CCSD - Issues

Community Centric Sustainable Development

Friday, January 21, 2005

A woman's story

A Community Centric Event

Finally, a story which a Wan Smolbag actress told me the other day on her return from a remote outer island community. It's sort of about conflict.

She had been running a workshop with women and the topic turned to impactsof population growth (Vanuatu is doubling every 25 years) and one woman asked the reasons why some women couldn't have children. A local healthworker gave a fairly dismissive answer saying that basically it was becausea woman had led a wild life, had many partners and had untreated STIs.

Morinda suggested there were other reasons too; that some people's bodies were strong and others weak and needed more care during pregnancy.

At which point a woman put up her hand. A woman aged around 50 with still quite young kids, she had had several miscarriages whilst she was young and a doctor had told her that unless she rested completely during pregnancy, she would never go the full term. Her husband was a 'good man' and tried to shield her from work but the women in his family made her work, said she was lazy etc. So with her husband she moved to the provincial capital and he did everything; the washing, the cooking, the cleaning, and when they had had 3 kids they returned to the village! She said she had never stood up and told this story before and it was, Morinda said, a way too of protecting the woman who had been made to feel ashamed by the nurse.

Now clearly there was a conflict in the village that had remained unsaid until that workshop. Young women cannot speak out against the elder women in their community. Sometimes people are the victims of the mores of the society in which they live, and it was Morinda's intervention, a national, but not from that community, that had enabled that debate to happen. This is not earth shattering stuff; we will continue visiting that village because they want us to and because they enjoy the discussions that the actors create and we will see what develops. But if Dr. Rodriguez advice was followed to the letter, Morinda should neverhave been there in the first place. Or maybe I am misrepresenting her?!

Merry Christmas to you, Doctor, and all other drumbeat subscribers,

Peter Walker,
Wan Smolbag Theatre theatre,

Liberia - Humanitarian Crisis

Crisis - Why did we not doing something to preempt crisis

IS: URGENT ACTION: Liberians Dying, Peacekeepers Needed
2003-08-02 03:03

Dear David Moore and Shannon Scribner,

Thank you for the Oxfam message. But why did you wait until today to send it.

By way of introduction let me say that I admire the Oxfam community and the work they have done over the years to help in crisis conditions. But in my view Oxfam now has a responsibility that goes far beyond what it is doing. I am concerned that Oxfam is engaged in crisis reponse rather than in addressing the systemic problems that create crisis, and in fact to the extent that it has started to look at development from a systemic perspective, it is getting it wrong.

It has been apparent for weeks, or is it months, or even years that there is a dramatic crisis in progress in Liberia, and the neighboring countries. So what now provokes the need for urgent action NOW rather than weeks or months or years ago. The whole framework for getting response from leadership in the NORTH just plain does not work. It has not worked for years, but nobody really seems to be bothered.Too many organizations feel that writing a letter is enough. Or faith based groups do some praying. But the sort of action that hurts or might hurt just does not get done. Not enough people are getting into harms way in order to stand up for what is right and needs to be done.

We all talk about how wrong it was for the world to ignore the emerging crisis of the holocaust in Nazi Germany, but we are doing more or less the same thing as we ignore the MANY emerging crises around the present day SOUTH, and indeed among the economically disadvantaged in the NORTH.

The systems we have at the moment do not hold people accountable for what they do not do.

Many Christians probably pray something along these lines when they go to Church: "Most merciful God, we confess that we have sinned against you in thought, word and deed, by what we have done, and by what we have left undone. We have not loved you with our whole heart; we have not loved our neighbors as ourselves. We are truly sorry and we humbly repent. etc. etc"

I get the impression we leave an awful lot undone. The behavior of leadership is a disgrace. But the NORTH leadership is our leadership. And we have tolerated rotten leadership of development for two or three decades. As a result all sorts of blameless people are dying and will continue to die.

Again, thank you for your message. But please think about the systemic problem that have caused this crisis, and the role we all play in allowing these systemic problems to continue year after year after year.

I am copying this message to the Information Society list, because I think that one of the big issues is the systemic failure to get important information communicated in a way that is meaningful to the people who elect government leadership in the countries of the NORTH. This is meant to be a role of the media, but media is now more about entertainment and commercial profit than it is about information and communication ........ but it is information and communication that makes for a good democracy and not "media" as it presently operates.

Guns and landmines and soldiers and oil and diamonds and gold and war and refugees and famine and illness are the outcome of years of development failure. There is plenty of blame to go around. But what about systemic solutions for tomorrow? There are plenty of good people. good ideas, amazing technology, but at the end of the day the development establishment cannot pull it all together.

This needs to be fixed.


Peter Burgess
In a message dated 8/1/2003 6:09:47 PM Eastern Daylight Time, writes:>
Subj:URGENT ACTION: Liberians Dying, Peacekeepers Needed >
Date:8/1/2003 6:09:47 PM Eastern Daylight Time>>>>

Dear Peter,

As you may know, the African country of Liberia is in> the midst of a horrific civil war. During renewed fighting,> over a thousand people have been killed. Hundreds of thousands> have been displaced. Civilians are running out of food> and many lack clean water. Diseases such as cholera could> kill thousands. > > We need your help to try to stop the violence in Liberia!

Click on the link below to ask President Bush to immediately> deploy US peacekeeping troops to Liberia. > > > President Bush has promised US support and has stationed three ships off the coast of Liberia. But he has not made the concrete commitments necessary to bring peace to Liberia. Peacekeeping troops from other West African countries are slated to enter the country soon. US troops should join them on the ground.

