High level Forum
Dr Douste-Blazy, Honourable Ministers, Ms Veneman, Dr Wolfowitz, Ladies and gentlemen,
Good morning. Today, I want to raise some questions.
In a year when there have been more meetings on poverty and development than anyone can probably remember, what is it precisely that we are trying to decide here?
There is one basic issue: what must be done - and by whom - if developing countries are to have a greater chance of achieving the health MDGs - or for that matter any other health related goal.
We have agreement on the goals themselves, and we now have commitments from the G8 and other donor nations to increase levels of aid - particularly in Africa - isn't this enough?
We can argue about the exact amounts needed, but there are other immediate questions. The donors here will talk about having good policies, plans and systems in place. Ministers of Finance will ask how they can be sure that aid will actually arrive, when their past experience tells them that aid is very unreliable. Ministers of Health will be concerned about how they can compete with other sectors for a fair share of the pot. There may be no simple solution. But we have a responsibility to find practical ways of rebuilding trust and confidence.
What is so special about health in all this? Several things. It is obviously vital to people's livelihood. That goes without saying. For our meeting here there are two points. Health is a complex sector to fund. There is a growing number of actors. If they all do act independently, it is extraordinarily hard for governments to manage scarce resources and build national systems (for procuring drugs, channelling money or measuring outcomes) that everyone can use with confidence. Secondly, health requires long-term recurrent financial commitments: AIDS treatment is for life. You can't hire more nurses unless you are sure that the money won't dry up. Making sure finance is predictable and sustainable are critical issues for us.
AIDS, TB and malaria have received a huge amount of attention, and a growing amount of financial support. What stands in the way now of getting results?
We are getting results already. The point is that we could do better. This is true not just for AIDS, TB and malaria, but also for child and maternal health - particularly if we had all the right systems in place. Key among the limiting factors is a shortage of trained staff in the right places. The response to the human resource crisis will be led by individual countries, but international action is needed: to generate the cash that is needed, to share experience and to tackle issues like migration.
We have special global initiatives to focus on immunization, polio eradication and AIDS, TB and malaria; do we need something similar to tackle the health MDGs? Probably not. The existing global initiatives like the Global Fund and GAVI have focused minds, and focused resources on problems that really matter. But setting up new initiatives every time we have a problem cannot be the only response. There are many organizations that work on health. What we need is for them to work together effectively, playing to their strengths, rather than setting up ever more new structures and coordinating mechanisms.
If we are to make progress, why not focus on a few countries first?
There are some countries - many of them represented here - who could utilize more funds rapidly and effectively. Let us act on this. But the problems we are talking about here are not limited to those countries alone. There are millions of poor people in countries that do not have good policies or benevolent administrations. We have to deal with this. I do not like the term "fragile states", but we all know that there are environments where it is hard for poor people to get the services they need - whatever the reason. There are no easy solutions here either: but a demand that we think creatively about how to pursue development objectives in all parts of the world - not just the easy bits.
So this is our agenda:
- increasing resources for health, and making sure that they are spent effectively
- getting systems in place to set priorities and measure outcomes
- building systems staffed with enough trained staff to get the work done
- broadening our focus to all poor countries, not just the chosen few; and
- making sure that the special initiatives we have created add value to the health sector as a whole
The HLF has already moved this agenda a long way. I hope we can find ways of continuing the collaboration and sharing of knowledge in the future. Most important though, we have to find ways of pulling all this together and helping to make a greater impact in the places where it counts most. On the ground and in people's lives.