Paris, France, November 14, 2005 Philippe Douste-Blazy: President of the World Bank, Director General of World Health Organization, Ministers, Ladies and Gentlemen, I would first like to thank you for being here in very large numbers this morning especially since it is a very early time to do a press conference. The third high level forum on the Millennium Development Goals will open this morning. It is a pleasure and honor to welcome many high level people and experts who will take part, and I'd like in particular to welcome the two major players in this event, Mr. Paul Wolfowitz, President of the World Bank and Dr. Jong-wook Lee, Director General of the World Health Organization. I would also like to wholeheartedly thank Mr. Abdou Bakar Traoré, Minister of Economy and Finances of Mali, for having accepted to attend this press conference. Over these next two days, we are going to talk about health in developing countries. At the Millennium Summit five years ago, we set out objectives and a timetable. By 2015, we will need to have reduced infant mortality by two-thirds, maternal mortality by three-quarters, and we will need to have reversed the tide of HIV/AIDS, TB, Malaria, and other major diseases. The first meeting of the forum in Geneva in January 2004 revealed that many countries had no chance of meeting these objectives in time. People in these countries will see no improvement in their health, if we, multilateral agencies, developed countries, developing countries, and other entities do not change our ways. We need to identify critical sticking points and barriers to the development of health systems. In other words, we need to diagnose the situation and come up with improvements for the future. The Abuja Forum worked for these results, and here in Paris, we are now completing the cycle of these three meetings to define policies and next steps to achieve these aims. We are trying to set up an informal format where we will be able to speak freely, where everything will be on the table, and over 60 delegations have answered the invitation of Mr. Wolfowitz, Dr. Lee and myself, to attend: the director general of the alliance of UNICEF, the Global Fund for Vaccination, 20 ministers and secretaries of state that represent all the continents, the president of the African Development Bank, the heads of different agencies acting in the field of development assistance, are all present here in Paris. I am convinced that the importance of the matters that are going to be discussed and the quality of the participants to this forum will help us to find well-considered, new responses, and that we will be able to work jointly to meet our ends. I am convinced that when I meet my fellow ministers of foreign affairs, one of the major stakes of international diplomacy today is more than ever how to deal with health issues. Health in the world isn't just a technical matter that is reserved to doctors and technicians or people working in the humanitarian fields. Health is a problem also for the diplomatic community. Heads of State and Governments need to look into these issues. It is not just a question for multilateral agencies. It is one of the most important matters, more so even than energy. It is moral. It is ethical but it is also the issue of respect for the dignity of people in the world. I am now going to give the floor to Dr. Lee, Director General of the World Health Organization, for a few introductory comments. Thank you. Dr. Jong-wook Lee: Thank you Minister Douste-Blazy. We are here today to decide how we can turn these billions of dollars into real results so that the children can expect to live longer than the age of five in every country; so that people will not get HIV and won't die from AIDS; so that childbirth in Africa is as safe as it is for women in Europe. Focusing so heavily on development this year has been impressive to see. At the G8, and in September at the UN in New York, the entire world was focused on development. There is great promise of more financial support, but this is where it can get complicated. The money can be as much of a problem as a benefit if it is not well spent. It is up to the donors and everybody here at this meeting to spend on the real needs of countries. It is a special pleasure today to sit beside the Minister of Foreign Affairs of France because there is a strong French commitment on many of the issues, including the Global Fund, and also the effort to raise more funds in an innovative way. It is also a special pleasure for me to sit beside President Wolfowitz of the Bank, who - as we all know - as soon as he took over the job went to Africa. I know that his passion and his focus on Africa will result in real improvements of the quality of life of people in Africa. Of course, I am glad to also sit next to Minister Traoré of Mali. Thank you very much. Paul Wolfowitz: Good morning. Let me first thank our French hosts, in particular Minister Douste-Blazy for hosting this high level forum in Paris and supporting its goals, and thank you Mr. Minister for pulling together so many key decision-makers. I think you have already begun to getting important work accomplished. I'd like to also acknowledge Mr. Traoré from Mali for his efforts to ensure that increased aid to developing countries for health has been used effectively and transparently, and let me recognize the leadership of Director General Lee of the World Health Organization, who happened to manage many global health challenges, with the response to avian flu being the most recent in a long list. Looking at the stark picture of health problems facing poor countries today, what emerges is that a shocking number of