 Good morning. Good morning. Welcome to CSIS. We've tried to put out an extra amount of water today for those of you who've walked long distances and need to hydrate. I'm Steve Morrison, director of the CSIS Center for Global Health Policy. We're delighted to come together again this year with our partner, the Kaiser Family Foundation, Jen Cates, the senior vice president of the Kaiser Family Foundation, to review the outcome of the G8 and this year also the G20 with special focus on development and global health issues. This is, I believe, it's the sixth consecutive year that we've done this jointly with Kaiser. It's proven to be a very valuable tradition. And particularly to hear the reflections, the sort of reflections while they're still fresh from those policymakers who are at the table. And we have today Ambassador Len Edwards and NSC director Mark Abdu who kindly agreed to join us. And so we're very delighted to have them with us. I'll come back to them in a moment. Our partnership with Kaiser is among the most valuable that we have enjoyed over the last decade. Kaiser is a very exceptional institution. It's an operating foundation populated with great talent and sets the gold standard for data analysis and policy insights into health. We'll hear from Jen in a few minutes some of the most recent data 2001-2008 on OECD commitments. Ambassador Len Edwards kindly agreed to come to Washington to be with us today. He is the special representative of the Canadian Prime Minister to the summits, the Sherpa in the diplomatic language for the summits. He's the former as of June. He stepped down as the Deputy Foreign Minister. He has consecutively served as the Deputy Minister in three different agencies, departments, going back nine years, foreign affairs, agriculture, and trade, and served as ambassador to Japan and to Korea has had a very distinguished career. We're also very delighted to have Mark Abdu with us today. Mark is the director for global health and food security on the National Security Council at the White House. Prior to that, served in many positions at health and human services, most recently as the acting deputy director of the Office of Global Health Affairs. He's had extensive experience over the last several years in the various diplomatic fora in preparing for the GA and handling many other issues, including the preparation of the accountability report that we'll hear more about today. And so it brings a wealth of experience on these matters. While I'm on this, I want to quickly thank a number of people who contributed to making this event happen. Seth Gannon, Daniel Porter, Carolyn Schroet, Assad Moten, Catherine Strife, Lizzie Cohen, Suzanne Brundage from CSIS, from Kaiser Craig Pulaski, and Adam Wexler have been very helpful, and from the Canadian Embassy, Frank Ruddock. And we're joined today also from Ottawa Ron Garcin and Tracy Fife. I'm great to see you both here today. We'll hear more this morning about the moment of big transition that's underway. I'm going to say a few words about that big transition in terms of the way that the G8 and G20 are evolving. We'll hear a brief presentation from Jen Kates on the data that they've just issued, and then we will move to our two presenters, Ambassador Edwards and Mark Abdu, and then we will have a discussion. And as part of that discussion, open to the floor for comments from you. The G8 is an old club. It's an old and small club of liberal democracies of dominant donors dating back to 1975. It's important to remember that it didn't really begin to embrace seriously global health and development issues until the second half of the 90s, and that didn't really accelerate until this last decade. It's an organization that over time has acquired a pretty broad agenda of economics, development, security, conflict, issues. It has obviously strong constituencies, both in the alignment with the developing world, but also internally with non-governmental groups and advocacy groups, and many of you who are represented here today. In the last decade, there's been enormous activism by the G8. And I think when you see the data that Jen Kates is going to present on the period 2001 to 2008, it's rather dramatic the way the numbers were driven up during that period in terms of commitments on global health. And I think the G8 can claim predominant credit for having driven that process forward. There are many other high-impact contributions in the last decade, the Global Fund, the Gavi Alliance, many particular initiatives certainly surrounding HIV-AIDS, but then broadening in recent years. We are clearly at a turning point and an uncertain turning point in terms of the G8's future and its role. And I'll just quickly highlight. First is the decision taken at Muskoka to retire the Glen Eagle commitments, which was controversial, difficult, somewhat embarrassing, and to move on. And this was really a decision that was taken that at the five-year mark, it was time to retire this and move forward. That was an admission that things had become more difficult. I think it was an admission that the protracted global recession, the worsening debt and deficit situations in many of the G8 countries were such that you weren't going to see a quick turnaround. It also means that we see a concentration of leadership and continued funding in just a small core of states, US, Canada, UK in particular. The accountability mechanism that was rolled out at Muskoka, very important. A very new development in terms of peer review and data collection. Canada deserves enormous credit for having driven that process forward. Others like Mark, who contributed directly to that, will hear more about that. It will continue to be a live presence in the future in evaluating performance and guidance. We'll hear more today about the MCH initiative, the $5 billion five-year commitment, and how that was created, how that will move forward. It is an important initiative. It's modest. It's important. There are continued questions around implementation and coordination issues. So there's this unresolved question of what is the G8's future phase? And hopefully, we'll hear more from our speakers today about what kind of continued catalytic role it's going to play under these circumstances. Now, on the G20, we also have a transition underway there. It's a new entity by comparison, only two years old. Uncertain membership and mandate. It was created in the midst of the 2008 economic crisis to bring about greater coordination of emerging economies. It has yet to demonstrate, really, its ability to fulfill the kind of commitments made, going back to the last several meetings around the G20, with respect to bringing about much closer coordination on financial management, exiting the stimulus commitments, managing debt and deficit. What role will it play on development and global health in the long term is an open question. The Koreans have created the working group, the new working group on development. There's been some initial outreach in