Bangkok--Feb 4--MFA
Thirty Years of Primary Healthcare: Discern the Past; Understand the Present and The Way Forward" Remarks by Joy Phumaphi, Vice President of the World Bank’s Human Development Network, at the opening ceremony of the Prince Mahidol Award Conference, Thursday 31 January, 2008.
Your Royal Highness,
Honorable Ministers,
Distinguished guests from far and near,
Ladies and Gentlemen,
It is my very great pleasure to be here with you this morning at this opening ceremony of the 2008 Prince Mahidol Award Conference.
Let me extend my warm thanks, and those of my President, Robert Zoellick, to Her Royal Highness, Maha Chakri Sirindhorn, and the Royal Thai government for hosting this conference to breathe new life and speed into primary healthcare systems around the world at this, the halfway point to the Millennium Development Goals.
With this task in mind, it is fitting indeed to invoke the memory and achievements of Prince Mahidol, the Father of Modern Medicine in Thailand, and a man who saw many years ago that a well-functioning public healthcare system was a cornerstone of a vibrant, modern society.
Thailand has continued to follow the tradition established by the Prince through to the present day. For example, Thailand has accomplished the enviable milestone of universal health insurance coverage; has mobilized strong community participation in primary health care; and shown the world that HIV/AIDS could be confronted with well-financed prevention, care, and treatment programs.
These programs, initiated in the 1990?s, may have prevented as many as 7 million new cases of HIV infection by 2006. Thailand is in select company here. Only a handful of other countries have been able to reverse an HIV epidemic in this way.
In the last several years, that strong health system has also allowed Thailand to cope with and contain other epidemics of global significance such as avian influenza and SARS. This a clear case of how a strong, well-functioning national health care system can not only protect the people of Thailand, but the greater worldwide community as well.
Looking more widely a-field, we can see other examples of pioneering work in strengthening systems or improving the delivery of health services by engaging with civil society groups in countries such as Cambodia, Ethiopia, Malawi and Rwanda. I look forward to learning more about innovation and results in other countries over the next several days.
Which leads me to the thought that most of the world?s development thinking cascades from wealthy OECD countries in the North, to countries in the South. I would encourage Thailand, Rwanda, Ethiopia, and other countries which have achieved significant milestones in primary healthcare to export their development experience in a South-South dialogue, to show their neighbors in South Asia, and Africa, and other regions, what works, what doesn' t, and why.
This experience in running a successful health care system or improving service delivery should not stay confined to national borders?show others what you have done, and the world will learn from you.
With the MDGs literally just around the corner, there is no question that we need all the innovation and fresh thinking we can get to meet these transformational targets. Despite some notable examples of success, we continue to see unacceptable levels of sickness and death that abandon people to grinding poverty and desperation.
Almost 11 million children die every year, mainly from preventable causes such as pneumonia, diarrhea and malaria. More than 500,000 women die during pregnancy and childbirth every year. In 2006, almost 3 million people died from HIV/AIDS. Tuberculosis is curable, yet 1.7 million people die from it every year.
Nearly one-third of children under five in the developing world remain underweight or stunted, leading to irreversible brain and physical damage. Prevention is therefore a long-term investment which greatly bene?ts both present and successive generations. Conception to 24 months of age (Minus 9 to 24 months) is a crucial window of opportunity to prevent or reduce under-nutrition.
Proven interventions already exist, which if scaled-up could reduce all child deaths by about a quarter in the short term.
A country's sustained economic growth rate is significantly influenced by the health of its people. It is little wonder, therefore, that illness is a cause of poverty as families tap into savings or sell what they own to cover the costs of medical care. If we are serious about fighting poverty, improving the perilous health of millions of the world?s poorest people must be a top priority of the global development community.
What can we do?
Allow me then to suggest three themes directions which I believe best describe what we need to do to face up to the health and development challenges standing in between us and achieving the MDGs.
(i) We need to strengthen health systems across the board;
(ii) We need to focus on verifiable results;
(iii) We all need to work together better.
(1) Stronger, integrated, health systems are an essential platform for delivering on the health-related MDGs because they enable effective universal prevention, treatment, care, and mitigation of diseases such as HIV/AIDS, TB, and malaria. They enable community engagement to reach every mother and child and all vulnerable groups; they can safeguard people?s ability to thrive, acquire valuable skills and life experience which in turn boost economic growth, and reduce the poverty caused by catastrophic illness, and provide the structural "glue" that combines multiple health-related programs within public and private sector, and civil society health programs.
