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Quality of Growth - The Contribution of Health and Social Protection

Group Photo of Conference Participants

Welcome to the website of the Regional Conference of the GIZ Sector Network Health and Social Protection for the Africa, MENA and LAC regions, held in Accra, Ghana from 6 - 9 May 2014. Below, you find an article about the conference’s central topic, summaries of the three conference days and the presentations held by various delegates.

Let’s put health and social protection on the economic growth agenda

The message from GIZ’s Sector Network Health and Social Protection conference in Ghana is clear:

It is time to open our eyes and see how we can best link health and social protection with quality of growth.

Sub-Saharan Africa has seen robust economic growth in the past two decades. This year will be no different according to the World Bank, with average GDP growth predicted at 5.3 per cent. Yet despite the consistently positive numbers, poverty rates on the continent have barely changed. And, as the regional conference in Accra heard from its keynote speakers, inequality is rising.

Improve the quality of growth

 Hence the need for health and social protection programmes that both improve the quality of growth, and enable the poor to benefit as their countries get richer.

Bernd Appelt

Dr Bernd Appelt - Listen to an interview with him. - © GIZ

“If growth doesn’t translate into better education systems, better social services, better health services that help people participate, and get away from the poverty trap, then I think GDP growth is worth nothing,” says Dr Bernd Appelt, Speaker of the Sector Network in Africa and the Middle East.

Incentives to work together

 But if health and social services are to be a priority in growth, Dr Appelt believes, programmes supporting them must do more to integrate with the development agenda. And they must start taking responsibility for that themselves. Dr Appelt hopes a re-organisation at GIZ currently underway will help by creating incentives for different sectors to work together.

He gives as an example the relationship between water and sanitation projects and health. “A water project that does not improve the health of children is basically useless,” he says.

Linking up with other sectors

Dr Günther Taube, Director of the Health, Education and Social Protection Division at GIZ agrees. “We need to look more at inter-sectorial linkages,” he says. Linking health and social protection to economic growth means thinking beyond the specific technical challenges of individual programmes, and “putting them in a broader perspective.”

It also means paying more attention to national policies and priorities in the countries that are receiving development aid. “We have to work a bit more on this,” Dr Taube says. “It’s what should guide our activities.”

No shortage of funds for health

 But collaboration goes beyond teaming up with other sectors and strengthening relationships with partner governments.

“If you look at the global data, resources for health in developing countries continue to grow,” says Dr Elizabeth Pisani, guest speaker at the Accra conference. “The interesting thing is that there’s radically more money from non-government sources”.

In 1995, for example, only 4 percent of all development assistance for health came from non-bilateral sources. By 2011, that had shot up to 60 percent, with the entry of large foundations and multi-lateral organisations like the Global Fund. And, Dr Pisani believes, “The agencies that’ll do well in this market will be those that meet the needs both of the beneficiaries, and of this new pool of funders.”

Go out there and convince others

 As Dr Bernd Appelt acknowledges, all of this means a shift in thinking from a somewhat narrow understanding of health and social protection. “If people tell me health is something that happens in hospitals, they’ve misunderstood,” he says. “Health happens at schools, at workplaces, in urban spaces and wherever public policies, intelligent planning and management promote healthy living.” And he makes this plea to his fellow programme managers, experts and advisors. “Please, open your eyes and try to look for collaboration and cooperation with others. Go out there, convince others, and explain the links.”

It will not always be easy. But Dr Appelt believes that once the approach is made, staff working in other sectors are very appreciative. “They are actually thankful and will engage with you,” he says, “they share our views and values.”

Communication is key

 To achieve all of this, communication is going to be vital. Delegates at the conference were therefore encouraged, through workshops, to use social and traditional media more widely to communicate both with the grass roots and with policy makers and international donors. They were also invited to use the Healthy DEvelopments website to make the case for individual programmes, and for their contribution to more equitable and sustainable economic development.


Summary Day three

Welcome to beautiful, friendly Ghana

"Welcome to beautiful, friendly Ghana" said Ms Nana Oye Lithur, Ghana’s minister of gender, children and social protection, as she opened day 3 of the Regional Conference at which many non-GIZ delegates from Ghana and other African countries joined the audience. "The topic of this conference is timely and highly relevant for current global thinking about growth and equity. Social protection is no longer just an afterthought that addresses the negative impacts of economic development initiatives on the less privileged - today we know that it is a crucial factor for sustainable, inclusive development." In her inspiring speech, Ms Oye Lithur gave an overview of what she called Ghana’s social protection story, encompassing, interventions in education, employment, health and cash transfers. Ghana’s LEAP (Livelihoods and Empowerment Against Poverty) program provides cash transfers to over 74,000 households in 100 districts and it has been shown that every Cedi transferred resulted in an increase of 2,5 Cedi in the local economy. And the impacts are not just economic: Through LEAP, beneficiaries’ school enrollment and attendance, and their access to health service has also improved.

