Health and medical care is a highly humanitarian field of assistance with a direct bearing on the lives and health of individual citizens. Japan has furnished aid for the development of core health care systems at the national and regional levels, as well as for the broad-based provision of primary health care services to all segments of the public. For some years now, population, AIDS, and emerging and re-emerging infectious diseases such as malaria have become the key subjects on the agenda for discussion at summits of the leading industrial nations, thus underscoring a growing sense of alarm within the international community that these are challenges demanding concerted, emergency action by humanity at large. Japan itself has been actively involved in efforts to address these problems. In fact, its efforts have become one of the key areas for cooperation and assistance under the Japan-U.S. Common Agenda.¹⁸

Last year Japan's ODA devoted extensive attention to aid topics in this particular field. Following is an overview chiefly of developments within specific sectors over the intervening year.

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Section 1 Population and AIDS

The world population stood at an estimated 6 billion in 1999, and is expected to reach 8 billion by the year 2025. The task of curbing population growth has become a global challenge that is closely related to problems with the environment, food, and energy resources. In many developing countries, population growth in particular has factored significantly behind worsening conditions of poverty, unemployment, hunger, backward education, and environmental deterioration.

AIDS, moreover, has spread beyond national borders at an alarming pace. According to estimates issued by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO), as of the end of 1998, the number of people infected by HIV/AIDS totaled 33.4 million worldwide. In 1998 alone, as many as 5.8 million people were infected by the HIV, and another 2.5 million died of AIDS. In view of the fact that a majority of those infected live in the developing world, the AIDS pandemic represents a serious bottleneck to economic progress in many developing countries.

In February 1994 Japan announced its Global Issues Initiative on Population and AIDS (GII), an independent undertaking designed to furnish a total of $3 billion over the ensuing seven years (to FY2000) for active aid projects in these two fields. The GII is rooted in a comprehensive approach, shaped in part by the perspectives on reproductive health¹⁹ as articulated in the Programme of Action adopted at the International Conference on Population and Development (the ICPD, which convened in Cairo, September 1994). Those perspectives incorporate direct assistance for efforts in family planning and a variety of indirect assistance to help curb population growth and the spread of AIDS, including maternal and child health care, primary education, and steps for the empowerment of women. Specific efforts include such activities as medical examinations for pregnant women, immunization programs, and regular medical checkups, improvements in nutrition, the dissemination of family planning concepts, IEC (Information, Education and Communications) campaigns and the promotion of health systems, as modeled on Japan's mother and child health handbooks. Equipment and materials needed for these activities have also been provided, in addition to training programs for the health and medical staff.

In pushing ahead the GII, Japan selected 12 countries²⁰ for priority attention, and by 1998 had dispatched project formulation missions to a total of 15 countries²¹ for project finding and formulation purposes. The GII has been assigned an important place within the Japan- U.S. Common Agenda framework; in December 1998, Japan sent a joint team with U.S. to Zambia to formulate projects for Japan-U.S. collaboration in areas of population, AIDS and child health. Japan has been striving to work closely with various international organizations including the United Nations Population Fund (UNFPA), UNAIDS, and WHO. Further, it has placed importance on collaboration with NGOs independently active in these fields, and has enjoyed the participation and cooperation from the Japan Organization for International Cooperation in Family Planning (JOICFP) and other NGOs from the early project study stages.

As an outgrowth of these efforts, by the end of FY1998, Japan had already disbursed more than $3.7 billion for GII-related ODA projects, substantially exceeding its seven-year target. At the UN General Assembly Special Session on Population and Development (ICPD+5) that convened from June 30 to July 2, 1999, State Secretary for Foreign Affairs Nobutaka Machimura presented Japan's GII-related ODA contributions to date, and announced that Japan will continue to give population and HIV/AIDS high priority in its ODA policy for the future as well, focusing more on assistance for population growth control and the fight against HIV/AIDS.

State Secretary for Foreign Affairs Nobutaka Machimura
delivering his address at the UN General Assembly Special Session on Population and Development in July 1999.

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Section 2 Global Parasite Control

Malaria, schistosomiasis, and other parasitic diseases count among the most serious of health threats to people living in tropical zones. In fact, every year malaria alone infects more than 300 million people worldwide and takes the lives of an estimated 1 million.

Japan has acquired experience in subduing an array of parasitic diseases. At the Denver Summit in 1997, it underlined the importance of measures against parasitic infection and emphasized the need for cooperative programs to this end at the international level. Later, at the Birmingham Summit in 1998, then-Prime Minister Ryutaro Hashimoto re-emphasized these points, and recommended several steps to improve the effectiveness of international countermeasures against parasitic diseases. In particular, he proposed the establishment of centers for human resources development and research in Asia and Africa, the formation of center-led international networks through collaboration with WHO and the G8 countries, and the promotion of human resources development and information exchanges on countermeasures against parasitic infection. In line with these Japanese proposals, the summit communiqué incorporated G8 commitments for stronger cooperation in the battle against infectious and parasitic diseases and to assisting WHO efforts in those areas. Furthermore, the communiqué issued by the Köln Summit in June 1999 explicitly called for sustained efforts at the national and international levels to counter the spread of parasitic and infectious diseases.

