Hanoi GIZ Report

13th SN Conference Health and Social Protection Asia and Eastern Europe
13th Conference of the GIZ Sector Network Health and Social Protection Asia and Eastern Europe (SN HeSPAEE)
Demographic Megatrends in Asia and Eastern Europe Challenges and Opportunities for Health and Social Protection
November 13 14, 2013, Hanoi, Viet Nam
Acknowledgements
On behalf of the secretariat of the Sector Network, Health and Social Protection Asia and Eastern Europe, I would like to extend thanks to all those who helped make the meeting a success. First to Mr Thierry Khn for enabling a very open and lively exchange with BMZ. Thank you also to Ms Karin Kortmann, Mr Immanuel Gebhardt, and Dr Gnther Taube for taking time out of their busy schedules to participate in the meeting. Thank you also to Dr Klaus-Peter Schnellbach, for his continuous support, and to the members of the Sector Network Steering Committee who provided guidance throughout the planning process. Particular thanks are due to Prof Dr Nguyen Thi Xuyen, Vice Minister of Health in Viet Nam, for opening the conference and sharing the Vietnamese perspective with our participants. Special thanks also to our keynote speakers, Dr Thomas Bttner, Dr Karen Eggleston, Mr John Hyde and Prof Dr Giang Thanh Long, for their enlightening presentations and for sharing their expertise on demographic megatrends. While Mr Sameer Pujari, Ms Michelle N. Domingo-Palacpac, Mr Quyen Tran and Dr Thomas Ott contributed excellent examples of Innovative Approaches. The session coordinators played an important role in organising the thematic breakout sessions: Dr Barbara Kloss-Quiroga, Ms Kristin Hfner, Dr Heike Krumbiegel, Mr Frank Schneider, Ms Sandra Kissling, Ms Ingar Dring and Mr Lars Wissenbach. Very special thanks go to the Working Group / Task Team speakers Ms Franziska Frst and Dr Heike Krumbiegel who coordinated inputs from the Sector Network members. Thank you also to Mr Jost Wagner, Ms Nathamon Muangmit, Ms Shana Drr, Ms Miriam Colombo, Ms Le Thu Thuy, Ms Pham Thi Gam, Ms Le Thi Thu Thuy, Mr Le Duc Kim and Ms Marion Starke for their efforts in preparing the meeting and in ensuring it all ran smoothly. For their work in documenting the conference, we thank Mr Stefan Urban, for the photographs; Ms Rachel Harvey, who compiled this report; and the many rapporteurs who helped with note taking during the conference. Thank you also to the whole team at Sen Restaurant Tay Ho, for making our evening events so memorable. Finally, I would like to thank all participants for their enthusiastic contributions to the various sessions and for their continuing work within the Sector Network HeSPAEE. Anna Frisch, Sector Network Coordinator, Project Director GIZ Viet Nam
Table of Contents
Introduction .................................................................................................... 3 GIZ Sector Network Meeting Public Day 1 ................................................ 4 Official Opening Public Conference and Introduction to the Topic .......... 4 Demographic Developments Challenges and Opportunities .................. 6 The Demographic Challenge for Health and Social Protection ................. 8 Coffee Breaks and Networking ................................................................... 10 Expert Panel ................................................................................................. 11 Parallel Interactive Sessions....................................................................... 13 The New Funding Model of the Global Fund to Fight Aids, Tuberculosis and Malaria ................................................................................................... 17 Gala Dinner ................................................................................................... 18 GIZ Sector Network Meeting Public Day 2 .............................................. 19 Innovative Approaches ............................................................................... 19 Closing and Wrap up of Conference Public Days ..................................... 21 Appendix 1 Experts Biographies ............................................................. 22 Appendix 2 Abbreviations ........................................................................ 24 Appendix 3 Conference Agenda .............................................................. 25
Introduction
There is ample evidence of the demographic changes taking place in the world. But there is no simple answer to the complex questions posed by those shifts; the challenges and opportunities vary from one country to another. The 13th conference of this GIZ Sector Network asked to consider the particular impact of demographic megatrends on health and social protection in Asia and Eastern Europe. To help focus what is a broad topic, the conference was organised around five key demographic trends:
Continuing Population Growth Youth Bulge Global Aging Urbanisation Migration
Countries in Asia and Eastern Europe are facing these trends to different degrees and in different combinations. In Eastern Europe and Eastern Asia fertility rates are generally decreasing while life expectancy is increasing. Since 2010, much of Asia has been experiencing a youth bulge, but by 2040 that will be over. In Eastern Europe and Central Asia the total population is shrinking, while Asia is undergoing a rapid period of urbanisation and migration. Where the proportion of young people in a population is high, health and social protection systems will need increasingly to reflect their particular needs, such as in sexual and reproductive health. For example young people account for an estimated 40% of all new HIV infections among adults worldwide. The youth bulge also contributes to urbanisation and migration, further complicating the overall demographic picture. Aging populations are causing a shift in the global disease burden, from infectious, nutritional and maternal related illnesses to chronic and degenerative conditions. This implies greater demands for preventative health services and social protection systems to mitigate the specific risks of old age. Urbanisation tends to be characterised by inequalities, with poorer sectors of the population exposed to increased health hazards due to inadequate housing, sanitation and working conditions. Meanwhile migration patterns vary greatly from one region to another with an outflow of skilled health workers clearly placing a burden on the delivery of services in some countries, while an inflow of remittances contributes a significant proportion of GDP in others. The aim of the conference was to seek innovative solutions to address these challenges. By bringing together academic experts, field experience, and case studies, the Sector Network conference in Hanoi sought to motivate and inspire participants to incorporate demographic trends in their current and future work 3
GIZ Sector Network Meeting Public Day 1

