Speech by Ms Mieko Nishimizu

STATEMENT BY MS MIEKO NISHIMIZU, VICE-PRESIDENT, SOUTH ASIA REGION, WORLD BANK  AT THE MINISTERIAL CONFERENCE ON TB & SUSTAINABLE DEVELOPMENT

THURSDAY 23 MARCH

"Tuberculosis Control --Why It Makes Development Sense"

Imagine a world free of poverty. A world, where quality of life guarantees human dignity. A world, where everyone exercises basic human rights. A world, where all children will live to their fullest potential. That, is the dream the World Bank shares with all member nations. But, that dream will remain a mere dream, unless we join hands to overcome major global threats to the poor and the marginalized people around the world. Without question, tuberculosis is one such threat, and its control must be on the global development agenda. That is why I am here to talk about TB.

There is another reason why I am here -- I was a TB patient. I fell ill with tuberculosis when I was seven. Had it not been for streptomycin, which my family scouted all over Japan to secure for me, I would not be here today. A decade later at seventeen, I was still living in a mental shadow of "Consumption". I remember flying across the Pacific clutching an X-ray picture of my lungs -- all the way from Tokyo to San Francisco. I knew my X-ray carried that tell-tale sign of shadowy scars. I was petrified the U.S. Immigration might turn me away, aborting my dream to study in America. To this day still, I can hear that cheerful voice of an immigration officer -- "All better now, aren't you? Good luck!"

I invite you also to look into your past. In some way, your life must surely have been touched by tuberculosis -- by people whose dreams were thwarted by the disease. And I ask you to hold your personal memories throughout the coming two days. If you are so fortunate not to have such remembrance, I suggest you hold the image of Bishop Desmond Tutu and Nelson Mandela, who have both struggled with TB.

To let our memories fade is dangerous, because the disease is becoming more prevalent and lethal. Ignorance and neglect have contributed to unsafe provider behaviours, erratic drug supply and inaccessible services -- a deadly combination. It is dangerous, because the international community has committed to reduce poverty substantially by 2015. All of us are part of this commitment. To let our memories fade is to turn our back on that shared commitment.

TB and poverty are linked. Poor living and working conditions stimulate transmission and disease, and disease exacerbates economic and social distress. Generations of evidence support this fact.

Of 20 million people ill with TB today, nearly all -- about 95% -- live in the developing world. Over the last few years, my colleagues at the World Bank conducted participatory research and listening engagements with 60,000 poor people in 60 countries. The results are just published in the first volume called, "The Voices of the Poor: Can Anyone Hear Us". These voices confirm, over and over again, that one critical missing link, between poverty and a life worth living, is personal security -- especially freedom from disease. More than most anything else, it is the illness of bread-winners that tumbled them into poverty. Even more than education, they said, it is diseases such as TB that prevent them from "helping ourselves out of poverty".

Of all the developing regions of the world, South Asia (where my work is focused) has a lion's share of the people ill with TB. This is also the region that harbours the highest number of the poor and the majority of our world's children. Over the years, I too have heard the same -- from villagers in remote Himalayan valleys or scorching Indian desert plains, and from slum residents deep inside the old cities of Kathmandu, Karachi, Dhaka, and Delhi. It is a suffocating trap of misery and destitution when an illness -- often TB -- strikes. A widow in Rajasthan, India, said to me: "This, is not life. It is just keeping a body alive." Her husband died of "Consumption".

 Worse yet, the lethal combination of TB and HIV/AIDS compounds the poverty cycle. Worse yet still, this combination compounds the burden on health finance, and can put the entire public finance under an enormous pressure. To project it is not rocket science -- in India, for instance, the average treatment expenditure per year on one HIV/TB case costs more than educating 10 primary school students. Health expenditure to fight such epidemics will force very hard trade-offs in public finance. Every time I look at such financial projections, I shudder. Economists like me are not good at making impossible, unethical, trade-offs. I do not wish such nightmares on anyone, especially political leaders of developing nations. But, they will be the reality one day, if we do not act now.