Oxfam staff and other aid workers are trapped in homes> and offices, unable to help those in desperate need. Meanwhile, 50,000 people have fled to a soccer stadium in Monrovia. Each week, 350 people die from cholera.

Please take a minute right now to send an email to President> Bush. Just click on the link below. > >

And please tell your friends and family about this urgent humanitarian crisis.

Thank you for your help,

David Moore, Internet Campaign Organizer
Shannon Scribner, Acting Policy Advisor for Humanitarian Response

Peter Burgess
ATCnet in New York
Tel: 212 772 6918

Tuesday, January 18, 2005

Medical Open Access

The great value of information at the front lines
Dr. Edwin Mapara from Botswana

Subj: [hif-net-at-who] Open access (16)
Date: 1/18/2005 8:12:51 AM Eastern Standard Time
I have just had an open access article published in the December 2004 PLoS Medicine Journal (, "Picturing AIDS:Using images to Raise Community Awareness," co-authored with Prof David Morley [see note below].

Since then close to 200 colleagues have received a copy in Botswana across all sectors, and are academically surprised that what was a "condemned" village initiative in Health Promotion in Lobatse, Botswana, is being used in London. The icing on the cake was to stand with the Director General on the same platform at the World Health Organisation headquarters, Geneva on World AIDS Day 2004 and in a seminar for the WHO staff the following day in Geneva, talking and discussing the same PLoS Medicine, open access, article.

For the medical colleagues in Primary Health Care and in the districts, it is a worth-while open access resource, for its content, concepts and context! If this article was in a restricted publication, it might have only been in the hands of 20 or so consultants at the referral hospitals in their "restricted" offices and another 20 or so bureaucrats at the Ministry ofHealth on the shelves as a "decoration"!

Foreign researchers told our leaders in the 1990s, that "...using pictures is shock tactics, to cause fear and does not work!" Twelve years later in 2002, the "Picturing AIDS" strategy was a documented a "best practice" and is being replicated nation-wide. I first met with Prof David Morley on the 31st January 2003 at a seminarat the Institute of Child Health, where I shared my experiences of usingTeaching Aids At Low Cost (TALC) pictures (colour photos) to empower traditional doctors, traditional birth attendants, teachers, students, soldiers, People living with HIV/AIDS, commercial sex workers, the out of school youths, the media, the Church, the civil service.... and not least, the health care workers for whom the TALC slides were intended for in the first place.

People wanted to "...see AIDS" in the early days of the HIV/AIDS pandemic. We (Athlone hospital) obliged and used the 1989 TALC slides, with photos of Africans, to show HIV/AIDS. At the same time we addressed denial and the silence "...taboo subject" that is very loud in the developing countries.

Sadly HIV/AIDS has been so "medicalized" and is the domain of the priviliged few specialists, financialy, while the grassroots people who are being researched on rarely receive the feedback and do not benefit from the resources in "millions" that are earmarked for them. The biomedical model has disempowered the masses in the developing countries, who must take their own health in their hands, especially with the massive brain-drain.The Open Access Movement will at least inform, educate and communicate to us some wonderful works, experiences and best practices of others to spur us on.

Why re-invent the wheel? Africa has a lot of "restricted" Research Reports / Consultancy Reports on bookshelves or cupboards at headquarters gathering dust! Meanwhile every other donor funder's proposed proposal has "...15% for the consultant..." we shall hire, usually from Europe or America, to come and solve a local African problem.

The bureaucratic leaders tell the locals, the natives, that they must volunteer their services or presence. Taking a line from Jorge, our bureaucrats have a lot to answer for as; "There is no such a thing as a free lunch". Somebody has to pay (Jorge E.Maldonado). Picturing AIDS as an awareness strategy has been the fishing line that has been given to Botswana, partially answering Helen; "Personally I wish that people could to be taught how to fish (given the means to sustain themselves), so that they can stop being "victims" and free themselves from the bondage of free fish (endless charity) (HelenStrong)."

With Gordon Brown coming on board, we might see more people being taught how to fish than get the free fish! It took a while for the Picturing AIDS strategy to be accepted as the foreign consultants said, "... it goes against health promotion teachings!" I believe that pictures for the picturate and literature for the literate are viable ways of reaching the community!

For me, articles/publications in open and restricted journals are all worthy to look at. What matters is information that will make adifference. As for the publishers, they should have a choice to publish where they want to. There is a lot of time that goes into publishing a "worthy" scientific article, that I might not be able to do, being a "hands on" medical officer in a remote district hospital where I am expected to be "everything", with the exception of a researcher.

Even trying to get money for research is another battle in our set-ups. It is easier to squeeze water from a rock! If an open article or resticted article with the valuable health information will help another colleague to save a life or improve the quality of life of a society, I am happy!

Sub-Saharan Africa has roughly three "Twin Tower" disasters every day or one Tsunami disaster, 150 000 deaths, per month in health related deaths. Sadly, the majority of deaths are preventable but the information is mostly "restricted"!

We saw the pictures of the Twin Towers. We saw the pictures of theTsunami. Have we seen the pictures of HIV/AIDS? The scenes from these two tragic events that moved the world are even more shocking than the majority of TALC slides that my team in Botswana used for teaching, where Health Promotion Specialists talk of "shock tactics" and have held us back for many years.

The HIV/AIDS pandemic in Africa is "iatrogenic!" The Health Promotion curriculums have to be re-visited! If that will be done through the Open Access Approach, let it be so. Do we need Nelson Mandela to talk "open access" about his family to take a point home, when there are Open Access Publications!

As we discuss open access and restricted access publications, give a thought to the developing countries, where a lot of us live on less than a dollar per day! Sadly, even the life saving information is medicalized! Sorry for my round about way of supporting the Open Access Movement, as a process of empowerment in the village, de-medicalization, rationalisation, de-bureaucratisation and southernalisation especially in addressingHIV/AIDS.


