BHOS-beleidsnota
Reactie
| Naam | PharmAccess (Director Health Systems K Boahene) |
|---|---|
| Plaats | Amsterdam |
| Datum | 15 april 2022 |
Vraag1
(see english below)Nexus (samenhang) Ontwikkelingssamenwerking & Buitenlandse Handel
Het Nederlandse bedrijfsleven kan door middel van handel, investeringen en marktkracht een belangrijke rol spelen bij een aantal van de grote wereldwijde uitdagingen van deze tijd. Om de Nederlandse inzet richting het bedrijfsleven een focus mee te geven wordt gekozen voor een focus op de “twin-transities”; de digitale transitie (via onder meer artificiële intelligentie) en de verduurzamingtransitie. Deze twin-transities op digitale innovatie en verduurzaming zullen de komende jaren een grote rol spelen om de Parijs en Glasgow-doelen voor klimaat te halen. Die doelen moeten we in Nederland halen, maar ook wereldwijd. Hoewel er een grote behoefte is aan Nederlandse expertise en investeringen, zien we dat meer nodig kan zijn om het Nederlandse bedrijven te betrekken bij deze transities in (lage en) midden-inkomenslanden.
1. Hoe kan het Nederlandse bedrijfsleven meer betrokken worden bij de twin-transitie in (lage en) midden-inkomenslanden?
(EN)
Nexus between development cooperation and foreign trade
Through their trade, investment and market position, Dutch businesses can play a key role in tackling some of the major challenges facing the world today. The focus of Dutch policy vis-a-vis the private sector will be on the 'twin transitions' of digitalisation (including artificial intelligence) and sustainability – both of which will be key to achieving the Paris and Glasgow climate goals in the years ahead. We must achieve these goals not only in the Netherlands, but across the world as a whole. While Dutch expertise and investment funding are in great demand, we also see that more may be needed when it comes to getting Dutch companies involved in these transitions in low- and middle-income countries.
1. How can we increase the involvement of Dutch companies in the twin transitions in low- and middle-income countries?
PharmAccess’ Response
We would like to focus our responses primarily on health financing and delivery in Africa where PharmAccess collaborates with Dutch and African public and private sector to extend health care to millions of people excluded from the health system using digital technology as an enabler.
Response Q1
The Dutch private sector can play a key role in contributing to economic growth, sustainable development and poverty reduction in low-and middle-income countries (LMICs) through investments in health system. The Netherlands is regarded as a leader in the provision of social infrastructure: #2 Health System 2018 (Euro Health Consumer Index), #1 Pension System 2020 (Mercer Global Pension Index) and #5 Education System 2019 (Worldwide Educating for the Future Index/ Economist Intelligence Unit). The Netherlands has one the largest privately financed semi-public social infrastructure systems in the world, including health insurance and pensions. The Dutch private sector can export the Netherlands’ expertise in the financing and provision of social health infrastructure. Especially the knowledge of social redistribution of domestic finances for health to ensure health inclusion is essential to build inclusive, resilient health markets that are less reliant on donor funding. This can help strengthen the capacity of LMICs for domestic financing of health – eg., social health insurance and the complementary role of private sector in the management of health insurance.
Based on our experience and lessons learned, investments in improving the delivery systems of healthcare facilities through the introduction of quality standards (e.g., SafeCare), blended financing (e.g., Medical Credit Fund) for small and medium sized healthcare providers as well as local manufacturers of medical supplies and pharmaceuticals are also critical for ensuring better health services and enhancing participation in social health insurance and digital health financing platform (e.g., CarePay platform) to mobilize financing for health and manage healthcare transactions. Lastly, the Dutch expertise in data and technology analytics can be used to build strong regional knowledge institutes than strengthen data driven decision making for healthcare including better pandemic preparedness and response.
Vraag2
Nederland kent een lange traditie van publieke private samenwerking. Nu de mondiale uitdagingen steeds groter worden, is het van belang deze publiek-private samenwerkingen te verdiepen en te versnellen. De duurzame ontwikkelingsdoelen zijn in 2015 vastgesteld als actieplan voor overheden, bedrijven, kennisinstellingen en burgers om duurzame ontwikkeling te verwezenlijken wereldwijd.2. Hoe kunnen overheid, bedrijfsleven en kennisinstellingen beter samenwerken om de duurzame ontwikkelingsdoelen te halen?
