Japan’s Global Health Diplomacy in the
Post-COVID Era
The Paradigm Shift Needed on ODA and
Related Policies

Special Commission on Japan’s Strategy on
Development Assistance for HealthJapan’s Global Health Diplomacy in the Post-COVID Era―The Paradigm Shift Needed on
ODA and Related Policies

Originally published as “Posuto-Korona no wagakuni no kokusai hoken gaiko—motomerareru ODA
seisaku nado no paradaimu shifuto.”
Copyright © 2021 Japan Center for International Exchange All rights reserved.
Author:Special Commission on Japan’s Strategy on Development Assistance for HealthPublisher:
Japan Center for International Exchange (JCIE)
Cover design: Kiyoko Shiromasa
Layout:Patrick Ishiyama

CONTENTS
Frequently Used Abbreviations ............................................................................................................. 2
Recommendations .................................................................................................................................... 3
1. Delineate “control towers” for global health and ODA and strengthen their capabilities
2. Set new targets for contributions to global health
3. Pursue strategic selection and concentration
4. Create synergy through the improved alignment of multilateral and bilateral ODA
5. Strengthen partnership with NGOs and other players from within and outside of Japan
6. Strengthen human resource initiatives to develop innovative personnel who can
respond to the changing global health landscapeBackground Report ................................................................................................................................. 14
1. Twenty Years of Global Health and the Advent of COVID-19
2. Japan’s Development Assistance for Health: Background & Issues
3. Action Plans: Examples of Potential Actions

References ................................................................................................................................................. 43
Appendix ................................................................................................................................................... 46

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FREQUENTLY USED ABBREVIATIONS
ACT-AAccess to COVID-19 Tools Accelerator

ADB

Asian Development Bank

AMEDJapan Agency for Medical Research & Development

CFE

Contingency Fund for Emergencies (WHO)CSO

civil society organization

C-TAP

COVID-19 Technology Access Pool

DAH

development assistance for health

GFF

Global Financing Facility for Women, Children and Adolescents

HRC-GH

Human Resource Strategy Center for Global Health

IHME

Institute for Health Metrics and Evaluation

JBIC

Japan Bank for International Cooperation

JICA

Japan International Cooperation Agency

LMICs

low- and middle-income countries

MDGs

Millennium Development Goals

MHLW

Ministry of Health, Labour and Welfare of Japan

MOF

Ministry of Finance of Japan

MOFA

Ministry of Foreign Affairs of JapanNCGM

National Center for Global Health and MedicineNGOnongovernmental organization

ODA

official development assistanceOECD

Organisation for Economic Cooperation and Development

OECD DACOECD Development Assistance Committee

PEF

Pandemic Emergency Facility (World Bank)

PHC

primary health care

SATREPS

Science and Technology Research Partnership for Sustainable Development

SDGs

Sustainable Development Goals

TICAD

Tokyo International Conference on African Development

UHC

universal health coverage

WHO

World Health Organization

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RECOMMENDATIONSThis report compiles recommendations by the Special Commission on Japan’s Strategy on
Development Assistance for Health, a high-level commission of leaders from Japanese
government, academia, business, and civil society. It was convened to enhance Japan’s
strategy for donor assistance for health, make its development assistance more e!ective,
and provide recommendations on revising the Strategy for Global Health Diplomacy and the
Basic Design for Peace and Health. It also includes background information on the evolutionof Japan’s global health policy and potential measures that can be taken to implement thecommission’s broad recommendations.
This 23-member commission was launched in November 2019 and chaired by former
Minister of Health, Labour and Welfare Yasuhisa Shiozaki, a member of the House ofRepresentatives. Over the course of one year, commission members met frequently with one
another, as well as with experts in Japan and around the world, and their deliberations wereshaped by the emergence of the COVID-19 pandemic and the growing need for Japan andthe rest of the international community to rethink how we strengthen global health systems
for the post-COVID era. The commission’s recommendations were initially rolled out in Japanon November 30, 2020, and on December 18, they were adopted as the basis for reforms
proposed by the ruling Liberal Democratic Party’s Policy Research Council.
The commission was formed as part of the activities of the Executive Committee on Global

Health and Human Security (Chair: Keizo Takemi, Member, House of Councillors), for which
the Japan Center for International Exchange (JCIE) serves as the secretariat. The work of the
Executive Committee and the commission is supported, in part, by grant funding from theBill & Melinda Gates Foundation. All of the recommendations in this report solely re"ect the
informed deliberations of the commission members, and do not represent the views of JCIEor its funders.
____________________________________________________________________________________________

Significant advances have been made in global health since the start of the 21st century, but as
the world has become increasingly interconnected, the threat of pandemics has increased as well.
The novel coronavirus (COVID-19) has clearly demonstrated that infectious disease poses a fundamental threat to the security of the world’s health, economies, and societies. It has shown us
again the devastating toll that health crises take on the most vulnerable elements of society andhas highlighted the existence of health disparities, reminding us how important it is that we return to the concept of “human security.” Now more than ever, we must adopt a human security
approach—a human-centered, comprehensive, and cross-sectoral approach that focuses on theinterconnectedness of health threats and other risks, such as economic crises.
In light of the COVID-19 pandemic, countries around the world share a common goal ofbuilding national frameworks that can withstand COVID-19 or other yet-unknown diseases that
may be even more infectious and virulent. To prevent such pandemics from occurring in the3future, we must rebuild and dramatically strengthen systems at the international and regional
levels. In a world where nations are inevitably connected, building resilience against infectious
diseases at the individual, local, national, and global levels has become a top policy priority. It isclear that a new logical construct is needed to determine policy priorities while recognizing diverse perspectives and values. In addition, as the world population continues to age and we see
an increase in noncommunicable diseases (NCDs), the demand for medical and long-term careservices is expected to rise. Society as a whole must strengthen its ability to address and adapt toincreasingly diverse health needs.
As the host of the 2008 G8 Toyako Hokkaido Summit, Japan successfully elevated health systems strengthening to a central place on the global health agenda. It also positioned universal
health coverage (UHC) as a key issue and was instrumental in having UHC included as one ofthe objectives of the Sustainable Development Goals (SDGs) when they were adopted at the
UN General Assembly in 2015. At the 2016 G7 Ise-Shima Summit, which was the first G7 Summit held after the adoption of the SDGs, global health was high on the agenda, leading to theadoption of the “G7 Ise-Shima Vision for Global Health.” That vision, which was well received
by the global community, set out a framework based on three pillars—(1) the attainment of
UHC; (2) the reinforcement of the global health architecture to strengthen responses to publichealth emergencies; and (3) the tackling of antimicrobial resistance. At the G20 Osaka Summit
held in June 2019, the participating states affirmed their efforts to achieve UHC, and in conjunction with that event, Japan also hosted the first joint session of finance and health ministers,
which helped establish UHC financing as a priority issue. This was also the first time the topic of
population aging was included on the agenda of a G20 meeting.
While continuing to lead on these international efforts, Japan should strive to meet new andemerging needs as well. In the Political Declaration issued by the heads of all UN member states
for the 2019 UN High-Level Meeting on Universal Health Coverage, the global community wasurged to strongly commit to promoting primary healthcare as a way to improve access to basic
health services, particularly for those who are vulnerable or in vulnerable situations; and to thecreation of resilient and inclusive health systems. This was considered critical in order to achieve
UHC as one of the core issues of the SDGs. Another crucial step, as COVID-19 has made clear,is the establishment of close collaboration between medical and public health systems at the local
community level. Providing effective support on a global scale to reinforce systems that integrate
the medical and public health sectors will help strengthen the global response capacity andframework for addressing infectious disease emergencies in the future.
Recently, the world has been undergoing a turbulent period referred to as a “G-Zero” era ingeopolitical terms, and it is therefore important that Japan, as a democratic country that respects
individual freedom and the rule of law, take firm steps and work together with other countries
and international organizations to maintain international cooperation and avoid any gaps in assistance in order to ensure the security of both Japan and the world.
Over the past two decades, Japan has been a thought leader in international discussions on
global health in areas such as infectious disease, health systems strengthening, UHC, and responding to health emergencies, and it has a strong track record of international cooperation
as well thanks to the assistance it provides for building resilient health systems. The stable4

delivery of social services is conducive to peacebuilding. Japan introduced a universal healthinsurance system for its citizens before it became a rich country; it has become a world leader
in healthy longevity; and, thanks to its strong R&D capacity, it has produced a large number ofNobel laureates. Given this legacy, Japan has the potential to exercise stronger leadership in thearea of global health in keeping with the foreign policy approach of “human security.” Moreover, further strengthening official development assistance (ODA) would directly benefit
Japan’s national security.
Japanese ODA stands out compared to that of other G7 countries in that infrastructure, energy, and water/hygiene account for a much larger ratio of its assistance. But as long as healthsecurity is not ensured, Japan’s development assistance will not be effective, even in an area suchas infrastructure, where it has relative strength. Now that pandemic preparedness has become acommon goal for all countries regardless of their income level, Japan needs to dramatically shift
its emphasis to the health sector, and while reviewing its approach to global health as a whole, it
should reconsider its overall ODA strategy as well.
To this end, the Special Commission on Japan’s Strategy on Development Assistance for
Health (see the appendix for the objectives and members of the Commission) presents the following six recommendations for the Government of Japan’s global health strategy. Specifically,
the Commission requests that these recommendations be reflected in Japan’s Strategy for Global
Health Diplomacy, adopted by the relevant members of the Cabinet in 2013, and in a revision to
the Basic Design for Peace and Health, which was developed and approved in 2015 by the Headquarters for Healthcare Policy (chaired by the Prime Minister and comprised of all Cabinet
members) as a guideline for global health policy under the Development Cooperation Charter,and that they be implemented as part of the government’s overall global health strategy.

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1. Delineate “control towers” for global health and ODA and strengthen
their capabilities____________________________________________________________________________________________C U R R E NT STATU S AND I S S U ES It is essential that the Government of Japan clearly delineate“control towers” and strengthen their ability to play a strategic planning function in order forJapan to exercise leadership in the process of building up systems at the global and regional levels
to prevent future pandemics. The Council of Overseas Economic Cooperation-Related Cabinet
Ministers (1988–2006) and Council on Overseas Economic Cooperation (2006–2011), headedby the prime minister, were formed as decision-making bodies within the Cabinet to drive thestrategic planning and implementation of foreign economic cooperation, but when the Council
on National Strategy and Policy was established in 2011 under the Democratic Party administration, the Overseas Economic Cooperation Council was eliminated. In the area of global healthpolicy, the Strategy for Global Health Diplomacy was developed by the Ministry of Foreign Affairs (MOFA) in 2013, and the Basic Design for Peace and Health was developed and approvedin September 2015 by the Headquarters for Healthcare Policy (chaired by then Prime Minister
Shinzo Abe) as a cross-ministerial policy to further contribute to addressing global health issues,
including those facing low- and middle-income countries (LMICs). These measures provided an
opportunity for the strategic planning functions for global health policy, including donor assistance for health, to be shifted in name at least from MOFA to the Cabinet Secretariat. However,the foreign policies of the Headquarters for Healthcare Policy and its secretariat, the Office of
Healthcare Policy in the Cabinet Secretariat, are primarily focused on promoting international
expansion by Japanese companies and medical institutions and they are not responsible for coordinating ODA policy. It therefore remains unclear which body is responsible for decision-making and leadership functions pertaining to ODA in the health sector.
R EC O MME NDATI O N In order to facilitate more flexible and effective responses to develop-

ments worldwide, a restructuring should be undertaken to clearly delineate and strengthen thecapabilities of a “control tower” at the Cabinet level, directly under the prime minister, that is
responsible for decision-making on overall ODA policies. As part of this effort, a “control tower”
for global health, including health-related ODA, should be clearly delineated and strengthened.
That control tower would have the components and functions outlined below and it would serveto align existing strategies and policies, lay out a new global health strategy, and promote theimplementation of that strategy in a way that allows Japan to serve as the type of real partner
required by the international community.
• A “Council on Global Health Strategy” (tentative name) should be established as a centralcomponent of the overall global health control tower. Coordinating some of the functions of
the existing offices and mechanisms in the Cabinet Secretariat, its role will be to develop andadvance a global health strategy, with particular focus on health-related ODA in the areas
listed in the “Strategic Selection and Concentration” section below. The “Council on Global
Health Strategy” should be comprised of director-general level personnel from concerned

6ministries and agencies including MOFA, the Ministry of Health Labor and Welfare(MHLW), the Ministry of Finance (MOF), the Ministry of Economy, Trade and Industry,
the Japan International Cooperation Agency ( JICA), and the Japan Agency for Medical Research and Development (AMED), and an executive director should be selected to serve forsome period of time. The executive director should have strong expertise, experience, capabilities, and networks in the field (for example, an individual who has held executive positionsin an international organization) and should be selected from a wide range of candidates fromboth the public and private sectors, irrelevant of ministry affiliation.
• In light of the fact that the Basic Design for Peace and Health was approved by the Headquarters for Healthcare Policy, it would be appropriate to position the “Council on Global HealthStrategy” under the auspices of that body. Members of the secretariat for the Council would
be seconded from MOFA, MHLW, MOF, and other organizations with due consideration tobuilding an effective team.
• A mechanism for public-private exchange (for example, a “Public-Private Global Health Platform”—tentative name) should be created under the Council so that members of academia,
NGOs, and industry, including pharmaceutical and medical device companies, can participate in policymaking.
• Staffing and institutional arrangements should be improved, and at the same time efforts
should be made to establish clear and systematic decision-making processes and two-waylines of communication between, on the one hand, the “control tower” and the ministries andagencies involved with health-related ODA, and on the other hand, those actually implementing development assistance on the ground (e.g., diplomatic missions, local JICA offices,
NGOs working the field, etc.), especially for countries and regions that are high priorities forJapan’s development assistance for health.
In addition, as outlined below, Japan must further develop the type of domestic systems necessary to delineate and strengthen the functions of the “control tower” for overall global healthpolicy. To do so, a certain percentage of the ODA budget should be used to improve human resource development and multistakeholder cooperation within Japan.
• Develop and enhance the capabilities of government personnel involved in global health cooperation, and implement human resource development and exchanges in cooperation with
NGOs and other private-sector actors, including through the creation of a “revolving-door”
scheme.
• Help strengthen NGOs and encourage them to be more active as important partners of thegovernment.
• Allocate personnel to provide technical advice to the Council and its Secretariat to support
the strategic planning functions of the “control tower” and set up a specialized working groupfor each strategic area by actively utilizing external experts and think tanks, including NGOs.
• Invest in human resource development efforts, training initiatives, and the creation of networks connecting relevant personnel in the public and private sectors, including Ministry of7

Defense medical officers, to enable the government to expeditiously dispatch humanitarianassistance when a health emergency occurs. In addition, promote knowledge sharing to learn
from Japanese staff of UN agencies and other international organizations who have firsthandexperience on the ground in providing humanitarian assistance.
• Improve the IT environment and information dissemination capabilities of government ministries and agencies.