[HIF-net-at-WHO profile: Edwin Mapara is a medical doctor trained at theUniversity Teaching Hospital, Lusaka, Zambia. He is currently studying at the London School of Hygiene and Tropical Medicine. He is a former chief medical officer of Athlone Hospital, a 175-bed district hospital in Lobatse, Botswana, where he established the Athlone AIDS Awareness Programme, a model which is now being replicated in other district hospitals in Botswana. Edwin has a special interest in HIV/AIDS and the use of health information materials - especially TALC clinical slides -for sexual health promotion. ]

[Note from HIF-net-at-WHO moderator: Edwin Mapara and David Morley'sarticle is available free at: ]

HIF-net-at-WHO: working together to improve access to reliable information for healthcare providers in developing and transitional countries. Send list messages to . To join the list, send an email to with name, organization, country, and brief description of professional interests.

Monday, January 17, 2005

Brain Drain in Health Sector

It gets studied, but nothing ever gets done

Subj: Brain Drain ... Health ... Failed Development
Date: 12/26/2004 7:37:53 PM Eastern Standard Time
From: Profitinafrica

Dear Sebastian Mallaby

I have recently seen your article "How Africa subsidizes U.S. health care" in the Washington Post of November 29 2004 just prior to World AIDS day.

I very much appreciate you putting this information into print. Please do it as much as you can.

But the interesting thing is that this is a problem that was visible going back fifty years ... the start of the British National Health Service would have failed if the UK had not been able to import medical professionals from the Empire ... Indian and Pakistani doctors, nurse from the Caribbean. Fifty years later the medical professionals from Nigeria, Ghana, Uganda, Kenya are everywhere.

What is interesting is that the official development assistance (ODA) community has been terribly quiet about the problem, and nobody has put forward much that is practical and on a scale to make a difference. ODA talk is in great supply. ODA do is almost non existant ... certainly when the North is going to lose an important benefit.

Our group is starting to address some of the issues in a practical way. The ODA world has very little knowledge about the communities in the South .. a lot of studies ... but not much knowledge.

Communities in the South have enormous potential to improve ... but only if they have the opportunity to do so. The ODA community has missed this ... and instead of progress in development, the South is poorer today than forty years ago.

Why? What on earth has been going on?

Everything that is written shrieks "development failure" but somehow the ODA community and the general North readership does not see or hear it.

The way we have being doing development does not work. It is time to do better, and do something that will make a difference.

Our group is starting ... its a long journey, but at least we are going in the right direction


Peter B
Peter Burgess
TRACnet in New York
Tel: 212 772 6918
Blog: http://taame.blogspot

UN on fighting poverty

More of the same must fail

Subj: [breaking-the-silence] NYT: U.N. Report Urges Rich Nations to Double Aid to Poor
Date: 1/17/2005 4:00:11 PM Eastern Standard Time
Sent from the Internet (Details)
U.N. Report Urges Rich Nations to Double Aid to Poor
[ To download report:]

January 17, 2005
New York Times

UNITED NATIONS, Jan. 17 - An international team of experts sponsored by the United Nations proposed today a detailed, ambitious plan to halve extreme poverty and save the lives of millions of children and hundreds of thousands of mothers each year by 2015.

The 74-page report, which synthesizes 3,000 pages offindings by 265 experts, says that drastically reducingpoverty in its many guises - hunger, illiteracy, disease -is "utterly affordable." Industrialized nations will need to double aid to poor countries, to 0.5 percent of their national incomes, it said. The report of the United Nations Millennium Project, which was prepared under the stewardship of Prof. Jeffrey D. Sachs of Columbia University, advocates trade reforms to level the international playing field, as well a sweeping array of spending on, among other things, health, education, rural development, slum upgrading, roads and scientific research. Such an effort, the report said, would lift hundreds of millions of people out of poverty.

The Millennium Project's blueprint for development - viewedby some critics as utopian overreaching - is likely to shape the agenda for agencies of the United Nations over the coming decade and to influence other major players, including the World Bank and the governments of impoverished African countries. "We're talking about rich countries committing 50 cents out of every $100 of income to help the poorest people in the world get a foothold on the ladder of development," said Professor Sachs, who was appointed to lead the project bySecretary-General Kofi Annan in 2002. The worldwide outpouring of grief and aid since a huge tsunami killed more than 150,000 people in Asia and Africalast month has stirred hope here that the same well spring of empathy can be tapped for what Professor Sachs called "the silent tsunami" of global poverty that kills more than150,000 children every month from malaria alone.

The report, "Investing in Development: A Practical Plan toAchieve the Millennium Development Goals," is the first in a series of initiatives this year that are meant to focus the world's attention on fulfillment of sweeping poverty-fighting promises made by the world's leaders in 2000. In July, Britain will be host to a summit meeting of industrialized countries that will spotlight global poverty, particularly in Africa. Prime Minister Tony Blair has appointed a commission on Africa that is to report this spring. And Britain's finance chief, Gordon Brown, is campaigning for a "Marshall Plan" for Africa that includes debt relief and his own proposal to roughly double aid from rich nations. Britain itself has pledged to double aid by 2013 to 0.7 percent of its national income. The United States, which currently allocates less than 0.2 percent for aid, has not made a comparable pledge. In September, world leaders will gather here to take stock of progress toward the antipoverty goals they set in 2000, among them universal primary education and sharp reductionsin hunger, child and maternal mortality and the proportionof people living on less than $1 a day. Today's report says poor countries should stop tailoring their plans to combat poverty to the limited resources now available and instead draw up comprehensive approaches to achieve the poverty reduction goals, then figure the costs.The project calls on poor countries to improve their own governance, uphold the rule of law and spend more of their own money to combat poverty. But economists on the millennium team estimate that those resources will be inadequate and that donors will need to make up the difference.

