The Executive Board (EB) at its 140th session discussed agenda item 11.1, based on the report of the WHO Secretariat EB140/32. There was a general recognition that SDG 3 Ensure healthy lives and promote well-being for all and all ages is of crucial importance for the achievement of all the SDGs and that there is a need also to take into account other health-related targets. The universality of the 2030 Agenda for Sustainable Development (2030 Agenda) was stressed together with the importance of action at the national level. Several countries referred to the importance of universal health coverage (UHC), as well as non-communicable diseases and various health emergencies. References were also made in some interventions to gender and health and sexual and reproductive health and rights.
The following members of the EB took the floor:
Algeria, on behalf of AFRO, referred to the central formative role of health in sustainable development as being key and a pre-requisite. It is still under-estimated and the 2030 Agenda provides a wonderful opportunity for ensuring that health takes its rightful place, also taking advantage of all the possibilities for change that become available. For Africa, it not just related to instruments for change, but also facilitation factors for research, equity, respect for human rights etc. A regional forum had been held in December 2016 to strengthen health care systems, to achieve the SDGs, particularly UHC.
On WHO activities, he reiterated AFRO’s wish for WHO to continue to act as a driving force for powering forward health in UN system, in line with reform and using the focus of the 2030 goals. WHO needs appropriate funding and Member States and all development partners should commit to mobilize additional innovative financing. No option should be overlooked including raising levels of assessed contributions to achieve SDGs. He also stressed the important of transfer of technology and ensuring sufficient sustainability in Africa, saying that UHC should be at the heart of the right to health and its achievement
Malta, on behalf of EU and others, applauded the instruments of change and enabling factors included in the report with special appreciation for intersectoral action, One Health, health system strengthening in the context of UHC and respect for equity and human rights. They wished for clarity as to how WHO will guide and provide oversight at all levels and they encouraged the Secretariat to come back again on the 2030 Agenda health goal and targets and the feasibility of UHC. She referred to the relevant WHO multiple sectors, including the health emergencies programme, antimicrobial resistance (AMR), International Health Regulations, health system strengthening, human resource, engagement with non-state actors, ageing, disability, tobacco and alcohol control etc.
The EU thinks that WHO needs to be clear as to how it can add greatest value at country level. There should be more focus on priorities without spreading capacities too thin and they question how WHO will align SDG implementation with upcoming programme budget 2018-2019, in which connection they wish that the EB141 be informed about the 2017 alignment. She noted the engagement with various partnerships within and beyond UN in the report showing coherence and integration. While they support better coop between UN Agencies, it is important to avoid duplication. WHO should report back, in the context of resolution 69/11 (related to IAEG indicators), on the impact on their capacities and resources at all levels of the organization.
Thailand supports the role of WHO in the implementation of the 2030 Agenda. She said that UHC can be an excellent and effective mechanism and that many countries have proved that it is possible for UHC at low levels of GDP. There must, however. be a focus on South-South cooperation to fit national contexts.
Russian Federation supports the report and considers that SDG 3 is one of the most significant goals, as only a healthy population can promote and implement all the other SDGs. To achieve the SDGs the Russian Federation has adopted an integrated long-term strategy up to 2030. They also have an interdepartmental programme for healthy lifestyles and tackling non-communicable diseases (NCDs)up to 2025 and they are using uniform national clinical recommendations for a properly tailored approach. They have already made progress, for example, in improving infant and maternal mortality rates and increasing life expectancy. NCDs, infectious diseases and road-traffic accidents are priority areas for the Russian Federation’s future work.
Canada said that fundamental change in required how to do business requiring horizontal, cross-disciplinary and multi-sectoral work within the WHO and with its health and development partners. If no one is to be left behind, gender equality and human rights-based approach should be institutionalized in all WHO’s work.
SDGs should not be an ‘add on’ to WHO’s work but should shape its plans and programmes. The 2030 Agenda is universal for both developed and developing countries alike. Canada’s priorities related to indigenous health and a clean environment are closely related to the SDGs. It also wishes to work with development partners to ensure the implementation of the gender equality targets at home and abroad. Women and girls will be at the heart of their new approach, including health rights and empowerment and closing of existing gaps eg in nutrition and sexual and reproductive health and rights. The SDGs cannot be achieved if these are not addressed and Canada looks to the WHO for continued leadership in supporting Member States in implementing all the health-related targets
Mexico said that the 2030 Agenda presents an opportunity to build a framework for sustainable and inclusive development. It is an undertaking of the state, which has identified goals and targets to work on horizontally. In health sector have inter-sectoral strategies based on efforts to achieve the MDGs and national SDG targets.
