WHO-DGO-SPI-18.1-eng

72 Pages·2017·0.68 MB·English

Working towards achieving the
Sustainable Development Goals:
a WHO toolkit
WHO/DGO/SPI/18.1
© World Health Organization 2018
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Contents
Acknowledgements iv
Introduction 1
Health systems in the Sustainable Development Goal era 1
Using the toolkit 3
Action line 1. Intersectoral action by multiple stakeholders (see Annex 1) 4
Highlighted tool: Health in all policies: training manual 4
Action line 2. Strengthening health systems for universal health coverage (see Annex 2) 5
Highlighted tool: Healthy systems for universal health coverage – a joint vision for healthy lives 5
Action line 3. Respect for equity and human rights (see Annex 3) 6
Highlighted tool: Innov8 approach for reviewing national health programmes to leave no one behind:
technical handbook 6
Action line 4. Sustainable financing (see Annex 4) 7
Highlighted tool: eLearning course on health financing policy for universal health coverage 8
Action line 5. Scientific research and innovation (see Annex 5) 9
Highlighted tool: The world health report 2013: research for universal health coverage 9
Action line 6. Monitoring and evaluation (see Annex 6) 10
Highlighted tool: SCORE for health data technical package 10
References 11
Annex 1. Recommended tools for action line 1 – intersectoral action by multiple
stakeholders 14
Annex 2. Recommended tools for action line 2 – strengthening health systems
for universal health coverage 20
Annex 3. Recommended tools for action line 3 – respect for equity and human rights 30
Annex 4. Recommended tools for action line 4 – sustainable financing 31
Annex 5. Recommended tools for action line 5 – scientific research and innovation 33
Annex 6. Recommended tools for action line 6 – monitoring and evaluation 36
Annex 7. Recommended tools for action lines 1–6 (combined) 44
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Working towards achieving the Sustainable Development Goals
Acknowledgements
Paul Rosenberg and Christopher Dye developed this publication. The toolkit is
the result of a consultative process drawing on the expertise and experiences
of many WHO colleagues. The following people provided generous input
and feedback: Rabindra Abeyasinghe, Hala Abou-Taleb, Shambhu Acharya,
Giuseppe Annunziata, Maria Emilia Aragon de Leon, Nima Asgari-Jirandeh,
Britta Baer, Nick Banatvala, Darryl Barrett, Anjana Bhushan, Christine Brown,
Dean Chambliss, Snezhana Chichevalieva, Adrienne Cox, Vânia De La Fuente
Núñez, Katia de Pinho Campos, Luke Elich, Isabel Espinosa, Nils Fietje,
Ann-Kira Fortune, Jun Gao, Vittoria Gemelli, Ogtay Gozalov, Ahmadreza
Hosseinpoor, Mark Jacobs, Matthew Jowett, Humphrey Karamagi, Takeshi
Kasai, Mina Kashiwabara, Wasiq Mehmood Khan, Marija Kishman Hristovska,
Theadora Koller, Monica Kosinska, Joseph Kutzin, Ailan Li, Vivian Lin, Frederiek
Mantingh, Natela Menabde, Bettina Menne, Zafar Mirza, Fukushi Morishita,
Anna Cichowska Myrup, Maria Neira, Aasa Nihlén, Dorit Nitzan, Thomas
O’Connell, Kathryn O’Neill, Jonathon Passmore, Elizabet Paunovic, Hanne
Bak Pedersen, Maria Pena, Micaela Pereira, Galina Perfilieva, Michaela Pfeiffer,
Kalpeshsinh Rahevar, John Reeder, Ian Roberts, Nathalie Roebbel, Cris Scotter,
Hai-Rim Shin, Katherine Silburn, Agnès Soucat, Ryoko Takahashi, Yoshihiro
Takashima, Ronald Tamangan, Nicole Valentine, Martin Vandendyck, Menno
Van Hilten, Rui Miguel Vaz and Martin Weber.
The Bill & Melinda Gates Foundation provided financial support.
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A WHO toolkit
Introduction
More than two years after the 2030 Agenda for Sustainable Development
was adopted, many countries are still setting Sustainable Development Goal
priorities and developing strategies that can achieve them. The 2030 Agenda for
Sustainable Development proposes a bold new vision for global development,
but it does not provide a specific roadmap on how to achieve it. Decisions about
setting priorities, implementation, funding and all the actions that lie between
the status quo and success rest in the hands of domestic decision-makers.