"We are not telling countries what to do," Professor Sachs said. "I meet with national leaders, cabinet ministers, villagers all the time. They want to stay alive - to fight malaria, to get H.I.V.-infected people on ARV's," or antiretroviral therapies, "to build roads, to use fertilizers and agroforestry. These proposals are not imposed from the outside." The report advocates that rich countries support a crash development program this year in at least a dozen poor, well-governed nations that donors are confident will use the money wisely.

Ghana, Mozambique, Mali, Senegal and Tanzania are among those most often mentioned. It also recommends pressing this year for 17 "quick wins," policies that it says would swiftly translate into millions of improved and saved lives. Among them: mass distribution of insecticide-treated bednets and medicines to combat malaria, a leading killer of children; elimination of fees for primary schools, with lost revenue replaced by donors; expansion of school meals programs to hungry areas; providing regular deworming medicines to schoolchildren in affected areas to improve school attendance and health; distribution of free or subsidized fertilizer to impoverished African farmers; and expanded treatment of people with AIDS and tuberculosis.

The long list of "quick wins," as well as the daunting scope of development challenges the report advocates tackling simultaneously have led to internal debate among some experts working on the report. Professor Sachs, director of the Earth Institute at Columbia and a specialist in economic development as well as health policy and management, said many poor countries were ready to move forward on many fronts, especially with infusions of aid to improve their administrative and information systems. "The problem is not really the range of issues," he said, "but the lack of financing."

But Nancy Birdsall, who heads the Center for Global Development in Washington and was a leader of the project's education task force, said she worried that the report did not sufficiently emphasize that many difficult social and political changes having nothing to do with money will have to be made by the developing countries themselves to reduce poverty. And while she, too, strongly supports increased donor aid - her nonprofit institution recently published "Millions Saved," a book about successful initiatives in public health - she also said that the report recommended too many priorities and "quick wins."

"Having so many unfortunately reflects the difficult reality of setting priorities, even for the authors of this report," she said. "We wanted a constraint-free world, but that's not the way life is or the development challenge. Even if the money is there, where do you start? What do you work on?"

The report bears the unmistakable stamp of Professor Sachs, a crusader for the idea that within a generation, rich and poor countries together can end the extreme poverty afflicting more than a billion people. His indefatigable advocacy for a wide-ranging set of prescriptions and sharp increases in aid have intensified the long-smoldering debate about the efficacy of foreign aid for poor countries struggling with weak governance and corruption. Prominent development experts who were not on the Millennium Project team reacted to its report with comments that ranged from harshly critical to cautiously supportive.

William Easterly, an economics professor at New YorkUniversity, said an incremental approach with more modest goals - for example, the use of vaccinations to curtail childhood deaths from measles - would have been more effective that that of the report. "Its approach is a sort of utopian central planning by global bureaucrats, a crash program like a Great Leap Forward for poor countries," he said. "This will not work any better than central planning by bureaucrats has worked anywhere else, which is to say not at all."

But Professor Dani Rodrik, a Harvard University economist, said that while the plan requires "a huge leap of faith"that poor countries can handle sharply higher inflows of aid, it is worth a gamble, especially since the increased amount of donor assistance proposed is such a tiny share of rich countries' national incomes. "It has the potential of making a difference in a number of countries that take this opportunity and put it to good use," he said. "One has to ask the question: If not this,what else?"

Copyright 2004 The New York Times Company

Britain's Gordon Brown on the IFF proposal

Gordan Brown speaking in the USA, December 17, 2004

Subj: [Global-Peace-Organization] Digest Number 203
Date: 12/21/2004 8:10:19 PM Eastern Standard Time
From: "Paul Zeitz"
Subject: CFR: Gordon Brown on Making AIDS History
C. Peter McColough Series on International Economics:
Speaker: Gordon Brown MP, chancellor of the exchequer, United Kingdom
Presider: Robert E. Rubin, director, chairman of the executive committee, Citigroup; former U.S. secretary of the Treasury Council on Foreign Relations
December 17, 2004
New York, N.Y.

Gordon Brown MP Chancellor of the Exchequer
I would like to start by saying how delighted I am to be here. To be introduced by Robert Rubin -- held in respect and admired in every continent for your outstanding leadership during and since your successful time of office as Treasury Secretary. And to be invited here to make our case at the Council on Foreign Relations about the forthcoming British G-8 presidency is both humbling and challenging.

For this is the forum--set up to help rebuild the international order after World War I, central to the 1944 and 1945 conferences for building that order after World War II--where, out of the seeding of new ideas, the discussion of international events, so much that has been so good for the world has been initiated.

And at the heart of the internationalism advanced by the Council, just as it is at the heart of the close and historic links between our two countries, the U.K. and the U.S.-are our shared values: our shared passion for liberty and democracy; our fundamental beliefs: in opportunity for all, the work ethic, and enterprise; and our commitment to being open, outward looking, and engaged with the world--not least our shared convictions that economic expansion through trade and free markets is the key to growth and prosperity.

And let me start by acknowledging the debt the world owes to the United States for your leadership not just in the world economy but in the fight against international terrorism. And coming to New York three years after September 11th I am once again deeply impressed by the resilience and bravery in the face of tragedy. Indeed, America has shown by the actions of all its people that while buildings can be destroyed, values are indestructible; while lives have been put at risk, the cause of liberty never dies; and while hearts may be broken, your faith in the future is unbreakable.

