Health

Monitoring the commitments

G8 commitments on global health that are monitored in this report include pledges to:

• Pursue all necessary efforts to scale up towards the goal of universal access to comprehensive HIV/AIDS prevention, treatment, care and support programmes by 2010;
• Help to meet the needs of the Stop TB Partnership, which aims to cut TB deaths in half by 2015 (from a 1990 baseline);
• Continue to expand access to long-lasting insecticidetreated bednets to prevent transmission of malaria, with a goal of providing 100 million nets through bilateral and multilateral assistance by the end of 2010;
• Reach 85% coverage of prevention and treatment for malaria in high-burden countries to achieve a 50% reduction in malaria-related deaths;
• Maintain or increase financial contributions to support the Global Polio Eradication Initiative (GPEI) and encourage other public and private donors to do the same;
• Support the control or elimination of neglected tropical diseases; and reach at least 75% of the people affected by certain NTDs in the highest-burden countries;
• Work with other donors to replenish the Global Fund to Fight AIDS, Tuberculosis and Malaria and provide long-term predictable funding based on ambitious but realistic demand-driven targets;
• Support comprehensive approaches to address the strengthening of health systems, and work to increase health workforce coverage towards the WHO minimum threshold of 2.3 health workers per 1,000 people; and
• Ensure that by 2015 all children have access to basic health care to reduce mortality among those most at risk of dying from preventable causes, particularly women and children.

In addition to the above, the G8 set a five-year timeframe to deliver $60 billion for infectious diseases and health systems at both the Heiligendamm and Hokkaido summits. ONE has chosen not to monitor this commitment because it is less ambitious than the G8’s previous health pledges. Achieving the health outcomes to which the G8 have committed on HIV/AIDS, TB, malaria, polio, NTDs and health systems will require more than $60 billion in health spending over the next few years. Though a comprehensive costing is not available, a rough estimate of the needs for HIV/AIDS, malaria, polio, maternal, newborn and child health, tuberculosis and health systems would total $29.5 billion in 2010 alone.

ONE interprets the G8’s commitments to mean that each donor will provide its proportionate share of funding to achieve each of the health commitments listed above. This chapter monitors progress on the outcomes achieved through G8 commitments and overall health ODA from each donor country.

Progress since Gleneagles

In the past decade, efforts by the G8, other donors and African governments have helped to significantly scale up access to life-saving interventions such as antiretroviral therapy (ART), insecticide-treated bed-nets and vaccines; they have also helped to almost eradicate devastating diseases such as polio and Guinea worm. However, health systems in sub-Saharan Africa remain extremely weak and the region lags far behind in prevention, treatment and care efforts, particularly with respect to TB and maternal, newborn and child health.

Beyond 2010

In the years ahead, the G8 and other donors should work with African countries to accelerate progress against infectious diseases by following through on existing commitments to HIV/ AIDS, TB, malaria, polio and NTDs. In order to sustain these initiatives and address broader health goals, they also need to balance these efforts with a more comprehensive approach towards health that emphasises outcomes as opposed to inputs; enhances the long-term sustainability of health programmes through investments in local capacity and support for African health priorities; and strengthens work around maternal and child health. ONE’s recommendations for G8 countries’ future commitments to health include:

CONTINUE TO FIGHT INFECTIOUS DISEASES WITH AN EMPHASIS ON OUTCOMES

Progress against infectious diseases across sub-Saharan Africa could stall or even reverse without continued investments, especially for diseases such as polio and Guinea worm where global eradication is close to being achieved. Similarly, although progress against HIV/AIDS, TB and malaria has been remarkable over the past decade, the world is far from reaching the targets set for these diseases and obstacles such as drug resistance will only make this work more challenging in the years ahead. Future donor commitments on infectious diseases should reflect a transition from an emergency response to an approach that works in collaboration with national leadership and invests in the long-term sustainability of programmes. As part of this shift, indicators of progress should expand to include longer-term outcomes such as deaths averted, training of new healthcare workers and reductions in disease prevalence, in addition to inputs such as access to ARV treatment and insecticide-treated bed nets.

