The panjandrums of global health
1
Correspondence Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/ www.thelancet.com Vol 382 August 31, 2013 763 The panjandrums of global health Richard Horton’s Comment (July 13, p 112) 1 suggests that recent international commitments on development cooperation have done more harm than good for health- care in Africa. I disagree. But his conclusion that our “global health panjandrums” need better feedback from beneficiaries on the ground is sound. We now have a window of opportunity to get things right. As the international community designs successors to the Millennium Development Goals, it needs to listen to those on the receiving end of the existing international development machinery, and to draw lessons from a decade-long international drive for more effective aid. The Global Partnership for Effective Development Co-operation allows us to do just that. Founded after the 2011 Busan High-Level Forum on Aid Effectiveness, it offers a global platform for leaders to listen to the concerns of developing countries and—crucially—to take action. Busan saw donors and beneficiaries reaffirming their 2005 Paris Declaration commitments on aid quality—not stepping away from them as Horton suggests. A major independent evaluation showed that the Paris principles remain highly relevant, and that Paris-style aid reforms have contributed to results in the health sector. But it also reminded us that these reforms need to be put in to perspective and viewed alongside other resources, actors, and efforts. 2 Busan was in places messy, dealing with complexities that previous international summits on development had yet to address. It was a necessary step towards a global model fit for our times. That model must see leaders meeting their aid commitments alongside a broader set of enablers: cooperation on taxation, illicit financial flows, climate change, and South-South partnerships, to name a few. Without a fresh and far-reaching partnership for implementation, even the most ambitious of global goals will do little to address Africa’s health challenges. I am Coordinating Minister for the Economy and Minister of Finance of Nigeria, co-Chair of the Global Partnership for Effective Development Co-operation, and member of the UNAIDS–Lancet Commission. I declare that I have no conflicts of interest. Ngozi Okonjo-Iweala [email protected] Federal Ministry of Finance, Abuja, Nigeria 1 Horton R. Offline: The panjandrums of global health. Lancet 2013; 382: 112. 2 Wood B, Betts J, Etta F, et al. The evaluation of the Paris Declaration, final report. Danish Institute for International Studies, Copenhagen, 2011. http://www.oecd.org/ derec/dacnetwork/48152078.pdf (accessed Aug 18, 2013). For the Global Partnership for Effective Development Co-operation see http://www. effectivecooperation.org/ Syrian refugees in Lebanon: facts and solutions Roughly 600 000 Syrian refugees registered by the UN High Commissioner for Refugees (UNHCR) reside in Lebanon. However, the Lebanese Government has estimated this number to be about 1·5 million— which corresponds to an increase in Lebanon’s population of more than 25%. The living conditions of Syrian refugees are tragic; many have lost their homes and family members. Although there is a solidarity between populations, Syrian refugees put pressure on the Lebanese health-care system and economy, and Lebanon hosting capacities are overstreched, thus transforming the so-called Syrian crisis into a Lebanese–Syrian crisis. Foreign aid is far lower than what is needed to respond effectively to this humanitarian crisis. The UNHCR coordinates support with relevant ministries and non-governmental organisations such as the Amel Association. Irrespective of politics, religions, and geography, the Amel Association has so far been able to provide 110 000 services through its three mobile clinics and 24 centres throughout Lebanon. These services are important but remain modest compared with the actual needs of the Syrian refugees. Data collected by the Amel Association 1 since January, 2013, of more than 90 000 displaced Syrian patients have shown that: 47% of patients have skin diseases (leishmaniasis, scabies, lice, and staphylococcal skin infection); 27% of patients have digestive system diseases; 19% of patients have respiratory diseases; 7% of patients, especially children, suffer from malnutrition; 2% of patients have infectious diseases (measles, jaundice, and typhoid); and 13% of patients are diagnosed with mental illness as a result of trauma and displacement. The Lebanese Ministry of Health could not finance treatment of all displaced Syrians due to the lack of funds, but it ensured treatment of more than 600 cases of renal dialysis. In view of this Lebanese–Syrian crisis, surely the international community needs to find a solution to the Syrian crisis; meanwhile, we need an emergency plan for the Syrian refugees. First, to address the urgent needs of displaced Syrians, we recommend that a complete emergency plan for the economic, social, health, education, and relief domains be implemented by the Lebanese Government. This implementation should be done in cooperation with Lebanese civil society organisations and municipalities. This plan should fully integrate the Higher Relief Council, the Ministry of Public Health, and the Ministry of Social Affairs. Implementation requires financial support for Lebanon from all potential donor countries and the UN. A second emergency plan will be needed if the battle of Damascus happens, because an estimated 1 million Syrian refugees (a sixth of the Damascus population) could be expected to come to Lebanon. Finally, a third emergency plan should be applied when a political solution puts an end to the Syrian crisis. In that Published Online July 19, 2013 http://dx.doi.org/10.1016/ S0140-6736(13)61461-0 See Editorial page 743 Ayman Oghanna/Corbis
Transcript of The panjandrums of global health
Correspondence
Submissions should be made via our electronic submission system at http://ees.elsevier.com/thelancet/
www.thelancet.com Vol 382 August 31, 2013 763
The panjandrums of global health R i c h a r d H o r t o n ’s C o m m e n t (July 13, p 112)1 suggests that recent international commitments on development cooperation have done more harm than good for health-care in Africa. I disagree. But his conclusion that our “global health panjandrums” need better feedback from beneficiaries on the ground is sound. We now have a window of opportunity to get things right.