people are dying each year from preventable and treatable diseases. Every week in the developing world, 200,000 children under five die of diseases. That's 200,000 a week, and 10,000 women in a single week die giving birth. In sub-Saharan Africa alone, two million people have died of AIDS this year. The suffering is greatest in poorest countries where populations will have doubled by 2050 and health spending needs are enormous. We welcome pledges of extra financing that will come from this year's Group of 8 summit where the wealthiest countries promised 50 billion dollars in aid by 2010, including a doubling of aid to Africa, and extended debt relief for the poorest countries. But no amount of money in the world can improve health systems and the services they provide. We cannot do this without removing roadblocks of too little predictable financing, and having too few trained health workers. But developing countries themselves have to do better in terms of transparency in fighting corruption, in investing in stronger performing health systems, which are the driving force behind effective health responses. More donor pledges and additional generosity, which we will no doubt need, will depend on demonstrating that we can deliver the results. That is our agenda: to deliver the results. Results are possible. Take the case of Mozambique, a very poor country, with per capita income of just about 250 dollars. But it is making impressive progress. About 85% of pregnant women in Mozambique receive prenatal care; and 77% of children are immunized against measles. Mozambique has shown you can rapidly improve health results, even with a shortage of qualified health staff. Bangladesh is another encouraging example. A small community nutrition program piloted by a local NGO called BRAC was scaled up with effective help from donors to become the country's first large scale nutrition investment. Today, Bangladesh, despite its great poverty, is the only country in South Asia that is likely to vastly improve nutrition for its people, and has a chance of meeting the MDGs for nutrition. Indonesia has made rapid progress in improving health services. Child mortality has been cut in half since the 1980s. Maternal health improved through large-scale training and deployment programs of midwives in rural villages, supported in part by World Bank financing. So there is success in the overall bleak picture. We need to take these examples and use them to design other national health programs that can make a difference in the lives of poor people. All in all, many of the building blocks needed to successfully improve the health of poor people across the developing world, and achieve the health-related MDGs, are now in place. Now, however, the real work begins: achieving health MDGs will transform the human and economic welfare of tens of millions of poor people around the world. It is going to require much closer partnership between the donors and the recipient countries, much closer coordination among the various multiple donors and much improved health systems in the recipient countries. So there is a lot to do to make the new resources effective and to bring down these horrific tragic statistics. But it is in that spirit I look forward greatly to the talks here in Paris at this High Level Forum. Over the course of the next 48 hours, I hope we can make some significant progress towards reducing the tragic dimension of disease in the poorest part of the world. Thank you. Abdou Bakar Traoré: Good morning ladies and gentlemen. I would first like to start by answering the question why am I here today, why I decided to attend this press conference. Well, the first thing that needs to be said is that I come from Mali, a poor country, a country from Sub-Saharan Africa. The second aspect is that today I am Minister of the Economy and Finances of Mali. I am at the front-line as regards to financing and the intervention of technical and financial partners. As I said Mali is a poor country; a country of 1,200,000 square kilometers in sub-Saharan Africa. It's a landlocked country with a population of eleven million inhabitants. Ninety percent of the population is rural and our population is also very young: 46 percent of our population is under the age of 15. And alongside that, our country faces major challenges in particular as regards water, access to water, we have three or four months of rain. We have two major rivers in our country but water resources are insufficient in particular for irrigation. Less than 50 percent of our population has access to drinking water. So with those conditions, you can imagine that from an economic point of view, there are very precarious situations, and in particular as regards health. Now to focus on health, less than 50 percent of the population, as I said, has access to drinking water: 50 percent of the population lives far from health centers and that means that in Mali, modern medicine, if I can call it that way, is available only to a limited extent, but the huge majority of the population of Mali will use traditional medicine, but also what in Mali we call basic medicines, that are imported in Mali but that do not meet standards, and are sold for a few cents, and that is what people use to treat the diseases. So it is basically self prescription. What do we try to do, faced with this situation? Well, we try to set up a health policy that will be consistent, that will be robust. We have a medium term spending framework in Mali to finance health within our public policy plan and this enables us first of all to have predictability. Mr. Wolfowitz and Mr. Douste-Blazy mentioned this. It is very important