Ms Martha Gyonsah-Lutterodt of the Ghanaian ministry of health conveyed her Minister’s welcome to the conference delegates. In her speech, she made the case for the continuously evolving Ghanaian National Health Insurance Scheme (NHIS), a social health insurance open to all Ghanaians, including the extremely poor. But she recognized that more needed to be done: "In Ghana, we are fully committed to social protection for all - and we need the support of our development partners to find tools and solutions that are tailor-made for the Ghanaian context. So what I would like to ask all of you at this conference is to help make sure that the results of your deliberations are translated into action."

Speaking next, Mr Rüdiger John, the German Ambassador to Ghana, also welcomed conference delegates and re-emphasized that, time allowing, they should seize the opportunity to see some more of the country and to enjoy the famous Ghanaian hospitality. Keeping his contribution short, he sketched out the areas of German-supported interventions in the Ghanaian health sector and paid his respects to what the country had already achieved: "There is no doubt that in recent years Ghanaian progress in health and social protection has been impressive."

When it comes to social protection, hard choices have to be made

The morning session continued with the keynote addresses of two very different, yet equally inspiring distinguished speakers on the politico-economic perspective on quality of growth. First, Prof. Adam Habib, Principal of Wits University in South Africa, invited delegates not to fool themselves: "Let’s be honest: when it comes to social protection we have to make hard choices. As technocrats we tend to regard social policy as a technical exercise - but we are wrong. Social and economic policies are always advancement of political interests. In the end, national, continental and global power relations will determine what is possible."

Prof. Habib outlined that in many societies in transition, new elites are coming to the fore, instigating a new debate of the three inseparable topics growth, poverty alleviation and inequality. Interestingly, in most countries everybody - from the left to the far right - is committed to growth and to poverty alleviation. But the debate gets heated when it comes to inequality. Particularly in the private sector, many believe that inequality is an inevitable corollary of economic growth, something societies have to live with, alleviating its worst impacts to avoid civic unrest. Others think that it is just a question of time: Where economic growth continues, inequality will eventually disappear. But is that so?

He referred to the hypothesis just put forward by Thomas Pikkety in his book 'Capital in the twenty-first century': The economic inequality prevalent in Europe early in the 20th century was not overcome by countries’ continued economic growth but rather by the brutal yet equalizing impacts of the two world wars - clearly not a strategy to be recommended to developing countries and emerging economies in the 21st century. But what does it take to tackle inequality today?

When growth happens, the guys at the top grow faster than the guys at the bottom

"Let’s face it" Habib said, "when growth happens, the guys at the top grow faster than the guys at the bottom because they have access to capital. Whatever you do in terms of poverty alleviation cannot counteract the simple fact that return on capital is always greater than economic growth." But, according to Habib, social and economic policy can do three things: take measures against a growing remuneration gap; invest in quality in public health and education services; and make sure that social support is not designed to keep the poor quiet but to get them into employment. At the end of his speech, Prof. Habib asked delegates to be wary of technically supporting social protection programs that do not at the same time enable and empower the poor to hold the ruling elites responsible: To reduce inequality, what is needed is not technical advice but the creation of leverage for accountability of the elites.

As second keynote speaker, Ruslan Yemtsov, team leader for social protection at the World Bank, started by making delegates aware that in Africa, despite economic growth, poverty levels had remained roughly the same as at the turn of the millennium. He highlighted the fact that in most countries today, the poor, like everyone else, need to buy and pay for many things that did not use to have a monetary value. So, just to stay at the same level, poor people need to increase their income. Mr. Yemtsov showed that in different countries, economic growth had very different effects on inequality: In some countries, growth produced spectacular growth rates for the bottom 40% whilst in other countries, like the US, overall economic growth in recent decades had resulted in increased inequality and income losses for this group.

