Address by Mr. Callisto Madavo
to the Global Health Initiative
Durban, June 5, 2001 Distinguished guests,
· Thank you for that kind introduction. It is an honor for me to be here to discuss the fight against HIV/AIDS and other communicable diseases in Southern Africa. As a development professional and a Zimbabwean, these issues are indeed near to my heart.
· Tonight, I would like to focus on three of these diseases which are wreaking such terrible destruction on our continent: HIV/AIDS, tuberculosis, and malaria.
The devastation wrought by communicable diseases
· Sadly, the devastation wrought by HIV/AIDS, TB, and malaria in Africa continues to shock even those of us who have worked on public health issues for many years.
· 70 percent of people living with HIV/AIDS worldwide are African; 81 percent of women living with HIV/AIDS are African; and, staggeringly, 92 percent of children orphaned by AIDS are African.
· Worldwide, there were an estimated 8.4 million new tuberculosis cases in 1999, up from 8.0 million in 1997. The rise has been fueled by a 20 percent increase in incidence in the African countries most affected by HIV/AIDS. Most new cases are in Southern Africa.
· In Africa, nearly one million people die of malaria-related illness every year. Of these, approximately 700,000 are children.
· These statistics continue to take my breath away. But let us not get caught up only in statistics ¯ infection rates, morbidity rates, mortality rates. Behind these numbers are real people who are dying. They are the people who toil the soil, who raise and teach our children, who care for us when we ourselves are sick.
· Indeed, some of these diseases are no longer simply a public health issue. They have become a development issue. In particular, the HIV/AIDS epidemic is threatening to wipe out most of the hard-earned gains of the last decades in a number of countries. Let me take a few examples:
· Demography. Because of HIV/AIDS, life expectancy is severely decreasing in most of Southern Africa. This will have a significant impact on the demographic growth of these countries, and on their age structure. · Growth. When adult HIV prevalence reaches 8 percent, about where it is in 19 African countries today, the cost in per capita growth is estimated to be about 0.8 percent per year. Compared to historical performance in Africa, such losses are very significant.
· Health. Health care systems are stretched beyond their limits as they deal with a growing number of AIDS patients. For example, in Zambia and Zimbabwe HIV-positive patients occupy more than 50 percent of all beds in urban hospitals.
· Education. Across Africa, teachers and students are dying or leaving school for economic reasons, because of illness, or to care for family members, reducing the demand for education and the supply of teachers. This is taking a heavy toll on Africa's future prospects.
· Private Sector. As you well know, businesses throughout Africa are facing significant increases in costs due to absenteeism, higher labor turnover, and increasing recruitment, training, and staff welfare costs.
· These are huge challenges for Africa. Fortunately there are also examples that show a possible way ahead, and therefore hope for the future:
· Some governments have decided to aggressively tackle these issues. The examples of Senegal and Uganda show that a strong government commitment, plus a willingness to involve all actors in the fight against HIV/AIDS, can slow the epidemic. · At the micro-level also, we see business and civil society getting involved, to reinforce the prevention efforts, to care for the sick and their families. During my trips in Africa, I am always moved by the commitment of these people, whether they are health professionals, business people, or community leaders. · We also have the knowledge and the tools to prevent further spread of HIV/AIDS and to care for the millions of people who are infected and affected. We have drugs to effectively prevent and fight TB and malaria.
· And we have started to pull our efforts together to have a better impact on the ground. We have built solid partnerships among all key actors, such as the International Partnership Against AIDS in Africa, Roll Bank Malaria, and Stop TB – which all provide us with excellent road maps for action.
The need to scale up
· But, unfortunately, the fight against communicable disease in Africa is still being waged on too small a scale. For example, we know that treated bed nets can prevent malaria, yet only 2 percent of African children are protected from deadly mosquitoes. We need a massive scaling up of resources ¯ both human and financial ¯ if we are going to mount an effective response.
· The challenge is twofold.
· First, there is the public health issue. Wherever possible, we need to help sick people have access to treatment and cure. This requires not just drugs, but effective systems, and especially health care staff, to deliver them. · Second, there are broader issues that require us to work across a large range of sectors: for example, to help prevent these diseases, in particular HIV/AIDS, we need to go beyond the Ministries of Health.
