This morning the Economic and Social Council (ECOSOC), within the framework of its Annual Ministerial Review focusing on health, held a special event on Africa and least developed countries and heard national voluntary presentations by Sri Lanka and Sudan on progress in implementing their national development strategies towards the achievement of internationally agreed development goals, and in particular the health-related Millennium Development Goals.

Organized by the Office of the High Representative for the Least Developed Countries, Landlocked Developing Countries and Small Island Developing States and moderated by Daisy Mafubelu, Assistant Director-General of Family and Community Health at the World Health Organization, the special event on Africa and the least developed countries was co-chaired by ECOSOC President Sylvie Lucas and Cheick Sidi Diarra, United Nations Under-Secretary-General, Special Adviser on Africa and High Representative for Least Developed Countries, Landlocked Developing Countries, Small Island Developing Countries. Introducing the event, Ms. Lucas highlighted that, six years from the deadline for achieving the Millennium Development Goals, Africa and least developed countries remained off track to meeting the Goals on reducing child mortality, improving maternal health and combating infectious diseases. The slow progress in achieving the goals was largely attributed to health systems that were fragile and fragmented, to a crisis in the health sector workforce, and persisting inequalities in access to interventions that could keep people alive. Mr. Sidi Diarra particularly stressed that the human resource crisis should be addressed head on, and partnerships in global public health strengthened. The commitments made by the major donors on health Millennium Development Goals also had to be honoured despite the global economic downturn.

During the panel discussion and subsequent interactive dialogue on Africa and least developed countries – partnerships in health, speakers noted, among other things, that two thirds of the 33 million people living with AIDS lived in Africa, and over 80 per cent of all women living with the disease lived in Africa, as did more than 90 per cent of the children affected by the disease. Very urgent attention to the health workforce in African countries was needed. Also underscored was that need for strategic use of simple technologies and science for Africa and the rest of the developing world to achieve the Millennium Development Goals.

Panellists in the discussion on Africa and least developed countries – partnerships in health, were Ponmek Dalaloy, Minister of Health of the Lao People’s Democratic Republic and George Spia-Adjah Yankey, Minister of Health of Ghana; Klaus Leisinger, President and Executive Director of the Novartis Foundation for Sustainable Development, Mike Boyd, Acting Director General of the International Federation of Pharmaceutical Manufacturers and Associations, Francis Omaswa, Executive Director, African Center for Global Health and Social Transformation, and Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, participated as respondents. Also speaking in the debate were representatives of Morocco, India, Sudan, South Africa, Bangladesh, Kenya, Tanzania, Algeria and Portugal.

In a national voluntary presentation on Sri Lanka, H. A. P. Kahandaliyanage, Secretary of the Ministry of Healthcare and Nutrition of Sri Lanka, said that during almost three decades of confronting terrorism, Sri Lanka had made further gains and strides in human and social development, setting in place a supportive framework of social determinants for health. A series of socio-economic, political and institutional factors buttressed Sri Lanka’s success in the health sector, despite relatively limited resources. The State had systematically invested funds to develop human and physical resources in the public health-care sector, and those had expanded over time. Supported by high levels of literacy in society, there had also been growing awareness among the people about the benefits of good health. Health-care services had been provided free of charge and within facilities located close to clients. As a result, infant mortality had declined, placing Sri Lanka on track to achieve that Millennium Development Goal target in 2015. The maternal mortality rate was also likely to decline by 2015, thus also reaching the Goal target, and the health authorities were confident of being able to achieve complete malaria eradication by 2015.

In the discussion on Sri Lanka’s report, speakers took note, among other things, of the adoption of a national health plan for the period 2007-2016, which aimed to guarantee access to modern and high quality health. Speakers commended the fact that Sri Lanka had been one of the high-end performers in the efforts to achieve the internationally agreed development goals, including the Millennium Development Goals, as its achievements were unique, not only in the region, but also in comparison to many of the developed countries, despite its three-decade-long fight against terrorism as well as natural disasters. Several speakers asked for more information about cooperation with the international community in terms of humanitarian assistance and aid, in particular with regard to overcoming the effects of the 30-year conflict that had ravaged the country.

Speaking in the discussion on Sri Lanka were representatives of Bangladesh, Cuba, India, China, Venezuela, Pakistan, Algeria, Maldives, Morocco and the Philippines.

Eltigani Salih Fedail, Minister of International Cooperation of Sudan, presenting Sudan's national report on implementation of national development strategies, said that Sudan had sought to end the conflict in the country. Without peace, there could be no health services, or development. Sudan had been promised $4.8 billion in aid, but had not received more than $30,000, disbursed by the various financial institutions as part of the Highly Indebted Poor Countries initiative. Iqbal Ahmed Al Basheer, Deputy Under-Secretary of the Ministry of Health of Sudan, providing additional information, noted that there were only 1.5 health-care providers for every 1,000 people in Sudan. That issue affected the distribution of health services, which were markedly unequal. With regard to combating HIV/AIDS, malaria and other diseases, only 4 per cent of the population knew how to prevent HIV/AIDS. Only 55.1 per cent of the total population used improved water sources or had access to them, and only 31.4 per cent had access to sanitary means of excreta waste disposal. One of the major challenges, reducing child mortality, was due to a lack of an information system that allowed the health service to monitor trends. In addition, only 58.1 per cent of births were attended by qualified health personnel and the maternal mortality ratio itself was one the highest in the world – 1,106.7 per 100,000 women of reproductive age on average.

In the dialogue on Sudan, speakers noted Sudan was a developing country which had been afflicted by conflict, which had dramatically diminished its opportunities for development. Poverty affected 50 to 60 per cent of the population, in the North and more predominantly in the South of the country. Child mortality rates were alarming. Particularly noteworthy was Sudan’s basic nutrition plan, the nutrition emergency package, and the food fortification strategy. Speakers called on the international community to strengthen its support for Sudan, and Sudan, for its part, was urged to continue to cooperate with its partners for the full realization of the Millennium Development Goals.

