Good afternoon, one of the exciting things for the day and exciting moment and i have the honor of serving as the dean of school of Public Health, for all of you that are here for this exciting afternoon, im thrilled, welcome you. And also thrilled not to stand in the way of a great conversation, and so, im delighted to introduce our moderator, wellknown to all of you, im sure, michael, the chair of the department of Health Policy and management. Michael. Great. [applause] im michael and my job as moderator host today is basically to introduce chelsea and devi talk 20, 25 minutes and let you guys ask question and i sit and have a whole back and forth with them and i say now its time to go to reception and have some wine and thats my main job. Before i do my main job, i just want to say a couple of quick things, three quick things about this terrific book. First thing i want to say, as youll hear, im sure, this book contains four case studies of leading Global Health organizations around the world and uses those to provide extraordinary insights into where the world of Global Health is and where its going. And in that sense, it really adds tremendously to the literature and what we know on this topic, thats number one. Number two, the book also, in a really interesting way, and unusual way and i think in a pretty unique way, in those case studies, it looks at how those organizations are governed, what their rules around governance are, how they are financed, how transparent they are. It takes a look at all of the issues and tries to use that as a lens and find out how impactful and influential those organizations are and trying to correlate the governance, finance and transparency and i think thats unusual, unique and important. Last thing i want to say about this okay, in addition to specific case studies, the book also really examines and considers important, big important questions in the world of Global Health and the world of Public Health generally. For example, just to give one example, i think, you know, as the authors point out, theres a long history in Global Health and Public Health more generally of vertical diseasedriven initiative. At the same time, its argued by many that horizontal, you know, Health Systems approaches are really, perhaps, a better way to truly improve health. And one of the things the book does, how will the changing trends in Global Health and the new kinds of organizations that are coming into Global Health, how are they dealing with these issues of vertical versus diseases and versus Health Systems. Theyre big and important questions and i think the reflections that the authors have really add so much to our knowledge about this. Thats all im going to say, now, i want to introduce the authors and let them come up. First, devi sridhar, i gather just got off the plane a few hours ago, from edinburgh is the professor and chair of global Public Health at medical school at the university of edinburgh. Edinburgh, right . She directs the Global HealthGovernance Program there. She works closely, and i think this is really important, with ministries of health in both low and middle Income Countries around the world, really in an effort to sort of help translate the kind of research that she does into action and in places that really could use her advice and use her guidance. She also is a regular commentator on bbc and numerous other media outlets. She received bother her doctorate and masters from oxford. I recently learned, actually and i think this is one interesting fact. I learned that when devi was 18 she became the youngest Rhodes Scholar in history, which is quite, quite an accomplishment. So were really, really grateful and fortunate that shes here and that shes coauthoring, coauthor of this book with chelsea. Devis coauthor in this book is chelsea clinton, who we kind of feel just sort of one of us, is one of us here at columbia. Chelsea is the vice chair of the clinton foundation. She focuses in particular on the various Health Initiatives that the foundation has and work that the foundation engages in around the world. She has her doctorate, also, from oxford. She has her masters from a School Called the mailman cool of Public Health, Health Policy and management. And she is also a professor, an assistant professor here in the department here of Health Policy management. In fact, i would bet there are some people here in about two weeks are going to be sitting in on class number one of chelseas class, Global Health governance and shes been pretty busy writing books recently. Last thing id say about chelsea, she has another book you may or may not know, came out in hard cover, called its your world, get informed, get inspired get going, Something Like this, came out in paper back and shell be beginning a book tour on that, were incredibly greatful to have chelsea and devi with us today and i want to turn it over to them and formally welcome chelsea and devi. Thank you. Thank you. [applaus [applause] michael, thank you so much for that introduction. Linda, thank you and to everyone here at the Mailman School for hosting us today, i also want to thank sarah russo and everyone from oup, our publisher. I also see we have a very young member of the audience here, we both have very Young Children so please dont worry about if she feels the need to make her voice heard as well. Actually, while we were talking before coming out today, devi and i realized while working on this book, we had three children between the two of us. So, this book grew out of our research that we each had conducted independently on