As delivered

Dear friends,

The right to health has been recognised as a fundamental human right since the launch of the Universal Declaration of Human Rights in 1948. A lot of people are denied that right. At least a fifth – maybe more – of the human population does not have adequate access to health services.

Still, I am not among those who preach doom and gloom and suggest that everything is going backwards. That is simply not true. In the last 50 years we have seen a greater improvement in health for more people in the world than in the previous 500 years. Life expectancy in developing countries has gone up from 46 to 64 years. Immunisation saves the lives of two million children each year. We have more knowledge, better drugs, and we reach more people.

Formidable challenges remain. Millions of parents go to bed at night praying that no member of their family will fall sick. A hospital admission can throw a whole family back into deep poverty, prevent children from getting their education, parents from getting an income. Some sell their house, if they have one, others may borrow money from loan sharks. Better and more affordable health care for the poor is an investment in development, for the individual families and for society as a whole.

In 1820 the average life expectancy in Norway was 46 years, but the people back then could not really expect to live even that long. Dysentery, diphtheria, typhoid fever, smallpox, polio, tuberculosis, cholera epidemics and plague were part of their reality.

The big gains in our own history have come from improved living conditions and access to health services. Today, a Norwegian woman can expect to live to see her eightieth birthday. Norwegians today have little knowledge of the communicable diseases that killed so many of our ancestors and made life miserable for so many others.

In the world outside Norway, over 1.3 billion people lack access to safe water. As many as half the world’s population lacks safe sanitation. An unacceptable number of people live fragile lives, suffering and dying from illnesses that are entirely preventable.

Two days ago we launched the Anniversary of the first 50 years of Norway's development co-operation with a celebration performance in the Concert Hall here in Oslo. It was attended by the Crown Prince and many others with an interest in and a commitment to the cause of development. I think it is fair to say that this broad attendance reflects the strong consensus which exists in Norway, that as one of the richest countries in the world we have a responsibility to do what we can to reduce the enormous gap between our living conditions and those of millions of people around the world who live in abject poverty.

This launching will be followed by a number of other events around the country. We will use the occasion to take stock of what we have done in the past, but the overall focus will be on the future, and on learning from the experiences of the past 50 years. This is not the place to dwell on any errors we may have made, or on our hopes and plans for the future of development co-operation. Let me all the same make a couple of observations on this score.

I guess the biggest lesson I have learnt is that development must start from within the countries themselves, that the particular situation of each country must be the point of departure for our co-operation and that they must sit in the driver's seat. Also, that development co-operation is about much more than aid; the policies industrialised countries pursue in areas such as trade, market access and trade-related areas like access to medicines are at least as important, if not more so, than aid.

I think we cannot overemphasise the importance of having achieved agreement at the global level on what the fundamental goals of development co-operation: First and foremost that poverty reduction, and ultimately, poverty eradication, is now recognised as the overarching goal by the whole development community – by the developing countries themselves, the UN, the international finance institutions and the industrialised countries. Equally important is the growing recognition that attacking poverty is about much more than increasing income and economic growth – it is about empowerment, participation, health, education, equality between women and men, respect and dignity for all.

This new understanding is embodied in the Millennium Development Goals, which increasingly serve as the common frame of reference for new undertakings in development co-operation. The Millennium Development Goals include developing a Global Partnership for Development. This goal addresses other key components that are vital to poverty eradication and sustainable development, like good governance, market access, ODA and debt relief.

At this time of year we want people to show common sense while cross-country skiing in the Norwegian mountains. "Let others know where you intend to go before you set out," is one of the common sense rules for mountain trekking. "Make sure you have a map and a compass and that you know how to use them," is another. In this case, the Millennium Development Goals represent where we are going, and the targets and indicators laid down by the Secretary-General of the United Nations are our map and compass. We are ready to go.

I will start with funding both because it is a major constraint and because it occupies a central place in the report from the Commission on Macroeconomics and Health, which Professor Sachs will take us through in his intervention later this morning.

The Commission has, I believe, made a decisive contribution to ensure that the health part of the social sector receives the funding needed to meet the bold goals set for that sector at the Millennium Summit. I see a direct link between Dr. Brundtland’s commendable initiative to establish the Commission and the 20/20 initiative, which incidentally owes a good deal to Dr. Brundtlands determination. During her former tenure as prime minister she did much to convince the world community that developed and developing countries alike should agree to devote 20 per cent of ODA and their national budget respectively to basic social services.

