Let me start by welcoming you all, and extending my personal thanks to our hosts – the Department for International Development – for all the hard work that has gone into preparing for this very important meeting.

It is a meeting that I have been looking forward to since I first discussed it with Clare Short at the beginning of the year. It is a very special occasion when we bring together representatives of Member States from the six WHO regions, and the major providers of voluntary funds to WHO. I welcome you all – both as key stakeholders in world health and, of course, as key stakeholders in the World Health Organization.

As I said to the Executive Board in January, I have been seeking a chance to discuss how health strategies can help in addressing the global development agenda with heads of development agencies. We are indeed fortunate that it has been possible to bring together a group from major donor governments – selected largely on the basis of their contribution to WHO.

This is an informal meeting. But as its title suggests, it provides us with exciting opportunities.

Why, then, are we here?

First and foremost, because we share a commitment – not just to the overall cause of international health and development – but to the achievement of a very specific set of goals. Signing up to the International Development Goals means that we must all accept joint responsibility for their achievement. I believe that the goal of halving the number of people living in absolute poverty by 2015 is attainable. But it will require new ways of working, and changes in the way we use our resources. It will require that we are clear about the most effective strategies for reaching poor people. And – above all – it will require a collaborative effort.

We are in this together.

We therefore need to understand each other's positions on the role of health in development. We need to recognise each other's relative strengths – at a global level and in the field. We need to appreciate the constraints within which we all have to operate. And we need to share experiences.

Too often in the past WHO has tended to see bilateral development agencies simply as donors. From WHO's perspective, then, I see the purpose of this meeting as opening a new dialogue in international health. A dialogue which concentrates on how better health can lead people out of poverty. A dialogue which opens the door to innovative and exciting forms of partnership between national governments, bilateral and multilateral agencies. And a dialogue based on strategic collaboration, a common sense of purpose, and a common set of goals.

Friends and colleagues,

Let me take this opportunity to reflect on some of the issues we will be discussing tomorrow.

I would like to start with the role of health within the international development agenda.

At last year's World Health Assembly, I said that WHO must make the case for putting health at the centre of the development agenda. It is very clear that that better health provides a route which can lead people out of poverty – and that an investment in health is an investment in economic development.

I am struck by how far our understanding of the relationship between health and poverty reduction has progressed. The evidence is mounting all the time.

Tomorrow we will hear that a five-year difference in life expectancy between two otherwise similar countries, may result in per capita income growing up to 0.5% per year faster in the more healthy country. We already have evidence that improvements in health status have an impact on wages and productivity – particularly among the poor. We also know that improvements in health increase learning capacity in poor children. On the opposite side of the coin, we also know about the potentially devastating economic consequences of failing to contain the HIV/AIDS epidemic and to reduce the burden of disease resulting from malaria and TB – particularly in Africa.

The case for health-led development is growing.

But I am equally struck by how much more we need to know. We talk about the poor: but still know too little about who they are, the causes of their poverty, or how best to reach them. Poverty cannot be measured by income levels alone. Neither are the poor a single homogeneous group in any society. Poverty can be defined in different ways and linked to many factors: race, gender, language, and place of residence – to name but a few.

We need much better information about the poor and the factors that influence their health, if we are to act effectively.

It is a fact that few countries have information systems that routinely monitor either the health status or health service use of the poor. Unless we start to make better use of the epidemiological and sociological tools at our disposal, we cannot expect to make a convincing case. We can no longer rely on humanitarian appeals alone. Building the evidence base to underpin policies which benefit the poor is now a priority for WHO.

Given the explicit concern for equity in Health for All, I have been asked whether a growing concern for the health of the poor reflects a shift in emphasis for WHO. The answer is no. But we do no need to take a closer look at how to make a difference, and make more headway.

Ninety percent of the 1.3 billion people trapped in absolute poverty live in South Asia, Sub-Saharan Africa and China. For countries in those regions, policies which succeed in improving poor peoples' health are also likely to result in reducing overall inequities in health status.

As a global organisation, however, we must also take into account the consequences of relative poverty – focusing, for example, on the non-communicable disease burden which has had such a dramatic impact on the life expectancy of disadvantaged populations living in parts of the former Soviet Union and Central Asia.

Let me turn now to the agenda for international health itself.

