16 April 2011

2nd Day Plenary Session 3 - HiAP/HIA and the Official Development Aid, Promoting Health in Developing Countries

Juan Garay, European Commission

Health and development are dynamic not static concepts.

Development has many dimensions and including ideological. Current definitions focus on economic aspects.

But controversial in health equity, time lag and adult health and productivity.

Non-income development and growth+ ...

Perennial arguments - right to health and priority aspiration for people
Growing factors - health linked with globalized risks, knowledge and resources and health inequities linked with instability (political and economic)

WHO Article 1 "....attainment of all people's of the highest possible levels of health."

Mortality has declined and life expectancy has improved but there are wide ranges depending on income 1990s was poor for improvements in life expectancy. Absolute levels have reduced though the proportion reduction generally greater for high income countries...

Equity dimension for these rates has hardly been touched!

80% of under 5 deaths are due to global inequity!

Millenium Development Goals only cover 60% of preventable deaths.

Health expenditure has hardly moved in low income countries but substantially in high income countries.

Even at the same level of GDP there are significant differences.

GDP and public funding are not key determinants of reduce under 5 mortality.

But, spending at or above $100 of public spending on health (care) have mortality rates below 50... (and no countries spending less than $40 have mortality rates that are that low.

Aid is very fragmented - over 100 global initiatives - competing, duplication, etc.

Policy coherence for development:
Food security
Environmental change

Develop at global level develop expertise on HIA in the above area.

Peter Furu, University of Copenhagen

Almost $129 billion given in Official Development Assistance (ODA), planned ti grow at 2% per year compared to 8% in the past.

Health sector is the most complex with over 100

In 29 countries in sub-saharan Africa there are between 18-23 donors working in the health sector.

There are a range of different impact assessments that donor officials have to deal with.

Does the diversity in IAs facilitate effective aid giving? Or will they create more confusion than clarity?

How have donor partnerships used HIA and considered health?
OECD-Development Assistance Committee has an overarching objective (2011-2015)...future in which no country will depend on aid...

OECD-DAC, A practical guide to ex-ante poverty impact assessment
OECD, Guide on sustainable impact assessment

Poverty Impact Assessment:
Five capabilities considered - economic, human, political, socio-cultural and protective-security with environment and gender as cross-cutting issues.

Sustainable Impact Assessment
3 pillars of sustainable development
Social (health as one aspect)

HIA stand-alone versus integrated?
How do we build capacity in both developing and developed countries?

Examples of capacity development in HIA in Lao PDR, Vietnam and Cambodia.

E-learning online course has been developed.


Is diversity in IA create confusion or clarity?
How should health be addressed in an integrated way?

Carlos Dora, World Health Organization

ODA agencies not doing much around health - environmental and social focus, many gaps and lost opportunities.

Health could easily be integrated into existing mechanisms.

Use of EIA came through a negative impact of the use of pesticides and a resulting lawsuit.

Private capital flows are much bigger than public development aid. Development banks could play a role in monitoring the impacts of these flows, safeguards and performance standards are used to ensure projects protect environment and health.

Development bank safeguard systems.

WHO engaging with banks and undertaken adaptation of HIA tools, technical assistance and capacity building of staff to integrate health. 'Community health and development finance' (to be published in the near future).

HIA lends itself to transparency and accountability issues - provide a baseline for future monitoring, analysis of potential future impacts, development of high level management plan for addressing the identified impacts and mechanism for early and sustained engagement with stakeholders.

Document developed 'Managing the public health impacts of natural resource extraction activities' which outlines a broader framework within which HIA should be fitted.

Discussion draft can be found here:

Key concept is Healthy Green Growth/Economy - co-benefits of climate friendly policies