Hospitals & Asylums
Theme: Achieving the internationally agreed development goals, including those contained in the Millennium Declaration as implementing the outcomes of the major United Nations conferences and summits: Progress made, challenges and opportunities.
843 million people in developing and transition countries continue to be hungry and over a billion live on less than a dollar a day. Developing countries are acknowledging the need to commit more resources for development that benefit the poor. Donor countries are taking steps to increase official development assistance to countries committed to poverty and hunger reduction. With about 75 percent of the poor and hungry in developing countries living in rural areas, promoting investments in agricultural and rural development, in particular, is fundamental.
Our session this year takes place in special circumstances. The General Assembly has just concluded its high-level dialogue on Financing for Development. The preparations for the September High-Level Event on the 60th Anniversary of our Organization are well underway. In our deliberations, as in the Secretary-General's report, there is a sense of urgency to respond to the challenge of development- poverty, hunger, disease, illiteracy, marginalization and joblessness. We must congratulate the European Union's collective commitment to the 0.7% ODA target and timetable for its implementation. We must simultaneously welcome the agreement of the G-8 Finance Ministers to cancel the debt of poorest countries. Solutions for global underdevelopment will have to be comprehensive and coherently encompassing adequate external financing for development, larger and growing trade opportunities and good global governance. Such comprehensiveness and coherent solutions can be evolved only within the framework of the United Nations, and its economic and social arm - The Economic and Social Council.
The state of the world economy remains robust. One of the more striking aspects of the strong growth we have seen in recent years is that it is widespread among developing countries and economies in transition. Another is the resurgence of growth in sub-Saharan Africa. Many African countries are achieving annual per capita growth of 3 per cent, and are expected to reach more than 5 per cent this year. These are promising trends. But they are not free from risks, such as higher oil prices and, especially, current global economic imbalances in the trade and fiscal areas, which could stall momentum.
I hope other donors will follow the lead of the European Union, which has agreed to a substantial increase in official development assistance over the next decade, including a timetable for reaching the 0.7 per cent target for official development assistance by 2015. I am especially pleased that half this increase is to be used in Africa. The commitment of the Group of Eight countries to reach agreements on significant debt relief for the poorest countries is another very promising step.
First, we need to bring the various strands of implementation together. W e need to engage leaders, policy makers and all the capacities available in the UN system so that our regular reviews of progress lead to concrete, mutually reinforcing action.
Second, we need to connect, in a much more systematic manner, policy discussions and operational activities on the ground. It is with this in mind that I have called on the Council to convene a biennial, high-level Development Cooperation Forum.
Third, we need to respond to threats and challenges in the economic and social area with the same urgency that is brought to peace and security crises. Whether we are confronting a devastating tsunami in Asia, a famine in Africa or a debt crisis in Latin America, our responses must not only offer immediate relief, but also address the broader development dimensions.
Millions and millions of people are excluded from society, who are fleeing their homes who are discriminated against, who are stateless. They are the victims of human rights violations, war and conflict. Rather than benefiting from the protection of states they are denied that protection - if not effectively persecuted by them. Freedom, democracy, the respect for human rights and good governance are essential tools for success in such countries. But for these values to flourish, globalization must give them a chance. We need a different, more humane globalization, able to create opportunities for all and a better global governance system.
According to the mid-year update of the World Economic Situation and Prospects 2005 that you have on your tables, the world economy has behaved broadly in line with what we projected in January. Global economic growth has slowed, with gross world product (GWP) expected to expand at a rate of 3 1/4 per cent in 2005 and 3 1/2 per cent in 2006, following 4.1 per cent in 2004. The anticipated growth of the world economy for 2004-2006 is not only the strongest for the past few years but is unusually widespread among developing countries and economies in transition. Even with a deceleration, developing countries as a group are expected to grow at a rate approaching 6 per cent in 2005-2006, while the economies in transition will remain above 5 per cent.