Nepal stressed that it will take time to adopt them fully at the national level. Nepal has adopted the health targets in its national health sector strategy. Technical assistance will be required, given the complexity of the process and the SDGs pose such a huge challenge, including in addressing wider determinants of health. She referred to big data and use of modern technologies, as well as ensuring quality data and the need for capacity strengthening and health statistics, including civil registration, health financing and human resources for health.
China said that health is the core of the 2030 Agenda and they attach greater importance to the SDGs. G20 Summit adopted implementing 2030 Agenda and prioritizing health in September 2016. The Shanghai Consensus epitomizes the global consensus for the health SDG. China will share with others its learning gained in Health China.
Viet Nam said that they would like the WHO Secretariat to consider the following not included in the report: contextualizing the SDGs to countries for meaningful planning and support, with WHO engaging in dialogue to help countries define their road-maps; WHO’s focusing at the country-level as the SDGs to provide an opportunity for demonstrating a bottom-up approach in planning and ensuring a well-funded operation; monitoring and review of progress and national capacity building; using its convening role in engaging partnerships and aligning the health SDGs with other goals.
Bahrain referred to the progress in the Middle East at the regional level in improved statistics, but differ between countries. Some countries are experiencing crisis including war which is affecting progress. If achieve the goals will open up new perspectives for health and development and they reaffirm the importance of the WHO support.
United States appreciated the analysis that substantiates the role health will play for reinforcing its centrality in the SDGs and the efforts of WHO to improve its working processes. They recognize the value of expanding access across the life course for all people and support the shared position of WHO and the World Bank that household expenditures on health as a share of total household income is a better indicator to measure progress in this area.
Kuwait noted that the 2030 Agenda has led to improvements in areas including health care and improving wellbeing. In addition to Goal 3 other targets relate to health and greater awareness is necessary on the SDGs. They are aware of the different characteristics of different countries and should strengthen country offices in this respect.
Colombia welcomed the emphasis in dealing with health inter-sectorally, including civil society and said that technology is important in developing new forms of global strategies. The production, collection and analysis of information is important and WHO should strengthen its work in this regard, together with the necessary technical and other resources, particularly for different categories of countries. Coordination with other UN Agencies is important, with the active participation of WHO in the High-level Political Forum (HLPF) insofar as the implementation of Goal 3 will be reviewed.
Other Member States also commented:
Uruguay, on behalf of 13 countries, said that WHO has a leading role to play on the effective implementation of health in the SDGs and that no one should be left behind in the attainment of the highest standard of health and well-being. Non-discrimination and equality are at the heart of the 2030 Agenda, and health has an important place as the major contributor and beneficiary of sustainable development policies. They underline the crucial links between Goal 3 and Goal 5 on Gender equality and empowerment of all women and girls. Human rights concerns and violence against women and girls affect their health outcomes and health policies should address this cross-cutting issue. Without understanding and acting of the intersection between gender inequality, human rights and health outcomes it will be impossible to achieve health targets, such as HIV elimination, preventable deaths of newborns and undere-5s, or reduction of maternal mortality and morbidity. Universal access to sexual and reproductive health and rights, embedded in comprehensive primary health services available where people live, is an important cross-cutting health topic where accelerated global efforts are needed. Many SDGs cannot be achieved if women cannot decide freely and responsibly if, when and how many children to have with access to the full range of information and services to do so. Given the importance of sexual and reproductive health and rights in poverty alleviation and development, these health interventions should be reference in the next version of the report. The next Director-General should continue to show strong leadership on Goals 3 and 5, including targets 3.7, 5.6 and 16b.
Netherlands were pleased to hear that steps can be taken to align the WHO programme and budget with the SDGs and stressed that WHO should work with multi-stakeholder partnerships. WHO recognizes all the interlinkages and while they encourage others to acknowledge their impact on health, the relationship goes both ways and health also impacts their work.
