PHA-Exchange> JEFFREY SACHS: Don't be cowed by international agencies!

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From: Nance <nance at TheBellsConsultants.net>

  "We need a revolution for global justice"
 
Jeffery Sachs
Chairman of the Macroeconomics and Health Commission
Director of the Columbia University Earth Institute
Special Advisor to UN Secretary General Kofi Annan
 
Jeffrey Sachs addressed several hundred high level officials, Ministers
of Health, Finance and Planning, from 40 countries, Oct 29th, during
the 
2nd global Consultation of the Macroeconomics and Health Commission, 
convened by the World Health Organisation, with the participation of
the 
IMF, the World Bank, and the Bill and Melinda Gates Foundation.
 
Highlights of speech:
 
"Inputs are needed to realize the Millenium Development Goals!
 
We need a revolution for global justice and you are leading this 
remarkable effort!
The WHO is the progenitor of all this effort-  Dr Brundtland  and now
Dr 
Lee, with Dr. Kerstin Leitner; and Dr Sergio Spinaci who is the great 
mover of this project from its inception.*
 
The Millenium Development Goals are really about health, in fact, half 
the goals are explicitly about health
Reducing poverty by half cannot be reached without dealing with health
There is no future without dealing with the health burden !
 
As a macroeconomist, I can tell you all your countries can absorb 
increased resources without destabilization!
Don't believe that if HIV is there, or malaria, you can attract 
investments!
Don't believe your children can achieve if diarrheal disease is there.
Investing in health is not a thing to do on the side, but essential for
all aspects of economic development, it is essential for success.
87 billion dollars is a benchmark
The resources are available in the world - if not available in your 
country, don't be shy in saying we need more!
We are global citizens now, borders don't protect anyone!
All countries signed the Millenium Development Goals in 2001? In 
Monterrey there was a consensus- if developing countries agree to 
transparency, we donors will fund. We urged all donor countries reach 
the Millenium Development Goals targets.
I tell my fellow Americans: just take one cent out of each one hundred 
dollars! One tenth of one cent!
Look at the cost of those troops not doing much, costing so many
billions.
 
Let's invest in people, social stability and progress rather than wait 
for the explosion that is too expensive for anyone to bear.
Don't be shy about asking. In my country there is more money than what 
we know what to do with.
It's a tragedy for you and a danger for us. Don't stop absorbing when 
life expectancy is 55 or 49!
I even heard a representative from an international institution: "Can't
scale up because nurses are dying too fast" Yet, you don't even having 
nurses on ARV in medical institutions!
 
We are on the leading edge of a complete change in international 
philosophy!
"Can't afford to think big?" I don't want to hear anyone from
Washington 
ever coming to say this!
 
First, you need a strategy- top desk drawer- universal health plan you 
had shelved it away- after Alma Ata, send me a copy, we will publicize 
it. A strategy for universal access to health services!
 
Second, you need a plan, detailed sequencing of investments, when are 
health posts to be build, nurses and doctors to be trained, bed nets, 
ARV. How to reach into communities when not enough health workers ? - 
Perhaps there could be 3 month training instead of 6 years?
 
Third, no way you can pay for that yourself- no shame in poverty, real 
circumstances of our world- solvable- Of course, there is the need for 
more percentage of GDP for health, but that's not enough, perhaps it 
could go from 5 dollars to 10 to 30 or more, per capita? It is 4500 USD
per person to run a system in my country.
We need information system- and salaries sufficient so health care 
givers don't go to London or the US. You can't pay for it? I volunteer 
the US, EU, Japanese taxpayers!
Just say: "To fund health services in my country we need 200 million or
one billion, for you said you would fund this!"
 
Fourth part: Advocacy to get that to work, get civil society on board.
When the IMF-World Bank come to you and say to always be realistic,
tell 
them:
No more social marketing, that's a way to keep bed nets into hangars
No more chloroquine, when there is artemisine and other efficient
drugs.
When IMF-World Bank, come, tell them what real realism is:  it's not 
letting people die!
You don't throw away people for 1 dollar!
 
I'm going to do some 'Alphabet soup' P.R.S.P., (Poverty Reduction 
Strategic Plans), G.F.A.T.M. (Global Fund to fight Aids, TB, Malaria)
PRSPs? You got to get bold, get real programs. I am meeting with the 
Executive board of the IMF in a couple of weeks.
PRSPs? Get real numbers into them, are you on track to reduce infant 
mortality by two third, get on track and see what's needed! In 
Bangladesh- there is arsenic in the water - 60% is drinking water 
unsafe- but donors said : "we want free solutions to that"!
You can come up with a strategy.
GFATM: almost all of you have programs, but almost all of you are too 
small, there was arm-twisting in Malawi: you wanted 100 000 under 
treatment, and donors thought it was clever to bargain you down to 25
000!
Go back to GFATM with ambitious programs!
In early 2004 there is another round, I urge all of you to submit new 
programs at national scale, I will help you fight for scaled up
program.
The World Bank ought to be giving out grants not loans
President Bush says Irakis should get grants not loans, some of us have
been making the point for 20 years. Nigeria, Nicaragua, Mozambique 
should not be saddled with that either.
 
I think, in conclusion, that we are at a very important time! You don't
want a generation of orphans from AIDS. We are not at the beginning 
stage; we are at a moment of truth,
How uncivilized to let people die for pennies!
Don't be cowed by international agencies, its time for humanity, let's 
get it done.
 
*Dr. Kerstin Leitner, is Assistant Director-General, Sustainable 
Development and Healthy Environments, WHO
Dr Sergio Spinaci is Executive Secretary, Coordination of
Macroeconomics 
and Health, WHO