Economic and Social Council Assesses Progress in Global Public Health, Hears ‘We Should Do More, and Better’, Especially in Maternal, Newborn Health
Economic and Social Council Assesses Progress in Global Public Health, Hears ‘We Should Do More, and Better’, Especially in Maternal, Newborn Health
|Department of Public Information • News and Media Division • New York|
Economic and Social Council
2010 Substantive Session
21st & 22nd Meetings (AM & PM)
Economic and Social Council Assesses Progress in Global Public Health, Hears
‘We Should Do More, and Better’, Especially in Maternal, Newborn Health
Two Panels Consider United Nations Response to Global Health Challenges,
Coordinating Efforts for Achieving Health-Related Millennium Development Goals
Improving global health required a life-cycle approach, providing essential health services in an integrated package that included maternal, newborn and child health, sexual and reproductive health, and adequate budgeting for HIV/AIDS and malaria, United Nations experts stressed today as the Economic and Social Council opened its coordination segment under the theme of “implementing the internationally agreed development goals and commitments in regard to global public health”.
Five years ahead of the 2015 deadline to reach the Millennium Development Goals, “it is clear that we should do more, and better, in the health sector”, especially as related to maternal and newborn health, Council Vice-President Morten Wetland, of Norway, said in opening remarks. During its three-day segment, the Council would, among other things, take stock of how the United Nations was implementing the 2009 Ministerial Declaration on global health, which emphasized the critical link between health and development.
The day featured two panel discussions, the first of which — on achieving a comprehensive United Nations policy response to global health challenges — heard morning presentations by the heads of United Nations agencies, who focused on working together to reach health-related Goals and targets. Panellists underscored the need to ensure that health remained high on the international agenda and, to that end, described efforts to both streamline their work and align their policies and programmes with developing country priorities.
Executive Director of the United Nations Population Fund (UNFPA) Thoraya Obaid said that under the “Health 4 + 1” initiative, her agency was working with the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), the World Bank and the Joint United Nations Programme on HIV/AIDS (UNAIDS) to speed progress for the health of women, newborns and children in 25 high-priority countries. A maternal health fund also was active in 30 countries. Despite such efforts, however, there was a long way to go to achieve universal access to health services, particularly for sexual and reproductive health. Civil society must be engaged, as it provided 50 to 60 per cent of health care in some countries.
Stressing that point, Anthony Lake, Executive Director of UNICEF, said progress was dangerously lagging in the world’s poorest countries, where a woman was 300 times more likely to die from pregnancy-related causes than a woman in the industrialized world. There was an urgent need for skilled birth attendants who were also trained to provide basic life-saving medical services. Further, technology must be better used. There were more mobile phones in Africa than in the United States and Canada combined, which could be used to mobilize community health workers and provide real-time advice during labour and delivery.
In an afternoon panel — on coordinating efforts for achieving health-related Millennium Development Goals — panellists examined strategies to raise additional financing and make development assistance for health flows more predictable. They looked at how financing could be directed towards the most neglected areas, especially to achieve Goals 4 (child mortality) and 5 (maternal health), and how to tackle a lack of support for overall health systems.
For its part, the GAVI Alliance sought to “get more health for the money”, said its Chief Executive Officer, Julian Lob-Levyt, noting that the Alliance aimed to improve health outcomes by strengthening national health systems. The joint Health System Funding Platform — which involves the Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria and the World Bank — sought to make better use of new and existing funds for health systems, and to leverage additional funding. With that in mind, the Alliance had signed joint financing agreements with Nepal and planned to sign others with Ethiopia, Sierra Leone, Mali and Yemen.
On a similar note, Keith Hansen, Director of the Human Development Network at the World Bank, pointed out that country ownership was the only way to make the Platform work for the countries involved, as that would ensure development of locally appropriate and broadly supported strategies. Joint assessments provided a way to identify country priorities and recognize strengths and weaknesses. That process was not a “pass or fail” assessment, but rather a means of broadening the buy-in and ownership of all involved.
