Policy Dialogue on Reproductive Health and HIV/AIDS with Afro-Arab Parliamentarians
03 - 04 August 2009, Nairobi, Kenya

Opening Address by
Mr. Harry Jooseery
Executive Director, PPD

Hon. Wycliffe Ambetsa Oparanya, Minister of State for Planning, National Development and Vision 2030, Republic of Kenya

Honorable Ministers and PPD Board Members

Dr. Edward Sambili, Permanent Secretary, Ministry of Planning and Development and Vision 2030, Republic of Kenya

Dr. Boniface O. K’Oyugi, MBS, Chief Executive Officer, National Coordinating Agency for Population and Development (NCAPD), Secretary PPD Board, Republic of Kenya

Mr. Alexander Ilyin, Representative, UNFPA Country Office, Republic of Kenya

Distinguished Guests, Ladies and Gentlemen

I am pleased to welcome you to this Policy Dialogue for Ministers and Parliamentarians from Africa and Arab World on Reproductive Health and HIV/AIDS. It is indeed refreshing to see Parliamentarians and PPD Board Members from Benin, Gambia, Ghana, Kenya, Mali, Morocco, Senegal, South Africa, Tanzania, Tunisia, Uganda, Yemen and Zimbabwe, and I wish to thank you all for responding positively to our invitation. This meeting is being organized by PPD in collaboration with National Coordinating Agency for Population and Development (NCAPD) of the Government of Kenya and with technical and financial support from Packard Foundation and UNFPA to which I am very grateful and wish to express my heartfelt thanks. I wish to convey a special note of thanks to the Government of the Republic of Kenya for all the support and assistance provided in facilitating the organization of this meeting and most particularly to National Coordinating Agency for Population and Development (NCAPD) and its CEO Dr. Boniface Omuga K’Oyugi, MBS.

I am also very thankful to Hon. Wycliffe Ambetsa Oparanya, Minister of State for Planning, National Development and Vision 2030, Republic of Kenya for sparing his precious time to be with us this morning, despite his very busy schedule. Honorable Minister, your presence among us is a testimony of your own commitment and that of the Government of Kenya to support Reproductive Health and HIV/AIDS programme and for which I am indeed very appreciative and grateful. Honorable Minister, thank you once again.

Excellencies, Ladies and Gentlemen, the organization of this policy dialogue is more than opportune, given the present context, environment and emerging issues that are reshaping our life day by day. While life opportunities for many have expanded like never before in history, many of the human race are caught up in the vicious circle of abject poverty, deprivation, enduring hardships and inequality. While some celebrate the festival of light, others are burnt to ashes and the coexistence of this dualistic nature of our present day socio-economic trends calls for urgent and timely decision. You would realize that the population has quadrupled in 100 years, and there has never been such a huge cohort of adolescent and old people living ever before. Environmental degradation and climatic change, new diseases from the mysteriously origined HIV/AIDS to the madness of cow and feverishness of chicken or virality swine, coupled with social disruption and economic instability are threatening peoples’ health, livelihood and security more than ever before. If things do not change before 2015, we will be questioning the very survival of human species on earth.

Ladies and Gentlemen, it is unfortunate to note that for the past 10 years, investment in social welfare in most developing countries has staggered at a low level. For example, funding for family planning as a percentage of all population assistance has fallen from 55% in 1995 to 7% in 2005. Family Planning has lost focus amidst shifts in international health and development priorities. There is a need to reposition Family Planning into the development agenda. No development is sustainable unless we address Reproductive Health and Population issues. In the developing world, an estimated 137 million women who want to avoid a pregnancy, are not using any Family Planning method.

The situation aggravates in Sub-Saharan Africa which has the highest fertility rate in the world with 5-6 births per women. Only 18% of married women in Sub-Saharan Africa are using a modern Family Planning method. 35 million women in Sub-Saharan Africa have an unmet need for Family Planning. The percentage of unintended pregnancies in Lesotho is 50, Kenya 45, Uganda 46, Ghana 40 and one in every 3 births is unintended in Congo, Ethiopia, Senegal and Zimbabwe. There are about 5 million abortions each year in Sub-Saharan Africa, 98% of which are illegal, clandestine and unsafe. In developing countries a women’s lifetime risk of dying due to pregnancy and childbirth is 1:7, 160 times higher than in developed countries, in Sub-Saharan Africa the risk is highest in the world, 1:22 that is 3500 times higher than in developed countries.

