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GHF2006 – PL06 – Global Access to Health: An Agenda for the Future

Session outline

Plenary session PL06, Friday, September 1 2006, 16:00-17:45
Chair(s): Marcel Tanner, Swiss Tropical Institute, Switzerland
An Agenda for Sustainable Development in Health
Hassan Mshinda, Ifakara Health Research & Development Centre, Tanzania
Partnerships to Promote Global Public Health Security
David L. Heymann, Representative of the Director-General for Polio Eradication, World Health Organization, Switzerland
Access: Opportunities and Challenges
Ruth Dreifuss, Switzerland
Is Health a Commodity?
 Mr. Alok N. Mukhopadhyay,  Voluntary Health Association of India
Role and Responsibility of Academic Institutions
 Bruno Grijseel, Institute of Tropical Medicine, Antwerp, Belgium
Conclusion to the 2006 Edition of the Geneva Health Forum
Marcel Tanner, Swiss Tropical Institute, Switzerland
Closing Remarks
Claude Lecoultre and Louis Loutan, Geneva University Hospitals and Faculty of Medicine, Switzerland

Session Report

Submitted by: Jean-Pierre Joly (ICVolunteers); Contributors: Asta Lim (ICVolunteers)
Image: Jorge Garbino,

The final plenary session of the "Geneva Forum: Towards Global Access to Health" was dedicated to summarizing the key issues which emerged during the three days of discussion and exchange and to formulate suggestions on how to develop these issues in the future. The final plenary was also a moment to thank all the contributors of the Forum for their effort and participation.

The first speaker, Dr. Hassan Mshinda, Head of the Ifakara Health Research & Development Centre in Tanzania, stressed that previous health initiatives have concentrated on aspects such as equity, participation, and multi-sector and comprehensive healthcare. However, Dr. Mshinda urged that as an increasing number of actors are becoming involved, and a greater pressure is put on immediate results.

According to Dr. Mshinda, there is a clear need for an agenda in order to achieve sustainable development of health. The Paris Declaration on Aid Effectiveness set out the principles for doing a better job in delivering and managing aid. Global Health Initiatives have their merits, but it remains indispensable that countries strengthen their national health systems, because this is the key to improving access to health care, said Dr. Mshinda. In any case, such initiatives will eventually have to be absorbed by governments' health systems.

National governments have a key role to play and it is their responsibility to have a long term strategy for sustainable development of health care systems. Long term commitments from partners, as well as monitoring and audit tools could certainly enhance this process. Dr. Mshinda said that the challenge of Global Health Initiatives is to realize their integration at the global, national and regional levels. To create the necessary interaction between those different levels, there is a need to establish even more contractual partnerships.

Dr. David Heymann, Executive Director, Communicable Diseases, of the World Health Organization (WHO), spoke about the role of partnerships in promoting health security, emphasizing the global character of health problems and, more specifically, the security issues related to infectious diseases. He said that while new infectious diseases are appearing, more worrying is that infections such as cholera and yellow fever, which were thought to have been eradicated, are re-emerging. Analysis shows that increased international travel has stimulated the worldwide spread of some diseases, such as SARS and malaria. While malaria is not contagious, it does get transported through mosquitoes to areas where it normally does not occur. As a result, these diseases occur far from their original source.

The spread of numerous infectious diseases is closely linked to animals and insects. The movement of animals to market is a key factor in spreading infectious diseases to other locations, especially when cattle is not vaccinated. Other diseases can be transmitted through international trade in agricultural products as in the case of Creutzfeltd-Jacob disease. Dr. Heymann reminded the audience that there is always a risk of existing viruses mutating and creating new pandemics.

Will non-immunized humans serve as an intermediate host in the transmission of diseases? The framework for International Health Regulations has been improved and updated on an ongoing basis since 1947, said Dr. Heymann. The WHO receives inputs from 110 different networks around the world, whose task it is to collect data and to continuously monitor the development of diseases in their region. The WHO reacts to information gathered through the Global Outbreak Alert and Response Network (GOARN).

