Overview of Civil Society Overview of Civil Society Principles on IHP+Principles on IHP+

Civil Society Forum on the IHP+

23 May 2008, Movenpick Hotel, Geneva

Professor Brook K. Baker, Health GAP

Principle I: Comprehensive Primary Health Care for All

• The false battle between priority disease initiatives, health system strengthening, and public health for all must stop.

• There must be no Sophie’s choices between HIV/AIDS, TB, and malaria and child and maternal health and all other needed health interventions.

Imperatives for Priority Disease Programs

• Priority disease programs have to strengthened, deepened, and broadened to increase their integration with primary care systems.

• Priority disease programs must focus increased resources and energy on strengthening the underlying health systems upon which they depend.

• Priority disease programs must pay greater attention to education, training, distributing, and retaining health workers who can deliver needed health services.

Imperatives for Primary Health Care & Health System Strengthening

• Primary health care, child and maternal health, sexual and reproductive health, and public health (population-based focus on structural determinants of health and on prevention) must be strengthened.

• HSS requires investment of resources in health planning, human resources for health, health service dispersion to rural communities, health infrastructure and facilities, commodity procurement and supply systems, etc.

Principle II: Governments Must Pay Their Fair Share

• African governments have pledged 15% of GDP to health (Abuja) but few have delivered.

• “Massive increases in external assistance are needed” to finance MDG health goals. (WB, Health Financing Revisited 2006)

• WHO Commission on Macroeconomics and Health estimated at least $38 billion/year by 2015.

• World Bank estimates range between $25 billion and $70 billion in additional aid, per year, to meet MDG health goals.

• These estimates may be far too low, even for HRH alone.

Global Health Funding Needs and Commitments 2006/08-2015

Program Area Resource Needs Domestic/donor commitments

HRH Education and 2x salary (WHO 2007)

$548 billion2008-15

?

HIV/AIDS Phased Scale-Up (UNAIDS 2007)

$269 billion2008-15

$80 billion

TB (Global Plan to Stop TB 2006-2015)

$44.3 billion2006-15

$21.8 billion

Maternal and newborn (WHO Bulletin 2007)

$39 billion2006-15

Norway, Canada Netherland, UK$5.23 billion

Malaria (WHO Bulletin 2007)

$38 billion2006-15

$2.49 billion

Total $938.3 billion $109.52 billion

Costs for Educating Health Workers and Doubling Salaries (billions) (Unofficial WHO 2007)

Year Africa Dev. Countries

2008 $5.8 $51

2009 $6.7 $58

2010 $7.5 $64

2011 $8.0 $66

2012 $9.2 $69

2013 $10.9 $74

2014 $12.7 $80

2015 $14.6 $86

Total $75.4 $548

Earlier HRH/HSS Funding Needs Estimates

(World Health Report 2006, p. 13-14) Education & training costs (doctors, nurses, & midwives)

$7.7 billion/year for 10 years

Incremental operating costs for hiring new HCWs

$17.7 billion/year

Incremental costs for doubling salaries $53 billion/year

Additional, unestimated costs:•Building health education facilities & health infrastructure

•Hiring, training, and paying community health workers

•Health system strengthening – procurement & supply systems, health management

???

Developing Countries and Donor Countries Must Fill the Gap

• Developing countries must prioritize health, cost HRH/HSS based on need, and must increase efficiency and equity in service delivery.

• Even with best efforts, developing country resources will be insufficient.

• Donor funding must be long-term, predictable, and sufficient to fill all identified funding gaps

IMF’s Macroeconomic/Fiscal Restraint Policies Must Be Relaxed

• IMF’s macroeconomic fundamentalism - low inflation, low fiscal deficits, and low growth/employment rates – prevents adequate investments in health, esp. HRH/HSS.

• Hydraulic pressures exerted by the IMF lead to efficiency-only plans, sustainability concerns, and fungibility of aid.

• Only 27% of new aid spent in 29 African countries 1999-2005 (37% to foreign currency reserves and 37% to debt reduction). IEO IMF Report 2007.

Principle III: The People’s Voices Must Be Heard

• Democratic, transparent and accountable governance mechanisms at the national and international level.

• Substantive inputs, not token seats at the side table.

• Increased support for CS participation, especially by grassroots organizations.