A decline in the world economy by 2.6 per cent this year, a fall of about 10 per cent in global trade volumes in 2009, but also upwardly revised projections of expansion of 2.5 per cent for the global economy in 2010, were among the statistics and predictions discussed within the framework of the Economic and Social Council’s high-level policy dialogue with international financial and trade institutions held this afternoon at the Palais des Nations. The high-level discussion, which was moderated by United Nations Under-Secretary-General for Economic and Social Affairs, Sha Zukang, was followed by a discussion on partnerships in health, focusing on lessons learned from multi-stakeholder initiatives.

Pascal Lamy, Director-General of the World Trade Organization (WTO), said that the multilateral trading system had always been an insurance policy and a stabilizing factor for traders around the globe, in particular for many developing countries, which were actually feeling most of the heat now. Protectionism was a real threat. So far they had not seen high intensity protectionism but a drip of measures taken by countries which had only made recovery more difficult; continuous slippage; trade restrictive measures in the form of increased tariffs, new non-tariff measures, anti-dumping and countervailing actions exceeded the number of trade opening measures. Keeping trade open was an essential ingredient to help exit the crisis.

Supachai Panitchpakdi, Secretary-General of the United Nations Conference on Trade and Development (UNCTAD), observed that the symptoms of price deflation were still there and warned that a lot of employment figures were actually overstating the situation. The international community should not be misled by the so-called "green shoots", as all the indicators were still far away from showing that things were changing positively. With regard to food security, the shift away from aid to food production in Africa was wrong – there was a need for a Green Revolution in Africa, and food was still in crisis and a matter of national security in Africa.

Murilo Portugal, Deputy Managing Director of the International Monetary Fund (IMF), said that signs were emerging that the rate of decline in global activity was moderating, but the timing and pace of a durable recovery remained still uncertain. The IMF had substantially raised lending; reformed and increased the flexibility of the lending framework; and undertaken a major advocacy effort to expand its financial resources, so as to enable it to respond to the strong increase in the demand for lending. Lending commitments were now more than 11 times bigger than in the pre-crisis period, standing at a record level of close to $160 billion, which compared with $14 billion at the end of 2007 and $82.2 billion committed in 1998 in the wake of the crisis in Asia.

Joy Phumaphi, Vice President, Human Development Network of the World Bank, said that global credit crunch, in combination with uncertainty about future demand, had delayed investment and severely reduced demand for durable goods. While gross domestic product growth in developing countries was expected to remain positive this year, the reality was that, when China and India were omitted, gross domestic product in the remaining developing countries was projected to fall by 1.6 per cent. The slowdown in economic growth and much weaker capital flows had intensified financing pressures on many developing countries, with their overall financing gap viewed to range from $350 to $635 billion in 2009.

Juan Somavia, Director General of the International Labour Organization (ILO), said two weeks ago the tripartite International Labour Conference had unanimously adopted a Global Jobs Pact. It was an urgent call to put employment and social protection at the heart of recovery policies and policies in general. The central objective was to shorten the usual lag time of several long years between growth recovery and employment recovery. The Pact recognized that the crisis had ushered a change of era: not an end to globalization but a different, better globalization, a fairer, greener, and sustainable globalization, without the imbalances that had led to this crisis without a moral compass.

In the ensuing interactive dialogue, speakers raised a number of questions and comments, including regarding the fact that developing countries were bearing the brunt of the economic crisis, for which they were not responsible, and that the root causes of the crisis had to be addressed. Developed countries had to make full use of the flexibility that was granted to them within the IMF and developing countries should not be penalized if it became important to protect their own financial structures. National Governments had the main responsibility to respond to the crisis, speakers said, but it was the international community’s responsibility to support national measures and donors should deliver on their commitments to aid. Speakers believed that development strategies should take into account the lessons learned in the economic crisis. Trade was a key engine in recovery and trade protectionism had to be avoided by all means.

