Final Communique

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COMMUNIQUÉ

 Thursday 29 November 2001

Introduction

1. Commonwealth Health Ministers met in Christchurch, New Zealand for their thirteenth triennial meeting from 25^th to 29^th November 2001, and deliberated on the main theme of "Priority Setting in Health Systems". The meeting was chaired by the Honourable Annette King, Minister of Health of New Zealand, and attended by 104 delegates from 32 countries (23 of them led by Ministers). There were 21 accredited observers from Commonwealth health professional associations and NGOs. There was a parallel symposium and trade fair event organised by Kensington Publications Limited (KPL) on behalf of the Commonwealth Secretariat. A forum of Commonwealth health NGOs was held prior to the ministerial meeting and its report was presented to Ministers. The Rt. Hon. Don McKinnon, Secretary-General of the Commonwealth, led the Secretariat's team to the 13^th Commonwealth Health Ministers Meeting.

2. In preparation for the ministerial meeting, the Commonwealth Health Development Programme (CHDP) Steering Committee met on 24^th November to review the activities of the Commonwealth Secretariat's health programme and make recommendations to Ministers. The Senior Officials met on 25^th November to consider the draft agenda for the meeting and make recommendations to Ministers.

Action on 12CHMM recommendations

3. The Secretariat reported on action taken on the recommendations made at the 12^th Commonwealth Health Ministers' meeting in Barbados in 1998. Health Ministers noted progress being made by countries in such areas as:

• improved management
• monitoring and evaluation
• mainstreaming gender issues
• human resource management
• information systems
• sustainable financing of health systems
• diseases such as HIV/AIDS, tuberculosis and malaria and non-communicable diseases, with particular reference to the risk factor of obesity
• health promotion interventions including physical activity and sport

4. Ministers commended the Secretariat for action taken to

• mainstream gender in the health sector

• provide models of health information systems

• collect, analyse and disseminate key information and experiences on migration of health workers

• work on public/private partnerships for health in the Commonwealth

• publish "Models of Good Practice on Women and Health" and "Gender and Health Curriculum Outlines" (now widely used in member countries)

Work of the Health Department of the Commonwealth Secretariat

5. Ministers expressed satisfaction with the work of the Secretariat and endorsed the view of the CHDP that the Health Department had performed well with very little resources. The future of the Technical Support Group for Women and Health (TSG) was discussed extensively and a majority of countries present were supportive of the programme continuing for a further two years. The Secretariat was urged to explore more sustainable funding mechanisms to support the TSG by the end of the two-year period. Ministers congratulated the Commonwealth Steering Committee for Nursing and Midwifery for the progress made. There was unanimous support for their recommendations and the continuation of its work.

6. Appreciation was expressed for the work of the Secretariat on

• HIV/AIDS

• promoting peer education through the " Young Ambassadors for Positive Living" initiative

• collaboration with Commonwealth health NGOs

Impact of Globalisation on Health

7. In discussing globalisation, Ministers identified poverty as the main obstacle to development. Poverty prevents countries from exploiting the potential benefits of globalisation, which has the effect of widening the gap between rich and poor countries. Ministers urged the Commonwealth to develop structured responses to globalisation that would promote positive impact on health. These responses should acknowledge the inextricable links between health and the wider socio-economic development agenda. They should take account of moral and ethical considerations relating to equity in resource distribution.

8. Ministers expressed strong views about the imposition of conditions linked to development assistance, such as the removal of public subsidies. This militates against the development efforts of poorer countries, and is unfair if not applied in the same way to the more developed countries. Ministers urged the Commonwealth to work for fairness in financing and ensure that the rules apply to developing and developed countries alike.

Financial Resources

9. Ministers noted that health financing issues cannot be separated from general economic development. There is a need to highlight the extent of the burden of disease and its impact on development prospects, in order to mobilise urgently financial resources for health. It was also agreed that financial systems and accountability should be strengthened to increase confidence and encourage the flow of resources into the sector. At the same time, there is a need for increased efficiency in the use of existing resources, as the use of more resources does not necessarily equate to better health outcomes. Ministers noted that financing involves providing resources to other sectors that have health outcomes, as well as directly to the health sector.

10. The need to establish minimum levels of financial allocations to the health sector was widely discussed in view of the priority challenges facing the sector and their implications for development. In this regard, Ministers agreed that it was essential to support commitments such as the Abuja Declaration and the Nassau Declaration.

Human Resources

11. Ministers welcomed the draft code of practice for international recruitment prepared by the Secretariat and commended its timeliness. It was agreed that the current draft provided a basis for further work to develop a document to which members could subscribe. It was recommended that a Working Group should be established to work with the Secretariat by e-mail to finalise the draft for presentation to Ministers at the next pre-WHA meeting in May 2002. The Secretariat was requested to begin work to prepare a companion volume to the code, which will address issues relating to planning, training, recruitment, retention and inter-country relationships, and document examples of good practices.

HIV/AIDS

12. In discussing the continued devastating effects of HIV/AIDS on economic and social development, Ministers noted that poverty, lack of financial and human resources and debt burdens are eroding the impact of increased efforts being made by many countries to combat the pandemic and mitigate its effects. Ministers therefore urged Heads of Government to continue to give highest priority to poverty alleviation in all development negotiations. They also noted the vicious cycle in which developing countries continue to lose their health workers to HIV/AIDS, resulting in a depleted capacity to deliver adequate healthcare to reduce the impact of the pandemic.

