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Your Excellencies, Prime Minister Mitchell,Heads of Government, CARICOM Secretary-General, CDB President, OECS Director General, and Partners,   ·        It is a privilege for me to join you today to discuss development finance opportunities for Small States and how the blue economy has become the next frontier for economic growth for the Caribbean, as well as other island and coastal countries. ·        To discuss this, I cannot think of a better setting than being in the beautiful spice island of Grenada. With its rich and pristine coastline and colorful reefs, and understanding of climate risks, Grenada is demonstrating its commitment to inclusive growth and enhancing investment in the Blue Economy. ·        Often when we meet to discuss development prospects for Caribbean countries, we devote significant attention to common challenges: small scale, high debt, exposure to external shocks, and dependency on fossil fuels.  ·        Today, I would like to focus more on hope and opportunity. Small economies are more open to trade and foreign investment. While they are highly specialized in their export sectors, they are also more nimble and able to change the structure of their economies and exports over time. ·        In fact, Caribbean countries have been more successful in reinventing themselves than some of the region’s giants. This region managed to find a niche in the highly competitive global industry after it lost its trade preference treatment with Europe in the 1980s. ·        Today, there is an opportunity for CARICOM countries to find new sources of growth by transitioning to a blue economy and to leverage new sources of financing. ·        There are a number of important questions that would be useful to reflect on today, but for this discussion I would like to focus on two: 1.     What is the blue economy and what opportunities it can offer for growth? 2.     How can the World Bank assist the CARICOM countries to leverage new sources of financing in their pursuit of inclusive and sustainable growth? New report: “Toward a Blue Economy: A promise for sustainable growth in the Caribbean” ·        Ocean assets and services are drivers of economic growth: The Caribbean Sea generated US$407 billion in gross revenue in 2012, equivalent to almost 18 percent of Caribbean GDP, including mainland Caribbean coastal countries. This comes from marine tourism, oil and gas, maritime shipping, fishing, etc. ·        Caribbean island and coastal states may be small in terms of population and land area, but large when it comes to marine area.  In fact, they are ‘Great Ocean States’.  For example, St. Lucia’s ocean area is over 7 times greater than its land area and for Grenada over 70 times greater. ·        Ocean Health = Ocean Wealth Harnessing marine resources while preserving the Caribbean Sea’s health, can help countries address key challenges such as high unemployment, low growth, food security, poverty and resilience to climate change. – 1.5 million people rely on fishing for their livelihood and fish for food security; – Reefs such as Belize Barrier Reefs reduce 75% of destructive capabilities from storm surges – Marine Tourism directly and indirectly supports two million direct and indirect jobs and generates over US$ 40 billion annually to Caribbean islands alone. ·        With a growing population, demand for seafood and aquaculture production will increase, shipping traffic and tourism will continue to grow, and new ocean industries will emerge. ·        If we look globally, ocean based industries such as fisheries, tourism, and shipping drive global trade, and annually contribute around 3 percent or $1.5 trillion in value added globally. ·        If “Thinking green” was the focus of the past decade, Small Island Developing States and Coastal Economies are now starting to “think blue”.  ·        This report identifies key priorities to generate blue growth, while ensuring that oceans and marine ecosystems are sustainably managed and used. ·        Already the impacts of overfishing, coastal development, pollution and climate change are being felt by coastal communities around the world: about 75 percent of the region’s coral reefs are considered to be at risk from human activity and 85 percent of wastewater enters the Caribbean Sea untreated. ·        Tourists come to the Caribbean region largely for its beautiful beaches and sea attractions, which puts tremendous pressure on the very coastal ecosystems that drive economies.  ·        A successful transition to a blue economy would mean that countries could better measure the region’s rich marine resources, better manage its ocean space, and ultimately achieve greater growth and prosperity from sound management of the ocean. Three recommendations are: 1) Identify, value and map ocean assets: This will allow countries to better manage their ocean wealth and develop smart policies to promote a healthy, resilient and productive marine environment: marine special plans like OECS countries are planning to do with our support. 2) Regional integration and cooperation is essential to drive economic growth from the Caribbean Sea: This is particularly important as many ocean assets are transboundary in nature (fisheries; shipping; minerals; oil and gas; biodiversity). The Eastern Caribbean Regional Ocean Policy is a good framework that can help countries pool resources and more effectively manage their ocean wealth. 3) Promoting private sector investments in blue economy: This means creating enabling conditions for private investment in ocean industries; building ‘blue green’ infrastructure (e.g. building a port using natural mangrove barriers); and supporting ocean MSMEs to generate ‘blue jobs’. ·        Your Excellencies, in our view, there has never been a better time than now for the coastal and island nations to invest in the transition to a blue economy.  