Broken, Fragmented National Health Systems Cause Deaths Around the Globe, World Health Organization Tells Population Commission in Ongoing Debate

13 April 2010
Economic and Social CouncilPOP/981
Department of Public Information • News and Media Division • New York

Commission on Population and Development

Forty-third Session

4th & 5th Meetings (AM & PM)

Broken, Fragmented National Health Systems Cause Deaths Around the Globe,

World Health Organization Tells Population Commission in Ongoing Debate

‘We Must Bring Health to the People and People to Health,’ Commission Told,

Hearing Unreformed Systems Block Achievement of Millennium Development Goals

People around the world were dying because their needs went unmet by health systems that were fragmented, broken and struggling, the Commission on Population and Development heard today as it continued its general debate on national experiences related to health, morbidity, mortality and development.

In a keynote address, Carissa Etienne, Assistant Director-General of Health Systems and Services of the World Health Organization (WHO), said that with national health systems bearing the weight of rapidly expanding urban populations, as well as a dual burden from communicable and non-communicable diseases, people received health care that was too often inverse, impoverished, unsafe and misdirected.

She said that in WHO’s view, the primary health-care system provided the central direction for every health system, and the organization was promoting reforms in the area of primary health care, starting with universal health coverage.  The central thrust of its proposed reforms aimed at increasing the participation of the people who accessed health systems.  Among other things, delivery gaps should be closed.  “We must bring health to the people and people to health.”

Punctuating the need for the overhaul, she called attention to the growing global consensus that strong health systems were critical in achieving the Millennium Development Goals.  In that regard, unreformed, broken health systems continued to pose major obstacles to achieving the health-related targets of the Goals, and the lack of progress on Goal 5, which addressed maternal health, was the prime example -– indeed, the “litmus test” -- of the widespread failure of health systems.

Echoing her assertions, speakers throughout the day-long debate expressed grave concern over the lack of progress on Goal 5.  Many of them noted that more than 500,000 lives were lost each year worldwide due to maternity-related causes, with several highlighting how 98 per cent of those deaths occurred in developing countries and were often preventable.  That situation was particularly unacceptable from a human rights perspective, some said.

To that point, the representative of Australia said preventable maternal mortality and morbidity constituted a significant health inequity.  Speaking on behalf of the Pacific Islands Forum, he said access to quality emergency obstetric care and voluntary family planning services should be available to all, in all places and at all times.

The Secretary of the Department of Health of the Philippines acknowledged, however, that reducing maternal mortality was a complex issue involving socio-cultural factors and women’s economic status.  Indeed, while the majority of Filipino women were educated and held jobs, 11 mothers died every day, leaving at least 33 children motherless.  Family planning services appeared to be the missing link, she said, stressing that “mothers will continue to die unless they can have planned pregnancies”.

Similarly, the representative of the Netherlands said that, if the world was serious about reducing maternal mortality, it must address sensitive issues like contraception and sexuality, and should include a discussion of abortion.  The focus should also be on young people, since providing information, sex education and contraceptives to that population segment was crucial.

A number of representatives -– many from sub-Saharan Africa -- said that, despite the best intentions of their national health strategies to deliver health services that were both more broadly available and more targeted, their efforts were hampered by the persistent lack of resources.

While Kenya had elaborated a national blueprint of priority actions on health care, that country’s Minister of State for Planning, National Development and Vision 2030 stressed that universal accessibility to primary health care remained constrained by inadequate resources.  Recalling how a decade of political conflict and insecurity had eroded much of his country’s earlier progress, the representative of Côte d’Ivoire reminded the Commission how dependent his country remained on its development partners.

For their part, many donor countries reiterated their support, with Canada’s representative saying his country would use its position as President of the Group of Eight (G-8) this year to champion a major initiative to improve the health of women and children in developing countries.

Speaking in general discussion in the morning were ministers and senior officials of South Africa, Poland, Pakistan, Israel, Cuba, Japan, Uganda, Russian Federation and Ghana.

The representatives of Finland, Switzerland and Colombia also spoke.

Participating in the morning’s interactive discussion with Ms. Etienne were the representatives of Japan, Norway and Israel.  A representative of National Right to Life also spoke during that discussion.

Speaking in general discussion this afternoon were ministers and senior officials of Mexico, Gambia, Denmark and Nigeria.

The representatives of India, Sri Lanka, Brazil, Zambia, Peru, Botswana, Argentina, Norway, Republic of Korea and Spain also addressed the Commission.

The Director of the International Labour Organization Office for the United Nations also spoke, as did the Director of the United Nations International Strategy for Disaster Reduction.

The Commission will reconvene at 10 a.m. on Wednesday, 14 April, to continue its general debate.


The Commission on Population and Development today continued its general debate on “national experience in population matters: health, morbidity, mortality and development”.  The Commission, a functional body of the Economic and Social Council, monitors, reviews and assesses the implementation of the Programme of Action of the International Conference on Population and Development at the national, regional and international levels, and advises the Council thereon.  Its forty-third session is being held from 12 to 16 April.  (For more information on the session, please see Press Release POP/979.)


ANDREW GOLEDZINOWSKI ( Australia), speaking on behalf of the Pacific Islands Forum, said preventable maternal mortality and morbidity constituted a significant health inequity.  It was also an indicator of social justice and a serious human rights concern.  While Pacific member States had undertaken strategies for accelerated action to address it, some Pacific countries still experienced unacceptable and avoidable maternal deaths because women could not access relevant services.  Access to quality emergency obstetric care for all mothers and voluntary family planning services should be available to all, in all places and at all times.  Indeed, equitable access to quality and affordable health care was a basic human right.

He stressed that the empowerment and education of women was a critical factor in reducing maternal mortality.  Pacific nations had been honoured to join other Member States during the recent Commission on the Status of Women in adopting that body’s first resolution on maternal mortality and morbidity, which took note of the 2009 Madang Commitment of Pacific Health Ministers, as well as the 2008 Pacific Policy Framework for achieving universal access to reproductive health services.  Reiterating the Forum’s commitment to achieving Millennium Development Goal 5, he said further progress was needed to secure the political representation of women in decision-making on policies that affected their health and human rights.  He emphasized the importance of the education of women and girls, and underlined that violence against them was a serious issue in the Pacific.

Turning to the issue of non-communicable diseases, he said those were estimated to cause about 75 per cent of deaths in the Pacific.  The health costs related to those diseases were formidable, with as much as 60 per cent of the budgets of some Pacific island countries going to tertiary care.  With the support of its development partners, Pacific island countries were implementing the Pacific Framework for Non-Communicable Disease Prevention and Control, which focused on practical, cost-effective and evidence-based interventions.

WYCLIFFE AMBETSA OPARANYA, Minister of State for Planning, National Development and Vision 2030 of Kenya, associating himself with the “Group of 77” developing countries and China, said the goal of economic and social development was to improve people’s lives.  Like many sub-Saharan countries, Kenya had faced challenges in its efforts to improve the health of its people within the Cairo Population and Development Conference’s framework.  To address those challenges, “Kenya Vision 2030” was a national blueprint outlining priority actions, first in the area of primary health care, where the Government had revitalized the health infrastructure by promoting preventive health care and treatment of diseases at the community level.  Health facilities at “constituency” levels had increased through devolved funds and initiatives, but universal accessibility to primary health care was constrained by inadequate resources, among other things.