Speaking in the discussion on Sudan were representatives of China, Algeria, Cuba, Japan, the Philippines, Brazil, Barbados, Saint Lucia and Kazakhstan.

Guy Mettan, Head of the Club Suisse de la Presse, moderated the discussions on the national voluntary presentations.

The Council will meet again at 3 p.m. this afternoon to begin its general debate of the high-level segment. At the beginning of the meeting the Council will hear an introduction of the report of the Secretary-General on the thematic discussion entitled “Current global and national trends and their impact on social development, including public health”, followed by a statement by the Chairperson of the Committee for Development Planning, Professor Ffrench-Davies.


National Voluntary Presentation on Sri Lanka

H. A. P. KAHANDALIYANAGE, Secretary of the Ministry of Healthcare and Nutrition of Sri Lanka, presenting Sri Lanka's national report on efforts with regard to national development strategies and commitments to achieve internationally agreed development goals, including the Millennium Development Goals, said the realization of those goals required global partnerships. The Economic and Social Council (ECOSOC) had a long tradition of bringing multiple stakeholders in the global, social and economic sectors together. Sri Lanka was confident that the policy dialogue on the health-care sector taking place at this year's high-level segment would make a constructive contribution towards realizing the health-related Millennium Development Goals by 2015. Sri Lanka was early among developing countries to understand the importance of investing in human resources, gender equality and social development. In Sri Lanka, a large share of public expenditure had been allocated over the years to free education, free health services, food subsidies and subsidized credit with a view to improving living standards and ensuring minimum consumption levels, especially in rural areas. Those policies aimed at developing the full human potential were set against a firm commitment to democratic values embodied in democratic political institutions and electoral systems, based on universal adult franchise.

It had been said that the countries furthest away from achieving the Millennium Development Goals were those in conflict or those recently emerging from conflict; this had not been the case in Sri Lanka. During almost three decades of confronting terrorism, Sri Lanka had made further gains and strides in human and social development, setting in place a supportive framework of social determinants for health. A series of socio-economic, political and institutional factors buttressed Sri Lanka’s success in the health sector, despite relatively limited resources. The State had systematically invested funds to develop human and physical resources in the public health-care sector, and those had expanded over time. Supported by high levels of literacy in society, there had also been growing awareness among the people about the benefits of good health. Health-care services had been provided free of charge and within facilities located close to clients. A private sector had been allowed to expand in order to provide an alternative treatment source that would help reduce Government health-care costs. The health-care system that operated was one of pluralistic care, with a significantly large segment occupied by indigenous systems of medicine. The health-care sector contribution to human development came from both preventive and curative care.

The impact of Government policies on health-care indicators had been impressive, Mr. Kahandaliyanage highlighted. Infant mortality had declined, placing Sri Lanka on track to achieve that Millennium Development Goal target in 2015. The maternal mortality rate was also likely to decline by 2015, thus also reaching the Goal target, and the health authorities were confident of being able to achieve complete malaria eradication by 2015. Combating HIV/AIDS had been relatively easy due to its low prevalence and truncated nature of its spread in the country. Clearly, there was more to be achieved to provide inclusive conditions of healthy life to all social groups in all areas, and in that, many institutions other than those related to health care had to play a role in creating a supportive environment. In the midst of commendable achievements, the health-care system of Sri Lanka currently operated under many challenges and stresses. Those challenges were mostly systemic and institutional, associated with the overall country situation in terms of macroeconomic, developmental, historical, social, political and legal conditions. The principle lesson that Sri Lanka's experience offered was that human development could be brought to high levels even at low levels of per capita income through systematic and well thought out interventions by the State. To give sustainability to the process, however, there was a need for strong economic growth and an enabling global environment.

FAIYAZ M. KAZI (Bangladesh) said that Sri Lanka’s presentation today demonstrated the clear commitment to ensure basic heath care for all its citizens. Bangladesh complimented Sri Lanka on its high and sustained literacy rate, which had a positive impact on its health care system. Sri Lanka’s steady growth rate through the past 5 years was also remarkable. The hallmark of the Sri Lankan success in many issues was its resilience. The Sri Lankan health service infrastructure had shown an impressive capacity to withstand and surmount challenges. It was true that the tsunami in 2004 had put the health system under serious strain. In that context, Bangladesh wanted to know how Sri Lanka had incorporated its health strategy in its strategy for disaster reduction. Concerning health financing, did Sri Lanka intend to establish any mechanism, such as health insurance systems, for pulling in private resources that were not benefiting the private sector? In terms of the Millennium Development Goals, Bangladesh had concerns relating to maternal mortality. Noting that Sri Lanka had achieved a 97.6 per cent skilled attendance at delivery, which had reduced maternal mortality, Bangladesh wanted to know how Sri Lanka had gone about ensuring that success rate.

RESFEL PINO ALVAREZ (Cuba) said there was now a clear picture of the efforts made by Sri Lanka to ensure a better level of social justice and equity in the country, despite challenges faced in combating poverty and dealing with the aftermath of the conflict in the country. The steps taken by the Sri Lankan Government to eradicate poverty, ensure universal access to health care and education, as well as to advance social development programmes, was a sign of its commitment in meeting the Millennium Development Goals. In addition, Sri Lanka had taken effective measures to control non-communicable diseases, such as polio and malaria, among others. Cuba noted the adoption of the national health plan for the period 2007-2016, which aimed to guarantee access to modern and high quality health care. The Government’s aim to ensure the full realization of the right to development for the people in Sri Lanka was also welcomed. It was essential to have political will, which Sri Lanka had, but also financial resources, through international cooperation and assistance. In that context, Cuba asked Sri Lanka to elaborate on the assistance it had received, and if they could provide additional information on the challenges taken or faced in the climate of the post-conflict situation in the country.

