European perspectives on global health: a policy glossary

3. Europe must assert its role in global health governance
Financing for global health
The resource streams for global health are
difficult to calculate as they come from a wide
array of sources. Dominant in the global health
discussion is financing through foreign aid
but other sources of finance have increased
significantly. Of increasing importance is
global public goods financing. Europe needs to
explore new financing mechanisms to ensure
the three strategic priorities of global health :
security, equity and good governance.
The discussion of financing for global health is usually
dominated by a debate on funding for development
and a call to donor countries to increase their support
of developing countries. Lately, an additional debate
on financing global public goods – such as global
disease surveillance systems – has emerged, and
the UNDP is suggesting a new approach to global
public finance. The neglected area of financing for
global health is the financing of the regular budget of
international organisations – such as WHO. There is
a tendency to fund diseases, issues and programmes
– as discussed below – but not governance structures.
This though has led to a significant weakening of a
number of international organisations. Europe should
be at the forefront of exploring new financing and
governance mechanisms that ensure all three strategic
priorities of global health : security, equity and good
governance.
The most comprehensive study on resource needs for
global health is still the report of the Commission
on Macroeconomics and Health ( CMH ),
commissioned by WHO and directed by Jeffrey Sachs,
while other estimates tend to focus on the resource
needs for single issues or diseases.
The CMH report starts with the observation that
“only a handful of diseases and conditions are
responsible for most of the world’s health deficit :
HIV / AIDS ; malaria ; TB ; diseases that kill mothers
and their infants ; tobacco-related illness ; and
childhood diseases”. In order to improve health in
the developing world additional financing especially
in three areas is required : scaling-up of existing
interventions, R&D, and global public goods. The report
states that effective interventions exist to prevent
Global Health Policy Glossary
or cure most of the above-mentioned diseases.
Both national and international spending, however,
are insufficient to meet the challenges. While total
spending on health per person / year amounts to
nearly $2000 in the developed world, it is only $11 in
the least developed countries ( with $6 being public
domestic spending, $2.3 being donor assistance and
the rest being out-of-pocket expenditures ). In order
to scale up the existing interventions and to prevent
8 of the 16 million deaths per year from the above
mentioned diseases, $34 per person / year would be
necessary. The CMH report thus recommends that the
developing countries should increase their budgetary
spending on health by an additional 1 % of GNP by
2007 and 2 % by 2015, while donor countries should
help to close the gap by increasing from the current
levels of health-related ODA of approximately $6
billion per year to $27 billion by 2007 and $38 billion
by 2015.
More recent studies do not focus exclusively on
health, but deal with the resource needs for the
entire process of the Millennium Development Goals
( MDGs ). The study of the “High-Level Panel on
Financing for Development” that served as
input for the “International Conference on Financing
for Development” in Monterrey 2002 was the first
to specify the amount of ODA that is required to
meet the MDGs and gives the often cited figure of
$50 billion / year, supplemented by $3 billion / year
for humanitarian aid and $15 billion / year for the
provision of global public goods, leading to a total
of $68 billion / year or a doubling of the current
levels of aid. Other studies basically confirm these
quantities, while NGOs like Oxfam ( 2002 ) assume a
global need of around $100 billion / year. The report
of the Millennium Project ( 2005 ) estimates the
resource needs to be even higher and states that in
order to achieve the MDGs, ODA of $135 billion / year
( = 0,44 % of GNI ) will be needed in 2006 and
that international funding will have to rise to $195
billion / year ( = 0,54 % of GNI ) by 2015.
This logically leads to the question of where the
additional money should come from. The report of the
Millennium Project does not say much in that context ;
it only vaguely mentions the option to “frontload”
ODA through capital markets via the International
Finance Facility ( IFF ), as proposed by Gordon Brown,
the UK Chancellor. Other studies go further on these
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