I would like to congratulate many of you for the important steps that you are already taking. This brings me to the second question; how can the WBG leverage new sources of financing in support of growth? ·        In recent years, small states have taken a collective stand in international fora to highlight the development challenges they face and urge more attention to their concerns.   ·        In response, the World Bank Small States initiative, now chaired by Grenada, has developed a roadmap for World Bank Group Engagement with Small States which identifies priorities for engagement including: predictability of affordable financing; access to new and existing climate financing; and capacity building among others. ·        We are working with different partners in the region and across the globe to find ways to make these priorities become concrete actions. ·        For example, together with the Organization of the Eastern Caribbean States Commission, we have secured over $6 million in additional Global Environmental Facility grants to support the implementation of regional activities of the Eastern Caribbean Regional Oceans Policy (ECROP).  A comprehensive marine spatial plan is expected to be prepared and adopted under this program. The Caribbean states also require special financing to help them address common vulnerabilities. This means combining both public and private financing. 1.     In the context of small, open and highly volatile economies, continued efforts on fiscal consolidation and structural reforms are essential to free up greater public financing for growth. A few countries in the region have taken concrete measures that will allow them to save in good times so that they can respond fast when the need arises. Grenada has recently adopted a medium-term fiscal framework anchored on clear spending rules, While Saint Vincent and the Grenadines has established a contingent fund within the state budget that will be used exclusively to respond to disasters. 2.     Leveraging private finance in the face of increasing volatility is indeed challenging. The World Bank Group is addressing this by working on operationalizing a new approach to development financing. ·        We will be devoting more resources to help governments create the right conditions for boosting private investments in transport, connectivity, technology, as well as climate resilience. ·        We are also using concessional finance through the International Development Association (IDA) in innovative ways to mitigate risk, and blend finance to support private sector investment. This includes the new IDA 18 Private sector window, which will leverage $2.5 billion in IDA capital to mobilize at least $6-8 billion in private sector investments in the poorest and most fragile markets over the next three years. ·        In addition, under the three year IDA18 cycle, starting from July 1, US$630 million will be available to six eligible CARICOM countries: Dominica, Grenada, Guyana, Haiti, Saint Lucia, and Saint Vincent and the Grenadines. This is tripling of resources available under the IDA17 cycle providing a unique opportunity to earmark resources in support of regional and country priorities. ·        For the first time, IDA 18 also provides enhanced crisis response facilities and instruments that will be available to small states: The Catastrophe Deferred Drawdown Option (CAT-DDO) is a contingent financing line that until now was only offered to IBRD countries.  It provides immediate liquidity to countries after a catastrophe. ·        To build resilience, the Caribbean Catastrophe Risk Insurance Facility is another example of effective and attractive risk pooling mechanism able to mobilize emergency funds within the first two weeks of a disaster. Several countries, including Haiti, are members and have used this Facility. ·        In closing, I would like to reiterate the World Bank Group’s continued and deep commitment to work as your partners in support of country and regional priorities.   ·        At present, committed financing under World Bank assisted ongoing projects amounts to $1.5 billion in the region, out of which almost $1 billion is IDA concessional financing. This is complemented by analytic and knowledge support such as the Blue Economy report I discussed today. ·        Your Excellencies, this is a special time for CARICOM and its member-states to come together and join forces in the pursuit of stable growth, while leading the transition to a blue economy. ·        I look forward to an energizing and engaging discussion. ·        Thank you once again for inviting me to participate in this forum.    Read the report: Towards a Blue Economy

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PORT-AU-PRINCE, le 27 juin 2017 – Selon un nouveau rapport publié par la Banque mondiale aujourd’hui, le secteur de santé a besoin de plus d’investissements publiques et d’une meilleure allocation des dépenses pour améliorer l’accès aux soins pour tous les Haïtiens. Le rapport « Mieux dépenser pour mieux soigner : un regard sur le financement de la santé en Haïti» souligne que les dépenses publiques de santé par habitant n’atteignent que 13 dollars par an ce qui est inférieur à la moyenne de 15 dollars des pays à faible revenu, et bien en dessous de la moyenne des pays voisins comme la République Dominicaine (180 dollars) ou Cuba (781 dollars). Par ailleurs, une hausse importante de financement des ONG et de la communauté internationale a fait suite au tremblement de terre, mais ce financement baisse de façon significative, mettant en question la durabilité des investissements dans le secteur. Dans le contexte de succession de situations d’urgence auquel fait face le pays, plus de la moitié des dépenses totales de santé correspondent à des soins curatifs plutôt que préventifs. Par ailleurs, 38% des dépenses totales de santé sont consacrées au secteur hospitalier, notamment dû au nombre élevé d’hôpitaux – bien plus que dans d’autres pays comme le Burundi (23%) ou la Tanzanie (26%). Cependant, ces hôpitaux ne sont souvent pas suffisamment équipés pour le niveau de soins requis et donc ce niveau de dépenses ne se traduit pas par une augmentation des prestations de services.  