National South-South Support Structure Workshop
10 December 2009, Dhaka, Bangladesh

Address by
Mr. Harry S. Jooseery
Executive Director, Partners in Population and Development

H.E. Prof. A F M Ruhal Haque, MP, Honorable Minister, Ministry of Health and Family Welfare, Government of People’s Republic of Bangladesh and PPD Board Executive Member

Mr. Shaikh Altaf Ali, Secretary, Ministry of Health and Family Welfare, Government of People’s Republic of Bangladesh

Mr. Arthur Erken, Country Representative, UNFPA Bangladesh

Mr. Serajul Huq Khan, Joint Secretary and PCC of PPD

Distinguished Guests, Ladies and Gentlemen

I am pleased to welcome you to this “National South-South Support Structure Workshop” jointly organized by the Ministry of Health and Family Welfare and PPD.

Honorable Minister, please allow me to congratulate you on behalf of all the Board Members of PPD and on my own behalf and wish you continued success in your leadership for the health and wellbeing of the Bangladesh.

Bangladesh is one of the 10 founding members of PPD and hosting the PPD Permanent Secretariat since 1996. Bangladesh is an instrumental in promoting PPD. The history of PPD is hence marked by the extraordinary contribution of Bangladesh. I would like to thank the Government of Bangladesh for providing such support and guidance to PPD.

I would also like to thank Mr. Arthur Erken, the Country Representative, UNFPA for the technical and financial support provided to PPD for organizing different events.

I am also pleased to congratulate the members of National Task Force and thankful them for their acceptance to be part of the PPD family.

Honorable Minister, ladies and gentlemen - PPD is an intergovernmental organization established within the framework of the International Conference on Population and Development (ICPD) in Cairo in Egypt in 1994. This alliance provides the mechanism to promote partnership and cooperation between developing countries, towards achieving the ICPD goals and also the Millennium Development Goals. The Permanent Secretariat is based in Bangladesh. PPD has a Regional Office for Africa in Kampala, Uganda, a Program Office in China and another office in New York, USA, where we are also a Permanent Observer to the United Nations.

Fifteen Years after ICPD, we cannot but rejoice at the tremendous achievement registered in the area of Reproductive Health, Population and Development. The quality of life in general has improved substantially in the world.

Impressive gains have been achieved globally since ICPD:

• Over 50% of the couples worldwide are now using family planning
• Annual world population growth is now 73 million compared to 93 million in 1994
• Life Expectancy has increased from 61 to 63 years
• Childhood death has decreased by 10%
• More girls are in school and status of women has improved

We can proudly say that the Cairo Agenda has not remained a blueprint. It has ushered important changes in many parts of the world and ICPD must indeed be applauded for having been the turning point that has reshaped policies and program addressing Women’s Reproductive Health, Adolescent Sexual Health and many other culturally sensitive issues. We note with satisfaction that for the last 15 years the broad concept of reproductive health which was adopted at Cairo has been incorporated in increasing number of government policies. Though Reproductive Health was not included into MDGs in 2000, we are glad that it has been added as an additional target in the Millennium + 5 document adopted in 2005.

On the other hand we need to note the sad reality that maternal mortality has shown no decline in absolute numbers and we are still talking of 500,000 women that die yearly due to avoidable complications related to pregnancy and childbirth, most particularly in the less developed countries. The scourge of HIV/AIDS has devoured millions of lives, seriously affecting the prospects of the economic and social development in the many countries in Asia and Africa. The developing world is facing different critical challenges. Let us see some of the challenges:

The Population Growth

There is a resurgence of the population growth factor. The population growth rate of the world is 1.17 while that of developing countries is 2.2 and industrial country is 0.7. Complacency over the past years on the issue of population especially in developing countries has created a wide section of poorest of the poor, the bottom billion populations as they are called with less than US$1 per day. This is threatening health, stability and security. The upsurge of domestic violence, sexual abuse, violence on girls and women are indicative of social disruption that may lead to severe consequences.