Official Opening Public Conference and Introduction to the Topic

Thierry Khn - BMZ, Prof Dr Nguyen Thi Xuyen Vice Minister of Health, Viet Nam, Karin Kortmann Deputy Director General Sector Department The two public days of the conference on Demographic Megatrends in Asia and Eastern Europe got underway with official welcomes from representatives of GIZ, BMZ and the Vietnamese Ministry of Health. Karin Kortmann welcomed the participants and pointed out that while Germany was justly proud of its social insurance system, the oldest in the world that system was now under pressure because the population had been shrinking since 2003. In 1970 there were 25 pensioners for every one hundred workers in Germany, she said. That figure is now 32 and 4
expected to rise to 50 by 2030. The United Nations estimates the global population will reach 9.6 million by 2050. Responding to these trends will determine the social and economic success of a country, Ms Kortmann said. But elsewhere, national populations are rapidly aging, as made clear by Viet Nams Vice Minister for health, Prof Dr Nguyen Thi Xuyen. Viet Nam has recently welcomed its 90 millionth citizen and has become the 14th most populated country in the world. Viet Nam was part of the so-called golden population period, characterised by a high rate of working population compared to only a low proportion of dependent people. At the same time, the Vietnamese population has entered a period of aging in 2011 with an average life expectancy of 73. As a consequence, the current proportion of old people is 6% of the total population and will rise to 26% of the overall population by 2032. Therefore it was crucial to hold meetings such as this to discuss reducing birth rates and the integration of the elderly and those with disabilities into health and social protection systems, she said. Prof Dr Xuyen went on to praise the collaborative relationship between Viet Nam and GIZ and the spirit of mutual support and shared expertise.
Thierry Khn from BMZ reminded participants of the importance the German government places on health and social protection and the investments and partnerships it was making in support of its global development goals. He also underlined the significance of the conference topic. We must reflect the importance of demographic changes in our development efforts, he said. Germanys focus is on young people. This is unique potential in countries where the proportion of young people is growing. Mr Kuehn further agreed with Ms Kortmann that if we want to create strong health and social protection systems alongside sustainable development, we have to pay attention to demographic megatrends.
Demographic Developments Challenges and Opportunities

Keynote speaker 1: Dr Thomas Bttner, Former Assistant Director and Chief of the Population Studies Branch of the Population Division, UN DESA Demography is a friend if treated with respect, knowledge and evidence. That was the encouraging message from Dr Thomas Bttner, a demographics expert with decades of experience working for the UN. Dr Bttner was tasked with providing some context against which participants could better understand some of the key megatrends facing the world today overall population growth with a youth bulge in some countries, an aging society in others and a general pattern of urbanisation and migration. The good news is that there is growing acknowledgement that these trends are important. But Dr Bttner warned that population dynamics need long perspectives to be properly understood. What happened 40-60 years in the past still determines what is happening now. We need to get that message through to policy makers, he urged the conference. The projected global population by the end of the century is more than 10.8 billion. However, Dr Bttner said population growth was not inevitable. By far the greatest increase will be in Africa, followed by Asia, but rate of increase in Asia is slowing. Europe will move into negative territory. Within that trend there is a demographic arc charting a transition from high fertility and high mortality to low fertility and low mortality. In Africa, female fertility will reach what is known as the replacement rate of 2.1 children per woman by 2050. Asia is already approaching that point. As a comparison, Dr Bttner said United Nations projections suggested Chinas population would be reduced by 300 million by 2100, whereas Nigeria would see an increase of 700 million. But populations are constantly changing. The total number of children born depends on the fertility rate (number of children per woman) and the number of potential mothers. Women giving birth today were themselves born 15-50 years ago. All of which combined to create a phenomenon known as Population Momentum.
We are all living longer, with average life expectancies predicted to rise to 69 years by 2050 and 81 by 2100. That will mean a different, older world, Dr Bttner said. Age profiles within countries used to be pyramid shaped, he said, with more young people than old. But as countries develop, the shape becomes more like a rectangle. Demographers like to talk of a demographic window when the share of children in a population falls permanently below 30% and the share of older people is still less than 15%. But Dr Buettner warned that window only stays open for a limited time. Most developed countries have already passed it, but the least developed will not get there until 2020 at the earliest. Each country has its own trajectory. But the demographic bonus is only turned into a demographic dividend if countries prepare for it, he said. The Window of Opportunity (courtesy Dr Thomas Bttner)
Dr Bttner went on to highlight some key guiding principles for managing demographic changes: accelerate the transition to low fertility and low mortality, provide education after primary school, empower women and create jobs as well as data, data, data. Regular and accurate censuses were essential he said, but demographics are about more than just counting births and deaths. Demography is a friend if it is treated with respect, knowledge and evidence. And it is dynamic!
The Demographic Challenge for Health and Social Protection