As the international community designs successors to the Millennium Development Goals, it needs to listen to those on the receiving end of the existing international development machinery, and to draw lessons from a decade-long international drive for more eff ective aid.
The Global Partnership for Eff ective Development Co-operation allows us to do just that. Founded after the 2011 Busan High-Level Forum on Aid Effectiveness, it offers a global platform for leaders to listen to the concerns of developing countries and—crucially—to take action.
Busan saw donors and benefi ciaries reaffirming their 2005 Paris Declaration commitments on aid quality—not stepping away from them as Horton suggests. A major independent evaluation showed that the Paris principles remain highly relevant, and that Paris-style aid reforms have contributed to results in the health sector. But it also reminded us that these reforms need to be put in to perspective and viewed alongside other resources, actors, and eff orts.2
Busan was in places messy, dealing with complexities that previous international summits on development had yet to address. It was a necessary step towards a global model fi t for our times. That model must see leaders meeting their aid commitments alongside a broader set of enablers: cooperation on taxation, illicit fi nancial fl ows, climate change, and South-South partnerships, to name a few. Without
a fresh and far-reaching partnership for implementation, even the most ambitious of global goals will do little to address Africa’s health challenges.I am Coordinating Minister for the Economy and Minister of Finance of Nigeria, co-Chair of the Global Partnership for Eff ective Development Co-operation, and member of the UNAIDS–Lancet Commission. I declare that I have no confl icts of interest.
Ngozi [email protected]
Federal Ministry of Finance, Abuja, Nigeria
1 Horton R. Offl ine: The panjandrums of global health. Lancet 2013; 382: 112.
2 Wood B, Betts J, Etta F, et al. The evaluation of the Paris Declaration, fi nal report. Danish Institute for International Studies, Copenhagen, 2011. http://www.oecd.org/derec/dacnetwork/48152078.pdf (accessed Aug 18, 2013).
For the Global Partnership for Eff ective Development Co-operation see http://www.eff ectivecooperation.org/
Syrian refugees in Lebanon: facts and solutions
Roughly 600 000 Syrian refugees registered by the UN High Commissioner for Refugees (UNHCR) reside in Lebanon. However, the Lebanese Government has estimated this number to be about 1·5 million—which corresponds to an increase in Lebanon’s population of more than 25%. The living conditions of Syrian refugees are tragic; many have lost their homes and family members. Although there is a solidarity between populations, Syrian refugees put pressure on the Lebanese health-care system and economy, and Lebanon hosting capacities are overstreched, thus transforming the so-called Syrian crisis into a Lebanese–Syrian crisis.
Foreign aid is far lower than what is needed to respond effectively to this humanitarian crisis. The UNHCR coordinates support with relevant ministries and non-governmental organisations such as the Amel Association. Irrespective of politics, religions, and geography, the Amel Association has so far been able to provide 110 000 services through its three mobile clinics and 24 centres
throughout Lebanon. These services are important but remain modest compared with the actual needs of the Syrian refugees.
Data collected by the Amel Association1 since January, 2013, of more than 90 000 displaced Syrian patients have shown that: 47% of patients have skin diseases (leishmaniasis, scabies, lice, and staphylococcal skin infection); 27% of patients have digestive system diseases; 19% of patients have respiratory diseases; 7% of patients, especially children, suffer from malnutrition; 2% of patients have infectious diseases (measles, jaundice, and typhoid); and 13% of patients are diagnosed with mental illness as a result of trauma and displacement.
The Lebanese Ministry of Health could not finance treatment of all displaced Syrians due to the lack of funds, but it ensured treatment of more than 600 cases of renal dialysis.
In view of this Lebanese–Syrian crisis, surely the international community needs to find a solution to the Syrian crisis; meanwhile, we need an emergency plan for the Syrian refugees.
First, to address the urgent needs of displaced Syrians, we recommend that a complete emergency plan for the economic, social, health, education, and relief domains be implemented by the Lebanese Government. This implementation should be done in cooperation with Lebanese civil society organisations and municipalities. This plan should fully integrate the Higher Relief Council, the Ministry of Public Health, and the Ministry of Social Affairs. Implementation requires fi nancial support for Lebanon from all potential donor countries and the UN.
A second emergency plan will be needed if the battle of Damascus happens, because an estimated 1 million Syrian refugees (a sixth of the Damascus population) could be expected to come to Lebanon.
Finally, a third emergency plan should be applied when a political solution puts an end to the Syrian crisis. In that
Published OnlineJuly 19, 2013http://dx.doi.org/10.1016/S0140-6736(13)61461-0
See Editorial page 743
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