Worldwide, women now average 2.6 children during their lifetimes, 3.2 in developing countries excluding China, and 4.7 in the least developed countries. In the developed countries, women average 1.6 children. Some countries are undergoing explosive and possibly unsustainable population growth. For example, Pakistan was among the vanguard countries in Asia in strengthening Family Planning program more than 5 decades ago. Family Planning for the past decade lost its centrality in the development agenda as a result of shifts in international health and development priorities. This has created an estimated 13 million women in the developing world who want to avoid a pregnancy but do not have access to any Family Planning Method.

Maternal Mortality

Despite some improvement, maternal mortality continues to be very high in developing countries. Of the many health indicators that demonstrate comparison between developed and developing countries, maternal mortality shows the greatest disparity. Maternal mortality represents one of the widest health gaps between developed and developing nations, with 99 percent of all maternal deaths occurring in developing countries. Every year, eight million women suffer severe complications as a consequence of pregnancy, childbirth and unsafe abortion. Every minute, at least one woman dies from complications of pregnancy and childbirth. In developed countries, there are approximately 27 maternal deaths per 100,000 live births each year. In developing countries, the average is 18 times higher, at 480 deaths per 100,000. About half of the maternal deaths occurred in sub-Saharan Africa alone and one third took place in South Asia. Country-level differences in maternal mortality are even more dramatic.

Globally, 40-60 million women seek termination of an unwanted pregnancy under unsafe conditions in a year. Worldwide, almost 20 million unsafe abortions occur each year, of which 95% take place in the developing world. One in eight pregnancy-related deaths, an estimated 13% are due to unsafe abortions in the world. Poor maternal health also affects the chances of survival of the newborn. Although progress in infant and child survival has been made, an estimated 9.4 million babies still die shortly before or after their birth.

Climate Change

Global warming increased the average temperature of the Earth's near-surface air and oceans since the mid-20th century and its projected continuation. Increasing greenhouse gas concentrations resulting from human activity such as fossil fuel burning and deforestation caused most of the observed temperature increase since the middle of the 20th century. The latest data on climate change indicate that the global surface temperature will probably rise a further 1.1 to 6.4 °C the twenty-first century.

The growing health impacts of climate change affect different regions in markedly different ways. The places that have contributed the least to warming the Earth are the most vulnerable to the death and disease higher temperatures can bring. Regions at highest risk for enduring the health effects of climate change include coastlines along the Pacific and Indian oceans and sub-Saharan Africa. Poor countries are particularly prone to flooding. Climate change is overwhelming the social and other arrangements that in the past allowed countries and people to cope with floods.

Health System Development

Health system development is a recent challenge of healthcare in the region. The poor and other vulnerable groups in the Region continue to have poor access to quality health services. Those who need health services the most—groups with high burdens of morbidity and mortality—tend to use them the least because they face high barriers to access. Many kinds of disparities exist in terms of health risks, health-seeking behavior, access to services, responsiveness of the system and of providers, and health outcomes. The barriers include multiple dimensions of social exclusion. Health disparities of various types appear to be widening rather than narrowing, suggesting that health systems are not addressing these problems effectively. Reversing inequity, whether among individuals or populations, often requires inter-sectoral action and larger and better-targeted investments in services.

Health systems have become increasingly fragmented, which is generally an obstacle to effective delivery of health services and efficient achievement of health goals. Actions to strengthen health systems need to build system capacity and not just divert capacity from one part of the system to another to meet short-term goals.

As we are now passing very critical time with tough challenges, it seems that a nation alone cannot improve the health of their citizens by taking actions that lead to responsive, well resourced, efficient and well-regulated health systems. A recently disseminated document identified six health system building blocks, while addressing key cross-cutting concerns of equity, quality, gender and human rights. The six building blocks are:

• Health service delivery—safe, quality personal and non-personal health interventions.
• Health workforce—sufficient numbers and mix of competent staff, who are fairly distributed, responsive and productive.
• Health information systems—production, analysis, dissemination and use of reliable and timely information.
• Medical products and technology—high-quality, safe, efficacious, cost-effective and scientifically sound.
• Health financing—adequate in amount, ensuring access to needed services and raised in ways that protect people from financial catastrophe and impoverishment.
• Leadership and governance—effective strategic and policy frameworks, combined with oversight, working with partners, regulation and accountability.

