Funding of Global Health Policy Priorities - Assignment Example

Funding of Global Health Policy Priorities Introduction In the global health funding hit $31.3 billion (Stuckler, 2008). Thisfigure is the all-time highest figure, five times greater than the one used in 1990. Despite the 3.9% increase from 2012 to 2013, the yearly increase falls short of the best rates experienced over the past decade (Stuckler, 2008) With the funding from most of bilateral donors and development banks declining, the funding from the Global Fund to Fight AIDS, the GAVI Alliance, Tuberculosis and Malaria, the UK government, and non-governmental organizations are counteracting these cuts. The global health funding has remained relatively small in relation to what high-income nations spend on their own health sector. This funding on the global health only represents 1% of the expenditures of these countries (WHO, 2009). Large gaps exist between donor funding and disease burden in many countries, more so in relation to non-communicable diseases. For example, despite a slight increase in recent funding, non-communicable diseases are becoming a prominent and an increasing portion of the disease burden in the developing countries - yet they do not always seem to receive a proportionate amount of attention (WHO, 2009). Even though the attention of the global health community is mainly focused on the development assistance for health, research has found that most developing countries spend twenty times of their own resources on the health sector compared to donor funds (Schneider, 2009). Excluding the assistance offered by donors, government expenditure on health amounted to $613.4 billion in 2011 (WHO, 2009). This expenditure increased by around 7.3% between 2010 and 2012. In many nations, funds donated by donors for the health sector are 10% less the total amount the governments spend on health. However, in sub-Saharan Africa and Asia, the assistance offered to governments towards health accounts for more than 50% of what the governments spend on health. Global health policy actors The main actors in global health policy are rapidly changing. With new actors entering, there has been a shift in the overall fabric of policy decision-making. The change has meant a shift from traditional ‘global nation-based’ health-policy making structures of a system that places more emphasis on private sector actors. In the late 1980s and early 1990s, global health policy making shifted from the UN agencies towards the financial institutions. According to Sridhar & Woods (2013), the shift led to an increase in attention being given to the private actors in health policy. In the late 90s, the United Nations increasingly cooperated with the business. The collaboration increased the influence of private interests in the United Nation system. This development partly resulted from the decreasing levels of development assistance of the Organisation for Economic Co-operation and Development (OECD) countries to the UN. Particularly, it became acute in the 90s, and partly as a result of the fear that the UN would become marginalized in case it did not take a step of increasing its collaboration with the corporate sector. The corporate sector had gained power in overall policy-making (Sridhar & Woods, 2013). In most UN forums, civil society has been recognized as a very important body of actors in global policy-making. Its recognition was particularly seen during the International Conference on Population and Development held in 1994, and the UN Conference for Environment and Development held in 1992. During the two forums, womens organizations were so instrumental in the process of shaping the Program of Action. In regard to health matters, sectors of the civil societies that have no motive of making profits have played an important role for a longer period of time. Most notably, they have played an important role in debates concerning breast milk substitutes, essential drugs, and weaning foods in the 1970s and 1980s. Most recently the public health NGOs have been so important. For instance, they have helped in shaping pharmaceutical policies as well as emphasising on the needs and rights of those people infected with HIV and AIDS (Gostin & Mok, 2009). Also, Gostin & Mok (2009), outline that the global health policy scene has further been diversified with the emergence of new global health policy actors. The new global health policy actors emerged as a result of new independent public-private entities that are global legally. These actors include the Global Fund to Fight AIDS, Malaria and Tuberculosis (GFATM), Global Alliance for Vaccines and Immunizations (GAVI), the Global Alliance for Improved Nutrition (GAIN). The purpose of these actors is to address selected health issues and has further diversified the global health policy scene. Additionally, new challenges in facing the health research have further been defined under the public-private partnership umbrella called the Global Forum for Health Research (Gostin & Mok, 2009). There has been a substantial and continuous growth in the development aid to health since 1992 despite the fact that there has been a fall in total official development assistance since that time. Notably, the U.S provides about one third of the total bilateral aid directed towards health. However, other bilateral donors are considerably smaller. The multilateral agencies donate one third of the total official development support directed towards health sector. From this support, 80% of it always comes from the International Development Association (IDA). As a new source of funding, the Global Health programme of the Bill and Melinda Gates Foundation (BMGF) has not only become significant is size, but also in setting the health policy. The funding from the BMGF, USA and the IDA are of about the same order (WHO, 2009). The role of the US in the global health policy setting has increased remarkably