Regional Ministerial Meeting on MDGs in Asia and the Pacific: The Way Forward, 3-5 August 2005, Jakarta, Indonesia.

Contribution By Dr Samlee Plianbangchang Regional Director, WHO South-East Asia at the Regional Ministerial Meeting on MDGs in Asia and the Pacific: The Way Forward Jakarta, Indonesia 3-5 August 2005 Regional Ministerial Meeting on MDG, in Asia and the Pacific: The Way Forward 3-5 August 2005, Jakarta, Indonesia Contribution by Dr Samlee Plianbangchang Regional Director for WHO South-East Asia Honourable Chairman; Excellencies; Ladies and gentlemen; • I am pleased to contribute to the deliberations of the Working Group 2 of this Ministerial Meeting. • I thank the organizers for giving WHO this opportunity. Excellencies, • As we are all aware, across Asia and the Pacific, over 700 million people live in extreme poverty. • This is in spite of the fact that we are living in this age of internet, globalization and rapid economic growth. • Many of those people lack access to basic services, including health care. • They struggle to survive on as little as 1 US Dollar or less a day. 2 • Often, they go to bed hungry, suffer illnesses, lack appropriate medical treatment, and do not have access to safe drinking water or sanitation facilities. • This is in striking contrast to the situation of the better- off people living in the same country. • The gap between the rich and the poor is unacceptably wide indeed. • The poorest 20% of the world's population are 10 times more likely to die before the age of 14 than the richest 20%. • Similarly, in many developing countries, women have limited access to reproductive health services. • Nearly 40% of all births worldwide are not attended by skilled health attendants. • The number of women dying in childbirth will not be easily reduced. • In some least developed countries in the Region, a high proportion of women die in childbirth. • Only less than 50% of pregnant women in these countries receive appropriate care before delivery. • With regard to sanitation, the coverage is very low. • It is less than 50% in some countries, and even below 25% in some parts of the Region. 3 • Most countries will not be able to slow down the spread of HIV/AIDS. • We believe that health plays a crucial role in the fight against poverty. • It is therefore most appropriate that health is a key component of the Millennium Development Goals, which aim to reduce global poverty by half by 2015. • Six of the eight MDGs relate to health, covering the very fundamentals, such as survival of mothers, newborns and young children. • They also address the major communicable diseases that predominantly affect the poor. • HIV/AIDS, tuberculosis and malaria are not just the leading killers, but an economic deathblow for poor families. • Health-related MDGs set targets for the most important outcomes to be achieved. These include: - Fewer women dying in childbirth; - More children surviving the early years of life; - Successfully dealing with the catastrophe of HIV/AIDS; - Ensuring access to life-saving drugs by people; and 4 - Better health in all its forms for contributing to poverty reduction. Honourable Chairman, • In this connection, I would also like to mention that the emerging infectious diseases, such as SARS and Avian Influenza can affect our progress toward poverty reduction. • The outbreaks of highly pathogenic avian influenza (H5N1) in poultry, which started in 2003, have been unprecedented in their scope and severity. • The outbreaks have caused a huge economic loss to the affected countries in this Region, and seem difficult to contain. • If the outbreaks of Avian Influenza cannot be checked, these may lead to a future global influenza pandemic, which may start in Asia. • It is predicted that if this ever happened, it would be the worst influenza pandemic with serious consequences, in terms of both human life and economy of countries. • Therefore, in reviewing our strategies to attain MDGs, the prevention and control of emerging infectious diseases may also be kept in mind. 5 Honourable Chairman, • Achieving various health goals is certainly a daunting challenge. • Even though technology to address the various problems is available, we are not able to ensure that all the poor and the underprivileged will receive the services they need. • Through the Directly Observed Treatment Short Course (DOTS) strategy, we have a clear possibility to effectively control TB in many countries. • However, in some countries, to make this service accessible to those who are in need is still problematic. • Similarly, many interventions are also inexpensive. • It costs less than 2 US Dollars to immunize a child against key preventable diseases. • But to get every child, especially in the poor community, immunized is difficult indeed. • Nevertheless, no matter how formidable the challenge, there is a need to strengthen cooperation among countries in Asia and the Pacific. • This is to ensure collective commitment to the attainment of MDGs. 6 • In this context, I would urge that, as far as health is concerned, we jointly initiate action in four main areas: • Firstly, we have to define a clear and practical strategy to strengthen health systems, with special emphasis on public health infrastructure. • We need strong public health workforce to successfully develop and implement public health