Les coûts de traitement en milieu hospitalier sont bien supérieurs à ceux des centres de santé primaire et le pays ne dispose que de 0,3 dispensaires pour 10,000 habitants, un ratio bien inférieur à la norme établie par le Ministère de la santé et de la population d’Haïti. « Avec le déclin de l’aide internationale, une couverture sanitaire universelle ne peut être atteinte qu’en priorisant les soins de santé primaires et en étendant l’accès aux traitements essentiels pour les plus pauvres», a déclaré Eleonora Cavagnero, économiste de la santé pour Haïti à la Banque mondiale et auteure principale du rapport. Malgré des progrès observés au travers de l’augmentation de l’espérance de vie et de la diminution de la mortalité infantile et maternelle de moitié entre 1990 et 2015, Haïti fait face à de nombreux défis en matière de santé : la mortalité infantile et maternelle reste quatre à cinq fois plus élevée que pour l’ensemble de la région Amérique latine et Caraïbes. Seul 68% des enfants de moins de 24 mois ont reçu les trois doses du vaccin contre la diphtérie, le tétanos et la coqueluche, alors que ce chiffre est de 80% dans les pays de niveau économique similaire. « Les investissements n’ont pas été réalisés là où ils étaient les plus nécessaires, » a déclaré Mary Barton-Dock, Envoyée spéciale de la Banque mondiale en Haïti. « En ces temps de lourdes contraintes budgétaires, il faut passer à un mécanisme de financement fondé sur les résultats pour rendre le système de santé plus efficient et plus équitable. » Le rapport propose plusieurs options afin de « mieux dépenser pour mieux soigner » et offrir une meilleure couverture sanitaire pour les plus pauvres: ·       Accroitre les ressources publiques pour la santé : Malgré les besoins en matière de santé, la part du budget de l’état haïtien alloué à la santé n’a cessé de diminuer au cours de 12 dernières années, baissant de 16.6% du budget national en 2004 – un chiffre supérieur à la moyenne de la région d’Amérique latine et Caraïbes – à 4.4% du budget national actuel. Avec la forte diminution du financement des bailleurs de fonds de ces dernières années, le gouvernement doit planifier d’urgence un relèvement du financement public pour la santé et une meilleure coordination de l’aide internationale. L’élaboration de taxes spéciales pour la santé, telles qu’une taxe sur le tabac et l’alcool, pourrait permettre de mobiliser des fonds dans le secteur. ·       Prioriser les soins de santé primaires et préventifs : Cela implique rediriger une partie du financement vers les soins de santé primaires, et prioriser et chiffrer le Plan Directeur de santé actuel. Le renforcement de la prestation de services de soins de santé préventifs et primaires contribuerait à maximiser la réduction des principales causes de mortalité en Haïti. Les partenaires de développement devraient financer une assistance technique pour aider la pérennisation financière des hôpitaux, consolider l’infrastructure existante et mettre en place une politique d’octroi de licences. Cette réorientation des investissements dans le secteur santé devrait être guidée par des données objectives. ·       Accroitre l’accès équitable à des soins de qualité : Cela demande de mettre en œuvre une cartographie des institutions sanitaires en les reclassifiant afin d’améliorer leur capacité opérationnelle et de faciliter la mise en œuvre d’un réseau de référence pratique. Cette reclassification devrait permettre une meilleure répartition des équipements médicaux et médicaments. Une politique favorisant un accès géographique aux services de santé primaires de qualité plus équitable doit être mise en œuvre. Parmi les ménages qui n’ont pas consulté de professionnel de santé, 49% répondent ne pas l’avoir fait pour des raisons financières.  Cela devrait être accompagné par une amélioration de l’efficience et de la rentabilité de la prestation de services en liant le financement du personnel et des institutions sanitaires aux résultats. ———————————————————————————————————————————Contacts : À Washington : Christelle Chapoy, (202) 361 4255, cchapoy@worldbank.org Pour en savoir plus sur les activités de la Banque mondiale en Amérique latine et dans les Caraïbes : www.worldbank.org/lac Rejoignez-nous sur Facebook : http://www.facebook.com/worldbank Suivez notre actualité :          Sur Twitter : @WBCaribbean Sur YouTube : http://www.youtube.com/worldbank  

PORT-AU-PRINCE, June 27, 2017 – A new report issued today by the World Bank reveals that the health sector needs more public investments and better allocation of resources to improve access to health care for all Haitians. The report, titled “Better Spending, Better Care: A Look at Haiti’s Health Financing”, highlights that public spending on health care per capita is US$13 per year, which is below the average of US$15 in low-income countries and substantially lower than the average in neighboring countries, such as the Dominican Republic (US$180) and Cuba (US$781). In addition, there was a significant increase in funding from NGOs and the international community followed the earthquake, but this funding is falling significantly, calling into question the sustainability of investments in the sector. In the context of repeated emergencies faced by the country, more than half of total health expenditure goes toward curative rather than preventive health care. In fact, 38 percent of total health expenditure is devoted to the hospital sector, owing primarily to the large number of hospitals, which is significantly higher than