It gives me great pleasure to be here this morning at the 19th International Vitamin A Consultative Group meeting, the first to be held in South Africa. This group has an important responsibility to guide activities for reducing Vitamin A deficiency around the world. On behalf of USAID-the principal partner of IVACG-I'd like to welcome you all to South Africa and to this very important meeting. And-if you'll forgive me-to all our partners who have come all the way here from Central or South America: "Una muy cordial bienvenida a Sud Africa".

Today also marks a very special occasion on the global calendar: It is the United Nations' International Women's Day. With so many delegates here from around the world, it is appropriate for us to tackle one of the challenging issues, which so seriously affects the lives of women and children, like the prevention and treatment of Vitamin A deficiency.

During my (now rather lengthy) career with USAID, I had seen the devastating impact of micronutrient deficiencies on the health of mothers and children in all the countries where I have served: Bolivia, Haiti, Morocco, Nepal, Guatemala and now, South Africa.

But I have also seen how successful Vitamin A programs can improve the health of young children, their families, and their communities. The results that have been achieved by these programs in reducing Vitamin A deficiency worldwide are impressive: the eyesight and the very lives of many, many children have been saved, and you should all take pride in this.

As Mission Director for USAID in South Africa, I am very concerned about the statistics-which I have just learned--on the extent of Vitamin A deficiency in this country. While considerable progress has been made since the end of apartheid five years ago to improve the health status of women and children--and South African public health officials deserve congratulations on these achievements-the remaining problem is very serious, and requires a serious recommitment of effort to address it. The South African National Survey of 1996 shows that, overall, one -third of all children under the age of six years are measurably Vitamin A deficient.

We already know that diarrhea, acute respiratory infections and measles are among the main contributors to deaths of children under-five worldwide. Yet, there is strong evidence that the severity of all these diseases can be significantly reduced by sufficient Vitamin A intake. There is also some evidence that this is the case for HIV-positive children.

As you are also aware, research supported by USAID and others has shown that Vitamin A supplementation is now recognized as one of the most cost-effective interventions to substantially reduce overall child mortality and morbidity, amongst Vitamin A deficient populations.

Globally, an estimated 20-25 percent reduction in infant and child deaths can be achieved through Vitamin A interventions alone. This is an extraordinary statistic (a 25 percent reduction) in infant and child mortality. These reductions are achieved at remarkably low costs-one-half US dollar per person, per year for supplementation; and Vitamin A fortification is only twenty US cents per person, per year.

And the economic return on every dollar invested in Vitamin A supplementation results in an estimated economic gain of $146 through increased productivity levels, averted health care costs and lower worker absenteeism and disability.

This health intervention thus translates into substantial economic benefits as well as fundamental health benefits. As a result, USAID is currently supporting Vitamin A programs in 50 countries.

Here, in South Africa, USAID supports Vitamin A programs as a key part of a larger integrated primary health care activity with the South African Department of Health. Known as the "Equity Project" our program-led by Dr. Jon Rhodes of Management Sciences for Health--partners with the Eastern Cape Department of Health to improve the delivery of integrated primary health care services, including nutrition. I am also pleased to say that USAID will soon sign a Memorandum of Understanding with the University of Stellenbosch, near Cape Town, to provide supplemental funding for a national food consumption and nutrition survey, which will provide further information on the specific Vitamin A issues here in South Africa.

This food and nutrition survey will further provide valuable and necessary information for planning a more substantial food fortification program to protect South African's children against Vitamin A and other micronutrient deficiencies.

We can also be encouraged by the fact that Latin America is making tremendous strides in addressing Vitamin A deficiently through the fortification of commonly eaten foods, such as sugar, or in the case of Venezuela, maize flour.

Commercial fortification of sugar with Vitamin A on a national scale was first achieved in Guatemala, where I spent over fours years, prior to arriving in South Africa.

[Saludos calurosos a los Guatemaltecos que esten aqui con nosotros queremos eschuchar sus experiencias sobre el asunto de Vitamin a A en Guatemala.]

The Guatemala Sugar fortification program has dramatically reduced Vitamin A deficiency amongst the target population by almost 50 percent. Consumer demand for sugar fortified with Vitamin A has become so great in Guatemala, that just last year the government was forced-by public outcry--to rescind legislation it was considering to discontinue the practice of fortifying sugar. The national sugar fortification program in Guatemala continues apace. USAID was actively involved in supporting the fortification process in Guatemala, and we look forward to working more intensively with South African nutritional experts in this areas, as well. We have just read in the Sunday Tribune of the new partnership of the Department of Health and the Pioneer Food Group here in testing fortified "mealie meal" and we congratulate you on this initiative.

The initial objective of the International Vitamin A Consultative Group in 1975, when it was founded, was the same as it is now; to provide a forum for the exchange of new ideas, research findings, and program interventions, which lead to the reduction, control and eventual elimination of Vitamin A deficiency.

Through the intervening years, USAID has provided support to several IVACG meetings on the African continent, including Kenya in 1981; Senegal in 1983; Ethiopia in 1987; Tanzania in 1993, Egypt in 1997; and now Durban in 1999.

These meetings were well attended by African colleagues wanting to share their work and learn more from each other. And colleagues from outside Africa have been drawn to these meetings to learn more about successes on this continent in addressing the problem as well as the nature and size of the challenge of combating the sizeable Vitamin A deficiency which remains. USAID shares with its partners the firm desire to bring recognition to the important work being done in Africa and elsewhere to prevent and control Vitamin A deficiency in women and children.

Thank you, everyone, for coming to the IVACG conference this week. And welcome to beautiful, fascinating South Africa. Your international partnership shows the world that Vitamin A deficiency is a serious public health and development problem, deserving of attention at the highest levels. By coming together and combining your knowledge and experience in combating all aspects of the problem, I feel certain that Vitamin A deficiency will eventually become a problem of the past.

Again, thank you for attending this very important meeting, and best of luck in your work.