If we are to make the case that investing in health should be a cornerstone of international development, we must be clear as to where that investment should be directed. In this regard, WHO has a key role to play in setting the world health agenda. Strengthening our capacity to fulfil this role more effectively was one of my first priorities upon taking office. No other international organisation is better placed to provide the kind of evidence that is needed if governments and development agencies are to maximise the impact of their health spending. Through monitoring global trends, WHO is also well placed to anticipate future needs for research and development, and to forecast new and emerging threats to human health.

Tomorrow, Julio Frenk will talk to us in more detail about priorities in relation to the health of the poor. But let me highlight one example to illustrate the importance of focusing on the things that really matter. In poor countries, just five major childhood conditions – diarrhoea, acute respiratory disease, malaria, measles and perinatal conditions – account for up to 40% of all healthy life lost due to premature mortality and disability. All of these conditions can be prevented or cured at very low cost. We know how to do it, and working together I believe we can succeed.

I would like to make three general points about the global health agenda and the role of WHO.

First, we must be clear that WHO is but one of many players on the international scene. We can help provide the evidence that will set the agenda for us all, but we need to be more circumspect about our own contribution to that agenda. We should not try to do everything. Increasingly, I see our role as being catalytic – bringing together partners, forging strategic alliances, and using our technical strengths to influence the work of other agencies. As the lead agency, our success will depend on partnerships with other agencies, civil society, the private sector, and the research community. The final push toward the eradication of polio is a case in point. Polio can be eradicated by the year 2000 – but only if the effort in which we are now engaged receives support from all major development agencies. Roll Back Malaria and the Tobacco Free Initiative are other examples.

Second, generating evidence and monitoring trends in world health is necessary but not sufficient. We must be prepared to use this information on behalf of the poor, and others who lack a voice in the way that the resources for health are distributed. WHO can provide the mirror in which member states see a reflection of their own performance. If this performance is weak – particularly if the poor do not participate in the health gains – we must be prepared to challenge national leaders and hold them to account.

Lastly, the global health agenda cannot be about diseases and risk factors alone. Neither is it just a question of picking the right technical interventions. Let us think for a minute about the other factors that prevent poor people in many developing countries from getting better health care.

Is it not because too many governments find it difficult to shift resources away from expensive services which primarily benefit their more wealthy or influential constituents? We must address the policies, and not just the technical aspects of priority setting.

Is it not because we have made too little progress in ensuring that the poor are protected from financial exploitation or treatment of dubious efficacy when they use the private sector? We must place the development of regulatory capacity high on the health agenda.

Is it not because we have too often failed to ensure that the essential support systems that supply the drugs, maintain the equipment, and manage human resource development are in place?

We could extend the list. But the message is clear.

In too many countries health systems are ill-equipped to cope with present demands, let alone those they will face in the future. We cannot just go after the easy targets, and leave the more difficult institutional issues till later. If we do so, we will fail.

Which brings me to my next theme: what are the implications of this agenda for those of us who work in organisations concerned with international development?

First of all, we have to be clear that countries must remain in control of their own development. National ownership of the development process – in health or any other sector – is essential.

We can articulate priorities on the basis of sound evidence. But we should not prescribe. We can assist in building capacity to set national goals and objectives. But we need to take care that the way we work does not undermine the need for governments to determine their own spending strategies.

The challenge is to use the resources of development agencies to influence overall patterns of spending in favour of the interventions that will make the biggest difference. Too often in the past, donors have tended to concentrate on a few of their own priorities – leaving government to fund the less popular but nevertheless essential parts of the health system, such as hospital care.

We all recognise the need for concerted action across governments to tackle the broader determinants of ill health. But – to use a phrase which I believe is popular with our hosts – we also need a more "joined-up" approach within the international development community. That also goes for individual agencies – so that themes such as poverty reduction drive the work of all parts of the organisation – and do not become the preserve of special departments.

And, equally important, we need a "joined-up" approach between agencies.

Within the UN system, I support the Secretary-General's call for closer inter-agency collaboration. From what I have seen and learnt over the past year, I believe the time has come to make a more significant move.

Next week at the World Health Assembly I will announce that WHO is ready to join the UN Development Group. We are already active in many countries in helping to shape the UN Development Assistance Framework process. But we see UNDAF not just as a means for harmonising the work of UN agencies, but as a necessary step towards wider and more meaningful collaboration with other development partners as well.