In practical terms, strengthening health systems means putting together the right chain of events (financing, regulatory framework for private/public/ and civil society collaboration, governance, insurance, logistics, provider payment and incentive mechanisms, information, well-trained health workers, basic infrastructure, and supplies) to ensure that poor people get the good quality
health services they need. Many existing aid programs for health stall or actively fail because there is no functioning health system with the capacity to deliver services and drugs to the people who need them.
A strong health system does not mean we should work with just the public sector on its own. It needs to embrace all groups that produce good health outcomes including households, private providers, NGOs as well as the public sector.
The good news is that there is more health financing available to countries than ever before, some 14 billion dollars alone in the last 12 months, much of it earmarked for fighting priority diseases such as HIV/AIDS, malaria,tuberculosis, and some vaccine-preventable diseases.
To complement this situation, we need more resources to strengthen health systems at country level, to spur better integration that is so vital for core programs of maternal and child health, for nutrition, and for family planning priorities. With truly integrated health systems, we will greatly increase the returns on our investment in the big global programs for TB DOTS treatment, HIV/AIDS, and malaria.
(2) Focusing on results? without results, health system strengthening has no meaning. Without health system strengthening, there will be no results. One promising approach to strengthening health systems is?results-based financing.? In fact, using this new approach, the Bank is working with Mozambique, Rwanda, and other African countries, to help them lower their numbers of child deaths and improve their maternal health respectively.
This innovative financing approach is based on linking financing directly to verifiable results. We know for example that mothers are more likely to have successful births for their babies if they take place in health facilities where help, advice and equipment is on-hand, rather than at home. In India, for example, a government scheme convinced the majority of poor mothers in key states to have their babies in health facilities; a success made possible by subsidizing the cost of the mother's transport to and from the clinic, as well as providing incentives for the health workers to deliver better services.
Health systems, however, don't function in isolation, they need to show their worth and their value to people at the household level, at the community and local government levels, as well as the national levels. It is important to have systems that not only show results but respond to demand.
In Rwanda, for example, a results-based financing project helps the country's local municipalities to "incentivize" public, private and NGO delivery of basic health services including health promotion, behaviour change and preventive services that can be delivered at home (e.g., distribution of bed nets, hand-washing, nutrition, use of safe water systems). A recent evaluation found that the use of bed nets by children less than 5 years of age has increased from 4% in 2004 to more than 70% in 2007. The number of cases of malaria has decreased dramatically emptying paediatric wards.
Results like these really can make a difference.
(3) We need to work together better? with the health and development arena increasingly crowded by bilateral and multilateral partners, as well as new foundations and charities, it is clear that donors too have a bargain to keep. In fact, there is widespread recognition that the maternal and child survival MDG goals will not be achieved without significantly improved performance and coordination by all stakeholders within countries and internationally. .
That applies to us in the World Bank as well. This is why we have updated our health, nutrition, and population (HNP) strategy to help developing countries strengthen their health systems within a single country-driven system that is capable of ensuring that poor people get sustained access to the good quality health services needed to save and improve their lives.
This mission is strongly aligned with the newly- launched International Health Partnership (IHP) + which also aims to accelerate progress on the health MDGs by improving co-ordination of support for national health plans, and brings together international health organizations, major donor countries, as well as developing countries.
The African and Asian countries which signed the IHP in London last September agreed to accelerate action to scale up coverage and use of health services, and deliver improved outcomes against the health related MDGs and universal access commitments.
The countries, and donors in the IHP are committed to developing 'compacts' with international development partners which are expected to result in (i) an increased focus of national health strategies on health-related MDGs; (ii) improved harmonization and alignment of aid; and (iii) long term predictable financing.
While time and evaluation will tell whether this latest effort at better coordination and effectiveness is working, there can be no doubting the determination of the development community at this half-way point to the MDGs to spur better coordination and efficiency as well as leverage predicable and sustained aid delivery for health, and ensure mutual accountability and monitoring of performance.
In conclusion then, let us use this auspicious occasion today and tomorrow to step-up our efforts to help middle-income and developing countries to strengthen their health systems to achieve long-term, sustained good health, stronger growth, and more promising national prospects in the global economy.
Thank you very much.
Joy Phumaphi is Vice President of the World Bank's Human Development Network; a former WHO Assistant Director General for Family and Community Health; and a former Minister of Health in Botswana
Prime Minister at the Ministry of Foreign Affairs
Press Division, Department of Information Tel.(02) 643-5170
Fax. (02) 643-5169 E-mail : div0704@mfa.go.th End.