The developing countries, in particular, are showing greater resilience than in the past to the deceleration in economic growth in the developed world; growth in Africa, for example, is expected to be higher in 2005-2006 than in 2004. South Asia has joined East Asia in growing in the range of 6-7 per cent while Africa and Latin America are expected to exceed 5 and 4 per cent respectively in 2005-2006. Among sub-groupings, the least developed, the landlocked and the sub-Saharan African countries (excluding Nigeria and South Africa) are all expected to average growth approaching 6 per cent over the these two years. Looking back, output per capita rose by more than 3 per cent in 2004 in almost half the developing countries and these countries accounted for over 80 per cent of the developing world’s population.
International trade grew by some 11 per cent in 2004 and is forecast to increase by a further 8 per cent in 2005. At the same time, the international prices of many of the exports of developing countries, notably oil but also many other commodities, have risen in the past couple of years: oil prices, as everybody knows, have more than doubled but non-oil commodity prices have increased by more than a quarter in dollar terms and by about 10 per cent in real terms. In the cases of both oil and non-oil commodities, prices remain below their long-term averages and the recent improvements have been partially
offset by the depreciation of the United States dollar.
The net transfer of financial resources from developing countries continues to increase –from over $270 billion in 2003 to a record of over $350 billion in 2004. Admittedly, this net transfer overwhelmingly reflects a buildup of foreign exchange reserves by a number of countries with trade surpluses rather than the capital outflows and debt service payments that characterized the 1980s and some of the 1990s.
At the present time, a greater risk of a sudden and disruptive shock to the world economy seems likely to stem from the large and widening global imbalances: the current account deficit of the United States is expected to rise to over $700 billion in 2005 and to remain in that range in 2006. Reflecting this deficit, and despite some strength in recent weeks, the US dollar has depreciated vis-à-vis other major currencies over the past few years. So far, however, this depreciation does not appear to have had much corrective effect on the imbalances. As long as the large United States deficit persists, there will be
a risk of adverse reactions, either by policy makers or by markets. There are, for example, dangers of increasing protectionism in some areas. In financial markets, there is the persistent possibility of a new wave of weakening of the dollar, including a chance that it could take place in a disorderly manner. Such disorderly adjustment would have severely disruptive effects on world trade, global financial markets and, ultimately, global economic growth. Both analysis and evidence to date suggest that the depreciation of the United States dollar is not sufficient to reduce the imbalances to sustainable levels. We all recognize that economic growth alone, while necessary, will not be sufficient to ensure long-term development. The present period of robust global growth opens a window of opportunity for accelerating the implementation of the global development agenda set at the global conferences of the 1990s and at the Millennium Summit in 2000.
The historic commitment of world leaders to establish the Millennium Development Goals has re-iterated the plain and simple fact that the essential ingredient to making the world a better place to live is international cooperation. In 2004, the world economy recorded an overall excellent performance with the highest output expansion in more than a decade. According to the World Bank developing countries shared fully in this expansion, as they experienced their fastest GDP growth in the last three decades. Trade growth was also very strong with the developing countries' share in world merchandise exports reaching a 50-year peak of 31 per cent.
The two reasons for this success are commodity price increases that arose from robust global demand for raw materials and a strong expansion in the exports of manufactured goods. These two reasons explain the fact that all major developing regions recorded trade and current account surpluses in 2004. They have also contributed to the export performance of LDCs, which recorded their largest share of world merchandise trade since the mid eighties of 0.68 per cent.
China's emergence as one of the world's most important traders of manufactured goods has also had a positive effect on world trade. In 2004, its share of world exports doubled from 10 years ago to 8 per cent. On the import side, China's role as a market for raw materials rose sharply in recent years. In 2004, China's share of world fuels imports was about 4.5 percent, or three times larger than a decade ago.
The overall strong trade performance in 2004 was however clouded by the existence of large current account imbalances, in particular between the United States and East Asia. These imbalances widened further in the first half of 2005, a development which harbors considerable risks for the future expansion of the global economy an for trade in particular. The current US trade (current account) deficit is equivalent to 7% of world merchandise trade and a stabilization of this deficit or its reduction through a slowdown of United States' imports could severely affect the prospects for global trade expansion.
Following the strong 9 percent growth of world trade in 2004, the "'TO Secretariat projects real trade growth for 2005 to be 6.5%. This prediction is supported by data for the first quarter of 2005, which points to an even sharper than expected deceleration of trade in Western Europe and Asia. It is still too early to adjust this forecast downward, but the weak trade performance in the first quarter together with stronger than projected oil prices highlight its fragility.