(EN)
The Netherlands has a long tradition of public-private partnership. As the global challenges grow ever bigger, it is important to deepen and accelerate these partnerships. The Sustainable Development Goals were presented in 2015 as a plan of action for governments, companies, knowledge institutions and private individuals to achieve sustainable development worldwide.
2. How can government, the private sector and knowledge institutions work together better to achieve the Sustainable Development Goals?
Response to Q2
Governments (Dutch and Africa) have a key role as enablers of PPPs
Dutch government
First loss capital: In the contexts of emerging technologies and innovations, 'high technical risks’ may be viewed by traditional funders as outweighing the short term visible economic benefits, and governments in LMICs may be balancing a number of social and economic initiatives. Dutch development cooperation can provide first loss to enable companies to undertake risky business ventures that serve bigger social goals.
Political and financial leverage: The Dutch government can leverage its support for LMIC governments and global health and development institutions to strengthen the activities of Dutch organizations and companies locally. A bolder, more innovative agenda is needed to ensure a more efficient and effective operation of these multilateral organizations. Locally, the embassies can also play a key role of brokering collaborations between key local institutions and Dutch organizations and companies
Africa governments:
Africa government can do a lot in terms of implementing effective policy and regulations but also investing in physical and digital infrastructure to enable entrepreneurs grow their businesses in digital innovations. Also, many of the digital innovation is driven by the private sector, but local laws and regulation are not equipped for buying of software as a service, and data regulation laws are in infancy stage. This needs to improve to drive digital investments needed for resilient health systems.
Private sector:
When these enablers are created, the private sector can focus on solving the problems. Entrepreneurs and businesses do create wealth and jobs as well as play a huge role in providing health care. Increased private-sector participation in health care - in particular, private money at risk - can lead to efficiency gains. Public funding can be used to de-risk investments, test and scale the digital infrastructure needed to drive digital health applications.
Knowledge institutions:
Knowledge integrators: Knowledge institutions can focus on research that generate good data and analysis of the context, market opportunities, and impact to guide the decision of governments as well as the business models of companies. Knowledge institutes in LMICs should be strengthened and part of a global network coordinating e.g., future pandemic responses.
Vraag3
Nederland heeft sinds 2016 een actieplan beleidscoherentie voor ontwikkeling. Beleidscoherentie voor ontwikkeling heeft als doel om in niet-hulp (OS) beleid schade voor ontwikkelingslanden te verminderen en synergiën en samenwerking te versterken. Het Nederlandse actieplan is in 2018 herzien en geeft een overzicht van vijf Nederlandse beleidsthema’s die een invloed hebben op de ontwikkelingskansen in ontwikkelingslanden. Deze thema’s zijn: (1) het tegengaan van belastingontwijking/ontduiking, (2) ontwikkelingsvriendelijke handelsakkoorden, (3) een ontwikkelingsvriendelijk investeringsregime, (4) verduurzaming van productie en handel en (5) het tegengaan van klimaatverandering.3. Hoe kan de bovengenoemde Nederlandse inzet op beleidscoherentie voor ontwikkeling verder versterkt of verbeterd worden?
(EN)
The Netherlands has had an action plan on policy coherence for development since 2016. The aim of policy coherence is to reduce the negative effects on developing countries caused by policies in areas other than development, and to strengthen synergies and cooperation. The action plan, which was revised in 2018, identifies five Dutch policy themes that can enhance developing countries’ opportunities for development: (1) combating tax avoidance/evasion, (2) development-friendly trade agreements, (3) a development-friendly investment regime, (4) more sustainable production and trade, and (5) combating climate change.
