Speech By Ms E. Herfkens

OPENING STATEMENT BY MS E. HERFKENS, MINISTER FOR DEVELOPMENT COOPERATION, THE NETHERLANDS AT THE MINISTERIAL CONFERENCE ON TB & SUSTAINABLE DEVELOPMENT

WEDNESDAY 22 MARCH

Integration in general health services doesn't mean sleeping with the enemy

What could have possessed them?

Two international conferences on two vital issues in the Netherlands. One on water, one on TB. Nothing wrong with that. But why so close together? Who did the planning? Were they half asleep? Even people at my ministry were surprised when they saw the dates.

But the planners were wide awake. It was a very clever move. Holding the two conferences close together makes sense, because they have a lot in common. Water is not just a subject for water management ministers. And TB is not just for health ministers. Their colleagues at planning and finance are just as important. Technical expertise is one side of the coin. The other is political will. This holds for water, and for TB too.

Director-General Brundtland said it all in her report for this conference:

"Reasons for slow progress (in tuberculosis control) in many countries are, with few exceptions, no longer technical but of political and economic origin. Like malaria and HIV/AIDS the tuberculosis epidemic is viewed as a problem only of the poor and responsibility for tackling it is confined, wrongly, to the health sector.

National health systems are underfunded. Where resources do exist, drug procurement and distribution systems are often inefficient or non-existent, implementation is hampered by lack of managerial capacity, and training and retention of health workers is often a low priority.

Underlying all these problems in many countries is the lack of sustained interest in major health issues among politicians."

That is why I am pleased that many of the twenty countries taking part have delegated not just specialists in health, but also high officials or ministers of planning, finance or another relevant sector.

I don't really need to give you the hard figures on TB. You already know them.

You know it claims two million lives every year. You know that three-quarters of the victims are between the ages of fifteen and fifty, and that they are among the poorest of the poor. And you know that this year -like last year and the year before- there will be another eight million new cases of TB

We are talking about terrible human suffering. Not just for the victims, but for their families too. And we are talking about terrible damage to economies. Studies have shown a loss of four to seven percent of GDP in the Asian countries hardest hit by TB.

Not many investments in health care are as worthwhile as investing in the treatment of TB. There is an effective therapy - DOTS, developed by Karel Styblo, a Dutch doctor. On average this treatment costs just one hundred and twenty guilders per patient.

Not much - but it amounts to half the annual earnings of many TB victims. Seen in this light, 'not much' is relative.

Still, no more than sixteen percent of the world's TB victims have access to DOTS therapy.

The bitter truth is that people are dying.

With a little extra money, they could have lived long, healthy lives.

So things look clear cut.

What donors like the Netherlands have to do, it would seem, is spread the DOTS message throughout the world and pump extra money into the special TB programs that are up and running in many countries.

I disagree entirely with this line of thought and I like to tell you why.

First, because TB control in other countries is not really my responsibility nor that of any other donor.

It is the responsibility of governments and civil society in those countries themselves.

That is where responsibility lies for getting programs off the ground or improving them.

Donors can and should help you, with money and good advice. But it is the political will in your countries that counts.

The success of this conference depends on how political priorities are set in your countries with regards to investments in human development and health.

Second, I disagree because TB control cannot be seen as separate from a country's overall health policy. TB programs will not work -or much less efficient- in countries that lack a decent level of basic health care. Their success depends strongly on the strength of the health care system as a whole.

In many countries, TB programs operate in isolation. That is understandable. Treatment takes many months, the medication has often side-effects, and patients have to be supervised to complete their treatment.

Weighing up the pros and cons, I give priority to the development of a comprehensive policy for the health sector in general. This is more effective than just pumping money into extra TB programs. In countries where TB is endemic, within this entire health policy TB control should of course have a high priority.

Some countries have very good TB programs that are integrated in general health services.

In countries where this is not the case I would like to see a critical look at these programs to help us to decide how they can be integrated.

But without lowering the quality to the level of the common denominator.

In some circles, integration into general health services is for this reason seen as sleeping with the enemy. An understandable attitude, but not a very constructive one.

I would like to see TB programs given a thorough appraisal. A critical look at them would help us decide what elements can be integrated into general health services - and how it should be done. The aim should be to improve performance, while expanding the operational base and coverage.

Ownership (recognizing that it's your responsibility) and sector policy (fewer isolated projects or programs) don't just apply to TB control. They are at the heart of Dutch development policy. Owners base their policies on the international agreements they too have signed. Aid shifts from separate projects to sector support.

As a donor country, the Netherlands will continue to support the fight against TB.

But we will not do it on our own; not because we think it is important.

The Netherlands gives bilateral support to the health sector in countries that have asked for it. And TB control programs are included - at least if the country itself has given them priority.

The Netherlands also gives a lot of support through multilateral channels - through the Dutch partnership program with the WHO, for instance.

Forty million guilders have been earmarked for the poverty-related diseases like malaria, AIDS and TB. Another twenty million have been earmarked for strengthening health systems.

We also have an interest in stopping TB, a disease with no respect for borders.

Inadequate treatment leads to drug resistance. And when a disease becomes drug resistant, the disaster is complete. Then the costs of treatment are too high for anyone to pay.

To quote a WHO soundbite: poorly-managed TB programs are more dangerous than no treatment at all.

Stop TB is a global campaign for a global good. But you, as the worst hit countries, have a crucial role to play. Because your countries are home to eighty percent of the world's TB victims.

Don't misunderstand me.

I am not advocating sector policies because I want to shunt TB control to the sidelines.

On the contrary.

I firmly believe that a sectoral approach will lead to more sustainable TB programs, with much better coverage.

I also believe that it will raise the overall standard of health care policies.

I am arguing against compartmentalization and for cohesion, so that TB programs and the rest of the health sector can benefit from one another.

I sincerely hope that this conference will strengthen the global partnership to stop TB.