2. Set new targets for contributions to global health____________________________________________________________________________________________C U R R E NT STATU S AND I S S U ES According to the White Paper on Development Cooperation

2019, Japan’s gross expenditures for ODA in 2018 was approximately US$17.25 billion (roughly¥1.905 trillion), ranking fourth after the United States, Germany, and the United Kingdom. The
proportion of loan aid in bilateral assistance is relatively high compared to the other G7 countries.
When we look at the breakdown by sector, Japanese ODA is characterized by the high percentage
of development assistance that goes to the infrastructure and energy sectors, in which loans usually account for about 90 percent of the assistance. According to statistics published by theOrganization for Economic Co-operation and Development’s Development AssistanceCommittee (OECD DAC), Japan spent US$930 million (¥102.7 billion) on donor assistancefor health in 2018, making it the fourth-largest donor among the G7 countries after the UnitedStates, United Kingdom, and Germany. However, donor assistance for health accounts for onlyaround 5 percent of Japan’s total ODA (5.4 percent in 2018), which is roughly one-fourth of theweighted average of G7 countries (21.4 percent in 2018; obtained based on the total expenditureby each on donor assistance for health), and less than half when compared to the simple averageof G7 countries (12.2 percent in 2018).
R EC O MME NDATI O N Japan should aim to double the funding directed to global health activi-

ties from both the public and private sectors in the next five years. First, the public sector should
lead the way and double its contributions (i.e., ODA). Then, efforts should be made to ascertain
the private-sector trends in the global health field and, based on a clearer understanding of thecharacteristics of private-sector funding, Japan’s contributions in global health should be increased through public-private cooperation. To this end, there is a need to better understand theextent to which private resources are being directed toward global health.
In setting a target for contributions to global health, a future-back approach should be adopted,
which is a method of defining the desirable future state and working backwards, in reverse timelapse fashion, to design programs to get to that desired future. Applying this approach, a demand
analysis should be conducted to identify the desired future outcome, a global health strategy
should then be developed accordingly, and finally, a target should be set for public- and privatesector contributions to achieve the strategy.
In doing this, Japan should increase its funding to multilateral organizations, strategically enhance support to the governments receiving bilateral assistance (such as providing yen loans for8

recipient countries to plan and implement policies on health finance reform based on close dialogue with their Japanese counterparts), and significantly enhance support for advancing andincreasing the efficiency of the health policies/strategies of recipient governments.

3. Pursue strategic selection and concentration____________________________________________________________________________________________C U R R E NT STATU S AND I S S U ES Project evaluation has long been the mainstream of ODA

evaluation, while issue-based evaluations that transcend individual projects or schemes have notbeen conducted on a sufficiently regular basis. In order to make Japanese ODA more effective,
issue-based impact evaluations should be carried out that cover both bilateral and multilateralassistance and, taking Japan’s domestic policy priorities into account, those results should thenbe used to allocate resources. In these cases, given that a large amount of private-sector funding
is flowing to LMICs and that the mobilization of local funding for the self-sustaining development of the recipient country is being encouraged, ODA, which is primarily aimed at the development of LMICs, should be used as a catalyst to mobilize various resources.
R EC O MME NDATI O N Japan should aim to contribute in the following areas, taking into accountbilateral priorities, national security and economic implications, and the potential for Japaneseindustry to contribute, including through Japanese R&D and digital innovation or medical/biotech venture businesses:• Contributions for health policy reform, including the achievement of sustainable health financing in the recipient countries, and contributions that will directly promote UHC basedon primary healthcare, including programs for maternal and child health, preventive
healthcare, and health promotion• Contributions to the provision of international public goods that cannot be entrusted to market principles• Contributions to evidence-based, high return-on-investment activities
In addition, Japan’s global health strategy should be strengthened, taking into consideration
demographic shifts, growing disease burdens from NCDs, and the market potential of not just
low-income countries like those in Africa, but also middle-income countries such as the ASEAN
member countries.

4. Create synergy through the improved alignment of multilateral andbilateral ODA____________________________________________________________________________________________C U R R E NT STATU S AND I S S U ES While the harmonization of bilateral and multilateral assis-

tance has been promoted through such schemes as grant assistance through international

9organizations, there has been insufficient collaboration at the operating level. Although Japan has
tried to be actively involved in decision making by dispatching representatives to the boards oforganizations where it is a leading donor, such as the Global Fund to Fight AIDS, Tuberculosis
and Malaria, the World Bank, the World Health Organization, and UNICEF, these Japaneseboard members struggle to have a substantial influence on deliberations because they are frequently rotated out to new posts and do not have sufficient time to win recognition from otherboard members or the executives of those organizations. Another weakness arises from the factthat the ministries and agencies involved in development assistance for health tend to be stovepiped and there is no sufficient framework for considering an overarching strategy nor for linking
up with experts who are on the ground and involved in implementing development assistance.
In order to make the maximum use of Japan’s limited resources, it needs to improve multilateralbilateral partnership and create synergy in development assistance.
R EC O MME NDATI O N In terms of bilateral assistance, the institutional arrangements (includ-ing human resources) for engaging in policy consultations and dialogues with development
partners—including recipient government and international organizations—prior to project
formation should be strengthened as a step toward developing strategic consistency in Japan’s bilateral and multilateral assistance and improving development outcomes in a costeffective manner.
For multilateral assistance, prior to deliberating on whether to make or increase contributions
to international organizations, Japan should strategically set forth policy targets and strengthen
its involvement with the management, strategy development, and financial planning of those organizations by implementing the following measures:• Actively take part in board meetings and other important governance meetings (e.g., participate in working groups, serve as the chair of meetings, etc.).
• Build a domestic framework, including collaboration and dialogues with civil society and academia, in order to enhance Japan’s contributions to these governance meetings.
• Strive to have Japan’s viewpoint reflected in the policies and strategies of international organizations by strengthening policy dialogue and communication with the top management ofmultilateral institutions.
• Deepen mutual understanding with multilateral institutions and regularly evaluate them fromthe viewpoint of Japan’s national interests, reflecting the results in decision making on Japan’s
future handling of those institutions.
• Significantly enhance dialogue and coordination with the country offices of multilateral institutions. To that end, carry out the needed reforms at the country level for Japan’s ODA
planning and implementation systems (e.g., delegation of authority, strengthening of humanresources, etc.).
In addition, to maximize the synergy and impact of multilateral and bilateral investments in a
specific target country, collaboration should be strengthened in the following areas in a way that10

applies a consistent strategy to optimally leverage the funding and expertise invested throughboth multilateral and bilateral assistance channels.
• Engage in program development from the earliest stages via multilateral cooperation.
• In the process of implementing projects, strengthen dialogues and cooperation on countrylevel program evaluation between the multilateral assistance and bilateral assistance agencies
involved.
• Provide strategic technical cooperation related to support for health policies and health systems strengthening in alignment with multilateral institutions.
• Strengthen the training and allocation of relevant Japanese human resources from a mediumto long-term perspective.
• Based on the specific conditions of each recipient country, improve and strengthen bilateralassistance activities in order to realize effective development assistance that leverages the respective strengths of multilateral and bilateral assistance.

5. Strengthen partnership with NGOs and other players from within andoutside of Japan____________________________________________________________________________________________C U R R E NT STATU S AND I S S U ES In the era of the SDGs, which espouse the philosophy of“leaving no one behind,” there is greater awareness than ever before of just how critical it is toensure the participation of and partnership with a wide range of stakeholders. In particular, theimportance and the breadth of roles played by civil society organizations (CSOs) are growing.
Their increasingly diverse roles include not only implementing projects at the grassroots levelbut also participating in the governance of international organizations, creating mechanisms fordeveloping and providing equal access to pharmaceuticals and other medical supplies, and acting
as agenda-setters by identifying emerging problems. Amid the COVID-19 pandemic, there havebeen published reports projecting that interruptions in the access to basic healthcare services
and food due to travel restrictions and other causes will lead to increased mortality among children under the age of five and pregnant women in LMICs. It is therefore of even greater importance than ever to support local NGOs that have been steadily working to improve access toessential healthcare services for vulnerable populations. However, support offered throughNGOs in Japan and overseas account for only 1.8 percent (2016–2017 result) of Japan’s total
ODA—the lowest ratio among G7 countries—representing merely one-tenth of the DAC average (14.7 percent).
R EC O MME NDATI O N Consultations and dialogues with NGOs and CSOs should be promoted,

paying respect to the diverse roles they play and their autonomy, and partnerships should be
strengthened with domestic and foreign NGOs and other organizations in the development of
global health strategies and related policies as well as in the planning and implementation of

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ODA projects. Moreover, full support should be provided to realize the rapid development of
the human resources and capabilities of Japanese NGOs so that they can play a leading role ininternational cooperation.
In terms of project planning and implementation, an analysis should be conducted of the bottlenecks responsible for the fact that too few ODA funds are currently channeled through NGOs
and concrete measures should then be taken to expand that support. In particular, while working
to mainstream social development–related projects, the current system must be reviewed andresolutions should be found for the various issues that are impeding them from submitting bids
for ODA schemes, such as grants or technical assistance. In doing this, a more flexible approachto project planning should be applied that takes into consideration the size of implementing institutions and the structure of individual projects, and NGOs with strong fundraising bases, solid
financial foundations, and specialized expertise should be permitted to engage in larger-scale
projects and in creating international initiatives with Japanese ODA funding, being treated in thesame way as JICA and other partners that implement ODA projects. In addition, the participation of social entrepreneurs, local municipalities, and others should also be encouraged. JICA
should increase its collaboration with NGOs by actively engaging them (either through commissions or joint implementation) in the project planning and implementation phases.
In addition, based on the understanding that local NGOs are delivering highly effective support to vulnerable populations through their ongoing efforts to improve access to essential
healthcare services and disease prevention, even if a host country government does not submit arequest to support local NGOs’ projects, Japan should expand its mechanisms to support local
NGOs and should strengthen collaboration between local and Japanese NGOs.

6. Strengthen human resource initiatives to develop innovative personnel who can respond to the changing global health landscape____________________________________________________________________________________________C U R R E NT STATUS AND I S S UES In September 2017, the Human Resource Strategy Center

for Global Health (HRC-GH) was established within the National Center for Global Health andMedicine (NCGM) in response to a proposal in the Vision for the Development of Human Resources for Global Health Policy calling on Japan to establish a culture that promotes the circulation of human resources through industry-academia-government partnership. The HRC-GH
encourages the posting of Japanese global health professionals in UN organizations, and while it
has yielded some impact in the placement of young professionals, the impact of its strategic support of such postings for senior-level professionals remains limited. And despite a common
recognition that greater diversity is required among global health personnel in terms of areas of
specialization and job experience, the currently available career paths lack flexibility, and we arefar from seeing the type of smooth and dynamic circulation of human resources across sectors
and specializations that is needed. Moreover, despite the increasing diversification of health issues and policy-support needs, and the resultant need for greater diversity in terms of the capabilities of health experts, there are still limited opportunities for existing experts to develop their

12

capabilities and acquire new skills and there are inadequate mechanisms to discover and cultivate
diverse experts or to collaborate with experts in academia.
R EC O MME NDATI O N In order to increase the numbers of Japanese personnel in internationalorganizations, a medium-term plan should be formulated for the training and strengthening of
human resources, and the functions of the existing HRC-GH and the Recruitment Center forInternational Organizations should be enhanced with a particular focus on the discovery andsuccessful placement of executive-level personnel. The medium-term plan may include the following measures:• Take a medium- to long-term approach and cultivate exceptional individuals who would beappropriate candidates for top- and executive-level positions in those international organizations that Japan prioritizes.
• Consider dispatching Japanese personnel, the costs for whom would be covered by the Japanese government in combination with an increase in its voluntary contributions to the receiving organization, to increase the number of Japanese mid-level officers who are responsible
for the practical operations of international organizations (establishment of senior professional officers [SPOs]).
• Offer support for internships at international institutions.
In doing so, it is important to remember that there are many non-medical positions at international organizations, and thus Japan should look for people across a broad range of professions,developing and strengthening internationally oriented human resources from academia, thinktanks, industry, and NGOs.
In light of the broad range of organizations and jobs related to global health, Japan must develop systems to boost the circulation of human resources among diverse fields, including systems for human resource development and exchange across sectors and job types including government, international organizations, academia, industry, and NGOs; and it should create
support systems, such as a “perch” mechanism for job seekers (a position in Japan where people
can segue in and out of international posts). Members of academia, industry, and NGOs should
be encouraged to participate in expert meetings for setting standards and international businessleaders such as managers in foreign subsidiaries or foreign companies should be encouraged toconsider a career shift.

