Building and managing donor and stakeholder relations

developing countries’ needs with regard to tackling the COVID-19 pandemic, and also in connec- tion with the quest for a vaccine, many other areas of health development have suffered a dwin- dling of support.

Siloed approaches are very attractive to donors, but they can hamper efforts to achieve systemic goals such as universal health coverage or improved preparedness and response capacities. Parlia- ments in donor countries prefer to approve funds for aid programmes that pursue very specific ob- jectives. That is why working with the Inter-Parliamentary Union to alert national parliaments to global health priorities is a very important new development in global health diplomacy.

The Organisation for Economic Co-operation and Development (OECD) regularly provides an over- view of government aid that promotes and specifically targets the economic development and welfare of developing countries. The OECD Development Assistance Committee adopted ODA as the “gold standard” of foreign aid in 1969, and to this day it remains the main source of financing for development. The aid provided includes grants, “soft” loans and technical assistance. Soft loans are those in which the grant element makes up at least 25% of the total. In development cooper- ation, most ODA negotiations are concerned with bilateral aid, though countries are steadily in- creasing their contributions to multilateral aid by providing assistance to UN system organizations, the World Bank and specialized health agencies, such as the Gavi Alliance and the Global Fund.

Certain shifts have occurred in funding priorities: for example, Norway launched a global strategy in November 2019 to help combat noncommunicable diseases in low-income countries, thereby reinvigorating a neglected area of funding.

The members of the OECD Development Assistance Committee have generally accepted the target of 0.7% of a donor’s gross national income being earmarked for ODA, even though very few have actually achieved that target. The United Kingdom was the only large donor country to have reached the recommended level of spending alongside a group of smaller countries such as Den- mark, Luxembourg, Norway and Sweden, which are all fulfilling their obligations. It has though recently decided to not exceed 0.5. The United States has recently rescinded its decision to with- hold funding from WHO, it remains to be seen how this is reflected in ODA for health. Germany has significantly increased its contributions to WHO. Negotiating the funding of WHO is a key area of global health diplomacy in the years to come.

Negotiations on the funding of global health increasingly cover debt relief, loans and foreign direct investment. That is one reason why joint meetings of health and finance ministers are critical for global health diplomacy.

Partnerships are also negotiated with the private sector – for example, by the Gavi Alliance to en-

sure that vaccines are affordable. Gavi’s predictable funding and pooling of demand have created an incentive for the pharmaceutical industry to set up a tiered pricing policy, whereby low-income countries are charged less than higher-income ones for the same product. Through COVAX, the new vaccine pooling mechanism for COVID-19, the Gavi Alliance is now striving to negotiate a new financial mechanism.

Two areas in which global health diplomacy plays a crucial role in securing funding are described below:

Universal health coverage: Investment on a vast scale is required from the public and private sectors to ensure equitable access to health services. On the other hand, “digital health” presents a major economic opportunity for both sectors. Dealing with the multi-stakeholder opportunities and risks arising from the attempt to balance economic interests and social (and global) solidarity is a key challenge in global health diplomacy. The multi-stakeholder hearings at the UN in prepa- ration for the High-Level Meeting on Universal Health Coverage in 2019 – modelled on the multi-stakeholder SDG negotiations – are one example. The first-ever meeting between G20 health and finance ministers, which took place on the margins of the G20 summit in Osaka, Japan, in June 2019, was another significant milestone (see Case Study 2 by Satoshi Ezoe, Tamar Tche- lidze, Nathita Premabhuti, Marcelo A.C. Costa).

Replenishment of global health funds: Another significant challenge in global health diplo- macy is the replenishment of the funds of four major financing platforms: the Global Fund to Fight AIDS, Tuberculosis and Malaria; Gavi, the Vaccine Alliance; the Global Financing Facility for Wom- en, Children and Adolescents; and the Global Polio Eradication Initiative. Negotiating the replen- ishment model for financing is a particularly attractive opportunity for Heads of State and Govern- ment to engage in prestige diplomacy. A notable example is the French campaign to secure the replenishment of the Global Fund in 2018 and 2019. Becoming involved in such negotiations also appeals to donors, as it gives them high visibility and enables them to reach out to many different global health actors, such as governments, foundations, civil society and the private sector.

Resources

Health: launch of the campaign to replenish the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. In: France, Ministry of Europe and Foreign Affairs [website]. Paris: Ministry of Europe and Foreign Affairs; 2018 (https://www.diplomatie.gouv.fr/en/french-foreign-policy/

development-assistance/news/2018/article/health-launch-of-the-campaign-to-replenish-the- global-fund-to-fight-hiv-aids, accessed 14 September 2020).