G8 08 Policy Statement Health

Global Health Policy Statement G8 Summit 2008 December 19, 2007 We commend President Bush for demonstrating leadership in the fight against HIV/AIDS with the establishment of PEPFAR and the recent commitment of $30 billion of additional funding over five years. As members of InterAction and members of the global health community we ask the United States to continue its leadership by urging the G8 Summit to endorse and the G8 countries to fulfill prior G8 commitments in health care and, where necessary, adopt new commitments to: 1. Renew their commitment to MDG 4 and lead an international effort to reduce the deaths of children under five through significantly increased G8 country, other donors and developing country investments in child survival programs. 2. Improve maternal health in a holistic manner ensuring universal access to reproductive health care, expanding emergency obstetric care, and increasing skilled birth attendants with a commitment to timetables and benchmarks. 3. Ensure universal access to HIV/AIDS prevention, care and treatment by 2010, and cut malaria and tuberculosis rates in half by 2015 by promoting and financing the G8 share of the Global Fund to Fight AIDS, TB, and Malaria and other international and national infectious disease strategies. 4. Fully finance the Global Action Plan on Human Resources for Health, which will ensure achievement of the WHO goal of doubling health care workers in Africa by 2015. 5. Ensure the IMF allows greater policy, monetary, and fiscal space within country budgets to meet pressing health and other needs. 1) Increase Investment in Child Survival Programs – MDG 4 The United States and the other G8 countries need to renew their commitment to MDG 4 and lead an international effort to reduce the deaths of children under five through significantly increased G8, other donors and developing country investment in child survival programs. From the vantage point of five decades, the chances for children in the developing world to survive to their fifth birthday have improved dramatically. Nevertheless child survival rates since 1990 show slow improvement with the pace of progress uneven across regions and countries, and worst in subSaharan Africa. In sub Saharan Africa we still have 166 out of 1,000 children dying before their fifth birthday, 20 times the number in the developed world and we are concerned that MDG 4 will not be met. Virtually all of the deaths are preventable and global health experts estimate these lives can be saved provided donor countries and developing countries increase investments in existing, cost effective and proven interventions such as oral rehydration therapy, antibiotics, anti-malaria interventions, and micronutrients.

Public health experts predict that six million children could be saved every year if the global budget for child health increased by at least $5.1 billion. Saving these lives would improve the economic and social prospects of developing countries and would be an investment in human security. The U.S. one-third fair share of the projected annual cost, at least $1.6 billion, should be reached by 2011. We request the United States renew its commitment to MDG 4 and to child survival by announcing a significant increase in its child survival program funding. By taking this leadership role, the U.S. will encourage other G8 members to recommit to MDG 4 so all pledge to make the increased investments required by donor (and recipient) countries. 2) Increase Investment in Maternal Health Programs – MDG 5 Improve maternal health in a holistic manner ensuring universal access to reproductive health care, expanding emergency obstetric care, and increasing skilled birth attendants with a commitment to timetables and benchmarks. Over half a million women die each year in pregnancy and childbirth largely because skilled maternal health care is unavailable. Numerous studies have shown that a child’s chances of dying increase dramatically after a mother’s death, and the risk of death is greater for girls than for boys. During the past 18 months a broad consensus has emerged within the maternal health community about core maternal health strategies. These core maternal health services consist of prenatal care, skilled care for all pregnant women by a qualified midwife, nurse or doctor, family planning, increased vaccinations, and regular health check-ups, and emergency care for women and children in lifethreatening conditions. These are the basic elements that must be in place to meet MDG 5. Vertical disease-specific funding initiatives have not produced the robust outcome in maternal health globally, thus we ask the G8 to recognize that poverty, education, and conflict, gender-based violence, and food and nutrition security also contribute to maternal health. In line with the proposal made by Mr. Masahiko Koumura, Japan’s Minister of Foreign Affairs, we request that G8 members approach maternal health in a holistic manner where disease is combated and comprehensive health services are developed in parallel. Investing in women in crucial as it delivers long-term economic benefits to families, communities and societies. The United States and G8 countries must renew their commitment to maternal health programs, with timetables, benchmarks, and specifics on how to meet MDG5. 3) Increase Investment in Combating Infectious Diseases – MDG 6 Ensure universal access to HIV/AIDS prevention, care and treatment by 2010, and cut malaria and tuberculosis rates in half by 2015 by promoting and financing the G8 share of the Global Fund to Fight AIDS, TB, and Malaria and other international and national infectious disease strategies. Every day over 6800 persons, become infected with HIV and over 5700 persons die from AIDS. We applaud President Bush for demonstrating leadership in the fight against HIV/AIDS with the U.S. commitment of $30 billion of additional funding over five years. However, this funding level would simply continue the US current annual contribution. For the United States to continue its leadership the funding should increase to a substantially higher level so as to achieve the G8’s own commitment to universal access to HIV/AIDS services by 2010. In addition, with an estimated 2.5 million new infections each year (more than 3 people infected for every one person starting treatment) the global AIDS response should place much greater emphasis on prevention to truly bring about an end to the HIV/AIDS epidemic. One third of the world’s population is estimated to be infected with tuberculosis, the number one killer of people living with HIV/AIDS. It is responsible for 1.6 million deaths each year. Yet TB can be cured with drugs costing just $20. Without aggressive action, the deadly synergy between HIV/AIDS and TB

