PHA-Exchange> Chan, MDGs and Alma Ata

[Leslie London]

You're absolutely right, dare I say it, dead right!
We should avoid a situation where the MDGs become a substitute for the
goal of achieving the right to health and social justice.
There are (perhaps) only a (potentially useful) tool to be used to
lobby, organise, mobilise, do research and campaign for the right to
health rather than an end in themselves

Leslie London


>>> Intal - Wim De Ceukelaire <wim.deceukelaire at intal.be> 2007/08/16
09:06 pm >>>
Here's WHO director-general Chan's opening address at the
International
Conference on Health for Development in Buenos Aires, Argentina.
According to her the victory of the struggle for "Health for All" is
embodied in the Millennium Development Goals. Isn't she making a
mockery
of the right to health if she believes that the objective to reduce
child mortality by two-thirds is a call for social justice?

---


16 August 2007
The contribution of primary health care to the Millennium Development
Goals

Dr Margaret Chan

Director-General of the World Health Organization

Honourable ministers of health and foreign affairs, distinguished
delegates, ladies and gentlemen,

First and foremost, let me thank the government of Argentina and its
ministry of health for organizing this conference.

The topics being explored embrace some of the most pressing issues in
public health today.

How can we realize the great potential of health to drive human
development, as acknowledged in the Millennium Development Goals?

Obviously, if we want better health to work as a poverty reduction
strategy, we must reach the poor. And we must do so with appropriate,
high quality care.

What role can primary health care play in this quest?

What are our prospects of reaching the health-related Millennium
Development Goals?

More specifically, how can we overcome major barriers, such as weak
health systems, inadequate numbers of health care staff, and the
challenge of financing care for impoverished people?

You have been exploring these issues during the past three days, and I
look forward to your conclusions.

When I took office at the start of this year, I called for a renewed
emphasis on primary health care as an approach to strengthening health
systems.

The experiences and recommendations coming from this conference are
extremely relevant to public health today, both within countries and
for
the work of WHO.

Apart from the relevance of issues being addressed, the timing of this
conference is most opportune.

We are near the mid-point in the countdown to 2015, the year given so
much significance and promise by the Millennium Declaration and its
goals.

These goals represent the most ambitious commitment ever made by the
international community.

Their achievement would make the biggest difference in the lives and
future prospects of impoverished populations in the history of
humanity.

If the international community meets these goals, we will have the
upper
hand on ancient impediments to human development long considered
intractable: poverty, ignorance, disease, unhealthy environments, and
premature death from preventable causes.

This is our potential as we look towards the future, our unprecedented
opportunity to build a better world in the 21st century.

Looking back, we are approaching the 30th anniversary of another
historical set of commitments: the Declaration of Alma-Ata.

That document promoted primary health care as the key to attaining an
acceptable level of health for all people in this world. This was the
heart of the Health for All movement

Apart from its passionate call for equity and social justice, Health
for
All also launched a political struggle on at least three fronts.

First, it sought to make health part of the political agenda for
development, to upgrade the profile of health and increase its
prestige.

Second, it sought to broaden the approach to health, to move away from
the narrow medical model of cura
tive care. It acknowledged the power
of
prevention.

And it recognized that health has multiple determinants, including
some
in sectors other than health.

This meant that multiple sectors of government should collaborate, and
pay attention to their impact on health.

At that time, different sectors were working in an isolated,
fragmented
way according to a hierarchy that usually put health near the bottom.

On a third political front, the Declaration of Alma-Ata argued that
better health for populations should go hand-in-hand, in a mutually
supportive way, with better economic and social productivity.

That meant viewing health as far more than a burdensome political
duty,
a bottomless drain on public funds.

These, then, were some of the political struggles surrounding a
movement
launched in the name of social justice, and for the good of our common
humanity.

Ladies and gentlemen,

Let me try to capture some of the spirit of this movement with a
quote.
This is from a speech given by one of my predecessors, Dr Halfdan
Mahler, to the World Health Assembly in 1979.

That was the first Health Assembly held after the adoption of the
Alma-Ata declaration.

He said: “If human beings have the ingenuity to reach the moon and
probe
the planets, surely we will find the way to achieve our goals.”

He added: “What we need most of all is singleness of purpose,
absolute
determination to overcome obstacles, trial and error and retrial, and
refusal to retreat in frustration if progress is slower than we would
like.”

As Dr Mahler suggested, progress in improving the health of the poor,
in
reducing the great gaps in health outcomes, was indeed slower than we
would have liked.

But the Health for All movement paved the way for the even more
ambitious goals agreed on at the start of this century. The three
political struggles were victorious, and this victory is embodied in
the
Millennium Development Goals.

