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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