Participants
Co-Chair: John-Arne Røttingen, Norwegian Ministry of Foreign Affairs.
Steering Group members and alternates: Kristen Chenier, Global Affair Canada; Lynda Wardhani, Ministry of Foreign Affairs, Indonesia; Jin Hashimoto, Ministry of Foreign Affairs, Japan; David Whineray, FCDO, UK; Atul Gawande, Assistant Administrator for Global Health, USAID; Faith Nekabari Nfii, Africa CDC; Gabriella Fésüs, European Commission; Oswaldo Adolfo Rada Londoño, Senderos Asociación Mutual; Kieran Daly, Bill & Melinda Gates Foundation; Beck Smith, Wellcome.
Observers: Omar Abdi, UNICEF; Hajime Inoue, Health, Nutrition, and Population, World Bank; Hendrik Schmitz-Guinote, Office of the Chef de Cabinet, WHO.
Commitments Task Team Co-Chairs: Anna Seymour and Jo Scott- Nicholls, FCDO, UK.
Secretariat: Linda Muller.
Regrets
Dr Mercy Mwangangi, FGHI Co-Chair; Roman Macaya, Costa Rica; Dr Roger Kamba, Minister of Health, Democratic Republic of the Congo; Dr Ruth Nigatu, Ministry of Health, Ethiopia; Dr Patrick Kuma-Aboagye, Ghana Health Service; Desta Lakew, Amref Health Africa; RD Marte, APCASO.
Meeting objectives
The objectives of the meeting were for the Steering Group:
• to share feedback on the draft FGHI Commitments Paper, which is designed to facilitate discussions at Wilton Park;
• to explore options to drive accountability for implementation of FGHI commitments post-2023;
• to consider proposals for FGHI process outcome documents.
Discussion on the draft FGHI Commitments Paper
Steering Group members were in general agreement with the overarching approach of the FGHI Commitments Paper, with its focus on key strategic shifts and the development of roadmaps to operationalize them; and priorities for near-term action and commitments/calls to action to drive action. Steering Group members emphasized that the five key strategic shifts were relevant not only for global health initiatives but for the broader global health financing ecosystem as a whole, including bilateral donors, multilateral development banks, UN agencies and other funders.
Several Steering Group members proposed orienting the strategic shifts toward 2030 and beyond, instead of referring to a longer, 10-15 year time horizon. Upcoming GHI replenishments were highlighted as a near-term opportunity to drive change.
Steering Group members highlighted that the implementation of these strategic shifts should carefully consider country-led processes and domestic priorities.
Discussion on possible post-2023 accountability mechanisms
The discussion was framed around several proposed, not mutually-exclusive, accountability mechanisms, considering (i) GHI board coordination and accountability, (ii) joint (GHI, donor, implementing country, CSO) accountability and (iii) political accountability (see meeting slide deck for details).
There was a broad consensus on the need to establish robust coordination and accountability mechanisms to drive implementation of FGHI commitments. Key feedback on the proposed mechanisms included:
• on the coordination side, several calls to find a way to facilitate cross-board collaboration between GHIs
• support for the proposal to establish a joint (Gavi/GF/GFF) operations unit to develop and drive implementation of the roadmaps, reporting to a joint subcommittee of the boards, which in turn would report to GHI boards, who would ultimately oversee roadmap implementation
• a reticence to create new structures/initiatives
• the suggestion to embed FGHI commitments into the Africa Leadership Meeting’s Domestic Health Financing Tracker and Scorecard mechanism.
Discussion on FGHI process outcome documents
It was proposed that there be two main FGHI process outcomes documents, informed by the Commitments Task Team Commitments Paper:
• the main document being an FGHI Statement of Commitments for Collective Action, endorsed by FGHI co-chairs, on behalf of SG members
• a supporting, higher-level document endorsed by GHIs, other organizations, implementing countries, global heath donors and CSOs.
Two SG members noted that we should strive to have the main outcome document endorsed by all SG members, rather than by the Co-Chairs on behalf of SG members. SG members will need to explore what would be required for them to endorse the outcome document.
The goal is to have the FGHI Statement of Commitments for Collective Action agreed at the 26 November Lusaka meeting, and published on UHC Day on 12 December, together with the supporting document referred to above.
These FGHI-driven documents would be complemented by:
• GHI Secretariat reporting on implementation of commitments via committee and board papers
• GHI boards providing oversight via board policy decisions.
Additional accountability mechanisms discussed earlier will help drive attention and action.
Next steps
Steering Group members to reply to SG survey on the Commitments Paper, accountability mechanisms and FGHI outcomes documents, by 21 September: this will inform the next iteration of the Commitments Paper, which will be a pre-read for Wilton Park, to be shared on 26 September.
The FGHI Secretariat will reach out to SG members to firm up roles at Wilton Park (session leads, etc).
The importance of Steering Group members highlighting the FGHI agenda in GHI board discussions was again underscored.
Gavi has scheduled two FGHI technical briefings for Gavi board members, on Monday 2 October (10 – 11:15 and 14:30 – 15:45 CET): Steering Group members whose governments/organizations hold board seats are asked to encourage board members to attend and actively participate in the discussions, to share ideas on the role the board could play in reducing fragmentation and improving coordination across GHIs.
Steering Group members with seats on the board of the Global Fund are encouraged to request a similar technical briefing for Global Fund board members.