To put these recommendations into action, various Japanese government ministries (MoFA, the Ministry of Health and Welfare, and the Ministry of Education), aid agencies (JICA and the JBIC), and academics have begun meeting to make preparations for the establishment of centers for the promotion of human resources development and other forms of South-South cooperation in Thailand, Kenya, and Ghana.

Japan has been actively engaged in a variety of grant- and technical cooperation-based undertakings that are aimed at improving health conditions for citizens in developing countries where parasitic infection is a serious health risk. For example, over an eight year span beginning in FY1989, it provided a cumulative ¥10 billion in grant assistance to nine countries in western Africa for projects that sought to eradicate Guinea worm disease (dracunculiasis)²² by improving sanitary conditions with the supply of safe drinking water. Japan has also been providing grassroots project grant assistance for ventures under the Global 2000 Project spearheaded by the Carter Center, an ardent supporter of efforts to combat the Guinea worm. Further, to help prevent the spread of malaria, it has supplied mosquito nets to the Philippines, Laos, and Zambia. Various project-type technical cooperation-based efforts to fight malaria and other parasitic diseases are currently under way in Ghana and Zimbabwe. Also, as an example of Japanese assistance through international organizations, a fraction of the funding contributed by Japan to WHO has been allocated for countermeasures against tropical diseases (malaria and dracunculiasis).

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Section 3 Child Health: Polio Eradication in the Western Pacific Region²³

The World Summit for Children sponsored by UNICEF (United Nations Children's Fund) in 1990, declared the promotion of child health a goal of top priority if children were to enjoy a brighter future. Japan has endorsed and actively assisted international efforts toward this goal. In 1994, child health was added to the Japan-U.S. Common Agenda as another area for cooperation. Since then, Japan and the U.S. have been collaborating closely to provide aid for projects in this field (consolidated with population issues and AIDS in 1997, and currently addressed within the context of population issues and health).

As one foundation for tangible aid undertakings designed to protect the health of children, WHO and UNICEF have been pursuing an expanded program of immunization that seeks to promote conventional vaccination²⁴ programs for children on a universal scale. Japan has been aiding this drive through multilateral and bilateral frameworks for cooperation with UNICEF. Polio is a serious health threat to children. In 1988, WHO called for an all-out effort to eradicate polio worldwide by the year 2000. National Immunization Day (NID) programs count as one of several vital initiatives aimed at eradicating polio through child vaccinations conducted on a national scale. International aid for NID undertakings has been provided by donors on a coordinated basis. Unlike AIDS, for which no established curative therapies exist, polio can be prevented by immunization campaigns. In fact, it is quite possible to protect children from the harms of polio through systematic and well-organized immunization programs.

Since FY1993, Japan has provided East Asian and Western Pacific region countries as priority regions (China, Viet Nam, Laos, and Cambodia) with supplies of polio vaccine, cold chain equipment (for the transport of refrigerated vaccine), and related diagnostic equipment. By FY1998, Japan had disbursed ¥3 billion in aid for polio eradication programs throughout the region, the largest share of any donor (37 percent of the total). Particularly in regard to the eradication of polio in China, Japan has been providing both equipment and technical cooperation. Assistance through the provision of vaccine to 80 million children for an NID program nationwide led to a successful implementation of the program which now serves as an NID model for other countries. China, in particular, implemented several NIDs between 1993 and 1995, and has not reported a single case of wild polio virus since 1996. In fact, thanks largely to efforts of this kind, no cases of wild polio virus have been reported anywhere in the Western Pacific region since the last case was found in Cambodia in March 1997. By WHO criteria, a region can be declared free of polio if no cases are reported within a three year span. Accordingly, it seems highly likely that the Western Pacific region will be declared completely polio-free by the year 2000.

Encouraged by the remarkable progress that has been made in the Western Pacific region, Japan decided to expand the geographic scope of its aid for the eradication of polio. The idea of including Southwest Asia within the scope of such aid was brought up during talks under the Japan-U.S. Common Agenda framework in 1995, and in 1996, the Japanese government announced that it was prepared to extend such aid to Africa. Also, on the occasion of the TICAD II in October 1998, polio eradication was incorporated as one of the objectives of aid programs for Africa. Japan has provided various African countries with vaccines and related equipment for polio vaccination campaigns, and recently, in FY1999 it began dispatching JOCV teams to Africa, primarily for surveillance activities conducted in collaboration with the U.S. Peace Corps.

Polio eradication programs worldwide have been so successful to date that currently outbreaks of the disease appear to be limited almost exclusively to certain areas of Africa and Southwest Asia. Various factors have impeded effective vaccination programs in these areas, including civil war, obstacles to the local delivery of vaccine supplies, and hot, harsh climates. Nonetheless, in view of the accomplishments made to date, it is necessary to continue actively assisting such efforts until polio is eradicated completely.

In addition to the eradication of polio, though, stronger levels of international cooperation will also be required to fight outbreaks of tuberculosis and other emerging and re-emerging infectious diseases.

TOPICS 14. An Anti-Malaria Program for Improvements in the Health of Zambian Children

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