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BACKGROUND REPORT
1. Twenty Years of Global Health and the Advent of COVID-19____________________________________________________________________________________________The emergence of new global health organizations and the expansion of international initiatives

From the mid-1990s, the spread of HIV/AIDS worldwide generated a growing sense of crisisand subsequently a greater recognition of the need for global initiatives to address health issues.
The Millennium Development Goals (MDGs), adopted in September 2000, included three goals
focused on health, and around the same time, several new public-private partnerships—including Gavi, the Vaccine Alliance (established in 2000) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (established in 2002)—were established outside of the UN system to mobilize funding for communicable diseases. With these, the scale of funding in the health sector
expanded rapidly.1 In addition, the 2005 Paris Declaration on Aid Effectiveness helped further
promote donor coordination and development assistance cooperation based on ownership on
the part of partner countries (OECD 2005/2008).
The rise of advocacy for health system strengthening and UHC
Along with the expansion of funding for the fight against infectious diseases, strong advocacy byJapanese stakeholders helped to raise awareness of the need for health system strengthening(World Health Organization 2000). Furthermore, the discussions at the International Conferences on Financing for Development (UN 2003, 2009, and 2015), turned the focus to the issueof sustainable health financing through the mobilization of domestic funding and its effective use(WHO 2005). In particular, there was increased attention paid to the risk of individuals falling
into poverty as a result of having to pay for medical bills and so during the process of formulating
the Sustainable Development Goals (SDGs) in 2015, universal health coverage (UHC)2 wasput forward as a shared global goal (UN System Task Team 2012).
The developing partnership between global health organizations and multilateraldevelopment banks
A report by the 2013 Lancet Commission on Investing in Health ( Jamison et al. 2013) advocatedthe philosophy that “spending on healthcare is not consumption but investment,” and in 2018,
the World Bank published a report on the “Human Capital Index” in 2018, indicating that health
1. Development Assistance for Health (DAH), which stood at US$12 billion a year in 2000, increased
to US$38 billion in 2015 according to the Institute of Health Metrics and Evaluation (IHME).
2. UHC is defined as ensuring that all people receive quality healthcare services that meet their needs
without exposing them to financial hardship in paying for them. (Definition by the World HealthOrganization (WHO) in its “Universal Health Coverage: Supporting Country Needs,” 2013).

14

issues were becoming a more mainstream focus at the World Bank and other multilateral development financing agencies. Following the 2014 Ebola epidemic in Western Africa, the World
Health Organization (WHO) established the Contingency Fund for Emergencies (CFE) in
2015, and the World Bank created the Pandemic Emergency Facility (PEF) the following year.
Also in 2015, the Global Financing Facility for Women, Children and Adolescents (GFF) was
created as a mechanism for channeling World Bank and other funding into the area of maternaland child health, which was deemed to be one of the unmet goals of the MDGs. Since 2017, a
UHC Forum has been held every other year under the auspices of the WHO and World Bank,and a report assessing the progress made toward achieving UHC is published regularly (WHOand World Bank 2020). This growing recognition of the necessity for close cooperation between
national health and financial authorities in order to ensure the effective and efficient managementof health financing led to the convening of a meeting of finance and health ministers at the G20
Osaka Summit in 2019 (MOF 2019).
An expanded role for nonstate actors in the SDGs era
In the era of the SDGs, which espouse the philosophy of “leaving no one behind,” there is agreater awareness than ever before of just how critical it is to ensure the participation of and partnership with a wide range of stakeholders. NGOs in particular are playing increasingly diverseroles, not only implementing projects at the grassroots level but also participating in the governance of international organizations, creating mechanisms for developing and providing equitable
access to pharmaceuticals, and acting as agenda-setters by identifying emerging problems. The
importance and the breadth of the roles played by such civil society organizations (CSOs) are
growing. Public interest is also growing in corporate contributions to solving social problems.
There are many examples of companies not just in the healthcare sector but also in non-healthsectors such as ICT, logistics, finance, and natural resources as well that are working to resolve
healthcare issues in low- to middle-income countries (LMICs) through product development,social contribution programs, social businesses, and so on. Moreover, private foundations suchas the Bill & Melinda Gates Foundation and the Rockefeller Foundation, equipped with financial
clout and expertise, have gained substantial influence on global health governance.
Status and challenges of promoting UHC
Despite the expansion of initiatives in the global health sector, there are still major regional gaps
in terms of their achievement of coverage for health and medical services. In Africa, the Abuja
Declaration, adopted in 2000, called for 15 percent of the national budgets of African Union
members to be invested in the health sector, but most countries have failed to achieve that target,
leaving the individual burden rate high.3 Moreover, many countries’ health systems will not beable to keep up with the future increase in the burden of noncommunicable diseases and the
3. According to WHO estimates in 2019, more than 930 million people (12 percent of the world population) spent 10 percent of their household budget to healthcare, with 100 million persons sufferingfrom dire poverty due to healthcare payments every year.

15

subsequent changes in the population’s health needs (GBD 2020). The WHO projects that it will
require US$371 billion a year in funding to realize UHC in LMICs by 2030, with US$54 billion
a year needed in financial assistance (Stenberg et al. 2017). In 2019, a High-Level Meeting on
UHC was held in conjunction with the UN General Assembly, and the leaders of all UN member
countries agreed to accelerate progress toward achieving UHC.
Significance of COVID-19
At the end of 2019, the novel coronavirus (COVID-19) pandemic began. The pandemic is having a devastating impact on LMICs’ entire health systems and on their overall socioeconomic
conditions, increasing the number of people living in poverty and jeopardizing the progress
made thus far in global health (Lancet Public Health 2020).4 There have been reports estimatingthat interruptions in access to basic healthcare services and food due to travel restrictions andother causes will lead to a 9.8–44.7 percent increase per month in mortality among children under five years of age and an 8.3–38.6 percent increase in mortality rates for pregnant women in
118 LMICs (Roberton et al. 2020). While the need for development assistance is growing, aid
funding is not expected to increase, which means that the funding gap will likely expand further.
The need for new international cooperation
In light of the COVID-19 pandemic, it has become evident that the current system of international cooperation, and particularly the mechanisms to ensure research, development, andequitable access to vaccines and other pharmaceuticals, is insufficient (Sachs et al. 2020). In
April 2020, an initiative called the Access to COVID-19 Tools Accelerator (ACT-A)5 waslaunched, which then established COVAX for the global joint procurement of vaccines
against COVID-19 (WHO 2020a ad 2020b). And, in response to similar concerns, the
COVID-19 Technology Access Pool (C-TAP) was launched in May 2020 by the WHO withthe aim of making vaccines, diagnostics, therapeutics, and other health technologies forfighting COVID-19 “global public goods” that are accessible to all (WHO 2020c). The
amount of funding needed in the coming year by the ACT-A is estimated to be US$38 billion,
requiring major countries to work together to strengthen international assistance as part oftheir domestic economic stimulus packages.6
4. Based on statistics from the IHME, the “2020 Goalkeepers Report” says the vaccination rate in 2020is “going back to 1990s levels” and “has been set back about 25 years in about 25 weeks” due to
COVID-19.
5. A framework of international cooperation for accelerating the development of and equitable access to newtools (vaccines, therapeutics, and diagnostics) to fight COVID-19. It came into being under the leadership of the WHO, France, the European Commission, and the Bill & Melinda Gates Foundation.
6. According to the ACT-A’s investment plan, the total funding needs represent less than 1 percent ofwhat the G20 governments have already committed to domestic economic stimulus packages, showing expectations that they will contribute 1 percent, or at least 0.34 percent, of such packages to the
ACT-A. (“ACT Accelerator: An Economic Investment Case & Financing Requirements, September
2020–December 2021,” WHO, 2020.)

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Toward 2030
It is estimated that the world population will increase from 7.80 billion at present to 8.55 billion
in 2030 and that one in every six people will be over the age of 65 by 2050 (UN ECOSOC Population Division 2019). The double burden of malnutrition (i.e., undernourishment and obesity)and the disease burden stemming from noncommunicable diseases are expected to grow rapidly,
boosting demand for medical and nursing care services (Foreman et al. 2018). Meanwhile, major
gaps are expected to remain in sub-Saharan Africa in terms of the progress on addressing thechallenges that were carried over from the MDGs to the SDGs.7 Moreover, the risk of infectious
diseases spreading along with the movement of people will continue to rise, and it is possible thatas-yet-unknown infectious diseases that are even more contagious and more virulent than
COVID-19 could emerge through the spread of vector-borne and zoonotic diseases. Anotherconcern is the growing diversity and complexity of health problems as a result of such factors as
the increasing number of natural disasters and greater risk of food production shortages as a result of climate change, the subsequent outflows of the working population to urban areas (UNECOSOC 2018), the adverse effects of air pollution on health, and the shortage of safe water.
The response & partnership required
In order to ensure health security in our own countries and on a global scale, it is essential that
all countries in the world have resilient and inclusive health systems. While understanding how
difficult it is in financial terms for LMICs—whose per capita national income is less than onetenth that of Japan—to achieve UHC, Japan should, as a “peace-loving nation,” proactively contribute to the global good of ensuring health security worldwide by expanding development assistance for health, taking full account of analyses of the current status and reform timelines ofindividual countries. In order to enhance preparedness for the outbreak of another infectious
disease and at the same time get back on track in the post-COVID-19 world toward achieving
the SDG health targets, we must explore new types of international cooperation that engage governments, international organizations, businesses, CSOs, and academia. From the perspective of
optimizing our use of limited resources, it is necessary to fundamentally rethink health systems
and the provision of health services in order to substantially improve efficiency, and tostrengthen collaboration between multilateral organizations and bilateral development agencies
in order to promote greater synergy.

7. According to IHME (https://vizhub.healthdata.org/fgh/), 95 percent of countries that are unable
to achieve the SDG goal for decreasing the under-5 mortality rate and 88 percent of countries unable
to achieve the SDG goal for the mortality rate of expectant and nursing mothers as of 2030 are estimated to be in sub-Saharan Africa.

172. Japan’s Development Assistance for Health: Background & Issues____________________________________________________________________________________________The Japanese government’s system for planning & implementing development
assistance for health
From 1988 on, a ministerial council headed by the Prime Minister was established within thePrime Minister’s Office and was tasked with driving the strategic planning and implementationof foreign economic cooperation—first as the Council of Overseas Economic CooperationRelated Cabinet Ministers (1988–2006), then as the Council on Overseas Economic Cooperation (2006–2011)—but it was eliminated when the Council on National Strategy and Policy wasestablished in 2011 under the Democratic Party administration. After the Great East Japan
Earthquake, the country’s reconstruction and economic revitalization became top priorities, andthere was a growing tendency to discuss ODA strategy within the framework of Japan’s growthstrategy (Dan 2016). The Development Cooperation Charter adopted by the Cabinet in 2015
stipulates that development cooperation is essential to secure national interests. In particular, it
identified the promotion of private sector–led growth through cooperation among the public
and private sectors and local governments as a driver of economic development in developing
countries, which it noted would lead to Japan’s robust economic growth as well (MOFA 2015a).
In its health-related assistance, Japan promoted measures in the 1990s to address the population issue and HIV/AIDS as global problems, and from 2000 on, it played a leading role in international policy discussions on measures to cope with infectious diseases, strengthen health systems, and promote UHC. In keeping with that, departments supervising health issues have been
set up within the government.8 A bimonthly meeting is held between the Ministry of Foreign
Affairs (MOFA) and NGOs in the health sector, and the Japan International Cooperation
Agency ( JICA) has established a Human Development Department that includes numerous
health experts among its staff.9 Furthermore, Japan introduced the New Global Health Policy
8. The Global Health Policy Division was established under the Director-General for Global Issues at
the International Cooperation Bureau of MOFA in 2011. In 2016, International Health & Cooperation Office was established in the International Affairs Division of the Ministry of Health, Labour &Welfare (MHLW) (renaming the International Cooperation Office that had been created in 2001).
In 2016, MOFA and MHLW have alternated in posting their officials as the head of the Global
Health Policy Division and of the International Cooperation Office. At the MOF, the post of Special
Officer for Global Health was established at the Development Policy Division, International Bureau
in 2018. And, when JICA overhauled the organization of its head office in 2004, it established a twotiered system that combined a country-based approach and an issue-based approach, while also setting up a “Human Development Department,” specialized in such issues as healthcare, education/
vocational training, and social welfare, in an effort to beef up functions of identifying and formulating
development projects and to strengthening capacity to address challenging issues.
9. According to research by JICA’s Human Development Department, as of March 2020, health group
staffers and senior advisors in international cooperation in the healthcare sector at the department
number 37 persons in total (excluding dispatch workers from staffing agencies specialized in clerical
work and company-contracted in-house consultants). They include 12 employees with national
qualifications in the healthcare sector (medical doctors, public health nurses, midwives, clinical18

