Goals and targets for health in the post-2015 Health Agenda
Saturday, May 24, 2014 at 11:21AM Dr Margaret Chan, Director-General, World Health Organization was the first speaker at the Technical Briefing on “Goals and targets for health in the post-2015 development agenda” at the 67th Session of the World Health Assembly.
Dr Chan spoke about the background for the discussions on the agenda that are now taking place in the Open Working Group (OWG) on the Sustainable Development Goals (SDGs) as being part of the outcome of Rio + 20 process. She said that in the first draft of the Rio outcome document, health was “anaemic”, “on a respirator” and “in ICU.” She later clarified that the inclusion of health was much better in the final version of the outcome document, “The Future We Want.”
She expressed her thanks to Sweden and Botswana, as well as UNICEF, for their leadership in the health thematic consultation for the post-2015 development agenda. According to Dr Chan, there had been a long process of consultation on the document that was before this meeting, “Ensure healthy lives and universal health coverage.”. It was the result of a process of consultation based on what WHO had been hearing about the post-2015 development agenda, poverty eradication, inclusive growth and leaving nobody behind. Universal health coverage (UHC) has “a lot of space for inclusion.”
The focus in the past has been on financing which is important. Catastrophic healthcare costs push 100-150 million people into poverty annually and we can’t ignore the “social/financial piece.” We need a package of essential services that respect country ownership and leadership as priorities. She referred specifically to the Lancet Commission on Investing in Health which gives guidance on the importance of investment in health. The costs are much higher than originally anticipated. Looking at the results as shown in the MDGs, maternal mortality remains the most stubborn having only gone down from ½ million to around 289,000 (in 2013). It can be seen, however, that countries’ investment produces good results.
Good health information systems are needed, which are also important for accountability. As she pointed out, 90% coverage means nothing without vital statistics and civil registration.
UHC can be seen as a euphemism for strengthening healthcare and addressing inequities. UHC, however, cannot be achieved through voluntary community-based schemes, or user fees. It means that everyone should be covered. There is no such thing as “voluntary”, but how a country structures its system is its own prerogative.
WHO as a Member States’ organization
In response to a question on WHO’s bias towards UHC and move away from disease Dr Chan said that WHO is “never biased”, rather it understands the position as WHO is a Member States’ organization. Resolutions, as in the case of the one being negotiated in the World Health Assembly on the post-2015 development agenda, come from the countries that need to implement them. UHC is being pushed by many countries. It is “a progressive realization of the journey” and it is Member States that have to decide.
Dr Marie-Paule Kieny, Assistant Director-General, spoke on the development of the post-2015 development agenda and WHO’s views on the position of health in it.
She explained the process as being led by Member States, and referred to the work of the OWG and the UN Intergovernmental Committee of Experts on Sustainable Development Financing (ICESDF) that originated from the Rio + 20 outcome. She also drew attention to the High Level Panel (HLP) and the Sustainable Development Solutions Network (SDSN), both of which were initiated by the Secretary-General. Several reports had been written including ‘The Future We Want”, ”Realizing the Future We Want” and the HLP Report, and 11 thematic consultations and 88 country-level consultations had been held
The health MDGs, according to Dr Kieny, were successful insofar as there was more money for health; more progress had been made since 2000 than before; and there was political discourse at the highest levels. They have been driven by concrete measurable goals & targets. At the same time there was too little focus on equity; human rights were missing, and they did not fully integrate the Millennium Declaration. Progress now should be made on the most off-track MDGs such as MDGs 4 & 5.
The emerging agenda was “planet focused” with 16 SDGs [An SDG on Equalities is being added back in making the total 17 going forward] with health squarely included. The “People’s voice” rated better healthcare as their second priority No 2 after a good education. The focus will be on a goal in its own right and will be used for measuring progress across whole agenda.
WHO’s overarching goal: Ensure healthy lives and universal health coverage
WHO views the overarching goal as being “Ensure healthy lives and universal health coverage” with four sub-goals:
- Achieve the health-related Millennium Development Goals (MDGs)
- Address the burden of noncommunicable diseases, injuries and mental disorders
- Achieve Universal Health Coverage including financial risk protection
- Address the social and environmental determinants of health
Sexual and reproductive health in the health goal
As was brought out in the Q and A session following Dr Kieny’s presentation, the WHO goal differs from that discussed at the 11th Session of the OWG -- “Healthy life at all ages for all”. Sub-goal 1, while including off-track MDG target 5A on maternal mortality, omits MDG target 5B on universal access to reproductive health. In addition, Sub-goal 3 on universal health coverage of quality health services includes “At least 80% coverage of services in all population groups: …sexual and reproductive health services…” This is not as progressive as the targets included in the working document for OWG-11 in focus area 3 “ensuring universal access to comprehensive sexual and reproductive health for all, including family planning” and in focus area 5 “by 2030 ensure universal access to sexual and reproductive health and reproductive rights.”
While a target of 80% may be more realistic for universal health coverage by 2030, as the Co-Chairs have said on numerous occasions -- the SDGs must be ambitious. It is therefore to be hoped that WHO will bring their proposals into alignment with those being discussed in the OWG. It is extremely important, as Ministers of Health and their Senior Officials will be responsible for implementing the health SDG and WHO will be providing the technical expertise and guidance.