Board meeting of the United Nations Foundation

Geneva, Switzerland
15 June 2004

Mr Turner, Mr Wirth, members of the Board,

Thank you very much for this opportunity to meet with you all. It is a delight to be sharing this lunch with many friends who know the UN so well. It is nearly a year since I took over from Dr Brundtland. I was fortunate indeed in inheriting an Organization that was financially healthy and well respected by all our partners - for this, Dr Brundtland, I am very grateful to you.

Tim asked me to lead this luncheon discussion on the Millennium Development Goals with some comments on how they are shaping our work. Before I do so, I would like to thank you for the support UNF is providing to WHO. I do not need to describe each of the 50 or so projects we are collaborating together on. Suffice to say, your grants have been a significant catalyst for better working amongst UN agencies and other partners. Perhaps the best example comes from our partnership in polio eradication, where we are so close to success.

Just six countries remain endemic. Transmission in four of these - Afghanistan, Egypt, India and Pakistan - is at its lowest rate ever and should stop in Asia and North Africa by end-2004. Sub-Saharan Africa remains the greatest threat to global polio eradication because of the ongoing outbreak in Nigeria. The world is increasingly more vulnerable to importations of polio because fewer countries are holding preventive polio immunization campaigns - down from 100 in 2002 to just 20 last year.

As a result, polio from Nigeria has been imported into nine polio-free countries to date – most recently 3000 miles away in Botswana.

However, the recent signing of an MOU between the federal authorities and Kano State means that catch-up immunization campaigns will restart in this northern state of Nigeria very soon, and we are still on track for polio eradication within the next year - 25 years after we did the same for smallpox.

And now for a few comments on the Millennium Development Goals and how they are shaping our work. I do not want to repeat what you already know, so instead of describing what we do, I would like to ask five questions that continue to challenge us and that I hope will prompt some lively and useful discussion as we enjoy lunch.

First. Do we have the right tools to reach the MDGs? We need new research, of course. But countries are not off-track because their professionals do not know how to treat a child with diarrhoea, to deliver babies safely, or even prolong the life of people with AIDS. The issue is one of equitable access and of going to scale with our existing effective interventions. Success depends on reaching millions of people who currently do not have access to services or information.

Second. Do we have adequate resources? Current health spending in most low income countries is insufficient for achieving the health-related MDGs. But we know that more money is a necessary yet insufficient solution. Successful development also depends on other factors which are often lumped together as good governance - policies, effective institutions, active civil society, etc.

Third. How can we address the health worker crisis facing much of Africa? You may be aware that this was a major topic at the recent meeting of the World Health Assembly. Health workers are dying of AIDS. They are migrating to other countries for better conditions. The result is under-staffed health facilities and over-worked nurses, doctors, pharmacists and laboratory technicians. Some countries would like to see restrictions on migration, others call for compensation and others for increasing the training capacity. Whatever the solution, we need to find one fast.

Fourth. Do we have the correct goals and targets? Critics of the MDGs say they are too narrow. They have a point. They clearly are not comprehensive. For example, there are no indicators for reproductive health, nor for treatment for HIV, nor for the huge and growing burden of noncommunicable disease. We take the view that the MDGs are, therefore, a form of shorthand for the desirable indicators we want to achieve.

Fifth. Will we reach the MDGs by 2015? Late last year, I launched the "3 by 5" initiative, to scale up access to antiretroviral treatment for three million people with HIV living in developing countries, by 2005. Actually this was not a new target for WHO - Dr Brundtland must take the credit for her foresight in announcing this in 2002. Since then, we have developed a strategy and a business plan, and countries are now beginning to scale up access to treatment.

But not fast enough. Resources are still limited. Progress is slow. I believe that "3 by 5" is an early test of the resolve of the international community to reach an important public health target. If there is a lack of willingness to push ahead to reach "3 by 5", then I have to be sceptical about a willingness to achieve the MDGs. It would be tragic if these become yet another failed opportunity.

I think this is where innovative bodies such as the UN Foundation can have a very important beneficial effect. It can do this by adding strength exactly where it is most needed and by acting as a catalyst for change where a new direction is called for.

I look forward to hearing your views.

Thank you.