President. – The next item is the statement by the Commission on World Health Day.
Mariann Fischer Boel, Member of the Commission. Mr President, the global shortage of doctors, nurses and other health professionals has reached a crisis point in many parts of the world. Ageing populations in Europe, the United States and most wealthy countries, combined with increasingly sophisticated medical treatments that require specialised staff, mean that demand for health workers in the developed world is outstripping supply. Indeed, the demand for health workers is not only outstripping our internal capacity to produce doctors and nurses: it is placing a huge strain on the international market for health workers.
However, the shortage of health workers in rich nations does not even begin to approach the severe shortages being experienced in many parts of Africa, where the lack of health workers can often mean the difference between life and death. With less than one health worker per 1000 people in Africa, compared to over 10 health workers per 1000 people in Europe, it is hardly surprising that the shocking and unacceptable death toll of children and their mothers continues. More than one in five children die before their fifth birthday and more than one in a hundred mothers die as a result of complications of pregnancy in many African countries. Progress towards the Millennium Development Goals in Africa is unacceptably slow, with progress reversal in some countries as a consequence of HIV/Aids. The burden of caring for the sick falls on families and communities who have few resources to cope with this significant burden.
The World Health Report for 2006 focuses international attention on the health worker shortage, and is very much welcomed. It puts a spotlight on a crisis that has been evolving over many years, but that now represents probably the most significant barrier to progressing towards the health-related Millennium Development Goals – reducing maternal and child mortality and controlling communicable diseases such as HIV/Aids, TB and malaria. Without doctors, nurses, pharmacists and other health workers, it will be impossible to improve healthcare, or to meet our commitments to increase access to essential services.
The causes of this crisis are complex. There has been chronic under-investment in health services in developing countries for many years, including under-investment in training of health workers. Many countries in Africa are still trying to run their health services on a budget of less than EUR 10 per capita – that is much less than the minimum of EUR 30 recognised as necessary for providing essential services.
But the problem is not just lack of investment in Africa. Many countries in Europe and elsewhere have underinvested and inadequately planned for health worker training to meet the needs of ageing populations. The rich world can attract health workers from other countries; the consequences for poor countries is that they train health workers who leave the country, effectively providing a perverse subsidy to health services in developed countries, by shouldering the burden of training costs.
Training more health workers worldwide is only part of the solution. Many health workers who are trained do not want to work in the poorest and most remote areas where needs are greatest. There is a pattern of internal migration from rural to urban areas, and from the public to the private sector, and from poor countries to richer neighbouring countries and then to the richer, developed world. However, it is difficult to blame the individual, once you have seen the conditions under which they have to work. We need to better understand the motivations of health workers, and to create incentive systems that encourage them to work where there is the greatest need.
The ‘push’ factors of poor working conditions, low salaries – which are paid irregularly, lack of drugs and equipment and lack of career prospects all contribute to the migration of health workers. Indeed, it is surprising that, given these poor conditions, you still get a hard core of dedicated health workers in many African countries who continue to do a remarkable job in very difficult circumstances. It is important not to lose sight of the achievement and the increasable contribution of many health workers who continue to serve their people, despite the challenges of their jobs and working environment.
The ‘pull’ factors for migration – better salaries in rich countries, better working conditions and greater security, which are sometimes coupled with aggressive recruitment practices by private recruitment agencies – also play a significant role in increasing health worker mobility.
These issues have all been described in the communication from the Commission to Parliament on the EU strategy of action to address the crisis in human resources for health in developing countries. If we are to overcome the crisis, developing solutions must begin in the countries most affected and must support strengthening of their planning and financing of health worker training, support and finance, and improved terms of conditions of services. It is essential that country action be supported by regional and global action, sharing knowledge and best practice, sharing training resources and changing international recruitment policies to make them more ethical. It is important that we look closely at our own health worker training programmes and increase our own production capacity, to make us more self-sufficient.
The Commission has been leading and coordinating the development of a coherent European response. The communication on human resources for health has been debated and strong conclusions are due to be adopted by the Council. EU Member States have agreed a Statement of Commitment, which is being announced for World Health Day. That should demonstrate to the rest of the world that Europe takes this issue seriously and will support a significant response to the crisis.
John Bowis, on behalf of the PPE-DE Group. – Mr President, I endorse every word that the Commissioner has said tonight as we commemorate this year’s World Health Day with the WHO’s chosen theme of the appalling shortage of health workers.
In Europe we have three doctors per 1000 people and, as she has said, we are still short of health professionals. In Africa they have under five doctors per 100 000 people. In Europe it is our fault and in Africa it is also too often our fault. And why is it our fault? Because the developed countries take 63 000 doctors and nurses a year from developing countries and return just 1300 to those countries. That is an unethical, immoral imbalance. In Europe we must do much more to recruit and retain health professionals through training, through pay, through working conditions, through research facilities and so on, but with developing countries we must do so much more and above all we must stop this recruitment rape of their skills.
Sub-Saharan Africa has some 750 000 health workers for 682 million people. Europe has 15 times higher a ratio. Sub-Saharan Africa is short of one million health workers. Ghana has only 1500 doctors for its population of 20 million. Two-thirds of the young doctors in that country leave the country within three years of graduation, and yet Africa bears 25% of the world’s health and disease burden, and has only 0.6% of the world’s health professionals.
In the United Kingdom, my country, two thirds of new doctors and 40% of new nurses come from abroad. That is something of which we must be ashamed and we must pledge ourselves to show our guilt by stopping the recruitment rape and by ensuring that we can sustain, with the people of Africa, the health services and the health professionals they so desperately need.
Margrietus van den Berg, on behalf of the PSE Group. – (NL) Mr President, Commissioner, on this World Health Day, I am happy to contemplate the European contribution towards the achievement of the Millennium Objectives. No fewer than three out of these eight objectives are about health care, about the fight against diseases such as AIDS and malaria, about reducing child mortality and the mortality of mothers during pregnancy or childbirth. The world, particularly Africa, is still lagging behind in a spectacular fashion. Every year, worldwide, more than one million children die of malaria, six million children under the age of five die of a lack of food or qualitatively imbalanced nutrition, and two to three million children die of diseases which could have been prevented by vaccination. In 2005, one woman died every minute of complications during pregnancy and childbirth.
