From September 5-7, 2023, members of the GIZ Sector Network Health and Social Protection (HeSP) came together for the first time since the COVID-19 pandemic. More than 120 representatives of bilateral projects, sectoral and global programmes, and departments at head office gathered in Bad Soden, Germany, for the three-day conference. Roughly 80 more colleagues from around the world joined the proceedings online. Through a mix of plenary sessions, panel discussions, project presentations, working group meetings and informal discussions, participants learned about and unpacked the strategic directions for German development cooperation and for the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) in the coming years. Given the increasingly complex global challenges which confront the health and social protection community – pressures which one presenter memorably referred to as a ‘ring of fire’ – these strategies are more critical than ever.

A changed world – and a changed sector network, too

The world has changed dramatically since the last sector network meetings, held in 2019, and the network itself has changed as well. The two previous regional networks for Africa and Asia have been merged into one, offering exciting new chances for exchange and learning. The composition of the network has also evolved – more than half of the participants were attending a sector network meeting for the first time. Topics such as local vaccine production and adaptive social protection have risen in prominence in recent years, taking their places alongside long-standing areas of work such as health financing, digitalisation, and maternal health. 

The format of the meeting – which was moderated in Bad Soden by Anna von Roenne, the Managing Editor of the Healthy Developments portal – was also novel. Live-streamed sessions, interactive tools for polling and posing questions, and support from ‘virtual facilitators’ in Africa and Asia helped to break down the barriers between participants on- and off-site. The successful hybrid event was an important reminder of what is now possible in times which call for both reducing emissions and enhancing efficiency.

Advancing health and well-being during tumultuous times

Following the official welcome, the opening session featured a recorded keynote address from Ricardo Baptiste Leite, the CEO of the International Digital Health and AI Research Collaborative (I-DAIR), who made an impassioned call for a holistic understanding of health which takes into account the decisive role of social determinants. Factors such as socio-economic status, where a person lives and works, and other exogenous factors form an ecosystem which influence people and their choices. ‘COVID led people to understand that individual health status is not only about health,’ he said, but:

Our disease-driven health systems are built to respond to acute disease, not to promote health and well-being.

Ricardo Baptiste Leite, CEO, I-DAIR

This needs to change. But at a time when Sustainable Development Goal targets seem to be slipping out of reach, how can decision-makers be swayed to make ‘the right choices’ when it comes to investments in health and in social protection? Ricardo Leite, who is a parliamentarian in his native Portugal and the founder of the UNITE Parliamentarians Network for Global Health, offered five pragmatic tips (‘the ABCDE rules’) for advancing policy. 

First, citizens need to be aware of policy issues and to apply pressure on elected leaders. Second, money is often used as an excuse to say ‘no,’ so it must be clear where the budget can come from if additional investment is needed. Those who advocate for particular solutions can help parliamentarians ‘get to yes’ by presenting ways to fund them. Third, when it comes to health and social protection, doing nothing is also a political choice. It is important to talk more about the opportunity cost and the consequences of inaction.  Fourth, make use of data to describe the current situation and the change you expect to see as a result of a policy change. And finally, elections: while focusing on longer-term aims, take account of political cycles and help politicians to secure ‘quick wins’ which give them something to show the public. 

New BMZ strategy sees health and social protection as essential for building resilience

 The German Federal Ministry for Economic Cooperation and Development (BMZ) has identified health, social protection and population policy as one of six core areas in its 2030 strategy – and the recently issued strategy paper (in German) for the core area is very much in line with the holistic understanding of health and well-being advocated by Ricardo Leite. 

According to Tania Rödiger-Vorwerk, Deputy Director General at BMZ responsible for the directorate ‘Global Health, Resilience, Equality of Opportunity,’ at the heart of the strategy is an understanding that health and social protection are essential for building resilience, which is the basis for achieving other development goals. She also noted the ‘spirit and vision’ of the new strategy is that health and social protection are not divided:

The format of the strategy is an attempt to overcome siloed thinking by combining and linking together themes that are intimately interwoven.

Tania Rödiger-Vorwerk, Deputy Director General, BMZ

The strategy outlines three major areas of intervention. The first is health, One Health, and pandemic preparedness. Here, German development cooperation will continue to work to strengthen health systems, particularly in low-income countries, so that they can provide basic health services. It will focus on fighting infectious diseases, including through cooperation with multilateral partners such as Gavi and the Global Fund, and it will focus on supporting partner countries to move towards the sustainable financing of their health systems. Vaccine production in Africa is another important area of engagement.

In the second intervention area, German development cooperation aims to support partner countries to build universal, inclusive, adaptive social protection systems. At the international level, it will work closely with partners to advance the Global Accelerator on Jobs and Social Protection for Just Transitions and to deploy an integrated financing mechanism, together with the World Bank and the International Labour Organization (ILO), which will enhance coordination and integration with national strategies in pathfinder countries. It will also work to expand social protection systems in partner countries, including through the use of digital solutions which are inclusive and transparent. 