3. How can the Netherlands’ efforts to achieve policy coherence for development be further strengthened or enhanced?
Response to Q3
Policy coherence can be achieved if Dutch development cooperation is geared towards some of these primary challenges that all LMICs face in addressing sustainable development agenda such as (i) ensuring integration – making sure that actions for one SDG or targets reinforce progress on other SDGs; (ii) promoting alignment across local, national and international actions and (iii) overcoming fragmented or siloed policy actions in addressing complex issues. It is important that Dutch development cooperation is embedded in trade, poverty reduction and human rights policy, leveraging the potential of mobile technology, private investments to strengthen health systems. The impact of health on livelihoods and economy (health is wealth) underscores the need for a strong policy coherence. PharmAccess advocates and implements an integrated health systems strengthening approach aimed at building a resilient health system to address both the financing and delivery of care.
With over half of Africa population having access to mobile phone, mobile technology is bringing health care closer to the community. Real-time collection of data enabled by mobile technology ensures transparency in the delivery, utilization, costs of care and availability of funds, delivering value for more people. This is particularly vital during a crisis when it is not only critical to address the outbreak but also to commit resources to competing healthcare needs. The rise of digital health financing platforms in Africa facilitates new forms of financing health, e.g., the integration of multiple vertical funding streams (e.g., HIV, TB, malaria, mother and childcare) into primary care. This creates opportunities for innovation, efficiency and crowding-in of domestic resources for health. Lastly, tech innovations in telehealth and remote care will increase access to care without the need to build new hospitals everywhere, ensuring (poor) communities are better connected to healthcare.
Vraag4
Buitenlandse HandelInternationale handel en investeringen zijn van groot belang voor de Nederlandse welvaart en werkgelegenheid. De Nederlandse welvaart wordt voor een derde verdiend door internationale handel en een derde van onze banen zijn verbonden aan internationale handel. Onze internationale concurrentiepositie is onderhevig aan de “twin-transities” (digitalisering/innovatie en klimaat/duurzaamheid) en verschuivende geopolitieke verhoudingen. Het is voor Nederland van groot belang om het verdienvermogen te versterken nu en in de toekomst.
Strategisch en duurzaam handelsbeleid
In anticipatie op de geopolitieke en transitie-ontwikkelingen sturen ook buitenlandse staten sterker op hun nationale en internationale beleid. Zo passen staten in toenemende mate assertievere economische diplomatie toe en zetten zij economische machtsinstrumenten in om hun internationale doelen na te jagen. Nederland kan hierin niet achter blijven. De verwevenheid van ons land met de rest van de wereld is groter en kwetsbaarder dan ooit. Als onderdeel van een samenhangend buitenland beleid, zal Nederland zich toeleggen op een strategisch en duurzaam handelsbeleid.
4. Hoe kan de overheid het duurzame verdienvermogen van Nederlandse bedrijven in het buitenland versterken?
Foreign trade
International trade and investment are crucial to prosperity and jobs in the Netherlands. International trade accounts for a third of our national income and is linked to a third of our jobs. But our international competitiveness faces risks posed by the twin transitions (digitalisation/innovation and climate/sustainability) and the shifting geopolitical balance of power. It is therefore vital for the Netherlands to strengthen its earning capacity, both now and in the future.
Strategic and sustainable trade policy
Other states are also anticipating the above-mentioned transitions and geopolitical shifts, and are adjusting their national and international policies accordingly, for instance by pursuing their international objectives through more aggressive economic diplomacy and the use of economic instruments of power. The Netherlands cannot afford to fall behind. Our country’s interconnections with the rest of the world are both greater and more fragile than ever. The Netherlands will therefore focus on strategic and sustainable trade policy as part of its coherent foreign policy.
4. How can the government strengthen Dutch companies’ sustainable earning capacity abroad?
Response to Q4:
Especially in the field of health care which is a social public good, it is essential that local governments contract for health services that cater for the very poor. This ensures inclusivity. However, government contracts can be unreliable, hampering reliant income for private companies. Strengthened PPP regulation especially for new services such as software and technology will be the basis for better aid and trade agenda.
Vraag5
Thema’s en sectoren van de toekomstNu de wereld in transitie is om een goede toekomst voor ons en de generaties na ons te bewerkstelligen verandert de focus van bedrijven, overheid en kennisinstellingen.
