- Dr Vineeta Gupta (Director, ACTION Secretariat)
- Priya Basu (Executive Head of Secretariat, Financial Intermediary Fund for Pandemic Prevention, Preparedness and Response, World Bank Group)
- Marco Angelo (Global Health Advocate, Wemos)
- Anjela Taneja (Lead Campaigner on Inequality, Oxfam India)
- Olabukunola Williams (Sexual and Reproductive Health and Rights Leads, Akina Mama wa Afrika)
- Yann Illaiquer (Global Health Advocates France)
Dr Vineeta Gupta (moderator): I’d like to start with this. Anjela, why do we need a stronger public health system?
Anjela: There hasn’t been a framing of patient rights in private or public health services. It’s good to see strengthening of community-based processes. Yes, there was a gender framing, not just in the World Bank Group (WBG) framework, but most International Financial Institutions (IFIs) had a strong gender focus. But there is no focus on race, transgender people, no focus of Muslim minorities. Indicators are not disaggregated by social group. Is the Bank treasuring equity? The role of non-state actors is a priority, as well as supporting citizen enrolment in state insurance schemes. None of the projects emphasise regulation or compliance with regulatory frameworks. There are no measures to address variation in quality and costs of services. What we need is public health systems – invest in this. Regulate the private, ensure compliance with law, minimise outsourcing Public Private Partnerships (PPPs).
Buky (Olabukunola): Covid-19 was a big wake up call. Sexual Reproductive Health and Rights (SRHR) fell by the wayside. Maternal health became a problem, the issue of oxygen in Uganda became a huge issue. What lessons have we learned about putting equity at the heart of health financing? I have a hard time talking about health in which we must say there still must be profit. Health is a human right.
What is going to be the next decision? What lessons will be taken from the roll out in Kenya, so that the same mistakes are not made again? For those of us working on SRHR, most governments rely on external financing to even provide commodities. If we’re talking about health equity, equity for whom and for what?
When we talk about advocacy, and we say we need evidence, how much evidence does the Bank need? Do you need blood? Sometimes if feels like they’re just ticking the box. It is more frustrating for me, when Covid-19 happened, we said this is everything we’ve been saying. Systems don’t wait for crisis. We learned a lot of lessons from HIV. Countries are dealing with debt and climate crises. We subsidise Northern lifestyles; you extract from us, you pretend you are helping us with just aid. But at the end of the day, we have to actually put people over profit.
Vineeta (moderator): Yes, health is a human right. User fees historically have not worked. You have to show an ID card as being poor – and you need a home address etc to get that, so it doesn’t work.
Yann: You have illustrated how relying too much on the private sector is harmful. To put it bluntly, we learned that the world was not ready to deal with the pandemic when it happened. We now have:
- The need for stronger international cooperation and regulation
- The need to strengthen health systems across the world.
- The reform and scale up of global health and PPR.
- Establishment of a pandemic treaty, intellectual property rights reform, evolution of funding architecture.
The Financial Intermediary Fund (FIF) is now the third trust fund launch to fight pandemics. Even if the previous have not been evaluated (and to my knowledge none are planned), we know they have not been up to the task on Covid-19. New pandemics will come. We need to act now, so countries can have their health systems stronger.
Marco: It looks like the private sector could be a recipient of funding from the FIF. The International Finance Corporation (IFC) is involved. There will be a seat on the governing board for philanthropies, which are private actors and often defend the interests of private actors. We understand the role of multisectorism, but we want to flag the risks. Transparency International recently published a report showing that private sector involvement carries issue of conflict of interest, and private contracts are often not disclosed. With Covax, we saw private actors receive a lot of incentives, on top of funding from governments, but there were low requirements on their parts. Many pharmaceutical companies broke bilateral deals with companies. Those who struck the most deals also made the most money from the pandemic. Initiatives by World Health Organisation (WHO) to circumvent intellectual property barriers have been ignored by Big Pharma. Private actors successfully lobbied to maintain intellectual property rights.
We know the FIF will finance private actors. We do know that in the current health landscape, private companies are the best positioned for development of measures like vaccines, but what concerns us is what we don’t know. On communication from the Bank, we don’t know the size and scope of financing, the safeguards, the conditions etc. The FIF says it can support private sector efforts through private sector arms of MDBs – that’s all we know. What can and will be funded by the FIF? How will it address equitable distribution and manufacturing? Will there be conditions?
Vineeta (moderator): Priya, we are very glad that you can join us. What can the World Bank do to address these concerns?
Priya: This is not just lip service: equity and inclusion are pillars on which the FIF has been designed. We worked intensively over the last nine month with stakeholders to bring a governance structure that is truly equitable. The board met for the first time on the 8th of September. We have two seats for civil society, and one for those foundations and philanthropies who are donors to the FIF. It is cochaired by two Southern individuals. It’s the only fund out there that is fully dedicated entirely to pandemic preparedness and response. Many institutions, the International Development Association (IDA), Global Fund and others do focus on PPR but not fully.
It works through intermediaries so doesn’t invest directly to private actors. Multilateral Development Banks (MDBs), the WHO, UN Agencies etc – we will work through them and build more. We want to ensure for every dollar the FIF provides, governments also invest. We want to catalyse more funding. We want to find a way where governments make additional commitments to long-term PPR. We have about $1.4bn so far, and we hope to mobilise more. Not all of it has arrived as cash yet. First call for proposals will be modest, perhaps around $300m. But we also want to see the commitment on the other side.
There was a lot of talk on the private sector: we’ll see what the proposals actually say. Do they argue there is a need for PPPs? Is there a role for the private sector? Each proposal will be evaluated. Speaking more broadly, from where I sit, firstly the ‘private sector’ term can be interpreted differently. It’s shown in many countries where reaching last mile efforts on service delivery do require partnerships with Non Governmental Organisations (NGOs) and civil society. On medical counter measures, what does it take to get the private sector to invest more? We approach it by saying, what can the public money that the FIF has, be used if needed to bring in the private sector to areas they wouldn’t otherwise go?
Why the World Bank? Well, the FIF is a Word Bank instrument. In terms of safeguards, the FIF relies on those of all stakeholders. We have scaled up our financing in the wake of Covid-19.
Angela: It is critical to ensure we adhere to all factors, it is important to focus on racial inequalities.