DEVELOP STRONGER COMMITMENTS ON CHILD, MATERNAL AND REPRODUCTIVE HEALTH

While G8 leaders have committed to specific targets for reducing infectious diseases, they have not established similar goals for improving the health of children and mothers. Maternal mortality rates remain stubbornly high, while 8.8 million children die before the age of five each year. In addition, countries in sub-Saharan Africa have some of the lowest usage levels of modern contraceptives. The issue is on the agenda of both the 2010 G8 Summit and the 2010 African Union Summit. In 2010 and beyond, leaders must commit to ambitious targets with measurable outcomes focused on improving overall health for African mothers and their families. They must also develop a concrete framework through which to work in conjunction with national strategies to achieve these outcomes.

CHANGE THE APPROACH FROM ‘EMERGENCY’ RESOURCES FOR HEALTH TO SUSTAINABLE CAPACITY-BUILDING

In 2008, G7 investments for prevention, treatment and control of infectious diseases accounted for nearly 77% of total health ODA to Africa, while funds for health systems were just below 14%. Investments in disease-specific efforts have jumpstarted critical life-saving efforts over the past decade, but in the coming years donors must strike a better balance in funding to ensure that systems are in place to both facilitate the delivery of such interventions and improve health more broadly. In particular, progress in maternal and child health will depend on enhanced capacity. Whenever possible, investments in health systems should aim to strengthen local capacity and delivery systems, as opposed to creating parallel structures. Key outcomes of health systems strengthening should include empowered ministries of health, improved access to technology (including refrigeration, electricity, diagnostics and laboratories) and increased human capacity (doctors, nurses, community health workers and other health personnel).

FULLY FUND KEY MULTILATERAL MECHANISMS

Particularly during this time of global fiscal restraint, multilateral mechanisms offer donor countries an opportunity to leverage their investments to achieve greater collective health outcomes than they would achieve individually, while also allowing for greater country input and management. The Global Fund and GAVI are two mechanisms that have demonstrated tremendous success and are continuing to improve their approach and increase efficiency. 2010 marks the beginning of a replenishment period for the Global Fund, during which robust new pledges will enable it to maintain successful programmes and meet the demand for new ones. Similarly, GAVI is moving towards a model that better ensures long-term and predictable funding. Full financial support this year will allow GAVI to introduce new vaccines for pneumonia and rotavirus, the two leading disease killers of children under five. Increased contributions will have a direct impact on the success of both mechanisms in the coming years. Other multilateral mechanisms, including (but not limited to) the GPEI and UNICEF, play critical roles in improving global health and also require robust financial contributions in order to achieve polio eradication and vaccination targets. Fully financing multilateral mechanisms may require new and non-traditional sources of funding. The emergence of innovative financing mechanisms for health, including Advanced Market Commitments (AMCs), the International Finance Facility for Immunisation (IFFIm), UNITAID, (RED) and others is welcome. Donors should continue to encourage and facilitate such innovation to unlock potential new streams of funding in the coming years.

PUSH FOR BETTER HEALTH DATA

The challenge of outdated information is not unique to health, but without clear and universally understood data, it is difficult to measure progress and adjust donor efforts to increase efficiency and efficacy. In particular, official data on the global health workforce has not been updated in years, which poses a substantial obstacle for nuanced programmatic decisions in the field. Improved data collection and analysis will also help to ensure that financiers and recipients are accountable for the vast sums of money being invested in health. Such an effort should include investments in monitoring and evaluation capacity at the local, regional and global levels; at the same time, better coordination and streamlining of donor reporting requirements would allow recipient countries to focus the majority of their time and resources on programmes. Some efforts to improve health data are underway – including work by the WHO and others to strengthen the global evidence base on human resources for health – but much work remains to be done on this issue in the years ahead.