Global Responsibilities for Global Health Rights Conference
19 - 21 October 2009, Brussels, Belgium
Global Responsibilities for Global Health Rights Conference
The Global Responsibilities for Global Health Rights Conference, organised by the Hélène De Beir Foundation, brought together over 80 leading academics, practitoners and activists in global health field. Over three days the participants discussed the framework of the global health architecture and how to move forward with an overhaul of global funding modalities and international health initiatives.
Day one: Clarifying the conceptual framework:
The Conference opened with introductions to three key concepts; the right to health, global social health protection and human security. Participants explored the link between the right to health and the Millennium Development Goals (MDGs) and how to build political and public will to support a rights based approach to health. Some participants noted the importance of tying rights to equity and the need for structural reform to achieve real progress in universalising rights. In discussing redistribution at the international level participants discussed the practicalities of developing a global social health protection floor. Some preferred the idea of starting with national protection while others felt that a global mechanism bypassing the national level was needed and was what the World Bank (WB) was meant to do.
The final presentations and discussion focused on what human security approach can bring to global health. The way in which the human security approach can integrate other rights (e.g. education, health) was highlighted as was the importance of asking which humans and whose security. Some participants argued that the human security approach lacked moral grounding and lacked the accountability, civil society participation and concern for equity that human rights offer.
Day two: Practice: Key elements of the Funding Mechanism or Architecture
The second day began with a discussion of equal power in governance for contributing and recipient countries. Many participants noted that no country is strictly a donor or contributor, citing the brain drain as an example of “aid” from the South to the North. The fact that donor governments continue to treat aid as charity not global solidarity was highlighted as a key element of the governance issue with some cautioning that solidarity is not tied to rights. The importance of changing the current situation so that country priorities are respected, the massive burden of accounting to many different donors and the unresponsive nature of donor agencies were all discussed. The practicalities of mobilising politicians and that access to health are a deeply political matter were emphasised.
In discussing domestic funding and increasing fiscal space the importance of overturning the dominant development model was discussed. Encouraging African countries to meet the Abuja Declaration (15% of the annual national budget to health sector development) and the importance of creating a new culture in which countries contribute to the development of their health system year on year were highlighted. As the importance of increasing domestic resources is key, participants asked how and if national treasuries benefit from growth and increased wealth and how to translate this to increased tax revenue so as to increase the national budget; to ensure that 15% is not 15% of nothing. Participants were asked to think about the implications of IMF, WB and international health policies for those who work in health and the need for health workers and activists to become economically savvy and to know what donor governments are doing on the IMF and WB Boards to avoid becoming a “global ambulance”.
In addressing the present and future risks in Global HIV/AIDS funding participants were cautioned that things have changed and that their approach needs to integrate prevention and be more nuanced. We know that treatment and death resulting from waves of the epidemic are predictable but levels of funding are not. Some participants were less pessimistic about funding but acknowledged that the financial crisis has revealed vulnerabilities. The importance of knowing how funding is spent, (greater transparency and fewer international consultants), trying to get “more health for the money” and being innovative in looking for “new money” were also discussed. The importance of developing legal, human rights and ethical concepts that affirm the importance of continued funding was acknowledged.
The discussion around health systems strengthening explored the importance of moving away from disease specific approaches while noting there is no consensus on what is required. The importance of showing results to help maintain funding was acknowledged. Participants debated the benefits of an integrated approach noting that a health system can play a bigger role than providing health and contribute to countering corruption and dysfunction. The importance of showing results was emphasised. Several participants drew linkages with earlier discussions noting that the fact that donors look to the World Bank and IMF is a huge structural problem in the global financial health architecture with implications for health as well as other sectors.
The role of civil society and its engagement with global mechanisms was identified as key to delivery, monitoring and accountability. The absence of formal civil society involvement in many countries was identified as an obstacle that NGOs need to work together to overcome. Participants discussed the entry points for civil society and whether or not some of them were closing. The importance of North/South solidarity, and in particular funding solidarity to help overcome the absence of infrastructure in many countries closed the day’s discussion.
Day 3 - Practice and Existing Funding Mechanisms
Representatives of the Global Fund (GF), World Bank (WB) and European Commission (EC) presented their funding channels and expressed their optimism that the environment is changing and that progress in global health will be made despite the economic crisis. With regard to the concepts from the first day, the GF representative highlighted the fact that “GF principles are based on the right to health”. The EC representative spoke about the MDG contracts arguing that once public health funding is in place this enables a rights-based approach. The WB representative identified impediments to achieving the MDGs, (e.g. need for regular, sustained funding) and the increased focus on results based funding.
Mary Robinson emphasised that she believes that global responsibility for global health needs to be recognised and that thus far progress on the right to health has been too incremental. She added that individuals must hold their governments accountable for commitments they make and that includes the right to an equitable health system. She urged participants to talk about and work towards a Global Health Fund and have it on the agenda at the September 2010 MDG Summit.
Jeffery Sachs noted that ten years ago there were no global initiatives for health and emphasised the huge leap in the last ten years. He noted that funding pledges have been made by governments and that if they keep their promises there is no funding gap for health. He added that the GF and GAVI are highly effective ways to intervene and helped expose what the true needs are. Like Mary Robinson, Jeffery Sachs urged for the creation of a Global Health Fund. He too urged participants to try to push for ambitious goals at the 2010 Summit.