Global Health Landscape anno 2010 Dr. Dirk Van der Roost Prof Wim Van Damme ITM – Antwerp 28 September 2010

The global health landscape Some trends in global health 1.HIV/AIDS as a trigger, health high on the international agenda 2.Combating infectious diseases and the rise of the Global Health Initiatives 3.Rediscovering Primary Health Care 4.Social determinants of health Themes 1.Tackling global health threats 2.Drugs 3.Human resources for health 4.Universal coverage and social protection 5.Non communicable diseases Relation with the development agenda 1.Millennium Development Goals 2.The Paris Declaration Role of EDCTP?

« AIDS exceptionalism »

Estimated total annual resources available for AIDS, 1996 ‒ * US$ million Signing of Declaration of Commitment on HIV/AIDS Data include: International donors, domestic spending (including public spending and out-of- pocket expenditures) International Foundations and Global Fund included from 2003 onwards, PEPFAR included from 2004 onwards * Projections based on previous pledges and commitments (range of the estimation: US$7.5 to US$8.5 billion). 3.8

Donor Aid for Health has Increased Significantly Source: Michaud 2006 Most of the recent increases: Focus on Africa Focus on specific diseases Come from bilaterals and ‘other’ multilaterals (GAVI, Global Fund)

Donor Funding in Rwanda

Global Health Initiatives GAVI Global Fund to fight AIDS, Tuberculosis and Malaria PEPFAR, ‘The Global Health Initiative’

Fragmentation in international effort …. Source; Don De Savigny & COHRED

International health (2003)

Global health initiatives public private partnerships vertical programmes, narrow focus Product development / disease control / advocacy Strong fund raising capacity, additional/rediverted resources, ‘funding gaps’ Promising results, serious questions: Derived from an inclusive analysis and prioritisation of the needs? How to fit in the global architecture? Who is in the lead? Space for institutional capacity building?

Donors Distort Salary Structures Source: Global Health Partnerships: Assessing Country Consequences, McKinsey and Co, November 2005

Three important World Reports in 2008

Health budgets/capita/year Reality North $ Realistic optimum 500 $ Realistic minimum 50 $ Reality LDC 5 $ Reality neglected populations 0,5 $

Socio- economic & political context Governance Policy Cultural & social norms & values Social position Education Occupation Income Gender Ethnicity/race Material circumstances Social cohesion Psychological factors Behaviours Biological factors A PHC-oriented Health System Social Determinants of Health Inequities Distribution of health and well- being Limiting differential financial impacts Strengthening social empowerment, influencing practices of governance and accountability Closing differentials in access and use Leveraging IAH Influencing social norms, building societal trust & cohesiveness Health prevention, promotion and care Net effect is to promote population health equity

Commision on Social Determinants for health ‘Closing the gap in one generation’ 3 principles for action: Improve the conditions of daily life Tackle the distribution of power, money and resources (the structural drivers) Measure the problem, evaluate action, expand the knowledge base, develop a trained workforce and raise public awareness

Important themes at the WHA 1.Tackling global health threats pandemics/international health regulations, climate change, tobacco 2.Drugs innovative development mechanisms, counterfeit, IPR, substandard = ??? 3.Human resources for health WHReport 2004, Health Workforce Alliance, Code of practice on international migration Universal coverage and social protection WHReport 2008 and Non communicable diseases Resolution WHA 2010, double burden

Paris Declaration OECD –WB – main bilateral and multilateral donors, February 2005 Accra Agenda for Action, September 2008 Health sector: - Health as a tracer sector (OECD – DAC) -International Health Partnership+ -WB – GF – GAVI health systems strengthening platform

Paris – Accra Ownership Effectiveness Harmonisation Alignment Accountability country systems AIM PROCESS

MOH MOEC MOF PMO PRIVATE SECTORCIVIL SOCIETYLOCALGVT NACP CTU CCAIDS INT NGO PEPFAR Norad CIDA RNE GTZ Sida WB UNICEF UNAIDS WHO CF GFATM USAID NCTP HSSP GFCCP DAC CCM T-MAP 3/5 SWAP UNTG PRSP Donor collaboration is a challenge Source: Mbewe, WHO

Millennium Development Goals 1.Eradicate extreme poverty and hunger (people living with less than 1,25$/day -50%) 2.Achieve universal primary education 3.Promote gender equality and empower women 4.Reduce child mortality (-2/3) 5.Improve maternal health (-3/4) 6.Combat HIV/AIDS, malaria and other diseases (halt and begin to reverse the spread) 7.Ensure environmental sustainability (proportion of people without safe water -50%) 8.Develop a global partnership for development

Observations from the MDG summit, September 2010 ‘Global Strategy for Women’s and Children’s Health’, pledge of 40 billion $ in 5 years much stronger focus on equity and the strong affirmation that "focusing on the poorest" will be the best strategy. less focus on ODA; more on efficient use of resources. Financial Transaction Tax???? Not sure??? Used for development? Or for the banks??? Extension of mandate and replenishment of Global Fund?

12+ political issues Human rights vs health as a commodity National versus global responsibilities Equity and power relations Role of emerging economies, new players (China, India, Brazil, …) Contradictory geopolitical priorities Global health architecture and leadership Aid architecture (Paris, Global Funds, programmes or projects) Diseases vs health systems, vertical vs horizontal Threat of epidemics, pandemics Sexual and reproductive health and rights, population control Global pharmaceutical market and intellectual property Innovative financing Role of civil society ….

Health for all, how to achieve?

What about EDCTP? EDCTP has a broader scope and a more integrated approach and pursues the principles of: The declaration of Paris and Accra Agenda 2007 Lisbon Declaration and Europe 2020 strategy MDG (4),(5), EU Communication on Global Health African leadership and institutional CB

Challenges for discussion What is EDCTP Role in the global health field? With which stakeholders should EDCTP strengthen collaboration? How to put EU policy coherence in practice?

Executive summary