in countries such as Burundi (23 percent) and Tanzania (26 percent). The hospitals are often under-equipped to provide the level of care required, and the current level of expenditure has not led to increased service delivery. Costs for in-patient care are much higher than those in primary health centers. The nationwide ratio of clinics to inhabitants is 0.3 per 10,000, significantly below the standard set by Haiti’s Ministry of Public Health and Population. “The decline in international assistance means that unless primary health care is prioritized with greater access to essential treatment for the people most in need, universal health coverage will not be possible,” said Eleonora Cavagnero, Health Economist for Haiti at the World Bank and lead author of the report. Life expectancy increased and infant and maternal mortality were halved between 1990 and 2015. However, Haiti remains vulnerable to many heath challenges: infant and maternal mortality rates are four or five times higher than those of Latin America and the Caribbean. Only 68 percent of children under 24 months have received the three vaccines to prevent diphtheria, tetanus, and pertussis, compared to 80 percent in countries in a similar economic bracket. World Bank Special Envoy to Haiti, Mary A. Barton-Dock, points out that “investments have not been made in areas crying out for them. In the current environment of severe budgetary constraints, what is required is a results-based financing mechanism to make the health care system more efficient and more equitable.” The report proposes options to achieve better care through better spending, and improve health coverage for the poorest: ·       Increase public spending in health: Despite the country’s health needs, the government’s budget allocation for health declined significantly over the past twelve years, dropping from 16.6 percent of the national budget in 2004 (above the average for Latin America and the Caribbean) to 4.4 percent of the current budget. Given the sharp reduction in donor funding in recent years, the government must plan for an immediate increase in public expenditure in health and improved coordination of international assistance. The creation of special taxes—on tobacco and alcohol, for example—could help raise funds for the health sector. ·       Prioritize primary and preventive health care: This will involve redirecting funds to primary care, while prioritising and calculating the cost within the current Health Master Plan. Bolstering service delivery in primary and preventive health care will greatly assist in reducing the leading causes of mortality in Haiti. Development partners should finance technical assistance to help hospitals achieve financial sustainability, strengthen existing infrastructure, and put in place a licensing policy. This shift in investments in the heath sector should be evidence-based. ·       Improve equitable access to quality health care: This will be achieved by mapping health facilities and reclassifying them to improve their operational capacity and establish a functioning referral network. This reclassification exercise will help improve the distribution of medical equipment and medicines. A policy that promotes a more equitable geographic access to primary health services needs to be implemented. Among households that did not consult a health professional, 49% responded that they did not do so for financial reasons. This policy also promises to increase efficiency and cost-effectiveness in service delivery at the primary health care level by linking funding of health personnel and institutions to results. Contact: In Washington: Christelle Chapoy, (202) 361 4255, cchapoy@worldbank.org ———————————————————————————————————————————————– For more information on the World Bank in Latin America and the Caribbean, visit: www.worldbank.org/lac Follow us on Facebook: http://www.facebook.com/worldbank Twitter: @WBCaribbean YouTube: www.youtube.com/worldbank

Washington, June 28, 2017- The 2016-2020 Country Partnership Framework (CPF) that establishes the parameters for the World Bank’s collaboration with Bolivia has been in effect since last year. Under this agreement, the World Bank has made up to US$ 2 billion available to the country to finance development projects in different areas. To date, US$ 615 million of these resources have been approved for investment operations in transportation and  rural development. For the period 2017-2019, the World Bank Board of Directors is considering new operations for US$ 525 million in water and sanitation and irrigation, with a focus on risk prevention and resilience to climate change. The CPF was developed at the request of the Government of Bolivia. It is based on the systematic country diagnostic and the comparative advantages of the Bank over other financial institutions. The implementation of the CPF will benefit – directly or indirectly – more than 4.5 million citizens, most of them low-income. “This work framework guides the commitments and actions we are adopting to support the country. We are satisfied with the progress and the dialogue we have with national authorities, with whom we are analyzing the areas where Bank support can have the most impact,” said Nicola Pontara, World Bank Representative in Bolivia. The CPF was developed in accordance with the objectives of the Economic and Social Development Plan of the Plurinational State of Bolivia. The plan seeks to operationalize the Patriotic Agenda 2025 that establishes medium-term objectives to eliminate extreme poverty and translate growth into well-being. The CPF has two main pillars: to promote broad-based and inclusive growth and to support environmental and fiscal sustainability and resilience to climate change and economic shocks.  For more information, see http://documents.worldbank.org/curated/en/921771468186539912/pdf/100985-REVISED-OUO-9-R2015-0221.pdf.