I think the Commission has made the right move in finding the evidence that will convince finance ministers, who generally have the final say in funding and budgetary matters - that it makes eminent sense, from a purely economic point of view, to invest massively in health. This provides us with a powerful argument to strive towards what should be the goal for everything we do in this area: the right of all human beings to the highest possible standard of health, to quote the Constitution of the WHO.

The devastating impact of the HIV/aids pandemic on the hardest hit developing countries, in terms of reduced growth alone, has opened many eyes to the need for a dramatic increase in resources to address this developmental catastrophe.

That diseases and ill health may cause economic havoc, that work productivity is harmed, that children’s ability to learn is reduced and, more generally, that the human capacity to realise its full intellectual, moral and physical potential is weakened, - all this is intuitively easy to understand.

What the Commission has done, I guess, is to provide a wider audience than the professional health people with facts and figures which give evidence to a line of reasoning that many of us have advocated without having the scientific backing now before us.

Furthermore, Professor Sachs and his colleagues seem to have reversed the causal relationship widely believed to exist between development and improved health. Thus, rather than wait for the benefits of economic growth to trickle down to the poor, we should focus on improving their health situation because that will provide a powerful spur to growth. If this view gains world-wide currency, we will be facing a very different situation.

I was particularly struck by the report's affirmation that by 2015, eight million lives could be saved and 360 million dollars generated if the donor community and the developing countries together increase their expenditure on health by 66 million dollars. If I have understood the Commission right, this would only require 0.1 per cent of donors’ GNP, while low-income developing countries would have to increase health spending by 2 per cent of GNP.

Now that we have the evidence, what should we do next? We need to create a new partnership and a pact between developed and developing countries based on the principle of cost-sharing which lay behind the 20/20 initiative. Whether this means creating new structures is something I think we have to discuss further. We must listen carefully to what the developing countries themselves have to say and perhaps link this question to the overall implementation of all the Millennium Development Goals.

For my part, I am convinced that more funding must be given to the social sector. My government’s target is to of allocate 10 per cent of our aid budget to health and 15 per cent to education. A rough estimate of where we stand now indicates that we reached the health target last year. This year, we should achieve the goal recommended by the Commission of allocating 0.1 per cent of our GNP to ODA for health purposes. I am glad to report that we have a near-national consensus that our ODA should be increased to 1 per cent of GNP. From the government side we commit ourselves to do so within 2005. We will seek to persuade other industrialised countries to do the same.

I am equally convinced, however, that funding alone, and funding only the key interventions proposed by the Commission, are not enough, neither to solve the health equation of the development challenge or achieve sustainable poverty reduction. I believe this is the Commission’s view.

In addition, there are a number of bottlenecks that have to be addressed, not least in connection with the build-up of human resources that will be needed. Striking the right balance between the role of the public and private sectors in individual countries can also be quite a challenge.

I also want to underline that the Commission sees investment in education, water and sanitation and agricultural improvement as an essential element in poverty reduction strategies, also as a way of reaching the goals set for health outcomes. I fully agree with this.

We need evidence on the benefits of investing in these sectors and, on the value – in economic terms – of pursuing gender-sensitive policies.

I am glad to note that Professor Sachs has been appointed special adviser to the UNSG for the implementation of the Millennium Development Goals, which I assume means that he will put a price tag on each of them. I am sure he will carry out this task with the same dedication as he has shown as head of the Commission.

The importance of investing in health systems over and above the interventions dealing with specific diseases can hardly be overemphasised. I have first-hand experience of this from the fieldwork I did in Tanzania for my degree in anthropology. I lived in a village in a very poor area. People didn’t have much, but they had one great asset – a well-functioning local health clinic. The clinic also served around ten of the neighbouring villages. It did not have enough personnel, they couldn’t help everybody and sometimes they prescribed the wrong drugs – but that little clinic did a lot to improve the quality of life in the village, because that little clinic was there for the patients. So many other villages in Tanzania – in Africa – don’t have any health centre. They are without access to health services.