He said that Kenya’s implementation of child survival interventions had resulted in increased child vaccination coverage and timely supply of vaccines to health facilities.  However, infant mortality had dropped only from 60 per 1,000 live births in 1989 to 52 per 1,000 live births in 2009, and Kenya risked not achieving the Cairo outcome or Millennium Development Goal 4 on child health.  “Vision 2030” contained programmes to boost health and nutrition information.  On women’s health, reversing the high rates of maternal mortality was a challenge, but the Government was implementing various measures to reduce it, such as policies and training curriculums on task-shifting for health-care providers.  On communicable diseases, malaria was the leading cause of morbidity and mortality in Kenya, accounting for 5 per cent of deaths.  The 2015 Cairo target and Millennium Development Goal 6 on combating HIV/AIDS were unlikely to be attained if trends persisted.  Progress had been made in preventing mother-to-child transmission of HIV.   Kenya was committed to improving access to primary health-care services.

ZANE DANGOR, Special Adviser to the Minister of Social Development of South Africa, reaffirmed his country’s commitment to implementing the Cairo Programme of Action and its follow-up actions.  He highlighted several Africa-wide meetings on population and development and expressed South Africa’s determination to implement the decisions made during them.   South Africa shared the concerns that Africa’s life expectancy had virtually stagnated since the late 1980s.  Among other things, maternal, infant and child mortality remained at unacceptably high levels in many African countries, including in South Africa.

Noting that life expectancy at birth in his country had fallen from age 60 in the early 1990s to about 50 in 2007, he said that decline was largely driven by the HIV/AIDS pandemic and was particularly due to increases in mortality rates of infants, children and young adults.  Recently, those mortality trends had been gradually reversed through the world’s largest HIV/AIDS treatment and prevention programme.   South Africa’s health-care services had also expanded since 1994, improving the longevity of South Africans who did not contract HIV.  That had increased the incidence of old-age-related diseases as the cause of death.   South Africa’s Population Policy focused on data collection and research, and had led to an improved report on mortality data, he said, noting that mortality and morbidity trends differed between men and women, with women bearing the brunt of the HIV/AIDS burden.  In that regard, gender equity and equality were viewed as a prerequisite for improved health and development and reduced mortality and morbidity.

JARMO VIINANEN (Finland) said that, although non-communicable diseases were a major cause of mortality and morbidity, they were still neglected, with a survey showing that less than 1 per cent of the $22 billion spent on health by international aid agencies in low- and middle-income countries was spent on non-communicable disease control.  “All health matters should be dealt with in a coherent manner,” he said.  The growing burden of disease caused by non-communicable diseases was disproportionately affecting the poor.  Enhancing health systems for preventing non-communicable diseases was of utmost importance, and integrated action on known risk factors -– physical inactivity among them -– was needed.

He said Finland had a rich experience in successful non-communicable disease prevention.  In the 1960s, it had had the highest cardiovascular disease mortality in the world, but in 2009, that level had dropped to nearly one tenth of the level of 30 years earlier.  Success had been due, in part, to the involvement of actors at the primary health-care level and to international collaboration.  Urgent action was needed globally to stop the growth of non-communicable diseases and all must commit to implementing the related World Health Organization’s (WHO) global strategy.  On reproductive health, little progress had been made on Millennium Development Goal 5 (maternal mortality), which was unacceptable from a human rights perspective.  The right of adolescents to sexual and reproductive health services was especially important for promoting that Goal on a long-term basis.

MARIE MARCHAND ( Switzerland) said empowering individuals and communities so that they made health choices and rational use of health-care services was at the core of the Swiss contribution to the achievement of the health-related Millennium Development Goals.  In that regard, Switzerland promoted a comprehensive approach to planning, implementing and monitoring health-sector reforms in partner countries and supported the better management of health systems, as well as decentralized and stronger involvement of civil society in ensuring reproductive health and rights.

She said her country further attached particular importance to gender-specific approaches to achieving improvements in public health, which included approaches to addressing the HIV/AIDS problem and other sexually transmitted infections.  It also supported efforts to stop gender-based violence, including domestic violence and excision, and pursued awareness-raising programmes targeted on the health risk caused by female genital mutilation.  Additionally, Switzerland considered access to essential medicines to be an integral part of the overall approach to strengthening health-care services in developing countries and to facilitating access to those services.

ADAM FRONCZAK, Under Secretary of State, Ministry of Health of Poland, underlined his country’s achievements over the past 20 years in the transformation of its health-care system, but acknowledged that Poland still faced challenges, which the Government needed to tackle.  That notwithstanding, Poland was ready to share its experiences and knowledge acquired during the transformation period, which could serve as a reference for developing countries or countries in transition in their efforts to rebuild their health-care systems.

Reviewing the country’s health-sector reforms, he noted that Poland was undergoing a period of rapid demographic changes.  The mortality rate in the country had been reduced by 23 per cent from 1,137.6 in 1990 to 828.8 in 2008, as a result of lowering the incidence of deaths caused by circulatory diseases and external factors.  Still, however, the mortality rate caused by circulatory diseases was almost double that of countries most advanced in treating those diseases.  An indicator of the progress achieved in Poland in terms of the quality of health care was an increase in life expectancy, which for women had extended to 80 years and for men was 71 years.  Health care for pregnant women, as well as for children, was among the Government’s highest priorities.

He stated that the effective suppression of communicable diseases had been the greatest achievement of Polish public services over the past 50 years.  Mass vaccinations constituted the most effective example of public health intervention, which produced rapid effects in the form of savings to the health-care system and reduction in disease incidence.  Concluding his statement, he briefly described a series of projects, financed by Poland, in line with the Millennium Development Goals, as well as its systematic increase of allocations for development systems, with voluntary contributions earmarked for health protection and medical care.

SHAUKAT HAYAT DURRANI, Secretary, Ministry of Population Welfare of Pakistan, aligning himself with the Group of 77 developing countries and China, said his nation, the sixth most populous in the world, was undergoing demographic transition, with 41 per cent of the population below the age of 15 and only 4 per cent over the age of 65.  The latest national population policy was being finalized and its goals were set in three major areas of the Cairo outcome:  expanded access to education; reduced mortality rates; and increased access to reproductive health services and family planning.  The policy provided a broad framework for improving the quality of life by focusing on family planning, especially in rural areas.  The Government would focus on raising awareness, boosting advocacy and enhancing national capacity for monitoring goals and targets, among other efforts.

The national health policy provided equal attention to communicable and non-communicable diseases, he said, noting that its approach had been shaped in collaboration with civil society.  In the context of the priority theme, he highlighted the need for focus on family planning and provision of quality reproductive health.  Poverty eradication was vital to achieving the Millennium Development Goals, and people in developing countries would continue to face shortages of food, housing and education, among other things.  Meeting the challenges of health, morbidity, mortality and development required global cooperation.  Also, an equal focus on prevention of communicable and non-communicable diseases was needed, and he urged shared efforts in that regard.  Finally, there was a need to promote research, knowledge-sharing and provision of information technology for equitable access to health care services.