the world bank, on the World Health Organization, the global fund, and then a series of conversations wed had with colleagues and each other, gaps wed observed in the scholarly literature around Global Health governance and we couldnt find a resource that examined the questions that michael talked about in his incredibly generous introduction. Looking at the four big institutions in Global Health as judged by resources commanded in order, the global fund, the world bank, the World Health Organization, and davi, we wanted a resource that we could reference as well as use in the classes that we teach on either side of the atlantic, that examined these institutions in a comparative critical way on their governance, their financing, their transparency, their accountability. Since we couldnt find it, we decided to write it. So, indeed a couple of years and three kids later, here we are with two parts of the world and why. And we thought wed share a little of what we discuss in the book and really would welcome your questions and we particularly hope that students ask questions. I know that there are indeed some students here that will be taking my class later this term and i also recognize some of the students ive had the privilege of teaching before. So we just are so excited to have our first book event for our, maybe fifth child between the two of us, if books are also sort of like children. Here at a school that has meant and continues to mean so much to me. So, a few reflections from the book and then we hope that we can have a conversation. So, the four big institutions, we always find, its surprising to our students that the world bank, for example, funds more Global Health work around the world than the who does every year. And we also find our students surprised to find not long ago the world actually didnt have the global fund. And one of the questions we kind of use to frame much of what we query and at least attempt to answer throughout the book are what are the differences between the old institutions or the more traditional multilateral institutions, who and the world bank, versus the newer institutions or what are more known. And what are the key differences between the older and newer Global Health entities. The older institutions seem to have rather broad and ambitious mandates. Whore, the attainment by all people of the highest possible level of health. Sometimes i think one of whos kind of challenges in the world is because its called the World Health Organization, we tend to think it should be able to kind of do all things for all people to ensure that we each have the chance to live the healthiest lives possible. The world banks alleviate world poverty and improve quality of life. Those sound very different than the more kind of problemfocused and kind of narrower mission that the founders of the global fund and g gavi, and they fight aids, tuberculosis and malaria, and to increase access in poor countries. I think the difference very much is evidenced kind of on the major itself. The second big difference from the sort of who enfranchises the institutions, who gets to help curerate the agendas and strategies that they employ to achieve those agendas, how they hold themselves accountable or not, who they partner with, or dont, i know these may look a little silly, but when i go to the next slide youll understand. The World Health Organization from the world health assembly, kind of the ultimate governing body of the who as well as the executive board kind of the entity that oversees the work of the w. H. O. On a daytoday basis, the membership of these bodies are Member States, National Governments and their representatives. The same is true of the world bank. That looks very different than these slides that are much more colorful because the membership of the governing bodies of the global fund and gavi are much more diverse, compromised of National Governments, as well as private companies and ngos. So, we think although this slide may seem kind of a bit absurd when its stand alone, the juxtaposition is fairly illuminating, and this form of government and the enfranchisement of nonstate actors is something really the world has only begun a grand experiment with since the new millennium. Thank you for all for welcoming me to the Mailman School, im glad to be here. The first question we look at who pays for the institution. If you follow the heart of the money you look at the policies. We first looked at the w. H. O. , the organization we look at chief coordinator of health work. The budget has skyrocketed 80 , but increased over time. And what it means 80 of your budget is earmarked by specific donors for specific causes. 20 is what the director general actually can say what its for. This is, for example, norway and sweden saying were going to give you 10 million for this or, the Gates Foundation saying well give you 50 million for this. If youre director general and trying to run the organization or have a board, how much do they say over the priority if 80 of your budget is coming from earmarked sources . And actually owl of these contributors as theyre now called. So if we just take one year, very illuminating, you can see a huge chunk comes from the Gates Foundation, the u. S. , u. K. , and several others and you can see theres a few key donors that pay a large influence to the institution. Earlier with chelsea, the governance of the state, but look at who pays for it its not just governments. This is ida, which is part of how the bank finances its health work. One of the arms. And over time, ida money has grown and