New York, at the UN, with the World Bank. There's more continuing looking forward. And I hope we'll hear more about that today. But I think when we look at the G20, we need to keep in mind that there are many countervailing pressures operating upon it, many of which would argue not to enlarge the agenda around development and global health in any rushed fashion, and I think we're going to see quite a bit of caution and care moving forward. The G20 members, the G13, the emerging economies, are certainly seeing a much stronger stake in the developing world. Their engagement is matching the power and force in the developing world of the G8 countries. The G8 troubles are creating a space for them to get involved. Development and global health are promising opportunities. The G20 has already gotten its feet wet in a number of these areas, creating now this new committee on development. Those are the forces that are sort of pulling them in that direction, but I think there's also others that will push for quite a bit of caution. The emerging powers have very special sensitivities around accountability, transparency, disclosure of data. We can talk more about that. They do not have strong domestic constituencies, arguing for them to take on new commitments outside their borders in the developing world, and there's the immediate pressure to do first things first. That is to focus on those immediate macroeconomic policy coordination, regulatory reform, control of debt, exit strategies, all of those economic crisis obligations that are still yet to be really worked out. And there's also great questions around where's the leadership going to come from to move the G20 forward on these, and there are clearly risks. Climate change stalled as it moved into the G20 orbit. There's no question that international property rights, that viral sovereignty, that all of these issues have put into a G20 context might themselves invite more tension in deadlock than they do in terms of inviting forward progress. So with those words, thank you very much for being so patient and for being here with us. I'll invite Jen to show us some quick data. Thank you. I see that Steve's already started to go through my slide presentation. Good morning, everyone. I want to echo Steve's welcome, particularly to our guests from the Canadian government and the US government who kindly came to talk about the G8 and the experience that they recently went through at the G8. Also want to acknowledge our important long-term partnership with CSIS on this briefing, but also on many, many things as Steve mentioned. It's really been invaluable to us as a health organization that focuses on health policy issues to be able to partner with a foreign policy entity and bring those two perspectives together. So what we've always felt with this briefing is that we all spend so much energy focusing on what will happen at the G8 and then during the G8 what is happening at the G8. And I think it's important to do a readout on what actually did happen and not lose that momentum because it is after the summits where important things should or continue to happen. And at every G8 we look to see what will be the focus, what will be the issues that are elevated, will health rise to a top agenda item and if so what will be the topic. And as Steve mentioned, health has not always been at the top although in the last decade or so that's really changed. And I would say for the most part it's been very HIV focused. Also at the G8 we look to see what commitments were made. So what we know about this G8 is that there was a health issue at the top of the agenda. It was on maternal and child health and some new commitments were made and these are important for looking at markers and measuring going forward. What these commitments will lead to is sort of the key question that a lot of us are focusing on now. And to help set the stage a little bit I'm going to in a sense do a retrospective, kind of look back and see where the G8 has been. It's not just the G8 but the G8 forms the bulk of most of the donor government assistance on global health. And when we do this report every year where we look at data reported to the OECD by DAC governments on their global health funding commitments and just try to get a sense of trends. I will just one thing that we also do is we look at health broadly. We include health which is basic healthcare, general health issues as well as population and reproductive health which is where HIV and STD programs fall as well as reproductive health programs and water and sanitation related to health. So we've used an expanded definition. As this was up before and I think there's some notable things in the slide. We also are releasing this report now. The report's out there so I'm just going to spend a couple minutes on a few things. You can see the increase over time overall in official development assistance. That's the total numbers at the top. You can also see over that time that health is actually growing as a share of that. What you can't see here is some of the reasons behind this and that's in our report. Particularly this very large jump between 2007 and 2008 which we noticed and we thought well what was going on there. There were several things driving that that are really important for thinking about going forward. A lot of that increase was due to economic infrastructure projects that are not health related. A portion of that increase was due to ODA for Iraq, Afghanistan. A portion for debt relief and some of it due to currency exchange fluctuations. So a lot of these things when you take them out of the equation there's still an increase but not as dramatic. And then of course the global economic crisis. And this becomes really important because one of the challenges to analyzing any of these data is that there's a real lag. And so when we were able to look at the quote unquote most recent data we're looking at budgeting decisions that were made before the global economic crisis really hit. So this is as Steve said this is really about the G8's legacy and the donor government legacy on global health more looking back and not clear going forward. This just breaks down that those total amounts over time by the sectors. The main point to take away here is that health has risen as a share of overall development assistance. It's always been favored as an area. Other big areas are economic infrastructure, multi-sector which combines a lot of different things that doesn't fall into these other categories. We also speaking of this 2000 to 2007 to 2008 increase we were really curious what was driving that increase. What were the factors that contributed to a 31 billion dollar increase in official development assistance over that one year period. And you can see here it breaks it down by the different sectors that drove it. And the biggest thing as I mentioned earlier was the economic infrastructure projects. Also multi-sector efforts and commodity aid. Health drove 10% but it certainly wasn't the