Transcript Swedish aid for global health

Swedish aid for global health
« G R A N D C O N VER GEN CE» O R « SU ST A IN A BL E C O N VER GEN CE» ?
EBA Seminar; Stockholm Nov 7, 2014; Sigrun Møgedal
The Formula for «Grand Convergence"
SELECTIVE SCALE UP
Invest in drugs and technologies +
services to deliver them
Re-align and re-focus DAH
(to match “true priorities”)
Be pro-active on transition
(responding to domestic capacity)
Respond to underfunded Global Public
Goods
 Infections
 Maternal and child deaths
 Pro poor primary focus
 Fiscal policies for NCDs
The "Convergence” Agenda
STRENGTHS
The economic argument
CHALLENGES
Political and social determinants ignored
(Light touch on trade, taxes, multisector coherence)
The case for priorities
Claiming the keys for "true priorities"
(Political space for national decisions and accountability)
The focus on Global Public Goods
GPGs narrowed down to R&D for technologies
The compelling vision
Uneasy match with post 2015 vision
(Beyond mortality)
The focus on additional spending
No focus on effectiveness of current spending
(Match with Busan type “aid effectiveness” ?)
The case for progressive universalism
Relative neglect of “delivery science” – what to how
(Integrated delivery, Health and social care workforce)
Sustainable Development Imperatives
Healthy planet, healthy people, healthy economy.
Economy cannot any longer override environmental and social sustainability
• Broader and more interconnected action on health, with synergies across sectors and
dealing with political, social and economic determinants that maintain health inequity.
• A global agenda, beyond development assistance. Not just a matter acting with money.
Common but differentiated responsibilities. Healthy people and livelihoods at the core of social
sustainability.
• “Several enablers and drivers, strategies and approaches for sustainable development are
difficult to enumerate as goals, among others human rights, rights based approaches,
governance, rule of law, and wider participation in decision making” (quote from the OWG
report, and listed as cross-cutting - also in investment cases on HIV, TB RMNCh and NCDs)
Political Determinants of Health
Trans-national decisions (or lack of decisions) outside the domain of the health sector
can undermine health and maintain ill health and health inequity.
• Political determinants are about power and choice. What matters are how this power is
distributed, organized and used, who makes the choices, and what counts in making them
• Policy domains outside health do not recognize and respond to the health implications and
health impact of their agenda setting, decisions and actions (the co-herence agenda)
• Institutional dysfunctions allow health inequities to persist and become deeper and more
stubborn to deal with: democratic deficit, weak and fragmented accountability mechanisms,
institutional “stickiness”, missing institutions and inadequate policy space for health
• Not only choices of national governments, but also those of private and corporate sector and
other non-state actors have impact both within and across borders.
The Swedish Response
Sweden can lead beyond “Grand Convergence”: “Sustainable Convergence”
Was an early leader on GPG. Global leadership more than R&D investment in new technologies.
Sweden could pick up as champion for GPGH. Shared but differentiated responsibilities.
Does not shy away from acting on political, social and multi-sectoral determinants and rights –
should not shift to a “within the health sector only” focus on selective health investment
Has been at front in institutional reform of the UN system and is a trusted partner for LICs + LMICs
to build south/north inclusive global leadership. Enable a reformed WHO post2015 and make
multilateral system fit for purpose (takes more than trust funds…)
Has a basis for making UHC a “unifying force”. Aid effectiveness. IHP+. Investments in national
“horizontal capacity” to make the “diagonal approach” work. Health workforce and health metrix.
Broker new compacts for mutual accountability – make equity a core measure. Health security?
The «Ebola Test»
Preparedness (pre Ebola)
Response (post Ebola)
The domestic/DAH mix pre-ebola and how did it
contribute to access to PHC type services with
health workers on the ground? Equity measures?
What changes needs to be done? Consequences for
priority setting in the global health agenda
nationally and globally?
How did targeted health initiatives contribute to
access to PHC type services with health workers on
the ground? (GAVI, Polio, RMNCH, GF etc)
In what ways can the “diagonal approach” be fit
with a national “horizontal capacity” to make inputs
serve access to PHC and HRH on the ground?
In what ways did the multilateral system engage in
assessing preparedness and contribute to it?
How can WHO, other multilateral and bilateral
partners better support responses to IHR in LIC?
How would the convergence agenda contribute to
preparedness?
In what ways can one build a convergence agenda
that ensure critical capacity in surveillance?
In what ways were national institutions meant to
identify and act on early warning?
What is the critical capacity in the multi-sector
institutional response to preparedness and EW?