Rounding out the discussion, Leonard J. Edwards, Personal Representative of the Prime Minister of Canada for the Group of Eight (G-8) and Group of 20 (G-20) Summits, described the Muskoka Initiative on Maternal, Newborn and Under-Five Child Health, adopted two weeks ago by leaders at the G-8 Summit in Ontario, Canada. Under the plan, which covers the 2010-2015 period, countries would work with multiple partners to achieve health-related targets set in the Millennium Development Goals, namely Goals 4 and 5.
Also speaking today was Thomas Stelzer, Assistant Secretary-General for Policy Coordination and Inter-Agency Affairs of the Department of Economic and Social Affairs, who introduced two reports of the Secretary-General submitted under agenda item 4.
The President of the International Association of Economic and Social Councils and Similar Institutions (AICESIS) also made opening remarks.
The Economic and Social Council will reconvene at 10 a.m. on Wednesday, 7 July to continue its coordination segment, which will feature a panel discussion on operationalizing the United Nations short- and long-term responses to the economic and financial crisis.
The Economic and Social Council today opened its Coordination segment, to run from 6 to 8 July. It will focus on two main areas: “Follow-up to the 2009 Ministerial Declaration on implementing the internationally agreed goals and commitments in regard to global public health”; and the “follow-up to the International Conference on Financing for Development”.
MORTEN WETLAND (Norway), noting new developments in this year’s segment, said it would take place over three full days, due to the inclusion of an agenda item on “Follow-up to the International Conference on Financing for Development”. The three other issues on the agenda were: the follow-up to the 2009 Ministerial Declaration on global public health; the report of the United Nations Chief Executives Board for Coordination (CEB); and the integrated and coordinated implementation of and follow-up to major United Nations conferences and summits.
Noting that the 2009 Ministerial Declaration on global health emphasized the link between health and development, he said the Council would take stock of how the United Nations had implemented the text, a topical issue ahead of the high-level meeting on the Millennium Development Goals. Five years away from 2015, “it is clear that we should do more, and better, in the health sector”, he said, and specifically in areas such as maternal and newborn health.
Introducing the Secretary-General’s report entitled Theme of the coordination segment: implementing the internationally agreed development goals and commitments in regard to global public health (document E/2010/85), THOMAS STELZER, Assistant Secretary-General for Policy Coordination and Inter-Agency Affairs, Department of Economic and Social Affairs, said the 2009 Ministerial Declaration underscored that achieving health-related goals was essential to ensuring sustainable development. The Secretary-General’s report outlined the United Nations work related to health and development and assessed its efforts to facilitate the coordinated implementation the Ministerial Declaration. Despite the crippling effects of the food, energy and economic crisis, progress in the health-related Millennium Development Goals had been achieved. Setting goals had stimulated innovation, notably in fundraising and the way business was done. Partnerships formed in the areas of immunization and combating HIV/AIDS, for example, should inspire other partnerships in other areas.
He went on to say that considerable efforts had also been made to strengthen coordination among United Nations agencies, through the exchange of best practices. Various global health initiatives also had been established, in line with the Paris Declaration on Aid Effectiveness, including the International Health Partnership and the Harmonization of Health in Africa. As for the United Nations country-level experiences, national priorities increasingly had formed the basis for the United Nations programming. The World Health Organization (WHO), United Nations Children’s Fund (UNICEF) and Joint United Nations Programme on HIV/AIDS (UNAIDS), for example, had focused on 25 countries with the highest rates of maternal and newborn deaths.
The review of the 2009 Declaration showed that the United Nations had carried out comprehensive global public health initiatives, he said, underscoring the urgent need to maintain momentum and scale up resources. In that context, he cited the need for accountability mechanisms; strengthened partnerships; promotion of gender equality and equitable access to health services; and establishment of comprehensive human resource strategies — all of which were critical for improving global health. The high-level meeting on the Goals could draw a road map for the future. The report urged the need to reduce maternal and newborn deaths and, towards that goal, the summit should focus on nutrition. The report also highlighted the need for donors to deliver on their assistance pledges to substantially improve health outcomes.
