Moderator Clemens Gros (Insights for Development), Kate Dodson (United Nations Foundation), Elhadj As Sy (Kofi Annan Foundation), Dr. Bernhard Braune (BMZ), and Paul Zubeil (BMG)

The first Catalyst Dialogue – on global health architecture – featured at the 2022 Global Health Talk

Moderator Clemens Gros (Insights for Development), Kate Dodson (United Nations Foundation), Elhadj As Sy (Kofi Annan Foundation), Dr. Bernhard Braune (BMZ), and Paul Zubeil (BMG) © GIZ/Thomas Ecke

The innovative concept of a Catalyst Dialogue – generating critical insights of high-level experts to inspire Germany’s global health policy – was tested in a panel discussion on 5 July in Berlin.

The Global Health Talk is the annual highlight of the Global Health Hub Germany (GHHG). This year’s event, held on July 5 in Berlin, showcased a new feature: presentation and discussion of the first of a series of Catalyst Dialogues. These Dialogues are co-hosted by GHHG and the platform Healthy DEvelopments, respectively supported by the German Federal Ministry for Health (BMG) and the Ministry for Economic Cooperation and Development (BMZ).

The Catalyst Dialogues are an innovative format that brings together renowned specialists from diverse backgrounds for an intense focus on a topic of shared expertise. The issues raised in a group discussion are further probed in a series of individual interviews. The Catalyst Dialogue does not aim for consensual recommendations shared by all participants, but rather to distil out important insights and suggestions that surface from this vibrant exchange process. These sometimes contrasting perspectives are then summarised in a brief paper, designed to give impulses to Germany’s decision-makers in government and parliament. (The first Catalyst Dialogue Briefing Paper is due to be released in early September.)

The first Catalyst Dialogue was on global health architecture

In the context of the COVID pandemic and the challenges that it revealed for an efficient and effective global health response, GHHG’s Steering Committee proposed as priority for the first Catalyst Dialogue the question ‘What global health architecture do we need?’.  

Between April and June, this topic was debated by seven renowned experts representing academia (Anna Holzscheiter, Technical University Dresden), international organisations (Ilona Kickbusch, Graduate Institute of International and Development Studies, Geneva), foundations (Kate Dodson, United Nations Foundation), German development cooperation (Jean-Olivier Schmidt, Back-Up Health, GIZ), think tanks (Christoph Benn, Joep Lange Institute), the private sector (Roland Göhde, German Health Alliance) and the Global South (Elhadj As Sy, Kofi Annan Foundation). The exchange was thoughtful, stimulating and sometimes fierce and a number of suggestions emerged from it:

  1. Strengthen the role of WHO as the ‘normative pole’ of global health and its coordination function, primarily by funding it ‘properly’.
  2. Push for better coordination between the major global health initiatives and alignment with existing country systems by exerting political leadership on the governing boards of these institutions and by introducing follow-up mechanisms.
  3. Establish meaningful mechanisms for participation of non-state actors in global health decision making, for example, by empowering non-state actors to bring their voices into the World Health Assembly, and by giving civil society full voting rights on the major new initiatives currently emerging in global health.
  4. Offer technical development cooperation to support partner countries in strengthening their regulatory and management capacity to effectively coordinate their engagement with global health initiatives and to present their national policies and plans as the basis for donor alignment.
  5. In Germany, cultivate expertise for global health through systematic investment in  academic training and in promotion of think tanks and ‘public intellectuals’ in the country’s global health ecosystem.
  6. Map and connect German actors active in global health to enable synergies, for example, between bilateral development cooperation, private sector investment, civil society engagement and scientific or academic expertise.
  7. Reduce internal fragmentation in how Germany engages in global health governance by better coordinating and aligning positions and engagements across the multitude of German ministries and agencies with a mandate for global health.

How would these reflections be received by their intended audience: government decision-makers? The Global Health Talk offered the opportunity to find out.