biggest driver as we wouldn't expect it to be. But this I think is a helpful gauge as to what was driving that increase. We also always look at the donors that are contributing to health ODA. And as you can see here, the US is the largest and that's increased over time. And then by region, sub-Saharan Africa is the largest region and that's also increased over time. And again, all of these data are in the report. So this is just a flag for you. And one thing I'm not showing here is the sub-sectors of health. So if you look below these numbers, you can see what's driving the increase in health and it's largely been HIV AIDS funding. So a few take home messages and sort of a forward look. I think it's very clear ODA for health has increased over the period that we looked at, even if you adjust for inflation and exchange rate and look at all these other factors. But some real caveats to think about. The first being, as I mentioned, the lag in data and the budgeting decisions that we're looking at here were before the crisis. So it's not clear what they will mean for next year or beyond that. And we've already seen a slowing growth rate in health. I didn't show that here, but it has been slowing. So is there a caution that's warranted going forward? On the one hand, as we see from the G8, there's still attention to global health. There's the new initiative that was launched. There's the MDG review summit in the fall. There's the GHI by the US government. So there's still a lot of momentum around putting forth global health initiatives. On the other, if you look at the OECD's recent data on what's happening with official development assistance writ large, not on health, but just generally, it's actually relatively level between 2009 and 10, even in real and nominal terms. And some donors are actually decreasing and some are increasing. So it's not clear what this will mean. So going forward, it'd be really important to monitor how health fares in that equation and look at other markers in the near term since there's such a lag in the data. One marker, for example, is that what we'll talk about today is the fulfillment of some of these commitments. The other is to look at countries like the US, the UK, that tend to be the biggest donors and see what their funding amounts actually are. Global fund replenishment is in the fall, the MDG summit, these are all forward markers. I'll also flag a report that we're gonna release in about a week and a half on funding for AIDS by donor governments, which will actually provide some new data, more recent than this, which will give, I think, a little bit of a picture as to what might be happening. And just to wrap up, one thing to bring up Steve's point on the G20, I think the question of the G20 as donors is an important one to think about. If you look at the G20, there are 10 G20 members that are not in the DAC. And of these, five were global fund donors, three donated to GAVI and two to unit AIDS. So they are poised in some fashion to potentially be donors and six are actually, six of these non-DAC G20 members are classified by the World Bank as upper income countries. So what their role is will be important to monitor going forward. With that, we will hopefully hear from our government experts about what we can think about looking forward. Thank you, Steve, for the very kind introduction. That's very good to be here. I'm pleased to see Washington's a tiny bit hotter than Ottawa. I thought I was getting out of the hot town, but I came to a hotter one. It's great to be here for a number of reasons, whether perhaps being not one of them, but you actually have a chance to talk a bit about the summits. It's only been a week and three days since we wrapped up two back to back summits in Toronto and in Muskoka. And I think it's probably unique that any country has really organized these size of events back to back with them. And they truly were, I believe, quite an extraordinary set of events in conjunction of issues and so forth. As what I think has been pointed out is what used to be a single summit that we developed countries look forward to around the G8 has now become a series of G8 and G20 summits. And I'm pleased to comment on that. And of course, in our discussion period, which follows. I think what I'm going to do in order to set the stage for a good discussion is focus primarily on the G8 and talk a bit about the health aspects of the G8. Well, first a few general comments about how we approached this G8. And this is against the background of the fact that the G20 has been created. My Prime Minister Stephen Harper was very clear to me of what he wanted when we set out on this road last September really to start to work on these two summits. He wanted to have Canada look at the G8 and go to what he called a back to basics approach. And by that, it means to really try and find where the true value added of the G8 lies in a world in which we now have the G20 part of this evolutionary process that Stephen referred to. We felt that what we needed to do is play to the strengths of the G8, which is a group of leaders from developed countries, an organization where intimate and frank conversation is the norm, where we can deal with economic issues in passing but pass those on to the G20, but where we could really focus on two areas of strength of the G8 and one was the development agenda and the other was peace and security. Early on in the process, we then turned our attention to how we would approach the development agenda. As you know, it has been for some years now part of the practice in the G8 to get together with a group of African leaders. And Africa focus has always been a key part of the G8 and we decided to continue that practice and the Prime Minister ended up inviting seven African leaders to the summit. Then we turned our attention to what we would do under the development heading. And again, here the practice in the past has been to focus and as has been described, health has been a growing and important part of the G8 development agenda. And we had to select something and it became quickly evident when the Prime Minister came to this decision back in December that we would focus on MDGs four and five maternal and child health or child and maternal health, I guess to match up against the MDGs. And that this was something that fit well with the progress into 2010 when the UN would be holding its MDG summit in September, the high level of conference to review the implementation of the MDGs. And the two MDGs where progress has been leased were MDGs four and five. It didn't take very long in shopping this idea around. Here in Washington, of course, it received extremely favorable response. And in other capitals to realize that this was really, you might say a no-brainer, that this was an area where the world was crying out for attention and where the strength of the G8 as a catalyst, as a leader, as a convener, could really be helpful going into 2010. So this is how we started the process and I'll just describe