-PM-
Thirty Years of Primary Healthcare: Discern the Past; Understand the Present and The Way Forward" Remarks by Joy Phumaphi, Vice President of the World Bank’s Human Development Network, at the opening ceremony of the Prince Mahidol Award Conference, Thursday 31 January, 2008.
Your Royal Highness,
Honorable Ministers,
Distinguished guests from far and near,
Ladies and Gentlemen,
It is my very great pleasure to be here with you this morning at this opening ceremony of the 2008 Prince Mahidol Award Conference.
Let me extend my warm thanks, and those of my President, Robert Zoellick, to Her Royal Highness, Maha Chakri Sirindhorn, and the Royal Thai government for hosting this conference to breathe new life and speed into primary healthcare systems around the world at this, the halfway point to the Millennium Development Goals.
With this task in mind, it is fitting indeed to invoke the memory and achievements of Prince Mahidol, the Father of Modern Medicine in Thailand, and a man who saw many years ago that a well-functioning public healthcare system was a cornerstone of a vibrant, modern society.
Thailand has continued to follow the tradition established by the Prince through to the present day. For example, Thailand has accomplished the enviable milestone of universal health insurance coverage; has mobilized strong community participation in primary health care; and shown the world that HIV/AIDS could be confronted with well-financed prevention, care, and treatment programs.
These programs, initiated in the 1990?s, may have prevented as many as 7 million new cases of HIV infection by 2006. Thailand is in select company here. Only a handful of other countries have been able to reverse an HIV epidemic in this way.
In the last several years, that strong health system has also allowed Thailand to cope with and contain other epidemics of global significance such as avian influenza and SARS. This a clear case of how a strong, well-functioning national health care system can not only protect the people of Thailand, but the greater worldwide community as well.
Looking more widely a-field, we can see other examples of pioneering work in strengthening systems or improving the delivery of health services by engaging with civil society groups in countries such as Cambodia, Ethiopia, Malawi and Rwanda. I look forward to learning more about innovation and results in other countries over the next several days.
Which leads me to the thought that most of the world?s development thinking cascades from wealthy OECD countries in the North, to countries in the South. I would encourage Thailand, Rwanda, Ethiopia, and other countries which have achieved significant milestones in primary healthcare to export their development experience in a South-South dialogue, to show their neighbors in South Asia, and Africa, and other regions, what works, what doesn' t, and why.
This experience in running a successful health care system or improving service delivery should not stay confined to national borders?show others what you have done, and the world will learn from you.
With the MDGs literally just around the corner, there is no question that we need all the innovation and fresh thinking we can get to meet these transformational targets. Despite some notable examples of success, we continue to see unacceptable levels of sickness and death that abandon people to grinding poverty and desperation.
Almost 11 million children die every year, mainly from preventable causes such as pneumonia, diarrhea and malaria. More than 500,000 women die during pregnancy and childbirth every year. In 2006, almost 3 million people died from HIV/AIDS. Tuberculosis is curable, yet 1.7 million people die from it every year.
Nearly one-third of children under five in the developing world remain underweight or stunted, leading to irreversible brain and physical damage. Prevention is therefore a long-term investment which greatly bene?ts both present and successive generations. Conception to 24 months of age (Minus 9 to 24 months) is a crucial window of opportunity to prevent or reduce under-nutrition.
Proven interventions already exist, which if scaled-up could reduce all child deaths by about a quarter in the short term.
A country's sustained economic growth rate is significantly influenced by the health of its people. It is little wonder, therefore, that illness is a cause of poverty as families tap into savings or sell what they own to cover the costs of medical care. If we are serious about fighting poverty, improving the perilous health of millions of the world?s poorest people must be a top priority of the global development community.
What can we do?
Allow me then to suggest three themes directions which I believe best describe what we need to do to face up to the health and development challenges standing in between us and achieving the MDGs.
(i) We need to strengthen health systems across the board;
(ii) We need to focus on verifiable results;
(iii) We all need to work together better.
(1) Stronger, integrated, health systems are an essential platform for delivering on the health-related MDGs because they enable effective universal prevention, treatment, care, and mitigation of diseases such as HIV/AIDS, TB, and malaria. They enable community engagement to reach every mother and child and all vulnerable groups; they can safeguard people?s ability to thrive, acquire valuable skills and life experience which in turn boost economic growth, and reduce the poverty caused by catastrophic illness, and provide the structural "glue" that combines multiple health-related programs within public and private sector, and civil society health programs.
