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

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1 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? This paragraph should also discuss issues including migration, human resources for health and the impact of HIV/AIDS pandemic affects the lives of individuals and nations. It would also be important to provide rationale for how health came to become a global agenda. Reasons include the fact that infections do not respect national boundaries, necessitating research in different parts of the world and the need to share knowledge. It may also be pertinent to mention the presence of many players on the scene and the consequent need for coordination of efforts. There are also some challenges that the concept of global health faces and these could be pointed out in the first section. Agreeing on variables to measure global health could be listed as such. 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? This was well described. 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? The MDGs are well conceptualized with targets and indicators identified. The goals were well chosen to reflect global health issues however, the health MDGs do not make any reference to social health protection and the means to pay for the health programmes. It could also be emphasized that the achievement of health-related MGDs plays a significant role for the achievement of non-health goals. 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? Strengths: the recognition of the need for better coordination of aid; seeking to build on and cooperate with ongoing programmes rather than defining new directions; it is based on the principles of universal access to quality health care, equity and solidarity; an emphasis on reducing health inequalities. The Equity dimension through which equal access to health care regardless of ethnicity, gender, age, social status and ability to pay is guaranteed seems very crucial. Another merit of the EU policy on health and development cooperation is that it affirms the ownership based upon inclusive leadership and democratic governance. It supports the internationally agreed health related development goals. The need for social health protection and addressing issues related to access and impoverishment might be more emphasized. 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?

2 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? ODA should only increase if a deficit is discovered despite ensuring the efficient spending of assistance at the present levels. Financing from multiple sources helps to ensure that resources are available to fund the global health programmes and to extend coverage of health services. However, it should be noted that ODA or other sources of funding is not enough to strengthen health programs unless there is a strong political commitment by national governments. 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? Allocative efficiency is a vital issue in reaching better health outcomes. In this regard, countries have to be strengthened to identify their priorities which should in turn serve as the basis for assistance from development partners. This means that development partners should only choose where to intervene based on the priorities identified by the host country. In other words, needs and priorities of the recipient countries should be clearly defined and the aid should correspond to those needs and priorities. 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? Continuous advocacy and engagement of policy makers in dialogue. The institution of good governance is also important. Question 9: What are your suggestions for striking the right balance between addressing health priorities and providing support for developing health systems? Contributing to the priorities definition process would help understanding of the context and thus provide information on how to provide effective support Question 10: What are the main opportunities for increasing the level and enhancing the effectiveness of health aid from the EU? Carrying out a background research on the recipient countries to have a precise assessment of the needs and priorities. 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? Democracy is about the majority choosing those who lead a country and it is at the heart of good governance. As the right to health is a human right, leaders should ensure that the health of the population is catered for. Also, the healthier the population, the more productive a country is. When health services and the social determinants of health are adequately catered for, there would be less agitation within the populace thus bringing about stability in the polity. It is also key for sustained progress to enable social dialogue and involvement of voices of the poor in decision making and information sharing. Question 12: What impacts 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? Increase in the price of food and the economic downturn would mean that individuals and families have less to spend on other consumption activities like

3 health care. Also, they would not have enough to purchase nutritious food and therefore switch to non-nutritious ones. Institution of social protection mechanisms would help to mitigate the effects of the rise in food prices and the economic downturn. The EU should also cooperate with the ILO which has enormous experience in this area and recently launched the Social Protection Floor which includes a guaranteed access to a minimum set of health care services as a key component. Question 13: What should be the role of civil society in the health sector, at national and local levels? Civil society involvement in the debates on the health sector is very crucial. Despite the issues of accountability and transparency of civil society, civil society involvement promotes healthier discussions as it is a way to express the will of society and enhances democratic environment. Hence, the civil society should be involved in advocacy, evaluation and feedback to the policymakers; project implementation including education of the population. 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? To stem drain from the EU the reasons for leaving should be ascertained and actions put in place to mitigate these. 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? Although telemedicine may serve to provide services in remote areas, it is important to consider the cost effective and sustainability of this. 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? The EU could organize workshops to inform people about certain issues concerning the notion of global health. Question 17: What could the EU do to improve the research funding for global health? Advocacy at the regional level, campaigns at the global level, and provision of funds for research as part of EU aids to developing countries. Question 18: How, in your opinion, could the EU research funding effectively address the systemic weaknesses of health systems worldwide? A significant amount of research funding should be provided for health systems research rather than disease control only. In this regard, it is crucial to implement mechanisms to monitor research activities and enhance knowledge sharing among researchers to prevent overlaps.

4 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? I think the main issue with research in low income countries is that the demand for research is what stimulates research. Otherwise, researchers would conduct only studies which would serve personal interests. Knowledge sharing and cooperation between countries could let the scientist in low income countries have a better grasp on key issues concerning other countries. Question 20: Which kinds of global public goods for health should be given priority and how should they be financed and managed? Vaccination and immunization for vaccine preventable conditions, and drugs for the control of pandemics. Some of these are already being financed through global PPPs eg GFATM and GAVI Alliance. Countries and donors should be encouraged to remit contributions as and when due. However, efforts must also be put in place to ensure efficient spending. Question 21: Which do you think are the priority areas for coherence on global health policies, and how should they be addressed? Enhanced cooperation between global actors and national governments is a key to addressing the issues. 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? Participation of the local voices in the debates on global health could be one way of doing this or adopting a bottom-up approach while designing the policy proposals. 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? It would be difficult to define a universal minimum health service package as different regions have different peculiarities. Each country should define it s minimum health package based on it s population health profile and national health system priorities Question 24: What, in your opinion, should be the main principles guiding equitable social protection for health? Affordability, universal access based on need ; solidarity and equity. Question 25: Which fair financing principles and mechanisms should apply to health system financing to ensure equitable and universal coverage of basic health care? Financing based on ability to pay and access based on need

5 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? See above. Question 27: What, in your view, is the main added value offered by the EU in the field of global health? The reference to successful social models is an important added value. Question 28: Do you think that an EU social model could inspire global health equity? This would depend on the commitment of the country and the availability of the necessary infrastructure.