The EU role in global health

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1 The EU role in global health Contribution of Dominique Kerouedan, MD, MPH, PHD Independent Expert International Health QUESTIONNAIRE: Question 1: In your opinion, does the proposed concept global health cover the most relevant dimensions? If not, which other essential factors would you suggest? Human rights and especially women rights should be considered as a major determinant of better health and emphasised in the concept of Global health, including with respect to responses to address health problems such as the HIV spread for example in Africa. I don t agree with the fact that there has been progress made in MDG 6, despite enormous spending. We have to stop saying this, this is not true : the 5 y evaluation of the GFATM programmes shows that increased funding led to increased outputs (VCT, PMTCT, ARV therapy sites and activities), but very limited impact (HIV incidence).the WHO public health approach to ARV access in resource limited countries has not been evaluated. Quality of VCT, PMTCT, ARV therapy programmes has not been evaluated. As a result, we know nothing about what is really going on at country level with respect to HIV disease control except that may be those receiving ARV drugs are less dying than others, but again, what is the coverage for patients, for pregnant mothers, for children? All these are serious issues that the EU COM should acknowledge, assess correctly and show innovative analysis and strategy with respect to which remains a major global health challenge in the coming years and decades. There has been progress with respect to malaria control in few countries of the Eastern part of Africa, this are also the areas suffering today from drought and hunger Is the climate the main factor of the dicrease of mortality due to malaria or are the interventions contributing to this? I don t see TB mentioned at all despite major issues at stake around resistance to treatment cases Question 2: Are the effects of globalisation on health, on the spread of diseases (whether communicable or life style non communicable) and on equitable access to health care sufficiently described? Yes but we are not talking about epidemiological transition but rather all problems happening at once : developing countries have to deal with infectious diseases + mental health problems + chronic diseases and road accidents, all at once, there is no transition, which differs from what was observed in Europe. All this happens in a human and Financial resources limited context Question 3: Do you consider the health related MDGs a sufficient framework for a global health approach? If not, what else should also be considered?

2 No it s not Objectives should include all the current major challengers the world is facing and their impact on health in developing countries : climate change, reproductive health and human rights issues, chronic diseases, etc. Question 4: In your opinion, which are the main strengths and weaknesses of the current EU policy on health and development cooperation, and which dimensions should be given greater attention in order to face the challenges ahead? I disagree with the analysis of why the progress of achieving MDGs has stalled p. 5. Weak services and access to services are not the reasons ; there are no relevant strategies to reach Health MDGs at country level, and therefore as a consequence (not the cause) limited access and weak systems ; HRH shortage is indeed a bottleneck, but a strategies, guidelines, advise on how we implement MDGs are lacking, As I said above : the reis no leadership on HIV prevention at global or national levels ; but this is changing because Unaids Director is now more interested in HIV prevention than P Piot was. There needs to be innovative approaches to HIV prevention, there has been no progress on behavior change and communication. What has been done on Blood safety and blood transfusion safety? Why are prevention and care activities around STIs not funded anymore? As no institution takes the lead on HIV prevention, the EU could Question 5: Could you identify health problems that have been neglected by the EU and international health research agenda and propose the best means to support innovation to address them, especially in low and middle income countries? Research capitalizing success stories in disease control and examining how expanding these stories at national or regional levels in other countries/areas Question 6: Do you think that ODA commitments for health should increase, and how do you think that other sources of financing could contribute to addressing global health and universal access? Yes of course ODA commitments to health should increase But the main issue today is about the instruments channeling the funds, and its management, not about the amounts it seems to me (see my paper in The Lancet in August 2009). There are a number of evaluations and recommendations regarding the GFATM monies management which have to be looked at and followed before we discuss this further. All major health evaluations in 2009 provide very interesting recommendations; how can we wait more to implement them?

3 Question 7: How do you think fragmentation of aid for health could be reduced, with a view to increasing aid effectiveness and preventing detrimental health spending? There is no how here All is about political will (in the North and in the South) Donor Countries are not willing so far to do so In addition very little attention is given to management for results component of the Paris Declaration; it s time to emphasize this Question 8: In the context of aid effectiveness and alignment of financing to national priorities, what can be done to make sure that adequate attention is paid to health priorities and to strengthening health systems? To consider giving countries the leadership role in taking forward all these matters, as well as provide technical expertise Besides, EC should play a leading role together with COUNTRIES, as well as the WB, WHO, IHP+, regarding HSS, but this does not belong to GAVI and the GFATM to do this, even if that s what is happening (international platform) Question 9: What are your suggestions for striking the right balance between addressing health priorities and providing support for developing health systems? Support to both should be considered under the countries leadership according to national health sector and disease control strategies and priorities. The issue is rather how mandates, expertise and funding, as well as instruments are distributed, and it goes back to the previous question Question 10: What are the main opportunities for increasing the level and enhancing the effectiveness of health aid from the EU? Ensure high level technical expertise It means adjusting training curricula and Faculty to new GH challenges in public health schools and universities in EU Member States Where are the Global Health future experts currently trained? Are there any? Revising financial instruments to channel funding to health towards operational interventions, decentralized activities and quality Question 11: In your opinion, what are the links between health, governance, democracy, stability and security and how could the right to health be put into operation? The link is about political will to improve the population s health. There is no will so far Then we need to think how there remains leadership where consensus processes are favoured (global health institutions); the question is raised at global level only, because at country level, the country is supposed to lead policy making, processes, etc.