First, the goals place health firmly at the centre of the development
agenda.

Second, the goals make intersectoral collaboration a prerequisite for
success. They attack the root causes of poverty and acknowledge that
these causes interact.

Third, by making better health a poverty-reduction strategy, the goals
move the health sector from a mere consumer of resources to a producer
of economic gains.

In this sense, the Millennium Development Goals can be viewed as yet
another legacy of the Health for All movement and the declaration that
launched it.

The continuity is readily apparent. Both documents are visionary and
set
lofty goals. Both appeal to a set of fundamental human values.

Both express conviction that the world needs to change, and is
perfectly
capable of doing so. Doing so, moreover, is a responsibility shared by
all nations.

Both documents challenge the notion of a dog-eat-dog society, where
survival of the fittest reigns.

Both focus on the underdog, the most vulnerable populations. And both
aim to make these people fit to survive, fit to realize their human
potential.

Above all, both documents are all about equity. People should not be
robbed of opportunities to develop their human potential for unfair
reasons, including those with economic or social causes.

Ladies and gentlemen,

We have come full circle. We have again embarked on an urgent mission
aimed at reaching ambitious, time-bound goals.

We are again striving for equitable, comprehensive basic health care.

And again we make the same compelling humanitarian appeal: how can we
morally afford to let so many people suffer and die from easily
preventable or treatable causes?

But here is the difference between today and the situation in 1978. We
are departing from a higher ground, on a way paved uphill by the
struggle for health for all.

Those of us working in public health have many good reasons to be
optimistic.

Today, health enjoys support from an unprecedented number of
partnerships, foundations, and agencies implementing programmes i
n
countries.

There are more actors in health than in any other sector.

The number of innovative funding mechanisms continues to grow, as does
the size of resources they command.

There will always be unmet needs, but health has never before received
such attention or enjoyed such wealth.

Yet despite this unprecedented commitment and momentum, we are still
running behind.

In part, we are trying the catch up after years of inadequate
investment
in public health infrastructures.

More importantly, we are struggling against challenges that have grown
enormously in their complexity.

The world did not face HIV/AIDS in 1978. Since then, many diseases,
including tuberculosis and malaria, have dramatically resurged.

Globalization and rapid, unplanned urbanization have created new
problems and intensified others.

New diseases are now emerging at the unprecedented rate, on average,
of
one per year.

In many developing countries, the health burden is growing at a time
when public health is losing its capacity to respond.

The globalization of the labour market has contributed to the mass
exodus of health workers from the countries that invested in their
training.

WHO estimates that 4 million health workers are urgently needed to
provide the bare essentials of care in more than a quarter of the
world’s countries.

Chronic diseases, long considered the companions of affluent
societies,
have changed places. Low- and middle-income countries now bear the
greatest burden from these diseases.

The rise of chronic diseases has created a heavy additional burden for
health systems.

Moreover, the costs of caring for these diseases can be catastrophic
for
impoverished households, anchoring them even deeper in poverty.

Many of the world’s 1.3 billion poor still do not have access to
essential interventions because of weaknesses in the financing of
health
care.

As a result of all these trends, the gaps in health outcomes are
growing
wider.

It is by no means certain that we will reach the health-related
Millennium Development Goals.

Ladies and gentlemen,

We face a critical dilemma. Public health has effective interventions,
proven strategies for implementation, and new sources of substantial
funds.

We have unprecedented commitment.

But we are still not reaching underserved populations with
sustainable,
equitable, and comprehensive care on an adequate scale.

As I said, if we want better health to work as a poverty reduction
strategy, we must reach the poor. Here is where we fail.

In the past decade, we have seen an enormous growth in the number of
partnerships and initiatives implementing programmes in countries.

These initiatives are focused on delivering specific health outcomes.
Outcomes depend on a functioning health system. Yet the strengthening
of
health systems is rarely a core purpose of these initiatives.

Here is where all this welcome momentum reaches an impasse. Health
systems are not able to deliver interventions, on the necessary scale,
to those in greatest need.

This is not just the view of WHO.

In 2005, the Millennium Project Task Force issued its assessment of
the
prospects for achieving the goals for child and maternal health.

“The health system that should make interventions available,
accessible,
and utilized is in a crisis. Only a profound shift in how the global
health and development community thinks about and addresses health
systems can have the impact necessary to meet the Goals.”

Let us look at the reality.

The biggest impediment to achieving universal coverage with
antiretroviral drugs for HIV/AIDS is the absence of delivery systems
and
the lack of staff.

Numbers of maternal deaths will not fall until more pregnant women
have
access to skilled birth attendants and emergency obstetric care.

Child deaths from preventable causes will not drop until emergency
care
reaches neonates and children with acute respiratory infections.