Bangladesh said that health and human development should be a central theme and that WHO has begun to redesign its work in this regard. Bangladesh has appointed a coordinator for the implementation of the SDGs in the Prime Minister’s Office and has begun stocktaking of national action plans to see what should be added. There is strong emphasis on health. Meanwhile there is a lack of clarity for mobilizing UHC.
Lithuania welcomed One Health and the focus of implementation at country-level with adequate staff resources in country offices.
Japan recognized the central role of WHO in achieving the SDGs and pointed out the actions taken in Japan for their implementation. They referred to the new partnership for achieving UHC, which was launched in 2016, and the new framework for UHC in Africa. They are planning to convene an international UHC Conference with WHO and the World Bank later in the year. They also wish to support other countries in achieving the SDGs, including infectious disease control, health systems strengthening, women’s health and polio eradication.
Panama agrees with the Secretariat about the lack of recognition of central role of health in achieving the SDGs. Fourteen of the 17 goals and 38 of the 169 targets are linked to health and the relevance of health in achieving the SDGs is undeniable. It will require permanent and strong cooperation to achieve the goals. States define their technical priorities and create alliances. Panama has a Social Cabinet responsible for following up the 2030 Agenda and focusing on Goal 3 in the Health Ministry, integrating the SDGs into their programmes and plans.
Brazil, speaking on behalf of the region of the Americas, considers that the WHO must play a leading and collaborative role and work to influence governance and in partnerships across many of the SDGs to promote and protect health. He referred to the integration and interlinkages of Goal 3 with other SDGs, which is as important as intersectoral action across all of them. WHO’s programmes and policies should seek to align with, and support, the implementation of the 2030 Agenda. The proposed programme budget 2018-19 and programme of work 2020-25 provide a unique opportunity to focus on the 2030 Agenda, with the UHC target underpinning the others. There should also be coherence throughout the organization and collaborate in the monitoring and in the HLPF, also supporting national and regional efforts.
Australia welcomed the focus on strengthening health systems, while noting the universality of the Agenda with no one left behind. They are working at home and with countries in the region to strengthen health systems. WHO should continue to assist Member States by giving practical support in line with the national context; contributing to the evidence-base as how best to sustain health systems and move towards UHC; and at the global level shaping the global health architecture to effect progress more effectively at the country level, while being mindful of the limited capacity of some countries to undertake burdensome reporting.
Chile referred to the centrality of health in the 2030 Agenda, bearing in mind the need to deal with the different pillars, including human rights. The objectives are universal. emphasizing equity and the relationship of Goal 3 with other goals. The political relevance should be attached to all, while WHO should be focusing on better health systems.
Switzerland said that the report illustrates the first specific measures taken by WHO on the 2030 Agenda, recognizing that the SDGs should be worked on collectively. WHO should introduce incentives to stimulate to stimulate intersectoral approaches at all three levels of the organization. They are pleased to see the reference to the resolution on the quadrennial policy review for development of the UN system, which was successfully adopted. Switzerland encourages WHO to continue to be actively committed to seeking to align itself with the guidelines outlined therein. Agenda 2030 is the agenda for all, but roles have to be clearly defined and contributions based on competence. They expect WHO to play a leadership role in some areas and to develop robust and broad partnerships. A spirit of cooperation not competition is therefore important.
UN organizations and NGOs:
UNFPA said that the it would be advantageous if the linkages between goal 3 and the other goals be addressed at the HLPF. They should be further explored at the WHA and reflected in key messages for the HLPF, eg Goal 3 and Goal 5. Preventable maternal mortality, despite MDG progress, remains the most unequal social indicator. Adolescent girls rank at the top of new HIV infections in many developing countries and women and girls face numerous barriers in their own households and communities to access essential sexual and reproductive health information and services. Without addressing patterns of violence and discrimination, as well as barriers to autonomous and informed decision-making for women and girls including for their sexual and reproductive health, healthy lives for millions of them will continue to a distant reality.
International Planned Parenthood Federation expressed its concern that the Progress Report does not adequately highlight the importance of the intersection between gender equality and health in advance of the review at the HLPF. They also regretted the omission of sexual and reproductive health and reproductive rights as many of the SDGs cannot be achieved if women are not able to decide freely if, when, and how many children to have and have the information and means to do so.
