Pieter Fourie amp Erica Penfold SAIIA Regional Health Governance A suggested agenda for Southern African health diplomacy In this presentation 2 Hard truth Background The emergence of health in foreign policy ID: 536238
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Slide1
14 September 2015Pieter Fourie & Erica PenfoldSAIIA
Regional Health Governance
:
A suggested agenda for Southern African health diplomacySlide2
In this presentation2
Hard truth
Background
The emergence of health in foreign policy
Niche diplomacy
Health in the new multilateralism, and regionalism
A suggested agenda for SADC health diplomacy
ConclusionSlide3
Hard Truth: Policy utopianism vs. reality3
Narrative 1: policy sovereignty
But “best practice” comes from elsewhere
Narrative 2: policy solidarity
But state policies are not always aligned
supranationally
Reality 1: policy coercion
“Best practice” darlings (Botswana, Uganda, and (lately) South Africa)
Medical triumphalism
Reality 2: the money is going elsewhere, geographically as well as programmatically
So what can African and other developing states do?Slide4
Background: multilateral/regional health diplomacy?4
Will Global Health save George W. Bush’s foreign policy legacy?
2002: Global Fund to Fight AIDS, TB and Malaria
2003: President’s Emergency Plan for AIDS Relief
Middle powers also interested in health diplomacy
Niche diplomacy
Challenge rather than affirm the status quo
Regional health diplomacy: South America: yes
Southern Africa…?Slide5
The recent institutionalisation of health in foreign policy5
March 2007:
Oslo Ministerial Declaration
launches the
Global Health and Foreign Policy Initiative
Brazil, France, Indonesia, Norway, Senegal, South Africa, Thailand:
“We believe that health is the most important, yet still broadly neglected, long-term foreign policy issue of our time. […] We have therefore agreed to make impact on health a point of departure and a defining lens that each of our countries will use to examine key elements of foreign policy and development strategies, and to engage in a dialogue on how to deal with policy options from this perspective.”Slide6
Health foreign policy agenda includes6
Global health security
Shortage and global
maldistribution
of trained health workers
Aligning action in cases of natural disasters
Concerted response to the AIDS pandemic in particular
Combat climate change, and its consequences for health
Use health to identify development priorities, allocation of aid
Establish trade policies, esp. re. pharmaceutical access
Develop a new global health governance architecture
Mainstream health into training of diplomats
BUT: Do not overemphasize health
security
concerns at the expense
of issues regarding justice and equity
Where is the regional?Slide7
Niche diplomacy7
Gareth Evans: “Niche diplomacy involves concentrating resources in specific areas best able to generate returns worth having, rather than trying to cover the field.”
Successful foreign policy = ability to focus
Why? To build soft power:
Carter administration’s “medical diplomacy” in 1978
Michael Leavitt (Secretary of health and human services):
“Soft power builds trust for moments when hard power is required.”
“I have heard HIV/AIDS victims in distant villages in Africa say the words ‘U-S-A’ with their lips and ‘thank you’ with their eyes.”Slide8
Developing countries need niches too8
Brazil recognizes right to health in its 1988 constitution
After HAART in 1996 Brazil challenges pharmaceutical
IPRs
Transnational issue coalitions
Leader in negotiating the Framework Convention on Tobacco Control
Cuba, Venezuela and an “anti-imperialist” global agenda
Norm entrepreneurship, with a health lens
Brazil, India, and South Africa’s Treatment Action Campaign
Challenging WTO TRIPS agreement in the Doha Dev. Round
This can strengthen emerging middle powers, who are “ideally suited to partner with (
I)NGOs
in the pursuit of selected issues on the international agenda.”
Traditional middle powers (Australia, Canada, Norway)
confirm
status quo
Emerging middle powers (India, Brazil, South Africa, Mexico, Turkey)
challenge
status quoSlide9
Health in the new multilateralism (and regionalism?)9
Post-
Westphalian
global order
Multilateralism + Niche = Real Agency for developing countries?
Health = opportunity for norm entrepreneurship?
Southern African Development Community (SADC)
UN Security Council non-permanent 10
India-Brazil-South Africa (IBSA)
G-20
Brazil-Russia-India-China-South Africa (BRICS)
But also the H-8 (WHO, IBRD, GAVI Alliance, UNICEF, UNFPA, UNAIDS, Global Fund, Gates Foundation)Slide10
But health diplomacy does not feature prominently in most of these organisations
10
A new kind of (issue) regionalism needed?
Alma Ata declaration (1978): “Health for all by 2000”
Health as a human rights issue
Health prominent in MDGs and in the new
SDGs
Brazil (1988) and SA (1996) have Right to Health explicit in their constitutions
PAHO in South AmericaSlide11
SADC to the rescue?11
From SADCC to SADC
‘Service
organisation
’, to support national policies (bottom-up), rather than regional leadership body (top-down)
Pallotti
(2004): ‘A development community without a development policy’
Donors have much influence on health policies in Southern Africa
But ODA is decreasing (at worst), or flat-lining (at best)
So, we propose a tentative list of five agenda items for SADCSlide12
Recommendation 1: Civil society12
‘Catalytic diplomacy’: civil society intra- and inter-regional
A transnational social contract, democracy
Alma Ata (1978): citizen participation
Community-Based
Organisations
, Civil Soc.
Organisations
Technical needs
Disease surveillance partners
Access to healthcare and medicines
Canada, Brazil: FTCT
SA, India, Brazil: TRIPSSlide13
Recommendation 2: Trade13
Focus on health
NTBs
can help implement SADC Trade Protocol
Movement of pharmaceuticals and health products
Aligning national social policy responses
Emergency responses to disease control
Health personnel and health systems (health-promoting trade)
Harmonise
differing drug registration authorities in region
SADC regional interface with WHA,WTO, etc.
But beware a dominant South AfricaSlide14
Recommendation 3: Training health professionals14
Training and retaining health professionals
Brain drain
Africa: 2.3 health workers per 1,000 people;
USA: 24.8 workers per 1,000
Most African states fail to meet the ‘Health for All’ minimum standard of 1 doctor per 5,000 people
Prioritise
HR, staff exchanges
Dialogue on health migration
GATS provides scope to negotiate multilateral governance protocolsSlide15
Recommendation 4: Training for health diplomats15
Very technical skills
SADC could facilitate training of Southern African health diplomats, but also S-S
University of Pretoria: the only
MDip
(but no health)
Graduate Institute (Geneva): strong health diplomacy
programme
Key skills focusing on regional health profile
Multilateral resolutions and interfacing at WHASlide16
Recommendation 5: South Africa’s role, and establishing a PAHO16
The regional giant – but selfish
BRICS, IBSA
WHA
Set health diplomacy agenda, rather than waiting for ‘best practice’ from the global north
Pan African Health
Organisation
?Slide17
Also, consider:17
Manufacture of generic medicines
Engage with big
pharma
Learn from good practices in India, Brazil
Reduced drug prices
Integrated (regional) health system (‘patient identifier’)
Coordinated regional response
Focus on social determinants of health, rather than vertical silos
Coodinate
interaction with donorsSlide18
18
THANK YOU!
Penfold
, E. D. and Fourie, P. (2015) ‘Regional health governance: a suggested agenda for Southern African health diplomacy’, in
Global Social Policy
,
DOI: 10.1177/1468018115599817