ALEX LEVENTHAL, Director of Department of International Relations, Ministry of Health of Israel, noted that those in the public health sector had struggled for years to build positive health indicators to better understand the quality of health and not merely the issues surrounding the “negative” indicators of mortality and morbidity.  The challenge for Israel, where 38 per cent of the population was foreign born, was to produce clear and useable data that dealt with its various sub-populations.  To address its complex challenges, the country took a holistic approach, combining education, social and health services.  It had learned the necessity of addressing specific needs of its sub-populations, particularly in terms of cultural sensitivity.

He said that while access to health-care services was the most important factor in Israel’s health-care strategy, the Ministry of Health coordinated its activities with many other Government agencies and non-governmental organizations.  That allowed it to pinpoint other factors, like education, social issues and income, which played a role in personal and community health.  Indeed, the lowest rates of morbidity and mortality belonged to Israel’s Christian Arab minority.  That population group was well-educated and avoided consanguinity of marriage, which existed in many of the country’s Muslim communities.  Israel continued to invest in child and maternity care for its citizens and residents, and it enjoyed the highest life expectancy rates in the immediate region, with men’s life expectancy rates among the highest in the world.  Nevertheless, Israel could do more to prevent morbidity caused by non-communicable diseases, and, despite its records of cooperation on health issues with some of its closest neighbours, it could still do more in the realm of public health, which could serve as a pivotal bridge to promoting peace and cooperation in the Middle East.

JUAN CARLOS ALFONSO, Director, Centre for the Study of Population and Development, National Office of Statistics, Cuba, associating himself with the Group of 77 and China, said health, morbidity, mortality and development were priorities in his country, based on the principle that “health is the right of the people”.  His Government had devoted resources to the health sector.  When the Commission analyzed compliance with the Cairo Goals in 2014 and 2015, it would see that Cuba would have accomplished all its commitments ahead of time.  Indeed, Cuba had seen various improvements.  It was among those countries with a high human development index, at a position of 51.  The Government’s economic and social development programme had allowed Cuba to achieve socio-economic indicators, notably related to mortality and morbidity, similar to those in developed countries.  Much could be done with little, as long as political will prevailed.

Summarizing results, he said the infant mortality rate in developing countries had dropped from 99 deaths per 1,000 live births in 1990 to 72 in 2008.  In Cuba, deaths of children under age five and maternal mortality indicators continued to drop, showing clear progress in health and reproductive health.  Cuba devoted 18.5 per cent of its budget to health and social assistance, with free health care at all levels.  There were 248 health centres, where thousands of nationals and foreigners studied.  Such efforts allowed for the prevention of diseases such as polio, diphtheria and German measles, among others.  The main causes of death were not due to communicable diseases.  HIV/AIDS prevalence was at 0.1 per cent of those aged 15 to 49 years.  Progress in reproductive health had led to a decrease in fertility.  All legal, institutional and social conditions were in place for women to decide on the number and spacing of their children.  In 2009, contraceptive use by women of reproductive age stood at 78 per cent.

RYUZABURO SATO, Director, Department of International Research and Cooperation, National Institute of Population and Social Security Research, Ministry of Health, Labour and Welfare of Japan, said his country made great efforts to improve maternal and child health systems.  In 2008, the infant mortality rate was 2.6 deaths per 1,000 live births, down from 76.7 in 1947.  Similarly, in 2008, the maternal mortality ratio was 3.5 maternal deaths per 100,000 live births, down from 160.1 in 1947.  He believed Japan’s experience could provide useful lessons for other countries.

He said that developed countries, including Japan, were moving towards ultra-long-lived societies, which mankind had never experienced before.  Increased life expectancy, especially longer, healthy life expectancy, contributed to society and the economy in various forms, including a larger work force, consumer market and volunteer pool.  On the other hand, if an increase in life expectancy did not occur together with a longer, healthy life expectancy, it would cause a serious strain on society and the economy.  Consequently, Japan had been promoting a campaign called “Health Japan 21”, which aimed at increasing awareness of disease prevention and improving lifestyle habits.

Japan, based on its own experiences, had actively contributed to global health from the perspective of human security in the belief that that concept aimed to address global threats, such as infectious diseases, by focusing on each individual and by building societies that enabled people to realize their full potential through protection and empowerment, he said.  The concept of human security was one of Japan’s foreign policy pillars and was consistent with the Cairo Programme of Action.  The perspective of sexual and reproductive health was closely related to those important issues.  Japan shared the view, stated in the Action Programme, that it was indispensable to ensure access to information and services related to sexual and reproductive health, including family planning, for achieving sustainable development.

CLAUDIA BLUM ( Colombia), joining the statement made on behalf of the Group of 77 and China, said a better socio-economic situation was consistently related to better health.  A holistic approach was needed that went beyond health policy and helped to reduce social gaps through sound employment, education, housing and welfare policies.  Since 1993, the Government, through law 100, had established the country’s social security system, which provided access to health care for all through a payroll tax and insurances subsidies.  In December 2009, 95 per cent of the population had health insurance, with 53 per cent of them affiliated with the scheme of insurance subsidies.

She said that her country, as it underwent a demographic transition resulting from modernization that included decreasing mortality, fertility and growth rates, was experiencing an epidemiological transition -- communicable diseases decreased and non-communicable diseases increased.  Child mortality had also decreased from 42 per 1,000 live births in 1995 to 15.5 in 2005, but that progress had not been uniform across the country.  Among the 10 leading causes of mortality in Colombia, 8 corresponded to chronic and degenerative diseases.  Indeed, non-communicable diseases, which represented a high cost to the health system, posed a critical public health problem.  The Government had joined international efforts to promote healthy lifestyles, incorporating prevention and control of chronic diseases and risk factors into its National Public Health Plan.  That plan also sought to achieve a more equitable health system.  Beyond national efforts, however, international cooperation, technical assistance and technology transfer needed strengthening.  Access to medicines should also be promoted.

JEROEN STEEGHS ( Netherlands), aligning his remarks with those made on behalf of the European Union, said the Commission’s session was an opportunity to contribute to the upcoming high-level meeting on the Millennium Development Goals, particularly with respect to Goal 5.  Despite the special place of motherhood in many societies, women and mothers were not always as protected as they should be.  More than a half a million preventable maternal deaths occurred each year.  The highest maternal mortality rates existed in South-East Asia and sub-Saharan Africa, and only six countries accounted for half of all maternal deaths.

He stressed that if the world was serious about reducing maternal mortality, it must address all related areas, including those that touched on private issues like contraception and sexuality.  Indeed, the unmet need of so many women for contraception must be addressed.  Abortion should also be a topic of discussion, despite any sense of discomfort in talking about it.  In those discussions, the focus should be on young people.  Providing information, sex education and contraceptives to that population segment was crucial.  The Netherlands, together with the United Nations Population Fund (UNFPA), had organized an event on Millennium Development Goal 5 in Addis Ababa last year.  The resulting “Addis Call” had focused on improving adolescent health, particularly reproductive health.