The ‘moment of truth’: Dialogue participants meet Ministry officials

Introduced by Kristina Knispel, Managing Director of GHHG, the panel ‘Building the Global Health Architecture we need’ brought together two Catalyst Dialogue participants – Elhadj As Sy (Chair of the board, Kofi Annan Foundation) and Kate Dodson (Vice President for Global Health Strategy, United Nations Foundation) – with representatives of the two ministries most implicated in the Catalyst Dialogue initiative: Dr Bernhard Braune, Head of Division Global Health Policy and Financing, BMZ, and Paul Zubeil, Deputy Director-General , European and International Health Policy, BMG, in a frank, but cordial discussion.

In practice, the panel more closely resembled a further stage of the Catalyst Dialogue than a confrontation. The two Dialogue participants were invited to expound on key issues that had emerged during the Dialogue process, and the two Ministry representatives contributed additional reflections from the perspective of their respective institutions.

Global health: testimony of global diversity or fragmentation?

Moderator Clemens Gros set the stage by reminding participants of As Sy’s pithy diagnosis of global health history as ‘promises made and promises broken’ and raised the fundamental question of how to assess the current state of our global health architecture: as ‘fragmentation’ or ‘diversity’?

Kate Dodson pointed out that in many ways the last 20 years – with the MDGs and now the SDGs – have been a ‘golden age’ for increased international cohesion, with strong actors such as the Global Fund and Gavi providing vital contributions. Yet the world’s insufficient preparedness to confront a global health emergency was brutally revealed by COVID-19, with the Access to COVID-19 Tools Accelerator (ACT-A) only launched once the pandemic was underway. And all too often, existing incentives favour working in silos rather than collaboratively.

As Sy evoked the fragility of government commitments as another factor weakening adherence to the global health architecture – especially when governments change. Citizen constituencies, e.g. of scientists or activists, can play a major role in holding governments accountable. A global health architecture must take the community dimension into consideration. What is needed is consistency across the board: from design to implementation, including activism, technical empowerment, and ensuring the resources required for implementation – all of which depend on continuing leadership. ‘As we miss opportunities to create synergies between existing organisations, we create new organisations and end up with multiple layers of coordination. The cycle of panic and neglect must be broken!’

The two Ministry representatives acknowledged this uncompromising analysis. Paul Zubeil of BMG admitted that though Germany strongly advocates for global health, it is not on target for its support to the 2030 agenda, while concerning COVID, ‘we need to be far more ambitious than what we have been so far. The pandemic has exposed the gaps and failures of global health governance, including chronic underfunding of pandemic preparedness.’’

Dr. Braune of BMZ underlined inequitable access to healthcare as a ‘huge human rights issue that largely goes unnoticed…with the drama of children in partner countries dying for lack of preventive care – things that are fixed here [in Germany] in half a day… Unfortunately, under-five kids don’t vote, therefore there is no lobby for preventive care.’ Dr Braune made a parallel between prevention and pandemic preparedness: both are ‘invisible’ until we reap the consequences of not having them – the ‘prevention paradox’. He sees the problem in insufficient funding – and insufficient responsibility of national governments: ‘That is why civil society engagement is so crucial,’ he reminded the audience.

Reflecting together on solutions

Paul Zubeil, like the Dialogue participants, sees a strengthened role for the World Health Organization as the most effective safeguard against duplication and fragmentation of global health efforts. He underlined Germany’s role at the recent 75th World Health Assembly in securing increased, stable and predictable funding for WHO.

According to Dr. Braune, it is necessary to increase effective international initiatives such as the Global Fund and Gavi, but equally important to look at what is happening at country level to make sure that what is funded actually reaches those who need the services. ‘It’s about civil society, reinforcing democracy, getting the potential beneficiaries involved. The democratic process of spending a budget should not hamper progress. With good governance and democratic processes we can be more efficient.’

