Impressions from the 1st EU Global Health seminar in “La Hulpe”

Dear Colleagues,

Last week, a global health event took place in Brussels that has, perhaps surprisingly, remained slightly under the global health community “radar”. So we took the liberty to comment on it ourselves. The event (the 1st EU Global Health Seminar) was  titled:” Putting the EU Global Health Policy into Practice”. Around 80 European Commission and EU member states professionals from headquarters and field stations gathered in a fancy retreat center in La Hulpe, in the outskirts of Brussels. It was an EU event, after all. Topic of discussion: how to operationalize the EU Global Health Policy communication and Council conclusions published last year.

Perhaps inspired by the posh setting, the event turned out to be very interesting. Eloquent speeches and fierce discussions were held on global health policy, the contribution of EU institutions to health systems strengthening, getting results for money and improving coherence. The seminar was definitely a welcome initiative, as we hadn’t seen much so far in terms of implementation of the EU Global Health Policy (with the exception of the monthly global health policy forums organized in Brussels).

So why did this milestone event remain somewhat unnoticed, even in global health circles? One reason (pretext?) given by the organisers was that they did not have the budget to invite more people; another (and probably more valid) one was that they wanted to create an opportunity to better coordinate amongst themselves first, before reaching out to the world and the partners. (as you know, there is no equivalent to S&P or Moody’s to comment spontaneously on EU global health policy). So the organizers only invited staff from the European Commission and from the Member states’ health and development line ministries. Nevertheless, a minimum effort of openness would have given a boost to the programme. True, there were a few efforts in this regard: Dr Songane, former Health Minister from Mozambique had been invited for a keynote speech, and he rose to the occasion, framing the debate. Also, in the open session, a limited number of participants from the civil society could discuss with the seminar participants. Still, the event could have been far more inclusive.

We respect the decision to keep this first seminar private and we hope it will have inspired EC civil servants and health and development experts from EU countries to come up with a more coherent vision in the future, and with a real sense of global health “community”, if only to set an example (now that the European roof is coming down on Merkel & co).  We hope future events will be organized in a more inclusive and open way. In these, other partners, such as the United States, Brazil, Malawi and Thailand, just to name a few, could be given the chance to reflect on the stances the EU should take towards the many challenges in global health.

We are looking forward to the publication of the conclusions of this seminar. In the meantime, and to prepare for the next seminar, we would like to share some key messages for the EU, more in particular on its relation with developing countries. Recommendations are inspired by keynote speeches from Bruno Gryseels, Dr. Songane and Wim Van Damme.

 

Key Messages:

  1. The Paris declaration and Accra agenda for action represent widely endorsed rhetoric that should now be applied. Time for action. If not now, then when?
  2. Country ownership should be the overarching and guiding Paris-Accra principle, the others are just related to this overall goal, and will follow naturally, if one gets this one right. Of course some countries still face large capacity and governance challenges and need a specific approach. Commissioner Piebalgs seems to agree on this. Unfortunately, donors still tend to push their own agenda and view the Paris declaration as a tool to harmonize amongst themselves.
  3. If supporting health systems in partner countries is a key priority, the development of knowledge centres is a key element in the maturation of any country. Better coordination between DGDevelopment and DGResearch in this matter could be an important breakthrough.
  4. We need to move from charity to solidarity, hence, a firm, determined commitment for rapid development with the aim of establishing the foundation for self-reliance in the medium term is vital.
  5. More clarity and transparency is needed on the actors that set the agenda. Ideally, WHO should take the lead. The EU should thus advocate for a clear global health governance mandate of (a modernized) WHO and for more core funding for the institution, so that it has the resources necessary.
  6. More coherence is essential, to overcome the current fragmentation – messages from the EC and EU member states still differ too often. They need to agree amongst themselves, obviously, but more importantly also when talking to the various stakeholders. An institution often uses a different language, depending on the setting (for example in talks on trade in bilateral negotiations, versus at UNAIDS or Global Fund board).  Native Indians had a term for that.
  7. Health is an important component, but can’t be addressed in isolation. A whole of government approach is thus essential. (indeed a buzzword, as Richard Smith argues, but nevertheless, it is sorely needed)
  8. Health systems are complex systems that are inherently context-specific, yet, they have a number of common characteristics. Too often one confines a national health system to “the public health services” available in the country, while a more realistic vision would also include private for profit, not for profit and communities as integral parts of a health system. In this more holistic vision, public services would provide the backbone for all interventions that contribute to better health. EU support to health systems should thus also include non-public providers who are a reality in most countries and find ways to support the national government if it attempts to regulate and support those providers. See more on this in this Working Paper.

 

Finally, on a slightly different note, we allow ourselves to comment briefly on the current turmoil in the EU, as we believe it could also inspire relations with LMICs in the future. Although it might be too late by now, we still reckon European harmonisation and integration of social security and health systems is the way forward. These social systems should not remain (solely) a national duty and prerogative. Paraphrasing a now retired Flemish social democrat, “Europe will be social or it will not be”. (Probably the latter, if bookmakers and rating agencies are to be believed ) Nevertheless, if we do pull this off  in the coming years, against the odds, and thus manage to preserve and even strengthen our social model (which includes a modernisation but not a dismantling of it – not unlike the WHO reform needed), we could spread our “most civilised” social model to other parts of the world. In fact, to some extent, this is already happening, in different parts of the world, although European inspiration is not always obvious. We believe this is a legitimate aim, as of all models the European social model seems to guarantee human rights best. So no, this is not neo-colonialism or disguised imperialism. We might be doing many things wrong, in Europe, but we should be proud of the few things we do right. Or perhaps of the things we did right.

 

This blog post has been published as the Editorial to our IHP newsletter 125.

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