On my flight home from the G8 Summit in Hokkaido, Japan, I’m pondering the report card that our NGO Health Group devised and wondering if we were too easy
on them with our final overall grade of C-minus. And I’m daydreaming about
the non-political side of the three days in Hokkaido, Japan’s beautiful
northernmost island. More on that below.

On the whole, we gave the world’s
most powerful leaders poor marks on a complex ten-point matrix of health
issue content and financing results. The only exception was in their
commitment to strengthening health systems worldwide and to following
up on health at subsequent conferences. Here are the highlights:

Content: B-

An A- on the follow-up
mechanism that puts global health on the permanent G-8 agenda is pulled
down by Ds for the lack of language about primary health care, universal
access to reproductive health care, and rights of HIV-positive people.
A couple of Bs for noting the importance of a continuum of care and
the urgency of acting if the MDGs are to be achieved.

Finance: D

Real commitments were lacking
everywhere, and the grade for maternal and child health was F: the genuine
need for an additional US$10.2 billion a year was ignored.

General: C-

The Bs and Cs for content
(i.e., promises) were overwhelmed by the Ds and Fs for financing (i.e.,
reality) for a disappointing overall grade. The only A was for the (unfunded)
commitment to keep talking every year about global health, especially
maternal health, and to evaluate progress. We shall see if this actually
happens.

To view the full report card,
click here.

Further thoughts

• The maternal/newborn/reproductive
  health group was small, dedicated and indefatigable. Sumi Ishi and Makoto
  Yaguchi of the Japanese Organization for International Cooperation in
  Family Planning were magnificent in several languages, especially in
  the language of politics.
• It was important
  that World Bank President Robert Zoellick agreed at the May Tokyo International
  Conference on African Development (TICAD) that domestic spending ceilings
  imposed on African countries by international financial Institutions should
  be lifted so the countries can scale up health financing. This is a
  significant development for all the health campaigns, including maternal
  and child health, and it will be critical to see whether the bank follows
  through.
• The Global Health
  Workforce Alliance got it right: the G-8 took "significant and necessary
  steps" but there is still "an urgent need for continued leadership"
  in health worker coverage, Executive Director Mubashar Sheikh said.
  "The G8 have stated in Japan that health workers are the cornerstone
  of reliable health systems. Investment must now follow. Global commitments
  such as the Millennium Development Goals will remain a dream unless
  action is taken immediately to increase numbers of health workers and
  ensure their retention. We cannot afford to wait any longer," he
  added.

The actual language

The best language on maternal
health came from UN Secretary General Ban Ki-Moon in his opening statement
to the conference: "Maternal health stands as the slowest-moving
target of all the MDGs. US$10 billion would ensure coverage of basic
services for maternal, newborn and children’s health. More investment
for training community health workers would be a strong step towards
strengthening health systems."

The final paragraph of the
communiqué "recognizes that for progress to be made on maternal,
reproductive and child health, and emerging and neglected health priorities,
additional resources – from both domestic and international sources
– are needed if the health MDGs are to be achieved."

In the "Toyako Framework
for Action on Global Health: Report of the G-8 Health Experts Group"
maternal/newborn health was mentioned four times, including a full paragraph
on the need for a comprehensive approach to reducing maternal and newborn
mortality: the continuum of care, increased access to skilled birth
attendants, access to emergency obstetric care, and a recommendation
that reproductive health care should be made widely accessible.

Immediately after our group
press conference, I had an interview with a reporter who was here for
both the International Herald Tribune and Japan’s largest newspaper,
Asahi Shimbun. It was a great chance to elaborate on our rationale,
answer questions, talk about conservative U.S. positions on sexual and
reproductive health and rights, and to make some substantial points
about the benefits of investing in women. Clearly the economic arguments
are the winning ones.

In short, it was a good start
and amazing that we accomplished so much in our first year of work with
and about the G-8. The ground is prepared and change is happening.

All this takes enormous energy
from many people in different places, contributing different pieces
– British First Lady Sarah Brown and her warm, determined, consistent
reminders at every opportunity; the agencies who worked with the Secretary-General
to be sure he highlighted maternal health in his speech; the researchers
who helped us with the facts and the journalists who crafted the concepts
into ink. We thank everyone for the work well done and the work still
to be done.

Opportunities ahead include
the September special UN General Assembly session on the MDGs, and then
it’s on to the G-9 summit in 2009-in Italy.

The non-politics

All week the clouds hid the
near-vertical green mountaintops that surround this resort, but on the
final morning, as I was walking to the bus, the clouds lifted – and
there was Mount Yado, known as the Mount Fuji of Hokkaido. It was glorious,
towering over us in perfect symmetry.

The hour-long bus trips back
and forth to the conference site were wonderful. The things of daily
life are relatively small here: cars, of course, but also doorways,
chairs, bus seats …it took some getting used to! As did the security
everywhere: police wearing amazing outfits, especially in this heat-full-body
Kevlar protecting every joint, every vital part, even with flaps down
the back of their hats. Rumor said the security measures cost US$248
million, and I believe it.

I never saw a single weed in
the gardens that seem to be everywhere in Japan. Every house has flowers,
even if it’s just one marigold in a coffee can. Most are tidy and
geometric, but some homes are surrounded by chaotic riots of color.
The vegetable fields are in flower too — and the melons are worth a
trip to Japan all by themselves. I learned that ordinary citizens planted
thousands of flowers to welcome us. We saw them everywhere in unexpected
places, and that made us all feel very welcome and comfortable. Some
villages chose eight flowers, one for each of the G-8 countries.

The countryside is dotted by
shallow rivers, with rafts and canoes. Not many cows, but they must
be somewhere because the cheeses are amazing. We passed one farm with
a sign saying "Happy Life Holsteins." I don’t doubt it for a minute.

It really is spring here, very
late this far north. The wheat fields are only starting to turn gold
— winters are long and harsh: special signs along the road tell people
where the road is when it’s covered in snow. That’s the attention
to detail we saw everywhere — signs are very specific and the people
incredibly helpful. They were always willing to help get us un-lost.
They honor tradition and we honored that. It will take awhile to readjust
to New York!