Next, Mr. STELZER introduced the Secretary-General’s report entitled the Role of the Economic and Social Council in the integrated and coordinated implementation of the outcomes of and follow-up to major United Nations conferences and summits, in light of relevant General Assembly resolutions, including resolution 61/16 (document A/65/84-E/2010/90). The report, prepared as an update to last year’s report, illustrated recent developments in integrated conference follow-up. In addition, the report described recent efforts to streamline the Council’s programme of work during its substantive session in order to avoid duplication between the segments.
As for what type of review and scope would render the conference follow-up report most effective in the future, he suggested that such a report could be included in the annual report which assessed the chosen cross-cutting themes in an integrated manner. The annual ministerial review was a substantive and integrated opportunity for the Council to review conferences and summits and their outcomes, in accordance with resolution 61/16, he added.
ANTONIO MARZANO, President of the International Association of Economic and Social Councils and Similar Institutions (AICESIS), said his organization consisted of councils from 70 countries worldwide, which collaborate with their respective Governments to improve the economic and social life of citizens. Putting forward proposals aimed at increasing labour, decreasing poverty, redistributing wealth, and ensuring greater social fairness, the councils used social dialogue to find common ground. He noted that his organization, not limited by the time constraints present within politics, was able to focus on issues over the medium- and long-term.
Seeking long-term solutions, however, was a challenge, in light of continually troubled global financial markets. The economy had begun to recover, but “the outlook is still gloomy for social issues, the loss of jobs and the impact of the crisis on the weaker social groups”, he stressed, urging effective action to facilitate the creation of new jobs. Even more urgent was the need for youth policies aimed at facilitating young people’s adjustment to economic and social life. New generations had prepared themselves diligently for the labour market, yet they had to invest huge amounts of energy to find the right job opportunities. That issue may become an acute problem if adequate solutions were not found, he noted.
His organization could play an important role in promoting dialogue and discussion, he said. States and Governments were doing their utmost to cope, but their efforts to redress public budgets should be accompanied by thorough and concrete measures aimed at sustaining economic recovery and enabling job creation. In a time of great uncertainty underpinned by economic difficulties, gaps between social groups had widened and the conditions for the world’s poor had worsened. Councils in his organization could assist in strengthening social cohesion, an indispensable condition for strong and widespread economic growth, he noted.
Panel Discussion on Policy Response to Global Health Challenges
Moderated by Mr. WETLAND, the discussion included presentations from Anthony Lake, Executive Director of UNICEF; Thoraya Obaid, Executive Director, United Nations Population Fund (UNFPA); Michel Sidibé, Executive Director, Joint United Nations Programme on HIV/AIDS; and Carissa Etienne, Assistant Director-General, Health Systems and Services, World Health Organization.
Launching the discussion, Ms. OBAID said the theme of working together was not new, as no United Nations agency could work in a country without the help of the Government and other actors. She reminded delegates that Goal 5 included two targets: reducing maternal mortality and ensuring universal access to reproductive health. While early signs of decline in maternal deaths were promising, they were not sufficient, given the magnitude of what must be achieved. The health system was not an abstract concept — it was about humans — and the creation of silos to deal with health issues could not continue. Nor could the importance of reproductive rights be denied. In that context, she said the Health 4 initiative or “H4” — involving UNFPA, WHO, UNICEF and UNAIDS — was working to streamline activities in 25 high-priority countries.
Describing other efforts, she pointed out that the African Union’s Maputo Plan of Action for Sexual and Reproductive Rights was a comprehensive strategy to reduce maternal mortality, which had been launched in various countries. To address fistula, an illness that affected young pregnant women, a UNFPA trust fund had been established, which today was helping some 47 countries. To improve the health of HIV-positive mothers, the “H4” was focusing on 22 high-priority countries. To protect young people from HIV infection, it was important to provide them with age-appropriate sexual and reproductive health information. In all such work, “we must ensure the human right to health”, and human rights were linked to gender mainstreaming.
In sum, she said that while progress had been achieved, “we are far from achieving universal access to health services, particularly sexual and reproductive health”. Child and newborn health were increasingly visible on the global agenda, but more financial support was needed. The United Nations was harmonizing its work with national priorities. “Countries know what they want,” she said, noting that strengthening the health system was not an end in itself; the goal was to achieve better health outcomes. Momentum must be maintained, and civil society must be engaged, as it provided some 50 to 60 per cent of health care in some countries.