And in Iraq, Afghanistan, and round the world, I can assure you that Tony Blair and I are determined that this alliance endures, prospers, and advances from strength to strength. And when the transatlantic economic relationship between Europe and America now accounts for up to $2.5 trillions of commercial transactions each year, including $500 billions of foreign trade, and provides employment to over 12 million people on both sides of the Atlantic, we must do more to break down the tariff and non-tariff, regulatory, competition, and financial services barriers to greater trade and investment between our two continents.

And I repeat my proposal--more relevant than ever--a proposal born out of my experience as a finance minister--that European countries like Britain and the U.S. and the NAFTA countries should meet in a regular economic forum to examine shared economic challenges.

But this morning I want to discuss with you how, as the U.S. presidency of the G-7 of 2004 evolves into the British presidency of 2005, we can work together to fashion a global alliance for peace and prosperity that starts from the shared needs, common interests, and linked destinies of developed and developing worlds working together.

And I have a quite specific set of proposals: that as poor countries reform and agree to continue reform, the richest countries must ensure that all countries in desperate need of sustainable debt relief receive it; that we complete as a matter of urgency the first trade round the world has ever seen that sets out to rebalance the trading system to take account of the interests of the developing world; and most of all that we consider an innovative proposal to tackle HIV/AIDS, TB and malaria, to give every child the chance of primary education and to double aid to halve poverty.

Let me put my proposals in context. Just before the Iron Curtain descended over Europe in the late 1940s, Prime Minister Churchill and President Roosevelt came forward with bold proposals for a strengthened Atlantic Alliance and looked ahead to a new era and--in their day and for their times--built a new world order.

In that remarkable decade, visionaries here in America and round the world created: the United Nations; the World Bank and International Monetary Fund; and then, in a remarkable act of generosity--through the Marshall Plan--America transferred 1 percent of national income to the war-ravaged economies of Europe, recognizing that prosperity, like peace, was indivisible; that prosperity, to be sustained, had to be shared. And that vision led to not only a new military and political settlement but a call for a new economic and social order that tackled, in their words, "hunger, poverty, desperation, and chaos."

Like these visionaries of the postwar era, we are today dealing with military, security, and strategic challenges in a number of critical countries to which we must respond at a security and military level comprehensively with clear and defiant resolution but, as [Secretary of State George C.] Marshall did, also at an economic, social and cultural level. Like our predecessors, we are seeing the need for an offer to the least developed countries--the most recent being the Monterrey consensus and, in the USA, the Millennium Challenge Account--what Marshall argued for: "to permit the emergence of political and social conditions in which free institutions can exist"--and that such an offer can only succeed if it goes beyond compensation for poverty to dealing with its underlying causes, beyond temporary relief to wholesale economic development.

And like them we see that any future global economic and social order must be grounded in responsibilities as well as rights. So like theirs, our proposals also call on the poorest countries to rise to the challenge. And thus our vision of the way forward--akin to the 1940s challenge to rich and poor countries alike--is that only by each meeting their obligations for change all can benefit.

And we recognize the differences. We understand that when what happens to the poorest citizen in the poorest country can directly affect the richest citizen in the richest country, the security threat we face is not an Iron Curtain which separates East from West but a blanket of fear--permanent, guerilla war fought not by conventional armies or nation states but by cliques and factions of whose suicide bombers it is often said they cannot easily be deterred, they need succeed only once, and they do not have to win in order for us to lose. I am more confident that, by military and security measures and also by the far sightedness of our economic and social vision, we can separate those extremists from the peoples they seek to exploit.

But we also recognize that while the Marshall Plan was constructed in a postwar world of distinct national economies in need of rebuilding, our job now, in a more interdependent world--the world of globalization--is to help build for a wholly different environment of open, not sheltered, economies; international, not national, capital markets; and global, not local, competition--and to do so in a way that recognizes that the foundations of prosperity--the rule of law, transparency, and accountability--need to be built by support in aid not as compensation for poverty but as investment in the building on modern economies.

The answer is not to imply you have to choose between engaging in the global economy and addressing poverty, as if men and women of compassion should reject globalization. The answer is to advance globalization and justice together with new policies for a new era of engagement. Now exactly five years ago in New York and in a historic declaration, every world leader, every international body, almost every single country, signed up to a shared commitment to right the greatest wrongs of our time.

The promise that by 2015 every child would be at school--the right to education so everyone can help themselves. The promise that by 2015 avoidable infant deaths would be prevented--the right to a healthy life so all have the opportunity to make the most of their abilities. The promise that by 2015 poverty would be halved--the right to prosper so each and every individual can fulfill their potential. But already, so close to the start of our journey, we can see that our destination risks becoming out of reach, receding into the distance.

At best on present progress in Sub Saharan Africa: Primary education for all will be delivered not in 2015 but 2130. That is 115 years too late. The halving of poverty not by 2015 but 2150. That is 135 years too late. And elimination of avoidable infant deaths not by 2015 but by 2165. That is 150 years too late The world will not wait 150 years for promises made to be honored.

Recall the past promises: the promise in 1970 that all developed countries would set aside 0.7 percent of their national income for development aid; the promise of primary education for all made in 1980 in Jomtien (Thailand) and re-affirmed in 2000 in Dakar (Senegal); the promises at the World Summit for social development in 1995 on eliminating poverty. Promises which all have one thing in common--they have all been broken.

Martin Luther King spoke of the American constitution as a promissory note. And yet--for black Americans--the promise of equality for all had not been redeemed. He said that the check offering justice had been returned with "insufficient funds" written on it. And in this way he exposed on racial equality the gap between promises and reality.

