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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,
1996‒2005
9000
Signing of
Declaration
of
Commitment
on HIV/AIDS
8000
7000
US$ million
6000
8297*
• International donors,
domestic spending
(including public
spending and out-ofpocket expenditures)
• International
Foundations and
Global Fund included
from 2003 onwards,
PEPFAR included from
2004 onwards
5000
4000
3000
2000
1623
1000
Data include:
292
0
1996199719981999200020012002200320042005
* Projections based on previous
pledges and commitments (range
of the estimation: US$7.5 to
US$8.5 billion).
Donor Aid for Health has Increased
Significantly
16
14
Most of the recent
increases:
US$ billions
12
Private non-profit
10
Other multilaterals
Development banks
8
UN agencies
Bilateral agencies
6
4
2
0
2000
2005
year
Source: Michaud 2006
•Focus on Africa
•Focus on specific
diseases
•Come from
bilaterals and
‘other’ multilaterals
(GAVI, Global Fund)
Donor Funding in Rwanda
Distribution of Donor Funding by Strategic Objective
$80m
$60m
$40m
$20m
$m
other health
services
HIV/AIDS funding
c
ap a
ity
vic
S er
es
s p.
Ho
ral
fer
t. C
Ins
Re
alth
He
ss
ss
cce
cce
.A
C
.A
ogr
V,
anc
Fin
Ge
D,
HR
Global Health Initiatives
• GAVI
• Global Fund to fight AIDS,
Tuberculosis and Malaria
• PEPFAR, ‘The Global Health Initiative’
Fragmentation in
international effort ….
International health (2003)
OTHER
AIDS/HIV
Malaria
TB
Funds
Flow
CICCR
GAVI
& VF
Coordin /
Disease
Control
New Prod.
R&D
APOC
CONRAD
TB
Alliance Lap -
EMVI
Sequella
Found.
Vira mune
DP
MNT
GFUNC
MMV
I
Operat .
Research
NetMark
Plus
Prevention/Vaccine
AMD
HACI
TBDI
AAA
CPA
CVP
HPTN
IDRI (leishm . et al)
SDI
SSI
GAELF
Diflucan
ITI
AAI
INDEPTH
Size ~
Funding
MSF
DND
GDF
Coar
tem
Treatment/Drug
IPPPH database, Partnership websites
TB
Malaria
AIDS/STD
Other
PSI
Concept
Foundation
SEAM
Partners
TB Solutions ( Sequella F.) (MDRT )
Note:
Funding levels preliminary
Source: BCG Analysis, Bill & Melinda Gates Foundation Website,
CCA
ECI
MDP
Prod.
Distrib .
HIN SIGN
IPAAA
JPMW
Action
MIM IOWH
dap
TB ICC
Artesunate
ADD IPM
suppo
Secure
the
Future
Vision
LFI
GBC
2020
TFCSD
PHW
Stop TB
MVP
HVDDT
IAVI DVP
ACHAP (Botswana)
Roll Back Malaria
Micro bicides
HVI
GET
2020
GAEL
VITA
MVI
PDVI
Prod.
Transfer
GPEP
GWEP
GMP
The Global Fund for Aids, TB & Malaria
Stepping
Forward UNFPA
contra
access
GAIN
GRI
Diagnosis/Tests
Advocacy/ HealthEduc /
Community Mobiliz
Italics = Global
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
GFATM HAS ALLOWED SIGNIFICANT SALARY INFLATION TO OCCUR,
PARTICULARLY FOR PROGRAM MANAGERS
Dollars per month
Cambodia salaries for health programs
Viet Nam salaries for HIV/AIDS programs
1,800
1,200
800
900
50-100
MoH
100150
DFID
500
250-400
50-200
WB
GFATM*
Viet Nam salary story
•
MoH salaries ranged $50-100 per month
•
DFID offers health worker incentives in
HIV/AIDS program; WB begins
programs with significantly higher pay in
overlapping districts where “poaching”
will occur
•
GFATM granted PR (MoH HIV/AIDS
program) salary request of $900 per
month for program managers
•
Donor and GHP practices lead to
escalating distortion of salaries
and poaching of resources within
HIV/AIDS sector
MoH
DFID
GFATM
Round 4
GFATM National
Round5 programs
Cambodia salary story
•
MoH salaries ranged from $50 to
few hundred per month
•
CCM decided to pay GFATMassociated employee $1,200 per
month
•
For Round 5 grant proposal, CCM
further escalating salary cap
($1,200 + annual increase)
•
National programs followed suit for
increasing salaries, resulting in
major country-wide salary inflation
•
“This has been phenomenally
destructive.”
* Increase for program managers only of GFATM grants
Source: Global Health Partnerships: Assessing Country Consequences, McKinsey and Co, November 2005
Three important World
Reports in 2008
Health budgets/capita/year
Reality North
5.000 $
Realistic optimum
500 $
Realistic minimum
50 $
Reality LDC
5 $
Reality neglected populations
0,5 $
Socioeconomic &
political
context
Governance
Policy
Cultural &
social norms
& values
Influencing social
norms, building
societal trust &
cohesiveness
Material
circumstances
Social position
Social
cohesion
Education
Occupation
Psychological
factors
Income
Behaviours
Gender
Biological
factors
Ethnicity/race
Leveraging IAH
Strengthening social
empowerment, influencing
practices of governance and
accountability
Limiting
differential
financial
impacts
Closing differentials in
access and use
Health prevention,
promotion and care
A PHC-oriented Health
System
Social Determinants of Health Inequities
Distribution
of health
and wellbeing
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 2010
4. Universal coverage and social protection
WHReport 2008 and 2010
5. Non communicable diseases
Resolution WHA 2010, double burden
DAC member’s Official Development Assistance
in 2003 and 2004
Norway
Denmark
Luxembourg
Sweden
Netherlands
Portugal
Belgium
Switzerland
France
Ireland
United Kingdom
Finland
Germany
Canada
Australia
Spain
Greece
Austria
New Zealand
Japan
United States
Italy
ODA (US$billion) current
2004
2003
Avera
ge
countr
y
effort,
0.42%
20 18 16 14 12 10 8
6
4
2
UN
targe
t,
0.70
%
ODA/GNI (%)
2004
2003
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0
Source: Organisation for Economic Co-operation and Development (2005).
10.13
Paris Declaration
OECD –WB – main bilateral and multilateral donors,
February 2005
Accra Agenda for Action, September 2008
Health sector:
- Health as a tracer sector (OECD – DAC)
- International Health Partnership+
- WB – GF – GAVI health systems strengthening
platform
Paris – Accra
AIM
Ownership
Effectiveness
PROCESS
Harmonisation
Alignment
Accountability
country systems
Donor collaboration is a challenge
GTZ
WHO
CIDA
UNAIDS
RNE
UNICEF
Norad
WB
Sida
USAID
T-MAP
MOF
UNTG
CF
DAC
GFCCP
PEPFAR
GFATM
INT NGO
3/5
HSSP
MOH
PMO
PRSP
MOEC
SWAP
CCM
CTU
NCTP
CCAIDS
NACP
LOCALGVT
Source: Mbewe, WHO
CIVIL SOCIETY
PRIVATE SECTOR
Millennium Development
Goals
1.
2.
3.
4.
5.
6.
7.
8.
Eradicate extreme poverty and hunger (people
living with less than 1,25$/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
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),6
• 2010 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