This toolkit supports countries in adopting principles of sustainable
development across health programmes and in building more comprehensive
health systems. The tools support the development of health systems that are
more equitable, more affordable, more measurable, more testable and more
synergistic with health-related programmes beyond the traditional health system.
The toolkit seeks to enable countries to seize new opportunities presented by the
2030 Agenda for Sustainable Development and to deliver greater gains for health.
Health systems in the Sustainable Development Goal era
The 2030 Agenda for Sustainable Development introduced a more complete set
of goals, built on common principles of social inclusion, shared prosperity and
sustaining the planet’s natural systems (1). It envisions a new dynamic between
the Sustainable Development Goals in which good health and the other 16 Goals
are closely connected and interdependent. Progress towards one goal should
contribute to the achievement of others. One way to apply this vision to health
would be to expand the definition of the health system. Classically defined, health
systems deliver essential health-care services and public health functions. A more
comprehensive vision for health systems would consider non-traditional systems
that also produce good health, incorporating relationships with agriculture,
education, energy, the environment and other sectors represented by the other
16 Goals.
Harnessing the full potential of the 2030 Agenda for Sustainable Development
requires building more comprehensive systems that can deliver better health. To
better align the efforts of WHO programmes with this more comprehensive
approach, WHO has proposed six main lines of action (2). The six main lines of
action introduce a framework to focus action on building better, more connected
systems for health enabled by the principles of sustainable development. World
health statistics 2017: monitoring health for the SDGs (2) more thoroughly details
the six main lines of action.
The six main lines of action refer to six focus areas (Table 1). The first two lines
focus efforts at the system level. Strengthening the health system and achieving
universal health coverage builds a platform on which all other health targets can
be pursued. It is also well established that factors beyond the health system, such as
education, employment or environmental exposure, significantly influence health
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over the life-course (9, 10). Building and institutionalizing synergy between health-
related systems and the health system create a more comprehensive system for
health that can integrate disease prevention, health promotion and health services
to produce benefits across all of the health-related targets and beyond.
Table 1. Top tools for building more comprehensive systems for health
Focus Main line of action Top tool
Building better 1. Intersectoral action by Health in all policies: training manual (3)
systems for multiple stakeholders
health 2. Strengthening health Healthy systems for universal health cov-
systems for universal erage – a joint vision for healthy lives (4)
health coverage
Enabling 3. Respect for equity and Innov8 approach for reviewing national
factors human rights health programmes to leave no one
behind: technical handbook (5)
4. Sustainable financing eLearning course on health financing
policy for universal health coverage (6)
5. Scientific research and The world health report 2013: research
innovation for universal health coverage (7)
6. Monitoring and SCORE for health data technical package (8)
evaluation
The final four lines of action focus on factors enabling better systems for
health. First, health systems must focus on becoming more equitable. Pursu-
ing equitable access and use of health services and equitable health outcomes
is essential to ensure that no one is left behind and to enable greater progress
towards achieving the Sustainable Development Goal targets. Second, health
planners must focus on sustainable financing and ensuring that health services
are affordable for all. Universal health coverage is among the main goals of the
health agenda of the Sustainable Development Goals and is premised on financial
protection in health along with equitable access and use. Third, the Sustainable
Development Goals present an opportunity for countries to test the new vision
for sustainable development and to chart their own course towards achieving
the health targets. Countries need to mobilize domestic research and innova-
tion to test the most effective ways to achieve their goals and produce technolo-
gies across sectors that can respond to domestic health needs. Finally, progress
in health must be measurable, and with the burden of measurement shifting to
domestic sources, this requires strengthening health information systems and
analytical capacity to monitor health and its determinants.
The enabling factors proposed by the six main lines of action are among
many key qualities of more comprehensive health systems. They do not comprise
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A WHO toolkit
an exhaustive list. More comprehensive systems should also be resilient, adapt-
able and sustainable, among other qualities. Moreover, although they are organ-
ized as discrete areas of work, the lines of action are also interdependent, as are
the tools highlighted in this toolkit. For example, achieving greater health equity
requires sustainable financing to reach vulnerable populations and to address
the social and environmental determinants of health. It requires monitoring and
research to identify populations being left behind and the most effective path-
ways to improve equity.
