African nations can reach the health-related Millennium Development Goals
Dr Margaret Chan
Director-General of the World Health Organization
Excellencies, honourable ministers, distinguished delegates, representatives of the African Union, Dr Sambo, ladies and gentlemen,
We are meeting at a time of reckoning.
The Millennium Declaration and its Goals represent the most ambitious attack on human misery in history. This is our best chance ever to tackle poverty and its multiple interactions with health. We are in the homestretch now, with only five years to go before 2015.
As stated in your documents, progress in Africa towards the health-related goals has been perceptible, but slow. In many countries, progress has been discouragingly slow. Yet other African countries report remarkable gains.
What does this mean for national and international commitments to improve the health of the African people? Can we afford to fail?
The impact of the economic downturn on health is on your agenda, as is the future of financing for WHO, and the proposed programme budget for 2012–2013. As the economists tell us, the consequences of the 2008 financial crisis have been so dramatic, and so widespread, because they occurred at a time of radically increased interdependence among nations.
The consequences have also been profoundly unfair. Even countries that managed their economies well and did not take excessive financial risks have been harmed.
According to a recent report by the World Economic Forum, African economies have generally weathered the crisis well, and continue to show immense potential for growth. This is not the case in many other parts of the world.
Money is tight, and public health is feeling the pinch. It is being felt at levels ranging from national health budgets, to commitments of official development assistance, to funds available to support the work of the Global Fund, the GAVI Alliance, and other global health initiatives.
I can assure you: the austere economic outlook is also affecting WHO. The aspirations set out in the proposed programme budget may need to be adjusted in line with the reality of the global economic situation.
The climate is changing, and this bill, too, is falling due. This will be a big bill. We are paying dearly for policies that favoured the growth of economic wealth over the protection of ecological health.
Sceptics who doubt the reality of climate change would do well to look closely at recent events in China, Niger, Pakistan, and Russia. The downpours, mudslides, floods, heat waves, drought, wildfires, and ruined crops match closely the predictions of climate scientists. These scientists have repeatedly warned the world to expect an increase in the frequency and intensity of extreme weather events, and this is what we are seeing.
More and more, these events are being described as the worst on record, or the worst in a century, or the worst in the entire history of a country. Records are being broken a record number of times. Here in Africa, the Niger River is said to be at its highest level in more than 80 years.
Whether anyone can prove, beyond doubt, that these events are linked to climate change is not the main issue. These events are a warning. They give a vivid and measurable signal of what is looming on the horizon, and what this really means, also for human health.
The stress is felt internationally. The United Nations has struggled to secure emergency funds on a scale that matches the magnitude of suffering and loss in Pakistan. Grain prices on the international markets already reflect the huge crop losses in that country and in Russia. We have to anticipate another global crisis of soaring food prices that hit poor households the hardest.
Ladies and gentlemen,
This is a time of reckoning, and this is a fragile time.
Risks that have been present throughout human history have become much larger, and more universally disruptive, in a highly interdependent and interconnected world.
More and more, health is the unwitting victim of policies made in the international systems that tie countries, economies, and trade together. This is the new source of setbacks in the 21st century.
Events, such as the fuel and food crises, and the financial crisis, reshaped the first decade of a century that began with so much promise, also for public health. The Millennium Development Goals boosted international health development. The first decade of this century saw the creation of numerous global health initiatives, new funding mechanisms, and new financial instruments.
Commitments of official development assistance for health rose more than three-fold. Results seen in the past decade tell us that investment in health development is working.
The number of people in low- and middle-income countries receiving antiretroviral therapy for AIDS moved from under 200,000 in late 2002, to 3 million, then 4 million, and now beyond 5 million, an achievement unthinkable just a decade ago.
The number of under-five deaths dipped below 10 million for the first time in six decades, and then dropped again to below 9 million. The annual number of people newly ill with tuberculosis peaked and then began a slow but steady decline. For the first time in decades, it looks like the steadily deteriorating malaria situation might be turned around.
Global health initiatives, like the Global Fund, like the GAVI Alliance, have done great good over the past decade and are widely praised as models of success. In Africa, for example, 76% of external financial support for malaria control has come from the Global Fund.
These initiatives introduced the principle of results-based funding. And yet despite their own excellent, measurable results, they are now strapped for cash.
Other initiatives speeded the development of new vaccines to prevent pneumonia and diarrhoeal disease, the two biggest killers of young children in the developing world. Yet the implementation of these life-saving vaccines into routine immunization programmes is now in jeopardy because of funding shortfalls.
Tremendous progress towards the elimination of measles, especially here in Africa, is also now in jeopardy because of funding shortfalls. A highly contagious disease like measles can resurge very quickly. Some 28 countries in Africa have suffered measles outbreaks this year. As I said, progress is fragile.