ACHAMKULANGARE GOPINATHAN (India) commended the fact that Sri Lanka had been one of the high-end performers in the efforts to achieve the internationally agreed development goals, including the Millennium Development Goals, as its achievements were unique, not only in the region, but also in comparison to many of the developed countries, despite its three-decade-long fight against terrorism as well as natural disasters. India asked what the trend of expenditure on public health care had been in Sri Lanka over the years? There were also challenges in providing health care for the displaced in the aftermath of the conflict, and the Government should explain how it planned to meet that challenge, and from what policy perspectives. The scale of assistance being received for the health sector from the international community should also be elaborated.

CHEN ZHU (China) was pleased to see that Sri Lanka had overcome many challenges and had achieved remarkable progress meeting the Millennium Development Goals. Sri Lanka had formulated strategies for the health sector in line with its national priorities, which were to promote the health of women and children. Sri Lanka had set a great example for other developing countries. Sri Lanka and China faced a number of similar problems, for example the ageing population. China hoped that Sri Lanka’s health strategies would have further success and supported Sri Lanka in its efforts to achieve the Millennium Development Goals.

JULIO CESAR ALVIAREZ (Venezuela) said that Venezuela recognized the efforts made by the Government of Sri Lanka to uphold economic and social rights, and in particular the right to development, which was an inalienable and universal right. Sri Lanka’s presentation gave a clearer picture to the international community of the process under way to promote those rights in the country, and restore a state of normalcy in the post-conflict era. Particularly noteworthy, was the national health plan 2007-2016. Venezuela asked Sri Lanka to explain how cooperation with the international community was carried out on the ground, in terms of humanitarian assistance and aid to overcome the devastating effects of the conflict that had ravaged the country for more than 30 years?

ASAD M. KHAN (Pakistan) said Sri Lanka was one of the few developing countries that had made sustained investments in human and social programmes, and that was now bearing fruit, with nearly universal primary education and increasing life expectancy, showing that it was well on track to achieving all the health-related Millennium Development Goal targets. The return to normalcy after decades of terrorism should give further momentum to those achievements. That all persons had access to a health-services outlet within a three-kilometre radius was important. What measures were being taken to bring the indigenous traditional Ayurvedic system into mainstream health-care, and to increase its standards? Also, how did the Government plan to balance competing health system demands in a context of an aging population?

BOUALEM CHEBIHI (Algeria) said that Algeria had become aware of the tremendous efforts undertaken by Sri Lanka to achieve the Millennium Development Goals. Those lessons had to be shared with other countries since they had been achieved during a long conflict. Sri Lanka had noted that the international assistance it enjoyed was limited, and Algeria wished for further clarification. Algeria also urged the international community to support the Sri Lankan authorities in their efforts and local communities, which had demonstrated their capacity to deal with the tsunami.

AMINATH JAMEEL (Maldives) said the Maldives was the closest neighbour of Sri Lanka, and as it too went through the experiences of the tsunami, it congratulated Sri Lanka for its success achieved thus far, despite its long-term wartime history. It was now clear that there was a political will to promote rights in the country, and the Maldives was confident that Sri Lanka would successfully address the challenges it faced. The Maldives asked the delegation of Sri Lanka, how was the indigenous medicine system integrated into the mainstream health care system, and how did the Government undertake providing health care to all citizens in the country?

NOUZHA SKALLI (Morocco) congratulated Sri Lanka for the efforts and achievements that placed them on the right path to achieve the Millennium Development Goals, despite the difficulties such as the tsunami and the conflict. The achievements in terms of bringing down the rate of maternal mortality were particularly welcomed. However clarification was needed. The report showed that that was lower than one – and the meaning of that figure was unclear. The downturn in maternal mortality was a real success story – bringing that figure down was also linked to combating violence against women. In that connection, what legislation existed to bring about voluntary interruption of pregnancy? Also, was there a form of participatory governance, and what was women's place in decision-making at the national and regional level?

ERLINDA BASILIO (Philippines) commended Sri Lanka on its impressive track record in delivering health services to all its citizens. The Philippines was confident that Sri Lanka would be able to achieve its Millennium Development Goals. Sri Lanka was asked to provide more information about the problem in the north and east of the country. Sri Lanka was working very hard in those post-conflict zones and the programmes would require resources, human and financial resources. If Sri Lanka could comment more on that matter, ECOSOC would get a broader picture about the support needed.

H. A. P. KAHANDALIYANAGE, Secretary of the Ministry of Healthcare and Nutrition of Sri Lanka, in response to questions and comments, said that non-communicable diseases were a major challenge for the future, and as a result the Government had developed a national policy for future decisions to be based on. The policy focused more on prevention, promotion and the complications of the diseases. Funds had been allocated to support that policy measure. In addition to national strategies on non-communicable diseases, support from the World Health Organization (WHO) and the World Bank, among others, had also received in that regard.

On measures taken to reduce maternal mortality, there was a very good health structure in Sri Lanka, based on the six building block guidelines recommended by WHO, which had contributed to that gain. Regarding the statistics on maternal mortality, it was 3.7 per 1,000 live births, and that was the way in which the statistic as included in the report should be read. On issues related to the conflict, the Government had made plans to resettle the internally displaced persons in the country. However, assistance from development partners and international partners was still needed. The World Bank alone had donated $12 million specifically for that issue, and help had also being received from WHO, the United Nations Children’s Fund (UNICEF) and others in the resettlement of internally displaced persons. With respect to indigenous medicines, there was a separate ministry for indigenous medicines, which helped to continue to develop traditional medicine systems in the country.