Speaking next, Mr. LAKE, noting that the Fund’s primary concern was Goal 4 (child mortality), cited efforts to eradicate polio, prevent maternal-to-child transmission of HIV/AIDS, improve nutrition for all children and treat the world’s number one killers of children — pneumonia and diarrhoea. “We can’t succeed without understanding the linkages of all the Goals,” he said. “To save children’s lives, we have to save women’s lives.” In that context, he stressed that 41 per cent of all preventable deaths of children under age 5 occurred in the first hours and days of their lives. Saving the mother and the child were inseparable, and both goals must be accomplished.
As all the Goals were interconnected, he stressed that success required a highly integrated approach, particularly in the area of health. For its part, the Fund had worked to integrate its efforts in countries suffering the highest rates of maternal and child mortality. “We can deliver as one and benefit many,” he said, adding that progress was dangerously lagging in sub-Saharan Arica and South Asia. Citing examples, he said a woman in the world’s poorest countries was 300 times more likely than a woman from the industrialized world to die from pregnancy-related causes. “It need not be this way,” he stressed. To save lives required investment in integrated strategies and community-based care.
Most important was the need for more skilled birth attendants — about 350,000 globally — who also must be trained to provide basic life-saving medical services, he said. Innovative financing mechanisms were also needed to make health care more freely available. In Sierra Leone, for example, the introduction of free health services for pregnant and breast feeding women had increased visits to health providers by more than 170 per cent.
Technology also must be better used, he continued, noting that there were more mobile phones in Africa than in United States and Canada combined, a trend seen elsewhere. Improving technology would mobilize community health workers and provide real-time advice during labour and delivery. Finally, he said improving child health could benefit from an integrated community-based approach, as had been seen in Malawi and Nepal. Country-level efforts and a renewed commitment among United Nations agencies were also needed. In the end, no programme, no matter how flawlessly executed, would succeed without the communities themselves.
Mr. SIDIBÉ said health problems required responses which stretched beyond the health sector. The HIV/AIDS response pioneered such an approach, demonstrating the need and value of cooperation between various sectors and stakeholders. The coordination of United Nations agencies to respond to urgent development challenges had done much to strengthen focus and resource investment strategies to produce effective results. In the past five years, the number of people receiving HIV/AIDS treatment had risen to over 5 million, while the number of new infections had been reduced by 17 per cent.
He said that joint United Nations coordination, including the universal access debate and HIV/AIDS response, clearly showed that the Millennium Goals were an indivisible set. “When you start putting responses into isolation, the impact becomes limited,” he stressed, emphasizing the need for a response that would bring all health-related Goals together to deliver “value for the money”. In that regard, the Secretary-General’s joint action plan would provide a tremendous boost to the concept of integration.
In terms of mother-to-child transmission, he noted that care could not deal with the issue without addressing reproductive health and providing women with access to information. Such information could help avoid pregnancy and unsafe abortions, as well as ensure that young boys and girls could navigate their sexual identities. Furthermore, involving male partners in testing and care could strengthen efforts towards maternal health. Providing women with care before and after delivery would keep the mother alive and healthy to focus on her child’s health. To do that, improving health care systems was vital.
Health care methods were a major entry point for ending sexual violence. He stressed that the subject of HIV/AIDS must be taken out of isolation, for which he highlighted several major challenges. Among them was the need to better prioritize and allocate resources, to consider commodity and drug affordability, to eradicate stigma and discrimination, and to provide sustainable and predictable funding.
Ms. ETIENNE said her organization recognized that while Member States were working to enhance their health systems and meet the Millennium Development Goals, gaps remained with regard to Goals 4 and 5. Applauding the United Nations for working in a “totally different way”, she underscored efforts to address the Millennium Goals in a more comprehensive and integrated way. Furthermore, health and development partners were also changing their ways of working together, including by promoting greater partnerships.