Time after time, the Commission and the Member Sates promise to grant high priority to health care in the developing countries. Despite all these fine promises, they fail to deliver and to incorporate them in the annual spending plan. Not even 5% of the EU’s budget for development cooperation is spent annually on basic health care, which is completely at odds with the promise and wish of this House to spend 20% of the EU’s aid budget on basic education and basic health care. Put your money where your mouth is.
Moreover, when we grant budgetary support, we must be much tougher with regard to the spending criteria. There should be no budgetary support for those countries that do not qualify on account of bad governance. Where budgetary support is given, it has to target specific sectors, in other words, explicitly home in on health care or education. It must also be clear beyond any doubt that the money is actually spent on health care, which causes it was spent on, and what the results are, whereby a specific percentage accounts for monitoring expenses by a civic watchdog group. We owe this to the European taxpayer and the people and parliaments of the receiving countries. Spending, should, in fact, not only be done via European programmes, but can often be done more effectively by joining forces with organisations such as the World Health Organisation, UNAIDS, UNFPA and via global initiatives such as Global Fund.
Europe should guarantee the funding of projects for sexual and reproductive health care which, on account of policy by the US President to block resources for these projects, are short of funds. This is in stark contrast to the 12 billion which the US is investing in an absurd campaign which promotes no sex before marriage and fidelity to the partner. The US Congress concluded today that this campaign causes confusion and hampers existing campaigns. Many women and girls have died as a result of this outrageous policy. We in Europe cannot, and indeed should not, put up with this. I hope that my fellow Members of the other parties in this House will not side with Bush, but rather with the millions of women and girls.
In addition to spending that should be increased, we should also approach health care in developing countries in a structural and integral manner. Access to a basic service such as health care is of the essence for the poorest of the poor, but this access is often inadequate due to a lack of expertise and infrastructure at source. That is why we should invest in logistics and social infrastructure, in the transfer of knowledge and training local staff, and also in basic education, with a view to imparting basic knowledge in the areas of hygiene, healthy drinking water and healthy food. Not until such time as a basic structure is in place can poverty-related illnesses and other unnecessary causes of mortality be eliminated in a truly structural manner.
In our resolution, we are right to focus on the shortage of health workers, often caused by brain drain, a phenomenon whereby highly trained doctors and nurses decide to work elsewhere in the world. We must prevent this brain drain by actively concluding agreements between sectors and countries, by promoting circular migration, whereby people return to their home countries following a short spell abroad, by training and transferring knowledge and by creating better working conditions.
Finally, in many countries, corruption and bad governance prevent a large share of the money that is spent on health care from ending up with the poorest of the poor. Studies have shown that in a country such as Chad, only 1% of government funds that are spent on health care actually arrive at their destination.
This brings me to my own report on corruption and development cooperation which will be discussed during tomorrow’s plenary. Good governance and the fight against corruption are of the essence if we want to achieve the Millennium Objectives. Both donor and receiving countries should make an all-out effort to bring this about in the next few years.
In this plenum, I cannot emphasise enough the importance of the Millennium Objectives, particularly in respect of health care and education. It is now really vital to double the budget that is spent on these. By doing this, you are doubling the chance of developing the poorest of the poor of this world, helping them escape poverty and become healthy. Make poverty history!
Fiona Hall, on behalf of the ALDE Group. – Mr President, I welcome the Commissioner’s summary of the complex aspects of this problem. World Health Day is a good moment for taking stock. We have the Millennium Development Goals and many statements of good intent by governments and parliaments around the world, but unfortunately there is still a huge gap between the rhetoric and the reality on the ground. In too many places people are still dying simply because of the absence of basic medical facilities that could have saved their lives at very little cost. I will mention just one place: the equatorial region of the Democratic Republic of Congo, where the population is suffering a catastrophic death rate, not because of famine or even because of ongoing violence and insecurity, as is the case in the east of Congo, but simply because medical facilities are non-existent in that beautiful but inaccessible forest area.
We need to take a hard look at Commission spending on health and ask why such a low percentage of the EDF budget is earmarked for the health sector, as Mr van den Berg has just pointed out. That is despite the fact that Parliament has asked for one fifth of overall development funds to go to basic healthcare and basic education.
I want to turn to the issue of health workers. It is not just a question of inadequate funding: it is an area where European Member States are actively undermining the health services of developing countries by poaching their trained medical staff. Member States may have signed up to commitments not to actively recruit health workers from the poorest nations, but in practice they are finding ways round those promises. For example, the UK has the National Health Service code on recruitment of health workers, but it only applies to workers recruited by the NHS directly. The Code does not apply to nurses recruited by private agencies. Often the agency jobs are lower-skilled jobs, so those nurses do not even have the advantage of gaining specialist skills while they are in Europe. The result is devastating. In Swaziland there are about 3000 nurses and Swaziland is training about 100 per year. However, up to 80 nurses per year are leaving for the UK alone. That is on top of the huge number of Swazi nurses who are dying of Aids: 300 died of Aids in 2003-2004.
Member States must close the loopholes in their codes on health worker recruitment and put in place effective health workforce planning so that they are no longer tempted to poach trained personnel from the very countries where better healthcare is so desperately needed.
Marie-Hélène Aubert, on behalf of the Verts/ALE Group. – (FR) Mr President, Commissioner, ladies and gentlemen, if one has the opportunity to analyse the often transitory nature or the effectiveness of these world days devoted to some great cause or other, the conclusion is that it is an opportunity for us, on the one hand, to shed some light on a dramatic situation and on the shortage of healthcare personnel in the South, an issue to which we normally pay scant attention, and on the other hand table some proposals to implement in the short, medium or long term. Hence the need to incorporate these health objectives into the framework of the multiannual financial programming, which would make it possible to increase the predictability of EU funds, which is so lacking at present, and to give more practical support to national strategies for increasing the number of healthcare personnel.
One must not forget, however, that this problem that we are discussing today is not just another stroke of bad luck due to pure chance. This shortage of healthcare personnel is in fact the result of so-called ‘structural adjustment' programmes which have been brutally pursued by the international financial institutions and which have led to the collapse of public healthcare and education services in a good many countries. There is therefore ‘a fair bit’ of hypocrisy in stating in 2006 a determination to increase healthcare personnel over the next few years, while macroeconomic financial policies pursued elsewhere have had a detrimental effect on those same human resources for over ten years. Nevertheless we welcome this awareness, however late it was in arriving, of the pressing need to invest in human resources, without which no development policy, however virtuous, can be implemented.
