Reaching 2030 health and nonhealth Sustainable Development Goals

Reaching 2030 health and nonhealth Sustainable Development Goals. Mission : Impossible ? UNITAID-ANRS Symposium July 23 rd, 2017 Pr Jean-Paul MOATTI CEO Institut de recherche pour le Développement

UN 2019 First Global Sustainable Development Report and Science-Policy Interface

The group of independent scientists Gonzalo Hernández Licona Eun Mee Kim Jean-Pascal van Ypersele Katherine Richardson David Smith Peter Endah Muhammad Murniningtyas Messerli Saidam Wolfgang Lutz Amanda Glassman Parfait Ekoundou. Enyegue Jurgis Staniskis Eeva Furman Jean-Paul Moatti Ernest Foli

Mandate agreed by UN Member States in July 2016 • The GSDR is one important component of the • follow-up and review process for the 2030 Agenda for Sustainable Development • • The GSDR will inform the high-level political forum • (HLPF), and shall strengthen the science‐policy interface and provide a strong evidence‐based instrument to support policymakers in promoting poverty eradication and sustainable development • The report will be available for a wide range of stakeholders, • including business and civil society as well as the wide public

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SUSTAINABLE DEVELOPMENT GOALS (20152030)

Why a New Development Agenda? q. Shared agenda for both developed and developing countries q. Current development model is leading to breaches in the planetary boundaries, jeorpdazing the very existence of human civilization on this planet - effects of climate change. q New development agenda must eradicate poverty within the context of sustainable development (Rio+20 Outcome Document – The Future We Want).

SDG 3 Good health & well-being 13 targets for 2030 • 3. 1 Reduce maternal mortality to less than 70 per 100, 000 live births • 3. 2 Reduce neonatal mortality to at least as low as 12 per 1, 000 live births and under‐ 5 mortality to at least as low as 25 per 1, 000 live births • 3. 3 End the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water‐borne diseases and other communicable diseases • 3. 4 Reduce by one third premature mortality from non‐communicable diseases through prevention and treatment and promote mental health and well‐being • 3. 5 Strengthen prevention and treatment of narcotic substance abuse and harmful use of alcohol • 3. 6 Halve the number of global deaths and injuries from road traffic accidents • 3. 7 Ensure universal access to sexual and reproductive health‐care services and integration of reproductive health into national strategies and programmes

SDG 3 Good health & well-being 13 targets for 2030 • 3. 8 Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and to safe, effective and affordable essential medicines and vaccines for all • 3. 9 Substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination • 3. a Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control • 3. b Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health • 3. c Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries • 3. d Strengthen the capacity of all countries for early warning, risk reduction and management of national and global health risks

SDG 3 & the other SDG’s : the Herculean challenges 1 - How to maximise positive synergies and minimize potential contradictions (short/mid/long – term) between SDGs ? 10

End hunger 2. 1 Double agri Produc & incomes Malnutrition 2. 2 2. 3 Sust agri land soil quality 2. 4 6. 1 universal, equitable access to safe and affordable drinking water Genetic resources Investment, Internation cooperation 2. 5 2. a Limit extreme food price volatity World agri market 2. b 2. c 6. 3 improve water quality by reducting pollution. . Positive SDG 06 Clean Water & Sanitation SDG 2 to SDG 06 target 6. 2 acces to adequate, equitable sanitation, hygiene for all. . 6. 4 increase water‐use efficiency across all sectors. . reducing number of people suffering from water scarcity SDG 06 to SDG 2 (feedback) Negative SDG 2 to SDG 06 target 6. 6 protect, restore water related ecosystem forest, wetlands… Aucun negative Feedback 6. 5 implement integrated water resources management. . Transboundary cooperation 6. a expand international cooperation, and capacity building SDG 06 to SDG 2 (feeback) 6. B support participation of local community in improving water and sanitation management

Concentration of world income (IMF- 2015) Economics of Health Equity prepared by Mohammad Abu-Zaineh, Ph. D 12