WILBERFORCE KISAMBA-MUGERWA, Chairperson, National Planning Authority of Uganda, said his country had agreed to the 1994 Cairo Action Programme and had endorsed the Millennium Development Goals.  Between 1948 and 2002, Uganda’s population had increased fivefold, from 4.9 million to 24.3 million.  The country had a young age structure, with children under 15 years comprising 56 per cent of the population.  “This has a lot of planning implications,” he said.  A component of that bottom-heavy age structure was a high fertility rate of about seven children per woman.  Between 2001 and 2006, maternal and infant mortality had dropped, from 505 per 1,000 life births to 435 per 1,000 live births, and from 122 per 1,000 live births to 76 per 1,000 live births.  Apart from the population growth rate, fertility rate and contraceptive usage, all other indices had improved significantly in the past 10 years.

He said that for the past 14 years, the broad concept of reproductive health adopted at the International Conference had been incorporated into Government policies.  Since 1997, Uganda had implemented a poverty eradication action plan, which was a development framework and a medium-term planning tool.  The Government was committed to revising that plan every three years, with a view to incorporating new lessons pertinent to development objectives.  Universal primary education had been implemented since 1997, and primary school enrolment had jumped by almost 100 per cent.  However, the high rate of school dropouts, at 78 per cent at the primary school level, notably among girls, was a major drawback.  The national gender policy aimed to promote gender equality, while other policies had greatly improved women’s participation in decision-making.  The 2008 road map for reducing maternal and neonatal mortality and morbidity was awaiting budgetary provisions for implementation.  On HIV/AIDS, Uganda had pursued a multisectoral approach, and the latest figures showed that its prevalence had dropped to about 6.4 per cent, from 29 per cent in some sites at its peak in the 1990s.

ALEXANDER KOSHKIN, Third Secretary, Department of International Organizations, Ministry of Foreign Affairs, Russian Federation, expressing his heartfelt condolences to the Government and people of Poland, said the most acute population problem in his country was the high mortality level among “active age” people who died from preventable causes.  To change that trend, the Government, three years ago, had passed a population policy, covering the period through 2025, which sought to stabilize the population level.  In 2009, the Government finalized the first stage of that concept, which had registered success.  The natural decline of the population, as compared with 2006, had been reduced three-fold, while children born had increased 18 per cent, and child mortality had fallen by almost 20 per cent.  Another national health project had reduced child and maternal mortality and boosted reproductive health.  Moreover, the Government had increased child allowances for children up to 1.5 years.

Turning to HIV/AIDS, he said people needed special attention to prevent the spread of the disease.  The Government yearly conducted various initiatives, including educational activities.  It recently had paid attention to non-communicable diseases, with the launch of an initiative for an international conference to be held in 2011.  The Russian Federation also had participated in discussions aimed at organizing a high-level General Assembly meeting on non-communicable diseases.  Promoting a healthy lifestyle was important, and the Government had made efforts to reduce smoking and alcohol consumption among the population.  Other programmes were in place to reduce death from heart disease and heart attacks. Also, to minimize occupational hazards, the Government was developing a “Health at Work” programme.

MARIAN KPAKPAH, Acting Director of the National Population Council of Ghana, said her country’s national health policy, “Creating Wealth through Health”, recognized that ill health was both a cause and a consequence of poverty.  The policy was geared towards improving the health of every Ghanaian.  It sought to reduce high levels of morbidity and mortality, promote reproductive and sexual health, as well as the health and welfare of mothers and children, and to integrate family planning services into maternal and child health-care services.  Among the country’s successes were declining infant morality rates, lower under-five mortality rates and higher life expectancy at birth.  The total fertility rate had declined from 4.4 children in 2003 to 4.0 in 2008, while immunization coverage among children stood at 87 per cent.

Despite those successes, she said, the maternal mortality rate remained unacceptably high.  Ghana’s achievement of Millennium Development Goal 5 was unlikely amid current resource constraints.  Maternal mortality had been declared a national emergency in 2008, and Ghana had launched a campaign on accelerated reduction of maternal mortality in Africa in 2009 as part of the African Union’s efforts to increase public awareness about maternal and infant deaths.  Other areas of concern included declining contraceptive use and increasing HIV prevalence.  Malaria remained the leading cause of outpatient morbidity in all age and sex groups.  Still-birth rates had not shown any improvements, and new strains of epidemic-prone diseases had recently been recorded in some parts of Ghana.

Against that backdrop, the Government was rehabilitating health infrastructure nationwide, introducing more training programmes to localize medical treatment and increasing the number and intake of midwifery training schools, she said.  It was expanding the coverage of its national health insurance scheme and intensifying its immunization and family planning programmes.  It was promoting healthy lifestyles and had adopted a policy on the health of the elderly.

Keynote Address

CARISSA ETIENNE, Assistant Director-General of Health Systems and Services of the World Health Organization (WHO), speaking on “Strengthening health systems to address current and future challenges in public health”, said health systems were fragmented, broken and struggling.  As a consequence, people were dying because their needs were not being met.  WHO was working with countries to build health systems that were robust enough to confront new challenges.  Strong health systems allowed improvements in health outcomes related to HIV, tuberculosis and malaria, while also addressing non-communicable diseases like diabetes.

Stressing that the health circumstances of people everywhere were affected by poverty and inequity, she noted that the explosive growth of urban populations was a key factor for health systems.  As a result of urbanization, 170 million urban residents had no access to a latrine and millions were dying from air pollution.  Meanwhile, increases in life expectancy meant populations were rapidly ageing and health systems in many developing countries were not ready to respond.  Those systems were bearing a “dual burden” from communicable and non-communicable diseases, yet they were not organized, designed or equipped to do so.  That was particularly true in developing countries, she said, noting their particular inability to deal with the growing burden of road traffic deaths, which were rapidly becoming a leading cause of death.

Underlining the growing global consensus that strong health systems were critical in achieving the Millennium Development Goals, she said the lack of progress on Goal 5, which addressed maternal health, was the prime example –- indeed, the “litmus test” -- of the failure of health systems.  Despite achievements in reducing child deaths from malaria and in providing antiretroviral treatment to millions with HIV, broken health systems around the world were major obstacles to achieving the health-related Goals.

She went on to say that, irrespective of where they came from or their social status, people around the world wanted similar things from their health systems: quality care; respectful treatment; access to medicines; a fair deal; a say in what affected their lives; reliable health authorities; and access to affordable, quality health care.  Unfortunately, what they got was inverse, impoverished, fragmented, unsafe and misdirected care.

Noting the insufficient understanding of how to define a “health system”, she said WHO used six building blocks to describe a health system: human resources; medicines and technologies; governance; financing; service delivery; and information.  In the organization’s view, the primary health-care system provided the central direction for a health system.  Towards that goal, it was promoting reforms in primary health care, starting with universal health coverage.  Other reforms covered changes in service-delivery to make health systems people-centred, leadership to make health authorities more reliable and public policy to promote and protect the health of communities.

She suggested that the heart of comprehensive health-system reforms was increasing the participation of the people who accessed the system.  Moreover, in a well-functioning health system, its six building blocks would work in an interdependent manner.  WHO was helping countries to address human resource gaps related to the mix of skills, number, distribution and training of health workers, particularly through its forthcoming code of practice regarding training and recruitment.  The organization also helped countries ensure the quality, appropriateness and affordability of medicines and diagnostics, maintain efficient logistics systems and assure access to essential medicines and technologies.  In terms of governance, it was working with Governments to improve efficiency, increase aid effectiveness, promote accountability and design and implement regulatory frameworks.