This is why, as far as we are concerned, the EU’s action in this area should be focused on three areas. Firstly, as has already been mentioned, the amount earmarked for health issues within the framework of official development aid, which currently stands at around 5%. This is woefully inadequate, and the prospects are not all that encouraging; at least 20% is needed, not least to cover salary costs for training and for all manner of issues already mentioned. Secondly, putting an end to the budgetary restriction measures imposed by the international financial institutions. In cases such as these, the EU needs to bring its influence to bear, especially as regards the salary ceiling and civil service recruitment. Lastly, a code of ethics which would help to remedy the scandal of the two-tier recruitment, in the North, in terms of status and salary. Such recruitment, which happens in a fair number of our countries, must be combated, and the country of origin principle must be scrapped.
To conclude, we trust that these generous statements of intent will actually be followed up, thanks to the very firm commitment of the EU institutions and of Parliament in particular, and thanks to the campaign started by the NGOs and European civil society.
Ilda Figueiredo, on behalf of the GUE/NGL Group. – (PT) Access to healthcare is recognised as a fundamental human right. Yet large sections of the population are still not guaranteed this access.
The UN’s Millennium Development Goals include reducing by two thirds the mortality rate among children under five, reducing by three quarters the maternal mortality rate, halting and beginning to reverse the spread of AIDS and halting and beginning to reverse the incidence of malaria and other major diseases. The time has come to prevent the deaths of many millions of children and women due to a lack of primary healthcare, mother and child health, sexual and reproductive health, water and sanitation infrastructure, and education, including education in the field of health.
For this to happen, there needs to be greater solidarity between the most developed countries. We therefore feel it is vitally important to provide active support for training doctors in developing countries and access to medical training for students from rural and remote regions. In this regard, I wish to highlight the remarkable example of Cuba in training, free of charge, thousands of doctors and other healthcare personnel to work in Africa and Latin America.
It is similarly crucial to deliver access to high-quality, free, public healthcare services for all throughout the EU, which is not the case as things stand, due to the macroeconomic approach of the Stability and Growth Pact. In some countries there have been serious backward steps, as is the case in Portugal at the moment, and this is exacerbating poverty and social exclusion.
We have therefore tabled a number of amendments to the joint resolution, which will hopefully be adopted. On this World Health Day, what is needed, Commissioner, is for this debate to be followed up by action.
Kathy Sinnott, on behalf of the IND/DEM Group. – Mr President, in the EU we have an expanding need for well-trained committed doctors, nurses, therapists and technicians. Population-ageing, increases in the incidence of disease and increases in the treatments for them mean a greater demand for workers in the health sector. But we should not just consider our need for healthcare, but the needs of those who deliver it. Their first need is to be safe. We must do everything to protect them from diseases and accidents, especially needle-stick and exposure injuries. It is almost a tradition to overwork doctors and nurses, but tired, stressed staff are far more prone to dangers. Vaccines have a part to play in protecting healthcare workers, but we must, in mandating immunisations for our healthcare workers, acknowledge and compensate those who have suffered debilitating adverse reactions.
In Ireland we have seriously restricted, and still restrict, the number of young Irish people who train for medicine, nursing, pharmacology and the therapies. When we – as we inevitably do – experience shortfalls in services, we solve the problem by hiring people from other countries. We can now afford to do this and these excellent professionals are a boost to our health service. Our hospitals and our health services are staffed by health workers from India, the Philippines, South Africa and many other countries. I have been told by some of them that they see working in an EU country as a great opportunity, but I wonder if we ever give a thought to those left behind, especially to the sick.
Healthcare migration is certainly to our benefit, but as lives are saved in developed countries, they are lost in less developed countries. A Zambian Government official described to me the difficulty Zambia has in retaining doctors. Its government sends promising students to the EU to train, but once the training is complete they either do not return or when they do they find that their highly technical training relates very poorly to work in settings with little equipment and few drugs. They leave in frustration. We must address this problem urgently.
This brings me to my last point. I would like to ask what competence Members think we have to condemn another sovereign nation because its country refuses to fund projects it disagrees with. I am referring to the US-Mexico City policy of requiring that NGOs agree, as a condition of receiving US funds, that they should neither perform nor promote abortion as a method of family planning in other nations. In condemning the way the US is spending its foreign aid, Amendment 5 presumes a mandate that this House and this Union simply do not have.
Irena Belohorská (NI). – (SK) Every year on 7 April, we commemorate World Health Day. This year, it will be devoted to health workers, who will form the focus of the commemorations for the next decade. Even though the world’s problems include a shortage of medical staff in developing countries, as well as malaria and HIV, we in the EU are also facing major problems in the healthcare sector, particularly in the new part of the European Union.
Following accession to the EU, the ten new Member States have been experiencing a ‘brain drain’ in the form of a massive migration of doctors and nurses to Western Europe. As a result, there is a shortage of doctors in the new Member States. We have chiefly lost young multilingual people, who have decided to work in the western part of the European Union, attracted there by better conditions. The chances of them coming back are extremely slim.
Sadly, as we observe World Health Day, a major strike was announced in one of the largest hospitals in Slovakia, and more hospitals are joining in one by one. The motivation for this strike arises from the intolerable working conditions which our doctors and nurses have to endure. A doctor in Slovakia is paid anywhere between EUR 350 to EUR 500 a month, while a nurse brings home EUR 250 to 300 EUR. Under these circumstances, it comes as something of a surprise that our highly qualified personnel are willing to remain in their home country at all. They receive EUR 2 per hour for night shift work, which is truly shameful. We must therefore see to it that these people get adequate pay.
Cristina Gutiérrez-Cortines (PPE-DE). – (ES) Mr President, I would like to welcome those who have taken this initiative, and there are many involved in the decision-making chain, and it therefore seems to me to be exceptional.
I would like to talk about two issues in particular; firstly, the problem of training in the place of origin. I believe that one of Europe’s problems is that we have not drawn up any strategy on the policy of aid relating to health, and in particular training. On the one hand, I believe that we in Europe have been implementing a very self-centred policy of numerus clausus in the majority of universities and nursing schools, in order to guarantee employment for our students, without taking account of the fact that the prospects and needs of Europe were going to exceed our capacity to provide care; that is why doctors and nurses from other countries are needed.
This is clearly leading to the drain that is being talked about so often today. At the same time, however, I believe that, in the development aid strategy, universities should be created alongside hospitals. The investment policy must not be restricted to roads, but must also consider hospitals and human resources training. Furthermore, there must be a specific programme which offers results.