And so too the Millennium Development Goals--a commitment backed by a timetable--are now being downgraded from a pledge to just a possibility to just words. Yet another promissory note, yet another check marked "insufficient funds."

Now, since 2000 some progress has been made. Seventy billion dollars of unpayable debt is being written off. At the 2002 Monterrey Financing for Development conference, donor countries pledged an additional $16 billion a year for development aid from 2006. Under President Bush's leadership, the United States have promised $5 billion a year by 2006 through its Millennium Challenge Fund--increasing U.S. US foreign aid by 50 percent--and $500 million to promote HIV/AIDS prevention and provide antiretroviral therapy--in total more than tripling U.S. investment globally in tackling HIV/AIDS since 2001.

And five countries, including the U.K., have this year committed to a timetable for raising development aid to the U.N. target of 0.7 percent of national income. In addition, in the past decade in developing countries, primary school enrolments have increased at twice the rate of the 1980s. The proportion of those aged over 15 who can read has risen from 67 percent to 74 percent. Life expectancy has increased by from 53 years to 59 years. And the number of people living in extreme poverty has fallen by 10 percent.

But at the same time we face the challenge of a continent--Africa--where 30 countries still have an average life expectancy of less than 50. Where 25 million people are infected with HIV/AIDS. Where in 24 countries one in every ten children die before the age of one and the everyday story is of mothers struggling to save the life of their infant child and in doing so losing their own. Where millions of children die unnecessarily each year.

We cannot anymore blame these failures on a lack of science, medicine, or knowledge. And we cannot blame our inaction on ideological division, that we have been frozen into action by a failure to agree. I cannot think of a time when there has been so much basic agreement between developed and developing counties on the role of markets and public investment; on the importance of trade, private investment, and transparency in monetary and fiscal regimes -what you might call a new consensus. Instead, what we need is greater political will. And the U.K.'s plan is this.

We need to make an offer as bold as the offer that was made in the Marshall Plan of the 1940s. An offer that, as developing countries pursue corruption-free policies for stability, implement their own poverty-reduction plans, and take forward the policies necessary to expand development, attract private investment, encourage entrepreneurship, and reform trade at their own pace, the richest countries should offer: to make a reality of our pledge to wipe out 100 percent of debt that is unpayable; to dismantle our trade barriers and finance, for the poorest countries, the building of capacity to trade and attract investment so they can take advantage of opportunities in our markets; and to offer--in what Robert Rubin calls a "parallel agenda"--the resources that are urgently needed to meet the Millennium Development Goals--an extra $50 billion a year.

It is an offer made for security, economic, and moral reasons. It is an offer that requires accountability and transparency from the poorest countries to justify development aid. It is an offer, however, whose generosity--an act of statesmanship--would illuminate the values we are defending and show the world that we, the richest countries, are ready to march forward with the poorest countries under the banner of liberty, democracy, and opportunity for all. And out of this I believe we could achieve not only a major assault on poverty in the poorest countries but pave the way, as the Marshall Plan and the Bretton Woods institutions did, for greater trade and higher and longer-term world economic growth benefiting us all. Let me outline the scale and significance of our proposals.

Let us in 2005 make a historic offer that finally removes the burden of decades-old debts that today prevent the poorest countries ever escaping poverty and leading their own economic development. In 1997 just one country was going to receive debt relief. Now 27 countries are benefiting, with $70 billion of unpayable debt being written off.

And it is because of debt relief in Uganda that 4 million more children now go to primary school. Because of debt relief in Tanzania that 31,000 new classrooms have been built, 18,000 new teachers recruited, and the goal of primary education for all will be achieved by the end of 2005. Because of debt relief in Mozambique that half-a-million children are now being vaccinated against tetanus, whopping cough, and diphtheria.

And all achievements made without undermining creditor confidence. But when many developing countries are still choosing between servicing their debts and making the investments in health, education, and infrastructure that would allow them to achieve the Millennium Development Goals, we have to recognize that, while 100 percent bilateral debt relief has wiped out half the debts of most poor countries, the process can only be completed-as U.S. Treasury Secretary John Snow has suggested--with a bold act of offering 100 percent multilateral debt relief, relief from the $80 billion of debt owed to the IMF, the World Bank, and the African Development Bank, up to 80 percent of the historic debt of some of the poorest countries.

And instead of running down the resources the international financial institutions have available for development, I suggest that IMF debt write-off be financed by using IMF gold and that donor countries make a unique declaration that they will, on this occasion, repatriate their share of World Bank and African Development Bank debts owed by eligible developing countries. And to lead the process we, the U.K., are prepared to assume responsibility for 10 percent of all debts owed to the World Bank and the African Development Bank. But debt merely deals with the burdens of the past. It is not enough to break the vicious circle of debt, poverty, and under-development, we must also build a virtuous circle of private investment, open trade, and economic development. Less than 5 percent of total flows of foreign direct investment go to the least developed countries--and only 1 percent to the whole of Africa. Domestically generated savings and investment barely match foreign capital inflows--and the savings that do exist often leave the country in capital flight.

That is why country-owned poverty reduction strategies are rightly focusing on creating the right domestic conditions for private investment and commerce with the IMF, World Bank, and nations like ours providing direct support to help create a stable economic environment, an educated and healthy workforce, improved infrastructure, encouragement for entrepreneurship, well-functioning capital markets, and sound legal processes that strengthen property rights and deter corruption. We know now that who holds the raw materials is less important than who has the skills.

