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From Muskoka to Toronto to Seoul
in G8-G20 Global Health Governance

John Kirton, G8 Research Group, G20 Research Group, Global Health Diplomacy Program
June 29, 2010

See also Money Mobilized by the Muskoka Initiative

The Muskoka G8 Summit on June 25-26 and the Toronto G20 Summit on June 27-28 were the first gatherings of these global governance groups to be so close together in time, space and underlying coordination. They thus invite a close comparison of the relative performance and potential of each in governing global health and of how they could work together to provide this global good. Their prospects seemed promising, as the G8 chose the Muskoka Initiative on Maternal, Newborn and Under-Five Child Health as its “top priority,” with accountability for keeping past promises as its defining feature, and advances on food and nutrition and on the Global Fund Against HIV/AIDS, Tuberculosis and Malaria as agenda items. The Toronto G20, dealing with finance, economics, trade, development and reform of international financial institutions could affect crucial socioeconomic determinants of heath in a supportive way.

In all, the Muskoka Summit made 10 commitments on health, or 28% of its 36 commitments overall (see Appendix).

The G8’s Muskoka Initiative sought to start mobilizing $30 billion in new money from G8 members and others over the next five years to save the lives of about 30 million children and almost 2 million mothers, to meet the Millennium Development Goals (MDGs) 4 and 5 by their deadline of 2015. Working with other governments, foundations, international organizations, recipient governments and others, the G8 adopted a “comprehensive and integrated approach to accelerate progress on MDGs 4 and 5” by supporting country-led national health systems in developing countries deliver on key interventions along the continuum of care.

At Muskoka, the G8 raised $5 billion of additional funds to be disbursed over the next five years. According to estimates by the World Health Organization (WHO) and the World Bank, this will prevent 1.3 million deaths of children under five years of age, prevent 64,000 maternal deaths and enable access to modern methods of family planning for 12 million couples. The Netherlands, New Zealand, Norway, Korea, Spain and Switzerland, subject to their individual budgetary processes, and the Bill and Melinda Gates Foundation and United Nation Foundation pledged an additional $2.3 billion to be disbursed over the next five years.[1]

In its final communiqué, the G8 recognized that its members “fully anticipate, that over the period 2010-2015, subject to our respective budgetary processes, the Muskoka Initiative will mobilize significantly greater than $10 billion.”

The G8 reaffirmed its commitment make the three-year replenishment conference of the Global Fund in October a success and to “come as close as possible to universal access to prevention, treatment, care and support with respect to HIV/AIDS.” It also restated its commitment to eradicate polio and create a polio-free world.

The G8 addressed the closely related issue of food security, referring to the $22 billion over three years committed at the 2009 L’Aquila Summit. The G8 reinforced its commitment to allocate disburse the funds by 2012. It noted that as of April 30, 2010, members had disbursed or allocated $6.5 billion, which put the G8 slightly behind schedule in meeting the commitment.

The G8 recognized the importance of research to solve global hunger and reinforced support of agricultural investment by organizations such as the World Bank, regional development banks, the Food and Agriculture Organization, the United Nations Conference on Trade and Development and the International Fund for Agriculture and Development IFAD. The commitment also noted the importance of focusing on country-led initiatives. The G8 expressed support for enhancing responsible and sustainable investment.

Finally, the G8 emphasized the importance of regular reports to track progress on implementing commitments. It promised to release in 2011 a report on accountability on health as the 2010 summit priority and food security as the 2009 one.

However, French president Nicolas Sarkozy has not stated his intention to keep maternal, newborn and child health on the agenda for the 2011 G8 summit, which France will host. France’s relatively low pledge of $400 million over five years may indicate a lack of commitment to the Muskoka Initiative.

In contrast, the Toronto G20 Summit made only one direct reference to health, promising to “strengthen social safety nets (such as public health and pension plans).” This was fewer than the three references to health made at the previous G20 summit in Pittsburgh. The Toronto G20 did offer substantial support for the health-related issues of aging populations, climate change, food security, the Global Pulse Initiative and the Global Agriculture and Food Security Program. It committed to meeting the MDGs by 2015, including through official development assistance, and it endorsed the 2009 L’Aquila Food Security Initiative and created a development working group. The potential for G8-G20 partnership for global health was thus enhanced.

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Appendix: Health-Related Commitments in the 2010 G8 Muskoka Declaration

  1. We will focus the Accountability reporting in 2011 on health and food security.
  2. Since the most vulnerable states have made the least progress towards the MDGs, we will place special emphasis on helping them build the foundations for peace, security and sustainable development.
  3. We call on all development partners, at the September 2010 UN High-Level Plenary Meeting on the MDGs, to strengthen the collective resolve to accelerate progress towards these targets and call for an action-oriented outcome.
  4. To this end, the G8 undertake to mobilize as of today $5.0 billion of additional funding for disbursement over the next five years.
  5. We will track progress on delivering commitments through our accountability reporting, which, in 2011, will focus on health and food security.
  6. We will also focus efforts on training of medical personnel and on establishing stronger health innovation networks in Africa and other regions.
  7. We reaffirm our commitment to come as close as possible to universal access to prevention, treatment, care and support with respect to HIV/AIDS.
  8. We will support country-led efforts to achieve this objective by making the third voluntary replenishment conference of the Global Fund to Fight AIDS, TB and Malaria in October 2010 a success.
  9. We commit to promote integration of HIV and sexual and reproductive health, rights and services within the broader context of strengthening health systems.
  10. G8 donors also remain steadfast in their support for polio eradication and remain committed to a polio-free world.

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[1] The announced contributions are as follows: United States, $1.3 billion in 2010-11 (26% of total G8 funding); Canada $1.0 billion within five years (22%); United Kingdom, $600 million in 2010-11 (12%); Germany, approximately $500 million within five years (10%); France, $400 million within five years (8%); Japan, $500 million (10%); Russia, $75 million (10%). The Gates Foundation will contribute $1.5 billion (20.5%). The contributions of Italy, the European Union, the other countries and the UN Foundation have not been announced.

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