a little bit of how we got to Muskoka. The work of the UN is important in this respect. The United Nations Secretary General is calling for a joint action plan which is focusing on women's and child health. He had a meeting in April which we went to. And we wanted to ensure that what we did focused very much and collaborated very much with what the UN was doing so that we could in fact give a boost to the UN's efforts and it would be seen as part of it. Again, the logic was incontrovertible. Hundreds of thousands of women die each year as a result of pregnancy and childbirth and progress on child mortality as slow and uneven millions of children die each year even before their fifth birthday. And as you all know, if you follow this subject, millions of these deaths can actually be easily prevented through access to public health services that we take for granted in Canada and the United States and so on. So we did believe that the G8 could make a tangible difference in improving the health of women and children in developing countries. So we took a very straightforward approach as the chair of the G8. We went and saw the World Health Organization. They told us that the game-changers would be to focus on health systems to ensure availability of public health services along the full continuum of care from pre-pregnancy to childhood. We took their advice and working with our G8 partners, including the United States, of course, very much at the forefront of this effort. We focused the initiative squarely on scaling up investments in health systems to improve access to health services, as I said, along this continuum of care. For example, sexual and reproductive healthcare and services, including family planning, the ability to give birth in a healthy facility attended by trained health workers, pre- and postnatal visits with a healthcare worker, childhood immunizations, well, you know it, prevention and treatment of HIV, AIDS, malaria, diarrhea, pneumonia, safe drinking water, sanitation, and nutritious food. So once we determined what we would include in this, and there was a fairly significant work went into this within the G8 working with the OECD and others, we then focused on the issue of securing new resources. And what we wanted to get here, and I emphasize this, was new and additional money. We wanted to scale up investments to support the services we've just identified. And with this launch at the summit, G8 members committed to, as you've heard, five billion in new and additional financing for maternal and child health out to 2015. Now, let me emphasize that this is new money. There's nothing double counted. There's no recycled announcements. There's no robbing Peter to pay Paul. This is all new. We're also extremely confident that this figure will increase significantly in the years to come. And as the declaration out of Muskoka says, we expect to mobilize significantly more than 10 billion by 2015. So that was the G8 portion, but there's much more, much more to this initiative. And indeed, it was part of it right from the beginning because very quickly we reached out to other countries to enjoy this. And to see whether or not they would be interested in building a partnership around this initiative, even though they weren't going to be in Muskoka, if they would be ready to have their contributions listed in the declaration, have their countries listed in the declaration. And so, Netherlands, Norway, New Zealand, Republic of Korea, Spain, Switzerland all joined in and are mentioned in our Muskoka communique. We then went to the foundations, and here I pay particular tribute to the Gates Foundation. We stepped forward at a very critical time to announce a $1.5 billion sum over five years. This was hugely energizing to the whole process. And for those governments within the G8 that were still thinking about it, it sent a signal that this was a very serious initiative and that we had strong outside support. The United Nations Foundation also joined in and there were others as well. So what we had at the end of the day was a $5 billion commitment from the G8, joined with a $2.3 billion commitment from non-G8 sources, both government and non-governmental. I think this is the special thing about the Muskoka initiative, and that is it's more than a G8 initiative. And it played to what I said earlier are part of the strengths of the G8, its ability to capitalize, its ability to convene. And so this coalition of the committed, you might call it, which we rolled out in Muskoka, I think that's a very important example of what the G8 can do and what we can even do in constrained economic circumstances. And the coalition, I think this approach, this partnership approach, which has been used before, but in this particular instance around new and additional resources provides a good example for further efforts going forward. Now we see that the coalition of committed broadening in the months ahead. In fact, later this month, the African Union Summit will be held in Kampala. It too is choose chosen maternal and infant and child health as its theme for the summit. And as I said, we have been working very, very closely with the United Nations and UN Secretary General is leading development of a joint action plan on the health of women and children for agreement at the September MDG summit. For Canada, if I may put in an advertisement for my own country, we committed of that 5 billion, 1.1 billion, which in fact adds to, I believe I'm right here, 1.75 billion that we already spent on this. And for 2.85, I think total of my right raising on this. So a part of the figures that you see for the G8 Canada is a significant contributor. We hope, of course, that this ongoing effort we have been part of will result in some significant further resources at the MDG summit in September. Now something about accountability and that is that we have built that into our plans. We work closely with leading agencies and institutions such as the OECD, the World Bank and others to define what would be included in the funds. And now we have set up a tracking mechanism to do this. I'm going to come back to accountability in a second, but let me just turn quickly to the other thing we followed up in the scope and that was food security. The La Quila Food Security Initiative was launched, as you know, with $22 billion committed towards sustainable agricultural development. And the only other issue that apart from maternal health that we really focused on at Muskoka was to continue to drive this initiative. This was an initiative of President Obama's last year. We joined in, we put 600 million new dollars on the table to help meet our share of the commitment. So we've been working closely with the United States and with others, other G8 partners to ensure that this commitment is made. The accountability process around La Quila fed into, in fact, the accountability report, which as others have pointed out is a bit of a landmark achievement for the Muskoka summit. Let me now turn