International trade can be a powerful and effective driver for poverty alleviation and economic well-being. But, its efficacy depends upon a large number of factors. prime among them being a successful conclusion to the Doha Development Agenda negotiations. We are at a critical phase in the Doha Development Agenda negotiations. Last year we made substantial progress in some of the most difficult and controversial areas. Among the advances made. Members agreed to launch negotiations on trade facilitation but not to negotiate on three other new issues which did not carry the support of the full membership. Members also significantly bridged gaps in the agriculture negotiations - including a historic agreement to eliminate export subsidies by a date to be agreed.
The WI O's Sixth Ministerial Conference will be taking place in Hong Kong this December. Everyone recognizes that this must be a pivotal meeting whereby really substantial progress is made - building upon last year's successes. In 2003 almost two-thirds of developing country exports entered developed country markets duty free. Similarly, almost three-quarters of exports originating from LDCs enter developed country markets duty-free. A number of studies have shown that the residual level of protection in the developed countries is biased against products of export interest to developing and least-developed countries. Furthermore. the support provided by developed countries' governments to their agricultural sector continues to condition market access for agricultural exports originating from developing countries. Developing country governments have also been firm in their commitment to contribute towards developing a free and open trading system. Nevertheless, they also recognize that much work remains to be done to open their own markets, especially to products from other developing countries. Average tariffs in developing countries exceed that of developed countries. Reductions in these barriers will help further stimulate south-south trade.
Success in achieving the MDGs however, cannot be defined by trade negotiations. What matters is making trade work as a too] for development, which can only arise if openness is implemented in the context of coherent economic policies. A successful set of negotiations which addresses market access conditions and disciplines government support in agriculture combined with debt relief and enhanced aid will better position national governments to achieve the MDGs.
The outlook on the global economy looks more promising than for some years. Economic growth reached 3.8 percent in 2004-the fastest rate in four years, with developing countries surpassing growth figures in high-income countries. Their gains were widespread-all developing regions grew faster in 2004 than their average over the last decade. Financial flows to developing countries during the last year reached levels not seen since the onset of the financial crises of the late 1990s. Foreign direct investment (FDI) totaled $165.5 billion, up by $13.7 billion in 2004. However the same countries continue to be magnets for this type of long-term investment, namely Brazil, China, Mexico and Russia.
Nonetheless, conditions for achieving better economic performance in Sub-Saharan Africa are improving: 12 African countries are currently experiencing growth spurts above the trends for the region - with average GDP growth over the last decade of 5.5 percent or more. The goal to halve poverty by 2015 will likely be met at the global level, but not in Sub- Saharan Africa unless progress there can be accelerated quickly. Many developing countries are falling behind in the race to sharply lower the numbers of deaths among pregnant women and children under the age of five, by the year 2015. More than 11 million children died in 2002 before reaching their fifth birthday from preventable illness, while as many as 500,000 women perished during pregnancy or childbirth.
2005 Global Monitoring Report- by the World Bank and the EAU'-argues that faster progress towards the MDGs could be spurred if poor countries and their donors were to adopt a number of key measures, to:
Ensure that development efforts are country-owned. Scale up development impact through country-owned and led poverty reduction strategies;
Improve the environment for private sector-led economic growth. Strengthen fiscal management and governance, ease the business environment and invest in infrastructure with a special focus on small and medium enterprises that create the most jobs;
Scale up delivery of basic human services. Rapidly increase the supply of health care workers and teachers, provide larger and more flexible and predictable financing for these current cost-intensive services, and strengthen institutional capacity;
Dismantle barriers to trade. Through an ambitious Doha Round, including major reform of agricultural trade policies - and also increasing "aid for trade";
Double development aid in the next five years. In addition, improve the quality of aid, with faster progress on aid coordination and harmonization. Meeting the MDGs will require a doubling of the amount of official development assistance (ODA) reaching the poorest countries. Let us urge donors to use this year of stocktaking to raise their commitments and signal that support for the MDGs is forthcoming.
At stake are not just the prospects for hundreds of millions of people to escape poverty, hunger, and disease, but also prospects for long-term security and peace which are intrinsically tied to development.
As we reflect on how to speed up achieving these prospects, we must applaud the Group of Eight for the very uplifting news that it will cancel US$40 billion in debt, owed by 18 of the world's poorest nations, most of them in Africa, and much of it owed to international institutions such as the World Bank. This debt forgiveness is a very welcome sign of development progress ... but it cannot come at the expense of new development aid, and while applauding the generosity of the world's G-8 leaders, we must urge them to build on their debt relief initiative, and step up the amounts of long-term aid they provide to developing countries determined to achieve their MDGs over the course of the next 10 years.
During the next 10 years, we must include scaled-up, proven approaches in health and education, as well as strengthening economic reforms. This means a chance for every child to go to primary school. A place to go for medicine and basic health care. Clean water flowing from a tap. Sanitation. Electricity at the turn of a switch. These basic services are taken for granted by citizens of developed countries. Yet in much of the developing world, these services are either unavailable or available only at low quality or high private cost. The human development outcomes at the core of the Millennium Development Goals (MDGs)-primary education, literacy, gender equality, good health-depend on access to these basic services.
The last 18 months have been a good period for development and international development cooperation. With the global economy growing in 2004 at a fairly robust 4 per cent, developing country economies grew at a rate of 6.4 per cent, one of the highest of the last three decades. Even excluding the star performer, China, which grew at 9.5 per cent, the rate of growth of developing countries last year was 5.7 per cent. The rate varied in the different regions, but all of them shared in the overall growth. Asia led the pack with a rate of 6.9 per cent (6.0 per cent with China excluded). Latin America reached 5.7 per cent, a welcome recovery following five years of stagnation and crisis. Africa recorded its highest real GDP growth in about a decade at 4.6 per cent, marginally up from 4.3 percent in the previous year. Global growth has continued into 2005, but at a slower pace, with a forecast expansion of GDP for the year closer to 3 per cent. Most of this deceleration is attributable to the slowdown in developed economies, but some developing countries are also showing signs of losing momentum. Still, developing economies as a whole are forecast to grow at 5 to 5.5 per cent in 2005.
The average growth rate in Africa masks considerable differences in country performances. Only 13 countries recorded real output growth of more than 5 per cent in 2004, and about two-thirds of these are either oil exporters or are recovering from a very low base. Once more, the vast majority of African countries fell short of the 7 per cent per annum growth rate necessary for attaining the MDGs - a target which was met by only six countries in 2004. Prospects for 2005 are of some further improvement, but one still substantially short of the level required. With a GDP growth of rate of 7.1 per cent in 2004, East and South Asia recorded its highest growth since the Asian crisis. As already indicated, China was the country with the highest rate of growth, but growth was also strong in South Asia' (6.5 per cent), the ASEAN-42 (5.9 per cent) and the Newly Industrialized Asian economies3 (5.7 per cent). Unlike in the other two continents, growth in this sub region was generally led by a combination of strong foreign demand and a robust domestic demand. The sub region is to that extent somewhat less vulnerable to changes in the world economic performance, although other parts of Asia are not.
The global economy grew by an impressive 5.1 percent last year. Growth this year is expected to slow moderately to about 4.3 percent, but will remain relatively robust. Growth in sub-Saharan Africa reached an impressive 5 percent last year, the highest level in a decade. But more is needed to make decisive progress in poverty alleviation and meet the MDGs. Indeed, NEPAD targets the necessary level of growth at about 7 percent per year. Inflation remains relatively subdued. To date, higher oil prices have not significantly affected core inflation or inflationary expectations. The average rate of inflation in sub-Saharan Africa was below 10 percent last year, the lowest level in decades.
Developed countries need to scale up their aid to low-income countries, as pledged in the Monterrey Consensus. The recent declarations to raise aid levels are to be applauded. And we welcome efforts by member states to find ways to generate innovative sources of finance. The IMF will continue providing assistance to help poor countries manage aid inflows and to strengthen their institutions and human resources to manage their economic and financial policies. We fully support the ongoing efforts to enhance overall aid effectiveness and to reduce transaction costs by simplifying and harmonizing donor procedures and requirements for aid delivery. We also encourage donors to align their support more fully with country-led poverty reduction strategies, consistent with the principle of country ownership.