2011–2015 in 2010 and the Strategy for Global Health Diplomacy in 2013 (MOFA 2013), positioning health policy as an important issue on the diplomatic agenda.10 In September 2015,
the Basic Design for Peace and Health was drawn up (MOFA 2015b) by the Headquarters for
Healthcare Policy (chaired by then Prime Minister Shinzo Abe) as a cross-ministerial policy,
which shifted the function of strategic planning on development assistance for health from
MOFA to the Cabinet Secretariat. However, the international activities of the Headquarters for
Healthcare Policy and its secretariat, the Office of Healthcare Policy in the Cabinet Secretariat,
are primarily focused on promoting international expansion by Japanese companies and medical
institutions, and they do not have authority for coordinating ODA policy.11 It therefore remains
unclear where authority over the functions of decision-making and leadership is vested for development assistance for health.
Track record of Japan’s ODA & development assistance for health12
As seen in figures 1 and 2, Japan’s gross expenditure for ODA in 2018 was approximately
US$17.25 billion (roughly ¥1.905 trillion),13 ranking fourth after the United States, Germany, and the United Kingdom. The proportion of loan aid in bilateral assistance is relatively
high compared with other G7 countries. Japanese ODA is characterized by the high percentage of development assistance that goes to the infrastructure and energy sectors, in whichloan aid usually accounts for about 90 percent of the assistance. The proportion of multilateral aid is around 20 percent, the second lowest figure among the G7 countries, next to therate of the United States. Japanese aid provided through NGOs at home and abroad accounted for 1.8 percent of the country’s ODA in 2016–2017, the lowest among the G7 countries and only a little more than one-tenth of the Organisation for Economic Co-operation

nurses, or occupational therapists), and 23 others with master’s or higher degrees related tohealthcare and public health. There are 26 healthcare-specialized employees having knowledge inparticular on the medical care system and medical care finance (corresponding to any of the following careers: having experience in administrative work at relevant national, regional, and governmental special agencies; having completed related courses at universities or graduate schools; or having
completed relevant short-term courses and undertaken related projects).
10. In an address to the Symposium on Human Security, a major event held at the Fifth Tokyo International Conference on African Development (TICAD V) on June 2, 2013, then Prime Minister Shinzo
Abe said he has positioned global health as an important task of his diplomacy. https://japan.
kantei.go.jp/96_abe/actions/201306/02symposium_e.html.
11. According to the Act for Promotion of Healthcare and Medical Strategy, a legal basis for the Headquarters for Healthcare and Medical Strategy Promotion, the headquarters’ mandate is to prompt
Japan’s economic growth through leading-edge R&D on health and medical care, and the creationof new industries. Regarding the development of business activities abroad, the ultimate goal of theheadquarters is to contribute to Japanese economic growth while also helping to improve the qualityof healthcare abroad.
12. Based on data compiled by specially appointed Associate Professor Shuhei Nomura of Keio University’s School of Medicine on the basis of data prepared by the OECD/DAC; the ODA results listed
in this recommendation are gross expenditures.
13. According to the White Paper on Development Cooperation 2019.

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and Development (OECD) Development Assistance Committee (DAC) average (14.7 percent) (OECD-DAC 2019).
Japan’s total expenditure on development assistance for health in 2018 was US$930 million(¥102.7 billion), ranking fourth among the G7 countries following the United States, the United
Kingdom, and Germany. However, development assistance for health accounts for only around
5 percent of Japan’s total ODA (5.4 percent in 2018), which is roughly one-fourth of the weighted
average of the G7 countries (21.4 percent in 2018; obtained based on the total expenditure byeach on development assistance for health), and less than half when compared with the simple
average of the G7 countries (12.2 percent in 2018). Multilateral assistance occupies 60–70 percent of Japan’s ODA for health, which is a larger proportion than that of the top donors in total
expenditures, the United States, the United Kingdom, and Germany. Among the areas receiving
assistance within the health field, health policy and infectious diseases (other than malaria, tuberculosis, and sexually transmitted diseases) usually represent a large portion (13.9 percent and15.7 percent respectively in 2018). Assistance for water and sanitation, though not classified as
the health sector, totaled US$1.33 billion (7.7 percent) in 2018, representing the largest value
and percentage of the ODA total among the G7 countries (followed in value by Germany with
US$1,292.23 million [4.5 percent], France with US$952.91 million [6.2 percent], and theUnited Kingdom with US$665.28 million [3.4 percent]).
Figure 1. G7 countries’ ODA by primary sectors (2018)

Source: OECD iLibrary.

20

Figure 2. G7 countries’ ODA disbursements for health (2018)

Source: OECD iLibrary.

Figure 3. Japan’s development assistance for health by field (2011–2018)*Classification based on OECD statistics (e.g., health sector = statistical code 120+130)
Source: OECD iLibrary.

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Trends & challenges in development assistance for health(1) Bilateral aid

Japan’s bilateral development assistance for health focuses on relatively small-scale loan aid andtechnical assistance. In terms of sectors, emphasis is placed on infectious diseases (other thanmalaria, tuberculosis, and sexually transmitted diseases) and healthcare services such as medical
facilities and equipment (20.8 percent and 19.6 percent respectively of the 2018 total), followedby assistance for community-level healthcare infrastructure and the creation of systems forachieving UHC (15.98 percent and 14.4 percent respectively in 2018).
For sustained UHC, capacity-building in terms of human resources and systems is indispensable. Since 2015, development policy loans (i.e., yen loans for health programs) have been extended to several countries,14 and moving forward, it is necessary to undertake further reg-ular dialogues on coordinated assistance that draws on analyses of national economic prospects andfinancing challenges in the recipient countries and that involves the partner country government,
multilateral donors, and other bilateral aid agencies. In LMICs, it is often found that there is insufficient capacity on the part of healthcare facilities, communities, local governments, and otherparties to implement plans that have been mapped out. Japan’s technical cooperation assistanceat the local government and community levels has been one of its strengths.15 It is important toshow Japan’s unique way of providing aid by leveraging development policy loans to further expand the model of collaboration through policy dialogue with the central governments (healthand finance ministries) of partner countries and combining that with a further strengthening oftechnical and financial cooperation for the implementation of policy on the frontlines, near the
beneficiaries of that aid.
In addition, in order to achieve UHC, it is essential that progress be made on primary healthcare (PHC), which contributes to better access to basic healthcare services for vulnerable populations. Assistance is currently being provided as well that is explicitly focused on thestrengthening of services provided in regional and remote areas.16 It is important that Japan
14. This is a mechanism of granting loan aid once donor and recipient countries agree through bilateralpolicy dialogues on policy actions to be undertaken (e.g., establishment of standards for certifying
medical facilities or introduction of a computer system for clerical work of a health insurance system)
concerning the enhancement of capability to provide healthcare services, and of health finance andmedical security systems, which are necessary to achieve UHC, and once such policy actions are executed. This mechanism has already been or is being implemented in such countries as Kenya andSenegal, and its execution is under consideration elsewhere. Assistance provided in the health policy
sector in 2017, when development policy loans were granted, accounted for 30 percent of development assistance for health, constituting the largest proportion among all fields.
15. In the Philippines, for example, establishment of a universal health insurance system and enhancement of public healthcare services in regional areas are listed as priority policy issues for the achievement of UHC. JICA has carried out technical cooperation to support local governments, branchesof the Philippine Health Insurance Corporation, and health volunteers so that all expectant/nursing
mothers and infants may receive health insurance and expectant women may give birth safely withthe help of medical professionals in the country’s rural areas, where many poor people live.
16. For instance, under its national policy, Ghana sends health workers to places where help is needed
and they conduct community health service activities, such as outreach activities and community22

be increasingly inclusive—both in terms of the scope of those assisted and the content of theaid—by strengthening dialogues and exchanges with civil society at home and abroad during
the process of strategic and project development, by enhancing collaboration with civil society
groups and networks that contribute to the empowerment of vulnerable populations, and byincreasing the use of and support for local resources, including NGOs. In particular, given thatJapanese NGOs that are engaged in projects at the grassroots level have an advantage in carrying out programs for the capacity-building of local communities, NGOs, local governments,and so on, Japan must design its ODA in a way that makes optimal use of the strengths of thesetypes of NGOs.
Achieving UHC also requires that the social, economic, and environmental determinants ofhealth be addressed (UN 2019). Multisectoral coordination on nutrition-improvement projects
is underway in relevant countries, which has produced good examples of the health sector working closely with agricultural and water and sanitation projects.17 However, most projects to datefor improving disease control and health services have been carried out within the health sector,
and there are still just a limited number of cross-sectoral projects. One reason for that is that thepartner agencies involved in intergovernmental cooperation projects are usually the ministries
responsible for a particular field, and coordination among different ministries is often not incorporated into the project design. Another challenge is the ability to explicitly identify and broadly
publicize the positive health impacts of work in the road infrastructure and water/sewage sectors.
As it pushes to help “build resilient health systems,” Japan has supported the ability of countries in Asia and Africa to prepare for and respond to health crises through such measures as
capacity-building for infectious disease laboratories ( JICA 2020).18 At the same time, however,
the COVID-19 pandemic has made it clear that during a health crisis, there are limits to continuing technical assistance and training programs when those programs are premised on the abilityof people to travel. There is also room for improvement in terms of information-sharing and cooperation among Japan’s ministries and agencies so they can contribute to deliberations on
measures for individual countries.
education. JICA is backing up the implementation of regional health policies from multiple perspectives in Ghana through a series of technical cooperation projects and the dispatch of Japan Overseas
Cooperation Volunteers.
17. In the province of Niassa in northern Mozambique, JICA has been pushing ahead with projects in
the health and agricultural sectors at the same time as a project to ensure the stable supply of safe
water, thus promoting comprehensive activities aimed at improving nutrition. In Rwanda, moreover,
JICA has been assisting with measures for nutrition improvement, such as priority policies and plans,
and nutrition-related projects in the agricultural sector, through policy dialogue and financial aid(¥10 billion) based on the country’s “Sector Policy Loan for Nutrition Improvement through Agriculture Transformation” extended by Japan, thereby contributing to forging an environment where
local children find it easy to eat nutritious food.
18. These labs include the National Institute of Hygiene & Epidemiology (NIHE) of Vietnam; ResearchInstitute for Tropical Medicine (RITM) of the Philippines; Noguchi Memorial Institute for Medical
Research of Ghana; Kenya Medical Research Institute (KEMRI); School of Veterinary, Universityof Zambia (UNZA-SVM); University Teaching Hospital–Virology Laboratory (UTH-VL); National Institute of Biomedical Research (INRB), Democratic Republic of Congo; Nigeria Center for
Disease Control (NCDC); etc.

23

Japan has a considerable number of patients with infectious diseases in general, but their proportion of the total population is low. As a result, human resources are concentrated in otherfields and the scale of the budget for infectious disease research is relatively low as well (Study
Group 2016). In 2012, the Japan-based Global Health Innovative Technology Fund (GHIT
Fund)19 was established, supporting technological development in Japan for malaria, tuberculosis, and neglected tropical diseases, the treatment of which is in great need in LMICs. It is also
promoting international collaborative studies by research institutes in Japan as well as in LMICs
through the Science and Technology Research Partnership for Sustainable Development(SATREPS).20 However, support for strengthening the R&D capacity of research institutes in
LMICs, particularly for research involving clinical trials, remains insufficient.
(2) Multilateral assistanceMore than 50 percent of Japan’s development assistance for health goes through multilateral aid
agencies. (In 2018, 43.2 percent of the multilateral assistance for health was channeled via the
Global Fund to Fight AIDS, Tuberculosis and Malaria; 28.8 percent via World Bank; 8.6 percent
via WHO; and 5.8 percent via UNICEF.) As for the fields of support covered by such ODA,
sexually transmitted infections (including HIV/AIDS) and malaria, which are the fields supported by the Global Fund, account for much of the budget (17.96 percent and 17.77 percent
respectively in 2018), followed by health policy and infectious diseases other than malaria, tuberculosis, and sexually transmitted diseases (13.49 percent and 12.18 percent respectively in2018). Japan ranks fifth in cumulative contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria, following the United States, France, the United Kingdom, and Germany( JCIE 2020). Japan holds a seat on the Global Fund Board, and Japanese nationals are represented among the fund’s senior officials of major departments and committees, including theTechnical Evaluation Reference Group. Given that the establishment of the Global Fund was an
outgrowth of discussions held at the Kyushu-Okinawa G8 Summit held in 2000, Japan has continued to show its commitments as the fund’s “founder” ever since its establishment. Japan is thesecond largest contributor to the World Bank after the United States (MOFA 2018) and has ameasure of influence on the Board of Directors as one of the five largest financial contributors.
Japan is the fourth largest fund contributor to the WHO after the United States, the United Kingdom, and Germany (MOFA 2018). It has been selected as an Executive Board Member State,eligible to designate a Japanese expert to serve on the board, 13 times since joining the WHO,and Japanese nationals have been named the Director-General once and the Regional Director
19. A Japan-initiated international public- and private-sector fund for the promotion of the developmentof therapeutics, vaccines, and diagnostic for malaria, tuberculosis, and neglected tropical diseases.
20. SATREPS (Science and Technology Research Partnership for Sustainable Development) is a program covering global issues of particular concern to low- and middle-income countries. It is intended
to promote international joint research in cooperation with Japan’s ODA program under the supportof the Ministry of Education, Culture, Sports, Science and Technology, and MOFA. Previously,
SATREPS was promoted by JICA and Japan Science & Technology Agency (JST). Following theestablishment of the Japan Agency for Medical Research & Development (AMED) on April 1, 2015,
research in the infectious disease segment of the program has been transferred from JST to AMED.
Clinical tests are excluded from SATREPS.