Antiretroviral therapy for AIDS is a life-line, for a lifetime. Can we cut this life-line off because funds are running short, or because donors decide that investment in other priorities will yield a bigger payback? Do we have this moral option?
What will it mean if a financial crisis, seeded by greed, cancels out fragile health gains made possible by so much good will and innovation? Does the worst in human nature win over the best? These are big-picture issues, and they need to be raised.
Progress towards polio eradication is also fragile. Last year, this region faced widespread polio epidemics across 20 countries of West Africa, Central Africa, and the Horn of Africa. The situation was so alarming that some people began to talk about abandoning the goal of polio eradication.
The situation looks much better today. With your collaboration, we now have an aggressive new strategic plan to complete polio eradication. Among other things, it address head-on the problem of international spread that has made progress so fragile. It also introduces accountability at the sub-national level.
Today, Nigeria has reduced the incidence of polio by a striking 99%. The Horn of Africa is again polio-free. No virus has been detected in West Africa since the start of May, though it is too early to say the outbreak has been stopped.
We are deeply concerned about the outbreak in Angola, which is the only expanding polio outbreak in the world this year. Polio also persists in neighbouring Democratic Republic of the Congo, where the virus circulated undetected in one area for nearly two years.
This situation must be reversed. Every child must be reached, during campaigns and through strong routine immunization. A resurgence of polio, of deaths, and childhood paralysis is the predictable consequence if we fail to stay the course.
Ladies and gentlemen,
We need to raise some big-picture issues, but we also need to preserve our optimism and keep building the momentum.
I asked earlier: what does it mean that progress towards the MDGs is so uneven in Africa? One thing is clear. It means you cannot generalize about conditions in Africa.
Old perceptions, that Africa is uniformly poor and needy, universally sick and hungry, or badly governed across the board, no longer pertain to modern Africa. Countries at similar levels of socioeconomic development have strikingly different health outcomes, and this already tells us something.
Governance is improving and democracy is gaining ground. A middle class is emerging. Fertility is going down. Your populations are comparatively young, and this is an asset. As the economists argue, Africa is poised to cash in on a “demographic dividend” that can perpetuate a cycle of growth.
Let me state my view very clearly. The health-related MDGs are within the reach of African nations.
Look at malaria. Previous sessions of this regional committee helped move malaria back to the top of the international development agenda. You insisted that malaria was an emergency in Africa and a major impediment to development.
Ministers of health and heads of state set ambitious goals, and backed them up with campaigns, the pooled procurement of commodities, and the elimination of taxes and tariffs on these products. Some 240 million treated mosquito nets were distributed between 2006 and 2009. A further 70 million nets were delivered during the first half of this year.
Recorded malaria cases and deaths have fallen by 50% in high-burden African countries that have achieved high population coverage with nets and treatment programmes.
A recent analysis of malaria control in 35 African countries revealed that more than 560,000 lives were saved between 2000 and 2009. Nearly three-quarters of these lives were saved since 2006. We see the momentum growing and we see the results.
In addition, evidence suggests that large decreases in malaria cases and deaths have been accompanied by step declines in young-child deaths from all causes. For example, we know that when malaria cases are properly diagnosed and treated, other common diseases are also managed better.
Here in Equatorial Guinea, a recent study conducted on Bioko Island showed a 66% decrease in population-based under-five mortality in the fourth year after intensive malaria control activities began.
As I said, African nations can reach the health-related MDGs.
In early December, a new conjugate meningitis vaccine, tailor-made and priced for Africa, will be launched in Burkina Faso in a mass campaign. This vaccine has the power to transform the terrifying, recurring epidemics uniquely seen in the African meningitis belt.
You asked for this vaccine. You wanted it and you stated the price you could afford. As Niger’s minister of health argued at the time, “A vaccine that Africa cannot afford is worse than no vaccine at all.”
A unique WHO-PATH partnership, the Meningitis Vaccine Project, developed the new conjugate vaccine. It is manufactured in India, using technology transferred from the USA. The price per dose is less than 50 cents.
African scientists designed the study protocols and conducted the clinical trials. Canada assisted with regulatory approval. WHO pre-qualified the vaccine in June. The first 1.35 million doses arrived in Burkina Faso on 12 August.
Africa has a first-rate vaccine for an African disease. You also have a powerful model of partnership for the development of new products. This, too, is a success.
During last month’s International AIDS Conference, the most exciting good news came from researchers in South Africa. They presented evidence that a microbiocide gel, for use by women, reduced HIV transmission by 40%, rising to 54% with good adherence.
Though further research is needed, this is the first promise of a tool that helps women reduce their vulnerability to infection. It gives them a chance to move out of the role of being passive victims.