5. Op welke thema’s of sectoren ziet u kansen om internationaal te ondernemen?
(EN)
Themes and sectors of the future
The focus of companies, governments and knowledge institutions is changing in light of the global transition to ensure a bright future for current and future generations.
5. In which themes or sectors do you see opportunities for international enterprise?
Response to Q5:
In sub-Saharan Africa, mobile technology has emerged as a primary engine of economic growth, stimulating enormous private-sector spending in both R&D and infrastructure, and profoundly changing daily lives. There are about 477 million unique mobile phone subscribers, constituting 45% of population (The Mobile Economy of Sub-Saharan Africa. GSMA 2020). Smart phone adoption is expected to double over the next 5 years to represent 65% of all connections in the region. The spread of mobile technology has empowered the poor with access to information, job opportunities, and (financial) services that improve their standard of living. It enhances opportunities for data gathering and analysis for more targeted and effective poverty reduction strategies.
There is a big opportunity and role in digital and mobile technology and innovations for Dutch and international companies to collaborate with African fintech, governments and organizations. The role of international enterprise is not only a means to deliver critical services but also enables commerce and, thus, the means for economic growth. Digital inclusion, particularly in the wake of the COVID-19 pandemic, has proven critical for addressing challenges in physical infrastructure that leave the most rural and marginalized communities behind.
Developing and managing secure digital solutions requires extensive knowledge across issues like data privacy and security, standards, biometric development, device security, and more. This knowledge resides with the private sector entities that can invest private capital to continually innovate, to prevent fraud, and to provide protection for personal data.
Vraag6
Samenwerking publiek-privaat en rol Midden en Klein Bedrijf (MKB)Een succesvolle aanpak op het gebied van internationale handel vraagt samenwerking tussen burgers, bedrijven, maatschappelijke organisaties en de overheid. Het is nuttig om aan te sluiten op de behoeftes van de markt. Waar zijn bedrijven (specifiek het MKB) mee geholpen om de exportkracht en innovatiekracht te vergroten?
6. Hoe kan de overheid het bedrijfsleven (specifiek het MKB) dat internationaal onderneemt (of dat zou willen) beter ondersteunen om zaken te doen in het buitenland?
a. Welke ondersteuning hebben bedrijven nodig om internationaal succesvol te zijn op terreinen van digitale innovatie (innovatiesamenwerking) en verduurzaming?
b. Voor handel met welke landen (of regio’s of markten) zou ondersteuning moeten zijn?
c. Wat zou de overheid op het gebied van handelsbevordering niet meer moeten doen?
(EN)
Public-private cooperation and role of SMEs
A successful approach to international trade requires cooperation between the public, companies, civil society and government. It is also useful to align with market demand. What would help companies, and SMEs in particular, to increase their export performance and innovative capacity?
6. How can the government better support companies (and SMEs specifically), that are doing or wish to do business abroad?
a. What type of support do companies need in order to achieve international success in the areas of digital innovation (innovation partnerships) and sustainability?
b. For what countries, regions or markets should the government provide private sector support?
c. What type of trade promotion activities should the government stop doing?
Supporting Dutch enterprises/SMEs going to LMICs
De-risking private investments: Some of the key risks in operating in LMICs are associated with market deficiencies, changes in legislation and regulation and limited information, IT failures, and data breaches. This is relevant in contexts of emerging technologies and innovations where associated ‘high technical risks’ may be viewed by traditional funders as outweighing the short term visible economic benefits, and governments in developing countries may be balancing a number of social and economic initiatives. Dutch development cooperation can use development funds to de-risk private investments – e.g., provide first loss or grants (blended financing) - to stimulate companies to undertake risky business ventures in digital innovations that serve bigger social goals and drive sustainability.
Institutional advocacy & broker engagements There are restrictive legislations and/or frequent changes in legislations and regulations in LMICs due to capacity challenges and change of governments that distort investment climate and adversely affect businesses. The Dutch Ministry of Foreign Affairs and embassies can play a proactive role in using their political leverage in LMICs to stimulate institutional advocacy and broker engagements with governments to support Dutch organizations and companies, especially in the field of new technology this is a priority area.