my attention then to the accountability. I know that you have some interest in this and maybe I could just cover that before I conclude. Accountability, we believe, is one of the outstanding features of the Muskoka summit. I remember last year in Italy, when Prime Minister Harper mentioned this at the leaders meeting that he was going to make accountability a foundation piece for the G8 going forward. We had at the back of his mind, he had at the back of his mind. That again, the credibility of the G8 had to rest on being accountable. And we had long been criticized by NGOs and by our developing partners in the third world and elsewhere that we made big, fancy statements but we didn't live up to the words. And so we felt that we had to bring a new spirit of accountability to the G8. We was always our sense that the G8 had a good story to tell in development. Not a perfect story, but a good story, but we needed to improve the telling of it. So we're very pleased that with our presidency and with the support and leadership of others in the G8, we did release the Muskoka accountability report, assessing action and results against development related commitments. The report shows that the G8 is advancing credible responses to meet development challenges. For example, between 2004, 2009, G8 development assistance increased by over 40% to more than US 82.2 billion dollars. The G8 has provided about 80% of all resources to the global fund to fight AIDS, TB, and malaria. The G8 provides about 50% of all funds to the global polio eradication initiative. G8 members have canceled significant levels of debt, referred to earlier, freeing billions of dollars for developing countries to use more productively. The G8 has played a leading role strengthening countries capacities to prevent and resolve conflict. In fact, the G8 has surpassed its commitment in this respect. We said we would train 75,000 troops for peace operations by 2010. We've actually done 130,000 troops. A direct outcome of G8 support is increasingly effective African Union-led peace missions. However, this is not a perfect story, as I said, and we were prepared to find ourselves falling short in a number of areas. While Canada, the United States, and the United Kingdom have met our national glenegals commitments on aid volumes, some G8 members have further to go. We need to remain focused on the La Quila food security commitments as well to ensure we achieve the 20 billion dollars that were the objective. There were 22 billion dollars pledged. This is a landmark document. I think for the G8 going forward, it has to become an annual exercise. And I'm pleased to say that the French, who will be hosting next year, have already identified that food security and health will be the focus of the 2011 accountability exercise. The accountability report helps to further ensure continuity and attention to earlier centennial G8 commitments. Maybe just a final word then about the G20. It's been referred to, and perhaps there'll be some discussion shortly on this, but I think that this is a work in progress. The G20 agenda, as it broadens and takes on other issues, will likely see a greater convergence in subject matter between it and the G8. The area of development is the one where I think the jury is still out as to what can happen. Now, of course, the G20 is already involved in development issues. Right from the very beginning, part of the outcomes, and I refer to London particularly, were around the resourcing of international financial institutions. And indeed in Toronto, we celebrated success by concluding the general capital increases for the multilateral development banks, which put about 350 billion new dollars at the disposal of the banks and doubled the amount of lending capacity available. We also launched something called the SME Challenge. If any of you are interested, you probably know about it already, but this is quite an innovative new financing approach. And we canceled Haiti's debt. So where's the G20 going to go on development? It will certainly deepen at the Seoul Summit. Korea has made it clear as the next chair, they would like to see development as to be a centerpiece or one of the centerpieces of their summit. They have several themes they'll be pursuing, but this is certainly one they want to pursue. And we in Toronto saw the launch of a working group under the Sherpas that will help define the scope and subject matter for Korea's development plans. Our first meeting of this group actually is going to be taking place later this month. And I think there's even a preparatory call this week that my staff will be participating in. When you look at the areas, they're very broad. The paper that has been circulated, I believe at the UN just in the last few days, talks about nine areas, infrastructure, human resources development, trade, financial inclusion, food security, already there in a way, governance, something called the platform for knowledge of sharing, and the list goes on. Personally, I think that this is very much a work in progress, as I said. The Koreans themselves realize that greater focus is going to be perhaps brought to this agenda by the time solar rolls around, and it's only four months away. I expect that there's some hard work to be done here. I still think though, that there is a complementarity between the G20 and the G8 even in the development area. The G8 represents still the major donors. The G20 represents, I think, an opportunity to discuss the broader role that development plays in economic recovery. I think that the conclusion of additional African members as participants in the G20, as we did in Toronto, we had Malawi representing the African Union and Ethiopia and NEPAD, offers an opportunity for the developing world. To be part of the new framework, which came out of Pittsburgh and which was confirmed in Toronto. So I see development in that sense, very much at home in the G20, and providing a lot of, I think, very interesting opportunities for engagement. And of course, it will bring in the new emerging economies that need to play their bigger role on development. So I think the differing nature of the two groups will still mean the two groups have specific roles in development and it'll be distinct for some time to come. Of course, one can never predict the future. And as was pointed out, the role of the G8 is itself evolved considerably over time. Which Ben takes me back to your comment, Stephen, about the fact that in the mid-90s we weren't doing much on health. It's a major part of what we do. So I expect some of the G20 work is also going to evolve in that fashion. Perhaps I'll conclude with these comments and I look forward to our discussion. Thank you very much. Thanks, Jen and Steve. It's great to be here and it's particularly a privilege to be on this panel with our Canadian colleague, Ambassador Edwards. And kudos to the Canadians for doing a great job in getting us to a number of significant outcomes, including the Muskoka-MCH initiative. And