Using the toolkit
This toolkit offers selected tools that support readers in aligning their work with
the 2030 Agenda for Sustainable Development. The toolkit is intended for use
by all stakeholders working on the targets for health of the Sustainable Devel-
opment Goals at the country level. It is intended for disease specialists, policy-
makers, civil society, generalists and others. The goal in creating this toolkit is
to enhance programmes and improve health across all sectors and disciplines.
The toolkit supports the development of more broadly defined health systems to
become more equitable, more affordable, more measurable, more testable and
more synergistic with health-related programmes beyond the traditional health
system. It highlights a selection of WHO tools that align with and enable work
along the six main lines of action. Table 1 shows the six main lines of action and
the proposed tools.
The tools presented in this toolkit have been selected from a compendium
of WHO and joint publications compiled from public WHO web resources (see
Annexes 1–7). For each line of action, this toolkit highlights one tool. A tool can
be defined as a means for accomplishing a task or purpose, and for the purposes
of this toolkit, tools are intended to provoke new thinking and action to take
advantage of the opportunities presented by the 2030 Agenda for Sustainable
Development. They provide entry points, and as such they are not meant to
be comprehensive or exclusive. Instead, this toolkit should open new pathways
along which various other tools need to be introduced.
All stakeholders can use the toolkit and its tools to enhance their work on the
Sustainable Development Goals. For each of the six lines of action, the toolkit
outlines key areas for advancing the agenda for health of the Sustainable Devel-
opment Goals. It then suggests how to use the selected tools to address these
needs. For three lines of action, the toolkit and selected tools offer resources that
can be readily used without additional assistance. The other three lines of action
offer tools that are optimally used in a facilitated workshop or with technical
assistance but that can also be used independently as information products.
The toolkit is designed to function in coordination with other WHO resources
developed to support Member States in their work related to the Sustainable
Development Goals. For instance, it works alongside a course on the Sustainable
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Development Goals developed by the WHO Country Coordination Unit and the
United Nations System Staff College designed for WHO staff. The online course
provides a primer on the principles of the Sustainable Development Goals and
how Member States can benefit from working on the Sustainable Development
Goals, and the toolkit promotes the tools to operationalize this vision and realize
the benefits. It should also be viewed as a complementary resource to the strate-
gies and resolutions adopted by WHO regional bodies.
Action line 1. Intersectoral action by multiple stakeholders
(see Annex 1)
The 2030 Agenda for Sustainable Development envisions a more comprehensive
approach to development. It proposes that harnessing the synergy between
interconnected systems, rather than disjointed projects and programmes, will
accelerate the gains that can accrue to health and all other aspects of development.
Although ample evidence indicates the influences of social and environmental
determinants on health outcomes along the life-course (9), the persistent
challenge for health sector actors has long been developing programmes with
other government agencies to leverage these connections and improve health
outcomes. Health sector actors need to develop the skills and strategies necessary
to make the most of this synergy by working across government sectors.
Highlighted tool: Health in all policies: training manual
Building synergy between health and health-related systems to accelerate gains
in health and health equity is central to the vision for health of the Sustainable
Development Goals. Nevertheless, despite a long history of proposing intersec-
toral collaboration in health, it frequently remains one of the great untapped
opportunities to advance health through upstream disease prevention and health
promotion. The 2030 Agenda for Sustainable Development does not give guid-
ance on how this should be done either.
The Health in all policies: training manual (3) proposes to empower country-
level WHO staff members and health ministry leadership with the skills and
strategic approaches needed to implement intersectoral and health in all policies
initiatives. Intersectoral action takes different forms with many names. Health
in all policies is a type of intersectoral work seeking to systematically integrate
health concerns into the policies and processes of all other government sectors.
This training, while specifically oriented towards health in all policies, offers con-
cepts and skills that are necessary for any type of intersectoral work. These skills
are broadly useful for advancing health in the Sustainable Development Goals.
The skills and tools necessary to develop domestic intersectoral programmes
also support intersectoral action at the international level through health diplo-
macy. Issues affecting health ranging from climate change to medicines and
food security are often negotiated in the international arena as well, and health
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A WHO toolkit
diplomacy is needed to ensure that health is given priority at the highest politi-
cal levels (11).
