Healthy Aid
We’ve been enjoying leaving the office this week and yesterday we attended the media launch of the second Action For Global Health report. Action For Global Health is an advocacy network of European NGOs. The aim of this year’s policy report is to consider how European aid for health is delivered, and to create a strategy for increasing the quantity of aid, and the quality of its delivery. The 2007 report focused on aid effectiveness, and yesterday’s report addressed the question of ‘Why Europe must deliver more aid, better spent to save the health Millenium Goals’.
The meeting was chaired by Christine McCafferty MP and chair of the All Parliamentary Group on Population, Development and Reproductive Health. The panel included Neil Gerrard MP, Chair of the APPG on Aids, Gareth Thomas MP, Parliamentary Under-Secretary of State for DFID, Bruno Oudmayer from Action for Global Health and Christopher Kangale from Alliance Zambia. All were in agreement about the need to improve aid effectiveness through better coordination, predictability of aid levels and donor coordination.
The report includes eight recommendations for achieving MDGs 4,5 and 6:
More aid for health better spent
Predictable aid is needed for health systems
Promoting a division of labour
Too many initiatives
Civil society is vital to progress
Without gender policies, aid cannot be effective
Provide a mix of aid instruments for health
Prioritise human resources for health
Bruno Oudmayer began by summarising the recommendations outlined by Action for Global Health, particularly the need for a variety of instruments to be used in reaching the MDGs. He stressed the benefits of a variety of different approaches and the value of reviewing the position of European donors at the midpoint towards achieving the MDGs. Where there were questions about the efficiency of aid, he felt that they should not be used as an excuse to make pre-emptive excuses for not achieving the MDGs.
Christopher Kangale outlined the position of Zambia at the halfway point of the MDGs. Maternal mortality has decreased from 729 to 449 deaths per 100,000. Infant mortality has decreased from 168 to 119 per 100,000. But whilst overall HIV infection is decreasing, it is increasing in young people. Moreover, Zambia is in the midst of a crisis owing to a lack of health workers. Major weaknesses remain in the health system, but civil society groups play an active role in supporting the needs of specific groups within the community. He suggested ways in which external donors might improve the efficiency and extent of their contribution. He emphasized the need to focus on the results of improved coordination, not simply the mechanisms. He also spoke at length of his experiences in Zambia and underlined the extent to which focus on health systems, for example, had resulted in money being siphoned away from a high priority disease area, resulting in the collapse of a Tuberculosis programme. He said that debates about horizontal vs vertical health strategies were unhelpful.
The other speakers, particularly Gareth Thomas and Christine McCafferty, focused on the need to encourage and support female participation of women’s groups in health strategy planning. MDG 5 addresses the need to improve maternal health. The major cause of death in women between 15-19 is pregnancy. Women constitute more than 50% of the population, and if their role in encouraging health seeking behaviour is disregarded a huge resource is ignored. This was the basis for identifying a link between supporting community based healthcare, and ensuring that national health systems were the focus of European spending. Gareth Thomas used the opportunity to reiterate previous commitments made by the UK independently and in partnership with the USA.
However, in spite of the common support for MDGs there were differences in emphasis which underlined the difficulties (within Europe itself) of defining a singular and coherent strategy for achieving the MDGs. Several of the recommendations presented in the report address the need to better coordinate aid, both in terms of donor and recipient coordination. One problem raised included the difficulties posed by donor governments demanding the transparency which enables them to ensure that funds are used correctly, whilst still allowing funds to be used to support and sustain national health systems.
In the course of the open discussion, the nature of the relationship between national health systems and NGOs became increasingly debated. Gareth Thomas raised the element of competition introduced by NGOs. He told of one senior health minister who had been lured away from his government position by an American NGO who offered him triple his salary. Whilst emphasising the crucial role of healthcare in the community as a means of reaching the hard to reach and hardly reached, there was some confusion about whether it was better to fulfil these needs through national health system or through NGOs.
The consensus was that more money needs to be given, with greater emphasis on efficient activities, to achieving the MDGs. By coordinating donor activities within Europe, it is hoped that this will ensure that the by 2015 the MDGs are an achievement, rather than source of disappointment. Sophie and Christine
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