Drawing on her experience as co-chair of the Global Preparedness Monitoring Board, Kate Dodson underlined the importance of accountability to the intended beneficiaries and cautioned against the danger of a ‘cycle of neglect’, with many initiatives that could ‘wither on the vine’ without adequate follow-up and funding. Even the planned funding for WHO, she pointed out, is for the moment just a promise. ‘The blueprint is there: Dr Tedros of WHO called for a radical reorientation towards primary healthcare as the pathway both to universal health coverage and greater health security. And that is the responsibility for all players in the global health architecture, to service especially the needs of the most vulnerable. And we have to codify countermeasures such as the ACT-A, which is an important global coordination mechanism.’ 

As Sy pointed out: ‘When we talk of leadership, of governance, the tendency is to think of donors such as the G7, the G20 – no, it is every single country on the planet, starting with the lowest-income ones.’ He pointed at the health inequities laid bare in the COVID pandemic and the ugly linkages between conflicts, poverty and poor health: ‘Look at the map, and at the conflict map: the problems are all in the same places – food security, treatment of people with HIV, etc. We need to bring all these economic, political and other issues together to develop a complex solution to a complex problem – without contributing to fragmentation.’

What can and should Germany do to improve the global health architecture?

Dr Bernhard Braune, Head of Division Global Health Policy and Financing, BMZ
Dr Bernhard Braune, Head of Division Global Health Policy and Financing, BMZ

According to Dr. Braune, ‘We should do our homework: ensure funding, look at global health from a holistic viewpoint and strengthen coordination.’ Currently four federal ministries – BMG, BMZ, Foreign Affairs and the Ministry of Finance – receive funding for global health under one umbrella. It is important to look at how they can complement each other in the context of the government’s Global Health Strategy. For instance, in bilateral negotiations with partner countries, the Ministry of Finance plays a major role with the compelling economic argument in favour of prevention. This has allowed Germany to become one of the largest contributors to the ACT-A in the fight against COVID. ‘If we replicate that approach, I think that will enable us to play an even stronger role – and I think the German government is “fighting above the weight limit”, and not below it!’

Paul Zubeil agrees that Germany is perceived as a strong and reliable partner, active in promoting the global health agenda in international fora such as the G7 and the G20. ‘Our advantage is our strategic approach and our close communication with the other ministries involved in promoting global health. We get the necessary different perspectives from the different ministries to come to a common position. With the G7 we will have the Pact for Pandemic Readiness which will be a very good tool going forward, and a number of different initiatives including engaging with non-state actors. We thus have a rather complete package, and this forum today is another effective tool for engaging with a multitude of partners.’

According to As Sy, Germany is a positive example of a government that remains reliable despite à change in leadership. Germany delivers on its promises, reaches out to involve others – not just the G7 partners, but also from the private sector and the Global South – and is honest in its communication about the difficult road to travel: ‘If more countries did as much as Germany, it would be positive.’

For Kate Dodson, Germany has been, and should continue to be, a ‘mainstay in the global health ecosystem’. As such, it must:

  1. Continue to be a bridge builder 
  2. Continue to prioritise global common goods and global public goods for health
  3. Deepen the commitment to health concerns in policy
  4. Continue to demonstrate vision and leadership.

The need to decolonise global health

Echoing Dr Braune’s consternation over inequitable access to preventive care, several audience members broached the topic of ‘decolonising global health’. Dr Braune responded with great frankness: ‘Our history is haunting us, including in Germany. We need to be open to look at the issues. We answer with partnership and dialogue: In international cooperation it’s not the donor who has the solutions, it’s the partner country. Country-owned and -developed solutions are the only ones that can work.’

As Sy then reminded the audience, ‘Decolonisation is not a gift – it is something to be fought for, acquired through your own effort. It is up to the countries with the greatest needs, engaged citizenship, to fight for people’s rights at country level, so you have the credibility in international partnerships. Citizen engagement will give credibility at the global level.’

Dr Mary White-Kaba
July 2022

© GIZ/Thomas Ecke
© GIZ/Thomas Ecke

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