These six building blocks remind us again that we could not succeed unless we act in partnership and in coalition. We need to marshal our respective competences and capacities to meet the global challenge. We believe that Governments form the South have the potentials to raise the standard of living of their citizens, the capacity to enhance social welfare and the capability to promote development in the countries.

Socio-Cultural Factors

It is unfortunate that many developing countries are still patriarchal with strong gender discrimination and other forms of social exclusion adversely effecting Reproductive Health. The rise of religious bias and fundamentalism retards progress and unfortunately contributes enormously in making girls and women easy prey to male dominance. In Africa alone, 100 million women and girls have had genital mutilation. 27 out of the 46 states in Africa still practice Female Genital Cutting. Religious Opposition to Modern Contraception, Abortion and Women Empowerment in some parts of the world is very strong. In many counties the right for RH is completely denied to women and girls and discrimination against them exacerbates their sufferings. Social stigma against the victims of AIDS, people with diverse sexual orientation, divorce women are very strong in developing counties.

Scarcity of ODA

Donor countries have shied away from their commitment to Official Development Assistance (ODA). The funding for the RH programs has fallen by 60% during the last ten years. It is unfortunate that for the past 10 years, investment in social welfare in most developing countries has staggered at a low level. In 1970 OECD countries promised 0.7% of their GNP on Development Assistance. Unfortunately, this promise has not been kept and ODA turns around not more than 0.3% of the GNP. Expected ODA per year was approximately $ 200 billion, but in fact is only about $ 70 billion per year. Funding for Family Planning as a percentage of all population assistance has fallen from 55% in 1995 to 7% in 2005. The situation has been exacerbated by the present economic downturn for which developing countries cannot bear the brunt of responsibility. World Bank projects the real GDP growth to slow down across all developing countries in 2009.

Honorable Minister, ladies and gentlemen

In spite of diversify challenges, Bangladesh gives us many hopes. Bangladesh is a way ahead to achieve many of ICPD goals and MDGs. Bangladesh achieved a remarkable success in fertility reduction, maternal, child health, women empowerment and related areas by providing client oriented services delivery mechanism which could be a good lesson for replication in other PPD member countries.

The infant mortality rate showed a steady decline from 150 deaths per 1000 live births in 1973 to 47 only by 2007, while the under five-mortality rate declined from around 260 deaths per 1000 live births to only 61 over the same period. Life expectancy at birth rose from 48 years in the mid 1970s to 66 years in 2007. Immunization coverage increased from as low as 54% in 1990 to 88 % in 2006 and the country is expecting to attain polio-free status very soon.

Despite of adverse socio-economic conditions, the national family planning program of Bangladesh has made impressive progress in achieving contraceptive prevalence rate (CPR) from less than 8 % in 1975 to about 56 % in 2007. At the same time the total fertility rate has declined from 6.3 in 1973 to 2.7 in 2007 with a consequent fall in annual population growth rate from 2.9% per annum in the mid-1970s to 1.5% in 2007. Bangladesh is a unique country where we can see several innovative approaches successfully implemented on family planning programs. Male Involvement Project (MIP) is an example which was implemented by the Directorate of Family Planning and NIPORT with the technical assistance of Population Council in one thana of Tangail District, using the existing government infrastructure and manpower during the period between December 1996 and December 1997. It was observed that a program can be successful if management cadres can be motivated and involve in the process.

