It gives me great pleasure to welcome you today to
the Fifth Meeting of the Commission for Macroeconomics and Health.
Last year, in Paris, I said that "There is a growing consensus
among political leaders in all parts of the world that action
to confront the development crisis posed by ill health is urgently
I said that the question of resources is central to any meaningful
progress in health improvements for the poorest countries.
I also said the context in which we are working is
changing and that things continue to move at great speed.
The seven months that have passed since Paris have
reinforced these three points - in particular the last one. Things do
indeed move at great speed. Let me briefly sum up:
During this period, the premises for the debate
about access to drugs have changed drastically.
- Both countries and pharmaceutical companies have accepted the
principle of differential pricing of key drugs and pharmaceutical
products to enable wider access in poor countries.
Several companies have drastically
reduced the prices of important drugs for the least developed
countries and some other countries particularly affected by
disease. This, by the way, goes beyond drugs used for treatment of
HIV/AIDS and opportunistic infections. One recent example was
Novartis' agreement with WHO to sell its combination treatment for
malaria, Coartem, for a drastically reduced price to
malaria-endemic countries. Some companies have decided to simply
provide some drugs for free in poorest countries.
The principle of openness and
transparency in pricing of drugs is being increasingly accepted
and practiced by pharmaceutical companies.
Direct competition, in particular between
research-based companies and generic companies, is adding to the
dynamic of reduced prices.
Anticipation of higher and more
predictable sales of key drugs are also helping to drive down
prices, as we are currently experiencing through the Global TB
But we have also seen the development of the
political consensus into more concrete plans for action. The European
Commission's Communiqué on action against HIV/AIDS, TB and malaria
has been followed up with a Programme for Action, focusing on ensuring
optimal impact from existing interventions; increasing the
affordability of key pharmaceuticals; and increased investment in
research and development.
We have seen a growing consensus around a framework
which links the availability of new resources to the ways in which
they are used.
The first element of this framework is that there
really is a steep increase in resources. The United Nations
Secretary-General has spoken of an additional US$ 7 billion
per year for HIV/AIDS. I believe we should be looking toward a
progressive increase in funding - from all sources, both national and
international - toward a total of about US$ 10 billion a
year to cover the investments needed to tackle HIV, tuberculosis and
The second element is ensuring that essential
global functions take place, such as programmes of strategic research
for, and development of, necessary drugs and vaccines and strategic
partnerships to bring down medicine prices in order to improve access
in poorer communities.
But we also will need schemes for the efficient
purchase and equitable distribution of critical commodities, obviously
in ways that respect intellectual property, that build on existing
international trade agreements and that show how to take advantage of
the new advances in biotechnology. The Trade Commissioner, Pascal Lamy,
has played a key role in working to this end.
The third element in this framework is innovative
and urgent action to secure the effective operation of health
systems even when they are seriously under-funded. This means
improving the capacity of a variety of different provider groups to
deliver essential services and goods through a diversity of private,
voluntary and public channels. The emphasis must be on stewardship by
governments, even in complex emergencies. Effective stewardship calls
for the strengthening of human resource capacity through development
of leadership and public health skills, coupled with efforts to retain
critical staff. This would be backed by focused investment in
essential infrastructure, fair systems for health financing, logistics
for storing and distributing medicines and other vital commodities,
functioning laboratory services, and - importantly - monitoring the
quality and coverage of all services.
The overall goal would be to ensure that health
systems are able to deliver services that are as effective, responsive
and fairly financed as possible given the resources available.
The fourth element is to ensure the independent
authoritative monitoring and review of results, relating these
to investments, accompanied by rapid reporting and public relations -
in order to sustain long-term involvement.
The fifth element is to catalyse intense and social
mobilization at country and global levels, through a credible and
upbeat programme of advocacy with political leaders and key public
figures. It would work through governments, NGOs, and the media. It
would be based on the theme of working together to "make the
forces of globalization work for the secure future of humanity ".
Last, but not least, we need an effective, fast
mechanism for moving money.
As you know, much attention has been given over the
past few months to establishing a new Global AIDS and Health Fund.
Whilst the concept of a global fund has only recently hit the
headlines, the ideas have been brewing for some time. But a consensus
has gradually developed that a single fund, initially with a narrow
focus on HIV/AIDS, TB and malaria is the best starting point.