goes to the poorest country and largely finances Global Health and social sector whose. And again, growth over time. And who pays over time for the ida replenishment. And a similar list of donors, u. S. , japan, germany, United Kingdom and france and if we look at one year again, we pulled out 2012 to 2014 at the replenishment, you can see the u. S. , 15 the u. K. At 15 , so on, so forth. Notable that the u. S. Is the leading institution in terms of financing the banks ida. And where is the money going . Ill come back to this at the end of the financing section. A lot goes for Health Systems, the blue. And its global based and problem based initiatives as chelsea discussed with gavi, the world bank spends on hell systems and goes against the kind of trend of focusing on diseases. And trust funds, many people dont realize this makes up a lot of money shown in the next slide. What are trust funds . These are that donors can set up for specific countries or projects. Give an example again, norway can partner with the u. S. And say we want to do something in maternal healthen they pool the money and set up the governance and can run it through the bank. The bank holds it, but actually the financing and governance is separate. Theyre called trust funds, theyre separate to the ida, kind of what i call the back source of the bang bank in a way. Its hard to look at the trust funds if we plot it and the green is trust funds, you can see its the biggest lines, its a lot of money going into these and i want today draw attention to those. In a way similar to the earmarked funds, just a different modality. If we look at global funds, what are its donors, it actually is the u. S. , france, the u. K. , 95 comes from bilateral donors and hopes for partnership, they would attract new monies from private sector, from philanthropies, from a broader sectors, versus the financing base, but most of its bilateral, and 4 . The Gates Foundation and rondelling red you might have heard of, private company and is percentage goes. And gavi, and gates playing an important influence, 25 since it started and then the u. K. Here and then the u. S. So, what comes out here, just to kind of summarize, what does the financing sector tell us . A lot of the growth in financing, i think its estimated about twothirds since 2000, thats come from three donors, the u. S. , the u. K. And the Gates Foundation. So while we think of Global Health as this global activity, more and more initiatives and partnerships, actually the core financing base has narrowed down to three and thats made interesting and difficult positions for the director general or the head of the institutions to be in when youre depending on a few donors for large part of financing, ill turn back to chelsea. One of the areas that our students have gotten increasingly interested in is how much can they know if theyre curious about the work of any of these four institutions that we focused on. How much can they themselves discover . How transparent is the world bank in what it chooses to finance . How transparent is w. H. O. In who it chooses to partner with . How transparent is the global fund in what it chooses to provide financing for or not . How transparent is gavi in who it choose toss work with on new vaccines or not . And the answer varyies fairly significantly across these institutions. And the answers vary not only with respect to the public, but even with respect to some of the partners and the constituents that make up the governing bodies of institutions themselves. This is important not only because of an increasing norman expectation that all of us think share that we should be able to know kind of how our tax dollars are being spent and invested because ultimately the bilateral donations that the United States makes or the u. K. Makes are financed from our respective treasures, bies, but whether we may want to work with those institutions or partner with those institutions. For those of you interested in academic careers, how easy would it be to do research on those institutions or not. And so, as you kind of see in the kind of slightly populated graphs on the screen, all of the four organizations, but for the w. H. O. , have open information policiesment you know, what those mean in practice varies, but the global fund and gavi are often cited as real leaders in being transparent and open and acceptable by the National Transparency index, by publish what you fund and kind of the watchdog organizations and yet, the world bank, which has been probably of all of the institutions that we engage with, the most scrutinized for being the hardest to actually scrutinize, has made significant strides in the last six years in being more transparent about what it funds, where it funds, its contracting and of who it partners with and who it doesnt. The who provides very little visibilities into what it chooses to fund at a granular level and how it makes decisions and we call that out here because we think its important to note that kind of the institution most expected to set kind of the Global Health agenda, the nugs institution that has the ability on this screen to establish real norms in Global Health, the only institution that has the ability to engage in hard power, treaty obligations, it would have those enforced, if were thinking about the Tobacco Control convention or other work we think that w. H. O. Should engage with, it is the least transparent and the hardest, arguably, to then hold accountable or to hope to be able to persuade it to engage in moving the world toward Greater Health for all. And so t