Where is health on the Busan agenda?

Development Policy24 Nov 2011Olga Golichenko

Busan provides decision-makers with the key opportunity to make decisions that could make a huge difference to development and global health programmes. However, are developed countries and emerging economies really as committed as they say they are…?

Health not included in Busan Outcome Document

Despite the efforts of global health advocates at national and international levels, the fourth draft of the Busan outcome document does not have any references to health, aside from a passing mention of health pandemic challenges in the preamble.

A strong outcome document could help leverage support for the further implementation of existing aid effectiveness principles in health, and it’s a disappointment to many that health is largely absent from the draft. However, it is understandable that the outcome document has resisted references to specific sectors in favour of a more overarching approach. The one exception to this is climate change finance, which has a separate section, or so called “Building Block”, in the document, but given the significant financial resources which will start flowing to climate change, with no mechanisms to channel them, this is fair enough.

Health and aid effectiveness: on track or de-prioritised?

With no mention of health in the outcome document, the question is: has implementation of aid effectiveness in the health sector been on track, thus rendering specific reference unnecessary, or does it mean that health is likely to be de-prioritised in the future aid effectiveness agenda? Most likely both.

Compared to other sectors, health has been most progressive in implementation of aid effectiveness principles. Thanks to International Health Partnership and related initiatives (IHP+) as well as work undertaken by the OECD’s Task Team on Health as a Tracer Sector there is good progress in implementation of aid effectiveness in health. Evidence demonstrates that aid effectiveness is improving sector planning, budgeting, strengthening national systems and increasing resource allocations. IHP+ increases democratic ownership and contributes to improvement of health outcomes. The HIV sector demonstrates best practices of aid effectiveness implementation, including championing transparency through the International Aid Transparency Initiative (IATI), putting communities at the centre of HIV and AIDS response and development of the Investment Framework which ensures funding is allocated to the most efficient interventions.

The bad news is that health and social protection could indeed be de-prioritised in the coming years, with the Busan agenda focused on growth and trade.

Alarm bells are ringing

Perhaps most worrying of all, however, is the fact that the majority of donors are compromising country ownership and longer-term development outcomes for short term results, which demonstrate to donor countries’ taxpayers that aid works and national interests are being served.

At first glance, it is fair that in these times of financial crisis governments are able to demonstrate that every cent of taxpayers money brings results. But why should health and social services for the poorest and most excluded be compromised? It is often challenging to demonstrate immediate results of complex public health and social services programmes.

Donors are pushing back on timed commitments to untie aid. It is also unacceptable taking into consideration that tied aid reduces the purchasing power of aid by an estimated 15-40 per cent, and heightens the risk of unsuitable programmes being delivered.

The language of the outcome document on an accountability framework for implementation of the Busan commitments is extremely weak and unconvincing. If the monitoring framework is as weak as the current language, there is little likelihood of donors engaging more meaningfully with the aid effectiveness principles than at present.

Countries can still make progress on the Busan outcome document

One of the Sherpas who has been negotiating the Busan outcome document mentioned that the Busan aid effectiveness forum is not like Accra and Paris because it involves a complex dynamics between developed countries and emerging economies. The Busan outcome document has a complex structure – the preamble will be adopted by all and then different countries will deepened their aid commitments by signing different “Building Blocks”. Indeed, the world is changing as we are living it. Coming from middle-income country myself, I fully support bringing more actors from emerging economies to the table.

But the question is whether all the complex negotiations around the Busan outcome document with qualitatively improve aid effectiveness tools. Will it improve how aid is being implemented in countries? Will the health of the poorest people be improved? It seems that Organisation for Economic Co-operation and Development (OECD) countries are not sincere about how much progress on aid effectiveness they really want to make. Many countries say that they fully support country ownership, however at the same time they are push-baking on commitments to untie aid.

The Busan outcome document is still under negotiations and OECD countries should demonstrate that they indeed want to move aid effectiveness agenda forward. It should therefore include commitments on untying aid within concrete timeline and contain language on transparency (particularly, IATI). Countries should agree on a strong accountability framework which will monitor implementation of Busan commitments on international and national levels.

To engage further in the discussion on aid effectiveness and health, participate in ‘Effective Aid for Better Health‘ side event (27 November, 9 a.m.-12:45 p.m.)