Furthermore, there is one issue that is of great concern to me, because I have seen it first-hand: the difficulties in the distribution of medicines and the corruption that exists in their distribution. We are aware of the difficulties faced by hospitals on the ground, in Cameroon and in other countries, in carrying their work and accessing medicines, and that frequently the people distributing medicines for combating AIDS, which are being sent free of charge, are adding additional costs to them.
Within this context, I believe that, in its programmes, Europe must allocate more money to training, but at the same time control the distribution of aid much more effectively and prevent that corruption, which is a permanent obstacle, thereby putting to an end to the frustration of the people treating the sick.
Glenys Kinnock (PSE). – Mr President, it is an interesting statistic that there are more nurses from Malawi living in Manchester, in the United Kingdom, than there are living in Malawi; and there are more doctors from Ethiopia living in Chicago than there are in Ethiopia. There is an estimated global shortage of 820 000 doctors, nurses and other health workers. Obviously human resources are a central part of all human healthcare systems, but the reality is that the recruitment of health professionals and the scourge of HIV/Aids are continuing to prolong the crisis already afflicting very fragile healthcare systems in developing countries.
Many leave developing countries – as you said, Commissioner – because in developing countries they earn low wages, have poor working conditions, little prospect of advancement and a lack of training. In addition they have the pressure of dealing with high numbers of patients with HIV/Aids and other very difficult diseases.
This brain drain is the major obstacle to providing quality care in Africa. Countries are losing the most qualified and experienced nurses. Last year Kenya lost 3000 graduate nurses to other countries, mostly to the United States and the United Kingdom. There is a net flow of skills away from Africa, where individuals make decisions to go where they can earn and where they can take their careers forward. Many women that I have met across the United Kingdom working in elderly care centres, etc., are doing so because they want to earn money in order to send money back to care for their children in the countries where they come from. A consequence is that that the losing nations do not have that skill space that they need to educate their young people and develop their own economies. We in the European Union have to look at ways to compensate those countries that are being so drained of the skills that they need.
I welcome the Commission’s urgent attention to the crisis. We hope that we will see strategies – and that is the next step – that can deal with the root causes of the problem we are talking about this evening. That problem is that in spite of the terrible burden of disease there, Africa only has 0.6% of the world’s registered healthcare workers. How can that be acceptable when the healthcare and disease pressures are so enormous there?
I am concerned by Commissioner Frattini’s recent proposal to promote the recruitment of highly educated immigrants, including the creation of a ‘green card’ for researchers, engineers and doctors. Parliament must call for an active end to the recruitment of health workers. It rightly calls for the European Union to press for a global code of conduct on ethical recruitment. Commissioner, would you subscribe to the view that this is something that the Commission should do in order to try to deal with this crisis, which is what this evening’s debate is all about?
The other side of the coin is that in Europe we have an ageing population and we have declining birth rates. We are therefore trying to suck in the health workers from other countries in order to deal with our own problems. Raising wages to levels comparable with the industrialised world is very difficult for developing countries, but funding must be targeted at the health system and efforts must be made to decentralise healthcare and to support regional development.
I also believe – and no-one else has mentioned this, but it is in the resolution – that tele-medicine is a very important way of dealing with this issue. I was recently in Mauritania and saw how, in a very small hospital in a desert area of that country, health workers were making contact with French doctors in order to have some consultation on diagnoses for patients. That is something we could also look at investing in, in a more serious way than we do currently.
With regard to nurse practitioners, nurses should be given more status in developing countries than they now have. That is very important, as it is to look at what countries such as Uganda are doing, which is to decentralise the health service and take it out of the main cities, into the rural areas.
If we are actually going to deliver on the Millennium Development Goals we have a huge task. In relation to health, it is a major task and we need to make a contribution. In relation to the financial perspectives we are now discussing, we really do not have the options to deliver on the debates and on the commitments that you have discussed this evening.
Marios Matsakis (ALDE). – Mr President, good health is invaluable and it is thus not surprising that in the developed world we invest so much in healthcare and we expect to receive the best treatment whenever the need arises. But to have an effective healthcare system in operation, we need healthcare workers, people who are well trained, committed, and who are devoted to the care of their fellow human beings. The healthcare workers are the backbone of our health systems and to them we owe more than words can express.
However, the case with the developing world regarding health is, unfortunately, completely and shamefully different. There, good health is mostly the exception rather than the rule. Allow me to give you some figures in order to illustrate the point. One index figure that can be used to assess health provision in a country is, as has already been mentioned, the infant mortality rate. That is a measure of how many infants die per 1000 live births. The infant mortality rate in a country like Sweden, Germany or France – in fact most EU States – is around five deaths per 1000 live births. The corresponding figure in countries like Mozambique, Sierra Leone and Liberia is about 140 deaths per 1000 live births, and in Angola it is about 200 deaths per 1000 live births. In other words, the chance of an infant dying in Angola is about 4000% more than it is in an EU country. A premature or ill baby in Angola has a next to nil chance of surviving.
In many Third World countries basic healthcare is almost totally lacking and the few brave health workers who find themselves in those countries have to battle against all the odds to save life and limb. They have to cope with lack of infrastructure, lack of equipment, lack of medicines and a lack of understanding of hygiene by the population. Very often they are persecuted, arrested, tortured or murdered when caught up in local wars or social uprisings. In these areas, to be a health worker should be regarded as being a hero. These people deserve not just our admiration and respect but our active support, and we must do our utmost to provide them with all the help they need. We owe it to them and we owe it to our conscience.
Hiltrud Breyer (Verts/ALE). – (DE) Mr President, Commissioner, ladies and gentlemen, the motto of World Health Day is ‘Working together for health’; yet, unfortunately, not much of this cooperation remains. Cooperation primarily means ‘brain drain’. We have heard dramatic, affecting figures today; figures that should make us feel ashamed, as they make it clear that Europe is faced with a crisis in the health sector that it is not tackling at the roots – here in Europe – but is trying to solve by means of the brain drain from these countries.
The main health issue in Europe is the fight against lifestyle-related diseases, which are attributable to nutritional and environmental factors; whereas the situation in developing countries is that people are dying of diseases that are actually curable, for example in childbirth – women are developing fistulas as a result of giving birth – or that, as has just been reiterated, there is quite simply a lack of paediatric vaccines and the most essential measures are not being taken.
At the same time, we know that demographic developments will only intensify the problem. As a result of our ageing society, there is a lack of people going into the caring professions. That is why I also believe that the EU needs to show foresight in taking action at long last to counter this dramatic development.