programmes, such as disease control and prevention, immunization, maternal and child health, water and sanitation, environmental health, and nutrition for example. • We need public health services that reach out effectively into the community and the entire population. • We need to reorient our interventions in order to effectively reach the unreached. • This requires effective stewardship, adequate health facilities and staff, especially at the peripheral level, to ensure universal coverage of health services. • As we have seen, at times, drugs are available in urban settings, but do not reach those in rural areas who really need them most. • In many places, trained health workers are not available to provide essential care, and to carry out health promotion and disease prevention activities, which are prerequisites for sound public health interventions. 7 • When health systems are weak, it is usually the poor who suffer the most. • Strong public health infrastructure will guarantee sustainable development in health. • Secondly, we need additional funding for health care, and public health services. • We need more investment in health. • Health is often woefully under-funded. • Indeed, significant progress in health development will not be achieved without adequate financing. • Additional funding alone will, however, not be enough. • There is still room to rationalize the use of available funds by reducing unproductive spending, and thereby releasing the needed resources for priority and urgent health needs. • Currently, the bulk of funding usually goes to urban areas - often for costly curative services - at the expense of essential health interventions in rural areas. • In order to reduce the high proportion of out-of-pocket health expenditure, various mechanisms of risk sharing need to be introduced. • There is also a need to expand various social safety net programmes. 8 • This will enhance financial protection for the poor who constitute the vast majority in the Region. • Indeed, international partners have a key role to play in providing more funds for health. • There is a need for better coordination and alignment of external aid to ensure relevance to countries’ health priorities and needs. • Thirdly, there must be stronger multisectoral collaboration and action to ensure effective health promotion and disease prevention. • Partnerships among stakeholders and empowerment of people are the foundations of successful multisectoral and multidisciplinary actions in health development. • Recent evidence suggests that significant reduction in child mortality can be achieved from several diverse actions. • These also include improving access to drinking water, and increasing the years of schooling among women. • Responsibility for and commitment to the development of health for all people have to go beyond the health sector. • Other sectors have to share such responsibility and commitment. 9 • The health sector alone will not be able to achieve the total health development goal. • Fourthly, we need to seriously address the issue of inequity in health, including access to quality health services and health outcomes. • Disparities in access to health care can occur due to various factors, like income, location, ethnicity, and gender. • Often, these factors are actually overlapping. • There is therefore a need to develop programmes specially targeted to the underserved and vulnerable population groups. • The equity issue must be taken into consideration throughout the development process from policy formulation, resource allocation, to programme planning and implementation. • For effective policy development and programme planning to ensure equity in health, there is a need for better evidence and better disaggregated data and information. 10 Honourable Chairman, • Keeping in mind the above-mentioned concerns, the 58th World Health Assembly in May this year urged Member States to ensure timely priority actions to accelerate progress towards the attainment of health- related MDGs. • It is also heartening to note that the Japanese Government recently convened a High-Level Forum on the Health MDGs in Asia and the Pacific. • The Forum reviewed progress and successes, as well as the remaining challenges in our journey towards these goals. • It underlined the crucial importance of strengthening health systems capacity, promoting multisectoral actions, securing resources, and ensuring equity in access to quality health services. • To a large extent, some countries in Asia and the Pacific have already achieved certain health-related MDGs. • However, among others, we need to redouble our efforts in strengthening and accelerating the required partnerships and collaboration. 11 • I am confident that this Ministerial Meeting will be successful in developing a common strategy and platform for Asia and the Pacific to move forward more efficiently and effectively towards attainment of health- related MDGs by 2015. • Finally, I thank again the organizers of the meeting for giving an opportunity to WHO to contribute. • Before ending my statement, I would like to place on record my appreciation of the emphasis on the health aspect of the MDGs in the keynote speech made by Prof. Jeffrey Sachs this morning. • Thank you. M:\RD-OFFICE\Speeches\2005\UNESCAP Ministerial Mtg, 3-5 Aug 05, Jakarta.doc – 16 Aug 2005