From Patronage to Partnership

Your Excellencies, Honoured Guests, Ladies and Gentlemen, let me begin by welcoming you all to Cape Town.   I pray that you may have a wonderful time in this beautiful city that I am blessed to have as my home.

It is my distinctive privilege and pleasure to address you this morning as you begin the work of the Third Annual Meeting on Grand Challenges in Global Health.Recently, I have found myself reflecting on the changes I have seen during the last decade and a half on how the world approaches issues of global poverty and development. 

There have been huge advances made – not least being the fact that the global community has progressively adopted a partnership approach to development.  This approach stems from the recognition that for humanity to tackle global challenges effectively, we must begin to join forces, working together from all parts of the globe to find creative solutions. 

This is why I am proud to be here today, in this gathering of health scientists from around the world, all of whom are committed to finding solutions to the massive global health challenges that we face. If I had to give an overall theme to this process of change, I would give the following title:  ‘From Patronage to Partnership.’

To put this in very simple terms – it is clear that experts are moving away from telling others what is best for them.  They are collaborating more, and they are listening more to those affected in order to solve the problems of the world.  In particular we have seen the growing involvement of civil society in development questions across the board. 

The world renowned development economist and Nobel Prize Winner, Amartya Sen, correctly stated that the best and most equitable policies, programmes and solutions are reached when everyone is consulted, and everyone’s views are taken into account. If this trend towards effective partnership is to succeed, ladies and gentleman, it must be rooted in three important principles, followed by action.

First, in deciding what the most urgent global health challenges are, we must not forget that the most wide-spread challenges are those that affect the poor.  Therefore, our prioritisation of health challenges must be informed by a development perspective.  It is unacceptable that in Africa today it is estimated that every year around 8 million African lives are lost to preventable, treatable or manageable diseases and other health conditions. 

We are now just over half way towards our 2015 deadline to meet the Millennium Development Goals.  The picture, as you know, is mixed and particularly bad for Africa.  Of the 8 MDGs adopted in 2001, the majority of African countries are unlikely to meet the deadline.  This includes the three health MDGs. If developing countries are struggling to meet the 3 health MDGs, it would seem to me that it would be worthwhile if they could be  supported by being given a particular priority by the global health community.  And the challenge is not only in relation to finding medical solutions to the problems – as indeed many of these challenges already have medical solutions.  The challenge is also to find programming solutions.  This means addressing issues of resource allocation, and accessibility of interventions, and so on.

Secondly, if we are to focus on prioritizing global health challenges that disproportionately affect the developing world, collaboration between experts from the North and from the South must be strengthened. 

This must begin with a clear recognition that there is expertise from the South that is further accentuated by lived experience and understanding of context.  This knowledge is invaluable. 

For this reason I am delighted to see the myriad of faces that are here today representing all corners of the globe. 

The Global Health Programme within the Bill and Melinda Gates Foundation must be applauded for the initiative they have been taking to make this happen over the years. Third, it is important to recognize the important roles that can be played by different stakeholders to advance health solutions and their roll out to those who need them.   When the issue of debt cancellation was at the fore of the political and development scene, there was a gathering crescendo of lobbying from civil society in the run up to the G8 Summit in July 2000, in Birmingham.  The Jubilee 2000 Campaign organised various events, and these were supported on an unprecedented level.   I am very proud that Church organisations took the lead in spearheading the initiative.  And it was my great privilege to participate as one of the public faces of the Jubilee 2000 Campaign.  I am convinced that this public involvement was significant in bringing donor countries and institutions to the cancellation of much of the developing world’s debt.   

Civil society of course is not the only stakeholder to consider.  There are government structures, there is business, there is academia, there are international institutions, there is the media, and so on.  This gathering in itself is an excellent example of a collaboration between business and academia, and between the North and South.

In 2001, at the Abuja Summit, the member states of the African Union pledged themselves to commit at least 15% of their national budgets to healthcare. However, six years later, little progress has been made in reaching this goal.  This is why the ‘15% Now!’ Campaign was launched last year, by the Africa Public Health Rights Alliance. 

The Campaign is based on the premise that ‘we all have to be alive and well to exercise any other rights in any meaningful way.’  Thus the right to health and to healthcare is arguably the most crucial of all the rights articulated by the Universal Declaration on Human Rights; or in the constitutions of the World Health Organisation;   or the International Covenant on Economic, Social and Cultural Rights.

The necessity for an independent monitoring body was one of the motivating forces that led me to set up the African Monitor, which was launched last year. Its objective is to monitor commitments made by African governments and donors, and ensure that the voice of Africa’s grassroots is better heard within the development agenda. 

A recent study conducted by African Monitor to catalogue and track commitments made, indicated that firstly very few countries are meeting the 15% to health commitment. And secondly that even in planning documents like the Poverty Reduction Strategy Papers, there is insufficient attention given to this commitment. 