Keynote speaker 2: Dr Karen Eggleston, Faculty Director, Asia Health Policy Programme Walter H Shorenstein Asia-Pacific Centre, Stanford University The government is responsible for ensuring that every citizen has access to basic education and basic health care. Demographic shifts are intertwined with two other major global transitions in health and economics and therefore these areas need to be considered together. That was the opening message to the conference from Dr Karen Eggleston of Stanford University. The world is witnessing a move from infectious to noncommunicable chronic diseases and to more urbanised, sedentary lifestyles, alongside increasing economic development with centrally planned systems abandoned in favour of market-based approaches. Dr Eggleston said there is a synergy between increasing life expectancy and growth of GDP per capita. The New Demographic Transition, she said, meant that most gains in life expectancy were now realized late in life. But, echoing Dr Bttners earlier comments, she cautioned that the muchvaunted demographic dividend is a one-time boost in GDP per capita, and only if the working age proportion of the population is productively employed. A good example would be Chinas astonishing growth since 1970 , an estimated 15% - 26% of which can be attributed to a demographic dividend. Increased longevity will clearly have economic implications. If people are living longer, they may wish to work longer and save more, but they may also wish to have more leisure time. Policies, including fiscal policies, need to support that. Dr Eggleston suggested Asian and Eastern European countries could leverage new technologies and learn from the mistakes of countries with a slower rate of aging to seek more effective systems for health and social protection. For example by anticipating, and investing in, an increase in healthy life expectancy and avoiding policies that discourage working past sixty. Beyond the demographic trend of ageing, gender imbalance in countries like China and India is also likely to have a major impact on future prosperity. Dr Eggleston suggested two guiding principles for policy development: Sovereignty - of the individual (choice and responsibility) Solidarity - by helping the disadvantaged, troubled and/or suffering 8
These, she said, could be realised through policy choices such as support for households caring for a disabled or elderly person, balancing individuality and paternalism, and defining basic versus elective health services. The main functions of the government in the social services sector must be to supply legal frameworks, to supervise private institutions and to provide last-resort insurance and aid. The government is responsible for ensuring that every citizen has access to basic education and basic health care. OECD Health Data 2013 (Courtesy Dr Karen Eggleston)
In addition, Dr Eggleston said, it was important that the link between services provided by the government, and the taxes that finance them are clear. Time was needed for institutions and citizens to adapt. For example, governments might wish to raise the pensionable age, but they should only do so for young people, not those already approaching the existing eligible age. Longevity transition and population aging are long-term, fundamental trends reflecting and shaping all public policies. In addition, medical advances and technological changes lead to profound questions of affordability. Dr Eggleston predicated that payment for value would be an important policy focus in the future but, she added, there is no panacea.
Coffee Breaks and Networking

A Sector Network is a tool for knowledge exchange and thus, networking was of great importance for the success of the conference. On Wednesday, the participants had several possibilities to network and exchange: Five minutes introduction round in which participants were moving through the room and introduced themselves to each other.
Coffee breaks and a two hour networking lunch offered enough