· But there is another challenge – it is about the way we work on these issues. None of us can address these issues alone – and we need to find ways to work together, to develop genuine partnerships in which we are jointly responsible for the outcome.
· The challenges we face call for all of us here tonight ¯ government, business, the international financial institutions and donors, and others ¯ to enter into a compact, in which we view communicable disease as our common responsibility. In short, it is time to set controversy aside, mend fences, and form a united front against the HIV/AIDS epidemic and other communicable diseases.
· So then, what roles could each of us play in this compact? What can government, business, and the World Bank as an international organization do to facilitate access to needed care, treatment, and, of course, prevention services? Let me offer some suggestions.
Governments
· African governments need to take the lead on these efforts. Our development experience shows that there can be no success without their strong commitment. They need to help mobilize the population at large, the private sector, civil society, and donors. They need to create national programs around which all parties can come together.
· For example, on HIV/AIDS, the challenge we face calls for bold political action and leadership, not merely tacit approval of public HIV/AIDS interventions. Leaders need to speak openly about HIV/AIDS, overcome taboos, and place the epidemic at the center of their development agendas. They need to help put prevention at the core of the programs.
· And indeed governments have begun to take the initiative. Heads of States met in Abuja in April 2000 to state their commitment to fight malaria, and again in April 2001 to state the same commitment against HIV/AIDS.
· More broadly, governments need to improve the health infrastructure so that people in all geographic regions and in all socioeconomic groups can have effective and affordable access to prevention and treatment. This requires in-depth reforms to ensure sustained and increased public financing – as well as a better management of available resources.
Private Sector:
· Let me turn to the private sector. I see two major roles for the private sector in fighting communicable diseases: developing affordable treatments and vaccines, and addressing HIV/AIDS in the workplace.
· Let me start by the latter. Businesses can play a crucial leadership role in the communities where they operate. They have the potential to reach millions of workers and their families with HIV/AIDS prevention, care, and treatment services. They can also mitigate the impact of the epidemic by addressing HIV/AIDS in company health and life insurance plans.
· Throughout Africa we see shining examples of business cooperation in the fight against HIV/AIDS and other communicable diseases. Let me cite a few examples gathered by UNAIDS and the Global Business Council on HIV/AIDS:
· DaimlerChrysler/South Africa is working to prevent HIV/AIDS among auto workers and their families. Under an innovative partnership with GTZ, DaimlerChrysler is implementing a comprehensive corporate policy for HIV/AIDS at several of its auto plants. · Eskom, a power and utility company here in South Africa, provides employees at all levels with peer-led HIV/AIDS education, currently covering more than 75 percent of the workforce. Eskom has incorporated HIV/AIDS campaigns into a range of company training and induction programs. I am looking forward to hearing more about Eskom activities at this Summit. · Chevron Nigeria Limited has engaged in a range of HIV/AIDS education activities as part of the Chevron Workplace AIDS Prevention Program.
· These are not isolated actions. They are part of a broader trend. I have mentioned only a few companies – but similar examples exist for malaria, for instance with Exxon-Mobil, Agip, Shell, and BP Amoco, as well as with several mining companies, and many others.
· There is another aspect of the fight against communicable diseases where the private sector is critical – and that is the development of affordable treatments.
· The private sector is leading efforts to develop treatments that prolong life for those living with HIV, as well as vaccines to defeat the virus. Pharmaceutical companies such as Boehringer Ingelheim, Bristol-Myers Squibb, Merck and others are advancing the state of the art in HIV/AIDS research, moving us to a point where HIV can be treated as a chronic illness.
· But, as we all know, HIV/AIDS drugs remain out of reach for the vast majority of the 25 million Africans who need them. Pharmaceutical companies have recently done the right thing and cut their prices to make treatments more affordable. They have also joined with international efforts to accelerate access to HIV care.
· Some have gone even further. Boehringer-Ingelheim has agreed to provide Nevirapine, a drug which can prevent mother-to-child transmission of HIV, to African governments free of charge for five years.
