1. Swedish aid for global health «GRAND CONVERGENCE» OR «SUSTAINABLE CONVERGENCE»? EBA Seminar; Stockholm Nov 7, 2014; Sigrun Møgedal

2. The Formula for «Grand Convergence"  Infections  Maternal and child deaths  Pro poor primary focus  Fiscal policies for NCDs SELECTIVE SCALE UP Invest in drugs and technologies + services to deliver them Re-align and re-focus DAH (to match “true priorities”) Be pro-active on transition (responding to domestic capacity) Respond to underfunded Global Public Goods

3. The "Convergence” Agenda STRENGTHS The economic argument The case for priorities The focus on Global Public Goods The compelling vision The focus on additional spending The case for progressive universalism CHALLENGES Political and social determinants ignored (Light touch on trade, taxes, multisector coherence) Claiming the keys for "true priorities" ( Political space for national decisions and accountability) GPGs narrowed down to R&D for technologies Uneasy match with post 2015 vision (Beyond mortality) No focus on effectiveness of current spending (Match with Busan type “aid effectiveness” ?) Relative neglect of “delivery science” – what to how (Integrated delivery, Health and social care workforce)

4. Sustainable Development Imperatives Healthy planet, healthy people, healthy economy. Economy cannot any longer override environmental and social sustainability Broader and more interconnected action on health, with synergies across sectors and dealing with political, social and economic determinants that maintain health inequity. A global agenda, beyond development assistance. Not just a matter acting with money. Common but differentiated responsibilities. Healthy people and livelihoods at the core of social sustainability. “Several enablers and drivers, strategies and approaches for sustainable development are difficult to enumerate as goals, among others human rights, rights based approaches, governance, rule of law, and wider participation in decision making” (quote from the OWG report, and listed as cross-cutting - also in investment cases on HIV, TB RMNCh and NCDs)

5. Political Determinants of Health Trans-national decisions ( or lack of decisions ) outside the domain of the health sector can undermine health and maintain ill health and health inequity. Political determinants are about power and choice. What matters are how this power is distributed, organized and used, who makes the choices, and what counts in making them Policy domains outside health do not recognize and respond to the health implications and health impact of their agenda setting, decisions and actions (the co-herence agenda) Institutional dysfunctions allow health inequities to persist and become deeper and more stubborn to deal with: democratic deficit, weak and fragmented accountability mechanisms, institutional “stickiness”, missing institutions and inadequate policy space for health Not only choices of national governments, but also those of private and corporate sector and other non-state actors have impact both within and across borders.

6. The Swedish Response Sweden can lead beyond “Grand Convergence”: “Sustainable Convergence ” Was an early leader on GPG. Global leadership more than R&D investment in new technologies. Sweden could pick up as champion for GPGH. Shared but differentiated responsibilities. Does not shy away from acting on political, social and multi-sectoral determinants and rights – should not shift to a “within the health sector only” focus on selective health investment Has been at front in institutional reform of the UN system and is a trusted partner for LICs + LMICs to build south/north inclusive global leadership. Enable a reformed WHO post2015 and make multilateral system fit for purpose (takes more than trust funds…) Has a basis for making UHC a “unifying force”. Aid effectiveness. IHP+. Investments in national “horizontal capacity” to make the “diagonal approach” work. Health workforce and health metrix. Broker new compacts for mutual accountability – make equity a core measure. Health security?

7. The «Ebola Test» Preparedness (pre Ebola) The domestic/DAH mix pre-ebola and how did it contribute to access to PHC type services with health workers on the ground? Equity measures? How did targeted health initiatives contribute to access to PHC type services with health workers on the ground? (GAVI, Polio, RMNCH, GF etc) In what ways did the multilateral system engage in assessing preparedness and contribute to it? How would the convergence agenda contribute to preparedness? In what ways were national institutions meant to identify and act on early warning? Response (post Ebola) What changes needs to be done? Consequences for priority setting in the global health agenda nationally and globally? In what ways can the “diagonal approach” be fit with a national “horizontal capacity” to make inputs serve access to PHC and HRH on the ground? How can WHO, other multilateral and bilateral partners better support responses to IHR in LIC? In what ways can one build a convergence agenda that ensure critical capacity in surveillance? What is the critical capacity in the multi-sector institutional response to preparedness and EW?