WHO global coordination mechanism on the prevention and control of ...

WHO GCM/NCD

WHO global coordination mechanism on the prevention and control of noncommunicable diseases Working Group on how to realize governments’ commitments to provide financing for the prevention and control of NCDs First Meeting of the WHO GCM/NCD Working Group on how to realize governments’ commitments to provide financing for the prevention and control of NCDs Summary report by co-chairs 23-24 February 2015, Salle G & A, WHO HQ Geneva, SWITZERLAND Day one 23 February 2015 Introduction – Method of Work and Objectives 1. The first meeting of the Working Group commenced with welcoming remarks from Dr Bente Mikkelsen, Head a.i., Secretariat for the Global Coordination Mechanism (GCM) and UN Interagency Task Force. In addition to welcoming and thanking Members of the Working Group, she conveyed apologies from Dr Jane Chuma, Dr J. Jaime Miranda, and Dr Senendra Upretti who were unfortunately unable to attend. 2. Dr Mikkelsen invited the Members of the Working Group to introduce themselves. The Working Group approved the proposal of Dr Amiran Gamkrelidze and Ms Outi Kuivasniemi as the Co-chairs of Day 1, as the co-chairs appointed by the WHO DirectorGeneral, Dr Anders NORDSTROM (Ambassador for Global Health, Ministry of Foreign Affairs, Sweden) and Dr Indrani GUPTA (Head of the Health Policy Research Unit, Institute of Economic Growth, India) were absent. The Working Group agreed to appoint Dr Gene Bukhman as Rapporteur for the meeting and adopted the meeting agenda and programme of work. 3. After a short presentation on declarations of interest, Members were invited to identify any additional interests that may have arisen since they completed their written declarations of interest. There were no conflicts of interest declared. FINAL DRAFT 19 March 2015

4. Assistant Director General Dr Oleg Chestnov thanked the Co-chairs and gave his opening remarks summarised below:  The ADG emphasised the importance of this meetings as milestone for the GCM and the importance of the Working Group’s role to provide recommendations to the Director-General  He also highlighted the need to address the issue of encouraging governments to realise their commitments to increase and prioritise budgetary allocations for addressing NCDs  The ADG reiterated that the Working Group would have the full support of the Secretariat to facilitate their work 5. The proposed methods of work and objectives for the meeting were agreed and Dr Mikkelsen provided an overview of the background to the (GCM) and the task of the Working Group. The floor was opened to comments and the key points expressed by the members include: a. Prevention: the importance of recognising prevention as the more economically efficient than treatment was reiterated by a number of members of the Working Group b. Politics: the importance of engaging ministers beyond health and in particular the Ministry of Finance was highlighted c. Sustainability: a number of members highlighted the need for sustainable mechanisms of financing NCDs and importance of serious consideration to efficient spending of existing fund/budget. d. Communicable diseases: one member felt that the comparison between NCDs and communicable diseases were being overstressed and it was important to remember the differences

Session 1: Domestic Financing for NCDs 6. The first session considered Domestic Financing for NCDs. After a brief presentation from Dr Diane McIntyre, Professor of Health Economics and South African Research Chair, University of Cape Town and author of the policy brief, Dr Dorjsuren Bayarsaikhan, health economist, Health Financing Policy, WHO, explained WHO work supporting Member States in health financing. This was followed by a brief presentation from Ms Anne-Marie Perucic, Health Economist, WHO NMH. Ms Perucic presented on the use of tobacco taxation as a tool for domestic financing. Members commented on the presentations and interactive discussion pursued, the key points from the two days included: a. Country specificity: tax revenue potential and earmarking will be country specific b. Politics: the Working Group needs to look beyond the Ministry of Health to the Ministry of Finance and other departments, and focus on the economic arguments for financing NCDs. It was also noted local governments could be mobilised. c. Modelling: it was noted that a gap in modelling exists at country level to assess the economic and health benefits of tobacco taxation. d. Impact on poor: the regressive nature of tobacco tax was mentioned several times. The need for governments to support the poorest in society was emphasised. FINAL DRAFT 19 March 2015

e. Morality of tobacco taxation: one member raised concerns about being dependant on these bad habits for revenue. WHO Secretariat highlighted that first and foremost tobacco tax is a cost effective policy for reducing consumption of tobacco and second it is an option to raise revenue. f. Ease of tax collection: there was a question about the feasibility of collecting taxes on tobacco as a financing source. WHO Secretariat indicated that unlike other taxes, such as VAT or income tax, excise taxes were among the easiest to collect because they are levied at the manufacturing level and there are usually only a few manufacturers operating in a country. g. Livelihoods: A question of the livelihoods affected by reducing tobacco consumption was raised, the Secretariat and WHO experts indicated to the group that livelihoods were affected by increasing technology far more than decreasing consumption h. Expenditure tracking: the importance of expenditure tracking on diseases was highlighted i. Potential of domestic financing: a number of members mentioned the high importance of domestic financing as a sustainable source of financing j. Universal Health Coverage (UHC): the inclusion of NCDs into UHC was highlighted by a number of members, in particular the importance of the prevention of NCDs within UHC k. Country examples: examples from such as Georgia, Zambia, Indonesia, Finland, Australia and Thailand were used to demonstrate points raised l. Private Sector: The need to collaborate with pro-health private sector and the sector beyond health was stressed by members.