The financial resources have already been mentioned. We have spoken a good deal about African countries today, but I have the impression that, particularly in development policy, resources are being poured into other countries. We have heard today that the Commission does not have a strategy – the example of the green card has just been given again. The Commissioner has presented us with fine words today, but her colleagues in other fields of competence often do the opposite or pursue policies that support this very development instead of tackling it and contributing towards a solution.
The Commission has also been silent on the subject of the disputes over patents for AIDS drugs in Africa. The EU should have been vocal in condemning pharmaceutical giants who look on as people die an agonising death as a result of patents.
I hope that the Commissioner’s words are followed by action. What we need is not fine words because World Health Day is approaching, but a strategy, a real solution to the problem. I hope that we have made a start here this evening and that this has been a new departure. After all, we were all in agreement on the objective: that what we need is real action to tackle the problem.
Gabriele Zimmer (GUE/NGL). – (DE) Mr President, Commissioner, ‘Working together for health’ is a lovely motto for World Health Day, as long as it is also taken seriously by all those making speeches, producing press releases or conveying messages on the occasion of 7 April. In this respect, I should like to endorse the previous speaker’s words.
This is all the more applicable when it comes to health workers, to whom World Health Day 2007 is devoted. In my view, therefore, Parliament also needs to address the problem that ‘Working together for health’ and the improvement of working conditions for health workers in the EU are not really being taken seriously. The reverse is true.
I should like to make just four remarks, therefore. The first is that the debate on the Working Time Directive and on health-care reforms has worsened, and is continuing to worsen, the working conditions for health workers. I should like to remind the House of the dispute on the recognition of on-call duty as working time that is still ongoing, and of the strike by German hospital staff that has been going on for weeks and is paralysing many hospitals in Germany and thus also seriously impairing care for the people. The access of millions of people to health services is being restricted or complicated, and is by no means being improved or safeguarded.
My second remark is that, despite the enlargement of the EU and the growing health problems, the health and consumer protection appropriations in the budget adopted by the European Council in December 2005 have been cut in comparison with the present period.
My third remark is that, even though the Spring Summit of the Heads of State or Government on the Lisbon Strategy is being held just a few days before the annual World Health Day, health issues play only a secondary role there. What is at issue is greater competitiveness, greater strain and stress for the individual; which, of course, are known to be detrimental to the health of the majority of the population.
I should like to take the liberty of making a fourth remark at this juncture. The day before yesterday, the Commission opened the public consultation on the creation of a European defence equipment market. This makes clear the real political importance of today’s debate on World Health Day. Arms are a direct route to the destruction of health. In this context, however, I should also like to draw attention to the growing importance of military aspects in development policy, whose principal purpose is actually supposed to be the improvement of public health in poor countries.
From my point of view, there is enough cause – and also material – here for a discussion aiming at improving the health of people living in the EU and boosting the EU’s contribution to improving global health.
In this connection, I should also like to make an explicit plea for a study of the alternative world health report Global Health Watch 2005–2006, which pleads, in particular, for the extension, qualitative improvement and democratisation of the public-health field. It describes health workers as the lifeblood of health care. The matter of primary importance is not cost, capital or dubious productivity, therefore, but the qualified, responsible commitment of health workers, because their personalities, their professional and social competence, and also their opinions and suggestions should count.
For this reason, I propose a public consultation of health workers, asking them the following questions. In your opinion, what is the most common cause of illness, or particularly detrimental to public health? What is the thing that most hinders you from making maximum use of your know-how for the benefit of public health? In your opinion, what needs to be changed about the political framework to enable you to work better and improve public health? From your perspective, what should the EU do to boost its contribution to global health, to overcoming HIV/AIDS and epidemics, and to combating the effects on health of hunger, shortages of drinking water and environmental degradation?
Urszula Krupa (IND/DEM). – (PL) Mr President, the slogan for this year’s World Health Day is ‘Working Together for Health’. As we are all aware, health is a multifaceted issue. I could refer to the medical and social dimensions involved, but its political dimension is particularly significant. Health is therefore not simply an issue for individual human beings. The health of each and every one of its citizens should be a top priority for every state.
It is unacceptable to reduce financial resources, thus depriving millions of people of essential medical care and worsening the situation of the poorest and most vulnerable social groups. In particular, it is also unacceptable to deprive those who cannot stand up for themselves of the care they need, or to drastically cut such care. I have in mind unborn children, the elderly and the seriously ill.
Simply launching one appeal after another and celebrating World Health Days is not enough. Health workers need to be properly trained. For these individuals, devotion to the health sector is both a service and a calling. Without them, it is impossible to guarantee effective health care, and now I am not referring exclusively to the poorer countries. Against the background of contemporary globalisation and rampant liberalism, it is especially important to bring ethical and moral principles to bear on medicine and heath care, thus enabling each individual to be treated with dignity and respect, and his or her health to be promoted.
Essentially, the underlying problem afflicting contemporary health care is a world vision governed by a materialistic approach to life. This means that financial, business and economic interests have free rein, to the detriment of the life and health of human beings. The huge economic divide between the new Member States and the older ones, where salaries are exponentially higher and working conditions are outstanding, has resulted in the emigration of well-qualified medical workers. In Poland at least the conditions for professional training and development are quite favourable, but likely remuneration is unattractive, hence the brain drain.
I am concerned about the nature of a potential proposal on the introduction of an ethical recruitment code. I wonder what kind of criteria would be laid down in such a code so as to make it easier or harder for workers to emigrate. I very much hope any such criteria would not be content-related, so that poor countries do not lose even more outstanding specialists.
Jan Tadeusz Masiel (NI). – (PL) Mr President, as has been brought to our attention today, European health services are in a most unsatisfactory state, but things are far worse in Africa. One of the key issues to be dealt with concerning Africa is ensuring that AIDS victims benefit from generic medicines. The latter are certainly much cheaper, but they are still too expensive for Africans.
Mr Bowis raised another important issue relating to Africa, namely encouraging individuals trained in Europe to return to their home countries where they are sorely needed. What needs to be done in Europe is to increase the mobility of both patients and medical services. In Poland, for example, it is hard for nurses to find a job paying more than EUR 250 a month, whilst in Belgium hospital wards are being closed due to a shortage of nurses.
In addition to mobility, it is important to harmonise recognition of medical and paramedical qualifications. In general, Europe lacks a common health strategy and policy.
