TRUST FUND TO FIGHT DISEASE, IMPORTANCE OF HEALTH TO DEVELOPMENT AMONG ISSUES AT THEMATIC SESSION OF BRUSSELS CONFERENCE

Third UN Conference on LDCs
16 May 2001 - AM




BRUSSELS, 16 May -- As the Third United Nations Conference on Least Developed Countries continued this morning in Brussels, speakers at an interactive thematic session on the role of health in enhancing productive capacities said that the proposed international fund for HIV/AIDS and other communicable diseases would be a useful tool for least developed countries (LDCs), but they stressed it must be flexible and receive appropriate financing.

While great interest was expressed in the fund throughout the discussion -- some characterized it as “a breakthrough initiative” -- it was pointed out that it should receive support from governments and that it should have a flexible structure to meet the various requirements of different countries. Furthermore, if financing above and beyond the existing levels was not ensured, the international community would “be playing a shell game” with resources.

In a keynote address to the session, K.Y. Amoako, Executive Secretary, United Nations Economic Commission for Africa and member of the World Health Organization (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. “To meet our goals, we need more money and better systems.” 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.

In opening remarks, A. Asamoabaah, WHO Executive Director, said tackling health problems should be part of the economic equation, which could help developing countries to achieve sustainable economic progress. Access to resources, health infrastructure and technologies were required, and a greater commitment of the international community was needed to achieve that.

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.

Mr. BANDA said that developed and developing countries could, indeed, work together on problems of global importance, and today’s session was proof of that. There was a need to strengthen LDCs’ health systems and to provide additional financial resources for a comprehensive implementation of health services. In the global partnership, it was the responsibility of national governments to ensure that effective policies were put in place and that sound control measures were there to monitor the use of funds. The role of the international community was to provide assistance to national governments in their efforts. The time for rhetoric was gone -- it was now time for action.



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