A growing commitment to country ownership and leadership had resulted in the International Health Partnership Plus, a WHO and World Bank-coordinated framework in which 47 countries, agencies and development partners had agreed to work together in a process fully aligned with national priorities and capacities. Closer partnerships with civil society also had been developed. Her organization was working with partners outside of the health sector to help put “health in all policies”. The focus on the Goals also had spurred innovation in business and fund raising. “We must ensure more money for health, but more importantly, we must ensure more health for the money,” she said, noting that finding new ways to finance health was a key element of her organization’s annual report, due in November. Many countries still lacked capacity to measure births and deaths and were overburdened by requests from donor countries to track multiple, partner-specific indicators. Given that, the WHO had invested significant resources to help partners strengthen their national and district health information systems.
While recognizing that country efforts to improve health services would be country-specific, the WHO would promote primary health care-based systems, to be based on universal access to care and people-centred services, she said. In addition, it urged coherence in national health plans, and called on them to address the inter-linkages among the Millennium Goals. Calling also for the consistent assessment of current and future needs in light of shifting economic and social realities as well as an increase in non-communicable diseases, she emphasized the importance of the General Assembly’s adoption of its resolution on non-communicable diseases. “Over the next five years, we must tackle the unfinished Millennium Development Goals agenda and begin thinking beyond 2015, working together to plan a comprehensive response to all global health challenges,” she stressed.
When the floor was opened for questions and comments, speakers asked for panellists’ views on the greatest obstacle to a more integrated United Nations. The United States’ delegate asked how the joint work plans were going in high-impact countries and whether the co-sponsor-Secretariat model of UNAIDS could be replicated. He also wondered how the new United Nations gender entity might help the various agencies and requested examples of cost-effective innovations that had been seen elsewhere but were not used at the United Nations.
Other speakers underscored the need for a long-term perspective on global health beyond the Millennium Development Goals, as it would demand attention long after global crises subsided. Indeed, comprehensive policy responses required that credible data be collected. In that light, Indonesia’s delegate suggested that the United Nations establish a panel on global health to generate scientific debate and momentum for action, as had been done to address climate change. Another speaker asked about country measures to deal with multiple crises, like climate change, on health.
Others echoed the idea that attaining high-quality public health depended on achieving the Millennium Goals and stressed the United Nations central role in improving national capacity in the area of health. Among other things, they said United Nations funds and programmes should support health workers’ training, work to strengthen public health systems, improve sexual and reproductive education — particularly for adolescents — and promote international cooperation in the area of health, especially South-South initiatives. Some asked for more information on United Nations coordination with other stakeholders.
The delegate from the Bahamas pointed out that more women were dying of non-communicable diseases, such as cardiovascular disease and obesity. How could the Goals be linked to such problems?
Responding to the query on obstacles to “delivering as one”, Mr. SIDIBÉ said the main challenge was to ensure that programmes were led by Governments, as coordination was not possible if it was driven from the outside. Other challenges lay in coordinating and reducing transaction costs, as well as ensuring that programmes and resources were aligned with national priorities. There had been a proliferation of “feel-good” projects and moving away from them would bring efficiency and coordination. Reducing the unit costs of producing results was also essential, he explained, noting that countries faced human resource limits. Task-shifting must be ensured.
To the question on the UNAIDS structure, he said consolidating strategic information was critical, as was harmonizing technical support and mobilizing civil society, a key partner.
Ms. ETIENNE, addressing the issue of coordination, said the global public health discourse had been reduced to “single-entity items”. Discussion of “fragmented bits” of information had replaced what should be a comprehensive debate. In that context, she supported the creation of an international panel on global health that addressed all key health challenges. She underscored the need to coordinate around what countries defined as their national priorities. The United Nations worked best in that scenario. International health partnerships and a common funding platform were essential to supporting that work.
As for linking work on non-communicable diseases with maternal health, she noted the importance of enabling communities to comprehensively treat the whole individual. The greatest obstacle to working together was that agencies did not always understand national priorities for action.
Next, Ms. OBAID said she had seen all kinds of reform at the United Nations, but that which had recently begun was the most serious, as it truly engaged Governments, almost all of which wanted a “delivering as one” approach. “We’ve got to deliver,” which posed its own challenges. By way of example, she said the High-level Committee on Management had proposed harmonizing business practices, which did not receive the needed support from donors. Another challenge was that agencies often received different instructions from Governments.
