WHO support to Innovative Financing for Health
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1 WHO support to Innovative Financing for Health Tokyo, 16 December 2010 Simon Wreford-Howard External Relations Officer, WHO Department of Partnerships 1 Leading Group on Innovative Financing for Development, Tokyo, December 2010
2 WHO Partnership & Innovative Financing support Considerable financial requirements for health Overriding objective: reach the MDG's WHO's global health financing advisory role: High Level Task Force, World Health Report 2010 Set-up and hosting by WHO GFATM UNITAID Other PPP's: RMB, PMNCH, Governance WHO is a board member or observer to all PPP's WHO guidance on use of innovative funds IFFIm original investment case Development of the AMC Target Product profile Board member to UNITAID, GFATM, etc 2 Leading Group on Innovative Financing for Development, Tokyo, December 2010
3 Future support Guidance & support 2011: WHO publishes a reference analysis on innovative financing for health Support tool for innovative financing for health actors Because they work: WHO support to maintain and to strengthen existing innovative financing systems Access the untapped major G20 donors large potential WHO support to increase financing to UNITAID, IFFIm, Polio, GFATM WHO business case development for emerging systems Solidarity Tobacco Levy (STL) WHO global mandate to save lives and to protect health Development of the WHO STL Feasibility Study following the 2009 conclusions of High-Level Innovative Health Financing Task-Force Input / Output modeling, governance 3 Leading Group on Innovative Financing for Development, Tokyo, December 2010
4 The Tobacco Solidarity Levy (STL) WHO STL Feasibility Study STL is a micro-tax of either 5, 3 or 1 US$ cents per packet If fully applied to G20+ countries could raise + US$ 7 Bn / a US$ 4.3 Billion from high income countries (5 cents) US$ 1.7 Billion from upper middle income countries (3 cents) US$ 1.6 Billion from lower middle income countries (1 cent) Allocation keys Majority of SLT proceeds would flow into National budgets An allocation key of 30% for international health would generate US$ + 2 Billion /a Pilot amount for launch purposes If initially applied by several path-finding countries Amount TBD 4 Leading Group on Innovative Financing for Development, Tokyo, December 2010
5 Arguments for a Tobacco Solidarity Levy (STL) STL could be easily accepted by Governments and consumers Could be quickly launched as a pilot STL has double-impact: proceeds may be used for international health but also serve tobacco control STL funds originate from more of the global economy s haves than have-nots STL funds are collected from a large base STL funds are predictable and stable over time Micro-tax: STL funds are collected in a way that minimally distorts the global economy STL is technically and legally immediately feasible Tobacco has no social or economical necessity 5 Leading Group on Innovative Financing for Development, Tokyo, December 2010
6 Outcomes for 2011 Summer 2011: WHO publishes reference analysis on Innovative financing for Global Health: what works, what not WHO supports the strengthening of existing systems: UNITAID, IFFIm etc Innovative financing for Global Health is boosted via the launch of new systems: STL etc 6 Leading Group on Innovative Financing for Development, Tokyo, December 2010
7 Thank You & Questions 7 Leading Group on Innovative Financing for Development, Tokyo, December 2010
8 Backup Slides 8 Leading Group on Innovative Financing for Development, Tokyo, December 2010
9 Learnings for the future (1) IF for health has resulted, for now, in the emergence of: Pooled, predictable, sustainable and additional funding IF for health can only work if: Start-up is based on strong leadership and early adopter countries Highly creative thinking Working together what did not work because of lone-thinking? Use of WHO technical support / business models Buy-in and involvement from new stakeholders: see IFFIm road-shows, role of the UNSG for Innovative Financing Strong coordination & governance Legal adaptations in National Law and barriers to overcome: USA Deliver of strong results and capacity to communicate these Capacity to maintain systems in time So far, fantastic results for Innovative Financing for Health but how sustainable are they? So far + US$ 9 billion raised by the major systems producing key results Focus on immunization and HIV/Aids/TB programs MDG's 4,5 & 6 IFFIm frontloading AMC market-shaping UNITAID niche investments, market shaping, patent pooling GFATM financing instruments: D2H, Exchange Traded Fund (ETF) 9 Leading Group on Innovative Financing for Development, Tokyo, December 2010
10 Learnings for the future (2) How sustainable are the existing systems? IFFIm repayments in time high back-loading, Keynes thinking AMC product and tail price relationship with industry Low number of high yield air solidarity levies who next to adopt? Increased use for National priorities no more pooling: de-tax etc One-off operations: D2H Increased recognition that Innovative Financing goes hand-in-hand with innovative spending Critical role of implementing organizations and their governance structures Innovative financing a necessity September 2010 MDG summit highlights importance of Innovative Financing but also of the Private Sector Impact of innovative financing on the infra-structure of health financing Do positive outcomes outweigh transaction costs Innovative Financing has become a key component of National Health financing outside of the global & pooled context WHO World Health Report, November 2010 South-South innovative financing do not need the Global Funds to function 10 Leading Group on Innovative Financing for Development, Tokyo, December 2010
11 South-South non-pooled examples World Health Report 2011 identifies nine options for raising new domestic resources from innovative sources see page 29, notably: Indirect taxes Ghana funded its national health insurance partly by increasing the value-added tax (VAT) by 2.5% "Sin" taxes on tobacco and alcohol A 50% increase in tobacco tax alone would yield an additional US$ 1.42 billion just 22 low income countries for which sufficient data exists. This could increase government health expenditure by up to 25% National currency transaction levy Would be feasible in many countries e.g. India could raise US$ 370 million per year from a very small levy (0.005%) Solidarity levies Gabon raised US$ 30 million for health in 2009 partly by imposing a 1.5% levy on financial transactions abroad. 11 Leading Group on Innovative Financing for Development, Tokyo, December 2010
12 Challenges for Innovative Financing for Global Health National priorities Impact of financial crisis Innovative financing for direct budget support, Health, Education, Climate Change, other Complex environments & number of stakeholders Regrouping required not to do or to attempt too much Harmonization and Leadership on innovative financing for health - UNITAID, GAVI, other? South-South Innovative Health Financing Now a reality requires coordination with North-South approaches Push for innovative financing confronts institutionalized funding gaps Funding targets not met for quite some time now Why would it work now? Future of WHO financing question how far we can support 12 Leading Group on Innovative Financing for Development, Tokyo, December 2010
13 New Option for Innovative Financing: the Solidarity Tobacco Levy (STL) US$ 7,6 billion An amount as small as US$0.05 per pack of cigarettes sold in the high-income G20+ countries would raise US$4.3 billion (G20+: 19 G 20 countries, European Union, Chili and Norway) An even smaller amount of US$ 0.03 per pack of cigarettes sold in the upper-middle income G 20+ countries (which are also part of the list of the 28 countries that have the largest numbers of smokers in the world) would hypothetically raise another US$1.7 billion A US$ 0.01 amount raised in the G 20+ lower-middle income countries that have the largest numbers of smokers would raise an additional US$1.6 billion 13 Leading Group on Innovative Financing for Development, Tokyo, December 2010
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