During the high-level policy dialogue with the international financial and trade institutions on current developments in the world economy the following countries took the floor: Sudan, on behalf of the Group of 77 and China, Sweden, on behalf of the European Union, the Russian Federation, Indonesia, Brazil, China and Venezuela.

During the interactive dialogue on partnerships in health – lessons from multi-stakeholder initiatives, the Council heard from Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS); Philippe Douste-Blazy, Special Adviser on Innovative Financing for Development and Chair of the Board of UNITAID; Michel Kazatchkine, Executive Director of the Global Fund to Fight Aids, Tuberculosis and Malaria; Awa Marie Coll-Seck, Executive Director for the Roll Back Malaria Partnership; Marcos Espinal, Executive Secretary of the Stop TB Partnership; and Natalia Imbruglia, Spokesperson for the Campaign to End Fistula. It was noted that global health partnerships had come into being only in the last 10 years, really representing a whole new way of thinking about public health, and many examples were given of the effectiveness of partnerships in addressing diseases, in particular HIV/AIDS, tuberculosis and malaria.

Within the context of the panel discussion on partnerships in health representatives of the Philippines, Brazil and Malaysia and Barbados took the floor.

When ECOSOC meets tomorrow, Tuesday, 7 July, at 9:30 a.m., it will hear an introduction of the report of the Secretary-General on the Annual Ministerial Review followed by the National Voluntary Presentations by Bolivia, China and the Dominican Republic.

High-Level Policy Dialogue with International Financial and Trade Institutions on Current Developments in the World Economy

SYLVIE LUCAS, President of the Economic and Social Council, said this was a time when the world was in the midst of its most severe financial crisis and economic downturn since the Great Depression of 1929. Economic growth had decelerated sharply, and unemployment and poverty were on the rise. Since the 2000 Millennium Summit, the international community had made strides towards the achievement of the Millennium Development Goals, and those efforts had been helped by sustained economic growth and a near doubling of aid in the area of health from public and private sources between 2000 and 2006.

Owing to declining Government revenues and restricted access to affordable development finance, developing countries would, however, now be hard pressed to make necessary investments for achieving the Millennium Development Goals. The financial and economic crises could jeopardize future progress. One very clear lesson emerging was that sustained economic growth was the bedrock for the achievement of the Goals. The key challenge was thus to put the global economy back on track, and to ensure that actions and responses to the crisis were commensurate with its scale, depth and urgency, adequately financed, promptly implemented, and appropriately coordinated internationally. The Member States of the United Nations had called on the Council to fully take advantage of its advocacy role to promote recovery and development of the developing countries, in particular the most vulnerable.

SHA ZUKANG, Under-Secretary-General for Economic and Social Affairs, said that the United Nations forecasted that due to the world economic and financial crisis the world economy would decline by 2.6 per cent this year. For the developing world as a whole, there would be zero per capita income growth. At least 60 developing countries would face reduction in average income, with people living in sub-Saharan Africa, Western Asia and Latin America suffering the hardest. Unemployment would rise significantly and would cause significant setbacks in the fight against poverty. However, significant steps had been taken in response to the crisis: there had been a massive availability of new international liquidity and stimulus packages. Reforms of financial institutions were planned as well. To overcome the most devastating effects of the economic crisis, more measures had to be taken. Above all, more fiscal stimulus and closer international coordination of the stimulus packages were needed. Eighty percent of the stimulus was concentrated in the developed countries. Developing countries lacked the fiscal space to counteract the consequences of the crisis. Donors should accelerate the delivery for aid commitments, and lending should be stepped up substantially.

It would be critical to resist protectionist tendencies and intensify efforts to achieve a truly developmental outcome of the Doha Round of trade negotiations. Enabling a continued flow of remittances would help economic recovery in many developing countries. For humanitarian reasons as well, they must strongly resist more limits to migration and discrimination against migrant workers. The world, and the developing countries in particular, was facing multiple interconnected crises: the economic crisis, the food crisis and the increasing frequency of natural disasters. They must use the opportunity of large-scale investments to set the planet on a more equitable grow path. While the financial crisis posed many challenges, it should also be seen as an opportunity to reform health systems. Developing an agenda for health financing meant not only more money for health, but also more health for money. Mr. Sha emphasized that today, without strong links to poverty reduction, aid would not have positive impacts on the considerable gaps that existed across and within countries. In conclusion, they had to keep up the sense of urgency, for it was real. They must not lose the opportunity presented by these multiple interconnected crises to put the world on a more sustainable and equitable growth path.

