European Commission High Level conference on Global Health

• To present the European Commission Communication on Global Health and
• To discuss key challenges, goals, policy instruments and partnerships with stakeholders and global partners to see how the EU can most effectively engage with all actors to improve health at global level. More than 200 participants, including policy-makers, academics and civil society organisations attended.
  

The first day was divided into working groups on the following topics: Global Health for all / Coherence in response to globalization challenges / Innovation & access / Health as a human right / Governance / Research: local and global challenges

The second day was an opportunity to summarize all inputs of the working groups in plenary and to provide a list of recommendations per topic with high level speakers present (John Dalli, European Commissioner for Health and Consumers, Margaret Chan, Director General of WHO and Bience Gawanas, African Union Commissioner for social affairs).

Summary

• The conference was a good opportunity to gather all stakeholders active in health from donors to recipient countries, including international organisations, civil society, academics and the private sector. However, it was belated given the fact that the Communication and the Council conclusions on global health have already been adopted.
• From the discussions in the working groups, participants mainly emphasized on the need to be more operational and to implement the commitments and promises instead of reiterating them.
• In general, participants recognised that the role of the civil society organisations should be better emphasized and new tools for CS involvement need to be developed. CSOs and communities should be better involved in strengthening health systems as they play a central role in peoples health as service providers but also as stakeholders in the decision making process and as watchdog in monitoring the implementation of health policies. 

Main recommendations for each working group:

Session A: Global Health for all

• Emphasize the principle of solidarity and promote synergies between EU and U.S. global policies as well as South/South cooperation;
• Strengthen health systems in countries by better applying the aid effectiveness principles in the framework of the International Health Partnership;
•  Support more leadership and governance at global level (WHO) and national level;
• Involve more civil society (CSOs, CBOs, Parliaments, patient groups) which are not sufficiently represented in policy-making;
• Importance of the notion of gender equality in health: there is a need for a stronger focus on women and on sexual and reproductive health;
• Free access to health care at the point of delivery (starting with pregnant women and children);
• Link WHO 2010 report on health financing with the World Health Assembly resolution on access to services (2008).

From the discussions in this working group, participants mainly emphasized on the need to be more operational and to implement the commitments and promises instead of reiterating them. A point was raised as well to recognise the important role played by community-based workers in realising universal coverage and reaching the health MDGs. Finally, innovative mechanisms like the Global Fund (GFATM) were also mentioned as key instruments to be supported to achieve the health MDGs.

Session B: Coherence in response to globalization challenges

• Workforce: the crisis in human resources for health needs to be tackled at the source and to receive more attention;
• Emerging challenges: common guidelines could be elaborated in order to better identify emerging challenges at an earlier stage;
• Research and Development: ensuring that the results of research are translated into concrete actions by decision makers and stakeholders (donors, international organisations, civil society, private sector);
• Tools: improving the tools, including both legal obligations and incentives, covering all stakeholders to work together with a more coherent approach;
• Global health starts locally: countries and organisations need to take their responsibility in ensuring a coherent national approach to public health challenges.

• Taking a holistic, coherent and inclusive approach to health research to have coherent policies across regions and in international fora;
• Ensuring country ownership and support of health and research systems: adopt regional approaches and networks for innovation and access (North/South/South and South/South cooperation) and empower countries to engage in innovation;
• Identifying new financing mechanisms and incentives for innovation and access: adopt sustainable and predictable mechanisms for R&D funding and unlink the R&D costs from the price of medicines (meaning not including the cost of R&D in the price). The importance of multiple mechanisms (PDP, pooling funding) was also raised;
• Capacity needs should be strongly recognised: local ownership and leadership is needed on this issue and southern capacity into research projects needs to be built;
• Better linking innovation and access to health issues: the issue of access needs to be addressed from the start and innovation should be understood in a broad perspective.

• Content of the right to health: the right to health is acknowledged by the international community and the EU. It is recognised as a complex notion including both access to health, quality care and access to determinants of health (nutrition, water and sanitation);
• Gender reality of the right to health: the gender perspective is essential in pursuing the right to health as women and girls are victims of discrimination but also actors in upholding the right to health. Sexual and reproductive health is key for empowering women;
• Delivering the right to health: the first duty bearers are governments and political will is as important as resources to take the lead in setting objectives and priorities. Domestic resources need also to be mobilized to ensure the right to health;
• Important role of civil society organisations and national parliaments in ensuring the right to health (adopting adequate legislation and appropriate budget, raising awareness and watchdog role);
• Policy coherence: all developed and developing countries should ensure their policies are supportive to access to health for developing countries and situations undermining the right to health should be addressed.