The final area, sexual and reproductive health and rights, is central to the government’s Feminist Development Policy. Through both bilateral and multilateral engagements, German development cooperation seeks to strengthen the bodily autonomy of girls, women and young people by ensuring that sexual and reproductive health and rights are part of universal health coverage in partner countries. Tania Rödiger-Vorwerk acknowledged that the political and social environment in some countries makes this a challenging area: ‘It is difficult in some countries to put this into political dialogue,’ she said. ‘We know this, and our interpretation is that it’s even more important to do it.’

Bigger challenges, fewer resources: What does this mean for the way we work?

The new strategy sets out an ambitious vision for tackling increasingly complex challenges. However current fiscal realities mean that the resources available to implement it will be limited. ‘There is no silver bullet when it comes to funding,’ said Tania Rödiger-Vorwerk during a panel discussion which followed her presentation. ‘We have to learn to be clever. We are in a new phase of working together.’

She was joined on the stage by Silvia Morgenroth, the Head of Division West Africa II at BMZ, who singled out three main tendencies which will have implications for the way German development cooperation works in Africa in the coming years. The first is the clear trend towards more intense and volatile global challenges, which will require a greater degree of flexibility and adaptability in social protection programmes, but also in response to health threats. Second, budget restrictions mean that it will be necessary to make the most of synergies with other partners, including through multilateral approaches. And third, it will be necessary to adapt instruments and engagements to the growing number of fragile contexts on the continent. 

From their vantage points as commission managers of GIZ-implemented projects and programmes, Corinna Heineke and Ralf Radermacher reflected on how current programming already supports some of the directions outlined in the core strategy paper – and how the various instruments of German development cooperation could be more ‘cleverly’ combined in the future for maximum impact.

Both colleagues highlighted the complementarity between BMZ-commissioned bilateral and multilateral investments and called for even greater integration between them. For Ralf Radermacher, who heads the global programme Global Alliances for Social Protection and the Sector Initiative Social Protection, a core strength of German development cooperation is the ability of technical cooperation measures to unleash greater impacts from multilateral investments and from financial cooperation in partner countries. By providing complementary technical assistance, as GIZ does for the World Bank in Rwanda and Uzbekistan, and by supporting the development of social protection systems in partner countries, German technical cooperation helps to put in place the ‘plumbing’ that is essential for money to reach the people who need it during pandemics or other crises. He added:

Having a technical assistance agency is a contribution hardly any other development partners can make. I’d love BMZ bring it to the table and use it widely.

Ralf Radermacher, Commission Manager, GIZ

Technical cooperation projects can also be a source of useful strategic insights for BMZ as it steers its engagements with multilateral partners at the global level. Corinna Heineke, who until recently led the Improving Social Protection and Health project in Cambodia, noted that greater integration and closer exchange between bilateral and multilateral measures could help to ensure that BMZ priorities are reflected consistently in programming supported through multilateral partners.

We still see and observe that vertical programmes counteract the systems approach that BMZ has written into its new strategies.

Corinna Heineke, Commission Manager, GIZ

BMZ’s support for systems strengthening and health governance at country level has yielded important results, she noted. She mentioned the use of COVID emergency funds to strengthen laboratory systems by linking capacity development to procurement, the successful implementation of a pioneering, intersectoral One Health project on rabies control, and a project component on decentralisation and health as positive examples which can and should be promoted in the future.

GIZ Corporate Strategy 2028: Optimising processes and services to be ‘fit for the future’

 How is GIZ as an organisation positioning itself for the future? This was the topic of a plenary session devoted to the GIZ Corporate Strategy 2028, which provides a framework for transforming the way GIZ works so that it is better able to provide ‘integrated solutions’ to complex challenges.

Albert Engel, Director General of the GIZ Sectoral Department, introduced the rationale behind the new corporate strategy by drawing an analogy to a somewhat larger gathering unfolding in the south of Germany. At the same time as the sector network meeting, more than 700,000 people were gathering in Munich for the flagship trade fair of the German automobile industry, formerly known as the International Automobile Exhibition (IAA) – and since 2021 as ‘IAA Mobility.’ The organisers recognised that the world has changed fundamentally and that the future demands networked solutions, said Albert Engel.

‘The shift in strategy at GIZ is comparable. Our thinking in the past was never big or integrated,’ he continued. GIZ has operated as a ‘project organisation,’ using more or less the same processes, for decades. Yet the demands being placed on GIZ by commissioning agencies are changing and ‘we need to widen the view to see the bigger picture.’ The aim is to refine the services which the organisation provides, introduce a greater degree of standardisation, adapt internal processes in a way that speeds up implementation, and create scope for more and better innovation. One key priority is to develop a standardised product portfolio which can be individually tailored for use in different contexts. Another is to integrate modes of delivery across sectors and country portfolios to allow GIZ to address broader global challenges. 