In the same vein, commitments made to finance the Global Fund to combat HIV-AIDS, TB and malaria, for instance, are not being met by the donor community. The big question mark is this:  do we or do we not have the will power to meet commitments?  Governments and business can say the words, but they need all the encouragement, all the pressure, that we can give, to deliver the goods. 

Governments across the world, whether in the donor world or in the developing world, need to hear that their citizens truly want them to take the hard steps that are required, so we may live in a world where there is some for all, not all for just some:          – in a world where loving kindness and mercy are valued above naked profit at the expense of the poor and weak.

It is important while you sit here as scientists, for you to ask yourselves what your role and contribution will be to solving the world’s health problems, rooting your actions on partnership. 

I have highlighted four principles, none of which is more important that the understanding and acceptance of the responsibility that comes with the precious gift you all have – which is expect knowledge. 

As President of African Monitor, I do want to venture to say this: that I, and the rest of the world, hold you accountable for finding creative solutions to the health problems the world faces, particularly problems faced by the poor. This might seem like an unreasonable expectation – and some of your might be thinking I expect you to perform miracles.  But remember that I am an Archbishop, and believe in Jesus Christ whose was raised from the dead.  He is the one who brings the hope, the real hope, of new life, no matter how desperate circumstances may appear.

So I believe that miracles are possible – and there has never been a time when they are needed more urgently than now. 

I hope I am encouraging you to see your role as extending beyond just your laboratories, to changing the lives of people in a tangible way.  In my book, you are development specialists!

I have looked at your 14 Grand Challenges, and the 7 Goals under which they are organised.  I have to admit that I know very little about vaccines, immunisation, or insect control (other than my garden pests, and I’m not even very good at that);  nor do I know much about drug development and delivery, the handling of latent and chronic infection, or the measurement of health care.  As for nutrition, I admit merely to being knowledgeable about Cape Town restaurants that will overfeed you to a very satisfying extent!

However, I do want to hold on to the theme of moving from patronage to partnership as being fundamental to the most effective engagement with the barriers there are to good health.  Let me highlight, as I end, two particular areas that reflect what more needs to be done.

First, it is always a challenge to experts, in any field, to deal with those who are perceived as complete amateurs. 

But achieving good health is about achieving the good health of individual human beings, and therefore expertise can only be made to work, if it will work not only for, but in partnership with, those whom it is intended to assist.

Two years ago I participated in a consultation of religious leaders on global poverty that was held at Washington National Cathedral.  During that meeting we were addressed by an American expert in development economics, who spoke, among other things, about the provision of mosquito nets impregnated with insecticide.  Now this is a tremendously important initiative, that is making a huge difference in large areas of Africa. But as the expert spoke, one of the other participants, a woman from Uganda, pointed out that there were also large areas of Africa where people do not have settled accommodation, nor a comfy, or even not-so-comfy, bed, into which they can tuck themselves at night, and over which they can hang their mosquito net.  Her point was that there needed to be adequate listening, for all the dimensions of the problem to be fully addressed.

Thanks to the active participation of civil society, this perspective could now be taken into account.  It was a perspective that had not even been considered – because the experts had not realised that it existed, as it was so far from their own experience! The lessons here is - do not be afraid to admit that there may be things you don’t know, and that you don’t know that you don’t know, that may be relevant to your work. 

You may be experts in your field – but the expert on conditions in rural villages far from the centres of government are not the officials from the ministries – they are the people who live there.  They are the ones with whom you must build effective working partnerships. And if you cannot build these partnerships through government ministries, then consider whether the churches, other faith communities and broader civil society can help.

The second area which I wish to underline is one highlighted by the 15% Now Campaign.  Africa suffers from a chronic shortage of health workers.  We do not have enough, those we have are often inadequately trained. 

Furthermore, we suffer terrible brain drain as far too many of our best doctors, nurses and other professionals are lost to us.  

The same is true of scientists in medical and other fields.  Far too many western governments benefit from, promote and depend on brain drain to prop up their health care systems. This must be reversed – instead there should be a net transfer of human resources toward those with greatest need.  This means not only stemming the tide of those who leave Africa, but also ensuring far more, and far deeper, partnerships in areas of medical training and the strengthening and development of Africa’s own expertise and capacity in medical sciences.  The same is true of other areas of the developing world.

With these words, I hope you have been encouraged to talk more and learn more amongst each other at this conference, so that we can find the miracles we are looking for. 

I hope you have been encouraged to view yourselves as important players in effectively tackling global health challenges, thus positively affecting people lives. 

I hope you no longer see yourselves just as scientists, but also as development practitioners. 

And lastly, I hope that in all your actions, you will keep as the core of your foundation, the principles of partnership.

May you have fruitful discussions.

I thank You.