FERNANDO LAKSHMAN (Sri Lanka), providing complementary replies, said there was a dual system of funding which prevailed in the country. Public sector funding accounted for 48 per cent, whereas private sector funding accounted for 52 per cent of gross domestic product. Free education and health services started in 1930s after the introduction of some form of electoral system in the country. The culture that was referred to in their presentation alluded to the culture of good health practices, which had been promoted in Sri Lanka before western medicines were introduced into the country.


National Voluntary Presentation on Sudan

ELTIGANI SALIH FEDAIL, Minister of International Cooperation of Sudan, presenting Sudan's national report on implementation of national development strategies, observed that this was an important presentation, as Sudan was facing a great many challenges which it had to meet at the same time. Sudan had a great many natural and human resources, and thanks to that the challenges had become opportunities – also thanks to favourable planning. Sudan had sought to end the conflict in the country. Without peace, there could be no health services, or development. Peace, security and stability were the foundation to achieve all those goals, and Sudan had sought to build such a peace. The President, who had put an end to the war in the east of the country, and in Darfur by signing a peace agreement, had tried to contain all the deleterious effects of the conflict, particularly in the realm of health. There had been no health catastrophe in Darfur, as a genuine effort had been made to remove those negative effects and preserve and protect the health of citizens. Sudan's partners included the United Nations and the specialized agencies, which had made tremendous efforts to help the country to manage the post-conflict situation. Sudan had been promised $4.8 billion in aid, but had not received more than $30,000, disbursed by the various financial institutions as part of the Highly Indebted Poor Countries initiative. The Sudanese had to be able to live in peace.

IQBAL AHMED AL BASHEER, Deputy Under-Secretary of the Ministry of Health of Sudan, continuing the national presentation, said Sudan was a vast country, bordering on nine other countries, with generally free movement across those, with implications on health and development. The population was estimated at 40 million, with massive population movement and displacement, mainly due to civil conflict, which had both natural and man-made causes, including drought, desertification, and major floods. There was a high illiteracy rate, mainly among women, and low population awareness on health issues. There was a three-tiered health system. There were also multiple actors and partners in the health system, with Health Coordination Councils at all levels of the health system, with adequate representation of all partners to oversee the development of health policies and strategies and monitor their implementation. There was a problem with the number of health-care providers, as there were only 1.5 care providers for every 1,000 people. There was also a high turnover, especially of doctors. That issue affected the distribution of health services, which were markedly unequal.

There were only 53.7 per cent of school age children attending primary school, and there were disparities among States. The ratio of girls to boys was 93 per cent. With regard to combating HIV/AIDS, malaria and other diseases, there was only 4 per cent of the population with a comprehensive knowledge as how to prevent HIV/AIDS. Only 55.1 per cent of the total population used improved water sources or had access to them, and only 31.4 per cent had access to sanitary means of excreta waste disposal. One of the major challenges, reducing child mortality, was due to a lack of an information system that allowed the health service to monitor trends. There was still a high infant mortality rate: 80.7 out of 1,000 live births for the whole country. On improving maternal mortality, contraceptive use was very low, and only 58.1 per cent of births were attended by qualified health personnel. The maternal mortality ratio itself was one the highest in the world, 1,106.7 per 100,000 women of reproductive age on average. That was a gloomy picture, but there were still opportunities in that regard. There were efforts and opportunities for expanding child and mother access to maternity care.

CHEN ZHU (China) said that in order to achieve the Millennium Development Goals, Sudan had formulated a 25-year development strategy. That showed the seriousness with which Sudan approached the Millennium Development Goals. Sudan had made gradual progress. At the same time, in terms of human resources development, for example, Sudan still had certain challenges to face. Economic growth could not automatically result in the development of health services. Sudan should make full use of the economic growth to build basic health-care services. That would be vital to control chronic diseases and new infectious diseases. China asked for more data in terms of fiscal percentages, in terms of the gross domestic product and the distribution of medical professional among the population. China urged the international community to strengthen its support to Sudan.

IDRISS JAZAIRY (Algeria) said Sudan’s report was one of high quality and which presented important measures taken with regard to national development, despite the challenges the country faced. With respect to the fight against poverty, a recent survey as included in the report on Sudan indicated that it affected 50 to 60 per cent of the population, in the North and more predominantly in the South of the country. The child mortality rates were alarming. Sudan had a scattered population in addition to security problems, which hindered the path to achieve the Millennium Development Goals. Having said that, Algeria paid tribute to the Government of Sudan for the measures it had taken to achieve those goals. Noteworthy was the proposed five-year plan, 2007-2011. The plan was ambitious and aimed to bring about unification and peace in Sudan, based on the fair distribution of wealth, peace and the rule of law. The conflict that had broken out in Darfur had distracted the Government’s attention towards development, and had slowed down the process dramatically. The promotion of equality between the sexes, women’s rights, lowering the child mortality rate, improvement in maternal mortality, the use of contraception, improvement in measures to combat HIV/AIDS, the preservation of the environment and establishment of a global partnership for development were some of the challenges that remained.

RESFEL PINO ALVAREZ (Cuba) noted that there was a gender balance in Sudan’s delegation. The presentation had been a comprehensive, strong, and frank one, touching on achievements and efforts made to achieve the Millennium Development Goals, as well as the main challenges that Sudan still had before it in order to live up to those objectives. Sudan was a developing country which had been afflicted by a negative conflictual situation that had diminished its opportunities for development. Progress over recent years bore witness to the political will of the Government to remedy that. The efforts made to combat hunger, reduce poverty and extreme poverty, improvement in maternal mortality and child mortality and efforts to fight diseases and pandemics were noted, and positive endeavours already under way under those lines should continue. How could Sudan benefit from international cooperation on a larger scale, in particular with regard to gaining greater sources of financing, it was asked?

