To achieve the Sustainable Development Goals on Health, the EU should increase the priority afforded to health in development assistance, writes Frazer Goodwin.
Frazer Goodwin is Save the Children’s Senior Advocacy Advisor at the NGO’s EU office.
A year ago a new set of global Sustainable Development Goals (SDGs) were agreed at the UN in New York. Three months later, and less heralded, the Millennium Development Goals target date was passed. Given that these MDGs were also global goals with a 15-year timespan it is surprising that more effort has not been made to learn from them as we all attempt to implement the SDGs. Lessons that are especially relevant to the midterm review of the multi-financial framework (MFF), the revision of the EU consensus on development and the EU’s own Agenda 2030 implementing the SDGs.
At Save the Children we decided that in order to advise these major policy processes related to the health SDGs we would research in detail the experience the Commission had with the health MDGs. Over the last year we have conducted a thorough research into the EC support to the health MDGs with both a quantitative assessment of the financial support to the health MDGs overseen by the Commission, and a qualitative assessment of how effective that support was.
Complicating such a review is the fact that the world today is very different from when the MDGs were agreed at the start of the millennium. The events of 9/11 and the proceeding conflict and turmoil being just one example of the changes the world has seen. The rise of the BRICs (Brazil, Russia, India and China), and of course then a global financial crash that heralded an era of austerity.
Challenges to the EU have also come and gone over the period with the euro crisis and now the migration crisis joining Brexit as principle challenges confronting the EU. It is easy to forget that over the 15 years since the MDGs were agreed there were other crises involving health scares which momentarily grabbed leader’s main attention. Bird and swine flu achieved this, but the main health scare of the period was the ebola outbreak in West Africa. This highlighted the extent to which the health component of the MDGs had failed both the health systems of developing nations and global health more generally.
A further development over the period has been the rise in recognition from what may be termed the ‘mainstream’ or the ‘establishment’ of the significance of combatting inequality as a priority. Whether it be the work of Thomas Pickety, discussions at Davos, or pronouncements from the IMF and World Bank, the need for leaders to confront inequality has emerged as key.
An adjunct to this is also the increasing prominence of combatting tax avoidance, particularly via international financial flows to a variety of jurisdictions providing relaxed tax structures. The ability for large companies to minimize their tax obligations with complex international financial arrangements is increasingly being challenged. There is also realisation that it may also be damaging to brands. The impact such financial flows have to developing countries is profound as it both limits their own ability to raise domestic revenue and stymies efforts to increase aid as donor funds are squeezed.
Leadership of the EU has also seen a variety of figures coming and going over the last 15 years. The direction and character of the Commission has evolved a great deal indeed, with the Juncker Commission a completely different beast to that of Prodi’s.
So with the Commission challenged by major issues such as migration and Brexit what lessons has our research given to aid the funding and implementation of the EU dimension to the health SDGs?
The findings of the review that over the period there has been inconsistent support to health Aid from the Commission. For a short period, the highest level political attention was focussed on the issue as the Commission adopted a communication on the EU’s role in Global Health and the council responded to it in 2010. The following year health was 10.1% of EU Aid. But over the last long-term financial perspectives health only amounted to 7.7% of EU aid, despite relating to three out of eight of the MDGs.
Moreover, it is not just the total amounts for health that are important. How predictable the funds are is equally significant, especially for a sector with high recurrent costs where planning for increased services requires a high degree of financial certainty. The performance of the Commission for health aid predictability has fallen in international performance reviews, dropping from an above target level of 93% in 2011 to 79% in 2014.
Wanted: 7.6 million health workers
But, there are ways in which the EU can support health in low income settings beyond purely financial support. There are 7.6 million too few health workers and the EU itself needs to look at its own workforce training, recruitment and retention as part of solving this rather than hiring from abroad.
So, the report urges an increase in the priority afforded to health in development assistance, especially to confront issues of discrimination and exclusion at the heart of inequality. Political priority to health now would also lay the foundations for stronger health systems able to forestall future health crises like the ebola outbreak. The report also outlines why and how support for health for middle-income countries must continue, as well as detailing why and how fragmentation in the health sector must be avoided. It recommends that budget support be bolstered so as to create strong health systems and provides specific recommendations on how EU policy coherence for development must be stronger for health.
Overall, the lessons in this report can be used in a changing world to make health Overseas Development Aid (ODA) more efficient and impactful so it delivers greater results for the SDGs and brings healthcare to every last child.