said that the United States believed that only through broad-based economic growth would countries be able to reduce and eventually eliminate extreme poverty. Growth was the only way to address challenges that forced so many countries to depend on foreign aid. The path to achieving the Millennium Development Goals must be based on: strong country leadership and ownership of the development process; creating an enabling environment for partnerships to fuel economic development; investing in people, especially education and health, to help them find, and keep, better jobs; and support for fragile, post-conflict States.
Citing some of the United States efforts to boost capacity and growth in Africa, she said that the Government’s Agenda for Economic Growth in Africa aimed, among other things, to improve the policy environment for business-led growth, improve the competitiveness of firms, including in the agricultural sector; improve infrastructure that would help expand avenues for doing business; and expand partnerships with African small and medium-sized enterprises across Africa. That programme built on the Africa Finance Initiative, which would, over the next few years, mobilize some $1.5 billion in capital, garnered mostly from local financial institutions. She also said that the United States recognized that improving economic growth and building partnerships would only be successful if women were the beneficiaries of the majority of the efforts of public-private alliances.
She said that the United States was concerned, as was the United Nations, about the situation of fragile or conflict-affected States, for whom the Institute for State Effectiveness had stressed that the goal of achieving internationally-agreed development targets remained “illusory”. To that end, the United States had joined others in supporting integrated missions that aimed to stabilize post-conflict situations and simultaneously address serious long-term development needs. In closing, she asked all States to come together and help move fragile States onto a path of sustained -- and sustainable -- growth. All nations must work together to meet goals for poverty and hunger, focusing on what works: building tomorrow’s success from today’s results.
Mr. NAIDOO, Chairman of the Development Bank of South Africa and Board Chairman of the Global Alliance for Improved Nutrition, said his Bank had instituted a model for development that was both effective and sustainable. For every dollar that was invested in development, his Bank leveraged anywhere from 2 to 5 dollars from either the private sector or other development donors. With such a strategy, it was possible to invest in poor communities, improving the overall quality of life in those areas, while ensuring a positive return on investments and guaranteeing sustainability. He admitted, however, that there had been significant challenges in delivering on investments, due to an overall lack of infrastructure to implement many of the initiatives. By thinking outside the box, the Bank of South Africa had employed financial engineers and technical experts to help create the infrastructure that was necessary for the full implementation of development models. Already, this strategy was showing success in South Africa and other developing countries should be encouraged to follow similar models to achieve success in their own countries, as well.
However, he also stressed the need for national policies to support such models for development. For example, the current energy crisis in South Africa was intensified by the fact that the low cost of electricity in the country prevented investors from receiving an appropriate return on investments. In order to entice investment in the energy sector and in other areas, as well, national Governments needed to ensure that appropriate national policies were in place to support investment. Though the private sector had a critical role to play in helping to eradicate poverty and hunger, Governments still played the primary role. Through national policies and with the committed support of international partners, Governments had the responsibility to seek sustainable solutions that would reduce poverty and hunger over the long term.
The next panellist, Mr. DEUTSCHER, Chair of the Organisation for Economic Cooperation and Development, Development Assistance Committee, said he regretted to say that donors in the region were not on track to increase their official development assistance, as required -- and agreed -- to meet the Millennium Goals, especially in poverty and health. He added that, while overall official development assistance was increasing, that rise was not keeping track with current economic trends and donor agreements made at Monterrey and at the Assembly’s 2005 World Summit. The OECD’s estimates showed that donors would have to build in some $40 billion more into their development assistance estimates to meet those agreements.
He said that international donors were faced with raising that sum at a rate and in a time frame that had never before been seen in history. He was concerned that oft-repeated testaments of political will would not be enough to ensure the requisite scaling up on all sides. A massive effort on the part of donors and development institutions would be needed to ensure success. At the same time, he said that there must be greater transparency and accountability, enhanced infrastructure and improved governance in recipient States. Further, corruption was now openly recognized as undermining many of the partnerships donors and recipients shared, including for the Millennium Goals. The entire international community must work together to help ensure good governance and to curb corruption, at all levels, to get the developing world back on track.