PASCAL LAMY, Director-General of the World Trade Organization (WTO), said that today they were experiencing what was, by any measure, the worst economic crisis in generations and the first global crisis in the history of mankind. International trade, although one of the most regulated economic drivers, did not escape. The World Trade Organization’s economists predicted that trade volumes would fall by about 10 per cent in 2009. The multilateral trading system had always been an insurance policy and a stabilizing factor for traders around the globe, in particular for many developing countries, which were actually feeling most of the heat now. The poor and weakest economies around the world – which had in no way precipitated this crisis – would be the hardest hit. Making things worse, prices had fallen sharply for many of the commodities on which those countries depended for export earnings. The International Monetary Fund (IMF) also warned that low income countries could face deterioration in the balance of payments of roughly $165 billion. Protectionism was a real threat. So far they had not seen high intensity protectionism, but a drip of measures taken by countries which had only made recovery more difficult; continuous slippage; trade restrictive measures in the form of increased tariffs, new non-tariff measures, anti-dumping and countervailing actions exceeded the number of trade opening measures. They were also seeing bail-out packages and other rescue measures being adopted to help specific industries.

The International Labour Organization summit held two weeks ago reminded everyone of the need to resist protectionism. For this reason, ILO members had asked WTO to be vigilant and report on trade measures, which was what it had done. Three reports had been put forward to WTO members in which developments in the trading system since the crisis began were closely monitored. In today’s market there was a lack of transparency and an abnormally high aversion to risk. The G-20 had made a strong start in addressing that problem by pledging $250 million to support trade finance through export credit agencies and multilateral development banks. But the contraction of trade credit was part of the broader liquidity crisis and, although they had made some progress in pushing that problem to the forefront and addressing it, developing countries in particular had reported ongoing difficulties in obtaining the bank credits they needed to finance transactions. Trade finance was the oil of global commerce. It was vital that they monitored developments in that sector, using their network of banks, Governments and international institutions. In conclusion, Mr. Lamy stressed that keeping trade open was an essential ingredient to help exit the crisis.

SUPACHAI PANITCHPAKDI, Secretary-General of the United Nations Conference on Trade and Development (UNCTAD), said the data, numbers and figures all pointed to one direction: that the world was not yet out of the woods, and should not be rejoicing too soon as to the success of the measures it had taken to emerge from the financial and economic crisis. There were still many challenges and threats around the globe. Lessons should have been learnt from the Asian crisis 12 years ago. The causes of the crisis were known, and the world needed to think ahead as to how it could emerge from it, not just to take a temporary exit, which would ensure the need to pay tolls again and again. Real experience as to how to deal with this abnormal cycle of crises needed to be gained. The world had to learn from these crises and past ones and determine what could be done in order to move forward safely. At the moment, exit strategies seemed to be mapped out mainly by the advanced economies, which was the usual way of emerging from such a situation. Countries entered into crisis mode at different times. As the crisis deepened in some countries, there was an increase in speculation that had been the making of the Asian crisis on the exchange markets. There were the makings of a new type of crisis, in parallel with the economic crisis that had been generated by the advanced economies.