Finding a balance between standardisation and partner orientation

How do GIZ colleagues implementing programmes in partner countries view these new directions? Albert Engel was joined on the stage for a panel discussion by two GIZ commission managers – Silvia Popp, who heads the Social Protection for Workers in the Textile and Leather Sector project in Bangladesh, and Kai Strähler-Pohl, who leads the Improving Health Care project in Tanzania – as well as by Matthias Rompel, Director Division Southern Africa at GIZ.

Both Silvia Popp and Kai Strähler-Pohl noted that significant moves are already underway toward greater administrative integration within GIZ in the countries where they work – for example, through pooling resources and integrating certain common functions across projects. Greater standardisation of services represents a new frontier, however, and many questions remain open. Silvia Popp noted that many of the topics which health and social protection experts work on are so complex and context specific that they do not lend themselves well to a ‘building block’ approach.

Kai Strähler-Pohl agreed. He observed that GIZ, while working on behalf of the German government, has to cooperate closely with political partners and many other development partners. This makes coming in with standard solutions difficult.

My hope would be that in this drive for integrated products we leave enough room for customisation to respond to what partners want.

Kai Strähler-Pohl, Commission Manager, GIZ

Matthias Rompel agreed that GIZ’s partner orientation must be preserved at all costs, as it is the organisation’s unique selling point. He drew a distinction between standardisation at the ‘back end’ – i.e. how GIZ organises itself internally in terms of knowledge management and implementation modalities, so that every project does not need to be manufactured from scratch – and on the ‘front end,’ where GIZ interacts directly with partners and where the building blocks need to be adapted and shaped. 

Where have we come from, and how does this prepare us for the future?

Shifting gears from the broad GIZ corporate strategy to the details of the health and social protection portfolio, Michael Adelhardt, Head of Competence Center Health and Social Protection, provided a fascinating look back at the evolution of GIZ programming in the sector over time. He showed how each of the portfolios evolved thematically over the past 40 years, gradually adding on new issue areas in response to external developments (e.g. the Ebola outbreak in West Africa, the Rana Plaza disaster in Bangladesh) and prevailing political interests (e.g. the creation of new global initiatives, the 2015 refugee crisis). He noted that, while the thematic responses have broadened, funding has not. Apart from periodic surges linked to specific events – primarily pandemics or disease outbreaks with pandemic potential – financing for health and social protection, when taking inflation into account, has effectively remained flat over time.

The good news is that health and social protection is now anchored as a core area in the BMZ 2030 strategy, but according to Michael Adelhardt, it is external triggers that have moved the funding needle. ‘These types of shocks are coming more frequently,’ he said. ‘We need to be prepared for next ones.’ 

In the remainder of his presentation Michael Adelhardt reflected on some of the strengths which GIZ health and social protection projects can draw upon as they confront interrelated threats which he likened to a ‘ring of fire.’

We are facing serious threats to our planet, to livelihoods and the world order which add even more levels of complexity, uncertainty and pressure on resources. We have sectoral expertise, yes, but our main selling point is that we want to get to the bottom of things.

Michael Adelhardt, Head of Competence Center Health and Social Protection, GIZ

Thinking about systems, interconnections and causal relationships – focusing on the part of the iceberg that is under the water, rather than above it – allows us to focus where real changes can and are happening, he said.

Projects showcase their work – and learn from one another

While the plenary sessions framed broad strategic themes, break-out sessions gave participants the chance to delve into the details of specific project experiences. The 12 workshops which the meeting organisers selected from more than 30 submissions reflected the breadth and depth of the health and social protection portfolio: bilateral projects from Ghana, India, Indonesia, Nepal, Pakistan, Tanzania (Zanzibar) and Togo; a regional approach to pandemic prevention; global interventions focused on disability-inclusive health services, open source solutions, and e-payment systems; and a comparative look at health service costing studies from four different countries.

During breaks, in addition to intensive networking, participants had the opportunity to peruse the project marketplace. Many colleagues also seized the opportunity to participate in field trips to the BG Unfallklinik, a major hospital for accidents in Frankfurt, and to the Sozialrathaus Höchst, part of the Frankfurt City Administration responsible for social and youth welfare, in which they learned about Germany’s health and social protection systems firsthand.

A changing of the guard: New network speakers outline their priorities for the coming years

The final day of the meeting was taken up with internal network business: meetings of thematic working groups and the formal handover from the outgoing network speakers to the new ones.

The current sector network speakers, Valerie Broch Alvarez, Lisa Diarra and Ole Doetinchem, as well as their immediate predecessors – Sabine Ablefoni, Claudia Aguirre and Katja Altincicek – were recognised for their leadership and contributions. They are being succeeded by Alina Berendsen and Kirstin Grosse-Frie, with Franziska Fürst and Kelvin Hui as their deputies.

The incoming speakers reflected on their priorities for the next two years: deepening person-to-person connections between far-flung members of the network, improving knowledge management, enhancing connections with other sectors, and revitalising the network working groups. The parting message was one of energy and commitment: challenging times are coming, but there are strategies in place which provide guidance. There is also capable group of experts, linked together through the sector network, which is ready to move forward together.

September 2023

Image gallery of the event