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Cordaid NL
Health care

Blog: Beat the drum and cage the mammals

In the same magnificent townhall in Oslo where each year the Nobel Prize Award Ceremony is held, this month the incredible amount of 1 billion dollars was pledged towards the replenishment of the Global Financing Facility (GFF). Incredible because it is such a huge amount. Also, a big deception, since the aim was 2 billion dollars.

Remco van der Veen (second from the right) at the GFF Replenishment Event in Oslo.

This blog is written by Remco van der Veen, Cordaid’s Director International Offices. 

The GFF was created in 2015 and its ambitions are growing rapidly. The main investors are Norway, the Bill and Melinda Gates Foundation and Canada. The new kids on the block are the Netherlands with 58.5 million and Burkina Faso with 1 million. I’m glad to see the Netherlands jumping on the wagon as one of the larger stakeholders, also to influence the use of the funding in sexual and reproductive health. And it’s a good thing that Burkina Faso is showing its engagement, now not only as a receiver but also as a contributor.

Fragile countries

The funds will be used to improve health and nutrition for women, children and adolescent girls in low-income countries. As Cordaid we are very excited that 1/3rd of these countries belong to the world’s most fragile countries. The 1 billion will be used in the coming 5 years, not only for the current 27 countries, but the list will be extended to 50.

So what is the story we tell hardworking taxpayers when we ask them to pay even more? Please pay more so we can waste more?

This grant money helps countries to attract external investors and involve the private sector. The most noteworthy new investor is the World Bank, through the International Development Association and the International Bank for Reconstruction and Development. For every dollar spend 7 more dollars can be lend.

That is also one of the big worries of civil society organizations. It will become too attractive for countries to borrow more and more money. The good news during the meeting is that domestic funding already increased 5 times in the past 15 years.

The Ghana case

But who will benefit from this extra domestic money? Someone in the audience presented the ‘Ghana case’. He said that 41% of Ghana’s tax income goes to interest on loans and leaves the country, flowing back to foreign investors. This could undermine the sustainability of the health financing Cordaid and the GFF are looking for. All organizations, including Cordaid, will need to monitor this closely.

My personal worry is the everlasting quest to decrease inefficiencies in health systems. According to the World Health Organization, 20% to 40% of the investments in health is wasted by these inefficiencies, or worse, just get lost.

So what is the story we tell hardworking taxpayers when we ask them to pay even more? Please pay more so we can waste more? This will certainly not help us to establish a strong social contract.

Walk the walk

Country ownership was one of the most heard buzzwords in all the talks. But this door has already been kicked open often enough, by all stakeholders who, in the meantime, keep insisting on their own organizational priorities and rules and regulations. It’s really time we stop all this talk and we start walking the walk.

I couldn’t help but create my own motto: ‘Cage the MAMMALS’, Middle-Aged Mighty Men Afraid to Lose Supremacy.

We need to invest more efficiently and we need to invest more. In the Netherlands, we invest about 5000 euros per year per person in our own health. In middle-income countries like Ethiopia, that is now 30 dollars. This should be brought up to 90. In the Central African Republic, we haven’t even reached 5 dollars per capita. There’s still a very long way to go.

The key in these coming years is to increase the involvement of all the Ministers of Finance. They often prefer investing in infrastructure and see health care merely as a cost. This leads to limited budget allocations and even underspending on these limited budget lines.

Beautiful acronyms

On the first day of the conference, it was all about ‘beating the DRUM’. Not the instrument or the tobacco brand, but Domestic Resource Use and Mobilization. I admire people who come up with those beautiful acronyms. While observing all the men and women in their fancy suits, running from one meeting to another, I couldn’t help but create my own motto: ‘Cage the MAMMALS’, Middle-Aged Mighty Men Afraid to Lose Supremacy. In some cases, by the way, ‘Men’ can be replaced with ‘Madams’.

Time has come to cage them so they stay in their respective ministries and organizations, to organize the ACTION (Accountability, Coordination, Transparency, Ownership, Now!), instead of flying around the world talking all that talk. And yes…I’m fully aware I’m one of them.