This is a joint post by David Hercot & Kristof Decoster
We asked all of you about the five most important events of the year in international health that will affect developing countries’ health systems and health of their people. These are the answers we received from you. Thanks a lot for your inputs !
You can read the various inputs in full below. Our overall feeling when reading these comments is that we are at a key moment in history. Times are changing. International relations are evolving at a breakneck speed, with the BRICs countries (as well as some of the TIMBIs) rising on the global scene. Rich countries (some have already dubbed them the ‘formerly rich countries’) and particularly Europe are facing huge financial problems. They will be tempted to reassess priorities in aid. The results driven approach is already changing the rules. Can we already see the writing on the wall with the reduced growth in health ODA and the cancellation of round eleven by the GF? Are these the first signals of a gloomy health assistance future? Many African actors are slowly waking up to the new reality. And they take action. African countries are capitalizing on their growth figures to use the freed up fiscal space to increase social services (like in Ivory Coast). Against this backdrop, global health governance is sorely needed. The WHO – which should be the key institution for global health governance – is engaged in soul searching, or worse.
A number of conferences have been mentioned as key events of the year, both by people in the South and the North: the Social Determinants of Health conference (with a modest impact), the Special Meeting on Innovative Financing, the Maternal & Child Health Conference, the Non Communicable Diseases summit that will probably change little in the short term, the failure of the G20 to come up with an international transaction tax and the whopping failure of the Durban summit – although some disagree – are all signs that a healthy world is not in sight any time soon
We wish all global citizens, and especially the global health aficionados, a healthy and peaceful 2012. See you in a few weeks!
David Hercot & Kristof Decoster
Dirk van der Roost (ITM):
- The social determinants conference (I hope) and the board meeting of the Global Fund (I’m afraid).
- And also what did not happen: the reform of the international financial sector and a FTT.
Basile Keugoung (Emerging voice from Cameroun, and ITM colleague):
- Worst event : the report of the Global Fund with the cancellation of the 11th round.
- Best event: UN summit on maternal and child health in September.
Wim Van Damme (ITM ):
A few quick suggestions for the ‘most important events’:
- The crisis and soul searching in Global Health Governance (esp. at WHO & Global Fund);
- Durban: the inability of global community to reach firm conclusions on a climate change agenda;
- The G20 failure to reach agreement on the Financial Transaction Tax;
- The G20 failure to negotiate an important role for BRICs in global health.
Remco Van de Pas (Holland):
- Most inspiring event: the Arab spring in several countries; a democratic demand for a regime change that is more accountable protecting and fulfilling people’s rights, including health.
- Most disappointing event: the first World Conference on Social Determinants of Health; because the outcome document remains very modest in its scope and the conference was much less high-profile then it ought to be.
Kristof Decoster (ITM):
Some of my suggestions for top events in global health and aid:
- The West has ‘lost it’, financially speaking (both EU and US) – this will have (and already has) implications on aid and thus global health funding
- The Occupy movement has raised awareness about global & national injustice in the West (1 % vs 99 %), but so far, global finance is still setting the rules (there’s not yet a FTT, rating agencies and ‘the markets’ still dictate policies ). As a side-effect, democracy is under huge pressure in the West. And unfortunately, the Occupy Movement so far seems to attract little interest in the Global South (still conceived as ‘rich people from the North who want their middle class lives back…?’)
- The Global Fund funding difficulty is just a symptom of this ‘end of the traditional donors & G8 financial dominance’, just like the climate change funding difficulty (see the Green Climate Fund). This will only change if ‘ the people’ can reassert themselves (global financial taxes; tax global capital(ists) and MNCs properly). So the GF troubles are really not due to rebalancing finance for AIDS vs other health issues, I’m afraid.
- The inclusion of India and China (and other BRICs) in the international aid community (see Busan) – however, the Busan outcome document seems much less strict and more flexible than the Paris and Accra agendas.
- For now: traditional donor countries will increasingly focus on cost-effective ‘quick wins’ (vaccines) or on encouraging domestic financing (like in ART), for obvious reasons.
- African countries might see the “donor financing reluctance and gradual retreat” as a wake-up call, to take charge themselves of their health system (through domestic taxation, …); for some countries, and given growth figures, this is already happening.
Rachel Hammonds (ITM):
My top 3 list includes the obvious favourites.
- The cancellation of Round 11 (technically postponement unless you believe round 11 will never take place). I wonder about the significance of this decision – does it have broader implications vis-a-vis support for HIV/AIDS, or aid in general?