The Fund will enable those wishing to invest in
world health to back effective action without establishing independent
systems to move resources to community level. By pooling investments
from a variety of sources, and drawing on the best of international
and local expertise, the Fund will ensure the best possible results
from investments made. The Fund should also help countries who do not
presently benefit from significant external resources - such as those
emerging from conflict.
The objective of establishing a new Fund is to
bring additional and complementary resources to bear on
urgent health problems.
Discussions over the last month have led to an
An international fund which is
attractive to, and receives income from, government and private
An innovative alliance between developing countries
and funders with the UN system closely involved at all levels.
Developing countries fully involved in the planning of the Fund from
an early stage.
A Fund that supports country-level decision-making
and leadership; that is characterized by transparency and
accountability and that involves the voluntary and private sectors in
implementing effective actions.
A Fund that focuses on outcomes through the optimum
blend of programmes within different sectors, that contributes to the
coherence and effectiveness of development assistance.
A Fund that is fast moving and innovative: that
encourages new ways of working, and ensures that funds are disbursed
both rapidly and wisely.
A Fund characterized by streamlined management: no
elaborate planning processes; review criteria that are transparent and
A Fund which adapts the way it works at country
level to different national contexts, but focusing at all times on
results: successive tranches of funding should reward good
A Fund that operates in the context of
international agreements: including TRIPS and the safeguards included
All these developments greatly influence the work
we are expected to do in the Commission. The case for investment in
health has already been made and is gaining acceptance. But there is
still a profound need for scientifically based evidence for what works
and how new solutions can work in harmony with existing interventions.
This is our challenge. As the understanding of the
importance of health in development is increasing, the Commission's
work will also increase in significance.
I would briefly outline some of the areas where I
see there is a need for clear recommendations which the Commission
could contribute to.
It is clear that scaling up interventions against
priority diseases is inseparably linked with investments in health
systems. Moreover, access to care is not just about access to drugs.
It is about access to effective health systems.
Prevention, information work and safe and reliable
care require trained staff who receive their salaries on time and who
stay in their posts. It requires supplies, buildings, information
systems, supervisors. All this and more is needed for the safe
diagnosis and treatment of childhood pneumonia - let alone more
complex problems like the management of multi-drug resistant TB or
We need to know much more, however, about how we
invest wisely in health systems in poor countries so that we can see
rapid, measurable improvements in outcomes. When your option is to
double spending on health, from US$ 8 per person per year to US$ 16
per person per year, what are the priorities? How much should be spent
on salaries? How does one assure that capital investments are
protected? How do you build up an effective supply chain for basic
Another key area is to fully reflect the growing
evidence that noncommunicable diseases also batter the poor. Growing
urbanization leading to changes in diet, pollution, lack of clean
drinking water and sanitation and an increasing influence of tobacco
marketing all contribute to a double burden of disease for developing
It is important that the Commission Report makes a
strongly argued case for investing in health also for noncommunicable
diseases, injuries and mental health.
We must also address the mechanics of development
assistance for health. One clear and uniform demand by all
stakeholders in the ongoing debate about scaling up resources for
health is to find ways to reduce transaction costs, simplify
allocation and reporting procedures and find new and better ways to
balance in-country decision making with global best practices and
We must draw on the experiences of donor -
recipient country relationships, as well as those of OECD, DAC, the UN
and the development banks to improve effectiveness and sustainability
of the aid flows. We need to lay out the dilemmas of conflicting
We need to stress that the centralization of
resources into funds, as we are seeing at the moment must be a
complement to existing resource flows - not replace them.
We need to acknowledge that while evidence-based
best practices and performance criteria for continued financing need
to form the foundation for investments in health, we must avoid a
tendency towards scientific elitism, and make sure there is proper
control and ownership of the process in recipient countries.
National governments must have all the information
they need to help them decide between competing priorities - within
and between sectors. Providing this information is our task. Making
the tough decisions on the basis of that information is theirs.
Mr Chairman, Ladies and Gentlemen,
These are exciting times. We live in a rapidly
changing world. And we have an opportunity - greater perhaps than has
been granted to any other generation in history - to make certain that
those changes are for the good. Changes that will make the world a
more healthy and a more equitable place to live. I have convened
the Commission on Macroeconomics and Health to help us make the case
that good health is not just a good in its own right, but one of the
most powerful development strategies at our disposal.
I am impressed by the progress you have made in
your work already. And I look forward to the debate and discussion
over the next two days.