• Global Health begins at home: importance of national global health strategies to assure policy coherence at national and EU levels. In the same way, policy coherence is needed at WHO and UN level;
• Beyond the development agenda, to a global interdependence agenda: there is a need for an emancipative and participating North/South/South cooperation to build their own health governance institutions, health research and educational institutions;
• Strengthen WHO leadership role and governance: provide a better regulatory framework by strengthening WHO normative function and include other stakeholders in a meaningful manner into WHO governance.

• Importance of research in responding to global health challenges: need for research synthesis and comparative research to improve decision-making at different levels within health systems (operational level, programme level and national policy and systems level);
• Importance of recognising changing context for research: changing health actors, wider determinants on health, changing global research architecture, changing sets of actors, funding challenges;
• Strengthening the current state of research in health systems: the level of funding for research and especially health research in low income countries is very low. There is a need for greater ownership of priority settings in research;
• Empowering key actors: importance of fostering research partnerships (with North/South/South and South/South cooperation) and need for greater research coordination and coherence globally, regionally and nationally.

More information

Mr Dalli, European Commissioner for Health and Consumers, presented the new Communication from the European Commission on the EU role in Global Health. He reiterated the leading role that the EU has to play in addressing global health issues when one out of seven children in Sub-Saharan Africa do not survive their 5 first years and when maternal mortality on this continent is two hundred times higher than in the EU. Sub-Saharan Africa is also the part of the world bearing 20% of the world disease burden for only 3% health workers.

The EU strategy is therefore based on four principles:

• promoting shared health values and solidarity
• health as a prerequisite for economic prosperity
• promoting health in all EU policies
• strengthening the EU voice on the international stage

With this new policy framework, the EU is willing to present its vision for global health and to bring coherence and leadership on this issue.

Margaret Chan, Director General of WHO highlighted the importance of this year with the UN Summit on the MDGs in September in New York and the need to move forward to strengthen health systems. She welcomed the EU initiative on global health, especially the emphasis on universal coverage and capacity building if we want to achieve the health MDGs by 2015. The Alma Ata principles are far more challenging to implement than30 years ago and Mrs Chan illustrated this with the issue of national ownership which is difficult to achieve given the fact that there are more partners and agencies implementing programmes in health than in any other sector. This leads to fragmentation of care, high transaction costs, unpredictable funding and poor alignment with national priorities. There is therefore a need to emphasize the aid effectiveness principles and the Accra Agenda to achieve greater coherence in health.

Mrs Chan reaffirmed that the MDGs, despite slow progress, have led to new instruments for financing health initiatives and have increased the involvement in health development. There is a need to focus on health systems strengthening without forgetting other issues such as HIV, Tuberculosis or Malaria. Another important point is to make fairness a cornerstone of international health policy as it will not happen by itself. Differences between and in countries have never been higher than today and equity will only happens if fairness is an explicit objective; the EU has a strong role to play here in addressing this issue.

Bience Gawanas, African Union Commissioner for social affairs stressed the EU support to the African Union, especially with the Joint Africa-EU Strategy (JAES) established in 2007 and being currently revised for the next AU-EU Summit in Libya (November 2010). She reminded participants of the greatest challenges that HIV, Tuberculosis and Malaria, as well as maternal and child health represent for Africa and the efforts of the African Union to improve health in Sub-Saharan Africa. In 2007, the Africa Health Strategy was adopted with a clear vision to move towards a prosperous Africa free from diseases, based on the principle of equity and on empowering communities for an African driven response.

Mrs Gawanas stressed that health requires a multi-sectoral response as it is not only about infrastructure but also about human resource governance, financing, social protection, strengthening partnerships and increasing research.

She added that 2010 is a key year with the UN Summit, the end of the first action plan under the JAES and the African Union Summit on maternal and child health in July in Uganda. It is time to move from commitments to results.