Broken limbs, burns, asthma, diarrhoea, malaria, parasites from contaminated water, skin infections, pneumonia – these are diseases that can be seriously debilitating. A narrow, vertical approach tailored to specific health concerns would not be very productive in this context. The African setting requires addressing the health system, it requires a broad approach, rather than a vertical intervention focusing only on one aspect without a sustainable system to deliver the services in the long run. The question is what can be done at the three different levels, that is, in the community at the primary health care clinic, the district hospital, and the national level, bearing in mind that there are four functions: prevention, diagnosis, treatment, and referral. The horizontal approach is a well functioning health system, it is in fact a precondition for the vertical approach to function properly.

The health systems issue is a challenge we are acutely aware of in relation to the new global health initiatives like GAVI - where we are the biggest bilateral donor. This applies even more so in relation to the new Global Fund to Fight Aids, Tuberculosis and Malaria. We are also convinced that the allocation policies of these initiatives must have a clear poverty focus. Other aspects we consider important are national ownership, harmonisation of donor procedures, and effective co-ordination between all the partners, including the private sector and NGOs, with governments at the helm. We should also avoid as far as possible creating new structures at country level since national administrations are already overstretched.

Let me give you an example of the donor circus: The Tanzanian finance minister has to write almost 10.000 reports every year, and receive 2000 delegations. Just in health I’m sure the number is enormous, too. To lift the health sector in the poorest countries we have to deliver as donors! We have to be willing to let the countries be in the driver’s seat. In real terms.

I would also like to add a few comments on some of the specific recommendations of the report. I welcome the emphasis on diseases that are associated with poverty - HIV/aids, tuberculosis and malaria. I also strongly support the inclusion of childhood and maternity-related interventions. It is important to focus much more on the silent tragedy of new-born and maternal deaths which may well account for as many deaths as some of the more widely recognised health-related causes of death. I can't help feeling that there is an element of gender discrimination in the fact that maternal health has not received the same attention as other health problems. All the more reason to commend the Commission for not having overlooked this issue.

I would also like to make a few general remarks on the use of results-based performance criteria for evaluating further support to developing countries. This is much in vogue these days, particularly in the new global initiatives. The idea is of course inherently right and deserves our support. However, I would like to point out that rigid application of this principle might put the countries that are in most need of our assistance in an unfavourable position. These countries are also most in need of data and systems for data collection, and of administrative and other resources to implement programmes as efficiently and effectively as we all would like them to do. They also have a severe lack of the human resources needed to perform well. Thus, I would like to call for a flexible interpretation of result-based performance criteria that would allow criteria related to processes to be used to their fullest extent for the least developed countries.

Thus, I am glad that the Commission has taken such a clear stand on which countries should be supported as a matter of priority when it comes to donor funding for health and I assume for other sectors as well. The emphasis on the poorest countries is fully in line with our own policies. All our priority partner countries are in the category of least developed countries. We will follow up this poverty focus with other measures, the first of which is a new plan of action to combat poverty, which will be launched on Monday. One priority here is to move beyond aid and look at the total effect of our national policies on poverty reduction in the poorest countries.

Choosing the poorest countries as priority partners is maybe not very clever from the point of view of narrow national interests. The so-called return in terms of trade, investment and procurement is low. Furthermore, the prospect of achieving results in the short term are not the best. However, these countries have the greatest needs and this is where our development assistance can make the biggest difference. This difference should first and foremost be felt by the poorest people and should provide them with what they themselves consider to be most important for improving their lives. That is why our priority is clear! That is also why health and sustainable development will be a priority for Norway in the running up to the World Summit on Sustainable Development in Johannesburg later this year.

The World Bank collected the voices of more than 60,000 poor women and men from 60 countries, in an effort to understand poverty from the perspective of the poor themselves. The volumes of the series Voices of the Poor, clearly express the struggles and aspirations of poor people for a life of dignity. It is a publication I think all of us who are involved in development co-operation should consult regularly.

"We are above the dead and below the living", said a woman in Ethiopia to describe what is was like to be sick. Discussion groups in Africa mentioned ill health as the most important hardship resulting from poverty, with crime in second place.

Another poor man said simply: "Being well means not to worry about your children, to know that they have settled down; to have a house and livestock and not to wake up at night when the dogs start barking; to know that you can sell your output; to sit and chat with friends and neighbours. That’s what a man wants."

Great progress is possible. In the past half-century the world has made unprecedented economic gains. We could see a massive reduction in ill-health and poverty over the next few decades. With adequate resources, determination and new partnerships anything is possible, even freedom from want and freedom to live without worry over becoming ill.

Let’s make it happen!

Thank you for your attention.