Rapporti verbatim tad-dibattiti

L-Erbgħa, 11 ta' Marzu 2009 - Strasburgu

17. Rapport Nru 10/2008 tal-Qorti tal-Awdituri dwar l-Għajnuna tal-KE għall-Iżvilupp fir-rigward tas-Servizzi tas-Saħħa fl-Afrika tas-Sub-Saħara (dibattitu)

  Presidente. − L'ordine del giorno reca la discussione sull'interrogazione orale alla Commissione sulla relazione speciale della Corte dei conti n. 10/2008 sull'aiuto allo sviluppo fornito dalla CE ai servizi sanitari nell'Africa subsahariana, di Josep Borrell Fontelles, a nome della commissione per lo sviluppo (O-0030/2009 - B6-0016/2009).

  Anne Van Lancker, Auteur. − Voorzitter, commissaris, beste collega's, Afrika is het enige continent dat geen noemenswaardige vooruitgang boekt inzake de millenniumdoelstellingen, vooral op gezondheidsgebied, en met name moeder- en kindersterfte, de strijd tegen hiv/aids, tbc en malaria. Dat heeft alles te maken met hun zwakke gezondheidssystemen en met de human resources-crisis die in die sector heerst. Het is dan ook duidelijk dat investeren in gezondheidssystemen essentieel is in de strijd tegen armoede.

Dat is trouwens ook de mening van de Commissie, maar volgens het verslag van de Rekenkamer kan de Commissie dat al wel jarenlang beweren, in de praktijk komt daar bitter weinig van terecht. De Commissie doet inspanningen, vooral via verticale fondsen in de strijd tegen aids, en dit is volgens ons misschien wel noodzakelijk, maar het mag niet ten koste gaan van het globale pakket aan investeringen in de basisgezondheidszorg.

Mevrouw de commissaris, het budget voor basisgezondheidszorg is sedert 2000 proportioneel niet eens toegenomen in het kader van het ganse pakket officiële ontwikkelingshulp. Reden genoeg dus voor dit Parlement om op basis van het verslag van de Rekenkamer een aantal vragen te stellen en een aantal aanbevelingen te formuleren aan de Commissie. Ik heb vier punten.

Ten eerste. Verhoging van het budget voor de gezondheidszorg. Hier is duidelijk een gezamenlijk initiatief nodig van de EU met de partnerlanden. De ontwikkelingslanden hebben zich geëngageerd 15% van hun begroting te investeren in het kader van de Abuja-verklaring. Maar dat kan onmogelijk lukken, mevrouw de commissaris, als de Commissie en Europa maar 5,5% van het Europees Ontwikkelingsfonds hieraan spenderen. Ik zou dan ook graag van u willen weten op welke manier de Commissie ervoor wil zorgen dat in het kader van het 10e EOF de investeringen in gezondheid worden verhoogd.

Ten tweede. Beter en efficiënt gebruik van begrotingssteun. Dat is een paradepaardje van de Commissie, maar krijgt weinig goede punten in het verslag van de Rekenkamer. Begrotingssteun bevat nochtans een groot potentieel om tegemoet te komen aan de tekortkomingen in de zuiderse gezondheidszorgen. Sectoriële begrotingssteun kan echt gefocussed mikken op gezondheidssystemen, maar wordt amper gebruikt in Afrika bezuiden de Sahara.

Algemene begrotingssteun kan ook helpen, maar dan moet de Commissie de partners wel engageren en enthousiasmeren om gezondheidszorg als een focale sector te selecteren, en we roepen de Commissie daar dan ook toe op. Mijn vraag aan de Commissie: op welke manier gaat u ervoor zorgen dat zowel via sectorsteun als algemene begrotingssteun veel betere en meer resultaatgerichte actie wordt ondernomen.

MDG-contracten is een van de beloftevolle instrumenten van de Commissie. Ik ben er 100% voor, maar eerlijk gezegd is dit een beetje te weinig, te kort door de bocht, want deze zijn alleen bestemd voor de goede leerlingen, en dus zijn alternatieven absoluut wenselijk voor de anderen.

Ten derde: verhoging van de expertise. Volgens het verslag beschikt de Commissie ook over onvoldoende expertise om haar beleidsvoorstellen in de gezondheidszorg waar te maken. Daarom vragen we aan de Commissie om die expertise te garanderen door meer gezondheidsexperten op te nemen en ook beter samen te werken met de WHO en met de lidstaten.