Institutional & capacity: In the Netherlands, the government can take steps to improve the regulatory processes for entrepreneurs going abroad and supporting them in building market insights to inform business strategies. Dutch development co-operation can facilitate partner experience by developing a private sector relationship management system to improve the engagement experience of enterprises and stimulate other enterprise. It is also important to support capacity building in LMIC because promoting international business is a high-skill, labor-intensive practice, and that polices of LMICs should focus on creating a sizable personnel base to improve the international competitive position of the country. Expertise in software development and data analytics need to be strengthened locally.
Vraag7
OntwikkelingssamenwerkingDevelopment cooperation
Nederlandse inzet op Ontwikkelingssamenwerking
Nederland is op verschillende thema’s actief op gebied van ontwikkelingssamenwerking. Zo investeren we in het realiseren van de Sustainable Development Goals (SDG’s) en zetten we extra in op opvang in de regio, toegang tot vaccins, klimaatadaptatie en -mitigatie. Nederland gaat door met wat goed gaat en focust op waar Nederland goed in is, zoals verbinding tussen diplomatie en ontwikkelingssamenwerking. Meer informatie over het ontwikkelingssamenwerkingsbeleid van Nederland is te vinden op www.nlontwikkelingssamenwerking.nl.
7. Waar is Nederland op het gebied van ontwikkelingssamenwerking volgens u goed in? Op welke thema’s zou Nederland een aanjagende rol kunnen vervullen?
(EN)
Dutch development cooperation activities
The Netherlands is actively pursuing a number of policy themes in the area of development cooperation. For example, we're investing in efforts to advance the Sustainable Development Goals (SDGs), reception in the region, access to vaccines, and climate adaptation and mitigation. The Netherlands will continue its efforts in areas where progress is being made and will focus on its strengths, such as linking diplomacy and development. For more information about Dutch development policy, go to www.nlontwikkelingssamenwerking.nl.
7. In your opinion, what are the Netherlands’ strengths when it comes to development cooperation? In which policy themes could the Netherlands play a leading role?
The themes mentioned in the Dutch development cooperation policy are relevant because they reflect the values and principles of the Dutch government and society, which are fundamental to the attainment of the SDGs.
Besides, since the Netherlands is a signatory to the Universal Health Care declaration, and COVID has dramatically demonstrated the strong link between better health systems and economic growth and development, it is important that the Dutch development cooperation also focuses on a much broader health agenda, namely Universal Health Care. A better health system can deliver all the essential health services, including SRHR, which is an important theme for the Dutch government.
In addition, with the rise of digitalization in LMICs, it is also important that the development policy prioritizes innovations and digitalization, which are obviously linked to private sector development and better public governance, transparency and accountability in LMICs. About 10% of the GDP in transactions in Africa occurs via mobile payments compared to 2% in the European Union and the US (reference: Fintech in Sub-Saharan Africa: A Potential Game Changer), and this is bound to increase even further in the future. Dutch development cooperation can support innovation ecosystems, environments that encourage new ideas that respond to what the society and, market or an individual needs. These ecosystems involve strong collaboration between policy makers, private sector, organizations and academia. These actors working together can provide capital, physical infrastructure and an enabling policy to support innovations
Vraag8
Innoveren op OSNederlandse internationale samenwerking is flexibel en kennisintensief, we zijn vernieuwend. Zo ontwikkelt Nederland nieuwe manieren van werken en partnerschappen die daarna door bijv. de Europese Commissie en Wereldbank worden opgepakt of opgeschaald. De Nederlandse internationale samenwerking fungeert dus veelal als een creatieve en kennisintensieve incubator (een broedplaats voor nieuwe ideeën. Nederland is een relatief kleine donor, maar als lidstaat van de EU en via bilaterale hulp kan Nederland de zichtbaarheid van EU-hulp vergroten en additionele relevante kapitaalstromen generen.
