Mary Robinson

From the perspective of Mary Robinson, President of the Mary Robinson Foundation - Climate Justice and former president of Ireland and U.N. High Commissioner of Human Rights, donors should do much more in supporting health in developing countries – especially when those nations take bold steps to improve health care.

In a speech this week at the annual meeting of Finnish Heads of Mission at the Ministry of Foreign Affairs in Finland, Robinson also said that diplomats should more closely look at the example set by MLI in its work in five countries. Robinson’s human rights organization, Realizing Rights, was the first home of MLI before it moved to Aspen Global Health and Development, a program at the Aspen Institute.

A video of her speech is available online here. Below are excerpts of Robinson’s message:

”We [Realizing Rights] were working on the right to health. We were linking with the governments in Africa where we had a Ministerial Leadership Initiative which is in fact continuing under an Aspen Institute program.

The Ministerial Leadership Initiative is in four African countries and Nepal. Right now, I just want to focus a little bit on the four African countries. They are Ethiopia, Sierra Leone, Mali, and Senegal. And the way in which the Ministerial Leadership Initiative began was in fact a kind of competitive bidding by those countries. About 18 countries applied to be supported with technical cooperation under the Ministerial Leadership Initiative, where they would have support in developing financing for sustainable health, reproductive health and family planning, and capacity building in the ministry.

These were the three main streams in coping with the complexities of aid effectiveness. And these four countries won in the bidding. This in itself is quite important because they were very motivated.  In fact, we had a ceremony in Geneva where I gave small trophies to each of the winners and the ministers made a speech saying what they would do under the Ministerial Leadership Initiative,” Robinson said.

She said that one key part of the mission of MLI, which is supported by the Bill & Melinda Gates Foundation and the David and Lucile Packard Foundation, is to create opportunities for ministry leaders to learn from their peers in other countries.

“For example, there was a working meeting in Ethiopia where they learned of the Ethiopian [health system] practices. And Rwanda, which was not formally a part of the Ministerial Leadership Initiative, had a meeting with the health ministries in order to talk about the insurance for all that Rwanda has been able to bring about despite being still a very poor country. It was sort of a cross learning going on. “

Robinson focused in particular on Sierra Leone, and President Ernest Bai Koroma’s decision to offer free health care to pregnant women, women who were breastfeeding, and children under five.

“On the 27^th of April, 2010, (President Koroma) announced that there would be free health care for all pregnant women, lactating mothers, and children under 5. I was in Sierra Leone with my colleagues in June 2010 a few months after that and we visited some the clinics and the main hospital in Freetown.

And there was a lot of chaos in a sense. There were, in some cases, two women to a bed. There were long queues in the clinic, the health staff in the clinics and hospital were very tired and felt almost worn down by the numbers that were presenting. Three times or four times as many women and women with children under 5 were presenting to the clinic and the hospital. Not one single health worker said to us, ‘This is a bad idea.’

Robinson tours a health facility in Sierra Leone in June 2010

And yet, looking back on the donor response when the president initially said that he intended to make this political decision and announce this and broadcast it across the country, the World Bank was against it, the donor community was against it because Sierra Leone was not ready. They were too poor of a country for this. And that, I think, is also part of the problem.

If the climate of the donor community is keeping poor countries with limited access to health care because they are poor countries, it’s perpetuating the problem. The fact that the president of Sierra Leone made a political decision as president and said, ‘As far as I’m concerned, this is my priority,’ meant that the donors had to do more. The health clinics and the hospitals were, yes, quite overcome by the numbers, but there’s no doubt in my mind that it will fast track when Sierra Leone has much better statistics on maternal and child health than it otherwise would have had and that it is going in the right direction.

What I am thinking about is how we make sure that a poor country like Sierra Leone gets the political and donor support and the measure of capacity so that health care for all is a sustainable reality.”