Too frequently over the last weeks and months, there had been too many experts saying that the world was already seeing green shoots and a beginning of growth. That statement could do harm, as it boosted the confidence of speculators. Signals were still quite unclear. A few months ago, there had been a discussion on how to fight off deflationary effects, as deflation could be as devastating as inflation when it came to global growth. The symptoms of price deflation were still there. Moreover, a lot of employment figures were actually overstating the situation. The international community should not be misled by the so-called "green shoots", as all the indicators were still far away from showing that things were changing positively. A second round of stimulus measures could be required. With regard to food security, since the Food Summit in Rome last year, where financial pledges were made amounting to approximately $22 billion, only $2 billion had been delivered. The shift away from aid to food production in Africa was wrong – there was a need for a Green Revolution in Africa, and food was still in crisis and a matter of national security in Africa. People placed a lot of hope on the rise of China and India to improve the situation at least in Asia. However, the two of them did not have enough strength to pull all economies out of recession. Long-term development finance could not be allowed to wind down, and all efforts should be made to ensure that the official development assistance did not decline either.

MURILO PORTUGAL, Deputy Managing Director of the International Monetary Fund (IMF), said that following a steep decline in global output in the last quarter of last year and the first quarter of this year, signs were emerging that the rate of decline in global activity was moderating, but the timing and pace of a durable recovery remained still uncertain. Progress in returning the financial sector to health would be key. The updated projections of the IMF for global growth for 2009 to 2010 that would be released in the coming days would reflect a modest improvement for 2010. After the projected contraction of 1.4 per cent in 2009, the IMF was envisaging an expansion of 2.5 per cent of the global economy in 2010, which was somewhat better than its April projection of a 1.9 per cent growth for the world economy. That reflected improving prospects in emerging Asia, especially China ad India, and the United States. However, the global recovery would be fragile, with risks tilted to the downside. Inflation would likely remain contained.

The IMF had substantially raised lending; reformed and increased the flexibility of the lending framework; and undertaken a major advocacy effort to expand its financial resources, so as to enable it to respond to the strong increase in the demand for lending. Lending commitments were now more than 11 times bigger than in the pre-crisis period, standing at a record level of close to $160 billion dollars, which compared with $14 billion at the end of 2007 and $82.2 billion committed in 1998 in the wake of the crisis in Asia. In addition to its lending functions, the IMF had provided policy advice to both its advanced and its developing country members as to how to best cope with the crisis. Advice fell into to categories: the support for financial sector restructuring, which should remain the top priority; and expansionary monetary and fiscal policies to support aggregate demand, for countries that had low and sustainable debt position and access to financing to do so. As to reforms of the system of financial regulation and supervision in advanced countries, Mr. Portugal said that the priority was to ensure that regulation and supervision covered not only risks posed to an individual financial institution’s existence, but all potential sources of systemic risk arising from institutions, markets and products that were systemic. During that exercise to strengthen surveillance it was important that trends towards both globalization and innovation were preserved, since those trends had been the major sources of dynamism in the global economy over the last decades.

JOY PHUMAPHI, Vice President of the Human Development Network at the World Bank, said the global credit crunch, in combination with uncertainty about future demand, had delayed investment and severely reduced demand for durable goods. As a result, global trade and output had plummeted; world industrial production had fallen 15 per cent over the six months since the financial crisis intensified, with the failure of Lehman Brothers investment bank. While gross domestic product growth in developing countries was expected to remain positive this year, the reality was that, when China and India were omitted, gross domestic product in the remaining developing countries was projected to fall by 1.6 per cent. The slowdown in economic growth and much weaker capital flows had intensified financing pressures on many developing countries, with their overall financing gap viewed to range from $350 to $635 billion in 2009. Additionally while initially cushioned from the direct impact of the financial crisis, low-income developing countries were now being affected as the crisis impact spread through other channels. World Bank projections suggested that net private capital flows would not be enough to meet the external financing needs of many of the low-income countries, while the prospects for large increases in other sources of financing were poor.