it's no small feat that the Canadians were able to pull off two back-to-back summits of this complexity and to this degree of success. They were even able actually to get the health experts all to eat antelope in Geneva at that matter. And so you know the level of planning and detail that they have put into developing the summit. I'm not going to focus much on the G20 other than to say that I do agree with Ambassador Edwards that it is a work in progress, the G20's relationship to development and that we'll know more coming out of the sole summit as to what that work in progress is transforming into. I would say that it strikes me that the G20 is a sort of logical place to focus on economic growth and broad-based growth as a driver of development and making the next generation of emerging economies that can join the global economy and foster sustainable outcomes to basic human service needs for their people. Instead, I'm going to focus on a few things related to the G8, mainly global health and their accountability, the MCH initiative and development. As a backdrop to the G8 summit, our president, President Obama, recently released his national security strategy. In that strategy, the US recognizes development as a moral, strategic, and economic imperative. Countries that achieve sustained development gains are more capable partners they can engage in and contribute to the global economy and they provide citizens with the opportunity, the means, and freedom to improve their lives. The president will also be issuing a new development policy in the near future and at the start of the MCH summit, he previewed that policy in a fact sheet called the new US approach to development. It's on whitehouse.gov for those who are interested. And this development policy will focus on sustainable development outcomes by promoting broad-based economic growth, democratic governance, investing in game-changing innovations that have the potential to solve long-standing development challenges, and building effective public sector capacity to provide basic services over the long term. The policy also puts a premium on selectivity, leveraging the expertise and resources of others, mutual accountability, and on evidence of impact. This new approach served as the foundation for the outcomes the US hoped to help achieve at the summit. With regard to accountability, President Obama takes accountability very seriously, and I think both the Global Food Security Initiative and the Global Health Initiative ably demonstrate this. Canada showed tremendous leadership in coordinating a serious accountability process and accountability report that provides a candid assessment of G8 efforts. In health, we're doing pretty well, but there's certainly much more that needs to be done. The report is pretty frank about G8 countries' achievements and failures, and it makes clear that we need to redouble our efforts to meet our commitments. That's remarkable progress from where we were just a few years ago in the nascent accountability exercises under the German and Japanese presidencies. Just as donors ask our partners in the developing world to honor their commitments, we need to meet ours. This is tough, especially in tight budget times, but the credibility of both our governments and the G8 depends on it, and we do our partners and ourselves no service or favors when we make commitments and fail to honor them. This commitment to accountability and transparency guided our approach to the Canadian Muskoka NCH Initiative. Four months into office, I'm sure you all know, President Obama signaled an increased emphasis on maternal and child health when he announced the six year, $63 billion Global Health Initiative. The Muskoka Initiative, which will reduce the number of maternal newborn under five child deaths in developing countries by supporting strengthened country-led health systems and enabling the delivery of key interventions along the continuum of care, complements that increased emphasis and in ways builds on it. The GHI has been clear and transparent in what it will achieve over six years. The targets are out there, everybody's seen them and most of the global health world has commented on them, it seems, from the level of mail we've gotten about the initiative. We took that lens to Muskoka. Our objective was to work with our G8 partners to ensure outcomes were the headline for the initiative. Of course, to achieve outcomes, we need funding, that's a given, but in the G8 context and in the development field more broadly, we tended to focus too much on funding inputs and not enough on what we hoped that funding would achieve. We needed to change that and under Canadian leadership we did pretty well in terms of putting outcomes first when we make commitments and relying on data and evidence to guide our interventions. Our metric for success, of course, shouldn't be dollars spent, but instead actual lives saved. When it came time for the United States to make its funding commitment, we also wanted to be credible, transparent and accountable. Having a big number in the communique is great, but if we do that and don't deliver the goods later, as I said earlier, we do our partners and ourselves no favors. And it's better for our partners, to be perfectly honest, to know exactly what we are committing and what they can expect and they can then bank on them. These principles are particularly important in times of fiscal constraint and we owe it both to our domestic constituencies and to those we hope to help through our assistance to be absolutely clear as to what we're committing. So, we took credibility, transparency and accountability into account when we announced our commitment to the MCH initiative. That commitment was $1.346 billion above our fiscal year 2008 baseline. That commitment covers our fiscal years 2010 and 2011 and is in support of both the MCH initiative and program through the Global Health Initiative. The U.S. commitment is, as far as we can tell, the largest commitment over the 2008 baseline to the MCH initiative. And when you add the baseline with our commitment itself, it is roughly $2.6 something billion dollars. What this doesn't represent to be perfectly transparent is additional funding commitments above what the President announced in May 2009 in total for the Global Health Initiative. Our number is derived from the MCH family planning and malaria elements of enacted levels in fiscal year 2010 and the fiscal year 2011 President's budget. And on the malaria level, it's imputed at 89% given that malaria interventions, particularly in Sub-Saharan Africa, are overwhelmingly targeted at under five children and women of reproductive age. We only were able to commit two years at this point in time to the MCH initiative. This commitment, again, is based on the President's approach to development and the new business model we're implementing through the Global Health Initiative, both of which rely on rigorous evaluation of the impact of our programming to guide decisions