8. Op welke manier en op welk vlak kan de Nederlandse ontwikkelingssamenwerking nog meer innoveren?
(EN)
Innovative development cooperation
Dutch international cooperation is flexible and knowledge-intensive. We are also innovative, developing new ways of working and new types of partnership that are subsequently adopted or scaled up by others, like the European Commission and the World Bank. In this respect, Dutch international cooperation is like a creative and knowledge-intensive incubator. We are a relatively small donor, but as an EU member state and through bilateral aid we can make EU aid more visible and generate additional, relevant capital flows.
8. In what other ways and areas could Dutch development cooperation innovate more?
Supporting economic transformations and health systems strengthening: The COVID-19 pandemic and other urgent challenges clearly show the need for greater resilience and sustained outcomes in Africa economies. Also, addressing vulnerabilities and promoting inclusive and resilient growth requires significant investment and expertise. Dutch development cooperation can focus more on supporting structural economic transformations, prioritizing health systems strengthening, and leveraging investment and global cooperation. This shift can serve to amplify the impact of targeted interventions.
Optimizing political leverage: Dutch development cooperation can strengthen the impact of its work through how it uses its political leverage to proactively stimulate Africa governments and global institutions to collaborate with Dutch organizations and institutions locally. For example, the Dutch government supports many multi-lateral partnerships in global health such as the Global Fund for AIDS, TB and Malaria, WHO and the Global Financing Facility for Women, Children and Adolescents (GFF). The Netherlands can use its financial and political leverage to stimulate these multi-lateral organizations to seek better synergy with Dutch organizations and support their successful innovations. Multi-lateral organizations are risk averse and avoid pioneering interventions that have the potential to transform the constraints facing most health systems of LMICs. Locally, the embassies can play an active role of brokering collaborations between strategic local institutions and Dutch organizations and companies
Prioritizing research: Dutch development cooperation can contribute to deliver sustained international development outcomes in Africa by prioritizing research into the underlying issues and/or policies affecting sectors or regions, offering policy advice and other expertise
Vraag9
Een donor met durfDe Nederlandse internationale inzet is gedurfd, omdat we financiële investeringen koppelen aan onze diplomatieke inzet en expertise. We continueren thema’s waar we traditionele meerwaarde hebben: seksuele en reproductieve rechten en gezondheid (SRGR), water, voedselzekerheid en veiligheid & rechtsorde. Daarbij kunnen we nog meer gebruik maken van het diplomatieke gewicht van o.a. de EU. We investeren in systeemverandering om te zorgen dat we de SDG’s in 2030 realiseren. Met systeemverandering bedoelen we dat we de systemen die armoede en ongelijkheid in stand houden aanpakken.
9. Op welke manier/welk vlak kan Nederland als donor nog meer durf te tonen?
(EN)
A bold donor
Dutch international efforts can be characterised as bold, because we link financial investment to diplomatic efforts and expertise. We will continue our work on themes where we have always added value: sexual and reproductive health and rights (SRHR), water, food security, and security and the rule of law. We will also make better use of the diplomatic weight of the EU. To ensure we achieve the SDGs by 2030, we will invest in systemic change, i.e. tackling the structures that maintain poverty and inequality.
9. In what ways or areas could the Netherlands, as a donor, be even bolder?
Dutch development cooperation has a reputation globally as a flexible funder who is also willing to address challenging issues. It is important in the world of rising insecurity, divisiveness and dwindling donor funding that the Dutch government continues to serve as an example of good donorship principles. The focus on private sector approaches to transformative innovation is also commendable because it spurs innovations to deliver change aligned to the SDGs in Africa.
Due to a strong public opinion on development cooperation that favors quick results, development cooperation policy tend to be risk-averse. But we have seen that the transformative change needed in development often requires risks. Dutch development cooperation can, therefore, be bolder, for example, in supporting risky innovations (with unpredictable outcomes) that can leapfrog traditional healthcare delivery models essential to the provision of healthcare solutions across LMICs. This can be done by supporting the piloting of scalable next-generation models for private sector engagement. Especially the field of digital technology and new health models such as telemedicine and remote care will require new and bolder investments. Lastly, health systems change requires longer term investments and a trusted environment between all parties. Therefore bold, long-term investments will give the Netherlands as a donor a unique position to sustainably drive better healthcare, leading to better Global Health.