Mr. Chairperson, distinguished Russian Government Officials, Representatives from CIS countries, International Organizations, and Civil Society,
I am very pleased to be here with you this morning. This Forum reminds us about the importance of the Millennium Development Goals (MDGs). They are critical benchmarks to measure the impact of efforts by Governments, civil society organizations, and international agencies in improving the life of the poor in the CIS countries. Indeed, colleagues, the attainment of the MDGs represent not only a broad vision and a global aspiration, but an overarching framework for guiding development activities and investments in the region.
In that regard, I would like to congratulate the Russian Government for the initiative to organize this timely Forum.
I would like to use this opportunity to (i) briefly summarize the challenge ahead of us, (ii) discuss what we at the World Bank have learned over the last decade about what works in the fight against HIV/AIDS and TB; and (iii) suggest ways in which we can support the countries in the region to overcome this challenge.
The challenge As talks about a global recession intensify again, and economic uncertainty increases throughout the world, it is tempting to focus only on the immediate problems at hand. This is especially true when the short-term problems are very difficult to tackle. It is my goal today to remind ourselves about the importance of the medium term view. The CIS countries are facing a difficult challenge to achieve some of the Millennium Development Goals by 2015.
There has been significant progress in the CIS countries over the last decade, but efforts to attain the MDG6 by may be falling short of the original targets. Thousands of people across the CIS countries are already suffering the debilitating effects of ill health, stigma and discrimination. The continuing growth of new cases of HIV infection and the severity of the region’s TB epidemic, particularly multi-drug resistant TB cases, give us great cause for concern. The access to health services for vulnerable groups, including drug users and prisoners, is neither equitable nor sufficient.
We know that while the number of new cases has fallen significantly in most regions of the world over the last decade, it is on the rise in Eastern Europe and Central Asia, particularly in the CIS countries. In 2010 there were seven countries in the world where the number of HIV cases increased by 25 percent or more. Five of those countries were in this region.
TB also remains a stubborn related challenge in the CIS countries, particularly the strain resistant to drugs. Indeed, 10 of the 14 most affected countries in the world are in this region.
I also would like to remind ourselves that the cost of HIV/AIDS and TB is not only measured in human suffering, but poses a demographic and economic challenge as well. Apart from the human suffering associated with HIV and TB this dual epidemic also carries the potential for enormous economic costs as measured in terms of reduced trained labor force, job absenteeism, and increased expenditures on health and social programs.
What to Do? Given this challenging situation, and the fast approaching MDG target date of 2015, renewed commitment and action are needed on the part of all of us.
The economic slowdown and the growing fiscal deficits, particularly in the developed world, may constrain international assistance in the upcoming years. We have to realize that we will most likely need “to do more with less.” It would also be a mistake to think that countries in the region can simply treat their way out of the HIV and TB epidemics.
All of this implies that CIS countries will need to (i) prioritize interventions, and (ii) develop synergies between the MDG6 agenda and other health programs.
The evidence from successful international experience shows that it is critical to combine prevention, treatment, care, and institutional capacity building in the entire health sector. This can ensure an effective and sustained response to reduce the spread of communicable diseases such as HIV/AIDS and TB.
In the CIS, one notable shortfall to strengthening the effects of the response to the HIV and TB epidemics has been the resistance to focus prevention efforts where they produce maximum impact. I am talking about the need to target people who inject drugs, sex workers and their clients, and men who have sex with men, as well as prisoners and migrants who lack or have limited access to needed services.
Also, a concerted focus on bridging the gap between HIV treatment need and HIV treatment access is essential in the CIS countries. Treatment for HIV and AIDS has expanded in some CIS countries, particularly in the Russian Federation, as a result of significantly increased budgetary allocations by the Federal Government since 2005. This is generating good health outcomes as shown, for example, in the steady reduction of HIV infected newborns of HIV infected mothers. But these efforts need to be strengthened and scaled up to meet the universal access target.
The fight against HIV-AIDS, TB, and other communicable diseases should not be seen in isolation, but as part of a system. This calls for a major focus on strengthening health systems in the CIS countries. A focus on the entire health system would help increase efficiency and effectiveness of prevention and treatment as they are mutually complementary and reinforcing.
The World Bank-funded Russia TB and AIDS Control Project that was implemented by the Russian Government with technical support from WHO over 2004-09 is a good example of this. The project supported the modernization of the entire public health laboratory network, health surveillance systems, and improved knowledge and skills of health personnel in both the prison and civilian health facilities. These were shown to be key institutional building blocks for improving program management and policy formulation, as well as for delivering effective health services.
An effective response in the CIS countries would also require improved data collection and analysis, through national health surveillance systems. As shown by the successful experience of countries such as Brazil and Thailand, accurate and timely information is a key input to identify which interventions are most effective across different groups.
Controlling blood transfusion-transmitted communicable diseases is still a public health issue in Central Asia, as documented in a recent World Bank report done with the US Center for Disease Control and WHO. This needs to be addressed with the support of the international community. Towards 2015: A Renewed Push The Russian Government has brought us together because we must do more in the CIS region to help countries achieve the MDG6 targets by 2015. We must make every effort to ensure that the promises and commitments we make here at this Forum are kept and that they help pave the way for a renewed push toward the attainment of the MDG6 targets in this region.
A renewed push requires that the governments and leaders in the CIS, with the support of international organizations, embark with courage and conviction upon a sustained collective effort to reach the MDG6 targets.
These efforts must operate in coordination with programs in other sectors. Old prejudices and ineffective practices have to be replaced; particularly those that do not take into account scientific evidence and international experiences on how to better address the needs of marginalized population groups.
Our collective efforts to mobilize the financial and technical resources needed to complement Government efforts are critical. Together we have to make sure that investments in health in the CIS are predictable and sustained, despite current economic constraints facing a large number of countries across the world. They have to target the drivers of the twin epidemics of HIV and TB, while helping to strengthen the health system as a whole.
We at the World Bank are committed to continue our support for this effort in the CIS countries as part of our Country Assistance Partnerships and our collaborative engagement with the Russian Government and other bilateral donors and international organizations.
RSS