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The Sustainable Development

Goals:

The place of health in the post-2015

agenda

Marie-Paule Kieny, Assistant-Director General

Technical briefing 18 May 2015

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Goals, targets, indicators From MDG to SDG

MDG 2000

UN agencies-led process

Developing country focus: poverty reduction and social development (health, education, gender)

8 Goals (3 for health)

21 Targets (6 for health)

60 Indicators (21 for health)

SDG 2015

Intergovernmental process, UN in technical advisory role

All-country focus: economic, social and environmental pillars of development

17 Goals (1 for health)

169 Targets (13 for health)

many Indicators

Health Goal and Targets

Financing for Development

Indicator framework for SDG monitoring

SDG health goal 3 and its 13 targets

To ensure healthy lives and

promote wellbeing for all

at all ages

3.1 Reduce maternal mortality

3.2 Reduce child and neonatal

mortality

3.3 End epidemics of HIV, TB, malaria and NTD, and combat hepatitis, water-borne diseases and other

communicable diseases

3.4 Reduce mortality due to NCD and

improve mental health

3.8 Achieve universal health

coverage

3.7 Universal access to sexual and reproductive

health-care services

3.6 Reduce mortality due to road traffic

injuries

3.5 Strengthen prevention and treatment of substance

abuse (narcotics, alcohol)

3.d Enhance capacity for early warning, risk reduction and

management of national and global health risks

3.c Increased health financing and health workforce in

developing countries

3.a Strengthen implementation FCTC

(tobacco)

3.9 Reduce deaths and illness due to pollution and

contamination

3.b Access to affordable essential medicines and

technologies

Goal 1: End poverty Target 1.3: Implement social protection systems for all

Goal 2: End hunger, achieve food security and improved nutrition Target 2.2: end malnutrition, achieve targets for reductions child stunting and wasting

Goal 6: Ensure availability and sustainable management of water and sanitation for all Target 6.1: achieve universal and equitable access to safe and affordable drinking water

Goal 5: Achieve gender equality and empower all women and girls Target 5.2: end all forms of violence against all women and girls ….

Goal 4: Ensure inclusive and equitable education ……….. Target 4.2: ensure access to early childhood development, care and pre-primary education …

Goal 16:Promote peaceful and inclusive societies for sustainable development, …….. Target 16.1: reduce all forms of violence and related death rates everywhere

Health

Health is linked to many other SDGs and targets

Other goals and targets e.g. 10 (inequality), 11 (cities), 13 (climate change)

Health Goal and Targets

Financing for Development

Indicator framework for SDG monitoring

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Financing for development Ongoing preparations of the Addis Ababa Accord

3rd International Conference on Financing for Development, Addis Ababa, 13-16 July 2015

– Assess the progress in the implementation of the 2002 Monterrey Consensus and 2008 Doha Declaration

– Discussions on the outcome document - Addis Ababa Accord - ongoing: focus on means of implementation for SDGs, but also on whether systemic economic issues (e.g. debt relief, reform of IFI) should be included

Current draft of the outcome document – place of health – Health: in discussed from multiple angles, including the continued

financing of the unfinished MDG agenda, the need to include UHC and financial risk protection and new challenges of NCD and injuries

Health Goal and Targets

Financing for Development

Indicator framework for SDG monitoring

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Indicator framework Complex task for Statistical Commission

SDG indicator selection process – UN Statistical Commission tasked: will deliver by March 2016

– Inter-Agency and Expert Group (IAEG-SDG Indicators) established consisting of 28 representatives of National Statistical Offices, with UN agencies as observers; UN Statistical Division as the secretariat

– Initial focus is on global monitoring

– Current SDG proposals 304 indicators for the 169 targets (many want less than 100)

Health indicators – Health monitoring more advanced than for many other goals, e.g.

• nearly 100 targets and indicators agreed upon in WHA resolutions; Global Reference List of 100 Core Health Indicators;

• country M&E: typical 30-50 health indicators to monitor national health plan

– Proposals from UN agencies: latest proposal 27 indicators, can be reduced

Current indicator proposals Target Indicator 3.1 Reduce maternal mortality to <70 Maternal mortality ratio (<70 / 100,000 live births)

Skilled birth attendance (>80% in all groups)

3.2 End newborn and child preventable deaths Under-5 mortality rate (no more than 25 per 1,000 live births) Neonatal mortality rate (no more than 12) Full immunization coverage (>=90%)

3.3 End epidemics HIV incidence and mortality rates (90% reduction) TB incidence and mortality numbers (80% and 90% reductions) Malaria incidence and mortality rates (90% reduction) People requiring interventions against NTD (90% reduction) Hepatitis B incidence (90% reduction)

3.4 Reduce NCD mortality and improve mental health Mortality rate due to CVD, cancer, diabetes, or chronic respiratory disease between ages 30 and 70 (30% reduction)

3.5 Prevention and treatment of substance abuse Treatment coverage for substance abuse disorders(at least 80%) Alcohol per capita consumption (harmful use, 10% reduction)

3.6 Halve deaths and injuries from road traffic accidents Mortality numbers due to road traffic accidents (50% reduction)

3.7 Universal access to sexual and reproductive health care services

Adolescent birth rate Family planning coverage rate (at least 75%)

3.8 Universal health coverage Coverage of key health interventions (minimum 80% in all popul. groups) Incidence of catastrophic / impoverishing health spending (zero)

3.9 Reduce mortality and illness from pollution and contamination

Exposure to air pollution in cities

3.a Tobacco Tobacco use (30% reduction) 3.b Medicines and vaccines Access to affordable medicines

3.c Increase health financing and enhance health workforce in developing countries

General government expenditure on health Density and distribution of health workers

3.d Strengthen capacity health risks Implementation IHR core capacities

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Target 3.8: Universal Health Coverage An integrated approach

UHC: all people receiving the services they need without incurring financial ruin; strong equity emphasis; 2012 UN General Assembly resolution

Must simultaneously monitor coverage of interventions and financial protection

– Tracer interventions (some are in specific targets, others can be added): e.g. family planning, antenatal care, skilled attendance at birth, immunization, ART, TB treatment, hypertension treatment, diabetes treatment etc.

– Financial protection indicator: people incurring catastrophic expenditure / due to health expenses

UHC is the place to promote and monitor an integrated health agenda; equity is hardwired into UHC and the SDG; country-specificity central

Regular global UHC monitoring initiated: launch WHO/World Bank report, June 2015

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Conclusions

SDG process very broad and complex, but health is in a relatively good place

– With a very comprehensive set of health targets

– With multiple linkages to other SDGs as contributor and beneficiary

UHC provides a platform for an integrated approach for the SDG health-related targets

SDG financing and monitoring framework likely to be big and complex: – Continue and strengthen monitoring of progress towards the specific health targets supported

by strengthening of country health information systems in an integrated manner

Monitoring discussions focused on the 169 targets; also a need for a small number of indicators measuring overall SDG progress, including equity:

– A summary measure of health such as healthy life expectancy, premature mortality should be part of this