Background paper on Progress in the implementation of the 2030 Agenda for Sustainable Development for WHO Executive Board Meeting

The 140th session of the Executive Board will have before it a background paper Progress in the implementation of the 2030 Agenda for Sustainable Development, (EB140/32). Part I it explains how health can be transformed by, and play a transformative role in, achieving the 17 SDGs and Part II describes some of the ways in which the 2030 Agenda is reshaping WHO’s work at the country level, with coordination at regional and global levels.

I           Central and transformative role of health in sustainable development

Based on the premise that sustainable development is “development that meets the needs of the present without compromising the ability of future generations to meet their own needs” the SDGs which are “owned by every country…form a blueprint for satisfying the needs of the present by overcoming constraints …based on social inclusion, shared prosperity and environmental stewardship.” Goal 3: Ensuring healthy lives and promote well-being for all at all ages), which is linked to all other goals, moreover, is a “prerequisite for successful collective action on the social, economic and environmental determinants of health.” (para 3)

The report recognises the important of the effectiveness of health systems and that one of the strengths of the 2030 Agenda is that opportunities to improve health can be found across the SDGs. They also provide new ways to “confront today’s major challenges to health”, including ageing, disabilities, antimicrobial resistance (AMR), migration, urbanization and rural poverty. It also sets out six instruments of change and enabling factors: intersectoral action by multiple stakeholders; health system strengthening for universal health coverage (UHC); respect for equity and human rights, leaving no one behind and highlighting the empowerment of women; sustainable financing; scientific research and innovation; and monitoring and evaluation. (paras 4-6)

In all countries there is a link between health and social inclusion and poverty alleviation (Goal 1), while UHC contributes to public security (Goal 10). There are also links with food safety and nutrition (Goal 2); clean water and sanitation(Goal 6); clean household energy (Goal 7); sustainable cities and urban planning (Goal 11); climate change and its impacts (Goal 13); employment and decent work (Goal 8); and sustainable consumption and production (Goal 12). Collaborations among multiple stakeholder including the UN system, public and private sectors, and NGOs and CSOs, as well as the support of individual citizens is important in ensuring that the most is gained from the SDG framework. (para 8)

Health systems strengthening for universal health coverage

The SDGs, in comparison with the Millennium Development Goals (MDGs) emphasizes UHC with financial risk protection (target 3.8) as part of equitable and resilient health systems. UHC includes three broad aims:

• Accelerating progress towards better health through more ambitious targets for communicable disease control, improved nutrition and maternal and child health
• Expanding health outcomes including non-communicable diseases, mental health and injuries and associated interventions
• Promoting practical ways of implementing health interventions, increasing access to, and accelerating the development of medicines and vaccines; adequate financing for health and a stronger health workforce; and early warning and the management of health risks

It “encompasses integrated, people-centred health services through the life course” (paras 9-11)

Respect for equity and human rights

Inequity denies the principle of the right to the highest attainable standard of health by compromising the freedoms and entitlements of individuals. Equity is viewed as an enabling factor as well as an objective in its own right. In contrast to the MDGs that paid insufficient attention to inequities, the SDGs aim “to improve health for whole populations by improving the health of individuals,” while leaving no one behind. The mutual support between activities towards SDG 3 and SDG 5 on gender equality is noted in the report, as well as equality within countries (SDG 10 on reducing inequality) and transparency, accountability and non-discriminatory laws (SDG 16). (paras 12-13)

Sustainable financing

The report states that between 2/3rds and 3/4 of spending within the health sector should be allocated to health systems, which are greatly under-funded compared with disease control programmes. Meanwhile the Addis Ababa Action Agenda emphasized the responsibility of each country for its own economic and social development. There could be opportunities for joint funding across sectors where goals are aligned, eg the UN Secretary-General’s initiative on Sustainable Energy for All. Climate change financing is also available to protect health and funds from the Global Environment Facility which could help mitigate environmental health risks (Goal 12).  (paras 14-16)

Scientific research and innovation

Innovation can be used to find ways to expand the workforce outside the medical profession and the “use of common platforms for health delivery.” Interrelations between Goal 3 and other Goals can “help to create a narrative of change… for taking action on Health.” Innovation can also be used in the delivery and information and communication of primary care, such as the widespread use of mobile phones in promoting universal access to services. (para 17-18)

Monitoring and evaluation

Insofar as health benefits from and contributes to all the other goals, progress should be measured across all the goals, recognizing that in addition to the 13 targets under Goal 3, there are health targets in other Goals. Health research, monitoring and evaluation have all benefitted from technologies to collect and manage large volumes of primary data.  “Big data” can assist in building links between databases in various sectors. (paras 19-20)

II         Organization of WHO’s work on the 2030 Agenda

In the report, the Secretariat spells out support for the development of better systems to improve health, within and beyond the health sector, given WHO’s normative role. In orienting its work to the 2030 Agenda, it identifies actions to be taken at the country level, with coordination at regional and global levels and aligning the programme budget with the SDGs, while recognizing that further alignment is necessary in areas such as ageing and health, AMR, disabilities and rehabilitation, and nutrition and food safety. It is supporting country implementation using regional frameworks; strengthening health systems – foundation, institutions, transformation; and through the WHO Health Emergencies Programme, as part of which more than 100 outbreaks of infectious diseases are reported to WHO annually and more than 200 million people are annually affected by natural and man-made disasters. It is also deepening and expanding partnerships including strategic planning, implementation and reporting across the UN system; also through partnerships beyond the UN; and acting as a leader and partner in global health initiatives, including the Global Strategy for Women’s, Children’s and Adolescent Health (2016-2030), as well as a number of other bodies, including the Inter-agency Task Force on the Prevention and Control on Non-communicable Diseases and the Interagency and Expert Group on Sustainable Development Goal Indicators (IAEG-SDGs) (paras 22-29)

The Executive Board is invited to note the report.