At the UN High Level Event in New York on 25 September 2008, world leaders called for an additional US$30 billion to save 10 million lives – 3 million mothers and 7 million children. Thereafter, a High Level Taskforce on Innovative International Financing for Health Systems (Taskforce) was announced. The Taskforce is chaired by UK Prime Minister Gordon Brown and World Bank President Robert Zoellick and is focused on ways in which innovative financing mechanisms can be used to strengthen health systems in the poorest countries in the world.(See http://www.internationalhealthpartnership.net/taskforce.html)The objectives of the Task force are:
1. To make recommendations on the mix of innovative international financing mechanisms needed to deliver extra resources required;
2. To promote international support for these recommendations to ensure they are implemented.
Two Working Groups (WGs) were put together to achieve the objectives of the Taskforce: Working group 1 is supposed to foster a better understanding of the key elements of a well functioning health system and analyze existing financing gaps including the volumes and types of funding required. It was to identify the main constraints to scaling up interventions in support of the health MDGs and suggest ways to address these constraints. Working group II was charged with the duty of analyzing the existing innovative financing instruments to respond to health system constraints identified in WG I’s report. It was to make recommendations on instruments that are ready for expansion and examine possible new or complementary approaches.
On March 5 2009, a consultative meeting for Civil Society Organisations (CSO) largely from the north and a few from the south was held in London to review the work of the 2 WGs. During the London meeting, CS organizations requested the Taskforce to hold consultative meetings in the global south. Two consultative meetings were organized: between May 14-15 in Johannesburg, South Africa and May 25-26 2009 Abuja, Nigeria. AGHA Uganda represented Ugandan CS both in London and Abjua. Other CS organizations came from Ethiopia, Ghana, Nigeria, Malawi, Cameroon, Burundi, Burkina Faso.
At the Abuja meeting, CS groups recognized that the two Working Groups of the Task Force have conducted a great deal of valuable work. WG1 in particular has provided a useful analysis of the challenges of health systems financing and strengthening.
However, there are also several deficiencies and gaps with both reports. Moreover, the process of consultation and discussion has been inadequate and incomplete. CS has been consulted in a piecemeal manner and national governments not consulted at all.
CS groups also emphasized the importance of domestic sources of revenue for the health sector within their individual countries. They pointed out that domestic resource mobilization for health systems was not given adequate attention by the Task Force and its Working Groups. Developing countries have substantial domestic resources that are currently being lost to health investment. Ineffective and inefficient tax systems, coupled with capital flight, unfair trade, natural resource exploitation and corruption make too many countries over-dependent on external aid. CS groups therefore requested the Task Force to catalyze a serious global effort, involving low and middle income country governments and civil society, to strengthen the domestic revenue base of developing countries. In a statement sent to the Taskforce Secretariat, CSOs stated:
“Domestic financing systems must contribute to equitable health systems performance and community empowerment, and should be given priority and greater consideration. We recommend the Task Force, the WHO and other actors to support sustained regional and country-level consultations on the development and improvement of domestic health financing arrangements.”
CSO also recognized that financing for health systems cannot be looked at in isolation from greater issues relating to trade and fiscal policies. Less Developed Countries have an unfair place in international trade and debt burdens are great, and therefore they have a smaller Gross Domestic Product (GDP) and inevitably a small resource basket which limits their ability to allocate greater resources to the health sector. Additionally, many fiscal policies place inappropriate constraints on national budgets and therefore on public health expenditure. New rules and policies on fiscal space and macro-economic governance, at both the global and country levels, are required.
These, among other are issues that have been inadequately addressed by both Working Groups.
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