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Brussels, 31 March 2010

Global Health: Commission calls on EU to gear up on health actions

Why do we need a Communication on global health?

There are three reasons why we need this new approach:

  • first, over the last decade, we have not made sufficient progress towards the Millennium Development Goals (MDGs). With only five years remaining to the 2015 target date, the health MDGs are among those most off track;

  • second, we face new challenges, in particular pandemics and new diseases which have emerged over the last decade;

  • third we can do better. The EU is in a stronger position to take a lead than it was 10 years ago.

What has been done so far?

Globally, aid for health has quadrupled over the last decade from €4 billion to €16 billion annually. Collectively, through provision of medicines and prevention efforts, there are 3 million people alive today who would otherwise have succumbed to HIV/AIDS. Significant progress has also been made in the fight against Malaria and tuberculosis.

Money is not everything – we need to look at health policies and systems. For example, Sri Lanka and Angola have similar levels of prosperity, but Sri Lanka has 30 times lower rates of maternal mortality. Equatorial Guinea is roughly thirty times more prosperous than Malawi, but Malawi is closer to achieving the health MDGs.

Why now?

What we have achieved so far is not enough. For example half a million mothers are still dying every year in pregnancy or within 7 weeks of the birth of their baby. This shocking statistic has hardly changed over the last 10 years.

Maternal health is the MDG which is most off-track in most developing countries across the world. It is also litmus test for health systems - lack of progress shows current systems are not responding to needs and not close to those in need.

Moreover, progress towards all the Millennium Development Goals will be reviewed later this year in a High Level Event at the United Nations in New York. This is the moment for the Commission to set out its ideas for what the EU can contribute to that event by way of new policy thinking.

Why the EU?

Tackling poverty in general and making progress on health-related MDGs in particular is something no one country can achieve alone. These are global problems and the EU is a silent giant in this field.

First, it is by far the biggest aid donor, accounting for around 60% of all official development assistance worldwide. Second, the EU is the world's largest trading partner, and through its own standards and its weight in the international trading system can have a positive impact. And finally, the EU has a model to share, based on solidarity and universal coverage.

What is the Commission proposing?

  • Directing aid to health systems, rather than individual diseases. People need comprehensive health services, not care which discriminates between people with different diseases. In concrete terms the Commission is proposing that by 2015, half of aid to the health sector should be aligned to Developing countries' own systems. This means increased use of budget support and MDG-Contracts instruments which provide aid through the national budgets of the partner Governments.

  • Better use of research and knowledge of health systems. This means networking the EU's own research capacities under the Framework Programme for research and technological development with those of developing countries. This helps ensure that new knowledge and new treatments are available to the people who most need them

  • Stronger EU political and financial involvement in global initiatives like the Global Fund to fight Aids Tuberculosis and Malaria (GFTAM) and the global Alliance for Vaccines and Immunisation (GAVI). The EU should also support world-wide bodies like the World Health Organisation to encourage systems-based solutions and reduce the number of small budget projects and programmes.

What next?

The Communication adopted today will go to Development Ministers. Council Conclusions are expected to be adopted at the Foreign Affairs Council on 11 May. So this document is an important step for Europe on the road to the September UN Summit on the MDGs.

Can the Commission provide a concrete example of what it means by directing aid to health systems?

In Zambia for example, EU support has improved health through a comprehensive approach to strengthening health systems. The EC has contributed in a variety or ways including budget support, complementary actions on health system priorities as well as health human resource policies and health information systems. Zambia has an "enabling environment" (democracy, stability…) allowing it to meet the Abuja targets for health expenditure (15% national budget allocation to health). Recent Demographic Health Surveys show progress on the MDGs and reduced infant and maternal mortality. Universal access targets for antiretroviral therapy for HIV/AIDS are also being met in Zambia.

What is the EU doing to help developing countries attain the health-related MDGs?

MDG 4 – Reduce Child Mortality

Between 1990 and 2008, the number of deaths among children under 5 years old fell from 12.5 million to less than 9 million whilst under five mortality fell from 90 deaths per 1,000 live births to 65 deaths per 1,000. Most deaths of children under five years old are due to acute respiratory infections (mostly pneumonia), diarrheal infections, malaria and measles all of which are avoidable. Promoting the use of insecticide treated bed nets to help prevent malaria, for example, has been shown to reduce under five mortality rates by up to 20% which equals the prevention of almost half a million deaths each year to children in Sub-Saharan Africa. Improved immunization can avert deaths too. Countries that have adopted well-known and effective anti-measles strategies (e.g. Botswana, Malawi, South Africa) have reduced measles deaths to near zero since 2000. It is not only the reduction of child mortality that is necessary but also actions to improve nutrition, gender equality, education and household incomes. There is a clear relationship between child mortality and poverty. Poor families are often unable to obtain even the most basic healthcare for their children and they usually suffer most from food scarcity and lack of access to a safe water source or adequate sanitation.