Mr. WILLOUGHBY, Chief Executive of the New Partnership for Africa’s Development (NEPAD), said Africa had experienced great gains in economic growth in recent years and its economy was now more broad-based than ever before. Driving that growth was a strong global demand for African commodities, increased debt relief, and increased engagement by China and India in African economies. However, more than anything else, strong internal strategies developed by African countries were to credit for the recent success. Unfortunately, the increase in economic growth had not yet resulted in the reduction of African poverty and hunger rates. Adequate resources were still not available to developing countries to fully implement national poverty alleviation strategies. In order to right that wrong, current growth rates needed to be maintained by African countries and increased resources needed to be mobilized internationally for the implementation of national strategies to reduce poverty and hunger.
The implementation of appropriate national policies in the agriculture and infrastructure sectors would also allow Africa to boost and sustain growth, while reducing poverty and hunger rates, he continued. Growth in the agricultural sector was directly linked to improvements in food security and poverty alleviation and a variety of African-led conferences and agreements had already laid out agreed-upon goals to help improve the agricultural sector overall. It was now time for national Governments to ensure full implementation of strategies to achieve those goals. Turning to the infrastructure sector, he said current investment levels were well below what was necessary and needed to be reversed immediately, in particular in fragile post-conflict countries on the continent. African countries had the responsibility to implement appropriate national policies to boost private sector investment and mobilize domestic resources, but international support and investment was equally important. Policy coherence could only be measured through clear and concrete development objectives and it was the responsibility of all countries to support those objectives, honour past commitments and ensure that national efforts did not go to waste.
When the floor was opened for discussion, Member States and Government ministers, representatives of United Nations and affiliated development agencies shared their respective national experiences, and their global or regional programme initiatives aimed at reducing poverty and hunger. There was clear agreement that, with the target date for the Millennium Development Goals fast-approaching, efforts needed to be scaled up in those areas, especially to help build and/or rehabilitate infrastructure in Africa, which was critical to putting the continent back on track.
Opening this part of the morning’s activities, special guest Dr. JEFFERY D. SACHS, Director of The Earth Institute at Columbia University, said that, while he appreciated the panellists’ intelligent and considered interventions, the international community had actually been “stuck on the same path for the past six years”. Everybody knew that, while increased commitments had been made for aid, nothing had happened. Further, targets for Africa had been based on the value of the United States dollar in 2002. “Traditional donors are just sleepwalking in most cases,” he said, adding: “They seem to think that 2010 and 2015 will never arrive.” Further, there was a feeling that the whisper in the corridors of power was that the Goals would never be achieved anyway.
But he believed -- or hoped -- that Governments actually understood that the political costs of a world that did not achieve those basic targets “were so horrendous”, that they would work hard to meet them. Still, he had to ask of his own country, where was the United States concrete effort to meet the official development assistance target of 0.7 per cent of gross domestic product (GDP)? The United States economy was $15 trillion. So, while $6 billion a year for Africa was commendable, some $35 billion had been given away in bonuses on Wall Street for the past two or three years. With all that in mind, he stressed that, for the United States, that 0.7 per cent was equal to some $100 billion. “We, all of us, have to get the denominators right,” he said.
He went on to say that commitments had been made, costing had been done, and everyone knew where the investments had to go. “Unless we get serious, we will come back next year, and the year after that and the year after that, with the same good wisdom, but the same failure,” he said. Most importantly, agriculture was key, in every dimension. It was where the poor lived, it was what people survived on, and it was the way they fought disease. “If you want private-sector growth, the agricultural sector was the leading driver of growth,” he said. In closing, he stressed that “the money is there” and there is “no limit to what we can do”. “Let’s follow through on commitments,” he said. “Without concrete action, those promises remained only words for us, but mean the deaths of 10 million children under 5 each year for them.”
AD MELKERT, United Nations Development Programme (UNDP), said the Millennium Development Goals agenda was relevant not just for Africa, but for all countries worldwide. South-South cooperation, international investments and a concentrated mobilization of global resources to achieve the Millennium Development Goals would lead to positive results for all Member States. The United Nations Development Programme stood ready to offer its full support and guidance to help countries achieve the development levels needed to achieve the Millennium Goals and to reduce current poverty and hunger rates.
One speaker from the developing world urged the participants to look beyond official development assistance and explore ways to mobilize -- and put to better use -- resources derived from remittances and foreign direct investment, among others. There was also a need to recognize that it would take more than a doubling or tripling of official development assistance for those “late comers” to the international trade arena. International agencies and foreign investors must do their part to help scale up in-country capacities, while developing countries must do their part to promote good governance.