Ladies and gentlemen, this situation can no more persist. The situation has been exacerbated by the present “made in the North” economic downturn for which developing countries cannot bear the brunt of responsibility. The 1 billion poorest of the poor, the “bottom billion”, as they are called, have been the mostly affected section of the world population with food, shelter and sanitation crises which loom upon them. As we talk now of an economic recovery, which is of course most welcome, we cannot afford to talk of a health recovery. Health is not to be lost and regained. The right to health is a fundamental human right and can never be questioned.

Excellencies, we are at the juncture where we cannot inadvertently jeopardize the future generation and allow 30 women to die every hour from preventable complications related to pregnancy and childbirth. 15 years back, the ICPD articulated a comprehensive approach to population and development which addresses many of the fundamental challenges facing the human community including poverty alleviation, provision of healthcare and education and preservation of the environment. Since then a substantial number of countries have reviewed their policies to embrace the global agenda, including those of the MDGs. The Accra Agenda for Action of September 2008 does recognize the progress made in reducing poverty, but underscores the too slow pace of progress. A new vigorous approach is needed to translate our global thinking into concrete local actions. We need to, firstly, strengthen health system for sustaining and scaling-up critical health interventions that will save lives.

The health system in Africa was built around curative services and it is mostly concentrated in urban areas. In most of countries, less than half of the population, mostly those living in major urban centers, have access to health facility, which is still unavailable for the vast majority of the population who live in rural areas.

Excellencies, Africa and the Arab world need an expanded health coverage and care and it is my wish that one day all our brothers and sisters in the developing world get access to free health care. We urge parliamentarians, policy makers, legislators, the private sector and the civil-society to converge for the promotion of free health care.

Secondly, the Human Resource Crisis is another problem in Africa where the challenge of developing and retaining human resources is extremely difficult and fundamental for development. Migration of
highly skilled persons from developing to developed countries has
increased in the last decade. Growing concerns among many rich countries about actual or future shortages has initiated large-scale recruitment of foreign-trained health workers. The UN Commission for Trade and Development estimated that each migrating African professional represents a loss of US$184,000 to Africa. Paradoxically, Africa spends US$4 billion a year on the salaries of 100,000 foreign experts.

The current human resources in some of the most affected countries in Africa would need to be scaled up by as much as 140% to attain the Millennium Declaration. The problem is so serious that in many instances there is simply not enough human capacity even to absorb, deploy and efficiently use the substantial additional funds that are considered necessary to improve health in these countries.

Africa has slightly less than 1.0 health worker/1,000 population, whereas a minimum health worker density of 2.5/1,000 population is required to make significant progress on global health goals.

While Africa has 11 percent of the world's population and 24 percent of the global burden of disease, it has only 3 percent of the world's health workers.

The impact of HIV/AIDS is estimated to be the cause of 19-53% of all deaths of government health employees in African countries today. Many of these, together with maternal deaths, could be avoided by integrating HIV/AIDS with Reproductive Health care. This would improve access to health services to a broader spectrum of the population

Thirdly, it is also important that developing countries synergize their effort and share their comparative advantage. There is a growing emergence of a South-South ODA with countries like China, Brazil and India reinforced by Indonesia, Thailand, Tunisia and South Africa. Other countries like Ghana, Kenya, Uganda and Bangladesh, among others, have undertaken innovative and meaningful program in the area of HIV/AIDS, Family Planning, Women Empowerment which can be shared among others. Promoting partnership and ownership through South-South Cooperation is one of the key routes for the attainment of ICPD and MDGs. Partners in Population and Development commits to take the lead in coordinating aid at all levels for the promotion of Reproductive Health, Population and Development and in conjunction with governments, private sector, civil-society and donors.

Excellences, in the midst of all these concerns and daunting challenges there is also a window of opportunity. The highest proportion of the population in developing countries is in the working age and this is a “demographic bonus” to advance economic development. The emergence of some developing countries as powerhouses are building blocks that encourage the reinforcement of South-South Cooperation for the promotion of Reproductive Health, population and sustainable development.

What we need is reinforced commitment and engagement coupled with pragmatism and proactivity. Improvement in health is likely to come in the future as it has in the past, from management of the conditions which lead to disease, rather than from management of the causes of deaths after it has occurred.

Thank you for your attention.

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