Where it is designed as transformative intervention, social protection can be a productive force

Mr. Yentsov agreed with Prof. Habib in pointing out that to support inclusive growth, social protection, including labour market policies, must be designed as a transformative and productive force rather than as hand-outs. According to World Bank figures, today, 40% of countries achieve social protection for 50% of those who need it - and they could fully achieve it if they implemented measures to redistribute income from the rich to the poor. 60% of countries lack the budget they would need to realize their citizens’ social protection. "This is where we face real dilemmas" said Mr. Yemtsow, "and where hard choices must be made: Who is going to benefit and who is going to pay for it? However we move forward, trade-offs are inevitable."

In the next part of the morning session, Dr. Diogo Milagre, Deputy Director of the National AIDS Council in Mozambique, Prof Baku Akosa, Member of National Development Planning Commission in Ghana and Ms Martha Gyonsah-Lutterodt of the Ghanaian ministry of health joined the two keynote speakers for a panel discussion. "The problem is that you won't understand Ghana if all you look at is our growth rate and our GDP" said Prof Akosa, "The Human Development Index is a much better indicator for the social challenges we face. Or just look at the rates of malnutrition and stunting." Ruslan Yemtsov agreed: "The same trend can be seen in India and countries in Latin America: There is considerable economic growth, but malnutrition persists whilst cases of obesity shoot up, too, creating a double burden for the health system. To address this, behaviours and attitudes need to change. For example, countries need to promote breastfeeding."

We have created consumerist cultures

"But look what happens in countries with fast economic growth," countered Adam Habib. "Young mothers who need to go to work are not able to breastfeed their children. If governments want them to breastfeed, they should introduce labour laws that protect maternity. Instead the push for economic growth creates consumerist cultures. Given the choice between milk and coke, it is all too clear what people will go for. You cannot ask workers to lower their wage expectations when companies continue to give disproportionate raises to their CEOs. But what does it take to foster the political will to put a hold to that?" Diogo Milagre agreed: "There is a great risk that the same is going to happen in countries like Ghana and Mozambique. If we think that growth and the private sector are going to ensure inclusive development, we go wrong. The large companies are often foreign and their investments go to urban communities where they have the infrastructure they need. But the majority of our population lives in rural contexts, where the infrastructure continues to be poor." The discussants agreed that the private sector has a crucial role but that sustainable development could only be achieved where the public sector played a shaping role and was ready to make the hard choices the two keynote speakers had talked about.

Lively discussions in interactive sessions

In the afternoon, participants were offered the choice of eight different thematic sessions, covering a broad range of topics illustrating GIZ’s engagement for quality growth: health and social protection as determinant and outcome of the demographic dividend; approaches to building the health workforce needed to realize Universal Health Coverage; corporate social responsibility (CSR) for health and social protection; redistribution and governance for health financing; and equality and inclusion as drivers of sustainable development. In their session "Who needs it? Selling health and social protection" Claire Bolderson and Elizabeth Pisani presented how effective use of public opinion and the media, and targeted advocacy to decision-makers, the tax-paying public as well as beneficiaries of health and social protection programs was one effective way to hold the elites, politicians and governments accountable to deliver on their social policy promises. Three teams from Tanzania, Kenya and South Africa had been asked to prepare their case for specific interventions. Participants, in the roles of decision-makers, beneficiaries and the tax-paying public, had the chance to give them feedback and to decide which of these programs they would like to fund. The lesson learnt from this session was clear to all: As health and social protection experts, if we want to make a difference, we must get better at listening and understanding, and at explaining and 'selling' our programs to these different groups.

A rich and inspiring third conference day ended with a group picture (see above) and great excitement about the planned bonfire and evening barbecue at the nearby beach. A big thank you to the conference organizers!

Summary Day two

Shared prosperity

„When we talk about economic growth at this conference, shouldn’t we discuss which kind of economic growth we stand for?“ asked Uwe Gehlen, head of GIZ competence center Social Protection, in his presentation to conference delegates at the start of day 2 of the Regional Conference in Accra. In a thought-provoking speech, he highlighted how at least four components of social protection, i.e. insurance, social safety nets, labour market policies and access to services, must be in place to ensure that growth is inclusive, sustainable and pro-poor. According to Mr. Gehlen, GIZ social protection efforts support „shared prosperity“, a term recently coined by the World Bank: Economic growth and equity are seen as the two key elements which must be kept in good balance by countries that aim to achieve sustainable growth and development.