Progress has also been made in improving Bangladesh’s Human Development Index. Between 1990 and 2007, the index increased by 32%, with marked improvement in life expectancy, adult literacy, gross primary school enrolment ratio, nutritional status and declining infant mortality rates. Primary school enrolment increased from 31% during 1970s to about 91% in 2007. The adult literacy rate was only 35% in 1990, which has increased considerably to about 54% in 2007. These results have been achieved by a stable macroeconomic environment leading to sustained economic growth, access to micro credit activities targeted at grass root level, and by the efforts of government and non-government organizations to expand the coverage of essential services to the disadvantaged sections of the society.

Recent developments in innovation thinking increasingly emphasize the opportunities that innovations can bring about to address development issues and spur wider social change. From the eradication of foot binding to foot pedaled water pumps, from the Pill to property rights, innovation can transform women’s lives. Virtuous circles of change can be sparked by women’s use of a seemingly simple technology, a shift in social attitudes about what is possible for women or increased access for women to economic opportunities, employment, savings and credit. Bangladesh experiences and achievement in women empowerment through government and NGOs activities is recognized by the international community. Today none of the global development thinkers cannot talk on Innovation and women’s empowerment without the referring the experience from Bangladesh.

During 1990s, micro-credit programme promoted as the single most important mechanism for poverty alleviation and women's empowerment in Bangladesh. The micro-credit programme of Bangladesh has gained worldwide reputation in reducing poverty and improving the status of rural women. Government has recently taken another initiative to integrated health and education into the existing micro-credit program. Many microcredit institutions have adopted this approach with their implementation program. Through this initiative the Government can reach to the hard to reach population with the essential services of health and education. A recent study on “Women’s Empowerment: Measuring the Global Gender Gap” covered 58 countries include all 30 OECD countries and 28 others from the developing world revealed that among the seven predominantly Muslim nations covered by this study, Bangladesh and Malaysian experiences in Family Planning, women empowerment, democracy, poverty alleviation are outperform. Bangladesh's experiences in Family Planning, women empowerment, democracy and poverty alleviation through micro-credit can be useful sources of your presentation. Bangladesh strongly committed to contribute South-South Cooperation through offering support to other developing countries by sharing and exchange of good practices in the fields of family planning and Micro-credit program.

Further, the Government of Bangladesh initiated Community Clinics for every population unit of 6000 people to provide one-stop Essential Services Package services. It has established about 12 thousand community clinics and currently it is setting up more than 6000 community clinics across the country to provide primary healthcare in remote areas within a year. A health assistant and a family welfare assistant will be appointed at each community clinic to provide primary healthcare to ensure the health rights and reduce the maternal and child mortality rate. Along with Community Clinics there are many innovative approaches initiated by the Government in collaboration with donors or NGOs to achieve ICPD goals and MDGs.

• The Government in cooperation with UNFPA launched an integrated program to provide married young people with youth-friendly reproductive health and family planning services.
• Government established “youth corners” in a number of govt. Maternal and Child Welfare Centers and other health clinics run by NGOs in order to provide both information and services catering specifically to the needs of young people.
• Training Religious Leaders throughout Bangladesh is another successful experience for ensuring that women have safe births and healthy lives. The project has three activities: 1) Training of senior Imams, Hindus and Buddhist Religious leaders as regional trainers to enabling them to assist in the training of local Imams/Hindu and Buddhist religious leaders; 2) training of Imams/Hindu and Buddhist religious leaders in each of the country’s 64 districts; and 3) advocacy meetings and follow-up training.

Honorable Minister, Ladies and Gentlemen - we need to reposition Family Planning and HIV/AIDs program into the development agenda, integrate Family Planning for a more concerted effort and positive result. While we need to find new champions for Family Planning and promote greater resource mobilization for Reproductive Health programs, we need perhaps more importantly to reinforce political commitments and promote good governance.

The South-South cooperation entails that we have among us the skills, capabilities and expertise, and if we can galvanize our efforts together, we can improve the destiny of our children and particularly the improvement of the total population including women.

PPD will ensure that developing countries, despite their low resource base, are able to fully utilize their comparative advantage and become leaders in their respective fields. PPD will continue to develop and build institutional and individual capacities, continue advocacy for better access to Family Planning Services, and the integration of RH with HIV/AIDS for a balanced sharing of resources, women empowerment and work for a secured supply of affordable and quality RH products and services in our member countries.