Reduced morbidity and mortality from malaria 
depend on delivering
interventions to hard-to-reach populations.

When staff numbers are inadequate, directly-observed treatment for
tuberculosis is compromised, promoting the emergence of drug
resistance,
including extensively drug-resistant disease.

Ladies and gentlemen,

When I think about this dilemma, I reach two conclusions.

First, in matters of health, I believe our world is out of balance,
possibly as never before in history. We have never had such a
sophisticated arsenal of technologies for treating disease and
prolonging life.

Yet the gaps in health outcomes keep getting wider. Life expectancy
can
vary by as much as 40 years between rich and poor countries. This is
unacceptable.

An estimated 10.5 million children under the age of five die each
year.
At least 60% of these deaths could have been prevented by just a
handful
of inexpensive measures. This is not fair.

Nor is it fair that more than one million people still die each year
from such an easily preventable disease as malaria.

I am sure Dr Mahler would agree. A world that can put a man on the
moon
should be able to put more children under bednets.

My second conclusion relates directly to the topic of this conference.
I
do not believe we will be able to reach the Millennium Development
Goals
unless we return to the values, principles, and approaches of primary
health care.

Again, we turn full circle.

Decades of experience tell us that primary health care is the best
route
to universal access, the best way to ensure sustainable improvements
in
health outcomes, and the best guarantee that access to care will be
fair.

Having said this, I want to commend PAHO and its member states for
their
enduring commitment to primary health care.

Ladies and gentlemen,

I would like to suggest four principles that can guide us as we
explore
ways to achieve equity-based comprehensive health care and look at the
contribution of primary health care.

First, we must maintain our commitment, determination, and above all,
our sense of urgency. As Dr Mahler stated almost 30 years ago, our
determination must be absolute. We must refuse to retreat.

A similar reminder of the urgency of our mission was made just three
weeks ago, when Gordon Brown, the new Prime Minister of the United
Kingdom, made his first address to the United Nations.

In that speech, he expressed dismay at the lack of progress in meeting
the Millennium Development Goals.

As he stated: “It is time to call it what it is: a development
emergency
which needs emergency action.”

I agree. This is indeed an emergency. And this should be a time of
tireless action and sleepless nights for all of us with a leadership
role in health.

Second, we must hold our politicians accountable for the promises they
make, whether to their voting constituency or at international
summits.
Promises should not be broken.

Third, if we want politicians to make the right promises and keep
them,
we must provide solid evidence. Evidence gives health arguments
persuasive power at the policy level.

Primary health care is not cheap. It is not a bargain-basement way for
governments to fulfil their duty to protect all citizens from risks
and
dangers to health.

We need a better body of evidence demonstrating costs and benefits,
best
practices, interventions that work best in specific situations, and
the
impact of these interventions on health outcomes.

We need proof of programmes, and proof of progress. As I have said,
what
gets measured gets done.

Finally, we must never underestimate the power of human ingenuity.
This
power goes hand-in-hand with resolute determination to reach a goal.

As one example, determination to reach the Millennium Development
Goals
has stimulated the creation of innovative funding mechanisms.

In just the past year, we have seen the launch of UNITAID, a drug
purchasing facility which draws revenue from a tax on airline tickets.

We have also seen the launch of the International Finance Fac
ility for
Immunization. Borrowing an approach used in financial markets, this
facility is frontloading 4 billion dollars to fund the immunization,
by
2015, of 500 million children.

Again, we can do things in grand ways, on a grand scale.

As my last remark, I believe that, when we talk about primary health
care, we must also acknowledge the great ingenuity of communities.

Human nature has certain commonalities that transcend differences of
place, race, religion, and culture.

Compassion in the face of suffering and a desire to help is one common
trait. Aspiration for a better life is another.

Time and time again we see how, when communities are given
opportunities
they want and programmes they can own, they are empowered to achieve
the
lives they desire.

Given a hand up, they can indeed lift themselves out of poverty and
improve their health.

We see this with microfinancing schemes for women. We see this with
programmes where communities take charge of disease detection and drug
distribution, with rapid and sustainable improvements for health.

Ladies and gentlemen,

This, then, is part of our common humanity, as expressed in the
Millennium Declaration. These are our shared traits of compassion,
inspiration, aspiration, and great ingenuity.

Our common humanity gives us reason to care. It is why we must act
with
urgency in the face of an emergency. It is also why we have so much to
gain, in the name of social justice.

Thank you.

-- 
Wim De Ceukelaire, coordinator of intal's international partnerships
wim.deceukelaire at intal.be | tel.: +32 2 209 23 55 | fax: +32 2 209 23
51
| mobile: +32 484 119231 | skype: wimdeceuk
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