Finally, I would like to mention the issue of additional investment in research programmes, for instance those working on cancer. It is shameful that such programmes have to be funded by events on television. The money ought to be coming instead from national budgets or perhaps European programmes. We proved capable of mobilising ourselves to respond to the sudden threat of avian influenza, but we do not seem able to overcome deadly diseases that have been with us for a very long time.
Françoise Grossetête (PPE-DE). – (FR) Mr President, Commissioner, the right to health is a universal value. Extraordinary progress has been made over the past 50 years. At the same time, however, costs have not stopped rising, yet we have a great deal of trouble admitting that prevention costs much less than cure. We are experiencing an actual health crisis due to a lack of foresight and in particular due to a purely accounts-based approach to health policy.
The right to health is a universal value, as I said. It is not only Europe that is affected; the entire world is, too, with developing countries the hardest hit. The consequence of the well-documented shortage in the training of medical staff – doctors, nurses, and so forth – in the EU is that Member States turn to doctors from developing countries, thereby exacerbating the shortage in those countries.
I should like to make three main points. Firstly, it is necessary to train health workers in developing countries and to channel every effort into ensuring that they stay. For this to happen, there needs to be better planning of medical systems in Europe and the United States.
Secondly, over several decades there have been some terrible pandemics in the world. Developing countries are the most vulnerable because they have neither the resources for information and awareness raising, nor sufficient medicines to stem diseases such as AIDS, malaria and tuberculosis. This is purely down to a lack of personnel.
Thirdly, I would have liked our resolution to be more precise on certain key points, for example the availability of medicines. Here too, in my view, the lack of personnel is crucial in that no one is there to act as a focal point. I therefore welcome the measures taken by some European businesses, which, in a show of solidarity with the people of these countries, distribute essential medicines or vaccines. Given that we are aware of the difficulty of carrying out such distribution in countries where there is a shortage of infrastructure and qualified personnel and where there is sometimes a complete lack of political will, the inescapable conclusion is that the EU must do all it can to support these measures and in fact must go further. Sadly, the Commission’s proposals are woefully inadequate, and things are not about to improve on the back of the famous agreement on the financial perspective. Who is bearing the brunt of this? The most serious aspect of this is that the main victims of our shortcomings are vulnerable people, including women and children.
Karin Scheele (PSE). – (DE) Mr President, the day after tomorrow, 7 April, is World Health Day, which this year is devoted to health workers. This is a good opportunity to call for fair, good working conditions for these workers and draw attention to the existing shortage of such workers.
When we talk of fair, good working conditions, we are not just talking about developing countries, of course, although we focus special attention on these, but also about Europe, and the forthcoming discussion on the Working Time Directive, in particular – which has already been mentioned today – will reveal how seriously Europe and this Parliament take fair working conditions for people in this field and the importance accorded to high-quality public and health services.
The shortage of health workers is a global phenomenon, and has numerous causes: the Commission points this out and so does the resolution that we shall be adopting tomorrow. It has also been discussed in great detail how developing countries, in particular – African countries being the worst example – suffer as a result of the brain drain: of rich countries’ recruitment measures.
In my opinion, an important point as regards the shortage of health workers is being obscured. Many countries are saving on public spending, and consequently important posts are lacking in the health and social services sector, too – either lying vacant or not being created in the first place. Many preach the virtues of the slimline, almost anorexic state, but they do not mention its impact on the functioning of the health system.
I hope that Amendment 6 will be adopted by a majority tomorrow, so that we have a comprehensive analysis of the shortage of health workers in the various countries of this earth. Health services in developing countries have also suffered as a result of the drastic budget cuts in the social sector arising from macroeconomic reforms such as structural adjustment programmes. The international financial institutions need to reconsider policies such as continuously putting emphasis on the privatisation of public-sector activities in developing countries.
Amendment 7 reveals another key reason for the shortage of health workers and for inadequate health spending by developing countries, African countries in particular. I certainly do not wish to play down the reasons such as corruption or the lack of political will that have been given, but it is also true that these countries’ external debts significantly reduce their scope for adequate spending in the social sector and on health.
Three of the eight Millennium Development Goals relate to health: reducing child mortality, improving maternal health and tackling HIV/AIDS. The international community, including the EU, must ensure that sufficient financial resources are available for tackling HIV/AIDS. We know that only some of the financial commitments entered into at the Cairo International Conference on Population and Development have in fact been honoured. We also know that the proportions of the HIV/AIDS pandemic are far greater than was assumed at that time.
It is important to provide sufficient resources for promoting reproductive health, which is also the reason for my appeal for majority support from the House for Amendment 5. In addition, Mrs Hall has already pointed out how this HIV/AIDS pandemic is neutralising the investments of many African countries.
Nicholson of Winterbourne (ALDE). – Mr President, World Health Day reminds us that access to health is the single most desirable goal that all humans wish to reach. Yet the range of challenges to global health today is wide and the prospects of achieving the international goals are daunting. Annually four million children die before they are one month old. Another four million children die from diarrhoea or pneumonia. Malaria is responsible for at least another million child deaths, and in total more than ten million children die every year as a result of conditions for which we have effective interventions.
These problems are outrageous in the context of global wealth in the 21st century. Yet there are new challenges to health associated with the accelerated globalisation of the markets, such as SARS and avian flu. In many countries HIV/Aids has already begun to destroy the modest progress made since the 1980s and is today threatening the survival of entire societies.
The world’s response, while impressive relative to other areas, is far from that which is required. But not all is bleak. The world has also witnessed unprecedented progress in science and knowledge and today we know how to address the great majority of the world’s disease burden. Many of the solutions are cheap and low-tech. Even greater, therefore, is the responsibility upon us, the imperative to focus on how these interventions can be delivered to those who need them. Health is at the very heart of the Millennium Development Goals and it must be recognised by all that health is central to development and to the fight to reduce poverty, as well as an important measure of human wellbeing.
The clear message coming out of 2005 and the Millennium Development Goals is that of health systems. We will only start to make real progress when we finally get serious about health systems. Without the basic systemic capacities in place in all countries, it will not be possible to do what politically has already been agreed upon: to scale up disease prevention and controlled programmes for reducing child and maternal mortality and roll back HIV/Aids, TB and malaria.