Distribution of information and education related to infectious diseases still rests on weak ground in developing countries, claimed Dr. Heymann. In this context, it is not surprising that the three diseases with the highest death toll, TB, malaria and HIV/AIDS continue their expansion in sub-Saharan countries. He highlighted the staggering negative economic impact of those diseases by giving one example: GDP in sub-Saharan Africa would have been 100 billion USD higher in 2000 if malaria had been eradicated 35 years ago.

Only systematic partnerships between developed and developing countries will enable significant changes to present trends, stated Dr. Heymann. Those partnerships should focus on four areas: research and development, access to vaccines, prevention, and monitoring. The WHO clearly places health at the centre of development, because it is essential for sustainable economic growth. Although the WHO has a role to play and global partnerships have been expanding, the rolling back of infectious diseases is primarily a matter of high level political commitment in developing countries themselves. The declines in HIV/AIDS in Uganda and of TB in Peru are examples of such commitment.

Ms. Ruth Dreifuss, former President of Switzerland, drew attention to the underlying political issues of the topics discussed during this Forum. These include the interdependence between the North and the South, the search for new medicines, the outcome of the World Trade Organization (WTO) summit at Doha, pandemics, and so on. In this context, she underscored the important role of NGOs in raising public awareness and the necessity of forming partnerships between the public and private sectors, while it should remain the responsibility of governments to provide the engine for the process.

Ms. Dreifuss further stressed the importance of the recommendations and conclusions of the Commission on Intellectual Property Rights, Innovation and Public Health, which she had chaired at the World Health Assembly (WHA) and the report of which has recently been completed. Three concepts surfaced in connection with vaccines and medicines in general: availability, acceptability and accessibility. The commission's major conclusions were that present efforts are not sufficient to assure the continuity of existing programmes; the generosity of the private sector should not be a substitute for the public sector spending; and a global action plan is essential for meeting the public's health needs. In order to stop the current stagnation, the speaker proposed four levels of intervention. First, structuring health care to avoid competition between private and public sectors. Secondly, training health workers and seeking to prevent their exodus to rich countries. Thirdly, focusing on vulnerable and marginalized groups such as children and women. And finally, to seek innovation in the pharmaceutical sector and promote the use of generic drugs.

The next speaker, Mr. Alok N. Mukhopadhyay, C.E.O. of the Voluntary Health Association of India, stressed the interdependence of economy and public health. "Health is not an expense but an investment for governments", he continued. All people want to live healthily and have a basic right to claim the conditions to create and maintain their health. A vital question for the speaker was whether health had to be offered as a commodity in the marketplace. He pointed out that more spirituality was needed. In this context, Mr. Mukhopadhyay quoted Mahatma Gandhi's view that "the world has enough for everyone's needs but not for everyone's greed". He concluded by stressing the lack of dialogue between the different medical and health care systems and the difficulties in attracting workers and experts to public health care.

The final speaker, Professor Bruno Grijseels from the Prince Leopold Institute of Tropical Medicine in Antwerp, highlighted the role and responsibility of academic institutions. Academics and scientists could learn from taking a holistic approach to global health problems instead of focusing on isolated research problems. Access to quality healthcare is a real challenge which can only be won by establishing partnerships, he said. Scientists have the responsibility not to lose sight of reality and to develop systems which can be implemented for the benefit of the public.

In her closing remarks, Professor Le Coultre, Membre of the Forum Organizing Committee and Vice-Dean of the Faculty of Medecine of the University of Geneva, commended the quality of interaction and idea-sharing at the Geneva Forum. She mentioned that this Forum had been a starting point, called for feedback from the participants and promised additional efforts to bring more people from the developing world to the next Global Health Forum.

Dr. Louis Loutan, President of the Forum Organizing Committee and the Geneva University Hospitals, thanked the organizing team, the advisory board, the Forum participants, the sponsors and the volunteers --there were over 60 involved in the conference-- for their contribution to this first edition of the event. He closed the Forum by inviting participants to use the conference web site's feedback form to share their impressions in view of a next edition of the event.

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