In practical terms, strengthening health systems means putting together the right chain of events (financing, regulatory framework for private/public/ and civil society collaboration, governance, insurance, logistics, provider payment and incentive mechanisms, information, well-trained health workers, basic infrastructure, and supplies) to ensure that poor people get the good quality
health services they need. Many existing aid programs for health stall or actively fail because there is no functioning health system with the capacity to deliver services and drugs to the people who need them.
A strong health system does not mean we should work with just the public sector on its own. It needs to embrace all groups that produce good health outcomes including households, private providers, NGOs as well as the public sector.
The good news is that there is more health financing available to countries than ever before, some 14 billion dollars alone in the last 12 months, much of it earmarked for fighting priority diseases such as HIV/AIDS, malaria,tuberculosis, and some vaccine-preventable diseases.
To complement this situation, we need more resources to strengthen health systems at country level, to spur better integration that is so vital for core programs of maternal and child health, for nutrition, and for family planning priorities. With truly integrated health systems, we will greatly increase the returns on our investment in the big global programs for TB DOTS treatment, HIV/AIDS, and malaria.
(2) Focusing on results? without results, health system strengthening has no meaning. Without health system strengthening, there will be no results. One promising approach to strengthening health systems is?results-based financing.? In fact, using this new approach, the Bank is working with Mozambique, Rwanda, and other African countries, to help them lower their numbers of child deaths and improve their maternal health respectively.
This innovative financing approach is based on linking financing directly to verifiable results. We know for example that mothers are more likely to have successful births for their babies if they take place in health facilities where help, advice and equipment is on-hand, rather than at home. In India, for example, a government scheme convinced the majority of poor mothers in key states to have their babies in health facilities; a success made possible by subsidizing the cost of the mother's transport to and from the clinic, as well as providing incentives for the health workers to deliver better services.
Health systems, however, don't function in isolation, they need to show their worth and their value to people at the household level, at the community and local government levels, as well as the national levels. It is important to have systems that not only show results but respond to demand.
In Rwanda, for example, a results-based financing project helps the country's local municipalities to "incentivize" public, private and NGO delivery of basic health services including health promotion, behaviour change and preventive services that can be delivered at home (e.g., distribution of bed nets, hand-washing, nutrition, use of safe water systems). A recent evaluation found that the use of bed nets by children less than 5 years of age has increased from 4% in 2004 to more than 70% in 2007. The number of cases of malaria has decreased dramatically emptying paediatric wards.
Results like these really can make a difference.
(3) We need to work together better? with the health and development arena increasingly crowded by bilateral and multilateral partners, as well as new foundations and charities, it is clear that donors too have a bargain to keep. In fact, there is widespread recognition that the maternal and child survival MDG goals will not be achieved without significantly improved performance and coordination by all stakeholders within countries and internationally. .
That applies to us in the World Bank as well. This is why we have updated our health, nutrition, and population (HNP) strategy to help developing countries strengthen their health systems within a single country-driven system that is capable of ensuring that poor people get sustained access to the good quality health services needed to save and improve their lives.
This mission is strongly aligned with the newly- launched International Health Partnership (IHP) + which also aims to accelerate progress on the health MDGs by improving co-ordination of support for national health plans, and brings together international health organizations, major donor countries, as well as developing countries.
The African and Asian countries which signed the IHP in London last September agreed to accelerate action to scale up coverage and use of health services, and deliver improved outcomes against the health related MDGs and universal access commitments.
The countries, and donors in the IHP are committed to developing 'compacts' with international development partners which are expected to result in (i) an increased focus of national health strategies on health-related MDGs; (ii) improved harmonization and alignment of aid; and (iii) long term predictable financing.
While time and evaluation will tell whether this latest effort at better coordination and effectiveness is working, there can be no doubting the determination of the development community at this half-way point to the MDGs to spur better coordination and efficiency as well as leverage predicable and sustained aid delivery for health, and ensure mutual accountability and monitoring of performance.
In conclusion then, let us use this auspicious occasion today and tomorrow to step-up our efforts to help middle-income and developing countries to strengthen their health systems to achieve long-term, sustained good health, stronger growth, and more promising national prospects in the global economy.
Thank you very much.
Joy Phumaphi is Vice President of the World Bank's Human Development Network; a former WHO Assistant Director General for Family and Community Health; and a former Minister of Health in Botswana
Prime Minister at the Ministry of Foreign Affairs
Press Division, Department of Information Tel.(02) 643-5170
Fax. (02) 643-5169 E-mail : div0704@mfa.go.th End.
-PM-