On top of the crisis, the deadline for the Millennium Development Goals (MDGs) was six short years away. Strong economic growth in developing countries in the past decade had put the MDG for poverty reduction (halving the proportion of extreme poverty) within reach at the global level. But projected economic growth in developing countries was now on average only about a third of that forecast before the onset of the financial crisis, Mrs. Phumaphi observed. Past trends showed that a decline in the average gross domestic product growth rate in developing countries by one percentage point could trap as many as 20 million more people in extreme poverty. According to a recent World Bank study, 23 countries depended on foreign aid for more than 30 per cent of their total health spending, and that maintaining donor aid flows during a crisis was urgent in order to safeguard health services. In Rwanda and Ethiopia, foreign aid donors subsidized more than 50 per cent of total Government budgeted health spending. Governments used that aid to expand their health services, but they were highly dependent on uninterrupted aid flows to keep services available, especially for the poorest and most vulnerable groups.

JUAN SOMAVIA, Director-General of the International Labour Organization (ILO), said two weeks ago the tripartite International Labour Conference had unanimously adopted a Global Jobs Pact, negotiated by national representatives of Governments, business and trade unions of the Member States of ILO. That was an urgent call to put employment and social protection at the heart of recovery policies and policies in general. It was a portfolio of practical, operational policy options. It was the productive response of the real economy actors to the excesses and mismanagement of the financial economy that underlay this crisis. It proposed actions that could be carried out immediately, nationally and internationally. The central objective was to shorten the usual lag time of several long years between growth recovery and employment recovery. Among the policy areas covered by the pact were: promoting tripartite consultations on recovery policies; reinforcing active labour market policies; safeguarding viable jobs; supporting sustainable enterprises; protecting workers rights; investing in tomorrow's green economy; investing in food security and rural development; and dealing fairly with migrant workers.

Among salient features of the Pact were that it was a collective policy commitment by the ILO's tripartite constituency, to make employment creation and social protection a central element of all economic and social policies and of extraordinary stimulus and recovery packages; it was a comprehensive approach, with policies that could reduce social tensions, protect people in the downturn, stimulate investment and prepare the growth of tomorrow; and it was a productive vision to tackle the crisis through investment and enterprise promotion. It was not an international legal obligation, but an agreement on common policy approaches, eventually leading to national and international programmes and stronger multilateral coordination. The Pact recognized that the crisis had ushered a change of era: not an end to globalization but a different, better globalization, a fairer, greener, and sustainable globalization, without the imbalances that had led to this crisis without a moral compass. If the international community decided to address head-on the global jobs crisis, if it acted in a coordinated manner, if there was a quantum jump in cooperation across multilateral bodies, then recovery could be accelerated, the length and depth of the jobs crisis could be shortened, and the most vulnerable protected from long-term damage, and in that, a world would be built that was economically, socially, environmentally and politically sustainable.

In the ensuing debate, speakers said that at a time when the world was confronted by the most severe economic crisis, it was of vital importance that the key actors could come together to discuss in a frank and open manner the current development in the world economy. While many steps had been taken to address the crisis, it was also clear that much more needed to be done to mitigate its impact. In particular, the developing countries were bearing the brunt of the economic crisis, for which they were not responsible. The root causes of the crisis had to be addressed as well. Democratization of financing and the participation of poor countries in world finance were needed since they could not go back to the abnormal and inhuman system that prevailed a few years ago. As most developed countries would be recovering during the next years, it was impossible for developing countries to fulfil their external obligations. Developed countries had to make full use of the flexibility that was granted to them within the IMF and developing countries should not be penalized if it became important to protect their own financial structures. Speakers also underlined that all countries were affected by the economic and financial crisis.

National Governments had the main responsibility to respond to the crisis, but it was the international community’s responsibility to support national measures and donors should deliver on their commitments to aid. Countries believed that development strategies should take into account the lessons learned in the economic crisis. Several countries reiterated their pledge to carry out their commitment to support developing countries. It was stated that confidence had to be restored, protectionism rejected and the Copenhagen deal in December had to be sealed. Migrant workers played a crucial role in economic recovery and their rights had to be protected. Speakers were especially concerned about the impact of the economic crisis on global health. Trade was a key engine in recovery and trade protectionism had to be avoided by all means. The World Trade Organization’s Aid for Trade efforts should be intensified.

