The 2010 Millennium Development Goals Review Summit - International Development Committee Contents


Written evidence submitted by Action for Global Health

BACKGROUND

  1.  Action for Global Health was established in October 2006, bringing together 15 non-governmental organisations (NGOs) based in five European countries—France, Germany, Italy, Spain and the United Kingdom—with a coordinating office in Brussels. It aims to monitor how the actions and policies of European governments affect health in developing countries, and to influence decision-makers to improve their practice, and support developing countries to achieve the health Millennium Development Goals (MDGs).

  2.  In the UK, Action for Global Health is represented by the International HIV/AIDS Alliance, Interact Worldwide and TB Alert, and since 2007 these organisations have been working with other UK-based development and health NGOs to share information and undertake joint advocacy under the auspices of Action for Global Health.

  3.  We welcome the opportunity to contribute to this International Development Committee (IDC) inquiry on the outcomes of the UN High-level MDG Review Summit which took place in New York in September 2010. This submission has been coordinated by the three core members of Action for Global Health—Interact Worldwide, the International HIV/AIDS Alliance, and TB Alert—with contributions from other members of the AfGH UK network. This submission represents the shared views of the health development organisations listed at the end.

Chapter 1:  Key outcomes from the Summit

  4.  There were two key outcomes from the 2010 High-Level Review Summit on the MDGs. The first is the official outcome document while the second is the UN Secretary General's Global Strategy for Women's and Children's Health[1] (the Strategy). The latter is a plan to fast-track progress on MDGs 4 and 5 (child and maternal health). Although new reports by the World Health Organisation (WHO) show maternal mortality rates declining by a third since 1990, this target still remain amongst the most off-track. And MDG 5 also includes an indicator on universal access to reproductive health, which has also not been adequately addressed.

  5.  We welcome the renewed focus on maternal and child health with the caveat that it's important that the implementation of the Strategy recognises the integration of health issues—as captured in the text— in order to make sure that it supports progress across the three health MDGs, including MDG 6 (HIV, TB, malaria and neglected tropical diseases). Additionally, as all of the MDGs are interconnected those specifically related to health will not be achieved without progress on, amongst others, promoting gender equality and improving water and sanitation.

  6.  It's especially important that financial resources committed to support the Strategy are "new funding". The US$40 billion committed by developing and developed countries and other global actors, cannot simply be a shift of resources from financing already committed to other health issues, thus undermining progress already made across the health MDGs.

  7.  As already stated, the Strategy lays out an integrated approach to women and children's health. It is a welcome starting point for placing the health Millennium Development Goals back on track. The plan correctly acknowledges that strong health systems with well-trained and fully staffed workforces are essential to better and longer lives for women and children in developing countries. It also acknowledges how health cannot be separated from improvements to water and sanitation.

  8.  The Strategy also recognises the importance of human rights in achieving the MDGs. In regards to the right to health specifically, women have to be empowered to be healthy but they also have to be healthy to be empowered. While a focus on health systems is welcome, due attention needs to be paid to women's empowerment in order to support them in knowing and demanding their rights within this system. Moreover, the Strategy makes little mention of the sexual and reproductive health of adolescents and young people meaning that it fails to address a key group that account for a large proportion of maternal deaths.

  9.  Very importantly, the Strategy places an emphasis on putting women and children at the centre of strong national health plans developed by the government. This element is critical to aligning the Strategy with aid effectiveness principles, particularly country ownership.

  10.  Although the Strategy recognises the importance of removing financial barriers to accessing healthcare, this issue should have been given much more importance. The removal of public sector healthcare user fees, particularly for vulnerable populations, is essential. The UK government has been a leading voice on this issue, recognising the disproportionate impact of user fees on the poorest and most marginalised, and should continue to keep this issue at the centre of its efforts for women and children.

  11.  What is missing from the Strategy in its current form is a focus on turning the commitments made against it into an action plan for progress on the health MDGs. The Strategy calls for an accountability framework to be developed and for the World Health Organisation to lead on this process. Moving forward swiftly on this framework will mean the difference between success or failure of this Strategy. Likewise the development of the accountability mechanism needs to include a range of actors, including civil society from developing and developed countries. Civil society in developing countries is often essential for delivering key health services when governments cannot or will not.

  12.  A system must be put in place that tracks progress against the Strategy on the ground. Donor countries must also make good on the Strategy's pledge (which they have backed) to cede control of national health plans to the governments of developing countries. Additionally, if there is a viable and fully-costed national health plan, donors should be working to make sure that it does not go unfunded.

  13.  In terms of other outcomes from the Summit, the UK missed an opportunity to be a champion on a financial transaction tax for development, which would provide long-term, sustainable funding for all of the MDGs. Both Spain and France came forward in support of a financial transaction tax and we are disappointed that the UK did not show the leadership to do the same.

Chapter 2:  DFID's role in delivering agreed strategies

  14.  Within the context of the Summit and the launch of the UNSG's Global Strategy for Women's and Children's Heath, the UK committed to increase efforts up to 2015 to double the number of maternal, newborn and children's lives saved. Through the UK's new Business Plan for Reproductive, Maternal and Newborn Health it is anticipated that UK aid will save the lives of at least 50,000 women in pregnancy and childbirth, a quarter of a million newborn babies and enable 10 million couples to access modern methods of family planning over the next five years.