time to get to know the other participants and to exchange experiences and ideas. Project directors from GIZ further had a small networking lunch with representatives from KOICA.
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Expert Panel
Dr Thomas Bttner - former Assistant Director and Chief of the Population Studies Branch of the Population Division, UN DESA; Dr Karen Eggleston Faculty Director, Asia Health Policy Programme Walter H Shorenstein AsiaPacific Research Centre, Stanford University; Prof Dr Giang Thanh Long Deputy Director, Institute of Public Policy and Management, National Economics University, Hanoi; John Hyde - Senior Advocacy Program Associate, Asian Forum of Parliamentarians on Population and Development.
An expert panel, on which Dr Bttner and Dr Eggleston were joined by Prof Dr Giang Thanh Long, of the National Economics University, Hanoi, and John Hyde, representing the Asian Forum of Parliamentarians on Population and Development, held a lively discussion, with many questions posed from the floor of the conference, moderated by Jost Wagner. The panel was in firm agreement that an aging population should not be considered a burden, but rather should be embraced as a treasured asset. Prof Dr Long put forward as an example the indirect economic contribution made by grandparents who allow a younger generation to go out to work by providing childcare. Dr Bttner suggested we look to Disneyland, Florida where, he said, much of the workforce appears to be over 70 years old, healthy and happy. Prof Dr Long was asked whether Viet Nam was able to take advantage of the demographic changes it was facing. With more than 5% of the population now over 60 years old, the country is already entering a period of population aging. Many older people in Viet Nam are still economically active whereas many young people are unemployed, Prof Dr Long said. So indicators that assume a certain age group as the working age group may be misleading here. He went on to point out that only 20% of older people in Viet Nam are covered by some kind of social protection, and yet just a small amount of money can make a big difference to their lives.
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Dr Bttner reinforced Prof Dr Longs point, saying numbers should always be questioned. You must look behind them. Always ask what the data means he urged participants. John Hyde took up the refrain in response to a question about the challenges of migration in Central Asia. Tajikistan and Uzbekistan have very high remittance rates for migrant workers, he said, and that is the kind of evidence on which decisions should be made. However, around the world, politicians tend to reflect the prejudices of their constituents, Mr Hyde said. We have to convince them that taking a human rights approach produces better outcomes. We have to start talking about the economic benefit of a human rights approach to health policy. Dr Eggleston agreed, saying there were synergies between migration and old age protection. China introduced a rural pension system that had an intergenerational impact, she said. When the older generation reached pensionable age, their adult children felt more confident about migrating in search of work. There was repeated mention of the challenge of aging populations, but the younger generation was not forgotten in the discussion. There was a general consensus that targeted youth health provision and social protection was a crucial investment in the future. Each panelist was then asked by Anna Frisch to give one piece of advice to those in the room working on issues of health and social protection. Mr Hyde urged people to embrace their local parliamentarians since they were likely to implement change more quickly in communities than higherranking ministers. Dr Eggleston suggested thinking and planning at least five to ten years ahead, while Prof Dr Long wanted policymaking to be more demand based. Dr Bttner said the focus should be on the young but he added, do not just concentrate on the most important thing. Make sure you have the whole picture.
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Parallel Interactive Sessions