Junio 28 de 2017- Desde el pasado año rige el Marco de Alianza con el País (MAP) que establece los parámetros de trabajo que el Banco Mundial ejecuta en Bolivia en el periodo 2016-2020. Bajo este acuerdo, se ha puesto a disposición del país un monto de hasta US$ 2.000 millones para financiar proyectos de desarrollo en diversas áreas. Hasta la fecha, de estos recursos han sido aprobados US$ 615 millones en operaciones de inversión en transporte y desarrollo rural y se encuentran en preparación, para consideración del Directorio del Banco entre 2017-2019, cuatro nuevas operaciones por US$ 525 millones en los sectores de agua y saneamiento y riego, con un enfoque en la generación de resiliencia y prevención de riesgos asociados a factores climáticos. El MAP fue desarrollado en base a la demanda del Gobierno boliviano, el diagnóstico sistemático del país y las ventajas comparativas de la institución frente a otros financiadores. Como resultado de su implementación, se beneficiarán -directa e indirectamente- más de 4.5 millones ciudadanos, en su mayoría de escasos recursos. “Este marco de trabajo guía los compromisos y acciones que estamos adoptando para apoyar al país. Estamos satisfechos con los avances y con el diálogo que tenemos con las autoridades nacionales con quienes, en conjunto, estamos analizando cuáles son las áreas donde el apoyo del Banco puede tener el mayor impacto”, señaló Nicola Pontara, Representante del Banco Mundial en Bolivia. El Marco de Alianza fue formulado en concordancia con los objetivos del Plan de Desarrollo Económico y Social del Gobierno del Estado Plurinacional de Bolivia, el cual responde a la Agenda Patriótica 2025, que establece objetivos a mediano plazo para eliminar la pobreza extrema y traducir el crecimiento en bienestar. El MAP tiene dos pilares principales: la promoción del crecimiento inclusivo y el apoyo a la sostenibilidad ambiental y fiscal con resiliencia al cambio climático y choques económicos. Para conocer más detalles http://documents.worldbank.org/curated/en/27654307   RELACIONADO: Video: Marco de Alianza con Bolivia 2016 – 2020 El Deber de Bolivia: Nicola Pontara: “Bolivia tiene a disposición $us 2.000 millones”  

Bien que l’espérance de vie ait augmenté entre 1990 et 2015, Haïti reste confronté à de nombreux défis pour le système de santé. L’accès aux soins de santé primaires et préventifs demeure faible, en particulier parmi les plus démunis. La mortalité infantile et maternelle est encore 3 à 5 fois supérieure à la moyenne régionale, et seulement 68 pour cent des enfants de moins de 24 mois ont reçu les trois vaccins pour prévenir la diphtérie, le tétanos et la coqueluche, comparé à 80 pour cent dans les pays de revenu économique similaire.À 13 $ par habitant par an, les dépenses publiques en santé sont inférieures à la moyenne des pays à faible revenu. Par ailleurs, plus de la moitié de toutes les dépenses de santé sont allouées à des soins curatifs plutôt que préventifs : Haïti possède de nombreux hôpitaux sous-équipés, mais seulement 0,3 dispensaires pour 10 000 personnes. Le rapport propose plusieurs options afin de « mieux dépenser pour mieux soigner » : Une meilleure couverture sanitaire pour les plus démunis va requérir une augmentation des dépenses publiques pour la santé et une meilleure utilisation des ressources existantes. Les soins de santé primaires doivent être priorisés et l’élimination des barrières financières et géographiques permettront d’accroître l’accès à des soins de qualité.Lire le rapport

While life expectancy has increased between 1990 and 2015, Haiti remains vulnerable to many heath challenges. Access to primary and preventive health care is low, particularly among the poorest. Infant and maternal mortality are still 5 and 3 times higher than the regional average, and only 68 percent of children under 24 months have received the three vaccines to prevent diphtheria, tetanus, and pertussis, compared to 80 percent in countries in a similar economic bracket. At $13 per capita a year, public spending on health is below the average for low-income countries. In addition, more than half of all health spending is allocated to curative rather than preventive care: Haiti has many under-equipped hospitals, but only 0.3 dispensaries per 10,000 people. The report proposes several options to achieve better care through better spending. Providing better health coverage for the poorest will require an increase in public spending for health and better use of existing resources. Primary health care needs to be prioritized, and removing financial and geographical barriers will increase access to quality care. Read the report 