  15.  In order to achieve this, the UK has committed to double its annual support for maternal, newborn and child health by 2012, sustaining this level to 2015. This means providing an average of £740 million for maternal, newborn and child health from 2010 to 2015. These figures mean that the UK will spend an additional £2.1 billion on maternal, newborn and child health. Part of this growth in the budget will come from the UK continuing to increase their spending on official development assistance (ODA) to reach the target of 0.7% of GNI by 2013.

  16.  DFID also made a large financial commitment on malaria at the MDG Summit, which is in line with their stated priorities. Recognising the interconnectedness of all the health MDGs, but in particular malaria and children's health, we are interested in hearing how this commitment fits with that made to the UNSG's Global Strategy on Women's and Children's Health.

  17.  The financial commitments to malaria and women's and children's health were made at the Summit before the completion of DFID's respective business plans on these areas of work. We would encourage the IDC to ask DFID how the "learning" from civil society input to forthcoming business plans and the completion of the multilateral aid review will impact the commitments made at the Summit? Additionally, after the multi-lateral aid review is complete, how will DFID ensure that its commitments to malaria and maternal health contribute to the replenishments of the Global Fund to Fight AIDS, Tuberculosis and Malaria and GAVI to which the UK have a responsibility to pay their "fair share"?

  18.  As a civil society network dedicated to health we welcome the show of commitment to health by the Government. However, it is important that this additional funding to maternal, newborn and child health is not simply a shift of resources from other health priorities. It is important that the Government recognises the inherent interconnectedness of all the MDGs, including those related to health, in order to channel funding in such a way as to support attainment of the right to health for all and the achievement of the three health MDGs.

  19.  Additionally, with the focus rightly on comprehensive national health plans in the Strategy, DFID should be working with the governments of developing countries as they decide their health priorities and support fully-costed and integrated national health plans.

  20.  Beyond just the financial figures, DFID should be a global leader on pushing for the development of the accountability framework on the Strategy in order to ensure that progress can be tracked.

  21.  Additionally, around issues of the health workforce specifically, recognising the critical shortage of health workers in developing countries, the UK needs to place a stronger focus on policy coherence with increased recognition of the impact of recruitment of health workers from developing countries. The UK should develop a clear action plan for the UK's commitment to the implementation of the Code of Practice on the international recruitment of health personnel and demonstrate how the Code can be used to improve practice at home as well as supporting countries where the crisis is most acute. Without a greater investment in the health workforce in developing countries the shortage of health workers in developing countries will continue to undermine progress on the health MDGs.

Chapter 3:  The role of the UN, the World Bank, the European Commission and NGOs in securing and delivering Summit outcomes, and how these organisations will be held accountable for achieving them AND The role of developing countries in securing and delivering Summit outcomes

  22.  All types of actors, including governments of developing and developed countries, key health funders like the Bill and Melinda Gates Foundation and NGOs have made pledges towards the UNSG's Global Strategy for Women's and Children's Health. It is essential that they're all held to account on these commitments through the development of an accountability framework as already stated.

  23.  An important element of developing the accountability framework, which should be a key issue for the UK Government, is recognising the important role played by civil society, in both developing and developed countries, in monitoring progress and holding their governments to account. It should be highlighted here that there was very limited opportunity for civil society to meaningfully engage in the MDG Summit itself. We welcomed the opportunity afforded by the Secretary of State's and Deputy Prime Minister's civil society briefings in New York, however, the UK should have led in efforts to improve the involvement of civil society in the proceedings themselves. Additionally, the lack of a single civil society representative on the UK delegation further sidelined civil society from a critical place at the table.

Chapter 4:  Looking ahead

  We recommend the following:

  24.  The government needs to ensure that the global strategy for women's and children's health supports progress against the three health-related MDGs, not priorities one at the expense of another. The health MDGs are inter-related and must all be supported to achieve the desired outcomes.

  25.  The UK needs to play a strong role in developing the accountability framework on the UNSG's Global Strategy for Women's and Children's Health, including serving as a champion for the strong involvement of civil society in this process.

  26.  The UK should be a global leader on calling for women and children, particularly those must vulnerable, to be at the centre of the implementation of the UNSG's Global Strategy for Women's and Children's Health.

  27.  The Government should provide a clear accounting of the commitments made to women's and children's health and malaria and what will be counted as part of these commitments.

  28.  The UK government should champion health workforce issues in its maternal and malaria priorities to ensure that efforts to scale up human resources for health in countries most of track/fragile states are central to its efforts to meet the health MDG related goals.

  29.  DFID needs to demonstrate its commitment to civil society engagement through leading by example and ensuring that civil society representatives are included in all future delegations at which global, regional and national policies are being discussed. Moreover, this commitment should translate to a demand for civil society to be at the decision-making table in developing countries.






1   http://www.un.org/en/mdg/summit2010/pdf/mdg%20outcome%20document.pdf). Back


 
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