since the 1990s. Traditionally, the USAID has largely emphasized on fostering goals such as economic liberation and on privatization. It has been emphasizing ties to US exports as well as technical assistance. Over the past one decade, the US has been active in trying to lift global health issues in new forums (Stuckler et al, 2008). One of the forums where the US has taken this step includes the G8. The US has also been instrumental in the process of creating the GFATM. Towards this creation, for example, the European Union was initially more critical. According to (Stuckler et al, 2008), the US foreign policy has been less inclined to act via international institutions such as the UN. Furthermore, it has been less inclined to work closely with other countries to pursue common goals and objectives, while the European foreign policy emphasis on multilateralism over unilateralism(Stuckler et al, 2008). Global health priorities In the recent years, global health priorities have been defined through several processes. They have also been defined differently by the actors in various forums. In 2000 and 2001, tuberculosis, HIV/AIDS, and malaria were discussed in different forums at the UN and outside the UN. In these forums, commitments to find a lasting solution to the mentioned diseases were made by the World Bank, the G8, the European Commission, and the World Economic Forum (WHO, 2009). Millennium Development Goals (MDGs) are entirely a product of consultations between international agencies. In addition, they were also adopted by the UN General Assembly in September 2001 as the road map for implementing the considerably broader Millennium Declaration, which it had adopted a year earlier; in September 2000. The MDGs have eight main goals. Three of these MDGs are focused on health. The goals are focused on child mortality, HIV/AIDS, maternal health, and malaria among other diseases (Shiffman, 2008). The Millennium Project led by the UN and directed by the economist Jeffrey Sachs, has a goal of ensuring that all developing nations meet the MDGs. The whole of the UN system has since been requested to adjust to addressing the MDGs. After that, they need to report to the Secretary General on what they have achieved in that location. For the health policies, this means that pressures from some of the member states, like the UK, for the WHO to focus its work differently on the MDGs, most notably to the objective concerning malaria, tuberculosis, and HIV/AIDS, while its wider mandate as the normative health organisation that sets norms and standards and it promotes the building up a wider health systems would not be so emphasised. The MDGs have recently become a significant tool to steer both the UN system towards a narrower agenda with more emphasis on country presences and selected interventions, but more recently increased attention has been placed on the need for addressing development; including health policy issues and systems more comprehensively (WHO, 2009).. The same priorities for health largely emerged from the report of the Commission of Macroeconomics and Health (CMH) in December 2001. The report concluded that public health resources need to be directed to health priorities such as malnutrition, which cause childhood infections, communicable diseases, and maternal and perinatal mortality (Schneider K & Garrett, 2009). Development aid for health is also mainly directed towards controlling communicable infectious. USAID has taken a step of funding financed population programmes, which include family planning for three decades. At the same time, its emphasis on health-related issues is more recent. The USAID population, nutrition, and health funding covers HIV/AIDS, family planning and reproductive health, child survival and maternal health, and infectious diseases. For the BMGF, it has provided strategic funding directed towards finding of new structures for global health policy making, which include GAIN and GAVI. It has also funded the implementation of the recommendations gotten from the CMH. Its Global Health programme mainly focuses on focuses on the prevention of infectious diseases, reproductive and child health, and vaccine research and development. With its focus on this these diseases and research, emphasises on the development and implementation of technologies. However, chronic conditions or recurrent costs are not financed. In GAVI, the significant BMGF funding is mainly targeted at new vaccines. There have been efforts to tackle health issues through new health technology research as well as development funding under the Bill and Melinda Gates Foundation which is funded by the Grand Challenges in Global Health initiative (Shiffman, 2008). From calculations from the burden-of disease and global, the aforementioned priorities indeed represent cause for the majority of ill-health and deaths in the sub-Saharan Africa. However, they do not represent the majority of deaths and ill-health in any other region in the world. Indeed, they cover less than a third of the global ill-health. Currently, non-communicable diseases are the main cause of most of the ill-health in developing nations, and their significance is increasing so fast. They have an effect on all socioeconomic groups and in most cases the risks are highest in the poorest segments of the populations (Shiffman, 2008). Stuckler (2011) argues that global unilateralism has connected the global health agenda to the national interests of the US. It has also created a systematic effort aimed at responding to the challenge of the current US administration to show some effectiveness. As a result, the four Es; which include economics, evidence, effectiveness, and efficiency are the today’s new battle cries for the development community. Several selected interventions aimed at eradicating infectious diseases fit well with these premises. The current list global health priorities can be seen as mainly