In the field of health, we have learnt our lessons. We know there are limits to what can be achieved through isolated interventions. We have seen too many pilots that never went to scale – remaining as islands of excellence in an under-resourced sea. We hear from our Member States about health projects that failed because insufficient attention was paid to the institutional environment in which they were implemented.

We now recognise that sector-wide approaches offer a way of supporting health development in ways that strengthen national ownership and build national systems. But we still need to ensure that sector programmes genuinely deliver better health outcomes – and that they are an effective means for negotiating policies and strategies that benefit poor people.

In this context, we welcome ideas such as the Comprehensive Development Framework that has been proposed by Jim Wolfensohn. The CDF takes sector-wide thinking a stage further – making the links between the overall economy, the structure of government, and the many facets of human development much more explicit.

I have heard people say that this kind of framework represents nothing more than good development practice. Indeed, the same has been said about sector-wide programmes. But I believe there is much to be gained by being explicit and systematic about good practice – particularly if it focuses our attention on the human development goals we are striving to achieve.

Before moving on, I want to return for a moment to the institutional issues which lie at the heart of poor health systems performance in many developing countries. We all know that most of them are not specific to the health sector alone – they are issues which affect the public sector as a whole.

This is an area where the need for better collaboration between agencies and governments is compelling. We in WHO have taken some important steps in widening the scope of our contacts – with the World Bank and the IMF for example. But I would like to see this collaboration go further. I would like to see our dialogue – particularly with the bilaterals – extend beyond exchanges between health professionals. Our staff need to interact with your development economists, with your public sector specialists, and with your social development advisers. I am convinced that such contacts will have tremendous benefits for all concerned.

Before ending, I would like to say a few more words about change in WHO.

Many of you will be familiar with the changes that we have made in Geneva. In the past nine months, WHO has embarked on a major process of renewal and reform. A new organisational structure at headquarters has been designed to streamline our work and promote greater synergy. Over 50 separate programmes have been brought together in nine new clusters. We have taken the first steps in realigning the budget with our new priorities. Rolling out the process of change to regional and country offices is now well underway. But we still have a long way to go.

Several observers – from our own country representatives to bilateral partners – have told us that WHO still tends to operate as a loose, and sometimes competing coalition of its constituent parts. We therefore need a corporate strategy which will provide the conceptual and managerial glue to bind together clusters, projects, regional and country offices in pursuit of common goals.

Developing such a strategy is the next step on the road to renewal.

We need a strategy which defines our corporate identity more clearly. A strategy for WHO's secretariat, which distinguishes our objectives from those of Member States.

We need a strategy as a framework for allocating resources, and monitoring our performance. The changes we made to the budget to be presented next week represent an important step. But the next budget – for the biennium 2002-3 – will be the first to be prepared from scratch under the new administration. Work on that budget will start soon.

We also recognise that we need to carefully revisit not just what we do, but how we do it. It is by focussing on our core functions, that WHO having will have a comparative advantage over other agencies.

We will return to these issues again tomorrow. But let me highlight one critical area – where change in WHO is long overdue. And that concerns our work at country level.

In too many countries our resources are not being used strategically. Our funds are divided between too many disparate activities, and there is little co-ordination between the work of the regions and headquarters.

You cannot achieve an impact in a country by dividing 4.9 million dollars between 44 national programmes, and over 400 "priority activities". But this is what has been happening.

Clearly we need to base our work in each country on an explicit country strategy which takes into account the needs of governments and the activities of other agencies. This is fundamental – and will be nothing new to the agencies here.

However, shifting the way we use the WHO country budget is not just a technical challenge.

Many Member States today regard WHO funds as their own. National programme managers – and, let's face it, some staff in WHO – will be reluctant to break with past practice. But if our resources are being used to less than optimal effect, we are obliged to do something about it.

WHO is accountable for the use of funds to its Governing Bodies, not to individual Member States. The Organization must be able to exercise sound professional judgement – in consultation with partner governments – as to how its resources, both human and financial should be used. Above all we must be able to show that our contribution to national health development delivers results. Results that positively influence the lives of poor people.

Finally, let me stress that we are under no illusions about the magnitude of the task in which we are engaged – at headquarters, in the regions and in countries. It is our aim to create a WHO that is better equipped to meet the challenges of the next century. To better serve our Member States and our partners in development.

As our focus shifts from structural to cultural change – the obstacles to be overcome are no less daunting. We are in for the long haul. And we earnestly seek your support in our efforts.