Global Health Policy Statement

G8 Summit 2008
December 19, 2007

We commend President Bush for demonstrating leadership in the fight against HIV/AIDS with the
establishment of PEPFAR and the recent commitment of $30 billion of additional funding over five
years. As members of InterAction and members of the global health community we ask the United
States to continue its leadership by urging the G8 Summit to endorse and the G8 countries to fulfill
prior G8 commitments in health care and, where necessary, adopt new commitments to:

1. Renew their commitment to MDG 4 and lead an international effort to reduce the deaths of
children under five through significantly increased G8 country, other donors and developing
country investments in child survival programs.

2. Improve maternal health in a holistic manner ensuring universal access to reproductive health
care, expanding emergency obstetric care, and increasing skilled birth attendants with a
commitment to timetables and benchmarks.

3. Ensure universal access to HIV/AIDS prevention, care and treatment by 2010, and cut malaria
and tuberculosis rates in half by 2015 by promoting and financing the G8 share of the Global
Fund to Fight AIDS, TB, and Malaria and other international and national infectious disease
strategies.

4. Fully finance the Global Action Plan on Human Resources for Health, which will ensure
achievement of the WHO goal of doubling health care workers in Africa by 2015.

5. Ensure the IMF allows greater policy, monetary, and fiscal space within country budgets to
meet pressing health and other needs.

1) Increase Investment in Child Survival Programs – MDG 4

The United States and the other G8 countries need to renew their commitment to MDG 4 and lead an
international effort to reduce the deaths of children under five through significantly increased G8, other
donors and developing country investment in child survival programs.

From the vantage point of five decades, the chances for children in the developing world to survive to
their fifth birthday have improved dramatically. Nevertheless child survival rates since 1990 show slow
improvement with the pace of progress uneven across regions and countries, and worst in sub-
Saharan Africa. In sub Saharan Africa we still have 166 out of 1,000 children dying before their fifth
birthday, 20 times the number in the developed world and we are concerned that MDG 4 will not be
met. Virtually all of the deaths are preventable and global health experts estimate these lives can be
saved provided donor countries and developing countries increase investments in existing, cost
effective and proven interventions such as oral rehydration therapy, antibiotics, anti-malaria
interventions, and micronutrients.
Public health experts predict that six million children could be saved every year if the global budget for
child health increased by at least $5.1 billion. Saving these lives would improve the economic and
social prospects of developing countries and would be an investment in human security. The U.S.
one-third fair share of the projected annual cost, at least $1.6 billion, should be reached by 2011.
We request the United States renew its commitment to MDG 4 and to child survival by announcing a
significant increase in its child survival program funding. By taking this leadership role, the U.S. will
encourage other G8 members to recommit to MDG 4 so all pledge to make the increased
investments required by donor (and recipient) countries.

2) Increase Investment in Maternal Health Programs – MDG 5

Improve maternal health in a holistic manner ensuring universal access to reproductive health care,
expanding emergency obstetric care, and increasing skilled birth attendants with a commitment to
timetables and benchmarks.

Over half a million women die each year in pregnancy and childbirth largely because skilled maternal
health care is unavailable. Numerous studies have shown that a child’s chances of dying increase
dramatically after a mother’s death, and the risk of death is greater for girls than for boys. During the
past 18 months a broad consensus has emerged within the maternal health community about core
maternal health strategies. These core maternal health services consist of prenatal care, skilled care
for all pregnant women by a qualified midwife, nurse or doctor, family planning, increased
vaccinations, and regular health check-ups, and emergency care for women and children in life-
threatening conditions. These are the basic elements that must be in place to meet MDG 5.

Vertical disease-specific funding initiatives have not produced the robust outcome in maternal health
globally, thus we ask the G8 to recognize that poverty, education, and conflict, gender-based
violence, and food and nutrition security also contribute to maternal health. In line with the proposal
made by Mr. Masahiko Koumura, Japan’s Minister of Foreign Affairs, we request that G8 members
approach maternal health in a holistic manner where disease is combated and comprehensive health
services are developed in parallel. Investing in women in crucial as it delivers long-term economic
benefits to families, communities and societies. The United States and G8 countries must renew their
commitment to maternal health programs, with timetables, benchmarks, and specifics on how to meet
MDG5.

3) Increase Investment in Combating Infectious Diseases – MDG 6

Ensure universal access to HIV/AIDS prevention, care and treatment by 2010, and cut malaria and
tuberculosis rates in half by 2015 by promoting and financing the G8 share of the Global Fund to
Fight AIDS, TB, and Malaria and other international and national infectious disease strategies.

Every day over 6800 persons, become infected with HIV and over 5700 persons die from AIDS. We
applaud President Bush for demonstrating leadership in the fight against HIV/AIDS with the U.S.
commitment of $30 billion of additional funding over five years. However, this funding level would
simply continue the US current annual contribution. For the United States to continue its leadership
the funding should increase to a substantially higher level so as to achieve the G8’s own commitment
to universal access to HIV/AIDS services by 2010. In addition, with an estimated 2.5 million new
infections each year (more than 3 people infected for every one person starting treatment) the global
AIDS response should place much greater emphasis on prevention to truly bring about an end to the
HIV/AIDS epidemic.