Session 2: Bilateral and Multilateral Financing for NCDs. 7. In the second session, the Working Group considered the issue of Bilateral and Multilateral Financing for NCDs. Following the initial presentation from Dr Rachel Nugent, Research Associate Professor, University of Washington and author of the policy briefing, Members shared experience and discussed key issues including: a. Best buys: WHO’s proposed global business case has been developed with price tag of $11.4bn, however it was noted countries need more technical support for implementation. One member also requested country specific integrated care packages including costs of prevention and costs of non-intervention b. NCD burden: it was noted the developing countries are asking for technical assistance for NCDs areas among their first priorities c. NCDs and poverty: misconceptions of NCDs as diseases of affluence are pervasive and result in the exclusion of NCDs from development agendas and thus, multilateral and bilateral funding. The need for research and understanding of NCDs in absolute poverty. The complexity of this relationship was acknowledged. d. Multisectoral: engage many sectors to address health problems which impact across sectors (e.g. transport, road, energy) e. Nuanced conversations: several members highlighted the importance of remembering that countries and diseases needed to be analysed individually f. Actors: it was suggested that the following actors would be useful in discussions of bilateral, multilateral and innovative financing: The World Bank, The Global Fund, and UNITAID. FINAL DRAFT 19 March 2015

g. OECD: several public submissions request the inclusion of NCDs in OECD database h. Country capacity: to collect and distribute financial contributions

Session 3: Innovative Financing for NCDs 8. The third session focused on Innovative Financing for NCDs. After the initial presentation from Mr Craig Courtney, Senior Independent Consultant, and author of the policy brief, Ms Perucic, WHO NMH, presented WHO’s existing proposal on “Solidarity Tobacco Contribution”. Members identified key issues drawing on experience in their own countries: a. Sustainable Development Goals: NCDs will be included in SDGs in 2015, some potential finance options are in development with the SDGs b. Solitary Contribution/Tax: It was reiterated that this was a hypothetical model and would not replace existing excise taxes. This model indicated the revenue generation potential of a small additional tax levied on the consumption of cigarettes. c. Other options: included lotteries, impact bonds, micro financing, incentivised funding, individual sponsorship, private sector partnerships, results based financing, reducing costs by working with industry (some of these would fall in innovative and multilateral and bilateral financing)

Day two 24 February 2015 9. Dr Chestnov (ADG/NMH) opened the meeting. The Working Group was co-chaired by Dr Anders Nordstrom (representative of Sweden) and Dr Gamkrelidze (working group member) as Dr Indrani Gupta (representative from India) was absent. Dr Nordstrom introduced himself and invited the members to introduce themselves. Dr Mikkelsen asked the Working Group to provide guidance as to who should be invited to next meeting, including any representatives of non-state actors and private entities. 10. The Co-chairs invited the Rapporteur, Dr Gene Bukhman, to summarise the outcomes of the first day. Key points from the members of the Working Group included: a. Matrix: the members requested a matrix to show shared principles and comparison of different options against the principles for Working Group to use b. Champions: the importance of political champions to generate visible leadership and show the political will for additional funding. c. Private sector: the importance of private sector engagement d. Accountability: the importance of the accountability framework to follow up on commitments e. Health systems: focus should be in health system strengthening and NCD prevention 11. Co-chair Dr Nordstrom proposed a discussion of the agenda of issues on which the Working Group should focus in the coming months for discussion:  

How do we organise ourselves What is our method of outcomes

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 

Discuss the methods of work and the outcomes Talk about the 3 substantive issues but we will talk briefly

12. The Working Group discussed the priorities for how it should work together, which included: a. Ways of working; different and complementary methods of work were agreed. Inviting experts and partners, sub-working groups, additional short background papers, web based consultations etc. b. Recommendations: the recommendations to the Director-General should outline how Member States can finance for NCDs and how to implement those plans in low, middle and high income countries c. Timeframes: with staged goals from 2016 through to 2025 d. Transparency: internet based sharing of all documentation and the notes of meetings. A briefing session for MS after each meeting according to the terms of reference including a draft report in September. 13. The Working Group together refined the thinking from the two days into a list of seven key areas which need to be addressed and consequently would form the basis for the Working Group’s final report and drive the agenda of subsequent meetings. It was also noted that the WG should be aware of the existing work of United Nations, WHO and other organizations regarding the first three areas : 1) Changing global landscape of the burden of disease and the dynamics of financing - Increasing burden of disease of NCDs, etc. 2) Member States’ commitments - 2011 UNGA Political Declaration, 2014 UNGA Outcome Document and the post-2015 development agenda, etc. 3) Understanding the investment case for NCDs - NCD Best Buys, premature mortality, cost of inaction and action, etc. 4) How to finance the cost of NCD prevention and control? - Domestic, bilateral and multilateral, and innovative financing, etc. 5) Effective use of existing and new resources to achieve maximum health impact from NCD prevention and control - Effective and efficient use of resources, etc. 6) Actions with less financial implications - Prevention, engagement with pro-health private sector, integration of NCD with existing programmes, etc. (taking into account work of Working Group 3.1 on the private sector) 7) Enabling factors - Political leadership, advocacy, evidence, etc. 14. The dates for the next meeting were confirmed: 6-7 May and then 23-24 September 2015. Whilst the Working Group decided not to have their meetings online, relevant


documents and reports would be posted on the WHO GCM website to ensure transparency. 15. In closing the meeting the Co-chairs thanked Working Group Members for their preparation for and contribution to the discussion.