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and the explosion of extensively drug-resistant tuberculosis (XDR-TB) threaten the progress made to date. The Global Plan to Stop TB 2006-2015, a business plan endorsed by G8 governments for confronting tuberculosis internationally, still faces an annual global funding gap of over US$3 billion. The Untied States’ bilateral investments in global TB efforts have stagnated at less than $100 million annually. PEPFAR investments in TB-HIV have increased to $120 million in FY 2007 and we applaud the United States government for its commitment. However critical TB-HIV interventions have not yet been taken to scale in most PEPFAR countries. The Japanese government has already signaled interest in a possible Stop TB Japan Initiative for the Hokkaido Summit. We therefore urge that the United States join with Japan and G8 members in launching its own expanded TB and TB-HIV initiative in line with the Global Plan to Stop TB and the Global MDR-TB and XDR-TB Response Plan 2007-2008. Malaria is also a leading killer of children under five and a major contributor to adult morbidity in sub-Saharan Africa. More than 300 million cases and more than one million deaths occur each year. The U.S. is to be commended for contributing to efforts to combat malaria through the President’s Malaria Initiative (PMI). We urge the United States to use its commitment and leadership on malaria to influence the G8 leaders to honor their original national commitments. Efforts to address all three diseases must include a significantly increased contribution to the Global Fund to Fight AIDS, TB, and Malaria and to meet the U.S. one-third fair share of the projected annual demand from low-income countries, $6-8 billion dollars by 2010. 4) Strengthening Health Systems and Health Financing Fully finance the Global Action Plan on Human Resources for Health, which will ensure achievement of the WHO goal of doubling health care workers in Africa by 2015. We are also pleased that the G8 is focused on strengthening health systems in Africa. The WHO estimates that 57 countries have extreme shortages of health workers with 36 of these in Africa. WHO has recognized that these countries are “very unlikely” to achieve the MDGs unless the shortages are addressed. The G8 nations must address this crisis while at the same time expanding health training to address the shortage of health workers at home and by discouraging active recruitment of health workers from impoverished countries. The G8 must provide ambitious, achievable, and specific benchmarks to bolster African health systems and abide by them. The WHO has set a goal of more than doubling of the number of health care workers in Africa while improving health worker training, management, and placement. The Global Health Workforce Alliance is an international partnership with its Secretariat hosted by WHO. The Alliance is developing, in consultation with partners including the United States and other G8 representatives, a Global Action Plan (“Roadmap”) on Human Resources for Health, to be completed early in 2008. The G8 should formally endorse and commit itself to supporting this “Roadmap”. The total cost for doubling sub-Saharan Africa’s health workforce has been estimated at $24 billion over five years, of which the US fair share would be $8 billion or about $1.6 billion each year. To ensure that health workforce strategies are fully funded, a necessary condition for achieving the MDGs, the G8 should commit to providing the necessary resources to ensure credible health workforce plans are fully implemented with adequate resources. In the past the G8 has made collective commitments towards meeting health needs in Africa but has not included a mechanism for ensuring that individual G8 countries, and other donors, provide the resources required to meet these commitments. To ensure G8 accountability, we urge the G8 to report annually on progress meeting these commitments and a strategy to overcome any shortcomings.

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In its Africa Health Strategy 2007-2015, the African Union endorsed a “review of user fees with a view to abolishing them.” The G8 should support this AU commitment by encouraging and supporting poor countries to abolish user fees for basic health services and replace them with equitable financing schemes that will be effective in enabling everyone access to essential health services. 5) IMF impact on health budgets Ensure the IMF allows greater policy, monetary, and fiscal space within country budgets to meet pressing health and other needs. IMF macroeconomic policies too often restrict governments’ ability to scale up investments in the health sector. This is done through: 1) wage ceilings that prevent hiring and retaining health professionals, and 2) unnecessary risk-averse targets for deficit and inflation reduction that constrain national health budgets. We therefore urge the G8 governments to call upon the IMF to: 1) forgo unduly restrictive fiscal and monetary policies that prevent increased investment in national health plans and 2) permit the programming of increased foreign aid for health rather than divert it to domestic debt payment and international currency reserves. December 21, 2007 The following organizations contributed to the health policy statement Global Health Council International Center for Research on Women Save the Children RESULTS Education Fund ONE Campaign / DATA (Debt, AIDS, Trade, Africa) Physicians for Human Rights ActionAid USA For questions or feedback please contact: John Ruthrauff, Senior Manager of Member Advocacy InterAction 1400 16th Street NW, Suite 210 Washington DC 20036 [email protected] 202-552-6523 InterAction is the largest alliance of U.S.-based international development and humanitarian nongovernmental originations. With more than 165 members operating in every developing country, we work to overcome poverty, exclusion, and suffering by advancing social justice and basic dignity for all.

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