SHOJI MIYAGAWA (Japan) said that Japan had presented the concept of human security during its own voluntary national presentation. There was a United Nations Trust Fund for Human Security which supported a number of projects on the ground. There were also projects in Sudan, such as the safe motherhood programme. Japan supposed that that was supported by the United Nations Population Fund and the Trust Fund. Japan wanted to know whether Sudan thought that project was suitable and should be extended.

ERLINDA BASILIO (Philippines) said Sudan’s health strategy was directly in line with the objectives set out in the Millennium Development Goals. Particularly noteworthy was Sudan’s basic nutrition plan, the nutrition emergency package, and the food fortification strategy, which addressed some of the challenges the Government faced. While the Philippines noted with appreciation the measures taken to enhance the skills of medical staff and health care professionals, there was a need for more health and medical professionals. The Philippines urged Sudan to continue to cooperate with its partners for the full realization of the Millennium Development Goals, and was confident that Sudan would be successful in achieving them.

RITA BERED DE CORTIS (Brazil) said Brazil understood the difficulties in having a large territory, with populations living in hard-to-reach areas, and wished to encourage Sudan to expand access to maternal and child health services. More information should be given on what could be done to improve the situation with regard to international aid, as Sudan had noted that more cooperation on the health system was required.

CHRISTOPHER F. HACKETT (Barbados) congratulated Sudan on the achievements it had made in the attainment of the Millennium Development Goals. Primary health care was a very good idea, but the sheer size of the problem seemed to be a difficult problem. ECOSOC should call for a more genuine partnership between the international community and Sudan to see if the international community could not give more of the much needed support.

DONATUS ST AIMEE (Saint Lucia) congratulated the delegation of Sudan and associated itself with the statement made by Barbados. The presentation focused a lot on security, which had to be dealt with, but there should also be preventative efforts made in the area of nutrition and education, which would assist in the efforts made on security. Saint Lucia asked if Sudan could share some of the best practices it had experienced in developing its health-care system.

BYRGANYM AITIMOVA (Kazakhstan) also noted that there was gender equality in the Sudanese delegation. Sudan was thanked for its intention to achieve the Millennium Development Goals. It was very difficult to achieve all social needs in a country like Sudan, as it was always before the Security Council due to instability and the security situation. Kazakhstan applauded Sudan's heroism in presenting its vision of opportunities, and supported today's appeal made in the presentation to Member States to fulfil their commitments of financial support for all activities of the Government. The speaker asked what kind of coordination efforts might be needed from the international community and from United Nations bodies?

IQBAL AHMED AL BASHEER, Deputy Under-Secretary of the Ministry of Health of Sudan, responding to questions and comments raised, regarding areas for support, said that most of the support was directed at specific programmes such as vaccines or tuberculosis. Sudan needed such targeted and coordinated support rather than vertical support from different donors. Regarding the distribution of health personnel in Sudan, Sudan had recently thought of task shifting. The distribution of doctors and other staff that was already working in health services was very unequal and Sudan was now thinking of including community workers into health services.

ELTIGANI SALIH FEDAIL, Minister of International Cooperation of Sudan, in complementarity answers, said that the presentation was based on the household survey of 2006, only one year after the long war. One year was not enough to make a big difference on the ground. There was also a very sharp variation in the sectors. Sudan was trying to come up with a balance in those areas. It was also now preparing for the household survey 2010 and had tried to come up with real indicators. Regarding human security, there was no consensus. If they discussed the issue in broader terms, it had to be noted that Japan was one of the countries that had contributed largely to human development, which was more inclusive and would help Sudan to achieve more.

Special Event on Africa and the Least Developed Countries: Partnerships and Health

SYLVIE LUCAS, President of the Economic and Social Council, chairing the event, said it was an honour for her to welcome the special event on “Africa and the Least Developed Countries: Partnerships and Health – Matching Health Outcomes with Human Development”, which was held in the context of this year’s Annual Ministerial Review of the Council. Health outcomes and the development needs of Africa and the least developed countries were of a special concern to the international community and the United Nations system. Six years from the deadline for achieving the Millennium Development Goals, Africa and least developed countries remained off track to meeting the Goals on reducing child mortality, improving maternal health and combating infectious diseases. There were also critical gaps in the health outcomes across the human development universe – extreme poverty and hunger, clean water and sanitation, education and training, gender equality, environmental sustainability, and the global partnerships for development. The slow progress in achieving the goals was largely attributed to health systems that were fragile and fragmented, to a crisis in the health sector workforce, and persisting inequalities in access to interventions that could keep people alive.

The shortfall of health workers in Africa and the least developed countries required urgent action now, underscored Ms. Lucas. Indeed, the potential impact of the current global financial and economic crisis on the global public health agenda would be felt even more greatly in African and least developed countries as official development assistance flows and other financing for development threatened to decrease. An effective, functioning and accessible health workforce was more critical than ever to overcome those enormous challenges. Besides investments in a well trained and adequately remunerated health workforces, reliable health systems needed also to look at sustained investments in procurement of medicines and vaccines, as well as information systems to track health trends and detect and respond to outbreaks. Service delivery at hospitals, clinics and outreach levels that were responsive to people’s needs, as well as governance systems that ensured equity, participation and efficient use of resources, constituted other important elements of strong and effective health systems.

CHEICK SIDI DIARRA, United Nations Under-Secretary-General, Special Adviser on Africa and High Representative for Least Developed Countries, Landlocked Developing Countries and Small Island Developing States, co-chair of the Special Event, said this was perhaps the first time that a special meeting had been devoted to Africa and the least developed countries in the context of the ECOSOC Annual Ministerial Review. All were aware of the pressing needs and challenges of the poorest and most vulnerable countries in achieving the health-related Millennium Development Goals and beyond. There could be no discussion on global public health without a candid discussion on the state of healthcare in Africa and the least developed countries. Despite steady progress and extraordinary attempts at coordination across the international community, without laser-like focus on the health needs of the poorest countries, achieving the broader Millennium Development Goals would remain elusive. This meeting would focus on a number of strategic areas: strengthening health systems; attention to critical access gaps; the crisis in the health workforce; and the imperative of multi-stakeholder partnerships.