A speaker from the Latin American and Caribbean region said that he was concerned that the Millennium Development Goals were being cleaved from the wider development agenda. Indeed, access to health, commerce and trade, and education were critical to sustainable development for all. The Millennium Goals should not be used to undercut -- or trump -- efforts to promote wider development, he said.
One minister said that African countries were made to feel embarrassed for putting the Millennium Goals on the table. But, why was that the case when those Goals had been adopted as a key acknowledgment of the global partnership required for Africa to achieve sustainable development? Long-promised commitments must be kept, she said, adding that, if the Millennium Goals failed, it was not because Africa had not done its best to hold up its end of the bargain; it would be because the other side of the partnership had fallen short of its commitments.
Another speaker from Africa stressed the need to increase international attention to improving agriculture and infrastructure, which were crucial to economic growth and development. The international development agenda would remain “stuck in the same gear”, continuing to ignore the fact that agriculture and infrastructure were the path to poverty reduction. He also said that, since the panel seemed to believe that the Millennium Goals were in danger of not being met for all, what sorts of initiatives were being considered for the post-2015 period?
The representative of the Global Call to Action against Poverty raised a number of concerns shared by members of the non-governmental organization community, in particular the non-governmental organization frustration with Governments that made many promises to achieve the Millennium Development Goals, but did not follow through on efforts to implement them. Instead, aid efforts were on the decline and donors were fading out before even reaching the finish line. Other non-governmental organization actors added that it was time to reframe thinking on international aid for poverty alleviation from a global aid model to a global human rights model, since all persons had the right to live free of poverty and hunger.
Responding to some questions concerning aid to Africa, Mr. WILLOUGHBY of NEPAD reiterated his concerns that, though money had been promised by developed countries, delivery of those funds was lagging far behind. Money that had already been delivered was often allocated for specific types of humanitarian assistance or debt relief and was not available for use in other sectors of development. African-led strategies were the key to successful implementation of the Millennium Goal to reduce poverty and hunger. International partners should align themselves with those strategies to provide long-term, predictable and adequate financial and technical resources to achieve internationally agreed-upon goals.
Panel Discussion on Education
The panel discussion on education was moderated by Iftekhar Ahmed Chowdhury, Foreign Adviser, Bangladesh. Speaking on the panel were: Nicholas Burnett, Director-General for Education for United Nations Educational, Scientific and Cultural Organization (UNESCO); Geraldine Bitamazire, the Minister for Education of Uganda; Desmond Bermingham, of the Fast Track Initiative Secretariat; Ann Cotton, the Founder and Executive Director of the Campaign for Female Education (CAMFED); and Yuto Kitamura, of Nagoya University, Japan.
Opening the discussion, Mr. CHOWDHURY, the Foreign Adviser of Bangladesh, said that positive gains in education could play a catalytic role in the achievement of other Millennium Development Goals. Economic growth would be more egalitarian and equitable if access to education was universal and unconditional. Unfortunately, access to education in most developing societies was both limited and unequal.
Poverty detrimentally affected parental decisions to send children to school, he continued. Past experiences had shown that public and affordable education was the only option for the poor to climb out of poverty. Some countries had demonstrated remarkable success in improving access to education through various policies and programmes, such as free schooling and conditional cash transfer programmes. His country, Bangladesh, was close to achieving universal primary education. However, ensuring universal enrolment was not an end in itself, but rather a means to an end. Preventing dropouts, ensuring quality education, and providing adequate education materials and technologies were some of the biggest challenges currently facing the global community and would require a strong boost by the global community in order to be overcome.
Mr. BURNETT, Director-General for Education for the United Nations Educational, Scientific and Cultural Organization, said there had been a steep rise in enrolment in primary schools since the year 2000. Unfortunately, there were still many questions regarding the quality of that education and whether young girls were able to access it as easily as young boys. Among the 25 countries with the highest net enrolment ratios since 2000, 11 schools had abolished school tuitions and more girls were attending primary schools than ever before. However, gender inequalities still prevailed and only 63 per cent of countries had achieved gender parity in primary education. That number dropped to 37 per cent for secondary education.