4 Question 12: What impact will the global crisis (climate change, food prices and economic downturn) have on global health and what could be done to help mitigate their ill effects? Impact: lack of interest on behalf of rich countries What can be done: read Pr Kourilsky s book Le temps de l altruisme Edition Odile Jacob September 2009 Question 13: What should be the role of civil society in the health sector, at national and local levels? Raise political will and interest Show and share what works in prevention and care Question 14: Which action do you think the EU should take to stem the brain drain of health workers, while respecting their freedom of movement? Plan, train and distribute health workers in Europe to serve the European population health needs in private and public sectors in urban and rural areas; act more strongly on the pull and demand side Question 15: What role do you see for new technologies (including telemedicine) in enabling developing countries to provide access to care even in remote areas and to allow better sharing of knowledge and expertise between health professionals, and how can the EU support this? This is great and already working in some areas (Latin America if I remember well) EU can support this financially and technically (providing funding for technical expertise, training and equipment) Question 16: What are the keys to ensuring equitable access to medicine and how could the EU help to do more on this, including by supporting innovation and management of intellectual property rights? Why not do more to help Southern countries produce medicines? IMPORTANT QUESTIONS ABOUT GOVERNANCE AND THE NEW AID ARCHITECTURE ARE NOT RAISED SUCH AS HOW YOU ORGANISE LEADERSHIP AT GLOBAL LEVEL IN PUBLIC PRIVATE PARTNERSHIP TO CHANGE INEFFECTIVE DISEASE CONTROL STRATEGIES? AND WHAT IS EU S ROLE HERE? Question 17: What could the EU do to improve the research funding for global health? What are the research priorities? Support to disease alert surveillance and response systems for developing countries is essential, in terms of safety and equity Question 18: How, in your opinion, could the EU research funding effectively address the systemic weaknesses of health systems worldwide? Is research a response to HS weaknesses? Political will, leadership, management capacity, experience sharing, expertise, coordinated national and international funding, decentralization, deconcentration, are some of the

5 answers Question 19: How do you think national capacity and local scientists in low income countries could be empowered to conduct research relevant to their countries priorities? There should be incentives for scientists in the North to produce this; there is none so far Call for proposals and access to funding, including EU and US funds, should be published in several different languages (French, Spanish, Portuguese, etc.); this is not happening generating inequity of access to research opportunities between English speaking countries and others in Africa especially See the FACTS initiative interesting initiative to value fieldwork Question 20: Which kinds of global public goods for health should be given priority and how should they be financed and managed? It seems that there is a missing question on disease alert and surveillance capacity of developing countries to start with Question 21: Which do you think are the priority areas for coherence on global health policies, and how should they be addressed? As financial instruments drive the way the EC is operating in health (as opposed to choosing instruments to fit the implementation of defined policies and strategies) there should be much more thinking and role of the EU in the GFATM Board and other institutions, especially at country level, about how EC funding at country level contributes to HSS, HRH development, HMIS and disease alert and surveillance and response, etc. Question 22: How could the legitimacy and efficiency of the present global health governance be improved and which role should the EU play in this? The EU should bring developing countries take a leadership role, or at least belong to major partnerships, which is not the case now, only politically correct positions Question 23: Do you think a definition of a universal minimum health service package would facilitate a rights approach and progress towards more equitable coverage of services? If so, how could such a universal minimum standard be defined? We need to sit together in a special working session on this, not through a consultation this general Has this not been done? Question 24: What, in your opinion, should be the main principles guiding equitable social protection for health? I would not spend time on principles but rather on strategies and hows at country level Question 25: Which fair financing principles and mechanisms should apply to health system financing to ensure equitable and universal coverage of basic health care? Again, what do we learn and what can be shared from country level experiences

6 Question 26: What is the role of civil society in global and national health governance and how can potential conflicts of interest between advocacy and service provision be avoided? The right question is rather : how is institutional strengthening of civil society organization funded and not only the activities they contribute to? Question 27: What, in your view, is the main added value offered by the EU in the field of global health? Its principles and experiences in the European region, need to be capitalized and shared Question 28: Do you think that an EU social model could inspire global health It seems the sentence is not finished here General comments Too many questions about principles Not enough questions on operation ways of doing things An excellent situation analysis but the contribution of the EU to Global health needs to be summarized separately : what are its components eventually? What are the EU s comparative advantages in the field of Global Health and what can the EU bring to the table? Global Health means partnering globally, for this to make sense, the EU and the EC have to identify specifically the areas of interventions How is this discussed with EU Member states?

The EU role in global health QUESTIONNAIRE: Question 1 Question 2 Question 3: Question 4: Question 5:

The EU role in global health QUESTIONNAIRE: Question 1 Question 2 Question 3: Question 4: Question 5: The EU role in global health QUESTIONNAIRE: Question 1: In your opinion, does the proposed concept global health cover the most relevant dimensions? If not, which other essential factors would you suggest?

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