Keynote Address at the Mekong Healthy Borders Meeting

Keynote Address by ADB Vice-President Stephen P. Groff on 6 August 2013 at the Mekong Healthy Borders Meeting in Bangkok, Thailand

Introduction

Good morning, and thank you, John, for your kind introduction. I am pleased to have the opportunity to speak at this important event that brings together delegates from the Greater Mekong Subregion (or GMS) countries and distinguished experts, all working for one common goal to help improve the health of people in the GMS, in particular --  those living in border areas.

For over 20 years, the GMS region has achieved rapid economic growth and development, which has benefitted the people of the region and beyond, and helped improve health indicators and the achievement of Millennium Development Goal targets. However, rapid development also comes with social costs, including the spread of some diseases. And at most risk are vulnerable populations such as migrant workers and border populations, particularly women and children.

The challenge for this group

The challenge for this group - in the context of a rapidly changing economic environment with new corridors and border areas opening up - is: how can we better ensure that we maximize the health benefits and minimize and mitigate the health risks from development projects?

To initiate the discussion, I would like to highlight two approaches that can help us respond to this challenge:

  • undertaking health impact assessments and
  • employing a multi-stakeholder approach to development

Health impact assessments

The countries and development partners represented here today already pay close attention to the environmental and social consequences development projects. We do this through analytical and participatory tools such as Environmental and Social Assessments. Most of us also look at the potential for the spread of HIV and AIDS, and perhaps other specific diseases. However, health impacts can extend beyond those analyzed by our current tools - either causing harm not accounted for or offering additional benefits that could be reaped with minor changes in planning or implementation. HIAs are a potentially powerful tool that help us identify, ex-ante, health risks and design the necessary mitigation measures; it also helps identify opportunities to refine project design to improve health outcomes. In the context of cross-border areas, this additional lens for health impacts through HIA methodology is particularly critical, as health costs and benefits may accrue to different populations than those who receive development project benefits.

HIAs are being undertaken for major development projects by GMS countries. An excellent example comes from the ADB partnership with Lao PDR, where we worked together on the Nam Theun 2 hydropower project. Impacts on health and mitigation efforts were extensively considered in the development of the dam and other physical assets. In addition, health benefits are being maximized through the Government’s partial financing of health sector needs from the revenues generated by the facility.

However, to date, there is no agreement on the standard use of or methodologies for HIA across sectors, countries or institutions. Current HIA practices encompass a broad range of methodologies, from cost-benefit analyses, to participatory approaches, to checklists. I hope this morning’s session will

  • provide an opportunity to learn from regional experiences in using HIA;
  • consider some of the challenges and benefits of HIA in a cross border context; and
  • debate HIA parameters, methods and principals

Need for collaboration

In the context of economic development, increasing labor migration and trade, and frequent disasters that trigger movement of people across the region, collaboration is essential. Development projects, particularly large infrastructure projects, also draw migrants from across the region, contributing to the flow of persons within countries and across borders. Social, environmental and climate changes magnify the health risks associated with these large population movements. In this setting, delivery of health services to these mobile populations and public health measures more broadly, such as control of communicable diseases, can be difficult. For example, conditions such as drug resistant malaria, the control of emerging diseases and dengue control cannot be addressed by individual country health services. All stakeholders -- including health systems, border area local governments, the private sector, development project proponents, communities and mobile populations -- must be engaged. If we do not control major outbreaks of diseases quickly, across borders and involving all governments and sectors, major epidemics with catastrophic human, social and economic impacts may result. I am therefore very pleased to see this meeting bringing together people from various countries and ministries to discuss how to move forward on ensuring healthy borders.

Engaging with the private sector is also essential. While governments have a large role to play in addressing regional public goods, partnering with the private sector can bring innovation, competition, and new solutions to mitigating harm and maximizing health benefits.

I appreciate the challenges inherent in these efforts. But at the same time, experience leaves me optimistic. The GMS and ASEAN more broadly are strong platforms for collaboration and integration. Regional responses to HIV and avian influenza demonstrate that good inter-sectoral, cross-country coordination is possible. Regional collaboration behind the new, multi-donor funded artemisinin, or drug resistant malaria, initiative is also heartening and underscores this lesson.

In addition, I have been impressed by some of the excellent examples of cross-border health collaboration being directed by provincial governments on both sides of the national boundaries in the GMS. Effective local leadership and action are necessary to mobilize response to communicable disease priorities. And good examples of public private partnerships that improve health outcomes also exist at both regional and national levels.

Conclusion

In conclusion, to help sustain economic growth in the GMS and improve the lives of the people in the GMS, it is important that we consider all possible consequences of major development activities, particularly in border areas. We need to promote appropriate health impact assessment, risk mitigation, and maximization of opportunities to improve health. We also need to appreciate that health solutions, particularly effective communicable disease control, often requires a multi-sectoral and multi-country approach, and support of the private sector.

I hope that through this meeting and other forums, dialogue with governments and stakeholders, and other advocacy efforts, a road map for the development of workable structures and procedures for various types of collaboration can be established.

I wish you a constructive and productive day. Thank you.