World Dental Federation noted that traditionally the focus has been on measuring disease rather than health. The Federation’s approach focusing on health rather than disease and ultimately supports the SDGs.
International Council of Nurses said that WHO should capitalize on its position to improve health and well-being as found in all 17 goals. Progress must be actively monitored. Health system strengthening is fundamental to achieve UHC, recognizing that the shift must be made to primary health care with its focus on health promotion and illness prevention with services focused around people and taking into account the social, economic and environmental determinants of health. The expertise of nurses should be harnessed in countries including in policy development and strategies.
International Association for Hospice and Palliative Care welcomes the focus on UHC. The WHO and Executive Board are asked to address the definition of palliative care, as there are currently no indicators on it. Access to palliative care is one of the most inequitable service in the world with 80 percent of people having less than adequate access to palliative care, with many still being left behind and to include it in the HLPF this summer.
International Federation of Medical Students’ Associations considers the involvement of medical students as fundamental and stress the importance of civil societies participation in the process of implementation. They called for greater recognition of the importance of youth participation. Proper implementation of the 2030 Agenda will require a paradigm shift towards a more holistic vision of health and well-being.
World Heart Federation stated that the 2030 Agenda affirms the central role of health as essential for sustainable development. Ensure adequate financial resources for NCDs as a critical component of the health agenda. As recognized in the Addis Ababa Agenda, taxation of unhealthy commodities, eg tobacco, alcohol and sugary drinks provides a win-win solution by increasing domestic revenue and decreasing consumption. Sustained official development assistance for health is crucial for lower income countries. To this end they called for a disaggregation of spending.
International Society of Nephrology
Alliance for Health Promotion stressed that positive change to health promotion as a contribution to the SDGs can be achieved through information and education to empower individuals and communities to take responsibility for their own health and well-being and other measures, as set out in the Ottawa Declaration and the Shanghai Consensus. Civil society organizations are important enablers in this regard.
Save the Children Fund called for urgent action on UHC. Targets on child and maternal mortality, and sexual and reproductive health services cannot be achieved unless systems are in place as quickly as possible to provide quality health services to all who need them. It does not mean health insurance schemes that only benefit those who are employed and thankfully indicator 3.8.2 has been changed to reflect this. Significant funding and tax reforms and significant political backing are urgently required, including donor investment.
WHO thanked the Board members for endorsing the lines of actions that are important in all settings for achieving the SDGs while emphasizing intersectoral action and UHC to build better systems for health. He also commented on enabling factors eg focus for equity; strengthening the evidence base; and monitoring and evaluation. Several Member States had added depth by referring to aspects not adequately addressed including non-state actors. Referring to sexual and reproductive health in target 3.7 and the related focus on sexual and reproductive health and reproductive rights in target 5.6, he wished to reassure the Board that they were not forgotten as the paper built on other previous work. “3.7 is carved in stone and is vitally important in the health goal,” as are all the other targets previously discussed. WHO will report more fully in progress report to WHA. On next steps he referred to the aligning of the programme budget with the 2030 Agenda, which is “work in progress.” WHO is also looking at aligning the programme with the SDGs during the course of the year. Several Member States had mentioned the HLPF which is an opportunity to speak about health. Over 40 countries will be presenting voluntary national reviews in context of other SDGs including poverty, hunger, gender equality, innovation, water and partnerships. WHO can work intersectorally and collaboratively in improving health in sustainable development.
Dr Margaret Chan, Director-General, personally sees the SDGs as an opportunity for all to take positive actions, ensuring no one is left behind. She quoted Dr Mahler – “women are the ingredients for development.” Goal 3 is important in itself, but the linkage with other goals is critically important to implement multi-sectoral action for people, planet, peace and prosperity. WHO needs to work with civil society, academia, the private sector and others. She had listened to comments from Algeria, Malta, Canada and others that SDGs is an opportunity as well as an instrument of change for all three levels of WHO and with partners. The SDGs should be linked to WHO reform. Internally it is important to reaffirm her promise to reflect the SDGs in the proposed programme budget 2018-19 which is a segway into global programme of work with the next one starting in 2020. In her discussions with next D-G, she will do her utmost to ensure that this transition is taken on board. There is also a group of countries looking at longer term financial solutions. The SDGs are an opportunity for the whole organization, and not just the Secretariat.
The Board took note of the report.