The afternoon session was devoted to sharing knowledge and experience through four parallel breakout groups with lead facilitators on hand to ensure things ran smoothly. Most combined a presentation relevant to their topic from a keynote speaker, followed by smaller group discussions, often based around specific case studies. The following represent the key findings as reported from each group. Breakout 1 Population Dynamics: Opportunities to realise the demographic dividend
The demographic dividend only becomes an opportunity when a country is able to maximize the potential of a large working-age population. If not, it is a challenge. Thierry Khn presented the new BMZ position paper Population Dynamics in German development cooperation which aims at stressing the cross-cutting nature of population dynamics and giving new conceptual directions to GDC existing involvement in the field of population dynamics. The issue requires a global response. For example, the 15 to 49 years age group is increasing exponentially in Pakistan. But Pakistan alone cannot create sufficient jobs and opportunities. Changes in migration and education laws may be required in donor countries. Neither can the challenge be adequately resolved without transparent, valid and tested data. Measuring the impact of interventions on demographic trends is difficult in the short term because it takes decades to materialize. However, timely interventions maximize impact. South-south learning is a good platform to allow governments to benefit from each others experiences. The BMZ is strongly engaged in setting the international agenda for population dynamics through upcoming conferences: review of 1994 International Conference on Population and Development (ICPD) and post2015 development processes. 13
Breakout 2 Population Dynamics: How to meet needs in pluralistic health systems In most countries in Asia the majority of health services and health commodities are provided by the private sector. But the type of care depends on wealth. In low-income countries, out of pocket private payments are the norm, whereas in higher-income countries the proportion of government funding is higher. Prof Dr Dominic Montagu, Associate Professor, Epidemiology & Biostatistics - lead private sector healthcare initiative, University of California, set the context for the second breakout session with some key trends and questions to think about. There is no reason to suggest that growth in the private health sector will lead to better outcomes than growth in the public sector, he said. Private facilities need to be integrated into overall country health systems and health system planning. For example, Prof Dr Montagu said, if you want to get family planning services to young women who do not want to go to a public clinic for reasons of anonymity, then private clinics should be supported to fill that need. There was some discussion about the possibility of development/NGO programmes having unintended consequences. If services are provided free, might that undermine the development of lasting private provision, for example? In other words the short-term goal of delivery might undermine the long-term strategy for health care provision in that country. The session then broke into four smaller groups, each presenting a case study followed by discussion focusing on successes and challenges, lessons learned and the practicality of exporting models to other contexts and countries: Bangladesh - mapping healthcare delivery in Bangladeshi cities Cambodia - peer education networks for diabetes and chronic NCDs Nepal - providing adolescent friendly public sector services as part of the National Adolescent Sexual and Reproductive Health programme Kyrgyzstan - Improving access to high quality target group specific Sexual Reproductive Health Services.
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Breakout 3 The political economy of old age protection in Asia The third breakout session began with an informative presentation by Prof Dr Giang Thanh Long, Deputy Director, Institute of Public Policy and Management, National Economics University, Hanoi, who pointed out that societal ageing is quickly accelerating across Asia, mainly due to declining fertility rates and increasing life expectancies. However, the low coverage rates of existing pension programmes are a big concern. Without adequate reforms, Asias pension systems will be weak in dealing with old-age income support in the face of population ageing, Prof Dr Long said. Possible reforms included: Expansion of coverage Improvement of institutional and administrative capacity Improvement of pension fund investments Enhancement of financial sustainability Protection for the poor older people
The session then divided into three groups, each concentrating on a different country case study. Indias comprehensive social security approach was one example, with discussion largely focusing on the problems of including informal workers in a pension system. In the case of Indonesia, the ambitious transformation of existing pension providers into the national social security system provided much food for thought. While in the case of the Philippines, the group concentrated on strategies to extend health and social security to the poor. These included micro-insurance development, a savings programme with a pension component for the informal sector, and the national health insurance programme.
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Breakout 4 Tackling exclusion: challenges of demographic trends from an inclusive perspective Uwe Gehlen introduced the topic of the fourth breakout session by distinguishing between two ways of looking at the issue of exclusion: a human rights perspective and an economic perspective. How can we ensure inclusive growth, he asked. In her presentation, Dr Marianne Schulze adopted a rights based approach to explain the different aspects of exclusion and the factors behind it. Among those are social attitudes, communication and information barriers, physical barriers, and affordability. Structural discrimination refers to the situation in which all these factors are present. To ensure inclusion a common sense approach should be taken, Dr Schulze suggested, with an appreciation that this is an issue that concerns all of us. The session then broke into smaller working groups, focusing on three different population groups: people with disabilities, the elderly and migrants. Group 1 thought of ways to foster inclusion in our work. They concluded that, taking into account demographic changes, policy makers should think ahead (early interventions) for example in the education and health sectors. Group 2 noted that the elderly are increasingly excluded because of changing family structures and hence, a lack of family support. Contributory pension systems do not target informal sector workers, meaning they are excluded from formal schemes and are at risk of financial hardship in old age. Therefore, it is important to give the elderly a voice and advocate for their rights. Creating jobs for the elderly, improving financial literacy and creating inclusive social pension schemes were put forward as areas where improvements could be made. Group 3 discussed how migrants are excluded from health and social protection systems. The degree varies substantially depending on the regulations taken by the home countries, the host countries, as well as the businesses receiving migrant workers. Nepal was discussed as a case study where 4.81% of the 15-24 year olds are estimated to be working abroad. Most need medical certificates before travelling, but there is no system of quality assurance in Nepal and often these documents are being faked. There is also little evidence of any follow up checks for returning migrants. Stronger monitoring systems could be part of the answer to help strengthen social protection.
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The New Funding Model of the Global Fund to Fight Aids, Tuberculosis and Malaria
Gail Steckley, Senior Fund Portfolio Manager, GFATM The final presentation of the day came from Gail Steckley, Senior Fund Portfolio Manager with the Global Fund to Fight Aids, Tuberculosis and Malaria (GFATM), an important partner for German development, given that the federal government contributes 200 million Euro per year to the Fund. The GFATM has recently changed its funding model towards what is hoped will be a process that allows for a more equitable dialogue with partner countries, Ms Steckley said. The idea was to have a bigger impact, more predictable funding, a more ambitious vision, flexible timing and to make the system simpler for both implementers and the Fund New funding model cycle and timing itself. New Funding Model: Cycle and Timing (courtesy Ms Gail Steckley)
Ongoing Country Dialogue
TRP 2nd GAC
National Strategic Plan/ Investment Case
Concept Note 2-3 months