Discussing a cultural change that must take root, she noted that. While decreasing maternal mortality had been achieved by Governments, UNFPA was assessed on the basis of whether it had achieved that goal. And, thus, issue of contributions and attributions must be clearly defined. Results were long-term and looking for quick fixes did not work.
As for the social determinants of health, studies on health and women’s empowerment were being undertaken, she noted.
Mr. LAKE added that the invention of one management platform among donors could be a mistake given a current lack of knowledge. The platform mentioned in the Secretary-General’s action plan was very specific and useful, he said, calling for States to move forward with it. With regard to United Nations coherence, he agreed with the statement made that it would not happen without pressure. “We all must put pressure on ourselves,” he stressed, hoping that donors, agencies and others would eventually work together to face impending challenges, owing to the increasing pressure to self-monitor and evaluate. Further, all United Nations agencies should “play as one, not act as one”.
Responding to a question about whether lessons could be learned from activities of the United Nations, he said they most certainly could, pointing to conditional cash transfers in a number of Latin American countries and free health care in Sierra Leone.
With regard to what should be done after 2015, he stressed that while States were making efforts towards the deadline, they often lost sight of the future. So focused on achieving all Millennium Goals, they could tend to operate in the easiest areas, leaving the hardest for later. Then, by 2014 to 2015, they may have expended political will and discovered problems had not been resolved, causing them to start all over again. “Let’s begin working now on the toughest areas so that 2015 becomes a benchmark, rather than the end of a sprint in what turns out to be a marathon.”
Also participating in the discussion were representatives of Bangladesh, Belgium (on behalf of the European Union), Brazil and Israel.
A representative of the Food and Agriculture Organization (FAO) also spoke.
Panel on Coordinating Achievement of the Health-related Goals
It was chaired by Mr. Wetland, and moderated by Tore Godal, Special Advisor to the Prime Minister of Norway. The panellists were: Dr. Julian Lob-Levyt, Chief Executive Officer of GAVI Alliance; Dr. Michel Kazatchkine, Executive Director, Global Fund to fight AIDS, Tuberculosis and Malaria; Keith Hansen, Director, Human Development Network, World Bank; Dr. Philippe Douste-Blazy, Special Adviser to the Secretary-General on Innovative Financing for Development; and Dr. Carissa Etienne, Assistant Director-General, Health Systems and Services, World Health Organization. The lead discussant was Leonard J. Edwards, Personal Representative of the Prime Minister of Canada for the G-8 and G-20 Summits.
The first speaker, Mr. LOB-LEVYT, said collaboration, partnerships and global alliances were becoming increasingly important in helping countries achieve the Millennium Development Goals. Such alliances, particularly initiatives that had been joined by the Bill and Melinda Gates Foundation, had had significant success in tackling HIV/AIDS.
He said that going forward, GAVI was focusing on the diseases that were major child killers: pneumonia and diarrhoea, largely through provision of pneumococcal and rotavirus vaccines. GAVI aimed to improve health outcomes through strengthening country-level systems to deliver health services equitably and sustainably, focusing on the Millennium Goals, and to use resources more effectively and efficiently.
“This is about getting results faster, and with only five years to go to achieve the [Millennium Development Goals], we’re talking about a real change of gears to get the results out,” he continued, saying that working with the Secretary-General, the World Bank, the Global Fund and the WHO, GAVI sought to “get more health for the money”, and accelerate progress on health-related goals. The aim of the joint Health System Funding Platform was “one plan, one budget, one results framework”, and he noted that a joint financing agreement had been signed with Nepal. Such agreements later would be signed with Ethiopia, Sierra Leone, Mali and Yemen.
Next, Mr. KAZATCHKINE said health was the one area of development where the international community had made considerable progress during the past decade. Indeed, there had been unprecedented societal mobilization around health in both the North and South, evinced by political commitment and the provision of increased financial resources. The Global Fund had been established in 2002 when virtually no one with the virus was receiving life-saving antiretroviral therapy in the developing world.