As President Bush has said: "Africa is a continent that has got vast potential, and the United States wants to help the people of Africa realize that potential." All of us here know that no country has moved from poverty to prosperity by cutting itself off from the international economy and without increasing its investment and trade. We also know that reducing tariffs and achieving the ambitious pro-poor trade agreement promised at Doha could boost the world's yearly income by over $500 billion. And while developing countries could gain the most, all countries and regions stand to benefit. So 2005 must become the year when through the world trade talks, we release the poorest countries from unfair trade barriers. But my proposals involve not just removing the barriers but a more positive encouragement of private investment and trade.

First, it is time for the richest countries to agree to open our markets, remove trade-distorting subsidies and, in particular, do more to tackle the scandal and waste of the European Common Agricultural Policy, showing we believe in free and fair trade.

Second, it is time to move beyond the old consensus of the 1980s and recognize that, while bringing down unjust tariffs and barriers can make a difference, developing countries must also be able to carefully design and sequence trade reform into their own poverty-reduction strategies.

And, third, it is not enough to say, "You're on your own, simply compete." We have to say, "We will help you build the capacity you need to trade"--not just opening the door, but helping developing countries gain the strength to cross the threshold. We have to recognize that they will need additional resources from the richest countries both to create the physical infrastructure and human capital to take advantage of trading opportunities--and to prevent their most vulnerable people from falling further into poverty. It is this last offer that could in my view unlock the stalled world trade talks and as we progress together--America and Europe--towards the next meeting in December 2005 in Hong Kong, we must drive forward this agenda. But any discussion of debt relief and encouragement for trade leads to the third great challenge of 2005: that progress on debt relief and capacity building for trade side by side with Rubin's "parallel agenda" of investment in education, health, and anti-poverty programs must also involve new resources--not aid as compensation for being poor but aid as investment in the future potential of the developing world, tackling the underlying causes of under-development. Making better use of existing aid--reordering priorities, untying aid, and pooling funds internationally to release additional funds for the poorest countries--is essential to achieve both value for money and the improved outcomes we seek. But the brutal fact is that, while 10 years ago aid to Africa was $33 per person per year, today it is just $27. All the public spending on education in Sub-Saharan Africa taken together is still, per pupil, under $50 a year, less than one dollar per week. And compared to $2,000 a year in America, Sub-Saharan Africa still devotes only $12 per person per year to health--and only $3 per person per year comes from aid. So the fact is that as the problems of disease and poverty have grown, financial support has been reduced. And the scale of the resources needed immediately to tackle disease, illiteracy, and global poverty, far less to meet the ambitious Millennium Development Goals to which we are pledged, is far beyond what traditional funding can offer. That is why the U.K. Government, as part of the financing package to reach the Millennium Development Goals, has put forward its proposal for stable, predictable, long-term funds frontloaded to tackle today's problems of poverty, disease, and illiteracy through a new global finance facility.

The International Finance Facility is in the tradition of the Marshall Plan. And it is modeled on the founding principles of the World Bank, where nations provided resources to an international institution that then borrowed on the international capital markets. But it is a temporary facility to meet the needs of development from now to 2015. Let me explain how the IFF will work. The IFF will be founded upon the additional $16 billion a year already pledged from the richest countries like ourselves at Monterrey. Donors will make this additional funding a long-term pledge--over 30 years. And using these binding donor commitments as security, the IFF will leverage in additional money from the international capital markets to raise the amount of development aid for the years to 2015 by $50 billion a year--which will be repaid during the second half of the life of the facility through donor commitments Let us be clear: the IFF is a temporary facility that involves no new bureaucracy.

The IFF would disburse development aid through grants and work through existing channels for delivering aid--indeed, current U.S. commitments to the Millennium Challenge Account, for example, could be scaled up by the IFF structure before being disbursed in exactly the same way as planned today by the Millennium Challenge Corporation. And I believe the IFF has the following advantages--it allows us to tackle the causes of under-development, not the symptoms; it allows us to ensure predictable funding where first aid is, not at the expense of long-term investment; and it allows us to frontload the flow of resources required to meet the Millennium Goals. First, the IFF would provide a predictable flow of aid to developing countries so they no longer have to suffer from an up to 40 percent variance in the amount of aid they receive from year to year, which itself prevents them from investing efficiently in health and education systems for the long term and tackling the causes of poverty rather than just the symptoms. Too often in the last 50 years, we have seen development funding as short-term charity aid, charity for being poor, instead of for a higher and more substantial purpose--long-term investment tied to tackling the underlying roots of poverty and promoting sustainable growth.

That is why the development funding I propose today through the IFF is specifically designed to generate the public investment needed to create the best environment to boost private investment and trade by increasing funds for health and education--not typically areas in which private capital flows but areas in which public investment is necessary to create an environment in which private commerce can flourish. Second, the IFF would create the scale of funding necessary to invest simultaneously across sectors--in education and health, trade capacity, and economic development--so that instead of having to choose between urgent emergency disaster relief and long-term investment, the impact of extra resources in one area reinforces what is being done in others and has a lasting effect.

For the fact is that no one area can be seen in isolation from another: every year of additional schooling that a mother has reduces her child's chances of dying by up to 10 percent, so if we cannot invest in education we cannot succeed in tackling diseases like HIV/AIDS, TB and malaria; teachers in dozens of countries are dying of HIV/AIDS faster than they can be trained, so if we cannot tackle ill-health we cannot solve our problems in education; 90 percent of diarrheal disease is caused by poor water, so if we cannot invest in sanitation we cannot succeed in public health; investment in transport and telecommunications are essential if developing countries are to reap the benefits of access to our markets, so if we cannot invest in infrastructure we cannot succeed in stimulating economic development; and because every dollar no longer required in repayment to meet the burden of unpayable debt can be money spent on education and health, if we cannot continue to secure debt relief we cannot succeed in education and health.