reflecting on health-related issues in the developing countries that are always perceived to be a threat to the vital interests of industrialised nations. Linking national interests to the development aid is not a new idea in any way. In the 1970s, for example, such concerns were central in the argumentation for population programme implementation. However, it is noteworthy that since the1990s the arguments for a greater US engagement in global health have increasingly been expressed in terms of enlightened self-interest or national interests (Stuckler, 2011). The joint strategic plan of the US Agency for International Development (USAID) and the US Department of State for the financial years 2004 to 2009 states that US foreign policy and development policy are fully directed towards advance the National Security Strategy. The strategy sets out its mission as being to create a more secure, democratic and prosperous world for the benefit of the American people and the international community. The purpose of the Strategy is to help American business succeed in foreign markets and help developing countries create conditions for investment and trade (Sridhar & Woods, 2013). Role of stakeholders in the global health sector Health as an issue basically involves multiple stakeholders, both within and outside the health sector. These stakeholders include NGOs, intergovernmental organizations, private organizations, academic experts, among other groups. All these stakeholders are making efforts to contribute positively to the global health and to ensure that quality health services are readily available. They organize forums that are well organized and geared towards ensuring that they are well connected to address the issues in the global health sector. The forums also ensure that there is a catalyzed and improved efficiency achieved through meaningful dialogue as well as meaningful interactions in the global health agenda. By recognizing that the private sector plays a crucial role in the health sector through addressing issues, the forums they organize play a crucial role in engaging it in the health sector. The forums also set private-public partnerships (PPP) that help in addressing challenges facing the global health sector. In addition, entrepreneurship can greatly flourish in the health sector. The stakeholders in the health sector take a step of galvanizing the business to act on the global health. A holistic and comprehensive approach used for improving the health sector has revealed that there exist several gaps. That is, there are opportunities in which industries and ideas can thrive when focused on health (Shiffman, 2008). In terms of delivering healthcare, there is a growing recognition that models that were being used in the older days are not sustainable in the developed countries. These models do not give broad enough in the developing and the less developed countries. As non-communicable and chronic disease rates continue to increase steadily, private sectors, governments, and non-governmental organizations are trying hard to disseminate, provide, and pay for sufficient prevention and treatment of these diseases. Emerging markets could similarly play a crucial role in finding a solution. They can be a source of innovation resulting from the availability of talent and the cost structures. The main goals of the dialogue on the delivery of healthcare is to better the understanding of the role of the private sector in the delivery of healthcare. The other objectives are to identify new innovative models that are more cost effective and to get greater awareness of the identified replicable and scalable models across markets (Stuckler et al, 2008). Prioritizing stakeholders While all stakeholders have some influence over the sect sector and they influenced the Global Health Council’s policy decisions, not all stakeholders have equal status. As a membership-based organization, priority in terms of service delivery is given to members who pay their dues. However, today, the Council’s policy-focused activities and products have not been highlighted as a membership benefit. The demand for policy services is likely to increase if the Council broadly articulates its core policy functions. As an advocacy organization, however, priority is mostly and understandably given to politically relevant issues and actors irrespective of their membership status. Who matters most The Global Health Council’s expansive policy network can serve as a great resource in advancing the Council’s policy goals. However, the sheer size of the network poses a challenge. Engaging equally with all stakeholders that operate within the network is not feasible nor would it be a strategic use of resources. Given its dual identity, the council has a few ways it can use to distinguish its relationship between members and non-member policy supporters. One way is to give priority to organizations based on their affiliation with the Council. Under this traditional association member-service scenario, member organisations’ positions and needs would be met first. The opinion and requests of non-member partners and other loosely affiliated stakeholders would carry less weight (Gostin & Mok, 2009). Another way to distinguish relationship is based on policy relevance. This scenario gives more weight to politically active and influential stakeholders who may or may not be members of the Council. In the dynamic and the sensitive policy environment that has been discussed in this dissertation, the Council constantly seeks a balance between the two relationship scenarios (Gostin & Mok, 2009). The global health stakeholders who are not affiliated with the Global Health Council have remained to be a big question for several decades. The Council would greatly benefit by understanding who those organizations are, their policy goals, the strategies they execute to achieve them, the actors that comprise their policy