Traditional coping strategies are no longer enough, to compensate for the blow to national economies and the stability of societies that TB, drug-resistant TB, and HIV/AIDS will cause. The deadline for action is today. We must act, act forcefully, and act now.

Fortunately, we do have the means to alter TB's course. This is what is exciting about the meeting we hold today and the work we will continue tomorrow. The public health strategy known as DOTS provides the cornerstone for this action.

But, for such a strategy to stop TB, it must be an integral part of poverty reduction strategies of each and every developing nation -- strategies that are of these nations' own conviction and political will, and strategies that are owned and supported by the international community.

Public policy and investment choices make a dramatic difference in the battle against the epidemic. The World Bank sees the Stop TB partnership as an integral part of our fight against poverty, and part of our guidebook to help developing nations improve their public policy and investment. I want to highlight five principles that are important to us in this engagement, with the hope that we can share them collectively in our partnership.

One: TB control is a global "public good", not just a national one. Benefits derive to all citizens of the world, not just to those treated and cured in any single nation state. There are no half-cures in TB control.

Without sound public health policy, regulation and investment, providers tend to offer and patients tend to seek too little care. Without generating and sharing knowledge on the epidemic, new strategies and technologies, we imperil all regardless of national borders.

Two: invest more, and invest wisely, in efficient and effective health policy, regulation and systems that serve all citizens with equity.

Otherwise, we cannot expect dramatic improvements in health outcomes, including TB. Nor can we expect to raise visibly access to quality services for poor people, hard-to-reach patients, HIV-positive TB patients, and those ill with drug-resistant disease.

Three: build strong public-private partnerships. Private providers are significant players everywhere including in developing world. In South Asia, for example, more than half the population will turn first to private providers when ill. Everyone benefits from a paradigm shift in both public and private care quality, and dove-tailed partnerships between them. Such partnerships must also go beyond the care providers, to the civil society at large that offers huge untapped potentials in fighting TB. Whether good communication, policies, or training, all that we do must be aligned perfectly to a common cause -- shared explicitly by all leaders and citizens -- to stop TB.

Four: erase gross inefficiencies and invest in best practices and new tools. There is no room for tests and treatments that waste the precious time and resources of patients and society. There is every room for best practices and new tools that make prevention and cure affordable, easier, and faster -- along with communication, communication, communication, to patients to seek care early and completely, and to care providers to do the right thing.

Five: last but not least, keep the national discipline of prudent fiscal policy and high-quality public expenditure. Otherwise, all the sound principles will remain just that -- principles, without the Stop-TB outcomes we want to see. Money is fungible, and potential burdens on health finance alone, and on public finance altogether, are likely to be significant. None of us can look to new partners to invest, if we cannot demonstrate the commitment to use our own resources efficiently, effectively, and equitably.

We can be part of the problem, or part of the solution. The World Bank is prepared to be part of the solution. We have committed our corporate mission to poverty reduction. Human development in general, and TB control in particular, are part of our strategic drivers. We already support policy and investments to strengthen health systems in 18 of the 20 countries represented here today. In many, there is demonstrable progress in TB control. But, there are many still where such a progress remains elusive.

Partnerships are at the heart of our success. But, it must be a partnership rooted in the strength of each nation's conviction and will to act, starting at the top political leadership and throughout the civil society. For leaders both in government and in civil society to choose not to act to stop TB -- knowing fully the consequences -- is unethical and a betrayal of their people. To focus the might of leadership everywhere on the problem, orchestrating all the change agents throughout the society, is at the heart of the solution. I call on all leaders and change agents of nations represented here, in governments as well as in civil societies, to act, act forcefully, and act now. Let us promise that, one year from now, no leader in this room can say they did not have the vision nor the means to move forward. The future is in our hands. The choice, is ours.