Participants

Co-Chairs: Dr Mercy Mwangangi, Kenya; Dr John-Arne Røttingen, Norway.

Steering Group members: Kristen Chenier, Global Affairs Canada; Dr Polydor Kabila, Democratic Republic of the Congo; Dr Ruth Nigatu, Ministry of Health, Ethiopia; Lynda Wardhani, Ministry of Foreign Affairs, Indonesia; Jin Hashimoto, Ministry of Foreign Affairs, Japan; Samrita Sidhu, FCDO, UK; Atul Gawande, Global Health Bureau, USAID; Dr Ahmed Ogwell Ouma, Africa CDC; Gabriella Fésüs, European Commission; Oswaldo Adolfo Rada Londoño, Senderos Asociación Mutual; Kieran Daly, Bill & Melinda Gates Foundation; Beck Smith, Wellcome.

Observers: Anurita Bains, UNICEF; Hajime Inoue, Health, Nutrition, and Population, World Bank; Hendrik Schmitz-Guinote, Office of the Chef de Cabinet, WHO.

Commitments Task Team Co-Chair: Gerald Manthalu, Ministry of Health, Malawi.

Secretariat: Linda Muller.

Regrets

Roman Macaya, Costa Rica; Dr Patrick Kuma-Aboagye, Ghana Health Service; Desta Lakew, Amref Health Africa; RD Marte, APCASO.

FGHI Co-Chairs’ Update and post-Wilton Park reflections from Steering Group members

See meeting slide deck for the Co-Chairs’ update.

Several SG members provided updates on how they are advancing the Wilton Park meeting outcomes in their countries, including by briefing Ministers, other ministries and development partners, and setting action plans in place, for individual countries, and beyond. One member noted the tension between wanting to build on recent momentum and move fast, and wanting to bring others along on the change process.

Several members noted the need to increase engagement with civil society organizations (CSOs) and community representatives, to highlight equity issues and to ensure references to country ownership are highlighted as being broader than government ownership. One member underscored the need to engage more substantively with the secretariats of global health initiatives (GHIs), including to begin concretizing short-term actions, calling for collaboration among board chairs, exploring a joint operations team, and having updates as part of board agendas. Commitments Task Team (CTT) Co-Chairs will convene Global Fund, Gavi, the GFF, WHO and the World Bank for a workshop on 7 November, providing an opportunity to dig into these issues with the group.

Further to the 20 October FGHI technical briefing for Global Fund board members, where no low- middle income countries intervened, several SG members highlighted the need to socialize the FGHI

process with implementing country constituencies and during bilateral meetings ahead of the 17 November Global Fund board retreat.

One SG member called for the identification of political champions to keep attention on the FGHI issues post-2023.

Update from the Extended Commitments Task Team (CTT+): toward an FGHI Compact

The CTT Co-Chair provided an update on the CCT+ work on developing an FGHI Compact (name still tbd). He noted that the FGHI Co-Chairs had published a Co-Chairs’ technical note as an accompanying document to the Wilton Park report that builds on the draft FGHI Commitments Paper developed by the CTT as the foundation for Wilton Park discussions. The technical note reflects feedback received at Wilton Park and can serve as a record of the technical foundation of FGHI deliberations.

A concise FGHI Compact (name still tbd) is being developed by CCT+ members to summarize stakeholder – especially SG and CTT member – collective commitments to change. SG members can expect to receive a draft for feedback on or around 9 November. The goal is to have general alignment of SG and CTT members by the time of the Conference on Public Health in Africa (CPHIA) in Lusaka at the end of November and to launch the Compact on Universal Health Coverage Day on 12 December. The Compact will include an overview of the five strategic shifts for the evolution of the global health financing ecosystem, priority areas for near-term action, cross-cutting steps for operationalizing change, and a call to action for specific stakeholder groups. The next steps in Compact development are outlined in the meeting slide deck.

The CTT Co-Chair challenged the group to find a platform for cross-board engagement, as one currently does not exist.

The discussion on FGHI Compact sign-on shone a light on the difficulty of securing formal institutional sign-off by government SG representatives. At an earlier SG meeting this was preferred over the initial proposal that the Co-Chairs sign the document on behalf of SG members. Another option would be to present the Compact as an FGHI process consensus document. The Secretariat will put together a one-pager for discussion and decision at the next SG meeting.

Discussion on driving implementation of FGHI commitments

There was consensus on the need to ensure mechanisms to monitor implementation of FGHI commitments and on the centrality of GHI boards and cross-board collaboration in this regard. The opportunity to strengthen existing governance support fora including the Global Fund’s Africa Constituency Bureau was noted.

Several SG members supported the creation of a Friends of the FGHI arrangement, potentially led by two high-income country representatives and two low- middle-income country representatives, to help drive accountability and implementation of commitments and continued cross-board deliberation and collaboration, with one SG member noting that there is no place today where different pieces work together in a holistic way and expressing concern that without such a mechanism, implementation of commitments risks not getting traction. A one-page terms of reference for a Friends of the FGHI mechanism could be developed.

One SG member requested a follow-up call to further discuss, concerned that such an arrangement could risk alienating GHIs and become more than the light-touch mechanism proposed. There was a call for a mapping of existing Friends mechanisms to explore if FGHI follow-up could be embedded in any of them, which the Secretariat has initiated.

It was proposed that an alternative could be for the current SG to meet several months into 2024 to assess progress.

Collaboration with existing regional mechanisms such as the Africa Leadership Meeting and National Health Financing Dialogues could be useful complementary accountability mechanisms.

November’s CPHIA in Lusaka

The CPHIA provides opportunities to advance the FGHI agenda with African health ministers and public health stakeholders through FGHI-specific meetings, through raising FGHI issues during conference sessions and side meetings and in bilateral conversations. Africa CDC expressed its full support for the FGHI process and commitment to advancing it in bilateral meetings with ministers.

FGHI-specific meetings at CPHIA are:

  • Sunday, November 26, 9 am to 12 noon – hybrid Steering Group meeting.
  • Sunday, November 26, 2 to 5 pm – Friends of the FGHI meeting. This is an opportunity to broaden FGHI engagement with key stakeholders in Africa and for meeting participants to share steps they are taking/can take to move this change agenda forward.
  • Monday November 27, 6 to 8 pm – The Future of Global Health Initiatives: the future we want to see. This official CPHIA side event, co-convened with Africa CDC and Amref, will bring together a panel of African public health leaders to discuss how they are helping to catalyze collective action to shape a global health financing ecosystem that is fit for purpose through to 2030 and beyond.