network and the extent to which they overlap with the Council’s policy functions and audiences. The Council might start by exploring the non-affiliated organisations that were identified by the key informants as potential institutional models (Schneider, 2009). The impact of recent Global Financial Crisis Modern advances in medical care are increasingly being driven by the market forces. However, they only benefited about 20% of the world’s current population. On the onset of the 20th century, 89% of the yearly world on medical care was only spent on 15% of the world’s population. From this percentage, only 7% of it bears the bear the global burden of disease. The annual expenditure on medical care ranges from about $6000 in the US to less than $10 in the African poorest country. Half of the world’s population lives in those nations that are unable to afford the annual per capita healthcare expenditure of more than $15. In addition, a bigger percentage of this population cannot even access basic drugs. Between 50% and 60% of the world’s population live in miserable conditions. They live below what can be defined as “ethical poverty line”. Basically, they live on less than $3.00 per person per day. Living in such conditions has greatly disadvantaged these populations since their benefit from the progress in science and medicine is limited (Gostin & Mok, 2009). The other impact of the global financial crisis is manifested through wasteful consumption patterns. The wasteful consumption patterns include the emergence of infectious diseases that cause a lot of premature deaths. They have caused a significant possibility of the reemergence of major pandemics such as H5N1 or H1N1 flu. There is also the likelihood of having an increase in the burden of diseases resulting from non-communicable diseases, trauma, and extensively adverse social conditions. In contrast to other consequences of the global economic crisis, many countries have reported an increase in their expenditure on health. Those that have been expecting to face increasing pressure from their treasuries need arguments that are based on evidence. The arguments need to demonstrate the economic benefits gained from investing in health. Some countries have pointed out that accessing good medical care is a right for its citizens and need to be the case made to governments and financial institutions (Stuckler et al, 2011). For countries to achieve a significant progress towards the millennium development goals, there should be a good global healthcare. Countries have witnessed a significant reduction in child mortality rate and more gains in the prevention and treatment of tuberculosis, HIV/AIDS, poliomyelitis, malaria, and the neglected tropical diseases. Contrary to that, little has been changed in the newborn and maternal mortality, especially in African countries. In addition, nutrition has relatively been neglected, and many countries still have less than half of their population unable to access to essential medicines and adequate sanitation. Several countries, especially in Africa, have taken the advantage of the small resurrection of the global economy to increase their domestic expenditures on health. Aid directed to the health sector has more than doubled in the recent years. The aid comes from both innovative and traditional sources. The consequences of the global economic crisis, however, put these achievements at risk and are likely to jeopardise the progress on the remaining challenging (Shiffman, 2008). Substantial improvements in the global health sector could be achieved in the short-run, even though such improvements are likely to be contingent on the redistribution of global economic resources. With time, new resources could be mobilised for ambitious and justified global health goals. This goal could only be achieved provided that social and political forces are in a position to confront the waste, mis-allocation, and distorted preferences. Even though governments are paying more attention to the offshore world and tax evasion as a result of the looming financial pressures caused by the global financial crisis, their efforts have to go further. By committing themselves to rectifying tax evasion, abolishing offshore tax haves, and eliminating the transfer-pricing systems, mostly adopted by corporations, governments will be in a better position to generate the resources to fund their health provisions (WHO, 2008). Conclusion In general, apart from globalization contributing to the increase of transfer of infectious diseases from the north to the south, it has also increased the transfer of non-communicable diseases. Today, global public health policies are increasing becoming concentrated around conditions around infectious diseases and their technological solutions. Addressing infectious diseases is also an important global step directed towards achieving the millennium development goals. However, the global health sector needs funding that has forced the various stakeholders to come to its rescue. Bibliography Gostin, LO & Mok EA. 2009. Grand challenges in global health governance. British Medical Bulletin, 87 (1) 7–18. Schneider K & Garrett L. 2009. The end of the era of generosity? Global health amid economic crisis. Philosophy, Ethics, and Humanities in Medicine, 4 (1). Shiffman J. 2008. ‘Has Donor Prioritization of HIV/AIDS displaced aid for other health issues?’ Health Policy and Planning, 2008, 23: 95‐100. Sridhar D & Woods N. 2013. Trojan Multilateralism: Global Cooperation in Health. Global Policy; 4(4): 325–335. Stuckler D, Basu S, Wang S, McKee M. 2011. Does recession reduce global health aid? Evidence from15 high income countries, 1975 – 2007. Bulletin of the World Health Organization. 89: 252‐257. Stuckler, D et al. 2008. WHOs budgetary allocations and burden of disease: a comparative analysis. Lancet, 372 (9649): 1563‐1569. WHO. 2009. 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