24

of the Regional Office for the Western Pacific (WPRO) three times. Japan’s contributions to
UNICEF have ranked between seventh and ninth (MOFA 2018), and it has long been a memberof the Executive Board. Looking at other international organizations, there was a substantialchange in this year’s contribution to Gavi. The total contribution to Gavi in the previous funding
cycle (2016–2020) was US$95 million, but about US$300 million has been pledged for the current cycle (2021–2025) with a view to fighting the COVID-19 pandemic and establishing a vaccine supply system, among other purposes (Gavi 2020). Since last year, Japan has dispatched analternate director for a board seat it shares with the United States, Australia, and South Korea.
As described above, Japan has been actively engaged in decision-making through the boardsof the international organizations where it ranks in the top echelon in terms of contributions. But
because Japanese directors are frequently rotated out to new posts,21 it is difficult for them tobuild rapport with other board members or senior officials of those organizations, making it hard
for Japan to substantively contribute to discussions. At home, there is also considerable room forJapan to transcend the stove-piped interests of ministries and agencies in order to strengthen
systems for developing cross-cutting strategies, while also finding ways to involve experts working on the frontlines in policy deliberations.
(3) Coordinating bilateral and multilateral ODA at the country level

While Japan has promoted the harmonization of bilateral and multilateral assistance throughsuch schemes as its Grant Aid through International Organizations, not enough has been done
to ensure sufficient coordination in the field. Japanese bilateral assistance does a good job oftraining healthcare workers and health-related policy experts, helping partner countries
strengthen health systems and institutions to make them more independent and sustainable.
Taking advantage of that strength, Japan should consider providing bilateral assistance that leverages assistance from the international organizations that are large-scale funders in the partnercountry, or that aims to broaden and deepen the impact of bilateral assistance.
International organizations have gradually made greater use of Japanese technologies (e.g.,
pharmaceuticals, medical devices, and other technologies), partly thanks to the efforts of Japanese companies,22 but the government system for identifying applications for technologies already developed by Japanese companies is insufficient, and even if a technology is identified,companies often lack the know-how regarding how it can be utilized in LMICs, or they are wary
about undertaking marketing campaigns in those countries. With regard to pharmaceuticals inparticular, Japan needs to deepen partnerships with international organizations as part of a strategy of streamlining the entire process from the search for compounds through to improved access to the final products.
21. In the case of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Japan is represented by its
17th director in 2020—the 18th year since the Fund was created.
22. To promote the use of Japanese technologies and the procurement of products by international organizations, the government is assisting organizations working to spread the use of pharmaceuticals,
etc. (such as Unitaid and the Global Fund) and leveraging their partnership with Japanese companies; it is also holding seminars encouraging company-targeting procurements by international organizations, thus boosting interest on the corporate side.

25

Evaluation initiatives
Given growing public awareness of the importance of accountability for ODA, initiatives to assess ODA have been strengthened (MOFA Economic Cooperation Bureau 2005). Efforts havebeen made to improve the dissemination of information on ODA-funded projects, including
through the establishment in October 2010 of a MOFA-JICA website intended to “visualize
ODA.” But the mainstream of ODA evaluation is project evaluation, and evaluations focused on
specific issues and themes are not regularly conducted.
The results of Japanese bilateral and multilateral assistance in the health sector are publishedannually by the OECD based on data compiled by MOFA. Also, in 2018, the Institute for Global
Health Policy Research at the Bureau of International Health Cooperation of the National Center for Global Health and Medicine (NCGM) was commissioned by the Bill & Melinda Gates
Foundation to set up a data platform dubbed the “Japan Tracker,” which visualizes the flow offinancial resources for international cooperation in the health sector, although it is unclear how
long this initiative will be continued.
For the effective use of ODA, in addition to having a clear grasp of its performance, Japan
must evaluate the impact of the sector as a whole, combining both bilateral and multilateral assistance, and allocate its budget based on that as well as on domestic policy priorities.
Issues associated with human and intellectual resources
In September 2017, the Human Resource Strategy Center for Global Health (HRC-GH) wasestablished within the NCGM in response to a proposal on the Vision for the Development of
Human Resources for Global Health Policy calling on Japan to establish a culture that promotes
job rotation among sectors through industry-academia-government partnership. The HRC-GH
encourages the posting of Japanese global health professionals in UN organizations, and while ithas had some success in the placement of young professionals,23 the impact of its strategic support of such postings for senior-level professionals remains limited. Jobs that are grade P5 or
higher are decreasing at UN organizations due to financial constraints and other factors, and priority has been given to consultants, locally hired staff, and internal promotions. Moreover, the
COVID-19 pandemic has left the financial prospects of such organizations uncertain, and coupled with the fact that new recruitment itself has been on the decline, it is expected it will become
increasingly difficult to post Japanese personnel to these organizations. Therefore, Japan needs
to take the perspective that it will strategically identify positions to which it wants to have Japanese professionals posted in the future, and then develop potential executive candidates over the
medium to long term.
And despite a common recognition that greater diversity is required among global health personnel in terms of areas of specialization and job experience (Nakatani et al. 2020), the currently
available career paths lack flexibility, and we are far from seeing the type of smooth and dynamic
circulation of human resources across sectors and specializations that is needed. Moreover,
23. In FY2019, Japan had 18 professionals newly employed, promoted, or appointed as expert panel
members.

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despite the increasing diversification of health issues and policy-support needs, and the resultant
need for greater diversity in terms of the capabilities of health experts, there are still limited opportunities for existing experts to develop their capabilities and acquire new skills. And there are
inadequate mechanisms to discover and nurture different types of experts, or to facilitate collaboration with academic experts. Reflecting this, although there are some Japanese staff―while
few in number―in UN agencies due to the presence of a system under which a certain numberof people are to be employed from each member country, including Japan (as a large financial
contributor), there are very few Japanese nationals working actively in organizations that operate
as public-private partnerships, which are likely to play a growing role in the future. As Japan considers its human resource development strategy, in addition to setting quantitative targets for
personnel to be posted in international organizations—including not only UN agencies but public-private partnership organizations as well—it must consider measures for improving the qualifications of such personnel as well.
One of the factors that make Japanese nationals reluctant to work in international organizations is that the status of employment is unstable, with the positions being either fixed-term or
short-term in principle, which does not provide a great deal of incentive for people (particularly
healthcare professionals) to leave Japan—fundamentally “a seller’s market”—to acquire skills.
Furthermore, mid-career workers usually choose not to actively pursue these types of positions
because of such concerns as their spouse’s employment, children’s education, and nursing carefor family members, and so on. However, domestic positions intended for young people are increasingly leaning toward short-term, contract-based employment, making it easier for them toaccept work for international organizations. Yet, many people still hesitate to take the first step
toward international working experience. Therefore, Japan must be aware that there are subtle
differences in the barriers facing different generations and consider putting together comprehensive support, including improvements to the domestic system and discussions on work-style reform. The circulation of human resources between domestic and overseas positions can also be
expected to help strengthen Japanese organizations working in the global health field.
In the field of development assistance in Japan, the goal is often to “make use of Japaneseknowledge.” In fact, Japan has a great deal of knowledge that can be applied to development assistance for health, including its experience in achieving universal health coverage and a widearray of measures taken as one of the world’s leaders in terms of population aging. But Japan has
yet to develop systems and personnel capable of relativizing its experiences, exploring the possibility of applying them to the situations of other countries, and thereby sharing them globally.
Japan needs to promote efforts to undertake studies and recommendations in international contexts regarding knowledge of policies and practice, participate in international policy evaluationand policymaking frameworks, hone practical studies and policy theories, evaluate domestic systems based on the international context, and then apply that to future overseas assistance.

27

3. Action Plans: Examples of Potential Actions____________________________________________________________________________________________

Below is a summary of some of the diverse opinions expressed in the course of developing theserecommendations, organized in line with the overall recommendations. These do not necessarily
represent the consensus of committee members, but rather are proposed measures that may be auseful reference in carrying out the recommendations.
1) Delineate “control towers” for global health and ODA and strengthen theircapabilities
Short-term: Clearly delineate a “control tower” for strategic decision-making on the allocation of ODA and construct a “control tower” to coordinate global health policy as awhole (see fig. 1).
R EVI S E TH E BAS I C D ES I G N F O R P E AC E AND H E ALTH AND C L AR I F Y TH E I NSTI TUTI ONALF R AMEWOR K

F OR

DES I GNI NGANDI MP L E ME NTI NG

JAPAN’ S

D OMESTI C AND GLOBAL HE ALTH STR ATEGI ES Clarify the system for developing andimplementing strategies on overall domestic and foreign policy related to healthcare, andbased on that, revise the “Basic Design for Peace and Health.” [Diet members, relevant ministries/agencies]
ESTAB L I S H A “ GLOBAL HE ALTH STR ATEGY C OU NC I L” ( TE NTATIVE NAME ) Under

the “control tower” for global health, create a “Global Health Strategy Council” (tentativename) comprised of director-general-level personnel from MOFA, the Ministry of Health, Labour and Welfare (MHLW), the Ministry of Finance (MOF), the Ministry of Economy, Trade& Industry, JICA, and the Japan Agency for Medical Research & Development (AMED). The
purpose of this office is to work across ministries and agencies to share the overall picture ofJapan’s global health projects and to promote the formulation and implementation of a strategy for global health, including ODA. An executive director should be appointed for an extended period of time (i.e., longer than the usual term for government posts) who is a talented
person with sufficient knowledge, experience, capability, and networks in the field, going beyond the government agencies or public-private organizations, such as a person who has
served in an executive position in an international organization. [Diet members, relevant ministries/agencies]
C R E ATE A P U B L I C- P R IVATE P L ATF OR M TO I NF OR M THE “ GLOBAL HE ALTHSTR ATEGY C OUNC I L”

Organize a “Public-Private Global Health Platform” (tentativename) that reports up to the council and is comprised of representatives from academia,
NGOs, industry (including the pharmaceutical and medical equipment sectors), etc., in orderto obtain the broad array of knowledge and viewpoints required to map out strategies. [Dietmembers, relevant ministries/agencies]

28

Figure 4. Control tower for global health (draft)

ESTAB L I S H A STRONG S EC R ETAR IAT STRU CTU R E F OR THE “ C ONTROL TOWE R ”
WITH THE AB I L IT Y TO P ROVI D E TEC HNI CAL ADVI C E AND D R AW U P ON OUTS I D E
E XP E RTI S E Select an individual to serve as a technical advisor to the proposed “Global

Health Strategy Council” who has expertise and practical experience in global health, such as
someone with experience working for an international organization or as an advisor to thehealth ministry of an LMIC, and who also has experience in negotiations in international arenas and a strong professional network. In addition, there should be a technical assistant postin the council secretariat as well. That assistant should be a mid-career person with expertiseand practical experience in global health, such as a former international organization employee
or former leader of a global health–related ODA project in an LMIC, and should be well versedin the international discourse in the field. The proposed technical adviser and assistant should
provide the following types of services to the council and secretariat: utilize their international
networks to gather and summarize major health-related evidence, provide support and advice
for external communications and negotiations, control traffic related to the use of domestic
knowledge and networks (e.g., determine the applicability of international trends), etc. Also,
the secretariat should be staffed with experts—such as specialists well versed in the assessmentof global health indicators, management consultants knowledgeable about strategy formulation, etc.—thereby creating a strong secretariat system. Moreover, the secretariat should collaborate with external intellectual resources (academia, think tanks, and NGOs) and convene
specialized working groups as needed in each major field, such as health systems, infectious
diseases, preventive healthcare, nutrition, healthcare economy/finance, and so on. For example, it can utilize MOUs with relevant academic societies and universities that have related
departments, or the NGO consultant system, etc. [Diet members, relevant ministries/agencies, academia, NGOs]

29

STR E NGTHE N THE “ R I GHT P E R S ON I N THE R I GHT P L AC E ” SYSTE M F OR
AS S I GNI NG S P EC IAL I STS TO GOVE R NME NT P O STS I N JAPAN AND OVE R S E AS
D E AL I NG WITH G LO BAL H E ALTH Personnel (including “multilateral-bilateral health part-nership advisors,” described below) should be posted in places deemed priority countries
under the “Five-Year Global Health Strategy” (mentioned below) in a right-person-in-theright-place manner, thus boosting their authority and mobility. In that event, given the limited
number of global health specialists available, consideration should be given to dispatching experts in charge of a particular region. [Relevant ministries/agencies, JICA]