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Your Excellencies, Prime Minister Mitchell,Heads of Government, CARICOM Secretary-General, CDB President, OECS Director General, and Partners,   ·        It is a privilege for me to join you today to discuss development finance opportunities for Small States and how the blue economy has become the next frontier for economic growth for the Caribbean, as well as other island and coastal countries. ·        To discuss this, I cannot think of a better setting than being in the beautiful spice island of Grenada. With its rich and pristine coastline and colorful reefs, and understanding of climate risks, Grenada is demonstrating its commitment to inclusive growth and enhancing investment in the Blue Economy. ·        Often when we meet to discuss development prospects for Caribbean countries, we devote significant attention to common challenges: small scale, high debt, exposure to external shocks, and dependency on fossil fuels.  ·        Today, I would like to focus more on hope and opportunity. Small economies are more open to trade and foreign investment. While they are highly specialized in their export sectors, they are also more nimble and able to change the structure of their economies and exports over time. ·        In fact, Caribbean countries have been more successful in reinventing themselves than some of the region’s giants. This region managed to find a niche in the highly competitive global industry after it lost its trade preference treatment with Europe in the 1980s. ·        Today, there is an opportunity for CARICOM countries to find new sources of growth by transitioning to a blue economy and to leverage new sources of financing. ·        There are a number of important questions that would be useful to reflect on today, but for this discussion I would like to focus on two: 1.     What is the blue economy and what opportunities it can offer for growth? 2.     How can the World Bank assist the CARICOM countries to leverage new sources of financing in their pursuit of inclusive and sustainable growth? New report: “Toward a Blue Economy: A promise for sustainable growth in the Caribbean” ·        Ocean assets and services are drivers of economic growth: The Caribbean Sea generated US$407 billion in gross revenue in 2012, equivalent to almost 18 percent of Caribbean GDP, including mainland Caribbean coastal countries. This comes from marine tourism, oil and gas, maritime shipping, fishing, etc. ·        Caribbean island and coastal states may be small in terms of population and land area, but large when it comes to marine area.  In fact, they are ‘Great Ocean States’.  For example, St. Lucia’s ocean area is over 7 times greater than its land area and for Grenada over 70 times greater. ·        Ocean Health = Ocean Wealth Harnessing marine resources while preserving the Caribbean Sea’s health, can help countries address key challenges such as high unemployment, low growth, food security, poverty and resilience to climate change. – 1.5 million people rely on fishing for their livelihood and fish for food security; – Reefs such as Belize Barrier Reefs reduce 75% of destructive capabilities from storm surges – Marine Tourism directly and indirectly supports two million direct and indirect jobs and generates over US$ 40 billion annually to Caribbean islands alone. ·        With a growing population, demand for seafood and aquaculture production will increase, shipping traffic and tourism will continue to grow, and new ocean industries will emerge. ·        If we look globally, ocean based industries such as fisheries, tourism, and shipping drive global trade, and annually contribute around 3 percent or $1.5 trillion in value added globally. ·        If “Thinking green” was the focus of the past decade, Small Island Developing States and Coastal Economies are now starting to “think blue”.  ·        This report identifies key priorities to generate blue growth, while ensuring that oceans and marine ecosystems are sustainably managed and used. ·        Already the impacts of overfishing, coastal development, pollution and climate change are being felt by coastal communities around the world: about 75 percent of the region’s coral reefs are considered to be at risk from human activity and 85 percent of wastewater enters the Caribbean Sea untreated. ·        Tourists come to the Caribbean region largely for its beautiful beaches and sea attractions, which puts tremendous pressure on the very coastal ecosystems that drive economies.  ·        A successful transition to a blue economy would mean that countries could better measure the region’s rich marine resources, better manage its ocean space, and ultimately achieve greater growth and prosperity from sound management of the ocean. Three recommendations are: 1) Identify, value and map ocean assets: This will allow countries to better manage their ocean wealth and develop smart policies to promote a healthy, resilient and productive marine environment: marine special plans like OECS countries are planning to do with our support. 2) Regional integration and cooperation is essential to drive economic growth from the Caribbean Sea: This is particularly important as many ocean assets are transboundary in nature (fisheries; shipping; minerals; oil and gas; biodiversity). The Eastern Caribbean Regional Ocean Policy is a good framework that can help countries pool resources and more effectively manage their ocean wealth. 3) Promoting private sector investments in blue economy: This means creating enabling conditions for private investment in ocean industries; building ‘blue green’ infrastructure (e.g. building a port using natural mangrove barriers); and supporting ocean MSMEs to generate ‘blue jobs’. ·        Your Excellencies, in our view, there has never been a better time than now for the coastal and island nations to invest in the transition to a blue economy.  