related to future funding commitments. The good news is that the Global Health field has grown and matured. We've learned a great deal over the last decade about what works and what doesn't and about the difference between inputs and outcomes and about the importance and availability of the facts that can drive our analysis. So we plan on using the data and evidence generated through the implementation of the GHI in the fiscal year 2010 and 2011 as the basis for determining our Global Health funding allocations for fiscal year 2012. In terms of the specific interventions in the MCH initiative, one of the great things about it is it's not too prescriptive. There's a general body of evidence about what's needed and what worked and G8 and the other partners in this initiative are able to implement those according to their policy and programming objectives and priorities. What this presents is an opportunity. In order to really make sustainable progress, the president believes that we need to begin to forge a deliberative division of labor. We don't all need to be working in the same field, in the same place. We need to play to our respective added value. And so this is something that I hope as we move forward in implementing the MCH initiative, we can really take a look at, see how we can leverage each other's strengths to afford greater coverage and create better outcomes for the people that are trying to help. So I think that was probably enough of me talking and I'm going to stop there. And thanks again for coming. Thank you very much, Mark and Len. I'm gonna ask Jen to kick off our discussion here with a question. Would you like to do that? I actually had to have a question for Len specific to what the French are already beginning to talk about regarding next year's summit. What has been stated so far? What would be the next steps? And I think a lot of rather than lose momentum to think about the G8 going forward, we should all be thinking about what the points of intervention or opportunity are going forward. Well, it's a tough question to ask because France isn't represented on this panel. And I don't want to venture into ground where I'm speaking on behalf of my French colleagues. All we know is that the, as I said earlier that the accountability approach will be continued by the French. And we're going to be focusing on the two areas I mentioned, food security and maternal and child health. With respect to G8 practice, however, the next presidency really doesn't begin to make its plans known until into the autumn and then they only assume presidency in January. So I think we'll have to be a little patient before we can get a clear sense of what the French are going to pursue. But I think it's fair to say that all members of the G8 believe strongly that the G8 must continue to deliver value, must continue to focus on its core competencies and I expect that the French will continue to ensure that the G8 plays a very, very strong and useful role in it. That's a diplomatic answer. Works. Hope you don't mind. Appreciate it. You just follow up there. What I hear from your two presentations with respect to the G8 is that, certainly on behalf of the Canadian government and the United States government, the continued faith and belief in the value of the G8 in driving forward development agenda, a big shift towards the accountability and measurement of impacts, a focus in the near term upon two principal issues of the Food Security Initiative and the MCH and this kind of outreach function of trying to, in the case, in the midst of constrained budgets and tighter scrutiny of where the dollars are going, not only are you looking towards stronger accountability mechanisms, but you're also, you gotta look outside yourselves to new partners, right? And so, the G8 is doing that. Now, on the G20, I hear you saying that it's a work in progress. There is this division between, I mean, the G20 contains the G8 and it contains the emerging markets. It contains the NANDAC. It contains very wealthy countries that are large emerging markets that have quite a bit of resources that mostly are going towards internal purposes or they may have elaborated foreign assistance programs like China does that are highly branded and highly bilateral. So if the G8 is looking to continue to push in this way, accountability with a focus on a couple of core issues like food security, internal and child health, I assume also the HIV AIDS agenda does not fall away, the malaria agenda, as we've heard from Mark, that does not fall away either. How does the G8 imagine crossing that divide in order to bring the powerful emerging economies which have become donors unto themselves with equal, if not greater power and influence in the developing world in terms of the marketplace that struggle for influence. If you look at the numbers in terms of trade, concessionary financing, bilateral direct assistance, the Chinese are shoulder to shoulder with any of the G8 donors and you can make a similar argument less dramatic but a similar argument of some of the other BRICS countries. How do you imagine the G8 leadership, the UK, the US, Canada cracking that nut and trying to pull into these coalitions, those that are absent today? I mean, your MCH had a little bit of modest Korean involvement, but it was really the end states, the New Zealand and Norway and Netherlands and then a little from Switzerland and a little bit from whoever else I'm forgetting here. But there was not, it was notable that there was an absence of a commitment coming towards that MCH initiative from any of these powerful emerging markets except for Korea making them modest. Can you talk about that? Well, in terms of a global health agenda for the G20, there clearly isn't one and I think where the G20's real value at is, is as an entity that can figure out a pathway to help the very poor countries and developing countries really access the global economy and that's really what's needed for sustainable long-term economic growth and development across the board in many of those countries so that they can begin to put into place the policy decisions and legal and regulatory reforms that are really necessary to produce the types of development outcomes that lead to sustained provision of basic human needs and services. And so that's really where I think the value at is and I think that's what the G20's uniquely positioned to do and is moving in that direction under the Korean leadership. But presumably when you were looking for donors towards the MCH initiative, you talked to the BRICS countries, right? Well, we did some talking, but we, to be honest, we went to the countries where we felt that there was a ready opportunity to create partnerships. This is an ongoing effort. I mean, it didn't end in Muskoka and I think going into the review of the Millennium Development Goals this September, getting to the UN context, this is when we begin to expand that partnership and engage them. I agree entirely with Mark, by the way, about