Turning to the question of quality of education, he said international and national learning assessments pointed to low achievement in reading and mathematics, especially in developing countries. A lack of teachers was part of the reason behind the low achievement rates, as teaching staff had not kept pace with enrolment increases, especially in sub-Saharan Africa and South and West Asia. At the current rate of progress, more than two thirds of countries included in a recent analytical study by UNESCO were at risk of not achieving the goal of universal primary education by 2015. To ensure universal primary education, there would need to be higher domestic spending on education and a substantial increase in international aid levels for education, with an overall goal of providing quality education to every child, especially those living in fragile States.
Mr. BERMINGHAM, Head of the Fast Track Initiative Secretariat, said it was necessary to address the political and strategic challenges facing donor countries to help them create more long-term and predictable aid for basic education in developing countries. Donor countries needed to fully understand the long-term benefits of investing in education and should be encouraged to support “brave decisions” made by leaders of developing countries who invested in education, despite the fact that they would not see immediate gains.
The Fast Track Initiative “Compact” required low-income countries to establish sound national education plans, he said. It also required national Governments to allocate adequate funds in their budgets for education, while donors helped mobilize additional and predictable resources in the future. Typically, in Fast Track Initiative countries, 70 to 80 per cent of education costs were financed domestically. More financial aid for those countries was needed and should be delivered more effectively in the future. Low-income countries should lead the implementation of those funds and coordinate donor support to deliver results. Meanwhile, donors should harmonize procedures and strive to align with national education plans to ensure long-term, predictable financing. Member States should lead the call for more aid for basic education in the poorest countries, especially in Africa, and should ensure increased financing for basic education by 2010 and increased levels of predictable financing through the Fast Track Initiative Catalytic Fund for basic education to 2015.
Ms. BITAMAZIRE, Education Minister, Uganda, said since its independence, her country had gone through several periods of social and political upheaval. At the same time, high-level political vision, commitment and leadership, supported by strong national consensus on ensuring equitable access to quality education had allowed the country to record some successes in the provision of basic services over the past decade, including universal primary education. President Museveni launched the national Universal Primary Education Programme in 1997 and, today, primary school enrolment stood at 7.6 million students, split evenly between boys and girls.
She went on to say that the Government had mobilized parents and local authorities to drive the programme. At the same time, partnerships with the private sector and non-governmental organizations were also being promoted and developed. The Government had also targeted teacher development and support by, among other things, waiving tuition and fees at the Teacher’s College 1n 2003-2004 to attract bright, but often poor candidates to enrol in teacher education programmes. She added that universal primary education was also one of the key pillars of Uganda’s Poverty Reduction Strategy Paper. To that end, policies on basic and primary education had been integrated into national macro-poverty reduction initiatives.
Mr. KITAMURA, Nagoya University, Japan, sharing his experiences trying to ensure access to education in the Asian region, said that the focus should be on access, equity, quality and efficiency. Developing countries faced a host of challenges in addressing those pillars, however, including lagging socio-economic factors, and poor quality teaching and inappropriate teaching methods. Moreover, as those countries where often multicultural and multilingual, there was also a need to ensure a decentralized approach to teaching and learning.
He also stressed that developing countries often struggled to attract good teachers because the salaries were low and, often, the teaching profession was not considered a “high status” occupation. Developing countries also had to find ways to lure teachers, while stretching already tight development budgets. His experience had revealed that, more often than not, good students made good teachers. So, Asian Governments had begun implementing, among others, relevant programmes that targeted young people for future jobs in education. In closing, he said that achievement of the Millennium Goals required not only achieving agreed education targets, but raising the quality of teaching and learning. It also meant creating a sustainable learning environment and the means to continually and effectively improve that environment.
Ms. COTTON, the Founder and Executive Director of the Campaign for Female Education, said every child had the right to an education and that right included the right to access international funds promised and raised for education on an international level. Girls living in the rural areas of developing countries were particularly vulnerable and at risk of being denied access to education. Gender issues should, thus, be at the centre of national education strategies and ministers should implement urgent actions to improve access for girls to education and education services.
