The speech “ Showcasing Health as a Foreign Policy Issue on the International Agenda” was given in conjunction with the roundtable discussion on “The Role of Foreign Policy in Synergizing Global Health Polcy for the Realization of the Millenium Development Goals”. The event was hosted by the Policy Analysis and Development Agency, Department of Foreign Affairs of Indonesia, Bogor 3 June 2009.
Dear Moderator Director General Purwandianto, National Institute of Health, Your Excellency Ambassasador Tobing, Deplu, Dr. Salunke, WHO Representative to Indonesia, Special Advisor Lukito, Departement of Health and Director Soemarno Deplu. Dear Participants, Selamat Pagi.
Thank you so much for your kind invitation to this Expert Group meeting on Global Health Policy for the Realization of the Millenium Goals, here in beautiful Bogor. The theme of the meeting made me very exited about coming. The format expert meeting however, made me quite worried. But I bring with me the strong commitment of my Government towards this meetings objective, and toward Norway’s partnership with Indonesia in promoting global health. I hope my presentation may add to your understanding of this commitment and about Norway’s thinking regarding how to promote Health as a Foreign Policy Issue on the International Agenda.
Let me start off with the partneship dimension.
In 2006, my Foreign Minister Jonas Gahr Støre invited his close colleague Foreign Minister Hassan Wirajuda, together with the foreign ministers from Brazil, France, Senegal, South Africa and Thailand, to join in declaring that global health was “a pressing foreign policy issue of our time”. In March 2007 these 7 ministers adopted the Oslo Declaration that states that investment in health is fundamental to economic growth and development. This cooperation has been informal, engaged and very useful, not least in connection with the activities in Geneva, but even beyond. Last year , the seven-country initiative led the process towards passing a resolution on global health and foreign policy by the General Assembly of the UN and anchored the issue firmly as a international political question. Foreign policy and health also serves as focus of the Annual Ministerial Review of the ECOSOC in July.
In March 2007, President Yodhoyno and our Prime Minister Jens Stoltenberg discussed Health and Development Millenium Goals during the Prime Ministers visit to Jakarta. This resulted in your President becoming a Member in the Network of Global Leaders. Last years Sherpa meeting for the Networks was held in Bali, and last month they met in Oslo, with Bapak Emil Salim again paying a leading and higly appeciated role. This Network has just drawn up a new report on The Global Campaign for Health Millenium Development Goals to be launced in New York on 15. June. Where I hope both our Foreign Ministers and the UN Secretary General will be present.
A few days later, on 18. and 19. June, Norway and Indonesia will co-host a workshop in Oslo on the biological weapons convention and disease surveillance. This is a follow-up to the very successful seminar held in Jakarta last year, done in cooperation with the UN and the World Health Organization. The workshop will highlight the fact that strengthening our health systems and disease survey capacities is our best strategy against both unintended health disasters and the possible use of biological agents as a weapon. In the process, we improve our capacity to handle the health challenges of all people, every day.
Once again Norway and Indonesia joined forces on the international arena, fostering partnership to lead other countries for a common agenda, on global health. As we do within the non-proliferation and disarmament arena, climate change and environment, peace, human rights and democracy building, in addittion to a broad and active traditional bilateral agenda.
But why Health as a Foreign Policy Issue?
In this forum I belive we all agree that health is an investment in human dignity, human development – and thus in economic development and the welfare of people, communities and nations. Investing in health is a very powerful tool in the fight against extreme poverty. Threats to health can also compromise a country’s stability and security. Building capacity for global health security, facing threats to global health and making globalisation work for all – all of this depends on conscious use of foreign policy instruments – and on political will.
Health probably tells the strongest story of globalisation. An outbreak of a pandemic for example, as we recently saw in the Americas, immediately challenges our diplomatic and security systems, and the demands on the international coordinating bodies are immense. However, without them, we would soon be left to uncoordinated closing of borders and mismatched preventive action on a national basis, with hundreds of thousands of people falling through the failing safety nets.
Global health is therefore more than an “issue”; it has to do with managing complex international relations, important principles and major challenges of inequality and injustice. It involves changing economic priorities and establishing organisations and working relationships. In short: “We must reach beyond our grasp to fulfil our task”
Let me so say a few words about the Norwegian approach:
Health has always played a major role in our development policy. Since 2000 we have scaled up. Norway has focused on taking the lead in three concrete initiatives:
First there is GAVI, an alliance of major UN organisations, governments in developed and developing countries, the vaccine industry, and private actors such as the Bill and Melinda Gates Foundation. Prime Minister Jens Stoltenberg was the first prime minister to engage his government actively in this effort, and Norway has ever since been a staunch supporter of this effort with the ambitious vision of helping to immunise every child in the world. This is a new way of working, based on public–private partnership, focusing on performance and new incentives for partners to work together.
WHO estimates that between 2000 and 2008, some 3.4 million future deaths have been prevented through immunisation campaigns supported by GAVI. It has been successful, yes. But we must constantly look for improvements, be accountable and transparent and ready to adjust as we go ahead.
Second, Norway has been actively engaged with the Global Fund to fight AIDS, tuberculosis and malaria – since its creation. As you know, the Global Fund is also made up of a creative mix of governments, private actors and support from WHO, UNAIDS and the World Bank.
