G8 Summit 2009: what approach will Italy take to health?

In the past decade, the G8 played an important part in the establishment or support of global health initiatives that are at risk today of becoming part of the problem rather than the solution for granting health coverage to disadvantaged populations. The fragmentation of fi nancing for global health and increased transaction costs contrast with the need for effi cient and eff ective health systems, and underline the need for a review of quick-fi x and selective approaches. In view of the present economic crisis, a heightened commitment from wealthy countries to sustain global health will be needed. As chair of the G8 Summit 2009, Italy will have a unique opportunity to renew its commitment to global health and orient action towards a more eff ective approach. Italy’s Offi cial Development Assistance continues to suff er from structural weaknesses, characterised by an absence of clear political direction, weak management, and inadequate and unstable funding. The health sector has been no exception. Nevertheless, two aspects deserve to be noted. First, as the result of contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria, launched at the Genoa G8 Summit in 2001, the donations of Italian Offi cial Development Assistance for Health tripled between 2001 and 2007 (Italy is the fourth largest contributor to the Global Fund along with Japan, after France, the USA, and the UK). Italy also engaged in new fi nancing mechanisms, including the International Financial Facility for Immunisation and the Advance Market Commitment for vaccines initiatives, by pledging substantial funds. Arguably, this shift towards vertical initiatives has not been accompanied by attempts to address concerns about potential consequences for global health governance and the negative system-wide eff ects at a country level. The shift also contrasts with the longstanding guiding principles of the Italian Development Cooperation in the health sector—characterised by a comprehensive rather than a selective approach to health—and also with the domestic experience of the Italian National Health Service that provides universal and comprehensive care. Second, Italy’s contribution to global health already goes beyond traditional Offi cial Development Assistance. The Italian National Health Service and the decentra lised public institutions (regions and municipalities) are increasingly engaged in development cooperation. Civil society is very active (in Italy, 1433 not-for-profi t organisations are associated with international cooperation and solidarity activities, has produced a study that in every respect rivals those in diseases for which research receives vastly superior funds.