Continuing, she said WHO’s efforts to improve financing included raising money, protecting people from the financial consequences of ill health and optimizing the use of resources in the health system.  Indeed, all countries could improve their health systems by cutting waste.  Ultimate success would come only through pooled and pre-payment approaches that utilized tax- or insurance-based schemes.  She noted, in that regard, WHO’s position, expressed in its forthcoming report on world health, that point-of-service fees must be abolished.

As for health delivery, she said WHO helped countries maintain primary-care teams close to communities, provide patient-centred care and services throughout the course of one’s life and deliver integrated, comprehensive care. It was simple: “We must bring health to the people and people to health.” Moreover, health information was critical for managing care.

Clearly, countries were facing new and significant health challenges, with many of them struggling to meet those challenges, largely because, after years of neglect, health systems were ill-equipped to do so, she said.  On top of that, most health systems had never been oriented to respond to new and changing demands.  However, WHO could help countries uncover the ways in which their health systems must change and the means of doing so.

Interactive Discussion

In the brief discussion that followed, one speaker asked Ms. Etienne about formulating a global action plan for maternal and child health.  Another delegate commented on the problem of user fees that women with urgent pregnancy complications had to pay before they called an ambulance or opted for a caesarean section.  The situation was the same for other acute events and it was timely that Ms. Etienne had called the reduction of maternal mortality a “litmus test”.

Another speaker observed that the way to improve women’s health care was to improve health systems.  She asked about the maternal mortality estimate, which had dropped recently, from 500,000 to 300,000 deaths annually.  However, WHO had stated that there had not been a significant change.  Could Ms. Etienne explain that?

Another delegate wondered if it was time to have a checklist for countries to ensure their health systems were adequate.  What were the components of health care, especially secondary and tertiary health care?  Somewhere between 6 and 15 per cent of countries’ gross national product was being used for health.  Countries were interested to know if they had all the necessary components in place.

Responding, Ms. ETIENNE said that while it was an excellent idea to formulate a global action plan, it must be accompanied by investment to ensure local action and implementation. She was sure that health system requirements would be addressed in a global action plan.

On the issue of user fees, she said the World Health Report would make bold statements on those.  When a mother in labour had to decide immediately whether to opt for a caesarean birth it posed a huge barrier to access to care.  Maternal mortality could be explained, in part, by the fact that women had to pay for such services in their time of urgent need.

On the maternal mortality figures of 500,000 versus 300,000, she said The Lancet would soon have a lead article stating that the figure of 500,000 maternal deaths per year was incorrect.  WHO continued to report the 500,000 figure annually.

Turning to health systems, she said countries understood what was wrong with their health systems.  While it might be helpful to develop a checklist, health systems were specific to countries; no checklist would be sufficient for all nations.  “We will not have a blueprint,” she said.  However, a general list of what was needed for a well-functioning health system was being developed.  It was important to remember that a health system was a means to an end -– it must lead to better health outcomes for people.


MANJEEV SINGH PURI (India), associating himself with the statement made by the Group of 77 and China, said the Programme of Action laid a 20-year road map, recognizing the complex interplay among economic and sustainable development with population, gender equality, urbanization and migration.  Health indicators accounted for three of the eight Millennium Development Goals, and health directly impacted the rest.  Implementation of the Action Programme had a direct implication on realizing the Goals, and the global community must be seized of that priority and deepen its efforts to achieve the targets.  India was committed to realizing the Cairo outcome and the Goals.  “Our progress has been steady,” he said, noting that the Government attached the highest importance to realizing those targets.

In that context, he said India’s flagship national rural health mission, since 2005, had been among the biggest interventions of its kind in the health sector.  Aiming to cover 600 million people, especially women and children, it had provided effective primary health care and thus far, had benefited more than 10 million women.  It had emerged as a major success in reducing maternal and infant morality, falling dramatically from 1992-1993 to 2004-2006.  However, international cooperation had not been forthcoming in achieving health-related goals.  The global community must play a mutually supportive role.   India had proactively shared its development experience, notably by linking major hospitals in Africa with “super-specialty” hospitals in India, through an e-network project.  Also, while focusing on new challenges, efforts to fight communicable disease should not be diluted.  With that, he encouraged devising new and innovative financing to tackle non-communicable disease.

FELIZ VELEZ, Secretary-General of the National Council on Population of Mexico, said the wider coverage of health services was a priority for his Government.  Its current strategies in that regard, which, among other things, focused on the poor, would help Mexico achieve universal health coverage in 2012.  He noted that progress in terms of Mexico’s birth rates had accelerated due to the increasing use of contraceptives; standing at 37.7 per 1,000 in 1980, the birth rate was now below 20 per 1000.  The proportion of contraception use had been 70.9 per cent in 2006.  Additionally, fertility rates had been reduced from more than seven children per woman in the 1960s to just over two currently.  Reductions in general and infant mortality had also led to increases in life expectancy.

Calling the decrease in mortality one of his country’s greatest achievements in the last century, he noted that there had been a gradual decline in the incidence of some diseases, as well as greater concentrations in chronic degenerative diseases.  Those trends were closely linked with advances in development.  Yet, in the poorest areas of Mexico, particularly in its southern regions and among the indigenous population, preventable diseases were still highly lethal.  The increase of HIV/AIDS also posed a new challenge to Mexico’s national health system.  Among other diseases, cirrhosis and chronic liver diseases resulted from over-consumption of alcohol.

Welcoming the proposals on the Commission’s membership, he said the suggestion for the main theme for the Commission in 2012 was particularly relevant.  As a country that was hosting this year’s migration forum, Mexico believed discussion on that subject was important.  In light of the General Assembly’s schedule, he thought it would be useful for the Commission to repeat the practice of 2006 and discuss a theme that would result in useful and relevant input for the Assembly’s discussions.

ESPERANZA CABRAL, Secretary of the Department of Health of the Philippines, aligning with the Group of 77 and China, said middle-income countries had registered an annual gross domestic product (GDP) growth rate of 6 per cent in 2009, versus 1 per cent in high-income countries.  The trend for the past three years correlated to the human development index, and basic services indicators that a country could provide for the health of its population.  The health of Filipinos was being threatened by increasing HIV/AIDS prevalence.  While a low-prevalence country –- with less than 0.1 per cent of the adult population estimated to be HIV-positive –- data showed there had been an “alarming” increase among young professionals.  The Government had worked hard to improve health outcomes by providing financial protection for the poor and setting up more responsive health services, among other efforts.

She emphasized that every year, more than 500,000 lives were lost globally due to maternity-related causes; 98 per cent of those occurred in developing countries and most were preventable.  While the majority of women in the Philippines were educated and held jobs, 11 mothers died every day, leaving at least 33 children motherless.  As of 2006, 162 mothers per 100,000 live births died due to pregnancy and childbirth complications.  Maternal deaths comprised as much as 14 per cent of all deaths of Filipino women of reproductive age.  Maternal mortality reduction was a complex issue involving socio-cultural factors and women’s economic status.

Family planning services was the missing link, she said, adding: “Mothers will continue to die unless they can have planned pregnancies.”  The contraceptive prevalence rate was low, at 50.7 per cent in 2008, with only 34 per cent using modern contraceptive methods.  While rich women could buy contraceptives, poor women hardly had enough money to feed their children.  It was the State’s duty to ensure that reproductive health services and commodities were accessible and available, and were provided for free for the poor.  The Government was working to reduce maternal and neonatal deaths through a national programme premised on the principle that all pregnancies must be wanted, planned and supported.  There had been considerable improvement in women’s status, yet the persistent incidence of violence against women implied a need for more aggressive efforts.