GAC
Grant Making 1.5-3 months

Board
Grant Implementation 3 years
There was a new emphasis on continuing dialogue with partner countries, with the Fund getting involved much earlier and the board much later, in the hopes of ensuring submissions are better prepared. This will include greater clarity about the way any funding is split between diseases. But the key change to the funding model is the greater degree of flexibility over the timing of submissions, she said.
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The Fund has tried to focus on the countries that have the least ability to pay. The higher the income-level countries are (based on World Bank definitions) the greater the restrictions. In addition the Funds website has been improved with plenty of information on specific countries. The GFATM does not have country offices, Ms Steckley reminded participants. This was a deliberate policy so as not to duplicate existing technical expertise such as that provided by GIZ. It was the general view of the room that GIZ should get involved early in the process and keep a focus on strengthening in-country health systems.
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Gala Dinner
On the evening of November 13, 2013, the participants of the conference were cordially invited to join a gala dinner at the Sen Restaurant which is located in the Tay Ho district in Hanoi. In addition to an enormous buffet with various Vietnamese foods, the guests enjoyed traditional Vietnamese music and dance performances and were able to try the traditional bamboo dance. The restaurant at the lake offered the possibility for networking with a fantastic view and in a great atmosphere. It was a welcome change of scenery for the participant; they enjoyed getting some fresh air outside the conference hotel and they got to know yet another delightful spot in Hanoi.
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GIZ Sector Network Meeting Public Day 2

Demographic Megatrends in Asia and Eastern Europe Challenges and Opportunities for Health and Social Protection Innovative Approaches
More people have access to a mobile phone than access to clean water. It is a shocking fact, perhaps, but Sameer Pujari of the World Health Organisation (WHO), says this new global reality can be harnessed as a force for good. Mr Pujaris presentation on the second public day of the GIZ Sector Network, Health and Social Protection, Asia and Eastern Europe conference sparked the interest of a number of participants. The theme of the day was Innovative Approaches and the examples on offer ranged from the highly technical to the surprisingly simple. WHO ITU mHealth initiative to combat non-communicable diseases Reducing child malnutrition through social protection case study Nepal Intergenerational self-help club (ISHC) Viet Nam IT-Tool DeCiDe demographic challenges in development
For the first time we have a communication mechanism to reach out to every person on the planet, Mr Pujari said. All countries in the world, regardless of GDP, are concerned with saving money in the health sector. mHealth (mobile health) could be part of the answer. The WHO has teamed up with the International Telecommunication Union (ITU) - the United Nations specialized agency for information and communication technologies - to launch a generic mhealth platform that is now being piloted. It can be programmed to focus on any non-communicable disease (NCD) or risk factor. Mr Pujari said the model is direct, targeted, and could be very cost effective. There are challenges, such as how to encourage government ownership, but the early results are encouraging. Technology was also on offer as a support tool for those who are not experts to be able to incorporate demographics into their work. DeCiDe was developed by the Office for Applied Geographic Information Systems as an 19
open source platform for development workers. Dr Thomas Ott was on hand to show how the system suggests a number of potential demographic challenges and matches them with weighted potential options to help users make informed decisions. The conference participants also heard the details of an Asian Development Bank case study aimed at reducing child nutrition in the mountainous Karnali region of Nepal. In 2010, the Government introduced the Child Protection Grant that allocates 200 Nepalese Rupees (about two USD) per month for children under five years old. Michelle V Domingo-Palacpac, explained that the project provides training and information at the village level, including advice about food preparation and hygiene, with the ultimate aim of improving child nutrition through social protection. The messages are delivered in person, by radio, and through the medium of street performance. The project is also using a network of contacts established by the United Nations Childrens Fund, UNICEF, to support community health workers and build the capacity of the local government to ensure all births are registered. Quyen Tran, HelpAge International, described an equally locally focussed project but with a rapidly expanding reach. The Intergenerational Self-help Clubs are, he insisted, not just about old people. They arose out of a desire to move away from vertical models towards something that was more inclusive and beneficiary led. All ISHC activities are directly managed through a five person strong board elected by the members. Each has its own bookkeeping and filing system but must produce a monthly financial plan and report. Mr Tran said the clubs had proved successful in responding to the multiple needs of the beneficiaries. The clubs tackle any issues of interest to members, from healthy exercise to homecare. HelpAge International and local partners support the clubs in getting started, but the idea is that they should be self-managed and self-sustaining in the future. The ISHC model is based on the principle of the people know, the people decide, the people do, the people monitor and the people manage. The clubs have been rolled out across 13 provinces in Viet Nam and the model has clearly captured attention, with other agencies, such as Oxfam and the United Nations Population Fund, UNFPA, now seeking to replicate it.
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Closing and Wrap up of Conference Public Days

As two days of debate, discussion, networking and knowledge sharing came to an end, the conference once more reflected on those affected by Typhoon Haiyan. A donation box had been set up and participants were invited to give generously, including an option to purchase conference display photographs with all proceeds going to the Philippines. All tables in the room were then given ten minutes to discuss and agree their key takeaways form the conference. The following is a list of selected highlights: New appreciation of the important role of private sector Adding mobile health to existing eHealth projects Interesting to hear about the Demographic Arc Aging population is not just a problem there can be advantages Social inclusion is not just about disability but also other groups such as migrants Pay more attention to young people More in depth analysis in country of demographic trends in order to plan projects further ahead more effectively Importance of convincing policymakers to address demographic issues More information on the potential health dividend of demographics is necessary Importance of hard evidence How to integrate what we have learned into social protection systems
Dr Gnther Taube, Director of Health, Education and Social Protection promised that GIZ would take away a lot of new ideas about how to look at demographic changes in partner countries. We have done a lot of learning, before, during and after the public conference, he said. Another participant remarked how welcome it had been to exchange ideas over coffee and cake. But another colleague highlighted the potential danger of that approach, saying their key take-away would likely be three kilos of added weight. That is a health challenge the conference organisers perhaps had not anticipated!
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Appendix 1 Experts Biographies