There had been an extraordinary convergence within the United Nations system on the need to focus on strengthening health systems. The problems of access to health care in the poorest countries should be viewed through the lens of extreme poverty. Therefore, there had to be concerted efforts to implement national development strategies not on one or two, but all the Millennium Development Goals. The human resource crisis should be addressed head on, and partnerships in global public health strengthened. The commitments made by the major donors on health Millennium Development Goals had to be honoured despite the global economic downturn. While the global response to HIV/AIDS, malaria and tuberculosis should continue, the international community should not lose sight of the chronic non-communicable diseases and the diseases of climate change, which would increase the burden on health-care systems in Africa and the least developed countries. It was imperative to have a holistic view of health care as an enabler of socio-economic progress.

DAISY MAFUBELU, Assistant Director-General for Family and Community Health at WHO and Moderator of the Special Event, said that the clock towards the achievement of the Millennium Development Goals in 2015 was moving fast. In this session, the ECOSOC was focusing on specifically health-related Millennium Development Goals. As to the Millennium Development Goals concerning maternal mortality, 97 per cent of the cases were in developing countries and most of them in Africa. Therefore, it was important to discuss this issue and related questions in this forum.

PONMEK DALALOY, Minister of Health of the Lao People’s Democratic Republic, said that we were living in globalized times, in which an integrated health and environment sector was becoming the ultimate goal for sustainable development. Facing an economic global crisis, many countries had pertinently invested in health and environment. As for matching health outcomes with human development needs, Maximizing global health initiatives and health systems were in fact making a strong and cohesive coordination between the tasks to be accomplished and the implementer’s impacts. Laos had, through its real practices with the Global Fund to Fight AIDS, Tuberculosis and Malaria, successfully achieved the fixed targets and achieved capacity-building. First, the Global Fund had clear scope, precise targets, comprehensive goals, objectives, appropriate strategies, measures and implementation arrangements or mechanisms and styles which were guiding Laos in its implementing and operating activities. Second, Laos was trying to strongly promote ownership, harmonization, alignment, results-based outcomes, transparency, efficiency and accountability. Facing old and new challenges in health, increasing information, education and communication for people’s participation in the health sector and health systems strengthening were imperative needs. To match health outcomes with development needs, it was important to scale up country health literacy to increase people’s participation from the bottom up. The Lao Government had implemented policies, taking agriculture, communication, education ad health as pillars and considered the health sector as the spearhead for reducing poverty and superstition.

For matching health outcomes with human development needs, they had to strongly strengthen human resources development for health from the top down. The Lao health system was formed at the grassroots level, which was the implementing level, by the health village committee, formed by the village chief, by the team of health village volunteer or workers or traditional birth attendants and others. In the Lao system, the district level was the level of planning and financing. The provincial level was the strategic level and the central had a policy and normative role. The actual health system was correct in its organization structure in the Lao context, but its staffing was not yet pertinent because in the transitional period the Lao People’s Democratic Republic was still lacking medical doctors and family medical assistance and had a shortage of midwives. For matching the health outputs with human development, Laos needed technical and financial support.

GEORGE SPIA-ADJAH YANKEY, Minister of Health of Ghana, speaking on technology and the health Millennium Development Goals, said it was becoming increasingly clear that for Africa and the rest of the developing world to achieve the Millennium Development Goals they had to make strategic use of science and technology to address the challenges of poverty, hunger and diseases in their parts of the world. For those in Africa and the rest of the developing world, technology meant the application of knowledge to solve their problems and fulfil their needs using skills, processes, techniques and tools that could be acquired within their resources. Technology was simply the application of knowledge to meet human needs. Knowledge here included both embodied and disembodied or software and hardware. Almost invariably, it was the application of the two which best met the needs of mankind. Needs in that context included, food, health, education, shelter and clothing. Many children continued to die of malaria and diseases that were easily treatable, and mothers continued to die during childbirth and diseases that had long been eradicated in some parts of the world presented formidable challenges in other areas of the globe.

Obviously, they were struggling to meet the Millennium Development Goals not because they did not have the solutions to their health problems, but because they lacked the resources to apply the tested and well rehearsed interventions where it was needed in a sustained manner, Mr. Yankey noted. While the presence of those diseases constituted a drain on their resources they had no option but to spend more on their control. In a recent study conducted in Ghana, it was observed that malaria alone required $732 million each year. That was the burden of one disease in one developing country in Africa. The development of their health infrastructure had lagged behind as a result of continuing poor investments in the health sector. Their ability to invest more in the health sector stemmed out of many factors which unfortunately had been aggravated by the global economic recession. In conclusion, he called on the international community to help assist Ghana in achieving its goals and for partners to fulfil their aid commitments. The application of technological advancements would not only be a worthwhile venture, but would also help the Government provide good health services to its people at reasonable costs.

KLAUS M. LEISINGER, President and Chief Executive Officer of the Novartis Foundation for Sustainable Development, said the facts on morbidity and mortality of the vulnerable populations in Africa and the least developed countries were well known to everybody who cared to know. Remarkable progress had been made in the past decade in improving the health of poor people in low- and middle-income countries. Responsible for the successes achieved was a coalition of motivated actors from the international community, multilateral organizations, national Governments, non-governmental organizations and the private sector. However, the progress achieved was not equally distributed among the countries, nor had it been fairly distributed within them. Different qualities of governance, different priorities in the allocation of scarce resources and differences in the cost-effectiveness of the approaches chosen had led to significant differences in the health development performance for the world's poor. There were a lot of reasons for concern that the progress that could be achieved and would be desirable would not be reached.