Today, about 5 million people had gained access to AIDS treatment and, as a result, HIV-related mortality had decreased in many high-burden countries. Moreover, the number of new HIV infections had also decreased, particularly in sub-Saharan Africa. Along with its work to combat tuberculosis and malaria — which had been a neglected disease before the Fund’s start-up — the programmes the Fund supported had saved an estimated 5.7 million lives in the past six years, and an additional 4,000 lives were saved daily as thousands of new infections were prevented.
He said that the key objective of the Health System Funding Platform was to make health strategies more effective. The Platform would make many things easier for countries, as, for instance, they would write one application for funding assistance instead of two (to both GAVI and the Global Fund). Transaction costs would be reduced and unnecessary duplication avoided. In addition, funding accessed through the platform would be directly aligned with national priorities, timelines and indicators, as expressed in their national health strategies.
Finally, he emphasized that it was wrong to pit financing of health systems strengthening against financing for targeted disease programmes. The Global Fund was both a major investor in efforts to strengthen health systems, and its mandate also covered the fight against HIV/AIDS, malaria and tuberculosis. So, strengthening health systems and fighting specific diseases went hand in hand, as evidence had shown that interventions targeting such diseases had positive spillover effects to heath systems.
Mr. HANSEN said that support of the health systems funding platform was the “next logical step” in the development of much stronger architecture, serving as the financial coordination pillar within the framework of the International Health Partnership (IHP+). Underscoring the urgent need to get as much health as possible for the money, he stressed that the platform was a very effective mechanism to help do so. And, country ownership was the only way to make the platform work for countries involved, as that would ensure locally appropriate and broadly supported strategies.
Strong national strategies, he continued, provided countries with a road map of progress to sustain results over the long term, and thus, should include activities outside the health sector. He highlighted the importance of joint assessments, which provided a mechanism for identifying country priorities and recognizing strengths and weaknesses. That process, which directly supported national strategies through cooperation, was not a “pass or fail” assessment, but rather a means of strengthening systems by broadening the buy-in and ownership of all involved.
Further, joint assessments promoted greater transparency with the use of one single fiduciary framework, which would help to eliminate the duplication of efforts and fill existing gaps. As an example of that, he highlighted the case of Nepal, wherein the country had requested a joint assessment, which had taken place earlier this year. The suggestions it had received helped to strengthen its health systems and encouraged its Government to expand its pool of partnerships.
Mr. DOUSTE-BLAZY noted that the health-related Millennium Goals had been the first to benefit from innovative financing, with increasingly remarkable results. Such financing sources sought to respond to five challenges: how to resolve the issue of demand; how to resolve the issue of research and development; how to ensure regular and predictable financial flow; how to accelerate aid withdrawal; and how to work with market prices. To address those challenges, innovative mechanisms in use today must be expanded.
Furthermore, existing mechanisms must be developed by encouraging as many countries as possible to establish microcontributions of solidarity, linked to economic activities which had profited from globalization. In that regard, the scale of innovative financing should also be changed, and he called for a change in the nature of mobilized finances. A tax on inter-bank transactions of exchange was a great opportunity, owing to its technical, economic and political feasibility. With regard to how new finances would be spent, he noted that nearly 60 per cent of people living with HIV/AIDS still not did have access to treatment.
“History must not repeat itself where newer drugs are only affordable by people in the North while the people in the South need it most,” he stressed. With that in mind, his organization had launched the innovative Medicines Patent Pool initiative, which allowed patent holders to voluntarily offer their intellectual property related to HIV/AIDS medicines to the patent pool; companies could use it in exchange for a royalty payment. By harnessing the power of competition in medicines, the patent pool could save as much as $1 billion over five years.
Ms. ETIENNE said the Common Platform was fully in line with the stated objectives of the IHP+ partnership and was reaching a certain level of maturity while approaching its first birthday. Such coordinated global support to national strategies, policies and plans that were country owned and driven was key for aid effectiveness. The renewed focus on national health systems was due in part to the substantial debate on alignment and harmonization and the fact that health systems were not meeting people’s expectations and the resultant increasing internal pressures on national Governments.