the G20. I think the G20 has been very focused on its own core agenda around economic recovery and the regulatory reforms and so on. With a good bit, as I pointed out, of contributions towards development, the multilateral development banks and so on. And Toronto, in fact, called for a very healthy replenishment of the IDA under the World Bank and the African Development Fund. So we see that playing there. I think if we can get, within this context of a discourse around the global economic model, for the global economy of the future, in which developing countries, including the poorest, pay a role. That would be, I think, a very important outcome from a so-called development agenda in the G20. I worry, frankly, that if we go too quickly into too full a development agenda in the G20, we will lose our focus on the real core things that we still have to accomplish in the G20, which is to get global recovery in place. Yes. Can I follow up on that? I mean, when you look at what's happening in the creation of the Development Working Group for the G20, it's been surprising to see the speed and the scope of outreach that has happened, right? In terms of the solicitation of input at the UN, the World Bank, and now a number of others, this paper that's circulating that's very broad, as you say, covers the full waterfront in terms of possibilities, nine different categories. Can you comment a bit on that? I mean, I'm just quite surprised that the Koreans are taking that approach because when you hear them talk publicly, they say, we are not opening a Pandora's box. We're going to open the window in a very controlled and focused fashion because we understand what may happen along the line. But here we have a process that looks quite different. It looks like a very much of a, let's throw the doors open and here where we hear. Well, again, like I can't speak for the French, I can't really speak for the Koreans either. But they have been close partners this year. We've had these summits within the same year. And I know that from the Korean point of view that they still want to focus on these core issues that the G20 must continue to drive forward. But I think that, as I said earlier, it's a bit of a work in progress. I think they've cast the net wide but they know they're going to have to narrow it and focus it. So, and they also want to be inclusive, which I think is very healthy. It does pose challenges to management of the preparatory process when you engage so many outside the G20 in it. But there's no question that's a very healthy thing that they're trying to do. I just worry that the amount of time they have is very short. There are still many things we need to get done on the financial regulatory agenda, on the issues around stimulus versus combined with fiscal consolidation to important messages out of Toronto. The need to continue to reform the IMF government structures which are still falling behind. Further finishments of, as I said, the development funds. There's a lot to do in the G20. And if the Koreans can get a solid start on a very focused development agenda along the lines we've been discussing, I think that's a big plus. Mark, could you answer the question? I would agree with Ambassador Edwards that this is really a work in progress and that we're at the very beginning as he noted the first phone call on the development agenda under the Korean summit is tomorrow. And so it's likely that we'll see a considerable narrowing of the focus by the time we get to the fall. And that one of the really important things that this demonstrates is this notion of a division of labor. So if you've got the G8 working on more traditional development assistance or humanitarian assistance type projects, then not everybody from the G20 needs to jump on board. There are other aspects of development as part of the development assistance that we can deliberately forge this division of labor so that we're all working to our respective strengths and achieving more than we would if we were duplicating our efforts and being efficient. I actually wanted to get at that point of division of labor or the flip side of being collaboration and coordination. And going back to the G8 specifically in Muskoka, one way to think about accountability going forward is what the delivery on the commitments is. The other way is how are the partners that have already agreed to be part of the Muskoka initiative in the G8 and elsewhere talked at all about coordinating their efforts to take advantage of who is best situated to do what interventions and use the opportunity as one for better coordination on the ground. I'd be curious to hear if that conversation is in the works or that came up in the discussion around the initiative. Well, why don't I start Mark and you're closer to this accountability report than I was, but I know the only accountability report is more than just numbers. We were looking at how money's being spent effectively, the impact that it's having and so on. Now, admittedly, that too is a work in progress because you need guidelines and so forth against which to measure effectiveness and so on. The numbers are one thing. And if you just focus on the numbers, you get a mixed picture, but you need to go beyond that. You also need to go beyond, and here's why I think the G8 has played an important role, is the catalytic nature of the aid it's put in place and the changes that have been brought through these very significant sums that they put in place. And the accountability report does make some comment on that. In Muskoka, we had a chance again through our African leaders present to talk about accountability. And a number of the African leaders in the room expressed their interest in following up on that discussion further. In fact, the AU African Union is doing their own accountability report, which is to be made public at some point over the course of the summer. And there was an interest in really joining these two efforts up. So you begin to look at the continuum of the donor accountability versus recipient accountability and everything in between, including those institutions we turn to to help deliver the plans and so forth that are in place to help deliver. So I think this is something, a very healthy development, which is going in a positive direction. Sure, and I would say that the G8 process is a very important first step toward the larger joint action plan that will be launched at the MDG high-level plenary review. And that will also afford an opportunity for greater donor coordination. So I think implicit in the Muskoka initiative is a need for coordination, who's doing what and where and with whom. And that type of thinking is fundamental to the Global Health Initiative in which we're trying to forge deliberate alliances both with our partners in governments and in private pharmaceutical organizations to align behind country-led plans to improve health systems. And I think that will carry through into the fall as we reach the high-level plenary. Thank you.