to have predictability of resources, especially for a country like Mali, to know that we will have such funding for such time table and also to align that on the budgetary cycle is a very important aspect. Another very important aspect when setting up this type of framework and policy is that we can set up results-based management. That is to say that we work having very specific objectives in mind. So we are setting up this reform process with the help of all the partners who are sitting at the table with me the bilateral partners, such as France, the World Health Organization, the World Bank and many other institutions that have provided very valuable support on all these issues. I would like to acknowledge the pledges that are being made, and the commitments that are being made vis-à-vis our country. On debt relief and the multilateral debt: A country such as Mali would receive 20 billion CFA francs per years as a result of debt relief. Just imagine how important that sum is for our country. Just to give you an element of comparison our budget is 72 billion. So it is about one third of our budget that would be covered by this debt relief. Other initiatives that I would like to acknowledge are the very strong commitment to provide further support to developing countries with the doubling of aid by 2010. These are just a few words that I would like to say by way of introduction and I would like to wholeheartedly thank the organizers of this session. Thank you very much. Questions from the press: Q.: I would like to ask a question concerning bird flu that has only killed about 60 persons over the past three years. Over the time of this press conference, 60,000 women will die in child birth and thousands of children will die of preventable diseases. So the future, and worrying about the future, is a very good question; but there are a number of things that need to be done in the present. I would like to ask a question about the efficiency of aid and then I'd like to welcome the last report of the World Bank on equity and development. This is a true revolution from the point of view of economic specialists. The World Bank is no longer putting equity as a result of development but as a condition for development. Just one example: You are born as a man or as a woman and from the start you start on unequal footing in terms of education, health, inclusion within society, and at the end of the day, half of humankind cannot take part in development, and this is a major issue. From that point of view, Minister, I am somewhat worried about budgets for AIDS. AIDS, of course, is a major problem. It deserves very high-level funding, but to take the example of France, I am worrying whether it is not slightly disproportionate because public assistance, public aid in France, in terms of health, is for two-third aimed at AIDS. And I would like to know whether we are not insufficiently giving attention to other diseases and whether these important sums, to 100 million euros, soon 300 million euros, will be used according to the worries of the World Bank and that is to say, a social frame of mind. I am sorry, Minister, but you yourself has said this. The health problems of today are no longer problems for technicians of the health sector. Are we truly giving the priority to the feminization of this pandemic, as the MDGs themselves require? Question from the press: Q.: The health problems, as the Minister has said, are also problems of social protection. One of the major concerns for all developing countries is that there is no system of social protection. What is the place of this issue within the framework of policies in developing and developed countries, within the WHO, within the World Bank, and naturally within the countries concerned, and particularly Mali? Have you started to reflect on the implementation of the social protection system that will protect the population and patients but also the economy, an economic system that will ensure equitable remuneration for health practitioners? Is there an overall reflection to build such assistance in developing countries? Q.: From Jeune Afrique, I would like to put a very specific question to Mr. Traoré, in terms of needs for the health system. We have discussed countries such as Mozambique that is not represented, but imagine in a country such as Mali, what has been done for these countries to reach the Millennium Development Goals given that the budget of about 120 million dollars. Shouldn't it be doubled or at least increased? What are the needs of a Saharan country, a landlocked country, in terms of health? If the minister can respond to this question and perhaps also the head of the World Bank. Q.: I would just like to complete the question that was put by the person sitting in front of me with a question of brain drain, or at least the drain of qualified staff. We can bring in financial aid, we have explained that one of the conditions is to improve the health systems themselves. Should we not start by taking measures aiming at helping those persons who have been trained, who are qualified, to remain in the countries, rather than moving to developed countries, and to ensure that there is adequate staff in developing countries? Douste-Blazy: Now before responding, and before giving the floor to Mr. Wolfowitz and my other colleagues, I would like to point out a few things. It is quite obvious that there is no point in taking a specific interest in any given disease if we do not carry out an overall improvement of the health systems themselves. If we don't have a basic organization, a network of health workers or epidemiologists, which are unfortunately insufficient in