During the high-level policy dialogue with the international financial and trade institutions on current developments in the world economy the following countries took the floor: Sudan, on behalf of the Group of 77 and China, Sweden, on behalf of the European Union, the Russian Federation, Indonesia, Brazil, China and Venezuela.

MURILO PORTUGAL, Deputy Managing Director of the International Monetary Fund (IMF), said, in response to the remarks made by Brazil with regard to collaboration between the United Nations and the Bretton Woods institutions, that currently there was excellent collaboration with United Nations institutions. The IMF participated in several United Nations initiatives, such as the Secretary-General’s Task Force on the Food Crisis, as well as the Chief Executives Board, which produced the nine initiatives to deal with the current economic and financial crisis. There was very important and good collaboration taking place already, however, inter-governmental collaboration could be improved. It was important that that collaboration was intensified keeping in mind a pragmatic basis, where existing mechanisms and instruments were enhanced.

JOY PHUMAPHI, Vice President of the Human Development Network at the World Bank, said there was a definite need to enhance collaboration between the United Nations and the Bretton Woods institutions at country level, and to improve and harmonize technical support. Tremendous progress had been made over the past two years in harmonization. The crisis had been used as an opportunity in that regard, in particular with regard to the labour crisis. Between the IMF and the World Bank, they had been working to provide development assistance that would focus on the critical areas that could stimulate growth in the economy and protecting investments in the social sector. There was a need for a change in the governance structure of the Bretton Woods institutions, and both the World Bank and the IMF were engaged in the process of examining the system of governance in order to enhance it and improve its alignment with changing times and the development architecture and needs of developing countries. That would continue, until the structures and collaboration responded better to the needs of the developing countries.

Discussion on Partnerships in Health – Lessons From Multi-Stakeholder Initiatives

MICHEL SIDIBE, Executive Director of the Joint UN Programme on HIV/AIDS (UNAIDS), said that, to fight AIDS, partnerships with communities were crucial. It was clear that it was vital to produce results and be effective. Politicians had to sit down together and meet with others to discuss the subject and measures. During the past years, worldwide solidarity had been built and enormous resources had been devoted to the fight against AIDS. Solidarity between the North and the South had been mobilized effectively, for example, 3.2 million people were being treated in Africa today.

The aim was to break the trajectory of the disease. At the moment, when two people were put on treatment, there were five new infections at the same time. A nationalized response was needed that obliged partners and donors to align their programmes with national priorities in order to avoid duplication. Mr. Sidibé said that nothing would happen if financing were not predictable. Long-term investment was needed to make national response more effective. At the moment, 22 million people were infected in Africa. There had to be a real debate on the medication used for the treatment of AIDS, since 94 per cent of the people treated in Africa were treated with outdated medication. It was also important not to ignore the human rights debate, because the vulnerable groups did not have access to medication. A new movement had to be created, a movement called Millennium Development Goals plus AIDS. It was not acceptable that the vertical transmission of AIDS was eliminated in the developed world but that on the African continent, children were still born with AIDS.

PHILIPPE DOUSTE-BLAZY, Special Adviser on Innovative Financing for Development and Chair of the Board of UNITAID, said that within the climate of the global economic and financial crises, and with the G-20 meeting only a few weeks away, a message had to be sent about the need to maintain international aid on an ambitious scale. Currently, international aid fell short of the $50 billion which was urgently required to meet current needs. It was not possible to find that aid only via State assistance. Most countries were decreasing their level of international aid, which had resulted in a dramatic situation, with the largest nuclear weapon in the world being hunger.

There was an urgent need, together with national budgets, to come up with new sources of funding – innovative funding. It could be found through politicians, as mentioned by other panellists. For example, Gordon Brown, Prime Minister of the United Kingdom, had raised $1 million through treasury bonds. Creating partnerships with citizens was another way to come up with innovative funding sources. Sometimes one had to bypass politicians, and directly target citizens through voluntary contributions. With the advent of the Internet and credit cards, global citizens could be asked to make a contribution of $2, for example, with a purchase of airline tickets, which would change the world. Another new source of funding to be explored was creating partnerships with investors. People with money put their money in investments. Hundreds of thousands of people were ready to invest in funds – funds that showed social responsibility. In addition, one day it would be possible to convince the sovereign funds to continue in that regard. Mr. Douste-Blazy stressed that official development assistance should also not be abandoned.

