1 |1 | Health measurement and accountability in the 2030 agenda: some considerations

2 |2 | Health Goal 3: Ensure healthy lives and promote well being for all at all ages with 13 targets... 5 considerations about health in the SDGs

3 |3 | 1. The place of health in the SDGs Having one health goal is sufficient? – From 3 of 8 goals in MDG to 1 of 17 goals in SDG; 26 health indicators out of over 200 SDG indicators – Some issues are considered insufficiently explicit (but not too many) But overall: – The health SDG is framed broadly and connected with many other goals – Health is a major contributor to and beneficiary of development; it is also a critical measure of overall development – The targets align very well with global plans of action that have been developed / are under development

4 |4 | 2. UHC is central to the new agenda 3.1: Reduce maternal mortality 3.2: End preventable newborn and child deaths 3.3: End the epidemics of HIV, TB, malaria and NTD and combat hepatitis, waterborne and other communicable diseases 3.7: Ensure universal access to sexual and reproductive health-care services MDG unfinished and expanded agenda 3.4: Reduce mortality from NCD and promote mental health 3.5: Strengthen prevention and treatment of substance abuse 3.6: Halve global deaths and injuries from road traffic accidents 3.9: Reduce deaths from hazardous chemicals and air, water and soil pollution and contamination SDG3 means of Implementation targets 3.a: Strengthen implementation of framework convention on tobacco control 3.b: Provide access to medicines and vaccines for all, support R&D of vaccines and medicines for all 3.c: Increase health financing and health workforce in developing countries 3.d: Strengthen capacity for early warning, risk reduction and management of health risks SDG 3: Ensure healthy lives and promote well-being for all at all ages New SDG 3 targets Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services, medicines and vaccines for all Interactions with economic, other social and environmental SDGs and SDG 17 on means of implementation (financing, partnerships, technology, data)

5 |5 | 3. The SDGs can put health governance centre stage “business as usual” vs a deeper debate on the health architecture The MDG stimulated fragmentation of programmes within the health sector SDGs need to be proactive in reducing fragmentation with much more active collaboration with programs within the health sector - focus on country overall health strategies The SDG are: "Integrated and indivisible": progress in one area is dependent on progress in many others - this requires exploring new ways of governance within health and in other policy areas (“Health in all policies”) in order to promote and protect health How to translate this into practical action is the main challenge

6 |6 | 4 Not clear yet how the SDGs will influence financing for health The price tag for the full implementation of the agenda is estimated to be enormous (UN estimate: US$ trillion per year) but: Estimating costs of some of the aspirational targets will remain imprecise; it is even difficult for the more established targets including health SDG will be largely financed from domestic sources and market related borrowing, and not from development assistance Addis Ababa Action Agenda (July 2015) offered general principles but little concrete in terms of e.g. numerical targets – Emphasis on increasing country capacity to raise and spend funds domestically – Focus on making tax systems more efficient nationally; combat tax evasion and illicit tax flows globally; to incentivize the private sector Possible shifts within the health sector (NCD)?

7 |7 | 5. There will be a growing focus on monitoring and accountability SDG follow up and review will be voluntary and country-led – Global: a HLPF will play a critical role in overseeing a network of review processes – annual, informed by a global SDG progress report form UNSG; UN General Assembly to review in 2019 (every four years) – Regional: greater focus to regional mechanisms of review – Country: Reporting to inform national review processes + SDGs to hold governments accountable Global framework for monitoring the health goal requires: – A high level health goal indicator such as healthy life expectancy – A focus on progress towards universal health coverage – A high level assessment of progress towards the 13 health targets, and determinants of health – Explicit focus on equity Requires more aligned investments to: – Address data gaps, including data collection and analysis – Strengthen country led platforms for monitoring and evaluation

8 |8 | and 5 considerations about the way forward: measurement health-related SGDs

9 |9 | 1. Monitoring Universal Health Coverage WHO/World Bank monitoring framework, 2013 & 2014 UHC Global Monitoring Reports (2015 and upcoming Dec 2016) SDG target 3.8 – 3.8.1: coverage of essential health services (index) – 3.8.2: financial protection Challenges: – Coverage: lack of standardized surveys in high Income countries (equity) – Financial protection; few countries have recent data IHP for UHC 2030

UHC service coverage tracer indicators Data for these indicators come from a mix of household surveys and administrative data. Ten of the 16 tracer indicators of health service coverage are supported by recent, comparable estimates of national coverage For another four (pregnancy care, care seeking for suspected pneumonia in children, hospital inpatient admission rates and health worker density) well- maintained databases are available For the remaining two indicators (cervical cancer screening and access to essential medicines) there are currently no comprehensive databases

11 | 2. Defining standards: 100 Core Health Indicators Global Reference List of 100 Core Health Indicators (2015) Topics: – Health Status – Risk Factors – Service Coverage – Health Systems 11

12 | 3. Bringing together the available data… Overview of the global health situation (SDG 3 indicators + health-related indicators) Scope- an agenda for all countries Emphasis on equity- need for disaggregated data Country monitoring- data gaps and capacity

13 | …shows the need for strong country health information systems Major monitoring challenge (e.g., disaggregation) Some data sources weak (e.g., CRVS) Uncertainty of some global estimates (e.g., air pollution mortality ) Call to action to strengthen national HIS

4. Collective action : The Health Data Collaborative Platform for global public goods (development, harmonization and sharing of tools and guidance) - e.g.100 indicators 2015 published, ongoing work on facility survey instruments, global CRVS strengthening strategy Building upon existing frameworks : IHP+ M&E, HMN HIS, COIA accountability etc. Leverage existing technical collaborations and support mechanisms: global and regional initiatives Contribute and provide value add to existing strategies and global funding mechanisms: Global Strategy for Women’s, Children’s and Adolescent’s Health, global health security agenda, UHC Alliance; GFATM, GFF, GAVI etc. Global monitoring of progress Independent monitoring / assessment of development partner and country performance / country peer review mechanisms

5. New impetus for health monitoring and accountability Accountability- cyclical process of monitoring, review and remedial action Global, regional and country monitoring systems will need to adapt: – Data collection (multisectoral dimensions-> integrated manner) – Data analyses (collaboration with statistical community, multiple areas) How to construct a coherent narrative regarding health status and trends? Identify key issues, pressure on Governments to deliver, and provide a way to hold health providers to account Reporting focused on informing national review processes

Country-led platform for information and accountability

17 | Conclusions SDGs are very broad and complex, but health is in a relatively good place – With a very comprehensive set of health targets – With multiple linkages to other SDGs as contributor and beneficiary The SDG agenda provides a critical opportunity to consider health in a much more integral manner with the economic, social and environmental goals UHC provides a platform for an integrated approach for the SDG health-related targets Need to address persistent data gaps by strengthening country health statistical capacities in developing countries (NSO, MoH,…) Investment in health data (domestic, global) required, as well as harmonized and aligned support for strengthening country capacities and greater global and national collaboration

18 | Thank you