Health &Development Agenda

Triono Soendoro, MD., Ph.DMember of National Committee, Post-MDG 2015 office of the President & Chair, Post-MDG 2015 Agenda, MoH

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A NEW GLOBAL PARTNERSHIP

Eradicate Poverty & Transform Economies through Sustainable

Development

Session Outline

1. The consultation process (NY, London, Monrovia, Jakarta, Bali – from July 2012 – (final report)

2. Botswana: Feb 20133. Bangkok (SEARO): March 20134. Final Report: April-June 20135. The Way Forward

Ban Ki Moon & Co-Chairs

• I look forward to the Panel’s recommendations on a global post-2015 agenda with “shared responsibilities for all countries and with the fight against poverty and sustainable development at its core.”

(25/7/2012)

The Journey: Dev. Agenda

how the various sectors (even within health) collaborate and “compete” with each other

& how health has eventually

been included

Health & Others: Competes..

• 11 thematic group including health, led by Botswana and Sweden, supports from WHO and UNICEF

• Address 3 issues: unfinished agenda of MDGs; emerging threats - health transition n globalization; health in the post 2015 develop agenda

• Final report: submitted to the UN-SG in May 30 and discuss in the UN-GA in Sept 2013

Serial Consultation: Wants..

• Overarching, aspirational health goals;

• Stick with focused, targeted MDG-like goals; and

• Supports a tiered approach with a hierarchy of health goals and sub-goals.

Intensive Dialogue

From MDGs 2000 to Post MDGs 2015 development agenda:• What to keep, • What to amend, and • What to add

Key Elements: Agenda• A new and compelling narrative setting out

an approach to development, including the new challenges we face, and the importance of blending inclusive growth with sustainability.

• A focused framework of global goals, shared global metrics, and national targets, around which the global community can organise itself.

• This should have a clear time horizon (eg to 2030).

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Contn’d• Clear articulation: priorities not

captured in a goals framework; for action through UN & others.

• An articulation: what implementation mechanisms; to drive action & mobilize resources on global priorities.

• A framework: monitoring progress, reviewing, and updating the priorities.

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Contn’d• Principles of a new development

compact that defines roles and responsibilities for states, civil society, the private sector, foundations and the international development community.

• This should also endorse principles on development finance, recognizing common challenges but differentiated abilities and needs.

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Botswana: 4-6 March 2013• Participants – 50 high level persons including

ministers, members of the HLP, chiefs of IGOs, INGOs, private sectors, and high level experts.

• The culmination of 6 months extensive consultation on how health should be addressed in the post 2015 development agenda

• Web-based with 150,000 visitors, 13 face to face with 1,500 pants and more than 100 papers submitted to www.worldwewant2015.org/health with 3 proposed targets - HLE, UHC, MDG++

The Place of Health: Post 2015

• Health is critical contributor to development in sectors other than health, a beneficiary from development, and a key indicator of what rights-based, sustainable and equitable development seeks to achieve– Links with many other sectors need to

made explicit– Emphasis on the importance of social

determinants of health

Post-2015: The Goals1. Long healthy lives: is an end goal,

influenced by health but also by many other aspects of development

2. Universal Health Coverage: contribution of health to the end goal, supported in many papers

3. Continued Health MDGs, with equity element

4. Several specific goals proposed, e.g. Universal access to sexual and reproductive rights or improvements in mental health.

Equity and human rights as central elements

Post-MDG 2015 Agenda: Shape, Themes, Contents?

Bangkok: Mid-March13

VISION: Intensive Dialog• Vision: “Ending Poverty by promoting

equitable development, sustainable growth with equity through strengthen partnership”….

• Vision: Human Well-being for all by 2030?

• Vision: The fulfillment of the constitutive elements of human Well-being for all by 2030?

• Remember: Health for all by 2000?16

Our Challenges: Framework?

• Human Well-being: putting human as the central for the development (overaching).

• Thus, how to attain the constitutive elements of HUMAN: Vision.

• Shift: human as resources (OBJ) to human as human-being (SBJT)

• Poverty, promote equitable development, sustainable, environment, education, health etc are the instruments (object), not the (subject) for the development 17

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The Constitutive Element: Vision

Human

The Linkage: As Systems

• Requires careful consideration, both of health vis a vis other development areas, and of the various elements within the health agenda as a SYSTEMS.

• It is clear: the new framework must address the limitations of the MDGs

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Systems

A system is something that:• maintains its existence and• functions as a whole • through the interaction of

its parts. 

Thus, Systems Thinking • looks at the whole

and the parts and • the interactions

among the parts• studying the whole in

order to understand the parts

Non-Systems Thinking• Reductionism, which is

the usual scientific (technical, managerial) approach, looks at the parts in order to try to understand the whole.

• >400 years (descartes)• Now, we have to shift

our way of thinking, fragmentation?

Analytical Thinking

“We have been taught how to solve problems, but hardly how to define them.”

Jamshid Gharajedaghi

Pro-Cons: Systems Thinking• Rationalize target setting

and help develop a limited set of numeric targets that are adaptable at country level and relevant globally.

• Hierarchy of more sector- and program specific goals, targets and indicators can reflect existing agreements (including the current MDGs) and incorporate elements of the new health agenda

• Difficult to adapt, fragmentation to become integrated – systems thinking.

