Toespraak Eurocommissaris Piebalgs: 'iedereen heeft recht op gezondheidshulp' (en)

Andris Piebalgs

Commissioner for Development

Global Health: A Millennium Development Goal and a Right for All

Figures and graphics available in PDF and WORD PROCESSED

Cross Europe Conferenc e "Delivering the Right to Health with the Health MDGs, European Parliament

Brussels, 2 March 2010

Ladies and Gentlemen

Let me first thank Action for Global Health for inviting me to share my views with you, in this very timely Conference, and apologize for not being able to stay on. Let me also thank Eva Joly, and the Spanish and coming Belgian and Hungarian Presidencies for their participation today and for their commitment in our shared challenge on Global Health.

Some weeks ago I was here in the European Parliament where I pledged to stand for our EU commitments on the Millennium Development Goals, and ensure their delivery. "Delivering the Right to Health with the Health MDGs" is deeply related to these commitments.

Health is indeed a right for all: in Europe and beyond, for men and women, for the rich and the poor, for all human beings regardless of their status.

The rights' approach, which we value, is based on the universality of every human right and Europe is bound to promote and protect health as a human right. It thus requires that attention be paid to all individuals and to all health needs.

Health is also a prerequisite for economic development. With a life expectancy 30 years lower than in Europe, Sub-Saharan Africa is simply hampered in its economic growth.

The MDG framework focuses on three main priorities: mortality of children under five years (MDG4), maternal mortality (MDG5) and the impact of the major pandemics, such as HIV/AIDS and malaria (MDG6). The true reading of health is of course very much cross cutting and goes beyond these 3 objectives. It also includes nutrition, water and sanitation, gender equality, access to affordable essential medicines, sustainable health systems, availability of health professionals, etc. Aware of this cross cutting dimension, I believe however that we must first and foremost stick to the current MDG framework as the essential reference to our work on health, driver of the political momentum, and put all our energy in reaching the targets set.

And here, we have to face the facts: progress towards health-related MDGs remains totally insufficient. I will certainly not overflow you with numbers which you know better than I do. Bu t as a new comer to this field, I can share with you some which I personally find unacceptable:

Child mortality has barely been reduced in sub-Saharan Africa where 1 in 7 children still do not survive to reach their 5 th birthday. 9 million children under 5 die every year from lack of access to essential health care.

Maternal mortality is almost stagnant in sub-Saharan Africa and 200 times higher than in Europe. It is clearly the MDG that is most off track, closely related to gender inequalities and neglect of sexual and reproductive rights.

With 11% of the world's population and 24% of the global burden of disease, sub Sahara Africa only has 3% of the world's health workers.

These are not numbers. They are women and children.

While facing the reality straight in the eyes, I also want to recognize the work done. We also have so good stories to tell.

Thanks to the MDG framework and especially to the attention given to HIV/AIDS and other pandemics, we have been able to multiply by four worldwide direct aid to health since 2000, which now stands at 16 billion Euros a year. This has enabled access to HIV/AIDS treatment to over 3 million people in developing countries.

In Zambia, we have built a comprehensive and strong partnership with the Government and with all actors involved. The Commission, in close EU joint action, has contributed with predictable general and sector budget support, to health system priorities, health human resource policies and health information systems. Civil society organisations have brought their direct actions and participation in targeting specific diseases. This, together with increases in education rates, progress in gender equity, sustained economic growth have contributed to real progress. There are, of course, still problems but Zambia can now say that 80,000 children lives have been spared every year.

Now, in this global context and mixed picture, what can the EU do?

EU is the first partner of developing countries. This position gives us responsibilities and also enables us to play a leading role in the existing global health challenges. In agreement with the Spanish Presidency, the Commission is preparing a Communication on the EU's role in Global Health. The multiple challenges involved imply an intense consultation with all Commission services involved in order to best capture the complexity of the issue.

We intend to address the following priority areas:

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  The challenge of governance: The multiplicity of initiatives has resulted in increased funding but also requires stronger leadership at national and global level. The EU should strive to promote a strong vision, common voice and action in global health and should promote an inclusive framework under the UN leadership.
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  The challenge of coherence of policies: EU trade policies influence access to medicines. EU migration policies have direct implications on the capacities of partner countries to retain health professionals. EU Foreign and Security Policy needs to respond to global health threats and take into account the needs of population in fragile contexts. F ood security is closely linked with nutrition, the main attributable risk of ill health. C limate change - gradually influencing health globally- will also have a direct effect on global health. These are concrete examples of policies in which we need a proactive implication so as to contribute to the Health objective. We need proactively to ensure that policy coherence for development works for health.
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  The challenge of knowledge: We need to ensure increased level of research and development funding. Every € spent today is a € well invested and will more than pay back in the future.
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  Let me concentrate finally a bit more on the challenge of health coverage, and the direct contribution of development policy:
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  First of all, respecting our aid Commitments, ta rgeting them in priority to the MDGs where we are most lagging behind is obviously the first response. We also all know that we will not reach the MDGs with our ODA commitments alone. So we need to ensure that other, additional and innovative sources of financing are also directed towards the health sector.
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  T he increase in resources has been accompanied by an unacceptable fragmentation in the health sector. Today, there are more than 140 global health initiatives running in parallel. There were over 400 international health missions to Vietnam last year. In Rwanda, the Government has to report to donors on more than 600 health indicators. We need to avoid this fragmentation and multiplication of funds, if we are serious about applying the aid effectiveness principles in the field of health. Scattered actions can have impacts but can not guarantee sustainable progress.
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  I think we should also concretely advance on the question of division of labour applied to the Health sector.

How can we ensure that our institutional support to health systems can be more predictable and support countries that have comprehensive health plans and budget?

How can we help countries build comprehensive, sustainable and adapted health systems?

Division of labour of course concerns the Commission and the Members States. But how do we also ensure that institutional actors on the one hand and private foundations, global funds and civil society organisations on the other hand also divide the task among themselves and concentrate on where they bring the most added value?

No need to have a health system in place ready to deliver treatments or vaccines, if these are not available. Just as evident, what to do with the most efficient vaccine if you do not have the nurse to properly give it to the child?

Ladies and gentlemen,

These are preliminary thoughts I wanted to share with you on the challenges I see ahead in the field of Health. There are no magic solutions, nor one size fits all solutions. Let us look at what the situation is in Europe, where health coverage as we all know is already for us a challenge. But I believe actually that the various experiences from Member States in this field bring a valuable contribution to our dialogue with developing countries. As Nelson Mandela said, " Overcoming poverty is not a gesture of charity. It is an act of justice. It is the protection of a fundamental human right, the right to dignity and a decent life. While poverty persists, there is no true freedom ". His words very much apply to the right to health. And I will spare no efforts to promote and protect the right to health for all in my capacity as EU Commissioner for Development.

I thank you for your attention.