One third of the world’s population is estimated to be infected with tuberculosis, the number one killer
of people living with HIV/AIDS. It is responsible for 1.6 million deaths each year. Yet TB can be cured
with drugs costing just $20. Without aggressive action, the deadly synergy between HIV/AIDS and TB

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and the explosion of extensively drug-resistant tuberculosis (XDR-TB) threaten the progress made to
date. The Global Plan to Stop TB 2006-2015, a business plan endorsed by G8 governments for
confronting tuberculosis internationally, still faces an annual global funding gap of over US$3 billion.
The Untied States’ bilateral investments in global TB efforts have stagnated at less than $100 million
annually. PEPFAR investments in TB-HIV have increased to $120 million in FY 2007 and we applaud
the United States government for its commitment. However critical TB-HIV interventions have not yet
been taken to scale in most PEPFAR countries. The Japanese government has already signaled
interest in a possible Stop TB Japan Initiative for the Hokkaido Summit. We therefore urge that the
United States join with Japan and G8 members in launching its own expanded TB and TB-HIV
initiative in line with the Global Plan to Stop TB and the Global MDR-TB and XDR-TB Response Plan
2007-2008.

Malaria is also a leading killer of children under five and a major contributor to adult morbidity in
sub-Saharan Africa. More than 300 million cases and more than one million deaths occur each year.
The U.S. is to be commended for contributing to efforts to combat malaria through the President’s
Malaria Initiative (PMI). We urge the United States to use its commitment and leadership on malaria
to influence the G8 leaders to honor their original national commitments.

Efforts to address all three diseases must include a significantly increased contribution to the Global
Fund to Fight AIDS, TB, and Malaria and to meet the U.S. one-third fair share of the projected annual
demand from low-income countries, $6-8 billion dollars by 2010.

4) Strengthening Health Systems and Health Financing

Fully finance the Global Action Plan on Human Resources for Health, which will ensure achievement of
the WHO goal of doubling health care workers in Africa by 2015.

We are also pleased that the G8 is focused on strengthening health systems in Africa. The WHO
estimates that 57 countries have extreme shortages of health workers with 36 of these in Africa.
WHO has recognized that these countries are “very unlikely” to achieve the MDGs unless the
shortages are addressed. The G8 nations must address this crisis while at the same time expanding
health training to address the shortage of health workers at home and by discouraging active
recruitment of health workers from impoverished countries. The G8 must provide ambitious,
achievable, and specific benchmarks to bolster African health systems and abide by them. The WHO
has set a goal of more than doubling of the number of health care workers in Africa while improving
health worker training, management, and placement. The Global Health Workforce Alliance is an
international partnership with its Secretariat hosted by WHO. The Alliance is developing, in
consultation with partners including the United States and other G8 representatives, a Global Action
Plan (“Roadmap”) on Human Resources for Health, to be completed early in 2008. The G8 should
formally endorse and commit itself to supporting this “Roadmap”.

The total cost for doubling sub-Saharan Africa’s health workforce has been estimated at $24 billion
over five years, of which the US fair share would be $8 billion or about $1.6 billion each year. To
ensure that health workforce strategies are fully funded, a necessary condition for achieving the
MDGs, the G8 should commit to providing the necessary resources to ensure credible health
workforce plans are fully implemented with adequate resources.

In the past the G8 has made collective commitments towards meeting health needs in Africa but has
not included a mechanism for ensuring that individual G8 countries, and other donors, provide the
resources required to meet these commitments. To ensure G8 accountability, we urge the G8 to
report annually on progress meeting these commitments and a strategy to overcome any
shortcomings.

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In its Africa Health Strategy 2007-2015, the African Union endorsed a “review of user fees with a view
to abolishing them.” The G8 should support this AU commitment by encouraging and supporting
poor countries to abolish user fees for basic health services and replace them with equitable financing
schemes that will be effective in enabling everyone access to essential health services.

5) IMF impact on health budgets

Ensure the IMF allows greater policy, monetary, and fiscal space within country budgets to meet
pressing health and other needs.

IMF macroeconomic policies too often restrict governments’ ability to scale up investments in the
health sector. This is done through: 1) wage ceilings that prevent hiring and retaining health
professionals, and 2) unnecessary risk-averse targets for deficit and inflation reduction that constrain
national health budgets. We therefore urge the G8 governments to call upon the IMF to: 1) forgo
unduly restrictive fiscal and monetary policies that prevent increased investment in national health
plans and 2) permit the programming of increased foreign aid for health rather than divert it to
domestic debt payment and international currency reserves.

December 21, 2007

The following organizations contributed to the health policy statement
Global Health Council
International Center for Research on Women
Save the Children
RESULTS Education Fund
ONE Campaign / DATA (Debt, AIDS, Trade, Africa)
Physicians for Human Rights
ActionAid USA

For questions or feedback please contact:

John Ruthrauff, Senior Manager of Member Advocacy
InterAction
1400 16th Street NW, Suite 210
Washington DC 20036
jruthrauff@interAction.org
202-552-6523

InterAction is the largest alliance of U.S.-based international development and humanitarian

nongovernmental originations. With more than 165 members operating in every developing country,
we work to overcome poverty, exclusion, and suffering by advancing social justice and basic dignity
for all.