In that situation, it was very important to learn from best practices and apply lessons learned; to be aware that there was a distribution of responsibility and division of duty in well-organized societies; and to use all possibilities for cooperation in good faith in order to take advantage of the feasible synergies and the plurality of resources, skills and experience that could be brought together. The private sector was expected to be part of the solution and not part of the problem, first of all competing with integrity, being profitable, socially responsible, and environmentally sustainable in core competence. Enlightened nations and actors of civil society would give incentives to those companies who lived up to societal expectations, and offered and delivered solutions that could make a difference in cooperation with the other actors needed for sustainable success. If all actors would walk as they talked in international conferences and public statements, and would cooperate in good faith for the benefit of the world's poor, a new dynamic would become reality, a dynamic that made the Millennium Development Goals reachable.

MIKE BOYD, Acting Director General of the International Federation of Pharmaceutical Manufacturers and Associations, said that lasting change was rarely sudden. Over the last decade or so, a quiet transformation had been going on, strengthening the links between the developed world and Africa, especially in the area of health. The untold story of HIV/AIDS was the amount of working time lost each year to the disease; dealing with AIDS in Africa was both a humanitarian and an economic imperative. While the same was true for malaria, which historically had been a major brake on economic development of the continent, and it remained so today, costing Africa’s economy an estimated $12 billion per year. Part of the quiet transformation that had been going on was the growing involvement of the research-based pharmaceutical industry, represented at international level by the International Federation, in improving Africa’s health. All in all, their industry made a very significant contribution to helping achieve the health-related United Nations Millennium Development Goals. From their inception in 2000 to the end of 2007, their companies had made available enough medical assistance to reach 1.75 billion people, and most of those people were in Africa, because that was where the bulk of their efforts were concentrated. The value of assistance to developing countries provided by their companies in 2005 amounted to $1.5 billion – equivalent to 11 per cent of all health development aid provided that year by all the Organization for Cooperation and Development in Europe’s Governments.

The industry programmes were active in different countries: 23 in Burkina Faso, 19 in Ethiopia, 43 in Kenya, 28 in Mali, 41 in Uganda and 25 in Zambia. In Uganda, there were programmes in HIV, providing the latest antiretroviral medicines at preferential prices, but also programmes to prevent mother-to-child transmission, to help treat children with AIDS and to teach African health workers to treat AIDS effectively. There were also programmes to address malaria and other tropical diseases. Some of those programmes, such as the Mectizan Donation Programme for River Blindness, were huge, reaching over 60 million people and have been going for many years – 21 in the case of Mectizan. The Federation also ran programmes to help strengthen primary health care and health infrastructure in Africa, and in Uganda alone there were five capacity-building programmes which were not focused on any particular disease.

FRANCIS OMASWA, Executive Director of the African Centre for Global Health and Social Transformation, responding to panellists, and in particular on the human resource problem in the health sector, said the poor in Africa rated health as their first priority. Freeing people from the humiliations and indignities brought about by ill health and unmitigated disability, freeing the time and energy lost through illness, caring for the sick and burying the dead was what human development was about. Such time could be used for economic productivity, educational opportunity, recreation and social activity that dignified the human condition and bound society and made life truly worth living. The disease burden in Africa was incredibly high – both chronic and acute. For many years he had been a member of a group of surgeons who travelled to remote hospitals every three months in one of eight countries in the east, central and south regions of Africa to hold surgical camps. They were always overwhelmed by hundreds and thousands of patients, some blind from cataracts, others with bumps and lumps, women with fistula and huge uterine fibroids, young children with grotesque neglected birth defects. Among those populations premature death was accepted as normal – designated as fate or even as acts of God. Every death should be regarded as a failure of the health system.

Mr. Omaswa said that some suggestions for critical interventions, among others that held strong potential at this point in time for better health outcomes and human development in Africa, included a need to launch a vigorous advocacy campaign to reject rampant ill health and premature death and in support of strong and transformed pro-poor health systems at the same level that Africa fought for a global response to HIV/AIDS. Government leadership and stewardship was critical in that journey. Without strong Governments in Africa the change that they desired would not come. The health workforce needed very urgent attention in African countries. Africa needed a critical mass of appropriately skilled cadres of health professionals in each and every country who were motivated to serve in rural areas. They also needed to be facilitated to meet together regularly holding each other as peers to be accountable, as well as being accountable to Governments. Lastly, financing instruments for channelling money to health programmes should support integrated delivery of both personal care and public health and across the broad capacity for planning, implementation and monitoring and evaluation. Countries should find innovative ways to raise local funds for priority health programmes.

MICHEL KAZATCHKINE, President of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said the disease targeted by the Global Fund were the three diseases with the greatest human, societal and developmental impact. Two thirds of the 33 million people living with AIDS lived in Africa, and over 80 per cent of all women living with the disease lived in Africa, as did more than 90 per cent of the children affected by the disease. Africa was also, and understandably, the largest portfolio of the Global Fund, which had committed billions of dollars to fighting these diseases in sub-Saharan Africa and strengthening health systems. In the past five to six years, but particularly in the last three years, there had been tremendous progress in the fight against the three diseases. In 2002, barely anybody was accessing anti-retrovirals in Africa. Today, their number was over 3 million, more than half of whom were supported by the Global Fund, and reports showed a trend of decreasing mortality due to AIDS. There was also a significant increase in coverage preventing mother-to-child transmission of the disease, and tremendous hope had spread throughout the African continent. With regard to malaria, formerly a somewhat neglected disease, it now showed a decrease in child mortality as well as in infected cases. With regard to tuberculosis, there was also significant progress in case detection and treatment.