- Soul searching as to the future role of WHO in global health – where, why and how did it go off course and what are the parallels with the failure of Western leaders to address widening inequity in the West – lots of ‘leaders’ asleep at the wheel.
- I add a wild card that I like to hope is another small step towards ensuring maternal mortality receives the attention it requires. (I certainly don’t believe in Stephen Harper and his Muskoka Initiative – after all his government is now claiming Canada cannot afford to comply with emissions targets…). I am referring to the Alyne da Silva Pimentel v. Brazil (Committee on the Elimination of Discrimination Against Women -CEDAW) decision.
It is a July 2011 United Nations CEDAW decision brought against Brazil and addressing maternal mortality and the State’s obligations to regulate private actors. The Committee found for the deceased plaintiff noting that the State failed to guarantee access to appropriate quality emergency obstetric care.
‘In the first maternal death case to be decided by an international human rights body, the United Nations Committee on the Elimination of Discrimination against Women (CEDAW) establishes that governments have a human rights obligation to guarantee that all women in their countries—regardless of income or racial background—have access to timely, non-discriminatory, and appropriate maternal health services. Even when governments outsource health services to private institutions, they remain directly responsible for their actions and have a duty to regulate and monitor said institutions.’ (Center for Reproductive Rights) http://reproductiverights.org/en/document/decision-alyne-da-silva-pimentel-v-brazil
Best wishes to all.
Ndoza Luwawa (Angola):
May I flag up the following events:
- The Special Meeting on Innovative Financing, New York October 13th 2011.
- India and China (and other BRICs) in the international aid community.
- Crisis and soul searching in Global Health Governance.
- The Maternal & Child Health Conference
We encourage the International community to address the lingering constraints affecting development/Health assistance in developing countries. Despite the donors’ stubborn < 0,7% aid commitments, we were pleased to read the Spanish President stating, at a Special Meeting: It is essential that developed countries maintain their ODA commitments for 2015 and that the principles of aid effectiveness be fully respected by all. But all this, on its own, will not be enough (www.leadinggroup.org/rubrique20.html).
But in any case, the developing countries, especially AU countries, have to do their part too, to enhance the tiny progress achieved with the 2001 Abuja Declaration (WHO, Abuja 10 years on). As pinpointed by the Global Health Report 2010, time is short, but solutions exist (Congrats Rwanda and Eritrea).
Jean Patrick Alfred (Emerging Voice, Haïti):
Les cinq événements d’Haïti:
[Ed: A new health minister; UN made cholera in Haiti; a recognized need to invest more in health by the Prime minister]:
- l’arrivée du nouveau ministre de la sante qui est une femme technique qui a travaillé pendant longtemps à MSH et qui veut enclencher le changement.
- le lancement des assisses départementales de la sante qui nous amènera aux etats generaux de la sante d’où sortira une nouvelle politique de sante et un plan stratégique de 10 ans.
- le contrôle du choléra qui est maintenant dans sa phase endémique.
- la formation par l’Université de Montréal de la quatrième cohorte en maitrise en administration des services de santé.
- le premier ministre qui est medecin qui a reconnu dans sa déclaration de politique générale que c’était inacceptable que seulement 4,8% du budget soit alloué à la sante; maintenant on attend le concret.
Samuel Ohouo Brou (Médecin, Economiste de la Santé Cellule de Prospective et de Stratégie/Ministère de la Santé et de la Lutte contre le SIDA, Ivory Coast):
Les cinq évènements de la Côte d’Ivoire:
[Ed :Free care ; IHP+ signed]
- La décision de gratuité des consultations et actes de soins (bien qu’aucune étude préalable n’ait été fait et qui mérite donc d’être revisitée en profondeur (pérénité?)).
- L’adhésion de la Côte d’Ivoire à l’Initiative IHP+ impliquant l’élaboration du document de Politique Nationale de Santé, la révision du PNDS 2009-2013 et la conduite du processus d’aboutissement à la signature du COMPACT National.
- L’élaboration du cadre d’accélération de l’OMD 5.
- L'”accélération” de la coopération internationale en santé avec plusieurs partenaires: AFD,UE, PEPFAR.
- la bonne évolution de l’avant-projet de réforme appelé “Fonction Publique Hospitalière”.
David Hercot (ITM) :
- The changing Health ODA paradigm: Reduced funding at the Global Fund; reduced funding in the US state bill for 2012; reduced growth of Health ODA globally and paradoxically increased funding at GAVI.
- The NCD summit but it probably won’t have much influence in the short term.
- Cameron and the shifting policy towards results in UK and followed by most OECD donors.