The Japan's statement of Annual Ministerial Review at ECOSOC
Geneva, 7 July 2009
It is my great pleasure to attend the National Voluntary Presentation of the Annual Ministerial Review of ECOSOC today as one of the eight countries presenting its commitments to global public health.
I appreciate your strong determination in making this session such a productive and successful one.
Japan attaches great importance to the issue of global health. Today I would like to explain our current global health policy and its focus on health systems strengthening.
With the progress of globalization, threats including the internationalization of local conflicts, the spread of infectious diseases, the proliferation of poverty, outflows of refugees and the sudden occurrence of economic crises are increasingly endangering people. In order to address these global issues effectively, Japan has promoted the concept of human security. Human security aims to protect the vital core of all human lives in ways that enhance human freedom and human fulfillment through the protection and empowerment of both individuals and communities. In order to enhance human security under the “ownership” of each recipient country, Japan stresses that a “comprehensive approach” is important. This approach includes both a disease specific approach and a health systems strengthening approach involving all related stakeholders. It is becoming increasingly clear that neither a single approach nor a single stakeholder on their own is sufficient in tackling the diverse and multi-dimensional issue of global health.
Japan has always been an active player in the field of global health. At the G8 Kyushu Okinawa Summit in the year 2000, Japan took up the issue of infectious diseases for the first time in the Summit’s history. On the same occasion, Japan announced the Okinawa Infectious Diseases Initiative which would implement comprehensive measures to tackle the threats of emerging and reemerging infectious diseases. These two major events raised the international community’s awareness and prompted the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2002. Japan has steadily fulfilled its commitments to the Global Fund ever since. Currently, under the Health and Development Initiative, Japan is firmly implementing comprehensive health assistance programs particularly tailored to contribute to achieving the health MDGs.
However, the progress in achieving the health-related MDGs is seriously lagging behind despite the earnest efforts of Japan and all other countries and actors committed to improving global health. Especially in sub-Saharan Africa if the current trends persist, the prospect is that none of the health–related MDGs will be met. In the worst case scenario, there will simply be no progress at all by the year 2015 in sub-Saharan Africa.
Under these circumstances, Japan once again committed itself to bringing health issues to the center of the global development agenda. Japan played a leadership role at the Fourth Tokyo International Conference on African Development and again at the G8 Hokkaido Toyako Summit last year. My government emphasized the importance of a “comprehensive approach” which mutually reinforces the vertical, disease-specific approach and the horizontal, health systems strengthening approach in tackling the inter-related health challenges in the world.
One point worth mentioning is that Japan took a distinct approach in developing the “Toyako Framework for Action” by inviting all related stakeholders to participate in the formulation process. The G8 Health Experts Meetings held with the participation of the Health Eight and the representatives of Norway and the AU contributed to the discussions on health-related issues among the G8 leaders. In addition, Japan exchanged views with major national and international health-related NGOs based on their experiences in the field.
In parallel with these developments, the “Working Group on Challenges in Global Health and Japan’s Contribution” led by Prof. Keizo Takemi, the former Senior Vice Minister of Health, contributed to the discussions that took place at the summit and at its follow-up meetings. The Working Group succinctly proposed that the G8 should pay more attention to health systems strengthening. The Japanese Government took the proposal seriously and is currently following up in the formulation of international discussions around the proposal as well as the materialization of concrete projects.
Indeed, health systems strengthening is once again gaining global momentum as an effective approach to realizing universal access to basic health care services. A growing number of political leaders and international organizations are responding to Japan’s call to recognize the need to commit to health systems strengthening in a sustainable manner. Now that we have already passed the midpoint year in our efforts to achieve the MDGs, and the prospect of its achievement remaining unclear, all stakeholders should collaborate in implementing health systems strengthening measures based on their comparative advantages.
Now, I would like to briefly introduce a couple of good practices learned through our collaborative efforts with our partner developing countries in achieving prominent health goals through strengthening national health systems.
The first example is on tuberculosis (TB) control in Cambodia. Cambodia is classified as one of the 22 high-burden TB countries and TB is one of the leading causes of mortality. Recognizing the need to strengthen health systems in order to eliminate the threat of TB, Japan and Cambodia implemented a Tuberculosis Control Project from 1999 to 2009. A comprehensive approach based on health systems strengthening was taken. It included data aggregation, formulation of evidence-based national TB program based on these data, development of network for early diagnosis, measures for treatment and prevention, and capacity building of health workers. Through these approaches, Cambodia’s case detection rate and cure rate of TB successfully reached 70% and 85% respectively by the year 2005.
The second example concerns health capital investment plan support in Zambia. This project focused on creating a comprehensive health facility database by aggregating data from almost 1,400 health facilities across the country. The health information was effectively utilized for formulating Health Capital Investment Plan which, in turn, was used by Zambia and donor countries to allocate the right resources to the right places. This is a good example of health systems strengthening, especially in the field of health information, and promoting aid effectiveness and donor harmonization.
In addition to these two good practices, there are many other examples of health systems strengthening measures that link closely with other health fields and indeed, produce concrete results. For example, Japan has hitherto pursued interventions such as the improvement of total health service systems for the continuum of care for women and children as well as the training of skilled birth attendants. These interventions are based on our firm belief that the improvement of maternal, newborn and child health cannot be achieved without a solid backing of health systems strengthening. Furthermore, Japan considers cooperation for human resource development to be vital to the ownership of developing countries, as they form the basis of nation-building. With this in mind, Japan is currently following up on our commitments announced at TICAD IV, namely by training 100,000 health and medical workers in Africa. Japan’s health partnerships with international organizations as well as our bilateral partnerships such as the US-Japan Partnership for Global Health also place a special focus on health systems strengthening.
And now that the novel influenza H1N1 is spreading rapidly throughout the world, health systems strengthening is becoming more and more crucial in terms of pandemic preparedness. We should contribute to developing: appropriate surveillance; referral to health facilities; effective and timely information sharing; and distribution mechanism of test kits and medicines. In turn, the strengthening of all these elements of health systems in response to the pandemic influenza will also serve the purpose of building a strong foundation in responding to other outbreaks of infectious diseases.
As can be seen in these examples, Japan has been leading the international discussions on global health based on health systems strengthening. We are committed to continuing to take the lead in this field. However, when considering the diversity and seriousness of the health issues that the world is facing today, it is obvious that no single country or organization can solve them alone. All stakeholders, namely, donor countries, partner developing countries, international organizations, the private sector, academia and civil society, must take part and play their respective roles in this endeavor. Indeed, health systems strengthening should be enforced through a participatory approach to complement each other’s efforts.
Recently, there have been concerns raised on the need to fill in the funding gaps in order to achieve the MDGs by the year 2015. Japan, in this regard, has been steadily implementing its health initiatives and disbursed approximately US$ 4.6 billion in total to the Health and Development Initiative. The initial pledge of US$ 5 billion over five years is almost realized in just three years. In addition, Japan has disbursed, as of today, US$ 1.04 billion to the Global Fund.
In addition to the pursuit of various new funding sources, we should be contemplating ways in which resources can be allocated effectively and fairly to the vulnerable people who need them most. In this sense, the current economic crisis could be seen as a golden opportunity for the international community to mobilize its collective wisdom and experiences in order to utilize limited resources to its fullest potential. Japan, in collaboration with all stakeholders, will take this opportunity to promote global health towards the achievement of the MDGs.
Thank you very much for your kind attention.