CAMFED had successfully implemented education models in a number of developing countries to address those inequalities, she continued. Those models included monitoring instruments that helped track the success of students and provided greater support for them moving forward. As well, in each CAMFED school, a female teacher had been trained as a mentor and was able to effectively intervene when problems related to gender arose. The CAMFED model was locally derived, owned and driven and helped provide the most effective delivery of education assistance to schools. It also helped guarantee access to education by young women and girls. In conclusion, she stressed the need to keep the rights of children at the centre of all education strategies and to do away with the idea of benefactors and beneficiaries. “We don’t want grateful children,” she said. “We want children who know their rights.” It was time, now, to demand the funds to ensure those basic rights for children.
During the interactive discussion, representatives of Member States and non-governmental organization touched on many successes, challenges and constraints to providing access to education. One speaker who praised the panellists’ comments, especially regarding assisting marginalized groups, urged that more attention be paid to child protection and security matters -- concerning the physical protection of children themselves, as well as of school buildings and other premises -- in conflict-ridden and post-conflict societies. Another speaker called for more targeted assistance and interventions aimed at bringing children of indigenous groups into national education schemes, while acknowledging their unique cultures and backgrounds.
A representative of the World Food Programme (WFP) highlighted the importance of school feeding programmes, which not only boosted attendance and retention, especially in highly food-insecure environments, but also increased children’s attention spans. He added that the WFP used locally purchased food in those initiatives. A representative of Save the Children International stressed that some 35 million children and students were being kept out of school daily because of conflict. Those children deserved particular attention because, aside from the obvious physical dangers, they were frequently denied education because national development funds were being set aside for use “at some future time when there finally was peace”. That strategy was proving ruinous, because it often left post-conflict countries awash in youths who were of working age, but were uneducated and unskilled.
A speaker from Nigeria detailed the challenges faced by African countries when speaking to donors about the urgent need for funds for education. A lack of funds in one generation paved the way for a lack of overall improvements in development in the next, as an uneducated population aged and took on more positions of leadership and responsibility. It was impossible to manufacture human resources overnight and international assistance should be more closely aligned with national strategies, to improve overall development and education levels in particular.
Focusing on the issue of emergency education raised by some members of the panel, a representative of the United Nations Children’s Fund stressed the need for special attention to be paid to fragile States and countries in post-conflict transition periods. Substantial and predictable support for those countries was necessary to prevent a return to conflict and chaos and, consequently, a decline in the progress already achieved in those regions.
Responding to questions about ways to reach marginalized groups, Ms. COTTON noted that teachers often saw deployment to rural areas, where most indigenous or marginalized people lived, as punishment, and showed up for work sporadically or not at all. Her organization was working to ensure the provision of training for indigenous teachers and funnelling them back to their communities, raising the profile of those teachers who were leaving jobs in urban areas to go work in rural regions.
Mr. BERMINGHAM noted that the term “capacity-building” tended to create a fog around the issue. In his mind, it meant identifying, training and placing quality teachers and educators that could provide quality education. It was long-term institutional development to ensure lasting, quality education in countries. It meant creating and fully supporting an institutional framework that provided access to quality education.
Mr. BURNETT added that issues of equity and inclusion were not formally included in the Millennium Development Goals and it was, therefore, possible for statistics to show overall improvement, while masking a lack of improvement of specific minority groups. Mr. KITAMURA described a recent study of free primary education in Africa as an example of positive statistics masking negative realities on the ground. Though the introduction of free primary education in Uganda had increased enrolment levels, it masked a decline in the role local community members played in educating younger generations. He stressed, therefore, the need to ensure positive developments on all levels.
Panel Discussion on Health
The panel discussion was moderated by Dr. Anarfi Asamoa-Baah, Deputy Director-General of the World Health Organization. The panellists included Thoraya Obaid, Executive Director of United Nations Population Fund (UNFPA); Dr. Innocent Nyaruhirira, Executive Chairman, King Faisal Hospital, and Former Health Minister of Rwanda; Dr. Jim Yong Kim of the Harvard Medical School and Co-Founder of Partners in Health; Dr. Julian Lob-Levyt, Executive Secretary, GAVI Alliance; and Dean Hirsch, President of World Vision International.
Introducing the panel, Dr. ASAMOA-BAAH, Deputy Director-General of the World Health Organization, said that all the Millennium Development Goals were health related. For instance, a considerable proportion of ill-health was linked to food. At the same time, unless there was an educated population, promoting health was almost impossible. In reality, most diseases were, to a large extent, symptoms of other basic social problems. Thus, those situations could not be cured by simply curing the symptoms. People had to realize that the diseases of the future would be very different from those of today. Such diseases would travel and would not be satisfied with just killing the poor, but would also terrorize the rich. Thus, investing in health was no longer just a matter of charity. Instead, such investment was crucial for global security and peace.