PALITHA T. B. KOHONA (Sri Lanka) underlined how the Cairo Conference process, by recognizing gender equality and women’s empowerment, allowed women to make informed decisions about family planning.  Universal access to reproductive health care, assisted childbirth and the prevention of sexually transmitted diseases were among its core objectives.  Its approach, which advocated the promotion of universal education as part of efforts to eliminate infant, child and maternal mortality, marked a significant shift from the traditional focus on achieving demographic targets and managing population numbers.  However, the vast disparities emerging among and within developing countries sent a strong signal that a global stocktaking was needed.  Towards that goal, the notable lack of progress on Millennium Development Goal 8 (global partnership for development), presented a discouraging picture for developing countries.

Turning to his country’s specific circumstances, he said implementation of its population and reproductive health policy had matured, with the current focus on training reproductive health-care experts.  The prevalence rate for modern contraceptive methods had risen from 20 per cent in 1975 to 70 per cent in 2009.  Also, more than 96 per cent of childbirths were now attended by skilled health practitioners.  The mortality rate of children below age 5 had been reduced to about 10 per 1,000 in 2006 from 32 per 1,000 in 1990, while the infant morality rate had fallen from 18 per 1,000 in 1990 to 11 per 1,000 in 2008.  Maternal morality had been reduced from 27 per 100,000 live births in 1990 to 19 per 100,000 in 2007.  However, child malnutrition rates remained at 22.8 per cent and emerging challenges were posed by tropical diseases like dengue.  The Government had responded by launching several economic and social empowerment programmes and health projects, which included, among others, provision of a free midday meal to students and a nutritional food package for expectant mothers.

EDUARDO RIOS-NETO (Brazil), aligning himself with the statement by the Group of 77 and China, said the Programme of Action goals were among the most significant in promoting social and economic development.  They were especially relevant in the context of preparing for the September Summit on the Millennium Development Goals, and the Commission should make clear recommendations in that regard.  The United Nations should redouble efforts in the delivery of development cooperation and focus on a more effective development cooperation agenda.  There was a range of substantive issues that must be tackled -– among them was dismantling trade barriers that hampered access to affordable food and medicine.

He said that, in Brazil, cardiovascular disease was the major cause of death (27.4 per cent).  Non-communicable diseases were related to behavioural risk factors like tobacco use.  The Government had launched studies to identify social, economic and environmental factors that contributed to health risks.  In Brazil, external causes of death, including suicide and traffic accidents, had accounted for 9 per cent of total deaths in 1980, but had risen to 13 per cent in 2000.  Infectious diseases still posed a serious threat and, in some regions, were responsible for up to 6 per cent of all deaths.  To combat HIV/AIDS, Brazil had created policies that reached out to more than 320,000 affected people and made antiretroviral treatment free for 180,000 patients.  The association between tuberculosis and HIV/AIDS was a concern.  Dengue fever, among the most serious infectious diseases in Brazil, had been exacerbated by trade, migration and inadequate trash collection services.

Describing successes, he said the Government had achieved Goal 6 (HIV/AIDS), was on track to achieve Goal 4 (child mortality) and had made health access a constitutional right.  Access to medicine was a major challenge for poor countries and Brazil’s success in fighting HIV/AIDS underscored the importance of universal access to prevention, treatment, care and support.  The United Nations should be more supportive of generic medications and free and fair trade in them.  In closing, he underscored the role of biodiversity and traditional knowledge in global health issues.

AWA DEM, Principal Human Resource Economist, National Population Commission Secretariat of Gambia, said her country’s population policy articulated the direction, scope and operational modalities for effective implementation and development activities.  Though the National Population Programme embodied the recommendations of the Cairo Conference and Dakar Declaration, the objectives and targets set forth in the National Population Policy and action plan were in consonance with the Millennium Development Goals.  Those goals were eradication of extreme poverty and hunger; achievement of universal primary education; promotion of gender equality and women’s empowerment; reduction of child mortality; improvement of maternal health; combating HIV/AIDS, malaria and other diseases; achievement of environmental sustainability; and global partnership.

She said her Government, over the years, had invested its human and financial resources in addressing population and development issues, and that had yielded results.  Further, the Government recognized that universal access to reproductive health and services, including HIV/AIDS therapy, were a prerequisite for the attainment of the Millennium Development Goals.  Towards that end, the Government had been providing reproductive health services to Gambian women for free since last year.  The long-term objective of the health sector was to provide effective and affordable health care for all Gambians.  The objectives were to improve the administration and management of health services, provide better infrastructure for referral hospitals and health facilities, and extend the primary health-care services to all communities.  Gambia was validating a draft policy on non-communicable diseases, in recognition of the attention that deserved.

MUYAMBO SIPANGULE ( Zambia) said that implementing the Cairo Action Programme had been a challenge for his country, which was one of the world’s least developed.  However, his Government was determined to strengthen its health systems and had committed to a number of reforms that promoted accountability and transparency, as well as to partnerships with key stakeholders.  To improve the efficiency and effectiveness of the resources it deployed, the Government had adopted a sector-wide approach.  The Health Strategic Plan 2006-2010 put human resources reform at centre stage and focused on scaling up training, recruitment and retention of staff and management.  Those measures were beginning to bear fruit, as seen in the January 2010 staff-in-post head count, which indicated that 56 per cent of total posts were filled by health workers.  Due to its belief that infrastructure was critical to health service delivery, the Government had embarked on the construction of a general hospital in its capital, as well as district hospitals and health posts, including maternity wings.  The provision of therapeutic and diagnostic equipment and transport were also priorities.

He said significant progress had been recorded in implementing malaria control and prevention measures.  In other areas, the 79 per cent coverage of patients requiring antiretroviral therapy recorded in December 2009 was just shy of the universal access target of at least 80 per cent by 2015.  Strides in reducing maternal morality had cut the ratio from 729 per 100,000 live births in 2001-2002 to 591 per 100,000 in 2007.  At the same time, institutional child deliveries had risen from 43 to 48 per cent over the time period.  Contraceptive prevalence had increased from 24 to 33 per cent, and the current unmet need for family planning stood at 27 per cent.  Finally, by embracing the campaign for accelerated reduction of maternal mortality in Africa, Zambia aimed to raise awareness of that issue among politicians, cooperating partners, the private sector and its local communities.

GONZALO GUTIERREZ (Peru) underscoring that “public health is a priority”, said his country had strengthened primary care and enacted legislation on universal access to health services to limit inequality in that area.  However, children’s health, nationally and globally, was a concern and the international community must urgently promote the Millennium Development Goals, under a main theme of combating non-communicable diseases.  In Peru, infant mortality had fallen substantially.  To combat maternal mortality, the Government had launched a national strategic plan for 2009-2015, which aimed to prevent negative indicators related to death during pregnancy or childbirth.