The manual is most effectively used in a workshop format with a skilled
facilitator. The programme guides trainees through the process of identifying
opportunities in which health in all policies might be effective and explains
negotiation tactics and strategies to navigate these processes from beginning to
end. Among the many strengths of the training is the potential for scalability
and support. Attendees of one-off workshops often need ongoing support to put
new skills into practice. The workshop can take a training-of-trainers approach,
with the potential to build a network of in-country actors across civil society
that can support government actors. The manual also has many companion
resources, including numerous adaptations and similar training publications
that can support customized training as well as case study resources, including
the recent publication Progressing the Sustainable Development Goals through
health in all policies: case studies from around the world (12).
In the sustainable development era, health in all policies remains the ideal,
but it needs to be supported by more evidence demonstrating the most effective
pathways to improve health through multisectoral action. In this way, the 2030
Agenda for Sustainable Development is not only an agenda for action but also a
research agenda. Research will help to define how government agencies should
work together and which investments and programmes can produce the great-
est benefits.
Action line 2. Strengthening health systems for universal
health coverage (see Annex 2)
The 2030 Agenda for Sustainable Development changes the focus of the
Millennium Development Goals era on selecting specific priorities in health in
favour of a more comprehensive view of health and development. Progress across
a much broader vision of health and health-related systems requires a well-
functioning health system that can support affordable services across all areas
of health. Strengthening the health system is imperative to achieving universal
health coverage by ensuring that a full range of high-quality, people-centred
essential services can reach everyone affordably.
Highlighted tool: Healthy systems for universal health coverage – a joint
vision for healthy lives
Strengthening health systems involves a coordinated effort to improve access
to high-quality health services, medicines and technologies, sustainable financ-
ing and health system governance. Underpinning these main pillars of health
system function is a mix of processes and resources including the health work-
force, infrastructure, commodities, quality management, health information
systems and accountability. WHO offers a range of analytical, diagnostic and
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Working towards achieving the Sustainable Development Goals
guidance tools to support countries in improving performance across all of these
dimensions. WHO tools bring these aspects of strengthening health systems
together into a coherent vision for coordinated improvement of performance and
progress towards universal health coverage.
Healthy systems for universal health coverage – a joint vision for healthy lives
(4) is a publication by WHO and the World Bank for the UHC2030 platform.
In fewer than 30 pages, it offers an important primer on the shared vision for
strengthening systems as an instrument for achieving universal health coverage.
It is divided into key policy considerations for health services, governance and
financing with descriptions no longer than a paragraph each. It is a brief, help-
ful overview that should give readers a sufficient grasp of the issues to engage
effectively with more specific tools for planning, strategy or specific domains of
strengthening health systems. Users looking for a more comprehensive explo-
ration of planning and strategy for the health system should see Strategizing
national health in the 21st century: a handbook (13).
The health system is at the core of more comprehensive systems for health.
This toolkit addresses equity, financing, health information systems and research,
but these qualities are not meant to be an exclusive set. Strengthening health sys-
tems to deliver on the health aspects of the Sustainable Development Goals also
requires that they be resilient and sustainable among other qualities. The health
workforce, infrastructure, medicines, technologies and governance are key com-
ponents of the joint vision and any strengthening strategy. They are not covered
in this toolkit but are strongly associated with the qualities of more comprehen-
sive health systems.
Action line 3. Respect for equity and human rights (see Annex 3)
Emerging from the learned experience of implementing the Millennium Devel-
opment Goals, there is a clear consensus that equitable development is not only
a matter of social justice but that inequity has constrained progress across all
domains of development (14). As a result, millions were left behind from the
gains achieved in the Millennium Development Goals era, invisible in national
averages that hide the unevenness of social progress. Closing the gaps in health
outcomes within and between societies is therefore essential to achieving the
health-related targets of the Sustainable Development Goals and to progressively
realizing universal health coverage.
Highlighted tool: Innov8 approach for reviewing national health
programmes to leave no one behind: technical handbook
The Innov8 approach for reviewing national health programmes to leave no
one behind: technical handbook (Innov8) (5) evolved from the real experiences
of government responses to health inequity. Health inequities arise from the
societies in which people live – aspects of identity, policies, places and how
people live their lives. They are systematic in nature and difficult to disentangle
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