MICHEL KAZATCHKINE, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said, although it sometimes seemed that the international community had been talking about the importance of partnerships in global health for many years now, they were actually something quite new, and the global health partnerships represented on the panel, which had come into being only in the last 10 years, really representing a whole new way of thinking about public health. The three major killer diseases of the developing world could not be addressed by anyone acting alone, but required a global response. Governments could not fight epidemics alone. It was really the AIDS movement that had changed the paradigm of public health from something that Governments protected to something that required the engagement and cooperation of all sectors of society. The AIDS movement had also shown that responses to virtually any major health challenge were more effective and durable if they were based on collaboration, rather than on coercion.

The response to AIDS had certainly shaped the way that the Global Fund was structured and operated. Partnerships in health were rather a new idea, based on the realization that the fight against disease required new types of relationships based on shared responsibility and accountability. Partnerships were not without risk – they were not just about clear divisions of labour or memoranda of understanding between parties; they were about everybody being prepared to surrender some of their power, share information and knowledge, set aside differences, and work towards a common goal. Further partnerships were not always easy – they required work, time, attention and open communication and finding consensus among different points of view. But a real commitment to partnership should be based on the conviction that such investments in time and effort were necessary and worthwhile for health interventions to be effective and sustainable. The Millennium Development Goals continued to provide an excellent framework for partnership in health and between health and the broader development field. With only six years to go to the 2015 deadline for the Millennium Development Goals, it had never been more important than it was today to make partnerships work in global health.

AWA MARIE COLL-SECK, Executive Director of the Roll Back Malaria Partnership, said that basic health for the world’s poor was essential to global economic prosperity. Yet the poor continued to fall sick and died from diseases that were preventable and treatable with existing public health interventions. Malaria was a case in point: 300 million people contracted the disease every year. One million of those died. They lost one African child every 30 seconds. Almost half of the world’s population continued to live in places where malaria burdened economic, health systems and communities. No Government or institution operating alone could achieve the many malaria-related Millennium Development Goals. That was where partnerships came into play. In 1998, WHO, UNICEF, the United Nations Development Programme and the World Bank had founded the Roll Back Malaria partnership to provide a coordinated global approach to fighting the disease.

Ms. Coll-Seck pointed out six examples of what the partnership on malaria was delivering to support countries to reverse all those needless deaths and suffering from malaria: coordination and harmonization; financing; integration; affordability of medicines; technology transfer; and reversing malaria cases and deaths. The most daunting challenge that had to concern all of them was to sustain their focus and financing for malaria and other major diseases, so together they could help save lives in every endemic country and community and reach the Millennium Development Goals. At a time when the health of the economy was a shared preoccupation, she invited ECOSOC to consider the economic value of partnerships in health.

MARCOS ESPINAL, Executive Secretary of the Stop TB Partnership, said that in the 1990s the Philippines had a hard time coping with tuberculosis. Most patients avoided the free-of-charge public health system and went to private doctors. There was a mix of different strategies that seemed to be heading for trouble. Then the country did something extremely smart. People realized they should work together, not in isolation. The Government actively sought to form a partnership with a variety of groups – private doctors, pharmaceutical companies, non-governmental organizations, communities and the patients themselves. And thus, the Philippine Coalition against Tuberculosis, known as PhilCAT, had been founded in 1994. The Stop TB Partnership had a set of targets in the Global Plan to Stop TB. One of the main targets was that at least 70 per cent of infectious cases should be identified and recorded; and that 85 per cent should be cured. The Philippines had exceeded those targets since 2004. And that was achieved through community-based partnerships. That story illustrated not just a success for the Philippines, but also why the world needed global partnerships against tuberculosis.