Central to each and every health system are the people working in it and for it; having the right workers with the right skills in the right place doing the right things is fundamental to being able to address the full range of health challenges in a country. However, these elements also include health stewardship – the range of functions carried out by governments as they seek to achieve health objectives, sustainable health financing, efficient and effective health service delivery and the application of health knowledge, technology and infrastructure. While the lack of health workers is of particular urgency, the overall task is to improve all these aspects simultaneously.
Péter Olajos (PPE-DE). – (HU) According to a saying – also used in my country – ‘money can buy everything except good health'. At the same time, we know fully well that, unfortunately, health is often a matter of money. This is certainly true of public health.
This is the problem we are facing, when the World Health Day this year draws our attention to the shortage of health workers throughout the world. According to WHO, the shortage is caused by the fact that the training, remuneration, working conditions and management systems of health workers have been underfinanced for several decades. Moreover, due to demographic changes, there will probably be an increasing demand for doctors in Europe.
The absolute lack of money is only one part of the problem faced by public health. The other is the lack of appreciation for health workers in society and the lack of prestige of the profession. The number of those training to be doctors and nurses is constantly decreasing, because their average remuneration and social perception are not proportional with the difficulties and importance of their vocation. Therefore, appreciation for public health must be restored as soon as possible. The migration of health workers is already a considerable problem. A part of the shortage of doctors in England is supplemented with doctors from Hungary, where the shortage is supplemented by doctors and nurses arriving from Romania; Romania is trying to replace them with doctors and nurses from the Republic of Moldova. And the long list could be continued. It is obvious that the concerns are more serious in developing countries, but there is much to be done in Europe, too.
Another aspect of the concerns experienced in the area of remuneration is the widespread gratuity system in certain Member States. This is both legally and morally unacceptable, it is humiliating both for patients and doctors, and it also creates further inequalities in the public healthcare system. Therefore this should be eliminated as soon as possible.
Overall, we must provide more money and create more appreciation and clearer conditions to ensure that our public health standards throughout Europe do not deteriorate in the coming years, but on the contrary, they improve. I hope that the World Health Day will draw our attention even more to this important area, and will bring the solution closer.
Antonios Trakatellis (PPE-DE). – (EL) Mr President, I shall focus on three points, because a great deal has been said with which I agree.
The first point is that we need to concentrate our attention today, as we debate World Health Day, on prevention. Prevention and investing large amounts in prevention is very important, because it allows the incidence of disease to be limited and, by extension, the cost of treatment and hospital care to be reduced, with obvious beneficial results both for citizens and for the public purse. Improving the health of the population without doubt boosts progress, fortifies citizens by safeguarding a longer, better and more productive life and is the precondition to economic prosperity.
Second point: I should like us to focus our attention on those who have given us innovative treatments, innovative medication, inoculations and, in general, the knowledge to combat diseases and those who work with the sick – doctors, nurses and all health workers – and we must apply ourselves in this sector, to see where the gaps are, so that we can have adequacy in this sector. Of course, we will also need to use new knowledge and technologies, such as telemedicine, which is important if we are to offer a modern service.
Finally, the third point is the inequalities which exist today in the sector of the supply of health services. Even within the European Union there are inequalities and, of course, there are inequalities on the planet at the moment; we have deaths, we have a high incidence of disease and I think that the European Union should apply itself to this issue and invest money in this sector, because no one can be happy in the middle of unhappiness.
With these three points, and agreeing with everything said by my honourable friends, I too should like to pay homage to the people who work with the sick and offer these excellent services.
Thomas Ulmer (PPE-DE). – (DE) Mr President, Commissioner, ladies and gentlemen, this year, World Health Day is devoted to health workers. There are 35 million health workers worldwide, approximately 4 million of whom are in Germany, and well in excess of 12 million in the EU. These figures alone show that the South of our planet has far from satisfactory provision. There is a clear divide between the developed and the developing world as regards people’s chances of receiving health-care services. In the short term, it would be entirely appropriate to provide twice or several times as many resources as emergency assistance. What is indispensable, however, is an increase in human resources – in both Europe and the developing world.
Given the short time available, I should like to discuss just the conditions in Europe. The previous speakers have already commented on the developing world, and they have my full support.
I should like to select four European issues. Firstly, the ageing of our society brings with it new challenges, new illnesses, new treatment procedures and a growing need for nursing and care that we are already losing the ability to fully cover.
Secondly, an improvement in the skills and quality of the health professions in Europe is needed if we are to meet the excellence criteria we set ourselves. A dramatic increase in the training figures in all fields of the health service is needed if we are to meet these demands.
Thirdly, we need to enhance our cooperation within the Union. Although health policy plays a subordinate role, positive intervention is called for on our part. Health policy must not be reduced to monetary aspects – even if these words are sure to make the ears of my colleagues in Berlin burn.
Fourthly, we need to preserve the health of health workers by means of reasonable working hours and workloads and reduce cases of exhaustion. In this connection, I would appeal to the Commission to adopt Parliament’s position on the Working Time Directive.
Eija-Riitta Korhola (PPE-DE). – (FI) Mr President, the theme of World Health Day, which takes place the day after tomorrow, is employees in the healthcare sector. This year’s subject is very pertinent, since we are facing the threat of a worldwide pandemic. The problems associated with availability of healthcare staff and working conditions affect both the developing and the industrialised countries.
Focusing attention on the status of healthcare staff is the right way to get to grips with the causes of health problems and to try and prevent them. Investing in preventive work is always the best option as far as both people and the economy are concerned. It makes sense to invest resources in everyday structures that support people’s health, and not just in corrective work.
We need the political will to recognise the needs of healthcare staff and address them. Educated doctors and nurses save human lives. Unless their professional skills are appreciated and given support, the United Nations Millennium Development Goals, for example, will not be achieved. That appreciation must also be reflected in pay and working conditions.
The skills of healthcare personnel staff are being especially put to the test with new threats to health such as bird flu. Healthcare professionals must in all circumstances be sure that their working conditions are not needlessly exposed to infection. A possible global pandemic would also mean that staff would be confronted with difficult ethical questions. Even though it may be a basic premise that everyone is vaccinated and receives the drugs they need, there may come a situation where, for example, part of a vaccination batch is missing. Questions of healthcare prioritisation call for fundamental ethical debate as a basis on which to work.
With the threat of pandemics, the developing countries are in a particularly difficult situation, as malaria and HIV are already causing untold havoc. I strongly agree with the calls in the resolution to improve the focus for development cooperation so that it is used for human and social development.
Lívia Járóka (PPE-DE). – (HU) On the occasion of the World Health Day, please allow me to call your attention to another significant day, the International Roma Day, celebrated on 8 April. I would like to talk about the Roma.