A lively market place

A considerable part of the conference’s second day was dedicated to lively and focused exchange amongst peers about 14 different tools and approaches that network members currently implement. The so-called ‚market place‘ format allowed delegates to attend up to six consecutive 30-minute presentation and discussion sessions at the information ’stalls’ that had been set up by the various presenters. There was considerable interest in, for example, GIZ’s support to the global P4H network; in web-based cost-benefit projection tool for companies considering the implementation of workplace wellness programs; in the Ghanaian component of the 'Affordable Foods for Women‘ initiative; in the ESTHER partnerships between African and German hospitals managing cases of HIV infection and AIDS; and in a brainstorming about possible contributions to the ‚One World‘ theme of the year preceding the 500th anniversary of the Reformation.

BMZ’s new Africa policy

In the afternoon, the head of economic cooperation and development at the German Embassy in Ghana, Nicole Madonaldo, presented BMZ’s new Africa policy paper, entitled "Africa, a continent on the move from crises to opportunities“. In the years ahead, Germany commits to supporting African partner countries in efforts to achieve peace and security, economic development, food security, rural development as well as health and social protection: "It is widely known that Germany knows how to set up and running a viable social health insurance system“ said Ms. Madonaldo. "This is the kind of expertise many of our African partner countries are interested in and our development cooperation programs can share.“

Presenting the Global Fund’s new funding model

Tina Draser and Marion Gleixner, two senior managers at the Global Fund to fight AIDS, TBC and Malaria (GFATM) joined the conference for the last session of the day. First, Marion Gleixner introduced GIZ delegates to the Global Fund’s new funding model, which aims to ensure that countries with the highest disease burden and the lowest ability to pay receive the largest share of GF funding. To achieve the greatest possible impact as well as enhanced country ownership, the Global Fund now rewards countries’ willingness to contribute their own finances to the strengthening of their health systems. Last not least, the new funding model wants to provide countries with predictable funding and with flexible timing and a more streamlined process for the submission of proposals, both for implementers and the Global Fund.

Working with the Global Fund at country level

Kristina Kloss, Bernd Appelt and Holger Till, experts working in GIZ-supported HIV programs in Tanzania, South Africa and Ghana, have served as members of these countries’ Country Coordinating Mechanisms (CCM), the structures responsible for countries’ grant applications to the Global Fund. „So, what has been your experience of being a CCM member?“ asked Samatha Solokowski of the German BACKUP initiative who facilitated this discussion. "I must admit that it is quite a bit of work“ said Bernd Appelt. "The grant application I was asked to read in preparation of the last CCM meeting had 278 pages. Reading and commenting on a document like this can easily fill a whole working day! Still, it is a great way of getting a lot of valuable information about HIV politics and programming in South Africa.“ Kristina Kloss agreed: "Yes, it does take time and this is why it is an official part of my work. And it does not just provide you with a lot of information, it also gives you the chance to influence important decisions about HIV programming in your partner country.“ Holger Till from GIZ in Ghana pointed out that being a CCM member is both an honor and an obligation: Since he is not allowed to delegate participation in CCM meetings to other GIZ colleagues, he must either attend them himself or accept that German Development Cooperation is not represented.

Tina Draser took this opportunity to thank the GIZ colleagues and the German BACKUP initiative for their continued support to the Global Fund, at international and country level. "We need experts like you to be part of the CCMs if we want the Global Fund to achieve impact. Also, we highly appreciate the support BACKUP has been providing to strengthen CCMs in various African countries. This is the kind of cooperation we need to create synergies between bilateral and multilateral development cooperation.“

Summary Day one

"You cannot eat GDP“ said Bernd Appelt, speaker of the GIZ sector network health and social protection, quoting the title of a recent seminar by the Heinrich Böll-Foundation, as he opened the Regional Conference entitled 'Quality of Growth - the contribution of health and social protection‘ on May 6 at the La Palm Hotel in Accra, Ghana.

Addressing 80 delegates from GIZ health and social protection programs in over 20 countries in Africa, the Caribbean and the MENA region, he stressed that in order to become quality growth, economic growth must go hand in hand with the development of countries’ health and social protection systems. "The challenge for this conference - and that means: for us as GIZ experts - is to ensure that health and social protection are at the heart of the debate on how to achieve sustainable economic growth."

Anne Frisch, speaker of GIZ’s Asian and Eastern European sector network health and social protection, joined him in this appeal: "In our GIZ health and social protection programs, we have a broad portfolio, we have conceived many innovative approaches and we continue to attract co-financing from other development partners. At this conference, let us recognize and make use of the opportunities before us to put health and social protection at the center of partner countries’ development strategies."