developing countries and in Southern countries, if we don't have the basic system that will enable us to ensure basic public health services, you can have the best plan in the world, in New York, Washington, or in Paris, and it simply won't work. That is quite clear and that is the work of the people who are surrounding me here to discuss these issues. In countries such as France, before discussing public health issues, it took 30 years of political discussion. Just imagine what it is in the countries of the South. Now, we are discussing public health. That is the issue and that covers what he's been saying about epidemiology. I personally do not really know what the sentinel networks are in Africa, but when I looked at the situation in Niger and how it was organized in the month of July, I am asking myself where these networks are. They were lacking. That is for epidemiology. Statistics, what is the statistical treatment of all of these issues? We haven't seen any. Third, the health economy, which is what you talked about. Allow me to say that this will only come after we have a true public health system, certainly with regard to social protection services, but also with health services as such. On the brain drain - this is of course because there is no public health service to welcome them in their own country. Concerning France, I think that you are absolutely right - I think the time has come to think about this issue. The time has come for us to work on visibility of the actions of France abroad, in particular concerning health issues and training. Four or five percent of development aid is for health. That is insufficient if you look at the problems of health in the world today. I believe we need to re-establish the balance. There is an imbalance, which is certain. We have a desire to become the major contributors worldwide, which is true. But how can France also pay attention to the variety of different issues in this field. I think we should try to think about an agency, a body bringing together both the public and private sector to enable us to better organize the participation of foreign affairs in particular in these issues. If you look at the British Council, for instance, in Britain I believe the Quai d'Orsay should also be thinking about the visibility of its actions abroad, but I am sure that you will have an opportunity to discuss it again. Wolfowitz: Let me say a few words. First of all, the early comment about the importance of paying attention to women and having equity in women: I think it is undeniable. I remember a woman from a small village in Pakistan, who - when we discussed this subject - said, and I thought eloquently, development is like a cart with two wheels, the man and woman, and if one of the wheels doesn't turn, the cart won't go anywhere. If you take out the contribution of half the population, you're at the very least going to cut what you can accomplish in half. I mean there is an equity issue there but there is also a straight development issue. We have a loss of effective resources and it needs to be addressed. You also expressed some concern about possibly too much focus on AIDS. There's no question that AIDS is a plague, and it's having terrible effects, including on health workers. We were told last night that one-third of the brain drain of health workers in Zambia is health workers who are dying of AIDS. That's one strong illustration of why it's a serious problem. But I do think we've got to think of the whole health effort as a team sport, like European football or what in the U.S. we would call soccer. And when small children play soccer or football, if you've noticed, they all chase the ball. The ball goes one place, and 22 players, including both goalies, go after the ball. And sometimes it feels as though in the health field, we're all chasing the particular ball that has gotten the most appeal and the most attraction at one moment. So we've spent a big effort with some success in the last few years on AIDS, which is a good thing. I think the subject of malaria has been neglected. Now, I don't know if it's cause and effect; but we haven't kept our eye on the malaria ball, as well. And we are going to step up efforts on malaria. We have something the Bank is leading called the Malaria Booster Program focusing on some 15 African countries. But there, too, we'll make a mistake if we just say the issue is malaria in those 15 countries, because the issue is health care. The issue is making sure that you have a system that can deliver treatments for all these diseases and, even beyond that, that you have a system that delivers clean water. I don't know that we have statistics; but it's very clear that if you just could increase the access of people to clean water, you'd get many fewer of all kinds of diseases as a result. So it's very important to look at it as a system. It's a system that's killing people by the millions, and it's a system that needs to be fixed. I think that we should hear from the Minister from Mali as to what he feels his needs are; but I would say in general, from the perspective of the Bank and other donors, I think country-by-country, we need a better picture of what the needs are and what the different players are doing. There are now so many on the scene -- the World Bank, the various bilateral donors, the Global Fund, WHO, private foundations like Gates Foundation -- it's actually bewildering, and I think particularly for small countries with limited Government resources simply managing that huge number of donors is a challenge; and I think it's an obligation of the donors to reduce that challenge by coordinating among ourselves better.
