Dr. Davidson Gwatkin, who has worked on World Bank (www.worldbank.org) health projects including the 'Reaching the Poor Programme', stated yesterday that "the truth is that we do not really know if these projects reach the poor". He added that he believed this was probably true for everybody, including civil society.
In 2005, in response to this problem, NGOs from 82 countries signed the 2005 Cuenca Declaration, which the People's Health Movement (PHM) (www.phmovement.org) is promoting globally as a tool to "establish the right to health in an era of hegemonic globalization". The agreement itself is indicative of the opinion of many experts from NGOs that increasing globalization is merely serving to exacerbate an already desperate situation in many developing countries.
Dr. Gwatkin acknowledged that the World Bank has been heavily criticized, while other global institutions, governments, and, in some cases, NGOs themselves have been blamed for the failure of public money to reach the poor. As Roy Widdus and Guy Ellena both argued on Thursday corruption is one of the key factors to take into account when analyzing this failure. Mr. Widdus stressed that the first 150 pages of the report 'Transparency 2006', published by the organization Transparency International (www.transparency.org) are dedicated exclusively to this problem. A vast proportion of the funding intended for the poor never reaches its target, even in certain cases where over 50% of national government funding is in the form of bilateral aid. In the face of this acknowledged failure of funding to reach its target groups, Hani Serag of PHM argued that "health for all means that powerful interests have to be challenged".
Where the public sector has failed in developing countries, private companies have been quick to step in, growing by default, as Mr. Ellena conceded. With pharma companies under greater pressure to develop a commitment to corporate social responsibility and with other business-funded donors, such as the Bill and Melinda Gates Foundation, (www.gatesfoundation.org) becoming major players, private sector financing is increasingly under the spotlight. In this context, Klaus Leisinger highlighted the need for pharma companies to adopt a "code of conduct" and to "invite a broad stakeholders' debate". He further urged them to do their homework and to take account of the full complexity of the problem. But private interests in the field of health are, of course, widely criticized within civil society and Mr. Leisinger pointed out that, in order to gain greater support, companies would be well advised to cease focusing on amassing political capital while choosing to turn a blind eye to "the real scandals", adding that one area the pharmaceutical giants might consider addressing is the 25 billion US dollars spent annually on glossy magazine pull-outs.
With both public and private sector contributions under increasing scrutiny from civil society and the media, the Forum has also sought to reassess the role of public private partnerships (PPPs) in terms of the goal of global access to health. Whilst, as Mr. Widdus commented, PPPs themselves have also been subject to some "bashing" lately, there is an increased focus on improving the way they are constituted and managed. He stated that "market-driven R+D does not respond sufficiently to health problems experienced by the poor", adding that PPPs "are not all perfect", but he also highlighted the advantages of 'joint-venture' PPPs in which stakeholders truly share knowledge and experience. He stressed that the issues of governance, stakeholder representation, accountability, measurement of added-value and sustainability had all been identified as areas for improvement, either by PPPs themselves or by constructive critics.
The speakers generally agreed that, whether via international bodies or by means of bilateral agreements, nationally or in PPPs, the public sector would continue to play the key role in terms of setting strategy and providing funds for access to health. With a view to ensuring that a larger percentage of public funds actually reach their intended beneficiaries, Dr. Gwatkin urged NGOs to undertake monitoring of government and donor programmes in individual countries, stressing that together, "civil society and the public sector comprise a powerful force for change". He also mentioned that he would like to see efforts by international bodies, such as the World Health Organization (WHO) (www.who.int), to make their health and funding statistics more user-friendly as a means of improving grassroots use of them to increase global access to health.
Meanwhile, as a result of the Cuenca Declaration, civil society and NGO representatives are preparing the second 'Global Health Watch' as an alternative to the annual WHO report. Last year, more than 140 individuals and 70 organizations from around the world contributed to the first edition, coordinated and managed by PHM, Medact (UK) and the Global Equity Gauge Alliance (www.gega.org.za).