But it takes more than health and social protection expertise to attain these ambitious goals. This is why the conference started with a workshop entitled 'Making the case for health and social protection', led by two experienced, politically savvy communication experts, Elizabeth Pisani and Claire Bolderson. In their lively presentations and a practical exercise, they challenged participants to carefully consider how to adapt the way they present their programmes in order to effectively influence public opinion and political decision making: "If you’ve got a good story to tell about what you are doing and achieving, use the media - mainstream and social - to spread the word. The media are always looking for good stories - and if your story is good, they will make sure that it is seen and heard."

In the afternoon, the sector network’s working group 'Quality Management in Health‘ presented the new tool box on systemic quality management for the health sector which it just published.

In the last session of the day, Ella Schieber of GIZ’s Africa department and Karin Kortmann and Günther Taube of GIZ’s sectoral department formed a panel to discuss the future of health and social protection in Africa. Ms. Schieber pointed out how the BMZ’s new policy paper for Africa resonated with the topic of this conference: It’s theme, 'From crisis to opportunity' looks at the way economic growth has begun to positively transform the context for development in many African partner countries. Following on, Mr. Taube highlighted GIZ’s health-related activities in Ghana as an innovative example of how GIZ can engage with private enterprises to improve employees’ and whole communities’ health and social protection.

Delegates continued their lively discussions at a dinner reception. More interesting sessions are programmed for the next two days: See you here every night for a daily summary.

We would like to call your attention for the workshop “Making the case for health and social protection programmes”, on the morning of May 6th (parallel to the AV-meeting).

Universal access to health care is slipping down the list of global development priorities. Equality, Sustainability, Human Rights are the "fundamental principles" of the post-2015 agenda. Health and Social Protection are merely "enablers," possible steps along the way to higher goals. As a result, German Development Cooperation is cutting back on programmes supporting health and social protection. 
So how do we reverse that trend?

This three-hour workshop will challenge health and social protection experts to assess how they make the case for their sector and their programmes. 

  • Imagine that the BMZ decided to close half the German programmes in the country in which you work. Which arguments, data and stories would you put forward to convince the bosses to change their minds?
  • If you had to sell your programme to a major funder with no expertise in health how would you build your argument? What would you say?

Two experienced and politically savvy journalists, Claire Bolderson and Elisabeth Pisani, will use practical exercises and role-play to help you build your case and adapt it for different audiences. From the media to politicians, private sector funders to tax-payers; this workshop will help you convince them all of the need to keep health and social protection high on the list of global development priorities. 

The workshop is organized by the GHPC/Healthy DEvelopment team and the programmes with the strongest cases can be published in the upcoming 'Monthly Feature‘ series of the Healthy DEvelopments web portal. 

If you would like to take part, write to editor@healthy-developments.de

Background

Economies in the developing world are growing and they are growing faster than their populations. However by the end of this century Africa is expected to have nearly 3 billion inhabitants. In the MENA region and Latin America  the population will grow slower, nonetheless urbanization will change population density. But how will the Human Development Index (HDI) and the Gini Coefficient look like in the year 2100? On this background the two questions of what drives growth and how to assess the quality of growth become crucial. Social Capital is a determinant for economic growth and at the same time an outcome. This offers vast opportunities to enhance economic growth – healthy educated people live longer and can therefore work longer and are more productive if they know that social protection schemes ensures family welfare and promotes and underpins equal opportunities for the next generation. Therefore the Quality of Economic Growth is the central theme for the Regional Conference of the GIZ Sector Network Health and Social Protection Africa, MENA and LAC, which will take place from 6th – 9th,  May 2014 in Accra, Ghana.

In the international debate the relationship and interaction of the two dimensions of "economic" and "social" of sustainable development is discussed at all levels and various fora from the Rio + 20 Declaration of the United Nations "The Future We Want" to the Worldbank strategy paper 2012-2022 on Social Protection and Labour Strategy which connects the dimensions “economic” and “social” in its title  “Resilience, Equity, and Opportunity” to the new vision for inclusive growth of the OECD that combines strong economic growth with improvements in living standards and outcomes that matter for people’s quality of life (e.g. good health, jobs and skills, clean environment, community support).”

At this conference in Accra, Ghana, the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH  and its national and international development partners will share their experiences in the field of health and social protection as a determinant and outcome of economic growth in Africa, MENA and Latin-America through presentations, workshops and interactive sessions underpinned by key note presentations.

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