In the context of promoting South-South cooperation, RH and HIV/AIDS programs in Bangladesh, PPD commits to facilitate support and technical assistance. You will be happy to learn that a MoU has been signed between China and PPD to provide technical assistance to the PPD member countries. China is willing to provide technical assistance to Bangladesh through PPD.

Honorable Minister, ladies and gentlemen, PPD has developed a new Strategic Business Plan (2008-2011) that was approved by its Board. As stated in the plan, in the next four years PPD will focus on:

1. Advocacy
2. Capacity Building
3. The exchange of experience and good practice
4. Training and Research

We wish Bangladesh to be involved in all these four areas of focus of PPD and play a more active role in South-South Cooperation. I have the firm conviction, that together we will build a better future for our children. We need to create a solid foundation of strong and coherent partnership. Besides cross-sectoral collaborations between and within governments, we need also a strong private and public sector partnership, participation of NGOs, academia, professional organizations, media agencies and all other branches of the civil-society in a spirit and movement that acknowledge and respect the roles and responsibilities of all and in addition provide necessary conditions for the growth of each and every one. This is a new culture that we wish to instill to enable government and stakeholders alleviate the sufferings of millions of people in the developing world, and especially in Asia and Africa.

PPD would like to thank the government especially to the Honorable Minister, Secretary and PCC for constituting an effective National Task Force in Bangladesh to galvanize efforts to promote South-South Cooperation, with the involvement of respective stakeholders. Bangladesh can share a lot of its experiences, it can also learn from the experiences of other countries. The PPD will provide technical and other forms of assistance to the national task force for ensuring its achievement.

Goal, Objective and Terms of References given below:

Goal

To accelerate the progress towards achieving the ICPD agenda and the MDGs through south-south cooperation.

Objectives

• Co-ordinating with government and other stakeholders in the fields of Population, Reproductive Health and Development
• Increasing visibility of the PPD and promoting the concept of SSC
• Enhancing sustainable supply of RH related commodities
• Sharing of knowledge, information, documentation and dissemination
• Advocating for developing policies and creating enabling environment for SSC
• Facilitating National Capacity Building to address SSC

Terms of the References (ToR)

• NTFSSC consists of 20 members from relevant ministries, UN Agencies, NGOs/INGOs, CSOs, researchers and private sectors who are working in health and development filed
• The Director General of Family Planning will chair the NTFSSC and the Directorate of Family Planning, MoHFW will host the NTFSSC
• PCC of PPD will act as coordinator of the NTFSSC
• Director (MCH Services) and Line Director (MCRH) DGFP will be member secretary
• The NTFSSC will meet quarterly at a place and time directed by the chair
• The NTFSSC will discuss salient issues pertaining to RH program and propose intervention to promote ICPD and MDGs
• The NTFSSC will facilitate collection of data and documentation on best practices on RH program for sharing with other countries
• The NTFSSC will report quarterly to the Board Member of PPD and Honorable Minister of Health and Family Welfare of Bangladesh
• The member secretary of the NTFSSC will circulate meeting minutes to all of the members and Executive Director of PPD
• The PPD will provide financial and technical assistance when needed to the NTFSSC to enable it to achieve its goal.
• Chair of the NTFSSC will consult the PPD Executive Director and PCC of PPD as and when needed.
• Operations of NTFSSC will be guided by the rules and procedures (to be developed by the Task force).
• The committee will meet at least once in every three month
• To co-opt any member in the committee as and when necessary

Honorable Minister, I hope that your government will also provide necessary support for effective functioning of the Task Force and the all members will give their valuable inputs to achieve the goal of Task Force.

Let us join hand to continue promoting the partnership with Bangladesh and share to strive to improve our quality of life of our brothers and sisters in Bangladesh and in the developing world.

Ladies and Gentlemen, I thank you for your attention.

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