No wonder, then, that the findings were greeted with loud cheers and a standing ovation. The quest for better prevention tools owes a big debt to the nearly 900 South African women who volunteered to participate in the trial.
Africa continues to make headway against the neglected tropical diseases. As one example, nearly 65 million Africans have been treated in mass drug administration campaigns for the elimination of lymphatic filariasis. As another, more than 14 million Africans received treatment for schistosomiasis last year alone.
Imagine the scale of these achievements. I can assure you: this success will be rewarded with even more ambitious strategies and support. Every disease burden that Africa can bring down now frees capacity to tackle other priorities, or cope with the next global crisis that will surely come our way.
A similar swell of support is building for maternal and neonatal health. Never underestimate the power of targeted commitment, including that expressed by the international community and the African Union. And never underestimate the power of support from a growing number of African First Ladies.
Ladies and gentlemen,
Let me repeat some remarks made last month by the President of Tanzania, who heads the African Leaders Malaria Alliance. He described the audacious goals set for malaria control as a “moral imperative” and noted that African countries and their partners can either “capitalize on the successes of the past few years or slide backwards.” His conclusion is important: “African heads of state must continue to take the lead.”
This is my first advice to you. Know your success stories. Study them. Learn from them. And then sell them to your heads of state as well as to your development partners.
When you showcase your success, partners have an easier time securing funds. When you show leadership at the highest level, partners gain confidence in your commitment.
Strengthen your national health strategies and plans, and stick to your guns. Insist on effective aid. Set the priorities, own the agenda, and insist that aid is channelled in ways that strengthen national capacities. This is the surest route to self-reliance, the surest way to end dependence on aid.
The documents prepared for this session share one telling and uplifting feature. This is a firm and consistent emphasis on primary health care, as articulated in the Ouagadougou Declaration. This commitment to primary health care runs through your strategies and reports like a solid line, a stable reference point.
I agree. This is the best foundation for building Africa’s health systems and services. It is the best route to better health for Africa. You need to convince your development partners as well.
As you work to strengthen health systems, look for ways to eliminate waste and inefficiency. Cutting inefficiency and saving money is a far better option than cutting health budgets.
The World Health Report for 2010 can help you in this task. The report, on heath systems financing, offers a menu of options for raising sufficient resources and removing financial barriers to access, especially for the poor. The emphasis is firmly placed on moving towards universal coverage. Direct payments, including user fees, are identified as the greatest obstacle to progress.
In a key achievement, the report estimates that from 20% to 40% of all health spending is currently wasted through inefficiency. It points to ten specific areas where better policies and practices could increase the impact of expenditures, sometimes dramatically.
I have a final piece of advice. Pursue the strategy, on your agenda, for addressing the social determinants of health. This is important everywhere, but most especially so in Africa.
Africa has to catch up with the rest of the world. We all know this. In doing so, you have a unique opportunity to shape the infrastructures and policies that define the very fabric of development. As stated in your strategy, this is an opportunity to make health and health equity “the corporate business of the entire government, supported by the head of state.”
As you will be discussing, Africa needs to catch up with advances in information and communication technologies. Doing so has the potential to revolutionize health care. But Africa also needs infrastructure. You cannot deliver medicines in an email attachment.
Africa needs infrastructure for water and sanitation, electricity, and irrigation. You need roads, not only to transport goods to market. You need roads to extend health care to rural areas, to transport people in need of emergency care, and to deliver medicines and vaccines.
Urban growth in this region is now the fastest in the world. Africa needs urban planning, not only to boost the economic productivity of cities, but also to alleviate the health risks in sprawling urban slums. The two go together.
As cities grow, municipal authorities often find it cheaper to import processed foods from abroad than to gather fresh produce from the hinterlands. This undermines domestic agriculture, further contributing to migration from rural to urban areas. Processed foods, rich in fat, sugar, and salt, and low in essential nutrients, contribute to the rise of chronic diseases and starve young children of essential nutrients.
This region is losing a traditional asset: healthy diets. Africa needs to revitalize agriculture, not just for economic reasons, but also to ensure that your people eat the right kind of food. This, too, is preventive medicine. And this, too, is the corporate business of government.
Ladies and gentlemen,
As we all know, Africa is responsible for its own future and must shape its own destiny. The biggest share of spending on health continues to come from domestic sources, and this is commendable. Even so, external financial support and technical capacity building will be essential for some years to come. Again, we know this.
As I said, money is tight and I can do very little to improve the economic situation. But I can promote your successes as well as your needs. On this basis, I can advocate for more investment, on your terms, in the interest of self-reliance and the dignity, as well as the health, of your citizens.
This I can do.