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Global Health Landscape anno 2010

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 HIV/AIDS as a trigger, health high on the international agenda

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Global Health Landscape anno 2010

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

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

  3. « AIDS exceptionalism »

  4. Estimated total annual resources available for AIDS, 1996‒2005 9000 • 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$8.5 billion). Signing of Declaration of Commitment on HIV/AIDS 8297* 8000 7000 6000 5000 US$ million 4000 3000 2000 1623 1000 292 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 3.8

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

  6. Donor Funding in Rwanda

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

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

  9. OTHER AIDS/HIV Malaria TB Funds Flow CICCR The Global Fund for Aids, TB & Malaria Secure GAVI CCA GET GPEP the & VF HIN AAA APOC ACHAP (Botswana) GAEL SIGN Coordin / 2020 Future CPA Disease Roll Back Malaria Vision LFI VITA CVP GBC GWEP Control 2020 TFCSD PHW Micro - Stop TB bicides GMP TB HVI MMV HPTN Malaria MVP IPAAA I MVI JPMW TB New Prod. GFUNC AIDS/STD AMD IDRI ( leishm . et al) HVDDT IAVI Alliance DVP R&D Other Lap - Action IOWH MIM Sequella dap HACI ICC TB TBDI INDEPTH Artesunate Found. PDVI EMVI ADD IPM CONRAD SDI suppo Size ~ ECI Vira - Funding Prod. SSI PSI mune Concept GAELF Transfer DP MNT Foundation Diflucan MSF Italics = Global MDP GDF DND Prod. Stepping ITI Coar AAI NetMark UNFPA Forward Distrib . tem SEAM SEAM Plus contra access GAIN Partners Operat . GRI ( MDRT ) Research TB Solutions ( TB Solutions ( Sequella Sequella F.) F.) Prevention/Vaccine Treatment/Drug Diagnosis/Tests Advocacy/ HealthEduc / Community Mobiliz Note: Funding levels preliminary Source: BCG Analysis, Bill & Melinda Gates Foundation Website, IPPPH database, Partnership websites International health (2003)

  10. 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?

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

  12. Three important World Reports in 2008

  13. Health budgets/capita/year • Reality North 5.000 $ • Realistic optimum 500 $ • Realistic minimum 50 $ • Reality LDC 5 $ • Reality neglected populations 0,5 $

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

  15. 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

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

  17. DAC member’s Official Development Assistance in 2003 and 2004 Norway Denmark Luxembourg Sweden Netherlands Portugal 2004 Belgium 2003 Switzerland France Ireland ODA (US$billion) current United Kingdom 2004 Finland 2003 Germany Canada Average country effort, 0.42% UN target, 0.70% Australia Spain ODA/GNI (%) Greece Austria New Zealand Japan United States Italy 20 18 16 14 12 10 8 6 4 2 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 Source: Organisation for Economic Co-operation and Development (2005). 10.13

  18. 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

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

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

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

  22. 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?

  23. 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 • ….

  24. Health for all, how to achieve?

  25. 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),6 • 2010 EU Communication on Global Health • African leadership and institutional CB

  26. 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?

  27. Executive summary

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