Ten vierde: betere coördinatie binnen de gezondheidszorg. Commissaris, het is absoluut noodzakelijk dat er echt werk gemaakt wordt van de Europese gedragscode over de verdeling van het werk en ervoor te zorgen dat de investeringen en de programma's inzake gezondheidszorg tussen de verschillende landen van de Europese Unie echt beter gecoördineerd worden. En dat ervoor gezorgd wordt dat de zogenaamde wezen onder de hulpbehoevende landen ook een gezondheidshulp kunnen garanderen.

Tot slot, beste collega's, zou ik nog een woord van dank willen richten aan mijn collega Bart Staes die namens de Commissiebegrotingscontrole onze bezorgdheid vanuit de Commissie ontwikkelingssamenwerking ondersteunt en de Commissie vraagt haar plannen met het oog op de kwijtingsprocedure te verduidelijken, en wel liefst vóór eind 2009.

Het is duidelijk, commissaris, beste collega's, dit Parlement dringt er bij de Commissie op aan om haar beleidsprioriteiten met meer overtuiging en met betere instrumenten eindelijk ook in realiteit om te zetten. Dat is meer dan noodzakelijk, willen we tegen 2015 ook nog een kans maken om de millenniumdoelstellingen te halen, want, commissaris, basisgezondheidszorg verdient duurzame investeringen op lange termijn.

  Androulla Vassiliou, Member of the Commission. − Madam President, the Commission really welcomes the European Court of Auditors’ special report on EC support to health services in Africa. The debate on this oral question gives us an opportunity to discuss our health support to Africa with you, the European Parliament.

I am not going to repeat here the formal reaction the Commission has already made regarding the Court of Auditors’ special report, which has already been published on the Internet.

Unfortunately this report has not received wide coverage in the press and, when it was mentioned, things were sometimes oversimplified by saying that ‘Europe has not kept its promises in Africa’. Let me therefore just clarify a few essential points before we enter into the debate.

The Commission remains fully committed to supporting the Millennium Development Goals, the health-related Goals 4, 5 and 6 being an integral part of these goals: reduction of child mortality by two thirds, reduction of maternal mortality by three quarters, and halting and reversing the spread of HIV/AIDS. This is what our development cooperation stands for, but our commitment must not be measured by budgetary allocations to the health sector alone.

Doubtless, child mortality will be reduced by effective health service interventions, vaccinations in particular. Therefore we monitor vaccination coverage not only in our health programmes, but also in many of our general budget support operations. However, child mortality also depends on other factors such as nutrition, housing, access to safe water, sanitation and education. Therefore our contribution can and will frequently be outside the health-care sector itself.

When deciding on sectoral allocations and modalities of our development assistance, we agreed in Paris and Accra to increasingly respect basic principles of aid effectiveness. Here are just two examples. The first is leadership by partner governments. This means, after an in-depth discussion with the partner country, accepting the sectors proposed for support. It might not be the health sector but education or water and sanitation.

Second: alignment on national systems. This means channelling our aid, preferably as budget support (provided that the basic criteria are fulfilled). If the country has a sufficiently well formulated poverty strategy, our support may preferably be channelled as general budget support.

Although this support will then not be earmarked as health sector support, it is linked to targets for health, such as vaccination coverage rates or proportions of births assisted by skilled health personnel. Such targets are usually part of the poverty strategy and are monitored, and budget support disbursement is often linked to progress on them.

In addition to the global commitments on aid effectiveness made in Accra and Paris, we, the European Union, have collectively agreed on a code of conduct that foresees, for example, a reduction in the number of sectors in which each and every donor is active, in order to reduce the administrative and managerial burden on our partner countries through the multiplicity of donors. This is the meaning of the division of labour approach that EU Member States and the European Commission have agreed upon. We know that it will not always be easy to agree on this at the country level, particularly as health scores high in public opinion, and all donors and donor countries want to be present and to be seen. We will at times have to resist such a tendency and leave it to the other donors to do the job.

I therefore hope that our debate today will contribute to further clarifying these issues and to helping ensure that Europe fulfils its promises to Africa.

  John Bowis, on behalf of the PPE-DE Group. – Madam President, I thank the Commissioner for that response. I am sure you are right, Commissioner, that figures can mean many things and we need to look very carefully at them. But of course today we are looking at the Court of Auditors, so we have to look at the figures. I sometimes wish we would look at people rather than figures, but we agree ‘no wealth without health’. That is not just a slogan but a reality in so many low-income countries.

