6 things we learned on global health from #GlobalDev Week

At the 69th United Nations General Assembly in New York last week, member states discussed the way forward for the intergovernmental negotiations leading up to the adoption of the post-2015 sustainable development framework less than a year from now.

Through their country statements and by hosting events, national governments provided an insight into their priorities for the framework talks.

As Action for Global Health anticipates the start of these negotiations, there were six key messages that we took away from the discussions:

1. Several important goals that can influence health are questioned, but the health goal itself is recognized as too important to lose.

During UNGA week there were some discussions on revisiting the Open Working Group’s outcome document. Some countries, like Sweden and the United Kingdom, wanted to reopen discussions to reduce the number of goals and strengthen the targets proposed. Others, including delegates from Kenya, Indonesia, Nigeria and Gambia, felt that might be a risk as it could water down the final framework.

The following goals would be particularly at risk: Goal 8 on economic growth and decent work for all; Goal 10 on reducing inequality within and among countries; Goal 12 on sustainable consumption and production patterns; Goal 16 on access to justice for all; and Goal 17 on the means of implementation and a global partnership for sustainable development. In particular, Trade-Related Aspects of Intellectual Property Rights — or TRIPS — was a buzz topic.

In addition, part of the gender goal — Goal 5 — would be at serious risk, especially the targets around legal and political empowerment of women and girls, as well as equality.

Specifically, Goal 3 — ensuring healthy lives and promoting well-being for all and at all ages — seems to be well-positioned, and all member states appear to want to keep it, even if the outcome document is reopened. Goal 3 is a strong outcome-focused goal. It includes a target on ending AIDS and on sexual and reproductive health (but critically, not rights), and it adequately addresses the unfinished business of the Millennium Development Goals and emerging priorities such as noncommunicable diseases.

2. A lot of talk about ending inequalities, but how strongly it will be reflected in the final framework remains unclear.

During the discussions on the OWG document, the specific focus on vulnerable and marginalized groups was taken out of the target related to universal health coverage. This can have dramatic consequences, as the UHC monitoring framework proposed by the World Health Organization and the World Bank includes just 80 percent health coverage at the time of writing.

This is bad news for groups that are already marginalized, stigmatized, discriminated against, criminalized and excluded in countries across the globe. UHC will never be achieved if all people — irrespective of age, gender, religion, disease status, sexual orientation, gender identity and other factors — do not have access to the quality health services they need.

The stand-alone goal on reducing inequality within and between countries does, however, enjoy strong support from a wide range of countries, and will be an essential way to address the marginalization of people in its widest sense.

As a global health community, it’s vital to support a goal to reduce inequalities in access to health care and to ensure out-of-pocket payments do not fall on the most marginalized and disadvantaged.

3. Participation and accountability.

There was much discussion last week on accountability and participation, both among member states and civil society. The “global north” and “global south” agreed that the new framework should be constructive, transparent, open and inclusive, and build on existing mechanisms. The critical question that remains, however, is on how to turn a “money-and-power” conversation into an “accountability” conversation where civil society is meaningfully involved in deciding where the money should be spent post-2015.

We convened civil society organizations on the fringes of the UNGA to point out that meaningful engagement is done in a very ad hoc way in most countries. The danger is that civil society participation could end up as a token “tick-the-box” exercise, where rather than participating as equal partners around the table to define, implement and evaluate health policies, few CSOs are meaningfully asked to input.

Another challenge we face is bringing the private sector into the accountability debate to openly address issues such as open supply chains, corporate accountability — including transparency on pricing and transactional spending, and open procurement contracting. It’s crucial to tell the private sector the value for money of doing "clean" business from a transparency point of view.

Significantly, it’s interesting to see that the debate on post-2015 has a much stronger focus on accountability than was ever the case with the MDGs. As the new development framework is universal, there is much more awareness among governments and civil society. AfGH is therefore encouraged that a greater number of actors will be incorporated into the tracking process with more meaningful engagement.

4. The health goal is going in the right direction, but needs some tweaking at target level.

While the formulation of the health goal has broad support from member states, there is a risk that the targets might be merged. It is therefore imperative to work at the indicator level, going forward, so that at least the appropriate elements will be measured regardless of which target they are covered under.

Current weaknesses of the health goal targets are the exclusion of gender-based violence (currently only included under the gender goal); legal reform and nondiscrimination; sexual rights; attention for health systems strengthening, including community systems; social determinants of health; the right to health; and specific attention to marginalized populations. Some U.N. member states and CSOs feel there is a need to also focus on the second part of the health goal — to “promote well-being for all at all ages” — and, moreover, discuss the type of targets and indicators that could measure well-being, such as social determinants of health and the realization of the right to health.

UNAIDS presented its new “fast track” to end the AIDS epidemic by 2030. It proposed a 90-90-90 target for HIV treatment by 2020 — where 90 percent of people living with HIV know their HIV status, HIV treatment is offered to 90 percent of people who know their status, and 90 percent of people on HIV treatment can achieve undetectable levels of HIV in their body — and 95-95-95 by 2030. This is a target to reduce new adult HIV infections from 2.1 million in 2010 to 500,000 in 2020 and 200,000 in 2030. Finally, they aim to achieve zero HIV and AIDS discrimination by 2020.

5. How to ensure policy coherence for development when in trade and health.

The OWG’s target 17.10 reads: “Promoting a universal, rules-based, open, nondiscriminatory and equitable multilateral trading system under the World Trade Organization including through the conclusion of negotiations within its Doha Development Agenda.”

This is much less ambitious and a step back from previous U.N. agreements, as TRIPS is not even mentioned. Countries like France, Sweden and Norway were strongly advocating for TRIPS to be included, whereas the Netherlands and the U.K. had a weaker position.

Countries in the global south have viewed the debate with much suspicion. The Brazilian government expressed strong concerns, stating that the pharmaceutical industry in Brazil is the leading cause of the country’s deficit, and that civil society needs to be more vocal on this issue as well as including it as part of the accountability debate with the private sector.

6. Financing: a new facility, a new fund and new allocations.

On financing, it is interesting to learn that Spain created the first national fund for the post-2015 goals. Switzerland stated that it will allocate 0.5 percent of gross national income to international development and humanitarian cooperation. The U.K. has maintained its 0.7 percent commitment and called for stricter rules on transparency and accountability.

Finnish President Sauli Niinistö considers the report of the Intergovernmental Committee of Experts on Sustainable Development Financing — which Finland co-chairs — as a solid basis for talks on domestic resource mobilization, official development assistance and private sector finance. As was to be expected, the discussion among member states focused much more on domestic financing and private sector funding than on ODA, and was linked strongly to the issue of accountability.

There was a lot of noise around a new Global Financing Facility led by the World Bank, together with the United States, Canada and Norway, to mobilize support for developing countries’ plans to accelerate progress on the health-related MDGs, and bring an end to preventable maternal and child deaths by 2030.

The GFF will support countries in their efforts to mobilize both domestic and international resources required to scale up, and sustain essential health services for women, children and adolescents. Initial commitments include grants of $600 million from Norway and $200 million from Canada.

Accountability is key to addressing inequalities. And civil society is a resource that is currently underutilized. AfGH will continue to convene CSOs to influence the means of implementation of the post-2015 agenda, to increase and improve European governments’ financing for health, and to influence “road maps” such as the UHC monitoring framework developed by the WHO and World Bank.

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