O'Donnell, Minister State Department Foreign Affairs, at International Conference on Sector Wide approaches to Health
Address by Minister Liz O'Donnell TD, Minister of State at the Department of Foreign Affairs with Special responsibility for Development Cooperation and for Human Rights, at an International Conference on Sector Wide approaches to Health, Dublin Castle, 12 November 1997
In an increasingly cynical political environment, political leaders must sustain a strong faith in the capacity of human beings for good. It is this moral force that must guide all development efforts.
New Sense of International Community
Today, our definition of what it is to be human increasingly extends to a growing sense of international community and solidarity. Almost all civilised people recognise it as wrong that millions should die in famines; we see it as unacceptable that tyrants should violate the basic rights of their peoples. We support - in broad terms, at least - policies to bridge the gap between abject poverty and deprivation in developing countries and affluence in developed countries. There is strong democratic support for providing assistance to the poor of the world.
This may seem a rather abstract thought with which to open this Conference on sector wide approaches to health in developing countries but it goes to the heart, I believe, of what you will be considering here in Dublin Castle over the next two days.
A sectoral approach to health is about a partnership of goals and endeavours; about responding to the needs of communities; about accepting that these needs - poverty elimination, access to water, to food, to health, to education, to shelter - cannot be detached or divorced from each other into artificial or clean-cut categories. A sectoral approach is also about coherent strategy - essential to all good management.
Why we need Development Cooperation
Over recent years, some Governments in developed countries have suffered from what has been tersely but accurately called "aid fatigue". They point to demands at home as a reason for giving less to developing countries; they remark hopefully on forces of globalisation and private capital investment as a panacea that will lift all boats in all countries, rich or poor.
It needs to be said, in blunt terms, that this attractive vision is at best an exaggeration, at worst untrue.
Africa is a stark example of this fallacy of what might be termed Darwinian economics. Private aid flows to many developing countries have, it is true, increased notably in recent years but these have almost totally bypassed impoverished countries of Sub-Saharan Africa. Globalisation has made these countries not more prosperous but more marginalised. For many developing countries, their main prospect of achieving a decent life for their peoples is through concerted and coherent international action and by the provision of adequate development cooperation resources which will build local capacity.
Health Care as a Key Development Goal
In no social area, is this more true than in basic health care. The Copenhagen Social Summit may have defined for the international Community clear and concise social goals but these, to date, remain mainly an aspiration and not a reality for most developing countries.
An article in last years UNICEF report "The Progress of Nations" expressed this starkly: "children in rich countries do not die from common, preventable diseases of childhood. Children in poor countries do".
The 1997 WHO World Health Report bluntly noted that "health is influenced by social and economic circumstances over which the individual has little control, and over which the conventional health sector has also little sway". As a consequence, the WHO noted a widening and growing gap in health terms between rich and poor.
It is this reality that, above all else, provides the central justification for a sector wide approach to health care and why such a strategy makes good development cooperation sense and good economic and social sense in developing countries.
In recent years, the volume of Irish aid to the health sector has been increasing. In Uganda, Irish aid has supported the training of primary health care workers in national institutions. In Lesotho, funding has been given to the development of a national TB control programme. In South Africa, Irish aid has helped support the reform of district health services in the Free State Province. In these and many other cases, Irish aid has closely cooperated with partner countries and international agencies to ensure that national priorities are addressed.
As we look over the panorama of work which lies ahead and the distance yet to be travelled in poverty alleviation, we must not forget how much development cooperation has already achieved, including in the area of health care. Neither should we forget that money goes a long way if it is well managed. £2,000 can build a well in a poor country which dramatically alters the quality of life and health for a whole village.
For the entire international community, the AIDS epidemic represents one of the greatest scourges of our time. In the Southern African region alone, estimates indicate that the number of people with HIV infection in the area is in the region of 3-4 million people. The full resources of development cooperation and of Governments and the health sector are now required to confront this appalling situation.
The Development Assistance Committee (DAC) of the OECD last year published "Shaping the 21st Century: the contribution of Development Cooperation". It noted that over recent decades life expectancy in developing countries has risen by more than twenty years, from an average of forty one to sixty two years per person.
This is an extraordinary achievement. It is the best single answer that can be given to those who argue that development cooperation is wasted money.
Building on this achievement, the DAC has now set ambitious goals for development cooperation to be achieved by 2015. These includes that the death rate for infants and children under the age of five years should be reduced by two thirds the 1990 level by 2015. The rate of maternal mortality should be reduced by three fourths during this same period.
These are goals that Ireland warmly embraces. The Irish Government is committed to increasing our level of Development Cooperation from 0.31% of GNP this year - a level that has already significantly increased over recent years - to 0.45% of GNP in 2002. This afternoon , the Government will announce in Dail Eireann a significant increase in the Irish Aid budget for next year. This is a clear expression of our determination to expand Ireland's Development Cooperation Programmes.
I intend that the main emphasis of Ireland's bilateral aid programme will over coming years remain focussed on poverty alleviation through meeting basic needs in developing countries and in strengthening local capacity. Aid based on partnership is the way forward. Human rights and democracy will be central factors in all our development efforts.
Good health cannot be separated from tackling poverty, inadequate housing, lack of clean water, poor sanitation. There is no greater human right than the right to life itself - the right to clean water and the right not to die from preventable diseases.
That is why Irish Aid in the coming years will support health programmes not only directly but by playing our part in improving, in consultation with authorities and civil society, general social and economic conditions such as household income, housing, education, social services.
At a multilateral level, Ireland will work closely with international agencies in fostering good health care and tackling causes of health deprivation. We will continue to fund international health care programmes. We will encourage the international financial institutions, and the internationally community generally, to substantially alleviate the debt burden of the most impoverished countries.
It is pointless to talk of health care in many least developed countries when annual debt repayments are a multiple several times over of what is invested in health care or in education. This is, by any standards, an unacceptable situation. For this reason, I welcome recent progress - even if limited - towards easing the debt burden of the most heavily indebted countries. This achievement must be consolidated and extended.
We have achieved much in development cooperation over recent years. We still have a long way to go.
It is understandable that many people today see the reality of deprivation in developing countries through the lens of a CNN camera covering a humanitarian disaster.
The truth is more prosaic and was well summed up by Matthew Engel in an article in "The Guardian" last week. He wrote as follows of under - development in Africa: "It needs a Dickens rather than a news bulletin to describe it properly. And it is a reality that bears more relation to Dickensian London than to our own life in the 1990s: prone to gnawing hunger more often than utter starvation; ordinary, preventible diseases more than epidemics".
That is the scale of the challenge facing all of us in the international community. For you at this Conference, I know that this reality will be at the centre of your deliberations.
I wish you well as you consider the critical issues of health care and health protection in developing countries over the coming two days.