So to rise to the scale of the challenge we need a financing vehicle through which we make possible the funds for--and then the realization of our goals for--education, health, AIDS, economic development, debt relief and trade, all together at the same time. Third, the IFF is designed to be a fiscally neutral means of scaling up development aid between now and 2015, bringing forward in time the value of the commitments already made at the Monterrey conference and enabling us to frontload aid so a critical mass can be deployed as investment now over the next few years when it will have the most impact in achieving the Millennium Goals.

We know that by spending now in many areas we can not only save lives earlier but also reduce costs for the longer term. Take HIV/AIDS for example--which will be a priority of the international finance facility. Research shows that for every year we bring forward the discovery of an AIDS vaccine, we could save 2 million lives that would otherwise be lost.

So if we increased investment in AIDS research now and used it to find a vaccine--and then eventually to finance a jointly agreed advance purchase scheme to make the vaccine accessible to Africa at an affordable price--then we can not only save lives earlier but also reduce the costs of treating those with HIV/AIDS in the medium and longer term by up to $2 billion a year.

I also see an enormous opportunity for pushing forward the initiative to create a worldwide infrastructure--or platform--for sharing and coordinating research in AIDS, and then for encouraging the development of viable drugs. But it is generally recognized that the sums of money required involve at least a doubling of research money for AIDS. The generation that--by their generosity and far sightedness--advanced a cure to prevent HIV/AIDS would truly merit the title "the greatest generation." In the last 50 years, the Marshall Plan's European model could not be applied wholesale to developing countries, because in many poor countries neither the economic foundations nor the necessary open, transparent, and accountable systems for managing the public sector were properly in place to absorb aid and prevent corruption and waste. And the proposal I am making today will work only if we see development assistance in this light: with the multinational pooling of budgets and the proper monitoring of their use to achieve the greatest cost effectiveness of new aid; untying aid so maximizing its efficiency in diminishing poverty; more effective in-country use of funds to help countries invest and compete; and development funding focused on results and based on developing countries pursuing agreed goals for social and economic development. including tackling corruption.

And let me give an illustration of what--because of the IFF model--could already possible. The Global Alliance for Vaccines and Immunization (GAVI)--which is funded by the Gates Foundation and governments and has immunized over the last five years not a few children but a total of 50 million children round the world--in interested in applying the principles of the IFF to the immunization sector--donors making long-term commitments that can be securitized in order to frontload the funding available to prevent disease.

If, by these means--through the pilot we are developing with them--GAVI could increase the funding for its immunization program by an additional $4 billion over 10 years, then it would be possible that their work could save the lives between now and 2015 of an additional 5 million people. So in one fund, with one initiative, we can glimpse the possibilities open to us if we act together.

If we could make the same offer for health, for schools, for debt, for the capacity to trade, for research, and advance purchasing of drugs to cure malaria and HIV/AIDS, think of the changed world and the changed view of the developed countries in the developing countries. Marshall's Plan in the 1940s was investment for a purpose--for a Europe rebuilt. He summoned forth a new alliance for prosperity between rich and poor countries that, for his time, played a vital part in winning the peace.

So today--summoning up the spirit of Marshall--the new offer I suggest for developing countries is aid as public investment for a purpose, so that they can play their part in a stable, peaceful world. And by each meeting their obligations for change, all can benefit.

First, the obligations on developing countries: to end corruption, put in place stable economic policies, encourage private investment, meet their commitment to community ownership of their poverty-reduction strategies, and ensure resources go to fighting poverty.

Second, the obligations on business to engage with the development challenge and not to walk away, becoming long-term partners in growth and development.

Third, the obligations on international institutions to reform systems to ensure greater transparency and openness, and to focus on priorities that meet the international development targets.

Fourth, the obligations on the richest nations to the poorest of the world to curb our protectionism, to fulfill our commitments, and to help release the potential of the developing world through a substantial and decisive transfer of resources. Not aid that entrenches dependency but investment that empowers self sufficiency--investment money that is, in the truest sense of the word, freeing the poorest countries to find their way forward.

Here in the Council on Foreign Relations you have for over almost a century addressed the great challenges of our times. Your origins were the search for a new post First World War world order--and your contribution was to demand security with justice.

Then in the 1940s, you planned and discussed the policies that led to the Bretton Woods conference and the Marshall Plan--and your contribution was to demand far sighted acts of statesmanship.

Now here in New York and after September 11th, President Bush, your government, your armed forces, and your people have led a great and global effort worthy of America's history and its ideals: working together with steadfast resolve both to win the war against terrorism and to make an offer to developing countries that rises to the health, education, poverty, and economic challenges all have to meet. The words of one great poet sum up what we must now do: "The future has many names/ For the weak it is unattainable/For the fearful it is unknown/For the bold it is opportunity."

Let it be our generation that shows those who suffer in the bleakest places of the world that we can light a candle of hope which, radiating outwards, can cut through the darkness and shame of injustice and emblazon across the world--for all people everywhere to see and believe--a message of confidence and faith in the future.

Let it be our generation that--with practical and bold resolution--takes up the challenge and discharges our duty to remove the scar of poverty and hopelessness from the world's soul.

Saturday, January 15, 2005

Value creation

Why has investment in socio-economic development not resulted in much progress? The simple answer is that almost nothing done in the name of development has been value creating. Almost everything has been value destroying. It is not surprising that after about forty years of doing value destruction in development that many countries are in a very sad state with both the economy and the governments effectively bankrupt.

It is very sad, and could have been avoided. It should not be allowed to continue any longer.