Between 1990 and 2001, the proportion of people living in extreme poverty (less than 1 dollar a day) in developing countries declined from 28 to 21 percent, i.e. by 129 million people and is set to decline to 10 percent (622 million people) by 2015. Poverty reduction requires a twin-track approach which combines, ideally within the same communities,
(a) direct interventions and social investments to address the immediate needs of poor and hungry (social safety nets, conditional or unconditional cash transfers, health interventions, food and nutrition programmes) with
(b) long-term development programmes to enhance the performance of the productive sectors (especially to promote agriculture and rural development), create employment and
increase the value of the assets held by the poor (physical, human, financial).
On 24th May 2005, the European Union announced that its member states - who now provide about US$ 37 billion in ODA - would double ODA to developing countries by 2015. An agreement was recently reached by the G8 under which the World Bank, the IMF and the African Development Bank will immediately cancel all the debts, amounting to about US$ 40 billion, owed to them by 18 countries which have reached their PRSP completion point, with more countries to be included in the list in the future.
Strong local health systems are needed to provide universal access to primary health care, including sexual and reproductive services. Furthermore, resources to tackle major diseases such as HIV/AIDS, TB, and malaria going to new global partnerships, such as the Global Fund, need to work as allies in strengthening broad-based health systems. In many countries, especially in Africa, the shortage of human resources is reaching crisis proportions. This crisis has its roots in part in the process of globalization, particularly as it affects the migration of health workers between cities and rural areas, between countries and between continents. Stocks of health workers are being depleted as they themselves fall victim to the diseases they are attempting to treat, such as HIV/AIDS. More education and training is urgently needed.
Governments need to recognize that investment in their health systems is essential for their countries’ development – not only for the individual sector but as key enabler for poverty reduction and economic development. Panelists also underlined, however, the importance of investments outside of the health sector, in particular in education and water and sanitation, as well as in general infrastructure like communications, transportation and other areas impacting on health outcomes.
In many countries, the share of ODA targeted for productive sector development has declined significantly, while ODA targeted for the social sector has increased. Does the changing composition of aid have any implications for the ability of countries to promote high and sustained rates of economic growth and make sustainable progress towards development goals? Does the changing composition of aid decrease a country's chances to promote economic growth and gradually begin to finance development goals out of its own resources?
In international development it is the central role of state capacities, governance systems and institutions to promote economic and social development; increase the access of services to the vast majority of the poor; promote and enforce human rights legislation; enhance the participation of women in the development process; and protect the quality of the environment. The millennium project advises targeting the following areas,
-Promoting the rule of law. Legal and administrative systems require a properly resourced and adequately staff legislature, judiciary and executive branch of government.
- Promoting human rights. The goals reflect human rights assessments that checks MDGbased strategies for their national commitment to human rights.
- Promoting accountable and efficient public administration. Better governance depends on the systems of political and bureaucratic accountability, transparency and participation, especially by poor people.
- Promoting sound economic policies. Government actions – such as macroeconomic management, proper investments in infrastructure, and corruption-free delivery of public services – are keys to private sector development, as outlined in the report of the Commission on Private Sector Development and World Development Report 2005.
- Supporting civil society. Governments have a special responsibility to provide civil society with political freedom to express its views, a policy voice to participate in the planning and review and of MDG-based strategies, and institutional space to support the implementation of public investment strategies.