2) Set new targets for contributions to global health
Short-term: Map out a “Five-Year Global Health Strategy” and build a foundation for mobilizing private-sector resources
ESTAB L I S H A “ F IVE -YE AR GLOBAL HE ALTH STR ATEGY” The proposed “Global

Health Strategy Council” should adopt a “selection and concentration” strategy regarding
the fields, countries/regions, international organizations, etc., into which ODA and nonODA resources should be invested; discuss targets for global health contributions to beachieved in the next five years based on an analysis of funding demands and other factors
in priority countries; and then draw up a plan to provide the personnel (including humanresource development) and funding needed to achieve that. The planning and executionof this strategy should involve the participation of MOFA’s International Cooperation Bureau, JICA’s Operations Strategy Department and regional departments, and other departments overseeing the partner country as a whole, and their opinions should be appropriately reflected in the bilateral development assistance policies for the priority countries.
[Diet members, relevant ministries/agencies, JICA, NCGM, AMED, NGOs, industry, academia, think tanks, etc.]
P ROVI D E S U P P ORT F OR HE ALTH F I NANC I NG AND THE AC HI EVE ME NT OF U HCI N DEVE LOP I NG C OU NTR I ES I MPACTE D BY C OVI D - 1 9 In parallel with the formula-tion of the “Five-Year Global Health Strategy” noted above, countries should be selected
as soon as possible that, based on their needs and the state of their domestic finances/debt
burdens, should receive support to strengthen “UHC financing”—the importance of
which was reaffirmed at the G20 Summit meeting held in November 2020—and dialogues
should be carried out together with the World Bank, WHO, Asian Development Bank
(ADB), etc., to create programs centered on yen loans. In granting yen loans, the possibility of using matching loans to mobilize domestic funding should be explored. [Relevant
ministries/agencies, JICA]
MANAG E RO L L I NG P L ANS F O R I ND IVI D UAL PARTNE R C O U NTR I ES F ROM AS ECTOR - BAS E D P E R S P ECTIVE Looking about five years ahead, a sector-specific per-spective to project development plans (rolling plans) should be added for each country
and the allocation of resources for healthcare in priority partner countries should be30managed on the basis of the “Five-Year Global Health Strategy.” [Relevant ministries/agencies, JICA, etc.]
C R E ATE A STRONG BAS E F OR MOB I L I Z I NG P R IVATE - S ECTOR R ES OU RC ES F OR
GLOBAL HE ALTH In order to set targets for mobilizing private-sector resources for

global health, the target-setting baseline should be clarified, private-sector needs should
be identified, and investment risk should be assessed. Also, keeping in mind that, in addition to ODA, there are currently many public-sector funds being set up to supply risk
capital to the private sector both at home and abroad, private-sector engagement inglobal health should be encouraged.
•

Understand private-sector funding trends At the OECD DAC, propose ameans of measuring private-sector contributions sector by sector—including forthe health sector—and identify private-sector funding flows in the health sector either by including health-related companies and organizations in the coverage of theannual OECD survey of the flow of funding to low-income countries, or by working
cooperatively with organizations such as GBCHealth. [Relevant ministries/agencies, academia]•

Understand private-sector needs Identify private-sector needs in the global

health sector more independently, and then identify areas where the involvement ofprivate business should be supported through ODA. [ JICA, JETRO, industry]•

Establish guidance function Expand partnerships among relevant organizations

to help support actual project development by private businesses in the global
health sector (overseas pilot projects, direct investments/sales, social business, strategic social contribution projects), and consider launching a program to provide
guidance at the national level. Distinguish between what should be assisted throughmatching partnerships (i.e., with international organizations, various global healthinitiatives, local companies, local NGOs, etc.), through ODA, or through or publicprivate funding, and what should be developed by companies on their own, andthereby connect projects to the necessary resources. (An investment example might
be to assign a person with expertise in the healthcare sector to JETRO’s Global Acceleration Hub.) [Relevant ministries/agencies, JICA, JETRO]•

Understand and reduce investment risk in the health sector Improve the in-vestment environment for private businesses by identifying regulations and systems
that pose risks and encourage their reforms. Also, encourage the private sector toactively use funding from the Japan Bank for International Cooperation ( JBIC),
public-private funds, and JICA’s overseas loan and investment scheme in the healthsector, as part of measures to reduce financial risk (blended finance combining
grants, share purchases, investments in preferred stocks and subordinated debt,

31

providing subordinated loans, lending at below-market interest rates, etc.). [Relevant ministries/agencies, JBIC, JICA, academia]
Medium-term: Execute the “Five-Year Global Health Strategy” and ensure its impact isvisibleSTR E NGTHE N

HE ALTHF I NANC I NG

SYSTE MS

BY

HE L P I NG

PARTNE R

C OU NTR I ES P ROMOTE C OL L ABOR ATI ON B ET WE E N F I NANC E AND HE ALTHAUTH O R ITI ES In promoting the “Five-Year Global Health Strategy” at the national level,

Japan needs to strengthen support for the health policy sector, including assistance forhealth financing. To that end, Japan should consider, when so requested by a partner country, sending a health policy advisor to their health ministry, but also a finance advisor (focusing on public expenditure management, etc.) to the finance ministry, thus indirectly
assisting closer partnership between both ministries and improved sustainability of healthfinancing. [Relevant ministries/agencies, JICA, academia]
ESTAB L I S H A SYSTE M F OR P E R I OD I C MONITOR I NG AND EVALUATI ON OF
GLOBAL HE ALTH ODA Set up a third-party committee for evaluating and verifying pro-

gress in the “Five-Year Global Health Strategy” and a “Five-Year Plan for the Development of Global Health Professionals” (see below) and then make course adjustments asnecessary at the “Global Health Strategy Council.” [Relevant ministries/agencies, academia, think tanks, NGOs, etc.]
ME AS U R E AND P UB L I C LY DI S C LO S E THE R ETUR N ON I NVESTME NT F OR
GLOBAL HE ALTH ODA Based on the five-year strategic baseline, measure the impact ofbilateral assistance (participating in the government’s initiative for annual evaluation)
jointly with multilateral aid, measure national-level investment effects (system strengthening and health improvements in partner countries), and the effects of investments on
global health as a whole through multilateral aid, and publish the results at home andabroad in an easy-to-understand manner. [ JICA, NCGM, NGOs, academia]
3) Pursue strategic selection and concentration
Short-term: Strengthen the foundation for strategic selection and concentration
STR E NGTHE N ANALYS I S OF ODA F OR GLOBAL HE ALTH Gain a clearer overall pic-

ture of the funds allocated to the global health sector according to countries/regions andhealth fields (resource mapping) in cooperation with Japan Tracker, and work to share that
information with ministries/agencies and relevant organizations. [Relevant ministries/agencies, JICA, AMED, academia, etc.]
R ESTRU CTU R E TH E EVALUATI O N O F I NTE R NATI O NAL O RG ANI Z ATI O NS TO
P ROMOTE EVI D E NC E - BAS E D, STR ATEGI C C ONTR I BUTI ONS TO THE I R WOR K

Restructure the Evaluation of International Organizations carried out by MOFA and32

regularly conduct a comprehensive evaluation (in the form of a questionnaire seeking replies from each organization) of international organizations related to the health field (atpresent, WHO, UNAIDS, Global Fund, Gavi, Stop TB Partnership, Unitaid, and GFF).
The evaluation should use common indicators such as consistency with Japan’s global
health strategy and organizational strength (performance, transparency, etc.), and the results should be viewed as evidence when considering ODA disbursement strategy and thepriority international organizations. [Relevant ministries/agencies; the opinions of NGOs
and other experts should be sought in formulating indicators]
P ROMOTE I NTE R NATI ONAL P OL I CY R ES E ARC H AND D IALO GU E ON GLOBALHE ALTH In order for Japan to take the lead in the international debate on issues that are

growing in priority (e.g., health issues associated with aging populations, health system
resiliency to health emergencies, preventive medicine, noncommunicable diseases, crosssectoral health promotion and disease prevention, data-driven healthcare, improvementof legal systems in the healthcare sector, value-based care, etc.), promote international policy research and dialogues in partnership with international organizations, WHO collaborating centers (WHOCCs), and NGOs, think tanks, and academic institutions at home
and abroad. In doing so, seek to develop human resources capable of actively taking partin the process of international policy formation and policy dialogues by encouraging theparticipation of mid-career and younger people from organizations involved in the formulation and execution of ODA strategy. [Relevant ministries/agencies, JICA, NCGM, academia, NGOs, think tanks, etc.]
STR E NGTHE N

SYSTE MSF OR

MUTUALL E AR NI NGIN

WHI C HJAPANES E

KNOWL E D G E CAN B E S HAR E D AS AN I NTE R NATI ONAL P U B L I C GO OD Whilestrengthening the support system for academic work in the spheres of global health andpolicy research (e.g., research grants, data provision, relaxation of qualifications for participating in the Japanese delegation to various UN forums and international conferences),
identify how the body of knowledge in Japan can inform policy-oriented research at the
global level, and encourage researchers to publish the findings of such analyses in majorinternational journals. In terms of compiling health data, consider going beyond just conventional “national medical expenditures” to include estimates of disease prevention andhealth promotion expenses in order to compile data that sheds light on funding allocationsin the area of PHC. Also, using the WHOCCs in Japan as a bridge, link the WHO to domestic local governments, companies, and organizations, which so far have had little involvement in global health, in order to explore the possibility of communicating Japan’s
beneficial knowledge to the rest of the world. [Relevant ministries/agencies, academia,
think tanks, WHOCCs, local governments, industry, etc.]___________________________________

33

Reference: Proposed direction for ODA projects
Short-term: Expand support to strengthen systems at the global and national levels capable of responding to COVID-19 and future infectious diseases
L E AD I NTE R NATI O NAL C O O P E R ATI O N O N TH E C OVI D - 1 9 PANDE MI C Keeping in

mind the need for an integrated process from health technology R&D through to the ensuring of access to technologies contributing to global health, the immediate challenges
that need to be tackled include close coordination between ODA and non-ODA funding;promoting the development of COVID-19 pharmaceuticals, vaccines, and diagnostics(CEPI, AMED, etc.); and increasing investments in international frameworks working toensure equitable access to COVID-19 therapeutics, vaccines, and testing (ACT Accelerator, C-TAP, etc.). Then, Japan should utilize bilateral-multilateral collaboration to help
LMICs establish systems to deliver these technologies without fail to the people who needthem. Drawing on networks with the LMIC governments, infectious disease research centers, major medical facilities, and so on, Japan should conduct international joint studies(including epidemiologic research) on infection, treatment, etc., from a public health perspective and share its experiences and technologies globally, thereby playing a leading rolein international cooperative efforts to adapt to a world in which COVID-19 is an endemic
disease. [Relevant ministries/agencies, JICA, AMED, academia]
E NHANC E L MI C S ’ E F F ORTS TO BU I L D U P S U STAI NAB L E CAPAC IT Y TO R E S P OND TO E ME RGI NG I NF ECTI OU S DI S E AS ES Japan should ensure that coopera-tion does not end up being short-lived and sporadic by helping LMICs to build up independent and sustainable disease response capabilities that involve local-level cooperation between the medical and public health sectors. To give a specific example, Japan
should help strengthen PHC-based health systems that carry out and support local-level
health initiatives intended to improve health literacy in a manner that enables individuals to take the appropriate actions for disease prevention and health promotion, and thatprovide the most fundamental preventive and treatment services. Japan should actively
consider providing co-funding and parallel support in the field of maternal, newborn,and child health and nutrition as a GFF donor and Investors Group member. It should
further strengthen the capabilities and networks of infectious disease research centers;
establish systems that allow epidemic outbreaks to be caught swiftly and enable genomicand epidemiologic data to be accumulated and shared globally; and improve testing andquarantine systems to allow the resumption of cross-border movements of people andof economic activities. Japanese ODA should improve medical facilities and train
healthcare specialists in LMICs to enable treatment of serious cases in these countries
as well. [Relevant ministries/agencies, JICA, NCGM, NGOs, academia]
U S E YE N LOANS TO E XPAND “ HE ALTH P O L I CY F U ND I NG ” S U P P O RT F O R
GLOBAL HE ALTH While Japan provides financial support in the short term to ease theeconomic impact of COVID-19, it should actively consider providing health policy

34

support from a medium- to long-term perspective that looks beyond simply addressing
COVID-19 by combining yen loans (including joint funding with development financeinstitutions such as the World Bank and Asian Development Bank) with technical assistance (including by remote means), taking partner countries’ debt situations into account,in order to build resilient health systems. In so doing, Japan should try to gain the understanding of local NGOs as much as possible. Also, when there is a request from a partnercountry for help to improve healthcare infrastructure, Japan should provide necessary andreasonable support from a medium- to long-term perspective, taking account of the position and role of relevant medical facilities within the health system as a whole, employment and strengthening of healthcare personnel, financial sustainability, etc. [Relevant
ministries/agencies, JICA, NGOs, academia]
P ROVI D E AS S I STANC E TO P R EVE NT A S EC ONDARY HE ALTH C R I S I S Japan should

provide support to ensure steady access to essential healthcare services, including throughpartnership with international organizations and NGOs at home and abroad. [Relevant
ministries/agencies, JICA, NGOs, etc.]
STR E NGTHE N JAPAN’ S CAPAC IT Y TO S UP P ORT PANDE MI C R ES P ONS ES I N
L MI C S