Ms. OBAID, Executive Director of the United Nations Population Fund, said that social investments, particularly in health and education, were the building blocks of human development and economic growth. Yet, for too many women, education and health care remained out of reach and opportunity and development continued to pass them by. Nowhere was this seen more clearly than in the case of women dying during childbirth. Every minute, another woman died and the vast majority of those deaths could be easily prevented. Today, there were 300 million women living with injuries and disabilities caused by complications of pregnancy and childbirth. In many cases, women found out for the first time that they were HIV-positive when they were in a maternal health clinic, pregnant and giving birth, if they were lucky enough to go to a clinic. Often, HIV was transmitted to infants unknowingly. Most HIV infections occurred through sexual transmission, childbirth or breastfeeding. Therefore, investing in sexual and reproductive health, which included services for maternal health, was strategic for curbing the AIDS epidemic and saving women’s lives.
A study in Egypt had found that every dollar invested in family planning saved the Government $31 in spending on education, food, health, housing and water and sewage services, she went on. Studies in Mexico, Viet Nam and Thailand showed similar far-reaching savings. It was estimated that the global economic impact of maternal and newborn deaths amounted to $15 billion per year in lost productivity. It was time to make the health of women a development and financing priority. It was estimated that $6 billion in additional funding was needed each year to reduce maternal and newborn mortality. That was equivalent to one and a half day in global military spending. That amount could save the lives of 1 million women and 8 million newborns each year.
Dr. NYARUHIRIRA, Executive Chairman of King Faisal Hospital and former Health Minister of Rwanda, said Rwanda’s experience with malaria was to say no to it and stop it. Rwanda’s entire population was dying from malaria, although children under the age of 5 and women were most affected. People living in hot areas were very susceptible to the disease. In the highlands, there were peaks of epidemics. Key evidence-based interventions had been developed. Rwanda was treating victims with artemisinin combination therapy (ACT) drugs and was distributing malaria bed nets and providing home-based care for pregnant women in order to prevent mother-to-child transmissions. The Government’s policy was to treat all children under the age of 5 who were suffering from fevers. In 2006, the Government launched programmes to train community health workers and private-sector pharmacists to dispense ACT. Thanks to those efforts, up to 92 per cent of Rwandan children under age 5 were treated through home-based care.
Thanks to a coordinated, national, multi-channel distribution programme, 3 million Rwandans received insecticide-treated bed nets in 2006 and 2007. Rwandan ministers personally visited villages to ensure that children had mosquito nets. A 2005 demographic health survey showed how drastically Rwanda’s situation had improved. Thanks to the advent of ACT and bed nets, malaria’s prevalence in Rwanda fell more than 64 per cent from 2005 to 2007. The Government had also been very vigilant about drugs resistant to ACT and had demonstrated strong leadership in malaria control strategies and programmes nationally and locally. Health-care service coverage had risen from 24 per cent in 2004 to 74 per cent in 2006, he said. Providing health care to all Rwandans, particularly those in remote locations, was essential, he said, stressing that 90 per cent of the population lived in rural areas. He emphasized the importance of the national budget and the need to strengthen the health system through funding, in-country capacity-building and reducing the brain drain that was now occurring not only externally, but also internally from the public sector to the private sector. He also called for scaling up efforts through broad-based partnership.
Mr. HIRSCH, President of World Vision International, said that his organization’s experience in Laos, one of the countries where it worked, showed that a large percentage of the children were stunted as a result of lack of proper balance in food and nutrition. Addressing that challenge required a cultural shift in the attitude towards agriculture. There had been missed opportunities in addressing some of the challenges in many countries. In that regard, civil society could play strategic role. For instance, non-governmental organizations were in locations in the countries and could work with communities and ministries of health to address some of the challenges. The added value of civil society was that it could be part of the community and could add staff in reaching the Millennium Development Goals. World Vision had been able to help more than 120 million children. It also provided disaster assistance, focusing on those children that were sponsored.