Dr Thomas Bttner is an economist and demographics expert with more than two decades of experience working on population related issues with the United Nations Secretariat in New York. He is currently employed as a consultant having previously held the position of Assistant Director of the Population Division, Chief of Population Studies, within the Department for Economic and Social Affairs. Dr Bttner travels extensively to conduct specialist training and presentations. Widely published he has also been involved with the development and implementation of demographics related software and databases. He has sat on numerous influential panels, including more than ten years as a member of the German Fund for World Population (Deutsche Stiftung Weltbevlkerung DSW), and currently as a member of the Board of Trustees, Berlin Institutes for Population and Development.
John Hyde is the Senior Advocacy coordinator for the Asian Forum of Parliamentarians on Population and Development. He also coordinates regional parliamentarian groups in East, South-East Asia and the Pacific and was a key driver in the adoption of progressive positions on population and development at the recent United Nations Asia Pacific Population Conference. He was the Member for Perth in the West Australian Parliament for 12 years, until 2013. He also served as Parliamentary Secretary to the Attorney-General and Minister for Health, implementing a range of human rights, population and development initiatives. In 2012 he was named as the Population Champion for Australia by the AFPPD for his work in advocating for progress on population and development issues.
Prof Giang Thanh Long is Deputy Director of the Institute of Public Policy and Management (IPPM) at the National Economics University of Hanoi, and a Vice Director of the Institute of Social and Medical Studies (ISMS). He is also an Affiliate Research Fellow of the Oxford Institute of Population Ageing, University of Oxford. Professor Longs research interests include the economics of aging and micro-simulation of anti-poverty programs for the elderly, particularly in Viet Nam, Indonesia and Myanmar. He was a member of the drafting team for Viet Nams Social Protection Strategy 2011-2020 and his research has been published widely, including in the Asian Economic Journal, Asia Pacific Migration Journal, Asia Pacific Population Journal, Asia Pacific Development Journal, Development and Change, International Social Science Journal, and Journal of Population Ageing.
Dr Karen N. Eggleston is Fellow and Asia Health Policy Program Director: Walter H. Shorenstein Asia-Pacific Research Center, and Fellow: Center for Health Policy/Primary Care and Outcomes Research at the Freeman Spogli Institute for International Studies, Stanford University. She is also a Faculty Research Fellow at the National Bureau of Economic Research and an Advisory Board Member of the Aging and Health Research Center, Institute for Population and Development Studies, School of Public Policy and Administration, Xi'an Jiaotong University, China. In addition, Dr Eggleston
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serves on the Editorial Board of the Journal of the Economics of Aging, Elsevier, and the Research Advisory Group: Asia Pacific Observatory on Health Systems and Policies. She has written, edited or contributed chapters to several books, including Aging Asia: Economic and Social Implications of Rapid Demographic Change in China, Japan, and South Korea, co-edited with Shripad Tuljapurkar, (Stanford University Walter H. Shorenstein AsiaPacific Research Center series with Brookings Institution Press: 2011). Her work is featured regularly in peer-reviewed journals and other publications.
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Appendix 2 Abbreviations
BMZ Bundesministerium fr wirtschaftliche Zusammenarbeit und Entwicklung (German Federal Ministry for Economic Cooperation and Development) Country Coordinating Mechanism Capacity Development Financial Cooperation Focal Point German Development Cooperation Global Fund to Fight AIDS, Tuberculosis and Malaria Deutsche Gesellschaft fr Internationale Zusammenarbeit Human Capacity Development Human Resource Development Health Systems Strengthening International Telecommunication Union Kreditanstalt fr Wiederaufbau Programme-based Approach Public-Private Partnership Quality Management Sector Network Sector Network Health and Social Protection in Asia and Eastern Europe Sexual and Reproductive Health Sexual and Reproductive Health and Rights Technical Cooperation Task Team Universal Health Coverage United Nations Population Fund United Nations Childrens Fund Working Group World Health Organization
CCM CD FC FP GDC GFATM GIZ HCD HRD HSS ITU KfW PBA PPP QM SN SN HeSPAEE SRH SRHR TC TT UHC UNFPA UNICEF WG WHO
24
Appendix 3 Conference Agenda
13th Conference of the GIZ Sector Network Health and Social Protection Asia and Eastern Europe (SN HeSPAEE)
November 13 14, 2013, Hanoi, Viet Nam Wednesday, November 13, 2013
08:00-08:30
Registration Official Opening & Introduction into the topic Greeting by