The international community has committed and re-committed itself to the promotion of a fully literate world through quality universal primary education and quality adult literacy provision through formal and non formal education for over fifty years. The International Conference on Human Rights, (Teheran on 13 May 1968) in its Proclamation of Teheran stated: ‘The existence of over seven hundred million illiterates throughout the world is an enormous obstacle to all efforts at realizing the aims and purposes of the Charter of the United Nations and the provision of the Universal Declaration of Human Rights. International action aimed at eradicating illiteracy from the face of the earth and the promotion of education at all levels requires urgent attention. According to the estimates published by the EFA Global Monitoring Report, 2005, there are nearly 800 million adult illiterates in the world (adult defined as 15 or over), representing 18% of the adult population
The Task Force on Education and Gender Equality reported that nearly half of the 104 million out-of-school children, two thirds girls, live in countries in conflict or post-conflict settings. Data in the EFA Global Monitoring Report 2005 reveals
the expansion of formal schooling is slowly reducing the number of out-of-school children of primary-school age, from 106.9 million in 1998 to 103 million in 2001. Actual completion of primary schooling remains problematic. Children in low-income countries may not attend school or leave because of cost, need to supplement family income or a classroom environment that is not safe or appropriate to learning. Although survival rates to grade 5 increased in many countries during the 1990s, they fell short of 75% in thirty out of ninety-one countries.
The Millennium Declaration1, unanimously endorsed by 191 nations, emphasized the need to “promote gender equality and the empowerment of women as effective ways to combat poverty, hunger and disease and to stimulate development that is truly sustainable”. A growing body of evidence confirms that when greater equality between men and women exists and economies tend to grow faster, the poor move more quickly out of poverty, and the wellbeing of men, women, and children is enhanced.
Millennium Development Goal (MDG) 7 on ‘Environmental Sustainability’, focuses on the integration of the principles of sustainable development into country policies and programs, the reversal of the loss of environmental resources, the reduction by half of the proportion of people without access to safe drinking water, and the achievement of significant improvement in the lives of at least 100 million slum dwellers by 2020. Sustainable management of resources underpins development and environmental sustainability is the foundation on which achieving all the MDGs must be built. The Millennium Task force on water and sanitation highlighted the need to move sanitation at the top of the agenda, to integrate water and sanitation policies, planning and investment strategies into national priorities. High priority is given to hand washing, hygiene education, treating safe water at the household level, school sanitation with separate facilities for boys and girls, to promote total sanitation coverage and public sanitation, and treat sanitation as individual right and a civic responsibility.
Current projections are that 1 billion people will live in slums by 2020. The goal of achieving a significant improvement in lives of at least 100 million slum dwellers would therefore, if met, only impact on approximately 10%. Therefore consideration must be given to re-asses this target, and steps should be taken to not only support existing efforts being undertaken by slum residents, but also to prevent to prevent new slum formation and increasingly provide self-help housing and accessible and serviced land in addition to dealing with the existing phenomenon.
Which concrete decisions need to be taken prior to the September summit to empower countries to pursue goal-oriented development strategies. Which decisions needed to be reached at the summit to effectively support countries in the implementation of all internationally agreed development goals?
- A decision should be made before September to enable the UN to play a greater role on trade issues.
- World leaders should address trade imbalances by removing barriers to free trade, including unlimited access of products of LDCs, trade preferences, and withdrawal of production subsidies, and commodities. Africa needs to remain a priority.
- “Quick-win” initiatives should be launched,
- Strategies should be developed before September to address pockets of
- Innovative financing is needed to complement ODA commitments for example a $1 international tax on plane tickets.
- At the June Meeting, concrete actions should be taken to honor commitments of 0.7% ODA made at Monterrey including the adoption of a timeline for achieving the 0.7 target by 2015.
The September Summit should help
- Developing countries need to deepen their commitment to pro-poor policy reforms
- Developing countries need to develop greater capacities to utilize international money markets to build domestic resources.
- Debt servicing needs to be fair, adapted to country needs and preserve international lending mechanisms.
- Mobilizing domestic resources are crucial and need to include fiscal and budgetary provisions
- Regional initiatives, such as investment for infrastructure in South America, should be supported.
- The UN should be given a central role in follow-up to the decisions made at the September Summit. ECOSOC should be entrusted with the follow-up, but needs to be strengthened to fulfill this role. Moreover, the UN’s operational agencies need to operate more effectively and in a more coordinated manner with more stable financing.
- The Summit needs to adopt a strong commitment to national ownership of development strategies – actions need to be coordinated with sector specific strategies and need to support long-term development. National strategies also need to be more ambitious, reflect local conditions and go beyond the MDG targets if appropriate.
- The September summit should pay special attention to the needs of the least developed countries. Least developed countries, however, also need to work toward good governance and address corruption in a firm and transparent manner.