Civil society needed to define what they could contribute on an individual basis and what could be contributed by partnering with others, he went on. Health outcomes could not be achieved by having sector silos. Health needed to be integrated with the other sectors, such as water and food. A group like World Vision could engage with foundations, so that clean water would actually reach the children in need. Also, access to clean water should include ensuring the delivery of that water to the users.
Dr. KIM, Harvard Medical School and Co-Founder of Partners in Health, said more than 2 million people were living with HIV in the United States, where new drugs were being developed consistently. But, tuberculosis was almost exclusively a disease of the poor. There had not been a new drug developed to treat tuberculosis in more than 30 years. According to 2006 estimates, there were 9.15 million cases of tuberculosis, including 489,000 cases of multi-drug resistant tuberculosis, as well as 1.65 million deaths due to tuberculosis annually. The Millennium Development Goals called for halving tuberculosis-related deaths by 2015. Africa had experienced an explosion of tuberculosis cases in the 1990s and was not on course to meet the millennium targets. While the tuberculosis mortality rate had fallen worldwide, Africa and Europe were not on track to meet the millennium targets. In large countries, 29 per cent to 40 per cent of the people with tuberculosis also had HIV. That was as high as 90 per cent in some cases. Also, 20 per cent to 45 per cent of the adult population in sub-Saharan African countries had tuberculosis.
He turned to the role of academic institutions in helping the international community respond effectively to drug-resistant tuberculosis, as well as provide vaccine delivery and tackle maternal mortality and malaria. At Harvard Medical School, medical students were taught basic and clinical science, but did not receive a single day of training on health-care system delivery. Rather, the delivery of health care had been thought of as the art of medicine, with few people in the United States thinking about the complexity of health-care systems. Harvard was now working to learn from the excellent examples of health-care delivery in such countries as Thailand and Iran. Strong basic science and diagnostic tools were necessary, but the great challenge now would be to build on those systems. It was also imperative to address maternal mortality, he said, noting that 500,000 women died every year during pregnancy.
Dr. LOB-LEVYT, Executive Secretary, GAVI Alliance, said that the international community was now beginning to achieve results in terms of raising the funds for achieving the Millennium Development Goals. A new set of leaders had emerged around the health issues and were driving the new agenda. There were different types of global health partnerships. Some were focused on advocacy, while others were directed towards new product development or bringing in new finance. Those like GAVI and the Global Fund were focused on bringing in new finance. GAVI had had significant success in Africa, where millions of children died as a result of preventable diseases. Several years ago, the immunization level in sub-Saharan Africa was below 40 per cent. With GAVI’s input, there was now 70 per cent to 80 per cent coverage. That success needed to be celebrated.
Public-private partnerships were performance-related and, because of that razor-sharp focus, they had been successful in raising funds, he said. They were focused on delivering results. GAVI had raised several billion dollars from the capital markets for its work. In order to be effective, such funding needed to be long-term and predictable. The public-private partnerships also had highly accountable financing and had to be very careful how money was spent. The global health partnerships had recognized that vertical programmes were not enough. For long term sustainability, they needed to build integrated platforms. That called for collective work. They had also begun to listen to developing countries. There was the realization that no single factor could work alone anymore. Instead, organizations had to work together and behind and in support of national strategies. More money was needed, but the only way to get more money was to show that organizations could deliver results.
DEBORAH LANDEY, a representative of the Joint United Nations Programme on HIV/AIDS (UNAIDS), said that halting and reversing HIV/AIDS was one of the Millennium Development Goals. The response of the international community to the HIV/AIDS pandemic was beginning to show results, but many challenges remained. UNAIDS looked forward to the vital discussions coming up in June, which would take stock of the situation.
During the ensuing question-and-answer period, participants discussed the gap between research and malaria control, the merits and disadvantages of the brain drain from the public health sector, vertical versus horizontal health-care delivery, whether models and standards existed to coordinate partnerships and how to strike a balance between strengthening health-care systems as a whole, and systems focusing on treating specific diseases. Several delegates shed light on programmes in their respective countries in preventive health care, including infant and maternal care.
A representative of Amnesty International recommended five steps to improve maternal health care and reduce maternal mortality globally, stressing the need for a human-rights based approach that provided full services, including reproductive heath services, regardless of one’s ability to pay. A representative of the MacArthur Foundation noted that zero progress had been made towards achieving millennium target number five, and that postpartum haemorrhages accounted for one third of all maternal mortalities.