However, he said, there was a high prevalence of many diseases not included in the Millennium Development Goals, including heart disease, stroke, cancer and diabetes.  Pneumonia was a leading cause of death in children under age 5 in Peru.  Many such diseases could be prevented with access to low-cost drugs, and he urged better adaptation of the Agreement on Trade-Related Aspects of Intellectual Property Rights.  Also, it was unjustifiable that 1.2 million people died annually in traffic accidents.  Without immediate action, that would become the fifth leading cause of death worldwide.  In other areas, Peru had created a national sanitation plan for the 2006-2015 period, with the goal of providing 82 per cent of the people access to clean water and 77 per cent access to sanitation.

CHARLES T. NTWAAGAE ( Botswana) noted that despite the limited success recorded so far in his country, maternal health remained one of the major public health challenges today, with an estimated 193 out of every 100,000 mothers dying during or immediately after childbirth.  That was despite the fact that 95 per cent of pregnant mothers attended antenatal care and subsequently received professional assistance during delivery.

He said the country’s investment in the health sector in the 1980s and 1990s had increased the life expectancy from 55 in 1971 to a peak of 65 in 1991.  Infant mortality had also declined from 97 deaths per 1,000 live births in 1971 to 37 in 1996.  However, the HIV/AIDS pandemic presented fresh challenges to Botswana’s efforts to improve the well-being and health of its people.  Consequently, life expectancy had declined back to 55 years in 2001, and further to 54 years in 2006, owing to increased mortality due to HIV/AIDS-related illnesses.  However, Botswana’s Government had continued its unrelenting fight against HIV/AIDS.  As one of the first countries in Africa to step out of denial, the political leadership had declared AIDS a national crisis and committed substantial budgetary resources to fight the scourge.  Among the first on the continent to provide free antiretroviral therapy to those living with HIV/AIDS, Botswana had not only prolonged the lives of those concerned, but had also ensured that they continued to live productive lives and contributed effectively to national development.

The Government had also implemented a programme of prevention of mother-to- child transmission, with no less than 90 per cent of pregnant mothers today receiving treatment to reduce risks of transmission of the deadly virus to the unborn child, he said.  Along with the challenges of HIV/AIDS, Botswana had experienced an increase in the number of reported cases of tuberculosis.  Equally disturbing had been the emergence of a multiple drug resistant strain of tuberculosis, owing to a lack of adherence of individuals to treatment schedules.  Additionally disturbing was the recent rise in the incidence of non-communicable diseases like diabetes, cancer, heart disease and hypertension.  Because treatment for those ailments was often highly sophisticated, prolonged and required expertise and resources not at the country’s disposal, he appealed for expanded development assistance in that area, noting that Botswana, like most developing countries, still had significant levels of poverty, with an estimated 30 per cent of its population living below the poverty datum threshold.

HENRI-PAUL NORMANDIN ( Canada) said the significant increases in life expectancy, reductions in child mortality and a shift in the cause of death from communicable to non-communicable diseases represented a global average and did not reflect the reality of low-income countries.  For them, communicable diseases still represented the majority and the global disease burden was disproportionately heavy.  Canada recognized the importance of addressing health-related issues at home and abroad.  Preventing smoking, particularly among youth, was an important priority for the Canadian Government.  Overseas, Canada recognized the importance of strengthening health systems to ensure that all people had access to quality health services.  Towards that goal, it had announced the African Health Systems Initiative in 2006.  That 10-year programme focused on sub-Saharan Africa and aimed to sale up human resources for health.

He further underlined Canada’s support for programmes that combated major infectious diseases, noting its commitment of hundreds of millions of dollars to the Global Fund to Fight AIDS, Tuberculosis and Malaria.  Important contributions had also been made to immunization efforts around the world through its support to many partners, like the United Nations Children’s Fund (UNICEF) and the Global Polio Eradication Initiative.  Nevertheless, with progress reports on the Millennium Development Goals showing that advances towards Goal 5 (maternal health) and Goal 4 (child health) lagging, the pressing need for global action in those areas was clear.   Canada would use its position as President of the Group of Eight (G-8) this year to champion a major initiative to improve the health of women and children in developing countries.

JORGE ARGÜELLO (Argentina), associating himself with the Group of 77 and China, said that, while some countries had seen progress in implementing principles included in the Cairo Conference, vulnerable groups had limited or no access to sexual and reproductive health services.  Implementation was essential for the most vulnerable segments of the population.   Argentina encouraged the promotion of policies to reduce maternal mortality and morbidity, and emphasized the need to combat all forms of violence against women and gender stereotyping.

In the area of public health, he said there had been mobilization against communicable diseases, like malaria and HIV/AIDS, but despite that, Argentina was concerned at delays in access to essential services.  That had negatively impacted attainment of Millennium Goals 4 and 5.  To combat non-communicable diseases, he urged following WHO recommendations to create healthy lifestyles, notably by reducing hypertension risks and obesity.  The negative effects of the global economic and financial crisis must not create setbacks in implementing the Cairo goals or the Millennium Development Goals.  As such, he urged redoubling efforts, with international support.   Argentina was committed to the Cairo outcome and key actions for its follow-up; those commitments were important for the full implementation of the Millennium Development Goals.

BERIT AUSTVEG ( Norway) welcomed the renewed interest in primary health care, saying that it should be people-centred -- accessible, acceptable, affordable, of good quality and empowering, taking into account people’s own knowledge and skills.  It should take into account, not just what is fashionable or at the leading edge of technology, but what people see as their problems, including such basics as nutrition.  In that light, better observation and care could make the critical difference in reducing infant mortality.

With a larger number of adolescents than ever before in many countries, sex education and access to affordable protection against infection and unwanted pregnancy became more important, she said.  She expressed concern over restrictions on abortions that led to more deaths and the underfunding of family planning.  She said it was time to acknowledge sexual rights that included the right to a safe abortion for women with unwanted pregnancies and the right to non-discrimination based on sexual preferences.  It was also time to plan a Cairo process beyond 2015, proposing one similar to the five-year review in 1999.

SHIM YOON-JOE (Republic of Korea) said that unprecedented demographic changes stemming from decreasing mortality, increasing life expectancy and the growing burden of non-communicable diseases called on countries to scale up efforts to protect the most vulnerable, including senior citizens.  In his country, life expectancy had reached 79.6 years in 2007 and, as of this year, 11 per cent of the population, or 5.3 million people, were 65 years or older, and by 2026, 20 per cent of the population would be over age 65.  Recognizing the severity of ageing population issues, the Government had taken measures, including the basic law on low fertility and aged society, enacted in 2005.  Efforts to improve primary health care and long-term management of chronic conditions had been introduced to tackle challenges faced by older persons.

Beyond health care, various policies for senior citizens had been initiated, he explained, noting that employment service centres had been established and programmes to make use of leisure time had been introduced.  Preventive measures through health care and a social security system were crucial in preparing for drastic changes in population structures.  From its experience with the world’s fastest ageing population, the Republic of Korea believed that scaling-up interventions by Governments were needed to ensure a more stable environment for all populations.  The global community should boost collaboration, with a view to providing more effective care for vulnerable groups.

KIRSTINE VANGKILDE BERNER, Head of Section, Department for Global Cooperation and Economy, Ministry for Foreign Affairs of Denmark, declared that with only five years left to achieve the Millennium Development Goals, the need to improve women’s health and overcome social and cultural barriers to sexual and reproductive health and rights was more urgent than ever.