Huge challenges remained. There was no room for complacency. The financial and economic crisis also raised specific concerns, that donors would not sustain their commitments and official development assistance would decrease, as they struggled with the crisis. There were still huge challenges, with more than 4 million people in Africa in need of urgent AIDS treatment, with a need for universal coverage of all those at risk for malaria, urgent need to expand DOTS (the internationally recommended tuberculosis control strategy), to expand means of diagnosis of multi-drug resistant tuberculosis, and treating the latter. The first lesson learned over the last years was the feasibility of large-scale interventions in resource-constrained situations and their results. The Global Fund had learned about the power of partnerships, which was what allowed things to happen and to succeed. A partnership that included the multilateral system was truly successful. There had been significant progress made over the past two to three years with regard to partnership between the Global Fund and the multilateral system, and that was a positive advance. Partnership involved finding the right complementarity. The next lesson learned was how important it was to strengthen health systems and empower communities to implement prevention and care.

NOUZHA SKALLI (Morocco) said that the socio-economic situation of the least developed countries remained of concern. The majority of them would not reach the Millennium Development Goals. The food crisis was aggravated even more by the economic and financial crisis. In fact, the least developed countries faced stifling debt and inadequate aid levels, low participation in international trade, heightened vulnerability to climate change and spreading of disease, not to mention the backlog in human development. Morocco repeated its appeal to the international community to respect aid commitments. Morocco believed that particular attention had to be paid to least developed countries in Africa; those countries were suffering from the adverse effects of the economic crisis. Morocco had always called for initiatives to be effective. For its part, Morocco had cancelled all its bilateral debt with Africa’s least developed countries.

PRENZZT KAUR (India) said that as the adverse effects of the global economic and financial crisis on the Millennium Development Goals was likely to affect the African and least developed countries the most this event was timely. The African-Indian framework for cooperation conference held in New Delhi on 20 April 2008 had provided a solid foundation for stepped-up engagement in the future. That initiative would further enhance training, capacity-building, community health programmes and sharing of best practices. The initiative, among others, further supported the aims envisaged in meeting the Millennium Development Goals. While it might be known that 95 per cent of WHO drugs were generic drugs, it should be known that India was the largest producer of generic drugs, and had been a reliable and effective source of health-care products. India called upon all countries to respect the concept of territoriality in the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). India stood ready to work with African countries to strengthen drug price regularization.

ABDALMAHMOOD ABDALHALEE MOHAMAD (Sudan) said this debate assumed particular importance not only owing to the increased globalization of health problems, but also owing to the situation of the least developed countries in particular. Also important was the context of the current economic downturn. There was a need for a holistic approach, and the health aspect should be enhanced not only with support and technology, but also in solutions to address climate change. Special attention should be given to the development of traditional medicines and of indigenous medicines and plants. There was concern as to the lack of progress in achieving the Millennium Development Goals in the health sector in the least developed countries, and that should become a permanent item on the forthcoming Millennium Development Goal Summit and for the least developed countries.

NTHARI MATSAU (South Africa) said that health systems were now being recognized as fundamental in raising various indicators. South Africa was impressed by what Ghana had presented regarding e-health. The downside was that with e-health, development had to go together with other sectors, such as technology and electricity. As to drug prices, South Africa said that collaboration was good, but there was also room for improvement. Linked to that was also the issue of manufacturing drugs locally. Unless that was tackled, it would be a long time until the situation in least developed countries improved. Why should research-based drugs be patented for 20 years?

FAIYAZ M. KAZI (Bangladesh) said, with regard to the Asian context, it was welcoming to hear that not everything was as bleak as it was portrayed in the least developed countries in terms of achieving the Millennium Development Goals. With regard to catering for the needs of rural women suffering from snakebites in Ghana, that showed that sometimes what was needed was very basic technology to respond to the needs of a population. For instance, in Bangladesh’s experience, a simple sonar filter could protect hundreds of thousands of people from contaminated water. African countries and least developed countries capacity to develop their own responses to challenges was of the utmost importance for their sustained development.

PETER KENNETH (Kenya) said there was a need for the Council to send a special message to the Group of Eight (G-8) that the least developed countries required a Millennium Development Goal facility so as to achieve them. What were needed were additional resources, and where they had been provided, there had been improvements, particularly with regard to women and children. The developed countries had a responsibility to put together a bailout facility to improve the situation of Africa and the least developed countries.

DAVID H. MWAKYUSA (Tanzania) said that donor funding varied from country to country and in most countries health was not a priority. Fifteen per cent of overall budgets should go to health, and in Tanzania they were at 11 per cent. Tanzania was envious when listening to Sri Lanka who said that there were dependent for less than 5 per cent of assistance. The little that they had should be spent well. The least developed countries needed donor money but they also knew the different customs in their respective countries. They were asking donor countries to accept least developed countries in the driver seat. Tanzania asked donor countries to give their money as a duty to humankind.

BOUALEM CHEBIHI (Algeria) said the consequences of the global economic and financial crises were being felt, especially by the poorest populations in the world. Progress and results were not encouraging in African countries and least developed countries. The African and least developed countries suffered from a number of difficulties due to the energy, food and financial crises, leaving over 1 billion people in a precarious situation. Everyone was responsible for combating the difficulties faced by the least developed countries, and as such Algeria was ready to support them in the challenges that they faced, and in particular in achieving the Millennium Development Goals.

JOSE MARIA ALBUQUERQUE (Portugal) said the utmost importance of convening the Council in this special event could not be underestimated. Millennium Development Goal development aid was needed, but insufficient. Shortages of human resources were increasing the brain-drain of qualified health workers, especially in sub-Saharan Africa. Efforts to remedy that were under way, with centres of specialized medical training for Portuguese-speaking countries to be set up in Cape Verde. Partnerships such as those could be replicated and were a creative and cost-effective way to overcome development resource limitations.

For use of the information media; not an official record

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