The basis to advance on MDG4 is through multisectorial health services, including promotion of safe water, adequate nutrition and hygienic environments. The EU also supports the Global Alliance for Vaccines and Immunization which has helped to prevent an estimated 3.4 million deaths. European Union donors have contributed one-third of GAVI’s public funding.

MDG 5 – Improve Maternal Health

Maternal mortality has decreased by less than 1% per year between 1990 and 2005, far below the 5.5 per cent annual improvement needed to reach the MDG target. Increasing access to skilled attendants, emergency obstetric care and family planning services can help significantly as shown in Bangladesh and Sri Lanka. On the other hand good progress has been made in antenatal care; even in sub-Saharan Africa, more than two thirds of women receive antenatal care at least one time during pregnancy.

In order to advance of MDG5, it is essential to count on strong national commitments. One example is the Maputo Plan of Action on Sexual and Reproductive Health

The EU supports this action plan unanimously agreed by African Union Health Ministers in September 2006. This includes support for better family planning, improved contraceptive commodity security and action to reduce unsafe abortion. Major milestones have been attained: twenty-seven countries developed Maternal and New­born Health Road Maps, and several countries report progress in scaling up linkages between Sexual and Reproductive Health and HIV/AIDS;

MDG 6 - Combating HIV and AIDS, malaria and other diseases

HIV/AIDS, malaria and tuberculosis alone account for over 6 million deaths each year. Sub-Saharan Africa is the world's worst-affected region where besides ravaging lives, these diseases impede development and cause poverty. Many successes have however occurred in the AIDS response including increases in HIV treatment coverage and prevention of mother-to-child transmission services with an indication of decline in HIV incidence in some regions. Coverage for services to prevent mother-to-child HIV transmission rose from 10% in 2004 to 45% in 20081 ; the drop in new HIV infections among children in 2008 suggests that these efforts are saving lives and the number of HIV-related deaths has declined by over 10% over the past five years. UNAIDS and WHO estimate some 2.9 million lives have been saved since 1996. In Botswana, where treatment coverage is 80%, AIDS-related deaths have fallen by over 50% over the past five years.

Young women are particularly affected. In South Africa, the 15 to 24 age group is four times as likely to be HIV infected than young men. Few HIV prevention programmes exist for those over 25, with funding for HIV prevention the smallest percentage of HIV budgets of many countries. In Ghana for example, the prevention budget was cut in 2007 by 43% from 2005 levels2.

The EYU provides over half of the funding of the Global Fund to fight HIV/AIDS, tuberculosis and malaria which has contributed to have 2.5 million patients in developing countries receiving antiretroviral (ARV) treatment, 4.5 million orphans receiving medical services, education and community care, 6 million new cases of infectious tuberculosis treated and more than 100 million bed nets and malaria drug treatments delivered.

Equitable and affordable research is fundamental to improve health globally. The European & Developing Countries Clinical Trials Partnership (EDCTP) aims to accelerate the development of new or improved drugs, vaccines and microbicides against HIV/AIDS, malaria and tuberculosis and also supports health capacity building in sub-Saharan Africa by setting up health centres and training health care workers for instance. The basis of EDCTP is partnership with sub-Saharan countries. The partnership helps EU Member States to integrate and coordinate their own national research and development programmes and form partnerships with their African counterparts. The EU has supported EDCTP to the tune of €200 million committed so far by the European Commission and €97,6 million committed by the Members States up to the end of 2009.

Other examples of EU efforts in global health research priorities related to joining forces against malaria

Under the EU’s previous Framework Programme for Research (FP6, 2002-2006), a total of 17 cooperative malaria research projects were supported to the tune of about €64 million. These include three large projects which have helped greatly to structure the European Research Area in the field of malaria research (1) a strong malaria basic research network (BioMalPar); (2) a big research project to develop new antimalarial drugs (ANTIMAL); and (3) the European Malaria Vaccine Development Association (EMVDA) coordinated by EMVI (European Malaria Vaccine Initiative).

New parasite molecules have been discovered with a high potential for anti-malarial therapy, some of them are being investigated as drug targets other molecules are now in the pipeline for vaccine development. BioMalPar has become a cornerstone in malaria research and is now renowned in the scientific community for its outstanding activities. Europe is now recognised as the world leader in biology of malaria parasite and there is the aim of maintain this high profile and to achieve a European Malaria Graduate School and a virtual European Malaria Institute.

Under the Seventh Framework Programme for Research or FP7 (2007- 2013), the European Union continues its effort in malaria research, notably in identified gaps in certain areas of malaria research. For example, malaria in pregnancy was covered by a specific topic under FP7’s first call for proposals, and a call has been launched in 2009 to establish a major project on controlling the malaria mosquito vector.

1 :

World Health Organization, United Nations Children’s Fund, UNAIDS, 2009

2 :

2009 AIDS Epidemic Update, UNAIDS and WHO, 2009

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