We have seen a huge boost in treatment, counselling and prevention of HIV/AIDS. We have also seen the distribution of 70 million bed nets, the most cost-effective way of preventing malaria, the delivery of 74 million malaria treatments and the detection and treatment of 4.6 million additional cases of infectious tuberculosis. Today, we stand on the threshold of a real breakthrough in the battle against malaria – for so long at the core of global health efforts – and frustrations.
And third, more related to methodology, we have pushed for more results-based management. Global health issues cut across traditional organisational structures in international affairs – and should be addressed accordingly. UNAIDS was set up to work primarily through its sponsoring organisations in the UN system, while also forming partnerships with a broad range of NGOs, governments and other actors. Roll Back Malaria and Stop TB are other partnerships that were formed, anchored in the World Health Organization – reaching out.
Transparency and accountability are keys. And both may become more difficult to achieve in this new complex landscape. In order to keep the trust of both taxpayers and private investors, we must constantly improve our methods – how we spend and invest, how we monitor and report.
In a sea of challenges, let us take due note of the fact that there have been extraordinary results during this decade:
More than 200 million children have been vaccinated in low-income countries by vaccines previously not available to them.
More than 100 million bed nets have been distributed in sub-Saharan Africa. We can expect malaria mortality to be rolled back by more than 90% by 2015.
The cost of treating an AIDS patient has been reduced from more than 30 dollars a day to less than one. More than three million people are on treatment as we speak.
To sum up in two telling figures: GAVI and the Global Fund alone may have saved 6 million lives based on an investment of some 9 billion dollars.
Then some have asked: “Isn’t there a risk that we could lose coherence in our effort to promote global health if we concentrate on just a few diseases at a time? And don’t we risk losing overview by having all of these complex partnerships operating together, with nobody having an overall coordinating function?”
Those are very valid questions. And no answer should attempt to cut that debate short. It concerns the matrix of horizontal versus vertical interventions – and the governance of global health now that voluntary contributions outstrip the regular budget of WHO.
Norway’s consistent approach – as we support new partnerships and new ways of working – is to keep focusing on the need to strengthen the UN and the World Health Organization – and to keep a strong WHO at the core as our standard-setting and normative agency.
Let me then move on to the Millennium Development Goals and make a few reflections on our progress.
Norway has kept the MDGs as a guiding principle for its overall development cooperation efforts – the funding of which has now reached the historic goal that was set in 2005: 1% of GNI. Three of the MDGs are health goals, and this is where we have tried to maximise Norway’s contribution.
Important progress has been made on MDG 6, on halting and reversing the spread of HIV/AIDS, tuberculosis and malaria and making effective treatment available to all. There has been some success on MDG 4, on reducing the mortality rate of children under the age of five, primarily due to the immunisation campaigns. But the drama is still unfolding: far too many children still die of causes that are easy to prevent. This is not high tech. It is low tech.
In contrast to these relative success stories, we have failed miserably on MDG 5, on reducing maternal and infant mortality. The goal set in 2000 was to reduce maternal mortality by three quarters by 2015 and making reproductive health accessible to all.
Today, one mother and eight newborn babies die every minute – hardly any different to the situation ten years ago. These are terrible figures. It is still the case that the first day in a baby’s life is the most dangerous one. And for millions of women, nothing is more dangerous than giving birth.
On reproductive health there has been some progress as regards the availability of prenatal care, but the huge unmet needs for family planning undermine other goals.
What are the main reasons? It boils down to discrimination against women and their unmet nutritional, social and economic needs – and the lack of available and reliable quality health services.
And even where health services do exist, they tend to be poorly adapted to women’s needs and out of reach in practical terms.
We must find practical ways of addressing these issues – reaching the pregnant woman, following her through her pregnancy with enough assistance for her to make it safely to delivery.
What should so be the way forward?
Promoting effective and viable health systems is and will be vital. To reach the Millennium Development Goals by 2015, we all need to do even more for women and children. Invest more, work more closely together.
One major challenge is money – especially now that we are in the middle of a financial crisis. Aid budgets and private budgets for these purposes are sure to be reduced – although it is highly regrettable. We need to protect the health sector as best we can.
Health is simply too important to be left to health ministers alone. Finance ministers, prime ministers, presidents, and foreign ministers, are needed as well. The current global financial crisis is developing into a global economic crisis. We must now prevent it from developing into a social recession as well. In Europe, work is in progress to identify innovative financing mechanisms to help reach these goals. We need to develop new opportunities. Promising work is under-way. UNITAID is receiving additional millions from a modest tax on air tickets. Norway supports new initiatives that could stimulate other innovative financial mechanisms – from governments and individuals alike.
In addition – as I said at the start – we should see foreign policy in a broader sense through a “health lens”. The Foreign Policy and Global Health Initiative is all about engagement and outreach, building political alliances among states with different outlooks and different priorities, but with a strong and consistent political will to promote global health as a common cause.
The challenges on the health agenda are global. Indonesian and Norway must continue to work closely together in meeting these challenges. Your meeting today is important in finding common ground and how to move forward.
Thank you for your attention. Terima kasih