She said that the best way to ensure that priority health issues were addressed in a balanced manner was to support national health policy, strategy, and plan development. She emphasized the need for coherence between health strategies and health system capacities. That coherence would also help States increase cost efficiency at the domestic level. Noting that nearly 70 countries would be entering new phases of their national health planning cycles, she said the international community could help by contributing to a robust and comprehensive situation analysis. It could also help countries better translate national priorities into detailed resource plans and develop more systematic approaches to broad, inclusive policy dialogue.
The challenge would be to both find and grow new ways to fund health, and to look for new ways to make that funding go further, she said. The first step towards achieving those goals was for countries to decide to move towards universal access to health care. Secondly, countries must accept that the only way to meet those goals was to employ a pooled pre-payment approach, which used tax-based and/or insurance-based mechanisms. Charging users at point of service was inefficient, ineffective and inequitable; it impeded access to health services. Lastly, she urged countries to improve efficiencies on the domestic level, and in terms of international assistance.
Lead discussant Mr. EDWARDS highlighted the Muskoka Initiative on Maternal, Newborn and Under-Five Child Health, which had been adopted two weeks ago by leaders at the G-8 Summit in Ontario, Canada. By that initiative, covering the 2010 to 2015 period, the G-8 nations would work with multiple partners throughout the global community towards achieving the health-related targets set in the Millennium Development Goals, namely Goals 4 and 5.
He said that before the initiative had been launched, the leaders had been warned “not to reinvent the wheel” or duplicate work already under way in the area of child and maternal health. The aim, therefore, had been to mobilize new funds, rather than to redistribute monies that had already been committed. With that in mind, the political commitments made at Muskoka had been backed by new financing and new accountability mechanisms. Once the scope had been defined, the initiative pursued partnerships outside the G-8, especially from Africa and other parts of the developing world.
All new partners had given policy endorsement, he said, noting that the G-8 leaders had pledged some $5 billion over the next five years for programmes that covered, among others, antenatal care, attended childbirth and post-partum care; health education; treatment and prevention of diseases including infectious diseases; and prevention of mother-to-child transmission of HIV. Outside the G-8, other partners, including Norway and the Netherlands and the Gates Foundation, had provided another $2.7 billion. He was confident that by the end of 2015, G-8 members would have mobilized much more.
In the dialogue that followed, several speakers called for a comprehensive approach to all health-related Millennium Development Goals. The representative of Brazil noted that all development goals were interconnected and mutually reinforcing, stressing that any shortcoming in all other areas would have direct, dire consequences on health. In that regard, the United Nations system had a central role to play in encouraging coordination efforts and addressing development challenges which hindered developing countries from achieving the Millennium Goals, he stressed.
The representative of Belgium said mutual accountability was a top priority for the European Union, and reaffirmed the importance of accountability and transparency in efforts towards achieving the Goals. The upcoming Millennium Development Goals Summit should be an occasion for States to consider how to best make progress on global commitments, she said.
Several questions arose during the discussion, including questions by the representative of the Republic of Korea about how other stakeholders could be incorporated in coordination efforts and how existing funds could be better allocated. Additionally, Mongolia’s representative asked about incorporating the impacts of climate change into health-related initiatives.
Responding to some of the questions and comments, Mr. KAZATCHKINE said accountability should not focus only on how commitments were turned into dollars: it should cover the entire scope of the process, including following-up on how the monies for health-related projects were disbursed and, in terms of the Muskoka Initiative, how the funds would remain predictable over five years.
Here, Mr. EDWARDS added that accountability was one of the keys of the Muskoka Initiative, and while the details were still being worked out, the leaders of the plan had had positive meetings with the African Union on donor and recipient accountability.
On questions regarding health systems, Mr. LOB-LEVYT acknowledged that the health sphere was “quite crowded” and the broad effort, including the joint platform, aimed to avoid fragmentation while boosting efficient and effective provision of targeted health services. “It’s not rocket science: it’s the right people in the right place properly supported to carry out national priorities in the right way,” he said, adding that the efforts would be underpinned by concrete statistics and data.
Turning to the role of the United Nations, he said the GAVI Alliance had been set up specifically, not to have a country presence, but to work with the Organization, which had been vital. Indeed, GAVI depended on the WHO for its statistical data, and overall, “the very unusual partnership” had been an interesting relationship for all.
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