I would like to congratulate many of you for the important steps that you are already taking. This brings me to the second question; how can the WBG leverage new sources of financing in support of growth? ·        In recent years, small states have taken a collective stand in international fora to highlight the development challenges they face and urge more attention to their concerns.   ·        In response, the World Bank Small States initiative, now chaired by Grenada, has developed a roadmap for World Bank Group Engagement with Small States which identifies priorities for engagement including: predictability of affordable financing; access to new and existing climate financing; and capacity building among others. ·        We are working with different partners in the region and across the globe to find ways to make these priorities become concrete actions. ·        For example, together with the Organization of the Eastern Caribbean States Commission, we have secured over $6 million in additional Global Environmental Facility grants to support the implementation of regional activities of the Eastern Caribbean Regional Oceans Policy (ECROP).  A comprehensive marine spatial plan is expected to be prepared and adopted under this program. The Caribbean states also require special financing to help them address common vulnerabilities. This means combining both public and private financing. 1.     In the context of small, open and highly volatile economies, continued efforts on fiscal consolidation and structural reforms are essential to free up greater public financing for growth. A few countries in the region have taken concrete measures that will allow them to save in good times so that they can respond fast when the need arises. Grenada has recently adopted a medium-term fiscal framework anchored on clear spending rules, While Saint Vincent and the Grenadines has established a contingent fund within the state budget that will be used exclusively to respond to disasters. 2.     Leveraging private finance in the face of increasing volatility is indeed challenging. The World Bank Group is addressing this by working on operationalizing a new approach to development financing. ·        We will be devoting more resources to help governments create the right conditions for boosting private investments in transport, connectivity, technology, as well as climate resilience. ·        We are also using concessional finance through the International Development Association (IDA) in innovative ways to mitigate risk, and blend finance to support private sector investment. This includes the new IDA 18 Private sector window, which will leverage $2.5 billion in IDA capital to mobilize at least $6-8 billion in private sector investments in the poorest and most fragile markets over the next three years. ·        In addition, under the three year IDA18 cycle, starting from July 1, US$630 million will be available to six eligible CARICOM countries: Dominica, Grenada, Guyana, Haiti, Saint Lucia, and Saint Vincent and the Grenadines. This is tripling of resources available under the IDA17 cycle providing a unique opportunity to earmark resources in support of regional and country priorities. ·        For the first time, IDA 18 also provides enhanced crisis response facilities and instruments that will be available to small states: The Catastrophe Deferred Drawdown Option (CAT-DDO) is a contingent financing line that until now was only offered to IBRD countries.  It provides immediate liquidity to countries after a catastrophe. ·        To build resilience, the Caribbean Catastrophe Risk Insurance Facility is another example of effective and attractive risk pooling mechanism able to mobilize emergency funds within the first two weeks of a disaster. Several countries, including Haiti, are members and have used this Facility. ·        In closing, I would like to reiterate the World Bank Group’s continued and deep commitment to work as your partners in support of country and regional priorities.   ·        At present, committed financing under World Bank assisted ongoing projects amounts to $1.5 billion in the region, out of which almost $1 billion is IDA concessional financing. This is complemented by analytic and knowledge support such as the Blue Economy report I discussed today. ·        Your Excellencies, this is a special time for CARICOM and its member-states to come together and join forces in the pursuit of stable growth, while leading the transition to a blue economy. ·        I look forward to an energizing and engaging discussion. ·        Thank you once again for inviting me to participate in this forum.    Read the report: Towards a Blue Economy

