The prominent public commitments made by world leaders at the recent International Financing meeting at the UN General Assembly (UNGA) on 23 September are highly relevant to the IHP+Results agenda. We have started to look at how these match up with the ten recommendations of the High Level Taskforce on Innovative International Financing for Health Systems. We also want to understand what this means for IHP+ countries.
Minding the gaps
The UNGA announcements touch on 8 out of 10 of the Taskforce recommendations and have come soon after these recommendations were made. But there are still gaps. These public commitments lack detail of how they will be implemented. As with the Global IHP+ Compact commitments, we will be keen to see how the rhetoric translates into accountable actions by international agencies.
The Taskforce estimated that there is a $10bn gap in health financing for the health MDGs to be met. The UNGA announcements promise an additional $5.3bn. There are some truly innovative proposals for raising new cash in the taskforce recommendations. There is potential for the mandatory solidarity levy on airline tickets to be expanded and that the technical viability of other solidarity levies on tobacco and currency transactions should be explored further. Other potential innovations include catalytic funding for large-scale private giving initiatives, leveraging voluntary solidarity contributions and implementing a proposed “De-Tax”.
Fresh commitments were made in these areas, with suggested timetable for introducing voluntary solidarity contributions on air tickets, hotel books and other travel products; Italy will pilot a DeTax programme in the first quarter of 2010; and France is leading a working group to assess the technical and legal feasibility of a currency transaction levy and voluntary contributions based on international financial transactions. However, these commitments have been presented without details of how and when they will be achieved. Is political commitment enough? Who will be accountable for whether these commitments deliver results?
Some Recommendations are not specifically addressed
Taskforce recommendations 6 and 7 demand an increase in the capacity of governments to secure better performance and investment from non-state actors, and to fill gaps in costed and agreed national health strategies. These are not specifically UNGA Commitments. This is interesting, particularly as there is strong demand from IHP+ countries in these areas. It is true that these are difficult issues to address, and they do not lend themselves to international-level communiques. So we must wait and see if country-level work in these areas responds to the recommendations, or if further specific commitments will be made in these areas.
How will these commitments be experienced by countries?
As is the case for many of the commitments made at the UNGA on 23 September, the perennial question is how global commitments will make a difference at the country level. The 9th taskforce recommendation to establish a health systems funding platform for the Global Fund, GAVI Alliance, the World Bank and others to coordinate. This has the potential to have a positive impact on countries’ ability to use and access financing for health. But it is not at all clear how this will work, although there are plans to roll out the platform in several countries in 2010. The financing mechanisms used by the three organisations are very different, and there is a risk that this platform could combine the worst constraints of all three agencies to produce a financing mechanism that is either based on the lowest common denominator, or that is too rigorous because it tries to maintain the perceived unique advantages of each agency’s business model. It is important that the perspective of recipients is the foremost consideration in how this new approach is designed and put into practice. IHP+Results will monitor the progress of this platform. The November Boards of the Global Fund and GAVI will be key decision points in the process to watch out for.
The recurring promise of free health care
IHP+ countries have also made commitments to expand access to health services with a focus on expanding access to free health care. For example, Nepal has committed to doubling access to free and safe deliveries for (over a million) more pregnant women, while Burundi has committed to providing free health care to all pregnant women and under-fives. But this expansion is dependent on donor financing which is yet to be announced, while much of what has been committed is on a voluntary or otherwise uncertain basis. Whether the general commitments made can be translated into specific actions - which are then honoured - remains to be seen.
A step in the right direction, but accountability is key.
We believe that these commitments show a direct and prompt response to the Report of the High Level Taskforce on Innovative International Financing for Health Systems. These are positive steps in the right direction. But we believe this raises as many questions as answers and we will maintain a healthy dose of scepticism as we monitor what unfolds. Accountability mechanisms at international and country level are crucial if these commitments are to be implemented, and to translate effectively and to deliver results at the country-level.
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