13. Ministers noted that, despite the availability of drugs to combat HIV/AIDS, the costs involved leave many developing countries unable to make these available to their populations. Ministers welcomed progress made to date in Doha, on the WTO "Declaration on the TRIPS Agreement and Public Health", which emphasises that TRIPS does not and should not prevent members from taking measures to protect public health.

Bio-terrorism

14. There was extensive discussion on the new threat of bio-terrorism and the measures being taken by countries to address it. Recognising that WHO is already doing much work in this area, Ministers recommended that the Commonwealth should endorse the WHO resolution and support the activities involved. It was also noted that information on preparedness and other aspects of the fight against bio-terrorism could be obtained from the WHO.

Commonwealth Working Group on Traditional and Complementary Health Systems

15. The Ministers noted the work and proposals of the Commonwealth Working Group and Malaysia for the establishment of a Commonwealth Information Hub for Traditional and Complementary Medicine to be hosted by Malaysia and accepted the proposal. They noted that this was a Commonwealth initiative that arose from the 12^th Commonwealth Health Ministers Meeting, and also that Malaysia had made an offer of substantial funding for the project.

They invited the Secretariat to engage with the Government of Malaysia to prepare detailed proposals to address the following:

• future calls for financial help

• intellectual property rights of indigenous traditional healers

• governance arrangements

• due consideration of the public good

The proposals should be presented to the next pre-WHA in May 2002.

Globalisation and Health Care

16. The main recommendations agreed by Ministers were as follows:

a. The Commonwealth should develop structured, positive responses to globalisation that ensure health impact is an essential consideration;

b. The Commonwealth and institutions that regulate the world economy should develop co-ordinated action to address:

• poverty related to injustice
  
• access to medicines and

• the burden of disease including HIV/AIDS, TB and malaria;

c. The Commonwealth Secretariat should advocate strongly to ensure that double standards in finance and public subsidies are not applied through development assistance; and

d. Commonwealth countries are requested to support each other and to work with appropriate organisations to develop new initiatives which are designed to promote healthy nutrition targeted to reduce the incidence of non-communicable and communicable diseases.

Financial Resources

17. The main recommendations agreed by Ministers are as follows:

a. Commonwealth countries should take steps to assess what percentage of their national budgets should be allocated to the health sector, where appropriate, keeping in mind commitments such as the Abuja Declaration which recommends 15 % for African countries;

b. The Commonwealth Secretariat should advocate for donor countries to honour their commitment to providing development assistance averaging 0. 7 % of their GDP as agreed in the UN Resolution; and

c. The Commonwealth Secretariat should use its influence with financial agencies to accelerate debt cancellation in order to channel the dividends into health, education and poverty reduction programmes.

Human Resources

18. Recommendations were as follows:

a. The Commonwealth Secretariat should encourage and support programmes in countries to increase the number of health care workers who are trained and retained. It is advisable that such training take place within the cultural context of the country in which the person will be working;

b. The Commonwealth Secretariat should assist countries to review and update legislation and skill mix to facilitate multi-skilling of the health workforce;

c. Member states should ensure that there are mechanisms in place to regulate the practice of health workers in order to protect the safety of the public;

d. The Commonwealth Secretariat should establish a Working Group on the Code of Practice for International Recruitment to work with the Secretariat by electronic means to finalise the draft for presentation to Ministers at the next pre-WHA meeting in May 2002;

e. The Secretariat should begin work to prepare a companion volume to the Code of Practice which will address issues relating to planning, training, recruitment, retention, inter-country relationships, etc; and document examples of good practices, and provide a progress report to the next pre-WHA meeting in May 2002.

HIV/AIDS

19. Recommendations were as follows.

a. The Commonwealth Secretariat should advocate for expeditious access to the Global Fund to fight AIDS, TB and Malaria and for transparent processes linked to the disease burden of individual countries.

b. Member countries should continue to implement a multi-sectoral, multifaceted approach to HIV/AIDS and should specially target orphans, young people, and women, taking into consideration the human rights of individuals.

c. The Commonwealth should assist in facilitating the prevention of mother-to-child-transmission (MTCT) in member countries within the context of the constraints faced by individual countries.

d. Member countries should address the cultural beliefs and traditional practices that increase the vulnerability of women, men and young people to HIV/AIDS and direct efforts to reducing the associated stigma.

e. Commonwealth countries should share best practice in HIV/AIDS and promote regional programmes.

f. On account of the high morbidity and mortality due to HIV/AIDS, Commonwealth countries should advocate and lobby for increased access to and affordability of anti-retroviral drugs and drugs for opportunistic infections.

g. Member countries should follow through with their commitments made at the 2001 United Nations General Assembly Special Session on HIV/AIDS

h. In those countries where there is a low prevalence of HIV/AIDS, the Commonwealth should encourage them to remain vigilant with preventive campaigns to keep awareness high in the population.

Recommendations arising from Roundtable Discussions

I - Regional Co-operation

Commonwealth countries should co-operate to improve health outcomes ensuring that:

• national strategies are enhanced
• duplication is minimised

• the needs and concerns of co-operating countries are given equal consideration

II - Tobacco or Health

Commonwealth countries should continue to actively support the Framework Convention on Tobacco Control (FCTC) negotiating process as a mechanism to help control global tobacco use, recognising that some countries rely in part on benefits arising from tobacco income for their economic livelihood

III - Improving Efficiency and Effectiveness

Development partners should consider country assessments, as well as financial measures, in ascertaining the success of development projects. Support should be provided on a sustainable basis while encouraging inter-agency and country co-ordination.

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Last modified: December 10, 2001