The Roma population is young: they have a high birth rate and a high mortality rate. The life expectancy of the European Roma is ten years shorter than that of the majority populations. The number of Roma patients is several times higher than the average number of majority population patients: the number of TB patients is ten times higher, the number of patients with tumorous diseases is four times higher, iron deficiency and blood system disorders are ten times higher, the number of cerebrovascular disorders is six times higher, the number of patients suffering from essential hypertension is four times higher, and the number of patients with heart disease is fifteen times higher today in Europe. Unfortunately, although these data have been taken from a Hungarian report, they reflect the general picture across Europe.
One of the many reasons for the life expectancy of Roma being ten years shorter than that of the non-Roma is the discrimination experienced in the public health system. And this is where I need to mention the issue that many of you have already brought up today: the training provided for health workers. Are they sufficiently trained to treat their patients without any discrimination? (Unfortunately, we cannot talk much today about Roma patients and doctors. I would have gladly joined in this topic, too, but unfortunately I cannot do it.)
We celebrate the International Roma Day on 8 April all over the world, and in connection with this we accepted a resolution in the European Parliament last year, in which we called attention to the worrying health situation of the Roma. In the year that has passed, neither the European Commission nor the Member State governments have taken any corrective measures in the public health sector, or in order to eliminate the unemployment affecting the Roma or their exclusion from the economic, housing and education sector. We are asking the European Commission to release a Green Paper as soon as possible on the intolerable situation of the Roma, in order to eliminate their exclusion from public health, and to ensure that the extremely poor quality healthcare services provided to them are brought up to European standards.
Mairead McGuinness (PPE-DE). – Mr President, this is perhaps one of the most important debates we have had in this House. I am sorry that because of the late hour there are not more people here to listen to the appalling statistics of deaths of young children, of mothers – needless deaths from illnesses that we could cure so easily. I want to thank the Commission and my colleagues for highlighting the terrible ills that face us in the world and for trying to raise awareness of the appalling vista that lies ahead.
I come from Ireland, a country from which not so long ago we were exporting nurses because there were no jobs for them. Today, sadly, we are now importing people into the health-care sector in large numbers because we have such a shortage of skills. We are not thinking about the countries we are robbing of their people, because our motives are selfish: we need to look after our own. Yet, even when we take in people from outside, we see in our accident and emergency departments, on a daily basis, people who in many respects are in Third World conditions, lying on trolleys in unacceptable conditions. So the problems are first-hand and they are all-pervasive.
I was in Malawi last year. I witnessed what one of my colleagues has already spoken about: the lack of nurses – who are now in Manchester – and the appalling effects this is having in that country. It is hard to know what the answers are, but perhaps we should look at the job of the health-care workers and value what they do more than we do at the moment – in terms also of respecting and rewarding them.
It was asked how we can compensate the developing world for having taken their best. There is a huge moral question about how we reject the rest, but take the best. We must not do nothing. We are moving on to a debate on avian influenza and market support measures. Heaven help us if we have a human pandemic and see how stretched our health-care services will be worldwide.
I should like to read out what the World Health Organization wants us to do on Friday, the day we are talking about: ‘raise awareness of this chronic problem’ – the crisis concerning health-care workers – ‘and to build support to ensure that health workers will be working where they are needed, when they are needed, with the right skills to provide the highest attainable level of health for people everywhere’. I hope we achieve this.
Mariann Fischer Boel, Member of the Commission. Mr President, I am very impressed by the passionate contributions on this very important issue.
The process that the Commission is leading to develop an EU response to the human resources crisis demonstrates the strength of greater European coordination. The collective commitment of Member States and of the Commission is likely to have a much greater impact than the Commission or Member States working alone.
The response to the human resources crisis reflects the principle set out in The European Consensus on Development. It is the Member States’ commitment to increase the overall levels of development assistance, moving towards the target of 0.7% of GNI as ODA, that will provide the increasing budget for accelerated progress. But it is the coordinated efforts of the European Community that will ensure that the increased resources are more efficiently spent, providing coordinated, coherent backing for country-led and developed plans.
We believe that better coordinated and more coherent implementation of our common European policy, reflecting the commitments made in the Paris Declaration on Aid Effectiveness, provides the best means for a drastic increase in human and social development spending. That needs to be prioritised by the Member States and reflected in our common policy.
That is why the Commission has proposed a package of concrete measures on aid effectiveness. The package will allow the European Union to deliver more, faster and better aid.
At the Paris aid effectiveness meeting, the European Union made a commitment to increase the proportion of aid it provides as budget support. That commitment includes the potential to increase funding for both general and sector budget support, complemented, if necessary, by project-type funding. Delegations making programming decisions for the 10th EDF therefore have a choice of aid instruments with which to respond to nationally defined priorities. There is considerable scope for the national decision-making and country programming processes to focus increased effort on the health or social sectors through sector budget support, if that is prioritised at country level.
I should just like to answer some of the more specific questions that have been raised.
On the question of a code of conduct, I can confirm that the Commission is willing to consider how to develop and implement a European code of conduct for the ethical recruitment of health workers. On the question of tailored medicine, which was raised by two Members, we are currently supporting a study on the potential of trying to make better use of the available efforts as part of our partnership with the African Union.
Corruption is indeed a problem for development and particularly damaging for the delivery of key social services, such as health. As you know, we agreed on the need to address that problem through a whole range of measures. Tomorrow we will have plenty of time to have a more in-depth discussion, when we discuss Mr van den Berg’s excellent report on the issue.
Several Members have mentioned the question of the proportion of development funds that is allocated to human and social development. Most Commission financing is allocated through country programming. Currently, over 20% of the Commission’s development budget is allocated to social infrastructure. In addition, general budget support financing includes linkage to progress measured against health indicators and is therefore a mechanism for supporting and reinforcing country-level prioritisation of the Millennium Development Goals.
The Commission will be increasing the proportion of development assistance given as budget support and will seek to increase the link between budget support and progress towards the Millennium Development Goals. The decision on the proportion of financing allocated by countries to human and social development is ultimately a question for national governments. The Commission will continue in its policy dialogue with governments to emphasise the importance of human and social development for economic growth and for poverty reduction.
President. – To wind up the debate, I have received six motions for resolutions, pursuant to Rule 103(2)(1).
The debate is closed.
The vote will take place tomorrow, Thursday, at 12 noon.