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We will need to find ways to launch and develop similar actions for other communicable diseases. We will need also to strike a balance between the urgency of the crisis and the need to ensure that sufficient incentives are provided for the private sector to continue engaging in a constructive partnership.
International organizations
· As an example of what international organizations can do, let me update you on our recent progress.
· First, we have developed solid partnerships with other actors such as WHO, UNICEF, the private sector, foundations, and civil society. Enhanced coordination made possible by our shared initiatives – such as the International Partnership Against AIDS in Africa, Roll Back Malaria, Stop TB, the Global Alliance for Vaccines and Immunization (GAVI), and the International AIDS Vaccine Initiative (IAVI) – has improved the impact of our efforts.
· Second, we have committed to tripling concessional (IDA) support for infectious disease control from current levels of roughly US$200 million per year to between US$600-US$700 million per year. These funds ¯ which have a grant component of 65 percent ¯ are being used to strengthen infrastructure, scale-up disease control strategies, and ensure that existing interventions ¯ ranging from condom distribution to immunization ¯ are available to all people.
· Third, we are working closely with other organizations to ensure that priority products of the future ¯ such as vaccines against AIDS and malaria ¯ are more rapidly developed and tested.
· Fourth, we have launched a sweeping new program to mobilize resources for HIV/AIDS in Africa. The Multi-Country HIV/AIDS Program (MAP) for Africa has set aside an initial amount of US$500 million in IDA credits to scale up effective HIV/AIDS prevention, care, and treatment interventions, emphasizing the role of the private sector and civil society in responding to the epidemic.
· Since September 2000, when our Board of Directors approved the MAP, we have already approved US$300 million of the initial US$500 million for projects in Cameroon, Eritrea, Ethiopia, Gambia, Ghana, Kenya, and Uganda. In the coming weeks we will allocate the remainder of the initial US$500 million for projects in Burkina Faso, Nigeria, and Zambia.
· Shortly, we will ask our Board to replenish the MAP for an additional US$500 million to scale up national HIV/AIDS programs in Benin, Burundi, the Central African Republic, Cote d'Ivoire, Guinea, Guinea-Bissau, Madagascar, Malawi, Mauritania, Mozambique, Niger, Rwanda, Senegal, Tanzania, Togo, and Zimbabwe.
· The request to our Board for the next tranche of funding will include some grant resources to deal with cross-country aspects, such as transportation corridors, that are missed by country-specific lending.
· In addition, we are preparing to extend support to the lower middle-income Sub-Saharan countries that are not eligible for IDA credits. After all, how can we focus only on lower-income countries in Africa when relatively well-off countries such as Botswana, South Africa, and Swaziland have some of the highest HIV prevalence rates in the region? The short answer is, we cannot. · Under a "mini-MAP," we are exploring possible foundation and donor funding to "buy down" standard IBRD lending terms to more concessional IDA levels. This will enable higher-income countries such as Botswana, South Africa, Swaziland and, further to the north, Gabon and Equatorial Guinea, to ask for HIV/AIDS lending without adding significantly to their national debt.
· We see MAP as an expanding partnership. To act efficiently, we in the development and business communities must act together to help scale up HIV/AIDS prevention, care, and treatment options that have proven successful. We are making every effort to ensure that World Bank support complements the work of other donors, the UN system, and the private sector. · Finally, we stand ready to participate in a new Global Fund against communicable diseases. Following the G8 summit in Okinawa, several agencies have worked together to define an instrument to substantially increase financing resources devoted to the fight against communicable diseases. These proposals are expected to be discussed at the July meeting of the G8. If we are asked to do so, we would be willing to host this fund, and to help implement it – working very closely with our partners in that area.
In conclusion
· Let me say a few more words in conclusion. The challenge is huge. No one ¯ not the Bank, not the private sector, not donor agencies, not African governments, not NGOs ¯ will be able to win this battle alone. We need to work together, under the strong leadership of the African countries themselves. And we at the Bank, in conjunction with our development partners, stand ready to do our part in a vigorous and accelerated effort to address the challenge of infectious diseases in Africa.
Thank you.
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