We agree that the Court of Auditors says only 5.5% of EDF funding is going to health, whereas the European Union’s policy – and Parliament’s policy – is that 35% should be spent on health and education. There is a wrong figure there, and it may well not be as bad as that figure suggests. Nevertheless, it shows we have got to do a lot better, and that involves cooperation – if I can use that term – with the 15% pledge enshrined in the Abuja Declaration by the countries themselves.

But, Commissioner, I want to come back to the people. Go to Mali and see the diabetes out of control and look at the cost to families: over 30% of their family income spent on insulin, if they have to buy it – and they do have to buy it. Go to Chad and ask about the mental health services, and they will tell you that they used to have them before the civil war. Go anywhere in Africa and see the inhumane treatment of people with epilepsy, whereas for a few cents we could make most of them seizure-free. Go anywhere in Africa and see the AIDS orphans and see and meet the grandparents trying to raise the grandchildren because the parents are dead.

The statistics are there. We know that in the Americas 14% of the world’s population has 10% of the global burden of disease and 42% of the health workers. Sub-Saharan Africa has 11% of the world’s population, 25% of the global burden of disease and 3% of the health workers. It reflects the debate that we had earlier. But we have to look at those things because you cannot have health without health services, without health workers and without health education.

We also have to look at some of the projects that we are embarking on. It is not just TB, AIDS and malaria, but all the other diseases. It is the neglected diseases, for which the Commission stands proud with its cooperation with the pharmaceutical companies on that initiative to bring help to people in need of those medicines. We have to look at the causes of ill health, and the debates this evening have centred round those.

Only if we pull all these things together will the statistics add up – and that means the people will add up. What we do better will help people to be better, and then their economies could be better too.

  Bart Staes, namens de Verts/ALE-Fractie. – Voorzitter, collega's, het verslag van de Rekenkamer wordt eigenlijk pas volgende week officieel gepresenteerd in de Commissie begrotingscontrole. Mijn complimenten dus aan de Commissie ontwikkelingssamenwerking en zeer zeker ook aan mevrouw Anne Van Lancker, die ervoor hebben gezorgd dat dit debat hier vandaag plaatsvindt, en dat we morgen een resolutie zullen aannemen waarin heel nauwgezet wordt uiteengezet wat er fout is.

Laat ons goed luisteren naar het betoog van mevrouw Van Lancker, naar de aanbevelingen die zij in haar lange speech heeft gedaan. Laat ons goed luisteren, mevrouw de commissaris, naar het betoog van John Bowis, die op een zeer treffende wijze heeft uitgelegd wat er schort.

Wie het verslag van de Rekenkamer erop naleest, kan niet zomaar over de zaak heengaan. De cijfers zijn er, en mevrouw Van Lancker heeft het terecht gezegd, de millenniumdoelstellingen inzake deze sector zullen niet worden gehaald, of in elk geval zeer moeilijk. Kijk maar eens naar de cijfers die de Rekenkamer land per land vermeldt, en dan wordt u met de beide voeten op de grond geplaatst.

Aids-prevalentie, 34% van de bevolking is getroffen in Swaziland, 23% in Lesotho, 14% in Malawi. De kindersterfte in Swaziland was 78 op 1000 in 1997, nu 86 op 1000. In Lesotho was de levensverwachting medio jaren '90 nog 60 jaar, nu nog 41 jaar. In Kenia sterft meer dan 1 op de 10 kinderen vóór ze vijf jaar oud zijn. De aanbeveling, de analyse van de Rekenkamer over de efficiëntie van het EU-beleid in de voorbije jaren is pijnlijk verontrustend.

Ik hoop dan ook, commissaris, dat u er als Commissie in zult slagen om de vragen die ik als rapporteur van de Commissie begrotingscontrole in deze resolutie heb kunnen laten opnemen, inderdaad vóór 10 april zult beantwoorden, zodat we die antwoorden kunnen meenemen in de kwijtingsprocedure die eind april wordt afgerond.

  José Ribeiro e Castro (PPE-DE). - Senhora Presidente, Senhora Comissária, quem visita a África Subsariana reconhece facilmente, na generalidade dos países, a enorme debilidade dos seus sistemas de saúde e o impacto extremamente negativo que esta debilidade tem na vida e na saúde das populações que aqueles serviços deveriam servir.