In response, Ms. OBAID said maternal and child health care required comprehensive, available and accessible services at the community level. Indeed, a rights-based approach to health was a guiding principle. Dr. LOB-LEVYT agreed, saying the existence of high maternal mortality meant that a comprehensive and effective health-care system was not in place. The key was to provide a full range of basic health services, including immunizations, reproductive health care and tuberculosis treatment all in the same place. It was no longer acceptable to fund health care around a narrow set of outputs. However, many developing countries had limited capacity to provide integrated services.
Dr. KIM said Cuba had built a comprehensive national system capable of delivering health-care services to all and Chile had successfully integrated early childhood development with maternal and standard health care. Dr. NYARUHIRIRA said vertical health-care programmes, such as the one described by Belgium’s representative during the discussion, were good boosters and medical college faculties should indeed be involved in partnerships to improve health-care delivery. Rwanda was advocating for the recruitment of good practitioners in the private sector and for non-governmental organizations to ensure that recruited doctors and nurses provided care throughout the country’s clinics.
Continuing, several speakers talked about actions in their countries to address the health aspect of the Millennium Development Goals. The representative of Norway said his country had launched an initiative that included more efficient collaboration among stakeholders, the strengthening of the health sector and advocacy. Other speakers pointed out that, although results were needed, resources needed to be provided in a flexible way, so that health workers could actually deliver services. Concern was also expressed that, if health continued to be dealt with from a purely economic perspective, it would be very hard to achieve anything, as privatization of health care had led to many unfortunate consequences in many cases. Instead, a flexible approach should tailor health care to meet each country’s unique situation. The need to look at intellectual property issues, including access to generic drugs, was also stressed, along with the issue of brain drain and diversion of trained professionals from developing to developed countries.
Other speakers focused on the need for innovative financing mechanisms; the feminization of HIV/AIDS; finding funding for the development of new medicines; guaranteeing access to care; and ensuring that policies and practices did not do more harm than good. The need for the Millennium Development Goals to be viewed in a holistic way was also stressed.
Responding, Ms. OBAID said that many of the issues concerning the feminization of HIV/AIDS were culturally bound and called for culturally-determined responses. Dr. LOB-LEVYT said privatization should be entirely country-specific in terms of what would best meet the needs of a country, so that access was not denied. Without good competition and multiple providers, the best results would not be achieved. Dr. KIM said there was need to think of human resources in a new way. Mr. HIRSCH added that non-governmental organizations had greater access to children and could do more than they were doing now. The large non-governmental organizations were cognisant of the brain-drain challenge and understood the local necessity for capacity.
ASHA-ROSE MIGIRO, United Nations Deputy Secretary-General, said that today’s lively, enriching discussion drew a wide range of participants from Member States, United Nations entities and civil society. That was a testament to the importance that the international community gave to ensure universal achievement of the millennium targets by 2015. Several key messages emerged from the panels, among them that major progress had been made to achieve the millennium targets, but that the pace was too slow and that decisive action was needed to achieving them on time. Countries in Africa and the least developed countries off track to achieve the Goals must take extra steps to ensure that they caught up with the rest. All the Goals were interdependent and required multisectoral responses. But, progress was constrained by an internationally fragmented and inefficient response.
Improved aid effectiveness, scaled-up aid and increased predictability of aid flows were crucial to ensuring significant country-level impact, she continued. Better aid channels were urgently needed for post-conflict countries and Member States must develop stronger, more mutually supportive partnerships with the private sector and civil society. Climate change could thwart achievement of the Goals. Development must be environmentally responsible and sustainable and women must be empowered and engaged in development.
One panel shed light on how climate change, high food and energy prices and the current global economic downturn were negatively affecting the goals related to poverty and hunger, she said. Panellists called on national Governments and the international community to consider immediate measures, such as setting aside enough land for food crops and ensuring that food was available at affordable prices. The panel on education noted the sharp increase in primary school enrolment in Africa, particularly in sub-Saharan Africa and South and West Asia, but that Goal number three of achieving gender parity in primary and secondary education by 2005 had not been reached. Participants of the panel on health called for increasing investments in human resources, information, procurement and logistics, governance and service delivery in health systems, implementing policies to increase and retain health workers, and measures to increase the predictability of country-level aid, as well as honouring commitments made in order to fill many of health-care sector’s resource gaps.
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