In preparation for new infectious diseases that may emerge, Japan should
strengthen the systems that enable joint development with other Asian countries of therapeutics, vaccines, testing equipment, etc. (including through joint clinical trials), buildingon the networks that have been cultivated with the governments of developing countries,
infectious disease research centers, major medical facilities, etc. In addition, steps should
be taken during “peacetime” to improve Japan’s human contributions and prepare for the
dispatch of medical personnel for humanitarian assistance by building a network encompassing a broad array of talented individuals from the public and private sectors—including medical officers from the Defense Ministry and Japanese staff of international organizations who have frontline experience with humanitarian assistance in international
emergencies—as well as by strengthening human resource development and training. Accordingly, Japan should review existing frameworks such as the program for developing
infectious disease emergency specialists (IDES) and the Field Epidemiology Training Program (FETP) at the National Institute of Infectious Diseases. [Relevant ministries/agencies, AMED, JICA, NCGM, academia, industry]
Medium-term: Expand support for the establishment of sustainable “resilient & inclusive
health systems” and for the expansion of PHC intended to promote improvement in access by vulnerable people to basic healthcare services.
STR E NGTHE N AS S I STANC E F OR HE ALTH P OL I CYMAKI NG, I NC LUDI NG F OR
HE ALTH F I NANC I NG R E F OR M Work in partnership with the World Bank and other in-

ternational development finance institutions to push for health financing reform based on
the partner countries’ economic, financial, and debt situations, and on an analysis of relations between central and local governments, thereby promoting greater mobilization of35

domestic funding for healthcare and more efficient use of public expenditures. Japan
should encourage dialogue and cooperation between international organizations supporting health financing reform so that this support is carried out in a sustained manner and ina way that invites local ownership by partner countries. [Relevant ministries/agencies,
JICA, NCGM, academia]
S U P P ORT I NITIATIVES ON R E DU C I NG HE ALTH - R E L ATE D R I S K FACTO R S Stressthe importance of providing health-related services—including evidence-based disease
prevention activities and nutrition—in achieving sustained UHC; work together with theWHO, World Bank, and others to continuously monitor trends in health-related risk factors in each country; and strengthen the capacity to reflect those trends in policies. [Relevant ministries/agencies, JICA, NGOs, academia, industry]
STR E NGTHE N E F F ORTS TO ADDR ES S S O C IAL , EC ONOMI C, AND E NVI RO NME NTAL D ETE R MI NANTS O F H E ALTH Focusing on the root causes of vulnerability,

facilitate public-private efforts on health promotion through an integrated approach, partnering with actors in multiple sectors such as social welfare, water and sanitation, climatechange, social infrastructure, and agriculture. In particular, Japan should explicitly measure
the health improvement impact of projects in the water and sewage field, where Japanese
ODA is strong, and publicly communicate those effects. [Relevant ministries/agencies,
JICA, NGOs, industry, academia]
E XPAND S U P P ORT F OR C OMMU NIT Y HE ALTH SYSTE M STR E NGTHE NI NG Pro-

mote the achievement of UHC based on a strong foundation of PHC by increasing support to institutions and organizations in partner countries to strengthen health financing,
especially so that countries preparing to graduate from receiving ODA can improve theircapacity to expand health services on their own. Japan should also provide technical assistance to reinforce community health systems, including by providing assistance throughlocal NGOs. [Relevant ministries/agencies, JICA, NCGM, NGOs, academia]
E XPAND I NVESTME NT I N HE ALTH I NF R ASTRU CTU R E THAT C ON TR I BUTES TOSTR E NGTHE NI NG P HC SYSTE MS Japan should expand its investment in health infra-

structure that contributes to stronger systems for the provision of medical services at thecommunity level, and in other infrastructure that has significant health impacts. [Relevant
ministries/agencies, JICA, industry, NGOs]___________________________________

36

4) Create synergy through improved alignment of bilateral and multilateral ODA
Short-term: Create systems to enhance strategic synergy between bilateral and multilateral assistanceC R E ATE A “ GLOBAL HE ALTH AMBAS SAD OR ” P O S ITI ON In order to boost Japan’scontribution to the governance system of international organizations, consider creating a
position for a “global health ambassador” who will be consistently involved in the governance of major international organizations, irrespective of government ministries’ normal
personnel rotations every year or two. Also, the Japanese government should establish asystem to support that ambassador within the secretariat of the “Global Health Strategy
Council.” The post of ambassador should not be limited to personnel from government
ministries/agencies, but rather should be selected from a range of candidates—including
those in the private sector—on the basis of their experience, capabilities, etc. [Diet members, relevant ministries/agencies]
I NITIATE P O L I CY C O NS U LTATI O NS AMO NG JAPANES E MI NI STRY O F F I C IAL S
AND S E NI OR OF F I C IAL S F ROM GLOBAL HE ALTH ORGA NI Z ATI O NS In addition to

consultations held by each ministry with its counterpart international organization(s),hold joint policy consultations with members of the proposed “Global Health Strategy
Council,” thereby strengthening multilateral partnerships that engage all of the ministries
and agencies concerned with health. Moreover, provide opportunities for private sector–
led exchanges of opinion that involve representatives of NGOs, academia, and industry as
well as relevant ministries/agencies and government-affiliated agencies such as JICA.
[Relevant ministries/agencies, JICA, AMED, JCIE, etc.]
C R E ATE

A

“ MU LTI L ATE R AL- B I L ATE R AL

H E ALTH

PARTNE R S H I P

ADVI S OR ”

P O S ITI O N Reinforce the relevant functions of the country-based ODA task forces toimprove the partnership between bilateral and multilateral efforts at the country level.
The Japanese government should assign global health professionals (“multilateral-bilateral health partnership advisor”) to embassies, etc., as needed, so they will be responsible for overseeing that work. Alternatively, the government should add the role of coordinating bilateral and multilateral assistance to the portfolio of a health ministry advisor
or a JICA expert at the country level and take other measures such as strengthening thesystem of providing headquarters support from home ministries, JICA headquarters,
etc., to the country-based ODA task forces. Also, the personnel in charge of promoting
multilateral-bilateral partnership should maintain close and frequent communications
with the country-level offices of international organizations, NGOs, etc., while also
maintaining close coordination with headquarters officials from the ministries and agencies involved in the governance of international organizations or seconded to them.
[Diet members, MOFA, JICA]

37

EXPAND THE INPUT FROM EXPERTS THROUGH ADVISORY COMMITTEES, ETC., TO
SUPPORT JAPAN’S ENGAGEMENT IN GLOBAL HEALTH ORGANIZATIONS In addition

to improving contributions to the boards of international organizations through the appointment of a “global health ambassador,” the Japanese government should pave the way
for academia and industry representatives to participate in advisory committees involvedin the formulation of the standards and norms of international organizations, dispatching
personnel capable of making contributions to international organizations at various levels.
[Relevant ministries/agencies, academia, industry, etc.]
C R E ATE A MODE L F OR C O OR DI NATI ON WITH MU LTI L ATE R AL AS S I STANC E AT
THE C OUNTRY L EVE L Create a framework for deeper, mutually beneficial Japanese co-ordination with multilateral organizations in each partner country that builds on existing,country-level donor coordination mechanisms. This will engage Japan's country-based
ODA task forces and the multilateral-bilateral health partnership advisors, as well as locally based JICA health experts and others, and it will aim to develop a "collaboration
model" that employs measures such as joint project evaluations carried out by Japan andmultilateral organizations to deliver results. [MOFA/embassies, JICA]
Medium-term: Formulate strategy toward each international organization and deploy
the “coordination model” at the country level
F OR MU L ATE

I NVESTME NT

STR ATEG I ESFORE AC HG LO BALHE ALTHORGANI Z ATI ON Set policy targets for each global health organization that Japan supports

and draw up individual strategies for each in keeping with the overall strategy for multilateral ODA for health, as stipulated by the “Five-Year Global Health Strategy” as well as
cross-ministerial coordination on multilateral ODA through the “Global Health Strategy
Council.” These targets and strategies should be reflected in strategic adjustments to ODA
contributions. [Relevant ministries/agencies, JICA, academia, NGOs, etc.]
STR E NGTHE N CAPAC IT Y TO OF F E R E F F ECTIVE P OL I CY I NP UT F OR GLOBALHE ALTH ORGANI Z ATI ONS Build a process to facilitate dialogue and partnership be-

tween the “global health ambassador” and the secretariat of the “Global Health Strategy
Council,” on the one hand, and NGO, academic, and JICA experts who possess knowledgeof the issues handled by international organizations on the other; this process should take
into account each organization’s schedule of strategic planning assessments and pledging/replenishment cycles. [“Global Health Strategy Council” secretariat, NGOs, academia, JICA]
P ROMOTE C O OR D I NATI ON BY THE MU LTI L ATE R AL- B I L ATE R AL H E ALTH PART NE R S HI P ADVI S OR S With the support of officials at ministry headquarters who serve as

liaisons to each international organization as well as officials at JICA headquarters, the“multilateral-bilateral health partnership advisors” posted at embassies, etc., should support the more effective and efficient achievement of national health targets through the38

coordination of bilateral and multilateral ODA, working in cooperation with JICA’s country-level health experts and others as well. [MOFA/embassies, JICA]
5) Strengthen partnership with NGOs and other actors in Japan and abroad
Short-term: Apply the knowledge and expertise of Japanese and foreign NGOs when formulating policy and consider ways to expand their participation in ODA projects
E F F ECTIVE LY I NC OR P OR ATE THE KNOWL E D GE AND E XP E RTI S E OF NGO S I N
THE P OL I CYMAKI NG P RO C ES S For the purpose of mainstreaming ODA policy princi-

ples—such as the realization of “human security” and women’s empowerment—on which
the government and NGOs can agree, carry out joint studies on global health policy andnew, emerging issues based on advice and proposals from Japanese and overseas NGOs.
These should make use of regular exchanges of opinion between the secretariat of the“Global Health Strategy Council” and Japanese and overseas NGOs with specialized expertise, consultative forums with domestic NGOs (NGO consultative process), and funding for project formulation. [Relevant ministries/agencies, JICA, NGOs]
ORGANI Z E A TAS K F ORC E TO S UP P ORT GR E ATE R E NGAGE ME NT OF NGO S I N
ODA P ROJ ECTS With strong political leadership, organize a task force comprised ofmembers from implementing NGOs, MOFA’s International Cooperation Bureau, JICA,
etc., to discuss the positioning of social development issues in ODA strategy and the roleof NGOs at home and abroad in that context. Based on those deliberations, an assessment should be undertaken, and recommendations should be developed on concrete
ways that NGOs, social entrepreneurs, local governments, etc., can be involved as implementing organizations in project schemes that seek development solutions, as ameans to expand the engagement of Japanese and foreign NGOs. [Diet members, NGOs,
MOFA, JICA, etc.]
E XPAND S U P P ORT F OR LO CAL NGO S Further boost partnerships with local NGOs

through the Grant Assistance for Japanese NGO Projects program. At the same time, connections should be built among the “multilateral-bilateral health partnership advisors”
posted at embassies, JICA experts, etc., and the networks of health-related NGOs that are
already involved with each country’s health ministry. More proactive use should also bemade of schemes such as the Grant Assistance for Grassroots Human Security Projects,
which supports the activities of local NGOs. In doing this, the Japanese government
should consider the possibility of coordinating approaches to align with multilateral support for CSOs as well, for example by providing supplementary funding to NGOs that arereceiving assistance from health-related international organizations. Furthermore, steps
should be taken to make the proportion of Japanese nationals required in technical assistance projects flexible and to allow the involvement of a higher ratio of local staff and other
non-Japanese personnel. [MOFA, JICA, NGOs]

39

R E F L ECT TH E P E R S P ECTIVES O F NG O S AND OTH E R S STARTI N G I N THE
P ROJ ECT AS S ES S ME NT AND F OR MU L ATI ON STAGES Replicate the project formu-

lation studies that were previously conducted under Japan’s Global Issues Initiatives (GII)on Population and AIDS to assess new projects in countries identified as priorities underthe “Five-Year Global Health Strategy” in an effort to encourage the engagement of NGOs
and others. [MOFA, JICA]
Medium-term: Expand social development projects led by NGOs, etc.
E XPAND S C HE MES THAT S U P P ORT S O C IAL D EVE LOP ME NT ACTIVITI ES Revisit

the maximum amount of funding allowed under the Grant Assistance for Japanese NGO
Projects scheme to enable the implementation of projects that are larger in scale. Meanwhile, as part of those projects, have Japanese and foreign NGOs, social entrepreneurs,
local governments, etc., work to improve and expand project schemes intended to provide
solutions to development challenges. [MOFA, JICA, NGOs]
6) Strengthen human resource initiatives to develop innovative personnel who
can respond to the changing global health landscape
Short-term: Strengthen human resource development and assignment strategies in linewith the categorization of global health professionals, based on the experience of the
Human Resource Strategy Center for Global Health.
C OND U CT AN EVALUATI ON OF THE HU MAN R ES OU RC E STR ATEGY C E NTE R F OR
GLOBAL HE ALTH ( HRC- GH) The HRC-GH was created within NCGM based on the“Report of the Working Group on Human Resource Development in Global Health Policy” that was published in 2016. A third-party review of the center should be carried out
and the future direction of its expansion should be considered. [Third-party committee]
I DE NTI F YP O STSAND

HU MANR ES OU RC E

NE E D S

THATS HOU L DBE

P R I OR ITI Z E D F OR GLOBAL HE ALTH ODA Set posting and personnel priorities tostrengthen human resource development, discovery, and postings based both on (1) the
fields where global health professionals are needed and (2) the backgrounds of personnel
seeking to work in the global health sector. [Relevant ministries/agencies, JICA, NCGM,
NGOs, academia, industry]E XPAND THE ROL E OF THE HRC - GH UNDE R THE C ONTROL TOWE R Place the

HRC-GH under the abovementioned control tower so as to permit support for strategic
deployment of human resources, including the training and dispatch of global health personnel across relevant ministries/agencies and organizations; expand the center’s functions and systems; and enhance cooperation with MOFA’s Recruitment Center for International Organizations. Also, the Japanese government should create a system that permits
relevant organizations and centers to be involved in the HRC-GH’s governance so as to40

support the realization of a “revolving door” career path that enables personnel to truly
rotate through government, academia, medical institutions, businesses, international organizations, NGOs, think tanks, etc. [Diet members, relevant ministries/agencies,
NCGM, NGOs, industry, academia, JICA]
C R E ATEA

“ F IVE -YE AR

P L ANF OR

GLOBALHE ALTHHU MANR ES OU RC E

D EVE LO P ME NT ” Identify fields that the HRC-GH should emphasize under the “Five-

Year Global Health Strategy,” think through specific positions where the posting of Japanese staff should be sought in international organizations, and set targets and action plansaccordingly. [Relevant ministries/agencies, NCGM, JICA, industry, NGOs, academia]
ESTAB L I S H MEC HANI S MS F OR C U LTIVATI NG TEC HNI CAL E XP E RTI S E ( E XP E RT
ME ETI N G S , E XP E RT C O MMIT TE ES , ETC. ) In concert with relevant domestic aca-

demic associations, establish a systematic staffing system to take advantage of highly specialized opportunities, such as expert advisory commissions, thus strengthening involvement in the formulation of international norms. [Relevant ministries/agencies,
academia]
E XPAND OP P ORTU NITI ES F OR NONGOVE R NME NTAL ACTOR S TO B E E NG AGE D
I N P OL I CY DI S C U S S I ONS OF GLOBAL HE ALTH ORGANI Z ATI O NS Expand the in-volvement of experts from NGOs, academia, etc., in global health–related policy discussions in order to reduce information gaps between the government and other sectors regarding the policies of international organizations, invigorate cross-sectoral
policy discussions, and promote both the development of global health policy professionals and their rotation among different sectors. [Relevant ministries/agencies,
NGOs, academia, etc.]
Medium-term: Improve the quality and quantity of global health professionals
I NC R E AS E THE NU MB E R OF JAPANES E NATI ONAL S I N E XEC UTIVE P O STS AT
MA J O R G LO BAL H E ALTH O RG ANI Z ATI O NS Once a goal is set of having Japanese na-

tionals serve in executive posts in specific organizations, then Japan should consider establishing a mechanism to provide additional funding to them while at the same time dispatching Japanese personnel to those organizations in a way that creates opportunities forpeople to develop the experience and expertise needed to work at the highest levels ininternational organizations. This can include steps such as the creation of a new system for
dispatching senior professional officers (SPOs). [Relevant ministries/agencies]
E XPAND S U P P ORT F OR P EOP L E STARTI NG CAR E E R S I N GLOBAL HE ALTH Expand

scholarships in fields related to global health within programs assisting overseas study,
such as the “Tobitate! (Leap for Tomorrow) Study Abroad Initiative,” and at the same time,increase support for interns working at international organizations in the health sector.
The Japanese government should also expand the Junior Professional Officer ( JPO)

41

dispatch scheme, enlarge JICA’s Japan Overseas Cooperation Volunteers, etc., and support
applications for consultant positions solicited by international organizations, thereby mobilizing public-private partnership to broaden opportunities for young Japanese professionals to pursue careers in the global health sector. [Relevant ministries/agencies, industry, etc.]
STR E NGTHE N SYSTE MS F O R I D E NTI F YI NG AND S U P P O RTI NG P RO MI S I NG
CANDI DATES WITHOUT ME DI CAL BAC KGROU ND S WHO CAN MAKE MI D CAR E E R S HI F TS TO THE GLOBAL HE ALTH F I E L D Consider means of identifying can-didates for executive positions at international organizations from among nonmedical personnel with international leadership experience at foreign-owned businesses and elsewhere, and expand support for the acquisition of academic degrees related to global health.
[HRC-GH, relevant ministries/agencies, academia]
ESTAB L I S H A SYSTE M TO S U P P O RT MO R E F L E XI B L E “ R EVO LVI NG D O O R ”
CAR E E R PATHS While recognizing that overseas projects undertaken by NGOs are pre-cious occasions for global health–oriented personnel to experience work on the ground,strengthen personnel exchanges among global health–related sections of ministries/agencies/JICA, the private sector and NGOs, and between ministries/agencies/JICA and academia, thus reinforcing (or establishing) frameworks that enable a “revolving door” career path in which people can fully experience policymaking, practical duties, and research.
In addition, boost overseas postings by creating a cross-sectoral employment information
system concerning positions requiring knowledge of global health, and by introducing opportunities for domestic employment for those returning from overseas assignments,
among other means. [Relevant ministries/agencies, NGOs, academia, industry, JICA]P ROVI D E OP P ORTU NITI ES F OR TR AI NI NG AND E D U CATI ON F OR GLOBALHE ALTH S P EC IAL I STS TO R ES P OND TO I NC R E AS I NGLY DIVE R S E NE E D S Provide

opportunities not only for ad hoc training and study meetings but also for organized andsystematic training and education throughout the year. For example, the Japanese government should expand coaching and mentoring systems by implementing a program similar
to the MHLW’s Infectious Disease Emergency Specialist (IDES) Training Program inother fields as well, set up a special quota (training quota) to allow trainees to participate
throughout the year together with their mentors in board meetings of various internationalorganizations (such as the WHO’s World Health Assembly and Executive Board meetings,
Global Fund board meetings, etc.) as a form of policy-level on-the-job training, and makeit possible for experts other than those in the global health sector to use these options.
[Relevant ministries/agencies]

42

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APPENDIX
Special Commission on Japan’s Strategy on Development Assistancefor Health
The Special Commission on Japan’s Strategy on Development Assistance for Health was launchedin November 2019 and is chaired by Yasuhisa Shiozaki, member of the House of Representatives.
The commission seeks to enhance Japan’s strategy for donor assistance for health and make development assistance more effective toward 2030, the target year of the SDGs, and to provide recommendations on revising the process of the Strategy for Global Health Diplomacy and Basic Designfor Peace and Health. The initial members are listed below. Following five commission meetings,
three thematic sub-committee meetings, and an opportunity to participate in the Mahidol Award
Conference UHC Forum held in Thailand in January 2020, the commission convened a side meeting—co-organized with the JICA and the Japan Center for International Exchange ( JCIE)—toexchange views with government officials from countries that receive JICA support, internationalorganization representatives, academics, and civil society experts.
The commission was formed as part of the activities of the Executive Committee on Global
Health and Human Security (Chair: Keizo Takemi, Member, House of Councillors; Senior Fellow, JCIE) and was operated in cooperation with the Executive Committee members and related
agencies and with JCIE serving as the secretariat.
Members of the Commission
Alphabetical order
Director, Department of Global Network and Partnership, Bureau of International Health Cooperation, National Center for Global Health and Medicine(NCGM)
Yasumasa Fukushima Vice-Minister for Health, Chief Medical and Global. Health Officer, Ministry of
Health, Labour, and Welfare
Noriko Furuya
Member, House of Representatives; Member, Executive Committee on Global
Health and Human Security
Katsumi Hirano
Executive Senior Research Fellow, Institute of Developing Economies (IDE),
Japan External Trade Organization (JETRO)
Masaki Inaba
Representative, Japan CSO Network on Global Health; Policy Advisor, Japan
Civil Society Network on SDGs (SDGs Japan)
Sumie Ishii
Chairperson, Japanese Organization for International Cooperation in Family
Planning (JOICFP)
Kiyoshi Kodera
Chair of the Board, Water Aid Japan; Senior Research Associate, Overseas Development Institute (ODI), United Kingdom
Shunsuke Mabuchi
Secretariat for the Independent Panel for Pandemic Preparedness and Response(on leave from Bill & Melinda Gates Foundation)
Karen Makishima
Member, House of Representatives
Atsushi Mimura
Deputy Director-General, International Bureau, Ministry of Finance
Daikichi Momma
Executive Advisor, Nippon Life Insurance Company
Hiroshi Naka
Professor, Institute for Future Initiatives, University of Tokyo
Noriko Fujita

46

Hiroki Nakatani

Kyoko Okamura
Akio Okawara
Keiichi Ono
Yasuhisa Shiozaki
Yukio Takasu
Keizo Takemi
Ikuo Takizawa
Takao Toda
Atsushi Ueno
Mitsuhiro Ushio

Board Member and Director of the Human Resource Strategy Center for Global
Health, National Center for Global Health and Medicine (NCGM); Project
Professor, Global Research Institute at Keio University (KGRI); Board Chair
and Representative Director, Global Health Innovative Technology Fund
(GHIT Fund)
Nutrition Specialist, Health, Population and Nutrition, World Bank Group
President and CEO, Japan Center for International Exchange (JCIE); Director,
Executive Committee on Global Health and Human Security
Director-General for Global Issues, Ministry of Foreign Affairs
Member, House of Representatives; Senior Advisor, Executive Committee on
Global Health and Human Security [Chair]
Special Advisor on Human Security to the UN Secretary-General
Member, House of Councillors; Senior Fellow, JCIE; Chair, Executive Committee on Global Health and Human Security
Senior Deputy Director General and Senior Director, Office for COVID-19 Response, Human Development Department, Japan International Cooperation
Agency (JICA)
Vice President for Human Security and Global Health, JICA
Director-General / Assistant Minister, International Cooperation Bureau, Ministry of Foreign Affairs
Director, Hitachinaka Public Health Center, Ibaraki Prefectural Government; former Health Policy Advisor to the Vietnamese Ministry of Health (JICA Expert)※All members participated in their individual capacity and the Office for Healthcare Policy, Cabinet
Secretariat, joined the process as an observer. Due to personnel changes, members from the ministries
were changed midway through.
Members of the Working Group
Satoko ItohManaging Director, JCIE
Kenichi Komada
Assistant Director, Division of Global Health Policy and Research, Department
of Health Planning and Management, Bureau of International Health Cooperation, National Center for Global Health and Medicine (NCGM)
Shiori Nagatani
Program Officer, JCIE
Shuhei Nomura
Assistant Professor, Department of Global Health Policy, Graduate School of
Medicine, University of Tokyo; Project Associate Professor, Department of
Health Policy and Management, School of Medicine, Keio University
Haruka Sakamoto
Project Researcher, Department of Global Health Policy, Graduate School of
Medicine, University of Tokyo
Motoko Seko
Former Expert (Health), JICA; Member, Technical Review Panel, the Global
Fund to Fight AIDS, Tuberculosis and Malaria
Tomoko Suzuki
Chief Program Officer, JCIE
Ikuo Takizawa
Senior Deputy Director General and Senior Director, Office for COVID-19 Response, Human Development Department, JICA (see above) [Group Leader]
Makoto Tobe
Senior Advisor on Health, Human Development Department, JICA
Tomoko Yoshida
Senior Program Officer, JCIE/USA
Representatives from the Ministry of Foreign Affairs; Ministry of Finance; Ministry of Health, Labour,and Welfare(As of November 2020)47

Executive Committee on Global Health and Human Security
The Executive Committee on Global Health and Human Security is a high-level, public-private platformthat facilitates the Japanese government’s policymaking on global health and public-private collaborationin that field. Under the chairmanship of Professor Keizo Takemi, the committee holds quarterly meetings
to provide a venue for unofficial exchanges of views and information-sharing among senior representatives from government ministries, academia, private companies, and civil society organizations in Japan.
Relevant global health experts are invited to speak at the meetings to offer their knowledge and advice.
The committee is an integral part of the Global Health and Human Security Program of the Japan Center
for International Exchange (JCIE), which manages all aspects of the committee’s work.

Japan Center for International Exchange (JCIE)
Founded in 1970, JCIE is one of Japan’s leading foreign policy institutes. With offices in Tokyo and New
York, it organizes legislative exchanges and policy dialogues that bring together key figures from diverse
sectors of society, both in Japan and overseas. During the 1990s, it played a leading role in encouraging
the adoption of human security as a pillar of Japanese foreign policy, and this led to the launch of a seriesof major initiatives on global health. The Friends of the Global Fund, Japan, was created in 2004, theGlobal Health and Human Security Program in 2008, and the Healthy and Active Aging in Asia in 2017
to strengthen public-private partnership and Japan’s role in global health.
Meisan Tameike Bldg. 7F, 1-1-12 Akasaka, Minato-ku, Tokyo, Japan 107-0052
475 Riverside Drive, Suite 731, New York, NY 10115 USA
www.jcie.org

48