The first World Health Organization ad hoc Committee on the Tuberculosis Epidemic held in London in March 1998 had said that the main bottleneck to fighting tuberculosis was a shortage of drugs. In response, the Stop TB Partnership’s Global Drug Facility had been created in 2001. Since then, more than 14 million treatments had been delivered around the world, many of them as grants. For many years tuberculosis was an orphan of the research community. The tools currently most widely used were old. But their partners were working hard to fill that gap. A new technology able to diagnose drug-resistant tuberculosis in just two days instead of the traditional two months was being introduced by countries with the help of Stop TB partners including the World Health Organization, UNITAID and the Foundation for Innovative New Diagnostics.

NATALIA IMBRUGLIA, Spokesperson of the Campaign to End Fistula, said every minute a woman died during pregnancy or childbirth. For every woman who died, 20 to 30 women suffered a serious birth injury – and one of the more devastating of those injuries was obstetric fistula. Fistula was not something that people liked to talk about, and was a very shameful thing for the girls and women affected. Often, policymakers were not comfortable with it either. But the topic needed a voice. Thanks to money raised so far, between the campaign and Virgin Unite and the United Nations Population Fund, the joint programme had contributed to the health, economic and social upliftment of thousands of women in northern Nigeria. But it went beyond that – it was helping to ensure that fistula was no longer something that was hidden, forgotten, and unspoken.

The good news was that it was possible to end fistula and to end the suffering of millions of women. Like maternal mortality, fistula was almost entirely preventable if women had access to reproductive health care, family planning, skilled birth attendants and emergency obstetric care. And for the millions of women who were already living with fistula, simple surgery could normally treat the injury for only around 235 euros. Sadly though, most women with the condition did not know that treatment was available or simply could not afford it. Fistula should become a thing of the past. Those here today should become partners, and on their return home work to ensure that fistula and maternal health were properly addressed in their countries and integrated into healthcare systems.

In the ensuing debate, a speaker said that the Global Fund and other initiatives that had been discussed addressed very important issues. Many of the diseases that were neglected were often not given enough funding and the speaker called on countries to continue their commitments. Innovative sources of funding were necessary and creative partnerships had to be created. Everybody had to surrender some in those partnerships. Seven out of ten children infected with AIDS were treated within UNITAID, which was a fact one could be proud of. Partnership was the central issue of the discussion today. More had to be done than just distributing medications, stronger health care systems had to be created. A speaker asked if the fact that micro-contributions were unpredictable, such as a tax on airplane tickets, had any consequences. Another speaker emphasized that not all countries were convinced that air tickets did not have a negative impact on local economies that depended on tourism.

During the dialogue on partnerships in health the following delegations took the floor: the Philippines, Brazil, Malaysia and Barbados.

PHILIPPE DOUSTE-BLAZY, Special Adviser on Innovative Financing for Development and Chair of the Board of UNITAID, said it was very interesting to see, for example, concerning North-South relations in UNITAID, half of the countries had adopted a law to impose a $2 tax for airline tickets purchased. Airline companies have stated that if this $2 tax were applied it would decrease the number of sales; however, no negative effect on tourism had emerged as a result of such a tax. Concerning voluntary contributions, those contributions were of course not predictable and one could decide to contribute or not; however, if the voluntary contribution was addressed to more than 150 million people the income would be predictable, it was a simple mathematical equation, with a current total of 2.5 billion airline tickets sold. Furthermore, of the States that already submitted to include such a tax, they constituted a total of 65 per cent of the market which had already been contributing to such a measure.

MICHEL KAZATCHKINE, Executive Director, Global Fund to Fight AIDS, Tuberculosis and Malaria, in some final comments, said the fact that all were present to express their collective partnership in the panel was meaningful, but only truly meaningful if they were present at the country level, and that the country itself was in the driving seat, leading the operations. It was up to the multilaterals and bilaterals to harmonize and align around the national consensus plan, and that would only work if the country was in the driving seat.


For use of the information media; not an official record


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