“We all know the sad facts: every year half a million women die as a result of complications during pregnancy and childbirth, every year there are an estimated 19 million unsafe abortions in the developing world, 215 million women who would like to use contraception do not have the access.  But we also know that some countries have been able to make significant improvements with political commitment and the right political place,” she averred.

She said that rights -- equal rights -- were key words in Denmark’s development cooperation.  It was unacceptable that in 2010 far too many women with no rights to decide over their bodies persisted around the world, and that so many women and girls were still denied their rights to full and equal participation in society.  She not only considered genuine and honest gender equality to be a basic human right, but also that it had an economic side; genuine equality positively influenced sustainable economic development that benefited men and women, families, societies and nations.  “We all know that investment in women pays off.  All research shows that women are key drivers and agents of change,” she added.

SAM’ILA DANKO MAKAMA, Chairman, National Population Commission of Nigeria, alluded to the fact that in his country, the eighth most populous in the world with a population of over 140 million, provision of health-care services and social amenities still trailed far behind its population growth.  That situation had serious implications on morbidity and mortality, especially as it pertained to women and children, thereby slowing down progress towards the achievement of the Millennium Development Goals, particularly Goals 4, 5 and 6, and overall national development.

He said that underpinning to the interrelationships between population factors and broader development issues, particularly high fertility and its effects on the health and well-being of the citizenry, the National Population Policy Nigeria had been reviewed in 2004, under which objectives and targets were monitored through the conduct of sentinel surveys specifically designed for that purpose.  The 2008 Nigeria Demographic and Health Survey showed improvements in the levels of some key health indicators, which in turn had positively impacted the health, morbidity and mortality experiences of the vulnerable groups.  Among the specific areas of improvement, he cited improved preventive or treatment measures for measles, whooping cough, fever, diarrhoea, diphtheria, respiratory ailments, neonatal tetanus, acute respiratory infection and malaria.

The impact of those and other achievements had been the decline in the levels of early childhood mortality, from an infant mortality rate of 100 per every 1,000 live births in 2003 to the current 75 out of every 1,000 live births.  Child mortality and mortality in children age 5 and under had also declined, as had the neonatal and post-neonatal mortality rates.  Major causes of deaths among women in Nigeria were pregnancy-related, but there had been reductions in the risks of morbidity and mortality for both mother and newborn.  “We are however still concerned that 62 per cent of births still occur at home,” he said.  And although the nutritional status of children had improved “slightly” in the past five years, 41 per cent of children under age 5 in Nigeria were stunted, 14 per cent were wasted and 23 per cent were underweight.  Those indications of malnutrition placed children at increased risks of morbidity and mortality.

IBRAHIM LOPKO (C ôte d’Ivoire), recalling his country’s participation in the Cairo Conference in 1994, said the Government, in its efforts to implement the Action Programme, had adopted a national population policy in 1997, which had been revised in 2008.  Additionally, a reproductive health policy had been adopted in 1998 and a plan of action for women had been developed in 2002.  Côte d’Ivoire had also adopted a development strategy in 2006.  While a progress report in 1999 indicated the country had made progress in a number of socio-economic areas, the coup d’etat that same year, together with the political crises which followed, had eroded that progress.

He said that maternal and infant mortality rates in Côte d’Ivoire were currently among the highest in the world.  With its citizens and development partners, the Government was working to improve that situation.  In that respect, he highlighted the adoption in March 2009 of a poverty reduction plan, expressing hope that it represented a turning point in the Heavily Indebted Poor Countries (HIPC) Debt Initiative.  Côte d’Ivoire was also working to achieve gender equality and the protection of children.  It was enacting legislation to promote public health and wider use of contraceptives, and to reduce the transmission of HIV/AIDS from mother to infants.  In all of its efforts, Côte d’Ivoire depended on United Nations agencies and institutions, as well as all of its development partners.

ROMAN OYARZUN (Spain), endorsing the statement made on behalf of the European Union, said his country was making considerable efforts to develop health strategies and had adopted ones on cancer, mental health, stroke and rare diseases.  In all, Spain had tried to incorporate cross-cutting themes, such as a gender perspective, and involve many actors, including researchers, patients and the Administration.  Regarding maternal and infant mortality and morbidity, Spain’s system provided free coverage for mother and child, financed by the State budget.  The Government would adopt a strategy on sexual and reproductive health which would help guarantee those rights.  Also, a new law on sexual and reproductive health had entered into force.

He said that, since 2004, Spain had enacted a law on gender violence and created a training strategy for the early care of women who had been mistreated.  The Government had also adopted common indicators in the national health system on gender violence.  On other issues, he said that eliminating alcohol during pregnancy would lower the number of children born with foetal alcohol syndrome.  To reduce injuries from road traffic accidents, he emphasized the importance of education for young people.  Information campaigns were indispensable in that regard.  Since 2006, Spain had been among 10 major donors to UNFPA.  In 2009, it was the ninth donor to the Joint United Nations Programme on HIV/AIDS (UNAIDS).  Achieving the Millennium Development Goals would not be possible without focusing on health.

JANE STEWART, Special Representative and Director of the International Labour Organization (ILO) Office for the United Nations, said that action must be intensified to improve occupational health, given that at least half of the global population spent a third of each day working, and that each year about 337 million people experienced fatal and non-fatal work-related accidents, and 160 million suffered from work-related diseases.  She described ILO’s activities under the Promotional Framework for Occupational Safety and Health Convention 2006, which aimed to redress that situation.

She said climate change, economic and financial crises, natural disasters and health epidemics were reinforcing negative work-related health factors.  In that light, funding barriers to universal access to health services must be overcome and financial protection must be provided to meet catastrophic health-care costs and income support, she stressed.  She noted that the right to decent, safe and healthy working conditions had been a central issue for ILO since its creation in 1919 and that the organization stood ready to work with its partners in the United Nations system and with Member States to improve the health of working women and men.

SÁLVANO BRICEÑO, Director of the United Nations International Strategy for Disaster Reduction (UNISDR), observed that the recent earthquakes in Haiti and Chile, floods in Brazil and related loss of life had underscored the importance of ensuring that the human-built environment was resilient in the face of a number of natural hazards, both seismic and climatic.

He said disaster risk was increasing globally and was highly concentrated in middle- and low-income countries.  The increased frequency, intensity and unpredictability of extreme weather events, rising sea levels and temperatures, increased societal vulnerabilities, such as stresses on water availability, agriculture and ecosystems, was becoming a new reality and making disasters more devastating than ever before.  Additionally, rapid urbanization and population density in coastlines and seismic zones and destruction of wetlands, mangroves, watersheds and upland forests was intensifying those trends.  He reported that, over the past 30 years, the number of disasters triggered by natural hazards –- storms, floods, earthquakes and droughts –- had tripled.

The good news was that Governments had already started working to reduce vulnerability to natural hazards, he said, noting that in January 2005, Governments had adopted the Hyogo Framework for Action (2005-2015) Building Resilience of Nations and Communities to Disasters, a 10-year action plan to make the world safer from natural hazards.  The key areas of action included risk assessment and early warning, public awareness and education, environmental and urban planning and management, and strengthening the governance and management of risk as well as improved disaster preparedness.

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For information media • not an official record
For information media. Not an official record.