Ray Chambers (UN Secretary-General’s Special Envoy for Financing the Health Millennium Development Goals & Malaria) has published an op-ed piece on the Special Envoy’s Office website asking “How many lives can we save in 500 days”. This reflects the fact that we have only 500 days till the end of 2015 and the target date to reach the Millennium Development Goals (MDGs).
In the article, Mr Chambers concludes that there are three things that should (and can) be done to improve our chances:-
- 1. A financing boost that takes us to the MDG deadline and also lays the foundation for more sustainable funding approaches going forward.
- 2. Securing of commitments by all partners to a targeted number of lives saved and following-through with counting those lives saved.
- 3. Identifying ways to maximize existing service delivery platforms to do as much as possible to not “miss opportunities”
In recent years there has been an increasing feeling of concern among the global healthcare community that the large increases in funding are no longer sustainable. These increases have been, in large part, due to the increases in development aid from rich “northern” or high-income countries (HICs), which grew substantially up to the 2008 financial crisis. These donors are probably not going to increase their contributions in the years to come and we need to find other ways to bring new money into strengthening the health systems of the low and middle income countries (LICs & MICs). The probable direction of the Sustainable Development Goals (SDGs) post-2015 also means that broader health goals are likely to be adopted, possibly diluting the resources needed to continue to fight against the MDG target diseases of HIV/AIDS, malaria, and tuberculosis. The problem is that developing new and innovative ways of financing or of bringing in new donors – especially from among the newly developing countries (i.e. BRICS, MINT, Gulf States) – takes time and their governments need convincing of the business case for financing global health. Many of these countries have greatly increased their domestic financing of health, but their involvement in global health remains relatively low. In the field of malaria, the world is still heavily dependent on the USA, UK, and the Global Fund to fill the significant resourcing gap needed to finance the ambitious goals of malaria elimination in our lifetimes. The new WHO Global Technical Strategy for Malaria (now in development) will estimate the resource needs for the next 10 years, and it is likely to pose a real challenge to find those resources, even just to maintain the current gains against malaria.
Ray Chambers sees that “countries are better equipped than ever before to support internal development, based on strong economies, successful investments in health systems, strong leadership, and better cross-border cooperation”. In the Greater Mekong Area, we are already seeing more co-operation between countries as they look towards malaria elimination in the region. There are opportunities in Southern Africa (based around SADC) to do the same and drive malaria north. This is a hopeful sign, as is the growth of domestic investment in health systems that countries in the Asia-Pacific Region are making as their economies grow, releasing resources to enable this to happen.
Nigeria is a MINT country, and so has great opportunities to invest in health infrastructure and become more self-reliant in resourcing. This investment will both improve overall health in the country, but strengthen the fight against malaria. As one of the countries with the greatest malaria burden, there will continue to be a great need for more resources for malaria to maintain the gains already made in the country, as well as ensuring that surrounding countries are supported in their disease control efforts. The case for co-operation in this part of West Africa is also a strong one.
Rich developing countries will find it increasingly hard to get the HIC donor countries to fund their health systems, especially as the HIC electorates will be more-and-more reluctant to invest in countries that they feel are rich enough to fend for themselves. One has only to look at the backlash in the UK against international aid going to India or China – countries with their own space programmes.
The UN Special Envoy sends out a timely but optimistic message at this key milestone in global health. But what will be key to responding to his call will be the recognition by disease endemic countries that they need to be realistic about the willingness and ability of the HICs to continue to finance their health needs. They can support their case for help by showing a greater willingness and ability to help themselves, sending the message to donor countries that they do not expect a never-ending stream of support, but just the right level of investment to help them on the right path.
The full article can be found at: