– Sun shines over the Palais Des Nations at UN Geneva.
Our Founder attended the World Health Assembly last month in Geneva and sent home these reflections on the meeting, and some of the global health megatrends we’re keeping an eye on. Tell us what you think!
Global health in transition
The World Health Organisation (WHO) has brushed off a near death experience after sharp criticism for a slow international response to the Ebola crisis of 2014 to consolidate under new leadership and make the case for WHO transformation and investment to deliver on the promise of better health for all.
Making the case for investing in health at the 71st World Health Assembly (WHA71), the new Director General Dr Tedros called for investing in health for peace, health for security and health for development highlighting the power of health to transform lives, families, communities and nations.
The current Ebola outbreak in the Democratic Republic of Congo (DRC) has demonstrated the power of the reforms already in place in the health emergencies programme, positioning WHO to act with greater speed, predictability and authority. It has signalled a back to the future transition for WHO and global public health as WHO returns to its founding principles as the preeminent technical and normative organisation for health, exercising leadership, influence and coordination in an increasingly complex system of global health governance.
On the 40th anniversary of Alma Ata, health for all is once again in discussions in global public health, in fact right at the centre, placing sustainable development goal three (SDG 3) “to ensure healthy lives and promote well-being for all at all ages” at the heart of the WHO agenda.
Dr Tedros, on taking on the leadership of WHO committed to universal health coverage (UHC) as the foundation for delivering on this health goal, and has spent the last 12 months developing the WHO thirteenth General Programme of Work (GPW13), which sets out the WHO strategy for the next 5 years, investing in stronger health systems to help make the world fairer, safer and healthier.
In the GPW13, the WHO commits to the “triple billion” goals by 2023 which are:
1 billion more people benefitting from universal health coverage;
1 billion more people better protected from health emergencies; and
1 billion more people enjoying better health and wellbeing.
The GPW13, nominating a straightforward mission to “Promote health, keep the world safe, serve the vulnerable”, outlines how WHO plans to implement the actions required to meet these goals, and to measure its progress against those actions for greater accountability.
There are a number of strategic shifts outlined in the GPW13 which are fresh and are summarised as “stepping up leadership at all levels, driving impact in every country, and focusing global public goods on impact”.
A few shifts that stand out is how WHO will transform its approach to partnerships, communications and financing to resource its strategic priorities. The WHO will focus on demonstrating impact to strengthen the case for investing resources in WHO over and above the regular assessed contributions of member states, a kind of replenishment round to fund the Programme of Work. To quote the strategy, “WHO will seek good-quality, multi-year funding with greater flexibility. Value-for-money will be shown by evidence of cost-effectiveness and evidence of impact on the most vulnerable populations. WHO will also advocate for the larger envelope of global health funding that is required to achieve the SDGs”.
Watch this space as the WHO increasingly competes with GAVI, Global Fund, the Global Financing Facility for donor contributions from nation states and big philanthropy to achieve its own “triple billion” targets.
This comes at a time that when WHO is re-evaluating its relationships with partners, recognising the plurality of actors in the global health landscape requiring a more sophisticated understanding and use of partnerships to deliver on the global goals. Recognising this, Dr Tedros seeks to reinvigorate WHO’s convening power stating the “WHO must act in concert with partners, including civil society, research institutions and the private sector, and in close alignment with the United Nations system, in order to avoid duplication, using its Framework of Engagement with Non-State Actors (FENSA)”.
This means recognising the decentralisation of power in global health, recognising the risks in dealing with partners across the spectrum, such as vaccine producers or advocacy groups, and being willing to manage those risks to realise the benefits, rather than simply closing the door on potential collaborations. Watch for what this could mean for the functioning of the WHA itself, as the WHO grapples with how to formalise its relationships with partners. As Dr Tedros said in his opening comments, “FENSA is not a fence”! Expect more WHO reform on partnerships on the WHA72 agenda.
Insisting that all side events and technical briefings at the WHA71 were focussed on delivering universal health coverage, the WHO is supporting a strategic shift toward an integrative model of health promotion, protection and restoration with the patient at the centre. Too often our systems of care are fragmented by disease, by organ systems or by donor priorities. For example, if a patient living with diabetes has an increased risk of contracting tuberculosis (Tb), then why shouldn’t a Tb screening programme also include screening for diabetes? And if diabetes increases the risk of developing high blood pressure, then shouldn’t this be included too?
Over the last twenty or thirty years, there has been a strong focus on vertical programming for specific diseases or clusters of diseases such as HIV, Tb, Malaria or neglected tropical diseases. These programmes often existed in parallel or in competition with health systems, mainly due to the fragility of local systems. Over time, the global health community has developed a greater understanding of how stronger health systems are essential not just to tackle individual diseases, but also to provide health through the life cycle, taking an integrative approach to creating health where people live.
This transition, supporting the re-investment in individual systems of care; primary health, diagnostics, childbirth, ageing, and disability, with a whole of government and whole of society approach to deal comprehensively with all health determinants is at the centre of the WHO strategy.
The transition to investing in health promotion, health system strengthening and health protection is exemplified by the Global Polio Eradication Initiative (GPEI). The GPEI currently consumes fully 20% of the WHO budget. With only 9 cases of Polio identified this year in only 2 countries, Polio is on track to be certified eradicated by 2023. However eradicating Polio has required the scaling up of vaccine production, procurement, cold supply chains, surveillance, diagnostics and health worker training; all incredibly valuable for dealing with the myriad other health threats that vulnerable communities will face even after Polio has been declared eradicated. This support will not simply be able to be withdrawn. Watch how those resources will be transitioned to building resilience against other diseases. A post Polio WHO will look different. Just how that transition is managed is the task of the GPW13.
Health on the political agenda
Recognising the threat that poor health poses to countries’ wellbeing, development and economic growth, health remains high on the political agenda in 2018. There are two High Level Meetings (HLM) of the United Nations in New York in September this year where the world’s heads of government will come together to review progress, renew political commitments, and make new, ambitious and time-bound commitments to accelerate progress on Non-Communicable Diseases (NCDs) and Tuberculosis. The wider UN system only convenes HLMs on specific threats of global significance (other health threats include Ebola and antimicrobial resistance) and this represents an important opportunity to mobilise considerable support for firm commitments and accountability around these two issues which feeds into the broader commitments to achieve SDG3. The report, delivered at WHA, “Saving lives, spending less” shows how investing in scaling up interventions to address NCDs in low and middle income countries creates returns in employment, productivity and longer lives demonstrating the co-benefits of taking real action for better health for all. Followed closely by WHO’s “Time to Deliver” report of their High Level Commission providing leadership on the best buys in global public health to reduce the burden on cardiovascular diseases, diabetes, chronic lung disease and cancer.
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