• Dichotomous thinking: preventive promotive vs curative.

• Changes our perception, concepts: academic, practitioners, etc

• Health systems improvements: hard to understand

The Content (Bali Consult..)

• The content of post-2015 development agenda encompasses a set of important issues.

• These issues are overarching and related in one or other ways to sustainable development as the “interlinking” theme.

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HLPEP 4th meeting; Bali 25-27 March 2013

Content (GOALS): 15…• Poverty and inequality• Food security• Education• Health• Governance and

transparency• Employment and

livelihood security• Environmental

sustainability• Water and energy

• Peace, security, and social protection

• Cities and urbanization• Access to technology• Gender and youth• Ocean and seas• Disaster risk reduction• Sustainable

consumption and production patterns

• …etc

Bangkok Recommendations

• Maximizing health at all stages of life as overarching health goal with two specific health sector goals, i.e., accelerating progress of MDGs 4, 5 and 6, and reducing burden from NCDs

• UHC is the health sector key contribution and include ‘Universal access to quality comprehensive essential health services without financial barriers’

Sustainable Wellbeing for All (Wealth, healthy lives, education, nutrition, environment, etc.)

UHCAccess to quality comprehensive

essential primary care services (including all MDG++ and NCDs),

financial risk protection

Health sector contribution

Other sector contributions

Post 2015 Development Agenda: MODEL

Contributions of the health & other sectors

Draft Report (April 2013)

1. Towards a new global partnership for development• The world today• A new global partnership

2. Setting goals for the global partnership (refer to Communique/Bali-Monrovia)• A goal framework• Illustrative goals

3. A global consensus for action and accountability

The Frame of Goals

• MDGs 1-6– Halve poverty– Provide basic needs

• MDGs 7-8– Enviromental

stability– Aid

• Raise level of ambition– End poverty– Leave no one behind

• Use Resource Wisely– Manage as best– Beyond Aid

(partnership)

• Transformation– All inclusive– Fair, equal,

accountable(Keep, Adapt, Add)

Goals & Targets: Health

• Promote quality health care

• Maximize healthy lives and well-being

• Maximize health at all stages of life

• Reduce child death <5%• All children, adolescent,

pregnant women are fully vaccinated

• Universal access to sexual & reprod health services

• HIV, malaria, TBC, Diarrhea• Universal coverage of and

access to health services across all wealth quintiles

• Reduce mortality of NCD by 25% by 2025

• Etc……

Session: Final

1. Botswana – Feb 20132. Bangkok (SEARO) – March 20133. Post MDG-2015 development

consultation process – (Jul 12 – May 2013 – semi final report)

4. Final report: June 2013

Our Vision & Responsibility

“To end extreme poverty in all its forms in the context of

sustainable development and to have in place the building

blocks of sustained prosperity for all”

Partnerships (Bali)

• Multi-stakeholder partnerships, no longer fragmented

• Enables innovation, convince advocacy for good policies (HIAP), secure funding

• Implementation and scaling up to reach larger population

Five Principles: Goals

1. Leave No One Behind.2. Put Sustainable Development at the

Core3. Transform Economies for Jobs and

Inclusive Growth. 4. Build Peace and Effective, Open and

Accountable Institutions for All.5. Forge a New Global Partnership.

Global Goals & National Plans

• An approach for unifying global goals.

• Enable every nation to realize its own hopes and plans

• Choose an appropriate level of ambition for each target

• Input on what is realistic and achievable target at all level

Goal 4: Ensure Healthy Lives

• Focus on health outcomes; requires universal acces to basic health care means:1. Reaching more people for

essential services2. Broadening range of integrated

services3. Affordable4. Avoid discrimination

Goal 4: Cont’nd

• Ensure equity: interconnected (interaction social, econ & envir)

• Investing more in health: promotion and prevention (vaccination)

• Strengthening health system: health workers, nutritious food, safe water and sanitation, etc

Goals, Targets, and Indicators

TermHow it is Used in the

ReportExample from

MDGsGoals Expresses an ambitious, but

specific, commitment. Always starts with a verb/action.

(ENSURE HEALTHY LIVES)

Reduce child mortality

Targets1,2,

3

Quantified sub-components that will contribute in a major way to achievement of goal. Should be an outcome variable.

Reduce by two-thirds, between 1990 and 2015 (<5 mortality rate)

Indicators Precise metric from identified databases to assess if target is being met (often multiple indicators are used).

• Under-5 mortality rate

• IMR• Proportion of 1-year

olds immunized (UCI)

Target: 1,2, and 3

1. Candidates for global minimum standards, including ‘zero’goals;

2. Indicators to be disaggregated; 3. Targets require further technical

work to find appropriate indicators

Health: Target 1,2 1. End preventable infant and under-5 deaths.2. Increase by x% the proportion of children,

adolescents, at-risk adults and older people that are fully vaccinated.

3. Decrease the maternal mortality ratio to no more than x per 100,000.

4. Ensure universal sexual and reproductive health and rights.

5. Reduce the burden of disease from HIV/AIDS, tuberculosis, malaria, NTD and priority NCD 3

The Way Forward• Set of Goals or Goals: to be debated,

discussed, and improved (until…2015?)• Select targets at global level, national

level or even local level• Setting global minimum standard for

selected indicators• Setting disaggregate for relevant

indicators• Develop & formulate “agenda for HIAP”