Remarks at the
Stop TB Partners’ Forum
By
Praful Patel
Vice President, South Asia Region
The World Bank Group
New Dehli, India, March 24, 2004 It is a great privilege to join the Honorable Prime Minister this morning. We congratulate him, and the Ministry of Health for their extraordinary work in expanding access to TB control in India and in curing millions of patients. Let me speak personally for just a moment. My wife Anjana contracted TB when she was a little girl of six. Like me she lived in East Africa and when her family noticed an alarming curve to her back, they took her to the Rainbow Hospital in Nairobi, and into the hands of a Dr Neville. We don’t know whether that was his first name or his last but we do know he was from Australia, that he diagnosed spinal tuberculosis, grafted bone from Anjana’s shins to her spine and saved her life. Dr Neville was surely one of those remarkable people who have made a difference in the ongoing fight against this preventable and curable disease. It is a honor to follow Dr. Lee, Director-General of the World Health Organization. He has provided global leadership in the control of TB. I am most grateful to the Stop TB Partnership for organizing this Forum and to the Government of India for hosting us. India is laying a strong foundation for the demise of TB by building capacity at the state and local levels, forging new private and public partnerships, and using diverse delivery models. Today, I am representing Mr. James Wolfensohn, President of the World Bank. As the taped message from him, that you will see later, makes clear, we are committed to the global partnership. It is the Ministers and other representatives of governments here today, who are at the heart of the partnership. It is you who are leading the scale up of TB control to reach the 2005 targets. These targets are part of the global Millennium Development Goals or MDGs. The global commitment to the MDGs goes to the very core of what we yearn to achieve in global development. And we have a target date of 2015 by which to achieve dramatic change. But reaching the 2005 TB cure and case detection targets will be a major step towards 2015.
It’s worthwhile remembering the three main concerns that inspired the adoption of the health-focused MDGs: One was the sheer scale of preventable deaths and curable ill health in the developing world. The numbers were inescapable. Two was that those suffering the most were the world’s poorest people, with the least voice to fight for change. And three, the impact of all this ill health on economic and human development.
We know that TB and poverty are intimately linked. Nothing is more powerful than listening to the tales of TB patients themselves; listening to accounts of their daily struggles for health and economic survival. Surveys in India, China, Bangladesh and Malawi show that without access to effective DOTS programs, men, women and their families fall further into poverty while seeking care. We are gathered here to take a hard look at where we are in the global fight against TB. The progress report released here shows advances on many fronts, but still there is very far to go. Similarly, when we examine progress on the range of health MDGs, we also find a sobering situation. For most of the goals, such as under-five mortality and maternal mortality reductions, low-income countries are moving far too slowly. And the poorest of people in these countries are most at risk. Increased economic growth can stimulate progress on the MDGs. But we know this will not be enough. The choice – the active choice – to increase financing for health systems and poverty reduction strategies is key. We must ensure budgeting for public health priorities, such as DOTS or integrated management of childhood illnesses. And we must ensure that this increased financing increases TB cures among the poorest and most vulnerable. Support for improved policies, institutions, human resources, and services that reach the poor, can leverage big changes. Also, experience has taught us that greater engagement of communities in the services they receive can strengthen the effectiveness of those services. The revised National TB Control Program here in India is supporting 31,000 community volunteers in its effort. At the Bank, we are pleased to be supporting such innovation. The MDG emphasis on outcomes is critical. Good performance can stimulate client demand, motivate workers and energize political leaders and donors. Bad performance risks lives. Man-made drug-resistant TB is a sad example of this. Stop TB stands out for the consensus that exists around strategies, and its indicators of progress. Let’s build these good experiences into wider poverty reduction strategies and community development actions. There are now many countries moving faster with DOTS, despite the odds. Experiences from around the world show us that high cure rates are possible, if we build a secure health system that delivers the goods and if we engage patients, providers and communities. We all benefit. And I cannot for a moment forget that I have been a beneficiary too. Were it not for a Dr Neville and at least part of a system that worked in Nairobi, Kenya, many years back, my own treasured family might not exist today. There is simply no justification for the 5,500 TB deaths that happen each day. I have only to look at Anjana to be reminded of this. In closing, I would like to restate the World Bank’s commitment to support national DOTS programs, systems that buttress them, and global collaboration to Stop TB. We wish you all good work at this critical forum. Thank you. |
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