SDG 3 & the other SDG’s : the Herculean challenges 2 - How to implement multilateral cooperation for production of global public goods? 13

GLOBAL PUBLIC GOODS q GPG = extension of Samuelson’s pure national (or local) public goods to certain goods, the benefits of which accrue everywhere in the world. Links with global externalities. q 6 areas for GPG: : international economic stability, international security (political stability), international environment, international humanitarian assistance, prevention and containment of epidemics of infectious diseases, and knowledge (Research, Epidemiologic surveillance, Monitoring & Evaluation). [Stiglitz, 1995] q GPG: ↑ risk of suboptimal production because of the Westphalian dilemna: market and national governments mechanisms “bias toward the status quo and the voluntary nature of current international law in life-threatening issues”. [Nordhaus, 1994] q In the absence of global decision‐making what equilibrium for “decentralized” provision of GPGs ? What mix of multi/bi‐lateral and national provision of GPGs ?

SDG 3 & its 13 targets : the Herculean challenges 3 - How to strenghten health systems while health ODA focus has been put on vertical diseasetargeted programs ? 15

Riots in Womey (16/09/2014) – Ebola and Guinea forest

2030 FORECAST OF Total Health Expenditures Population in 2030 (in millions Healthcare EXP per capita in 2005 (USD) Healthcare EXP per capita in 2030 (USD) 541 710 286 506 North Africa and Middle East 305 438 170 292 South East Asia 1, 450 1, 924 26 99 731 1, 119 35 97 959 998 3, 304 5, 660 Population in 2005 (in millions) Latin America & Carribean REGIONS Sub-Saharan Africa High Income Countries World n 2 Even with optimistic growth scenarios, health MDGs are not achievable without 6, 263 7. 782 578 international solidarity Source: Van Der Gaag et al. 2009 952

SDG 3 & its 13 targets : the Herculean challenges 5 - How to improve efficiency in resource allocation for global health both in the health and non-health sectors ? 18

HETEREGONEITY IN MEDICAL SERVICES DELIVERY Scale and Average Unit Cost of VCT for HIV & STD’sprograms in 5 countries US$ Average Unit Costs 1, 000 10 1 1 10 Mexico 100 1, 000 Annual clients receiving VCT Uganda Russia India Source: Preliminary analysis of PANCEA data. Unpublished data. 2006 10, 000 100, 000 South Africa

SDG 3 & its 13 targets : the Herculean challenges 6 - How to increase equity in health status, health care utilization and health care financing ? 20

Box plot of OOP payments/expenditure net of basic food expenditure for 53 countries. Saksena P, Hsu J, Evans DB (2014) Financial Risk Protection and Universal Health Coverage: Evidence and Measurement Challenges. PLo. S Med 11(9): e 1001701. doi: 10. 1371/journal. pmed. 1001701 http: //www. plosmedicine. org/article/info: doi/10. 1371/journal. pmed. 1001701

SDG 3 & its 13 targets & the other SDGs: the Herculean challenges 7 - How to set priorities in health policies toward SDG 3 ? FOCUS ON REFORMS FOR UNIVERSAL HEALTH COVERAGE ! 22

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MESSAGE FOR THE FIGHT AGAINST HIV/AIDS • STOP SILO APPROACH • EMPHASIZE THE GLOBAL PUBLIC GOOD COMPONENT OF ACCESS TO ESSENTIAL MEDICINES AT INTERNATIONAL LEVEL → pre-qualification of drugs, pharmacovigilance → monitoring of price transactions → cost-effectiveness best practices • PROVIDE HIV PACKAGE OF PREVENTION AND CARE AS ESSENTIAL COMPONENT OF UHC AT NATIONAL LEVEL Economics of Health Equity prepared by Mohammad Abu‐ Zaineh, Ph. D 24

SDG 3 & its 13 targets & the other SDGs: the Herculean challenges MAKE OUR PLANET GREAT AGAIN 25