Os indicadores continuamente divulgados a nível internacional não cessam de o confirmar. E, nessa medida, é absolutamente perturbadora a noção de que gestos simples e práticos até não muito elaborados, nem sequer particularmente dispendiosos, poderiam ser suficientes para salvar muitas vidas. O apoio financeiro europeu pode ser crucial neste tocante e não podemos deixar de ter sempre presente como a cooperação na área da saúde é verdadeiramente estratégica e atravessa directamente não só um dos Objectivos do Milénio mas muitos dos Objectivos do Milénio. Ora, o Tribunal de Contas considerou que, cito, “o financiamento comunitário a favor do sector da saúde não aumentou desde o ano 2000 na proporção da sua ajuda total ao desenvolvimento, apesar dos compromissos assumidos pela Comissão relativamente aos objectivos do Milénio e da crise sanitária na África Subsariana”. Fim de citação. E reconheceu, cito de novo, “a Comissão contribuiu de forma significativa através dos seus financiamentos para constituir o fundo mundial de luta contra a Sida, a tuberculose e a malária, mas não concedeu a mesma atenção ao reforço dos sistemas de saúde que se previa ser uma das suas prioridades”. Fim de citação.

Segundo o Tribunal, isso terá acontecido, cito de novo, "porque a Comissão não tinha experiência suficiente em matéria de saúde para garantir que o financiamento da ajuda por ela concedida a este sector era utilizado da melhor forma”. Fim de citação.

Este é, portanto, um forte desafio que o Tribunal de Contas lança directamente à Comissão Europeia e que eu acompanho. Pelo nosso lado, quero reiterar esse mesmo desafio sustentado agora na objectividade destes dados e desta avaliação. Os serviços de saúde já fazem parte, mas devem fazer cada vez mais parte das nossas prioridades de ajuda ao desenvolvimento, sendo merecedores de um acréscimo no seu financiamento. Optimizar a forma como a ajuda é prestada tendo presente as necessidades aparentemente antagónicas de coordenação na sua gestão e de proximidade com as populações beneficiárias é prestar um serviço que pode salvar muitas vidas.

A Comissão Europeia não pode deixar de responder positivamente a este repto e é nesse sentido que a exorto. O colega Bowis, ainda há pouco, fez-nos aqui uma intervenção tocante e foi capaz de pôr rostos, rostos humanos na frieza seca destes números do Tribunal de Contas. O desafio para nós, Senhora Comissária, é o de a nossa cooperação ser capaz de pôr nestes mesmos rostos um olhar de alegria e de esperança. E para isso, Senhora Comissária, é indispensável que sejam outros os números na área da saúde na nossa cooperação.

  Marie Anne Isler Béguin (Verts/ALE). - Madame la Présidente, je ne voulais pas vraiment intervenir sur le rapport, mais ajouter un point qui me tient particulièrement à cœur et que j'ai soulevé à plusieurs reprises lors des réunions des ACP; c'est la question de la situation sanitaire des populations touareg au Niger. Dans ce contexte, Madame la Commissaire, je voudrais vraiment poser le problème de sociétés européennes qui vont exploiter des ressources naturelles dans des pays africains, et notamment la société Areva pour la France, qui va exploiter l'uranium au Niger, sans donner aucune information aux populations locales, si bien que les populations présentes là-bas se servent, par exemple, de matériels ou de ferraille radioactifs pour en faire des ustensiles de cuisine.

Aujourd'hui, les autorités nigérianes ne permettent pas de faire des études sérieuses sur la situation radioactive de ces populations, mais nous savons qu'elles sont dans une situation alarmante.

Nous avions demandé, lors d'une réunion ACP, qu'une étude épidémiologique soit menée sur ces populations. Je réitère aujourd'hui cette demande à la Commission.

PRESIDÊNCIA: Manuel António dos Santos
Vice-Presidente

  Androulla Vassiliou, Member of the Commission. − Mr President, not only have I listened carefully to what has been said tonight, and not only have I paid attention to what was said in the report by the Court of Auditors, but also, as I said before, I have just come back from a visit to Côte d’Ivoire and Liberia and have seen with my own eyes what the needs of these countries are in the field of health. They have needs in terms of infrastructure, needs in terms of the trained health providers we have already talked about, and needs in terms of medication.

Those needs are immense, and I cannot but agree with you that we have to intensify our efforts in offering our help, in the field of health, in the poor countries of Africa.

I can assure you that I will convey your comments to my colleague, Louis Michel, and I am sure he too will consider all your suggestions and comments with great attention, just as I have done.

  Presidente. − Comunico que recebi uma proposta de resolução⁽¹⁾ apresentada em conformidade com o nº 5 do artigo 108º do Regimento.

O debate está encerrado.

A votação terá lugar na quinta-feira, 12 de Março de 2009.

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