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Health: health and poverty reduction
To detail the relationship between health and poverty, to outline critical elements of a coherent approach in this area and to establish, for the first time, a single Community framework for action for the Community's future activities.
Communication from the Commission to the Council and the European Parliament of 22 March 2002. Health and Poverty Reduction in Developing Countries. [COM(2002)129 final - Not published in the Official Journal].
Health is a key determinant of economic growth and development, while ill health is both a cause and effect of poverty. Aside from the serious consequences for social welfare, ill health deprives developing countries of human resources and the high cost of ill health reduces economic growth and limits the resources governments have available for investment in public health. As a result, improving health in developing countries is essential in order to reduce poverty, which is the primary objective of the European Union's development policy.
There is increasing international consensus on the key principles of development policy. Most governments and international organisations, including the European Union, are committed to a series of eight millennium development goals, one of the most important ones being to improve health.
The Union has already undertaken many initiatives in this field, particularly with regard to the three communicable diseases that affect developing countries in particular, namely HIV/AIDS, malaria and tuberculosis. For example, it has already adopted a programme for action to accelerate the fight against these three diseases. This communication establishes, for the first time, a framework for action that will incorporate the Community's actions on health and poverty reduction. The framework is the Union's overall response to the commitments it has made in this field. The communication will be supplemented by a comprehensive work programme, detailing the priorities for action and the required human and financial resources.
Critical elements of a coherent approach
The Commission outlines critical elements of a coherent approach to improve the effectiveness of development assistance in the field of health:
- working for increased ownership, good governance and stewardship at national level in developing countriesThis objective may be pursued via the national poverty reduction strategies for example;
- establishing coordinated and pro-poor policiesServices and resources must be targeted on the diseases closely linked to poverty and/or the poorer geographic areas. The expansion of adequate social protection also has an important role to play;
ensuring a healthy environment
Environmental problems, such as poor water quality, contribute to health problems and it is thus essential to improve control and management of these problems;
reversing the decline in overall development aid
Aid levels have declined for much of the 1990s. Today, there is a new effort to increase aid but it is still insufficient;
encouraging investment in global public goods
It is important to encourage, in particular, investment in research and development in the health sector;
increasing public-private partnerships
This type of partnership already plays an important role. Private organisations make a considerable contribution to the international programmes in the field of health. A good example of this is the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria.
The objectives of Community policy on health and poverty are as follows:
- improving results in this area at country level, especially among the poorest;
- maximising health benefits and minimising potential negative effects of other Community activities;
- protecting the most vulnerable from poverty and supporting fair health financing mechanisms (guaranteeing equitable access to services);
- investing in the development of specific global public goods such as research and development.
In order to achieve these four objectives, the Commission has identified a set of priorities consisting of priority areas for action and future actions in each area. First and foremost, EC interventions must increase and the Member States and the Union must speak with one voice within international fora.
The country level will remain the major focus of Community actions on health. Actions should concentrate, in particular, on developing public health (especially prevention efforts), strengthening health systems to improve access, ensuring pro-poor systems of health financing and social protection, communicable diseases, and reproductive and sexual health and rights.
To this end, the Commission envisages a broad range of actions including implementing a comprehensive approach, reinforcing dialogue at country level with social sectors, and providing the necessary support to help countries with knowledge generation and management. The Union has drawn up country strategy papers for many developing countries. These papers set out the country's overall development strategy and it is important for them to reflect the Union's health principles.
The European Union brings added value to support for regional cooperation through its experience of regional integration. Health issues often transcend borders and greater regional integration or cooperation is thus essential. The Union's support should focus on health sector reform, demographic surveys, disease surveillance, issues related to drug production, purchasing and regulation, and support for research and development, education, etc.
The actions envisaged in this priority field include developing various partnerships, supporting knowledge acquisition and dissemination of best practice, supporting analyses of the capacity of regional institutions, and giving consideration in regional economic partnership agreements to the need to improve health.
Coordination, complementarity and synergy with Member States
Better coordination, complementarity and synergy at all levels between the policies and activities of the European Union and those of the Member States are essential. Specific measures to improve coherence and strengthen operational coordination must be identified. To this end, the Commission considers that its role in coordinating the EU's policies in this area must be strengthened. The Union and the Member States should also organise regular joint missions and fora.
Global level input
The European Union is a substantial donor to the United Nations and it has close relationships with other international organisations. It already plays an active role in the initiatives implemented at global level. However, the new global health agenda requires strengthened international partnerships and the Union must tackle certain priority issues. Key actions include ensuring the coherence of its actions with other Community policies and playing an active role in the development and implementation of global initiatives.
Civil society and non-governmental organisations (NGOs)
Civil society and NGOs play a key role in implementing development assistance and they have a growing impact on policy formulation. It is important to strengthen the links between the Union and civil society and to establish dialogue and a strategy for the major development cooperation issues. The establishment of a working group on health and poverty in which civil society may participate is one example of the measures envisaged.
The private sector should make a far greater contribution to improving health in developing countries, for example by making greater commitments to work on corporate responsibility and promoting the wide application of tiered pricing. The Union's cooperation with this sector is limited and should be reinforced. In particular, new incentives are being discussed to encourage multinationals to develop global goods such as research and development, and cooperation is being enhanced to ensure that private companies take greater responsibility for health in developing countries. The Commission also proposes exploring the possibility of increasing capacity in developing countries for local production of pharmaceuticals.
Monitoring and evaluation
Today, monitoring and evaluation of the European Union's investments and activities in this field focus on the global aspect, in other words evaluation of the progress made in relation to a country's general development strategy rather than monitoring and evaluation of individual investments in specific projects. This approach reflects the new approach of the development assistance policy. However, the evaluation of national strategies and global progress alone is not an effective method of health evaluation and monitoring. Together with the developing countries and other international actors, the Commission hopes to draw up more precise indicators for the various sectors of intervention. As regards monitoring Community aid management, it is also important to develop new mechanisms and guiding principles in order to improve effectiveness.