BMZ: Thierry Kuehn - Representative of BMZ Sector Department Health MOH: Ass. Prof. Dr. Nguyen Thi Xuyen - Vice Minister of Health Viet Nam GIZ: Karin Kortmann - Deputy Director General Sectoral Department
Song Hong Ballroom 1+2 Foyer
08:30-09:15
09:15-10:00
Demographic developments challenges and opportunities

Dr. Thomas Buettner former Assistant Director and Chief of the Population Studies Branch of the Population Division, UN DESA
Song Hong Ballroom 1+2
10:00-10:30
The demographic challenge for health and social protection

Dr. Karen Eggleston Faculty Director, Asia Health Policy Program Walter H. Shorenstein Asia-Pacific Research Center, Stanford University
10:30-11:00
Coffee Break Expert Panel & Talk Show

Dr. Thomas Buettner former Assistant Director and Chief of the Population Studies Branch of the Population Division, UN DESA Dr. Karen Eggleston Faculty Director, Asia Health Policy Program Walter H. Shorenstein Asia-Pacific Research Center, Stanford University Prof. Giang Thanh Long Deputy Director, Institute of Public Policy and Management, National Economics University, Hanoi John Hyde Senior Advocacy Program Associate, Asian Forum of
Song Hong Ballroom 1+2 Foyer
11:00-12:00
Song Hong Ballroom 1+2
25
Parliamentarians on Population and Development (AFPPD) Oven Dor Restaurant
12:00-14:00
Networking Lunch
14:00-15:00
Parallel Interactive Sessions

SESSION 2 Population Dynamics: How to meet the needs in pluralistic health systems SESSION 3 The political economy of old age protection in Asia SESSION 4 Tackling exclusion challenges of demographic trends from an inclusive perspective
SESSION 1 Population Dynamics: Opportunities to realise the demographic dividend
Song Lo
Song Hong 1
Song Thao & Song Da
Song Hong 2 Song Hong Ballroom 1+2 Foyer Song Hong Ballroom 1+2 Song Da & Song Thao & Song Lo
15:00-15:30
Coffee Break
15:30-16:30
Parallel Interactive Sessions (continued)
16:30-17:15
The new funding model of the GFATM

Gail Steckley Senior Fund Portfolio Manager. Global Fund to Fight AIDS, TB and Malaria
Song Thao & Song Da
18:30
Outside Dinner
Sen Restaurant Tay Ho
Thursday, November 14, 2013

Innovative Approaches
08:30-10:30 1. 2. 3. 4. WHO ITU mhealth initiative to combat NCDs Reducing child malnutrition through social protection case study Nepal Intergenerational Self-help Club (ISHC) IT-Tool DeCiDe: Demographic Challenges in Development Song Hong Ballroom 1+2
10:30-11:00
Coffee Break
Song Hong Ballroom 1+2 Foyer Song Hong Ballroom 1+2 Oven Dor Restaurant
11:00-12:00
Closing & wrap-up of the public days
12:00-13:00
Lunch
26

Hanoi GIZ Report

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13th SN Conference Health and Social Protection Asia and Eastern Europe

Continuing Population Growth Youth Bulge Global Aging Urbanisation Migration

GIZ Sector Network Meeting Public Day 1

Official Opening Public Conference and Introduction to the Topic

Demographic Developments Challenges and Opportunities

The Demographic Challenge for Health and Social Protection

Coffee Breaks and Networking

Coffee breaks and a two hour networking lunch offered enough

Parallel Interactive Sessions

National Strategic Plan/ Investment Case

Concept Note 2-3 months

Grant Making 1.5-3 months

Grant Implementation 3 years

GIZ Sector Network Meeting Public Day 2

Closing and Wrap up of Conference Public Days

Appendix 1 Experts Biographies

Appendix 3 Conference Agenda

Registration Official Opening & Introduction into the topic Greeting by

Song Hong Ballroom 1+2 Foyer

Demographic developments challenges and opportunities

Song Hong Ballroom 1+2

The demographic challenge for health and social protection

Coffee Break Expert Panel & Talk Show

Song Hong Ballroom 1+2 Foyer

Song Hong Ballroom 1+2

Parliamentarians on Population and Development (AFPPD) Oven Dor Restaurant

Parallel Interactive Sessions

SESSION 1 Population Dynamics: Opportunities to realise the demographic dividend

Song Thao & Song Da

Parallel Interactive Sessions (continued)

The new funding model of the GFATM

Song Thao & Song Da

Sen Restaurant Tay Ho

Thursday, November 14, 2013

Closing & wrap-up of the public days

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