PORT-AU-PRINCE, le 27 juin 2017 – Selon un nouveau rapport publié par la Banque mondiale aujourd’hui, le secteur de santé a besoin de plus d’investissements publiques et d’une meilleure allocation des dépenses pour améliorer l’accès aux soins pour tous les Haïtiens. Le rapport « Mieux dépenser pour mieux soigner : un regard sur le financement de la santé en Haïti» souligne que les dépenses publiques de santé par habitant n’atteignent que 13 dollars par an ce qui est inférieur à la moyenne de 15 dollars des pays à faible revenu, et bien en dessous de la moyenne des pays voisins comme la République Dominicaine (180 dollars) ou Cuba (781 dollars). Par ailleurs, une hausse importante de financement des ONG et de la communauté internationale a fait suite au tremblement de terre, mais ce financement baisse de façon significative, mettant en question la durabilité des investissements dans le secteur. Dans le contexte de succession de situations d’urgence auquel fait face le pays, plus de la moitié des dépenses totales de santé correspondent à des soins curatifs plutôt que préventifs. Par ailleurs, 38% des dépenses totales de santé sont consacrées au secteur hospitalier, notamment dû au nombre élevé d’hôpitaux – bien plus que dans d’autres pays comme le Burundi (23%) ou la Tanzanie (26%). Cependant, ces hôpitaux ne sont souvent pas suffisamment équipés pour le niveau de soins requis et donc ce niveau de dépenses ne se traduit pas par une augmentation des prestations de services.  Les coûts de traitement en milieu hospitalier sont bien supérieurs à ceux des centres de santé primaire et le pays ne dispose que de 0,3 dispensaires pour 10,000 habitants, un ratio bien inférieur à la norme établie par le Ministère de la santé et de la population d’Haïti. « Avec le déclin de l’aide internationale, une couverture sanitaire universelle ne peut être atteinte qu’en priorisant les soins de santé primaires et en étendant l’accès aux traitements essentiels pour les plus pauvres», a déclaré Eleonora Cavagnero, économiste de la santé pour Haïti à la Banque mondiale et auteure principale du rapport. Malgré des progrès observés au travers de l’augmentation de l’espérance de vie et de la diminution de la mortalité infantile et maternelle de moitié entre 1990 et 2015, Haïti fait face à de nombreux défis en matière de santé : la mortalité infantile et maternelle reste quatre à cinq fois plus élevée que pour l’ensemble de la région Amérique latine et Caraïbes. Seul 68% des enfants de moins de 24 mois ont reçu les trois doses du vaccin contre la diphtérie, le tétanos et la coqueluche, alors que ce chiffre est de 80% dans les pays de niveau économique similaire. « Les investissements n’ont pas été réalisés là où ils étaient les plus nécessaires, » a déclaré Mary Barton-Dock, Envoyée spéciale de la Banque mondiale en Haïti. « En ces temps de lourdes contraintes budgétaires, il faut passer à un mécanisme de financement fondé sur les résultats pour rendre le système de santé plus efficient et plus équitable. » Le rapport propose plusieurs options afin de « mieux dépenser pour mieux soigner » et offrir une meilleure couverture sanitaire pour les plus pauvres: ·       Accroitre les ressources publiques pour la santé : Malgré les besoins en matière de santé, la part du budget de l’état haïtien alloué à la santé n’a cessé de diminuer au cours de 12 dernières années, baissant de 16.6% du budget national en 2004 – un chiffre supérieur à la moyenne de la région d’Amérique latine et Caraïbes – à 4.4% du budget national actuel. Avec la forte diminution du financement des bailleurs de fonds de ces dernières années, le gouvernement doit planifier d’urgence un relèvement du financement public pour la santé et une meilleure coordination de l’aide internationale. L’élaboration de taxes spéciales pour la santé, telles qu’une taxe sur le tabac et l’alcool, pourrait permettre de mobiliser des fonds dans le secteur. ·       Prioriser les soins de santé primaires et préventifs : Cela implique rediriger une partie du financement vers les soins de santé primaires, et prioriser et chiffrer le Plan Directeur de santé actuel. Le renforcement de la prestation de services de soins de santé préventifs et primaires contribuerait à maximiser la réduction des principales causes de mortalité en Haïti. Les partenaires de développement devraient financer une assistance technique pour aider la pérennisation financière des hôpitaux, consolider l’infrastructure existante et mettre en place une politique d’octroi de licences. Cette réorientation des investissements dans le secteur santé devrait être guidée par des données objectives. ·       Accroitre l’accès équitable à des soins de qualité : Cela demande de mettre en œuvre une cartographie des institutions sanitaires en les reclassifiant afin d’améliorer leur capacité opérationnelle et de faciliter la mise en œuvre d’un réseau de référence pratique. Cette reclassification devrait permettre une meilleure répartition des équipements médicaux et médicaments. Une politique favorisant un accès géographique aux services de santé primaires de qualité plus équitable doit être mise en œuvre. Parmi les ménages qui n’ont pas consulté de professionnel de santé, 49% répondent ne pas l’avoir fait pour des raisons financières.  Cela devrait être accompagné par une amélioration de l’efficience et de la rentabilité de la prestation de services en liant le financement du personnel et des institutions sanitaires aux résultats. ———————————————————————————————————————————Contacts : À Washington : Christelle Chapoy, (202) 361 4255, cchapoy@worldbank.org Pour en savoir plus sur les activités de la Banque mondiale en Amérique latine et dans les Caraïbes : www.worldbank.org/lac Rejoignez-nous sur Facebook : http://www.facebook.com/worldbank Suivez notre actualité :          Sur Twitter : @WBCaribbean Sur YouTube : http://www.youtube.com/worldbank