Traoré:
Well, I noted three questions that I'd like to answer to. The first question is the question on social protection and what needs to be done about it. Well, in a country such as Mali, we don't have a system of universal coverage, as you have in France, for example. We have two funds. One is for the public sector, and the other fund is for the private sector or semi-public companies. Now, the retirement of these funds is in the red. And we have a fund for the public sector, and the Government pays 15 to 17 million CFA francs into the funds, because of course there are less and less people paying into the fund and more and more people benefiting from the fund. So this is why there is a deficit. More and more, you see mutual companies being set up, in particular for specific professions such as teachers, and this enables to afford coverage.
Another aspect is that the Government provides some forms of treatment for free. This isn't an ideal situation. Let me give you the example of the Caesarean cut. In Mali, our Council of Ministers just adopted a decree that makes Caesarean cuts free for women, because this is an issue of public health where we had lots of problems. Women very often were confronted to this problem of having to undergo Caesarean sections.
Other issue is, for example, prostate problems. And here again, we're going to try to set up a similar system where we will be providing some forms of treatment for free; but, generally speaking, we are carrying out an in-depth study with the support of the World's Bank on the two funds that exist in our country to see how we can find an optimum system. So this is something that we're working on now. Now, health and the Millennium Development Goals -- also, the budgetary issue, that was another question -- well, we have 72 billion CFA francs, that's the budget for health in Mali. Ten percent are recurrent costs, or it's seven percent if you like of our overall budget. It's, of course, insufficient; but, as you can well imagine, we have a budget where we have many constraints, and our budget in particular funds are priorities in terms of reducing poverty, for example. As regards the Millennium Development Goals now, some of these Millennium Development Goals, we believe that by 2015 we will have met those goals. We believe that. That's our expectation. It's the case, for example, for access to drinking water. It's also the case for teaching, universal teaching. But we won't be able to meet the target on quality education, because our major challenge in terms of education is providing quality education. Now, on health, we do have many limitations. Let me just give you a few elements. In 2015, for health, we should have a rate of infant mortality of 76 per 1000; today, we are at 229 per 1000. For mother mortality, we should be at 145 for 100,000; we are now at 182 per 100,000. So we have major challenges in Mali in terms of meeting the Millennium Development Goals by 2015, in particular in the area of health. And here, of course, the main aspect is to have resources; so we need a strong commitment from our partners, but this can only happen by our own commitment. So our Government has to be very focused, and very committed, in relation to our public policies. We have a plan for the reduction of poverty, 2003, and 2006. We're now going to have a second stage of that paper that sets out all the priorities of the Government in terms of public policy, and in particular in the fields of health and education. And I'd just like to say that the budget of health in Mali is a budget that focuses on strengthening infrastructure. In particular, for the 72 billion that I mentioned, about half -- 35 to 36 billion -- are spent on investment, strengthening networks, strengthening equipment and infrastructure. So these are the types of measures that we have been taking. Then, finally, a word on the brain drain, well, the Minister has said this. We don't really have a fully fledged public policy on health that would enable us to retain well-trained people, in particular those who have been able to study abroad in European or American universities. And there are two aspects there: there are the working conditions, but also the pay levels. The pay levels are very low in Mali. Salaries and wages are very low in Mali. And we also have a wage mass that's growing in a rather unsustainable way for our budget, so it would be difficult for us to pay all qualified people. The qualified people also need to be motivated. They need to have their own vision for Africa. |
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