Monthly Archives: August 2015

Strengthening health systems through a new global development framework

Strengthening health systems through a new global development framework

By Ariel Smilowitz

Last week, 193 countries officially agreed on a new agenda that will drive international development efforts for the next fifteen years. Replacing the Millennium Development Goals (MDGs), which are set to expire at the end of this year, the Sustainable Development Goals (SDGs) consist of 17 goals and 169 targets that aim to eradicate poverty, achieve gender equality, and combat climate change, among several other objectives.

The agreement reached, entitled “Transforming our World: The 2030 Agenda for Sustainable Development,” will be formally adopted at a special United Nations Summit starting September 25, and more than 160 world leaders are expected to attend the monumental event.

As the deadline for completing the MDGs and the rollout for the next set of goals rapidly approaches, 2015 will certainly be remembered as a watershed moment in the history of international development cooperation. It will be remembered as a year for reflection on how far we have come, as well as how far away we still remain.

For example, just over one year ago, President Obama welcomed over 50 leaders from across the African continent for the U.S.-Africa Leaders Summit, the largest any U.S. president has ever held with African heads of state. The first event of its kind, the Summit aimed to strengthen ties between the U.S. and Africa; however, unfortunately, President Ellen Johnson Sirleaf of Liberia and President Ernest Bai Koroma of Sierra Leone had to cancel their plans to attend the Summit. Why was this the case? As the U.S. was preparing to meet with African leaders to discuss its commitment to the African continent, Africa was reeling from the devastation of the largest recorded Ebola outbreak in human history.

Fast forward to last week. On August 5, the World Health Organization (WHO) confirmed two cases of Ebola — one in Guinea and one in Sierra Leone. According to WHO, this is the lowest weekly total since March, 2014 and marks the third consecutive decline in weekly case incidence. And yet, despite the fact that there has definitely been progress, much still needs to be done in order to ensure not only that Ebola (and other outbreaks) is completely eradicated, but also that there are strong and effective health systems in place in order to prevent future disasters.

As the Sustainable Development Goals prepare to pick up where the Millennium Development Goals left off, what sort of changes can we anticipate in how the goals will be implemented by member states, civil society leaders, NGOs, and other organizations around the world? In other words, how can we make sure that we are able to effectively transition from one set of goals to another, so that we can make more comprehensive gains in securing our well-being as a global community?

A new global public health agenda

For the past fifteen years, the international community has strived to improve public health through an MDG lens, with Goals 4 (reduce child mortality), 5 (improve maternal health), and 6 (combat HIV/Aids, Malaria, and other diseases) in mind. Now, with the rollout of the SDGs underway, SDG 3 (good health) is meant to incorporate those previous goals into a new overarching benchmark. Thus, organizations that have already been working to achieve these MDGs have to shift their original mission to coincide within the new development framework.

According to Cindil Redick, Manager of Advocacy and Special Projects for the One Million Community Health Workers (1mCHW) Campaign, the Campaign’s original mission was to work on achieving those three MDGs by strengthening health systems through the scale-up of community health workers in Africa. Established in 2013 and seated within Columbia University’s Earth Institute (Earth Institute Director Professor Jeffrey Sachs was one of the chief architects of the MDGs), the 1mCHW Campaign’s mission to achieve these goals by their 2015 expiration date was definitely ambitious.

Nevertheless, the Campaign has made significant progress and has worked with a number of African countries including Ghana, Kenya, Tanzania, Liberia, Malawi, and Nigeria to help their governments develop operational plans (referred to as “Roadmaps”) towards increasing the number of community health workers deployed throughout the region.

“A million community health workers isn’t going to happen by the end of the year,” says Redick. “But, the SDGs are being finalized in September, and Professor Sachs and the Sustainable Development Solutions Network (SDSN) have been working with the international community on developing the SDG indicators. One of the indicators for SDG 3 (good health) is universal health coverage (UHC), so the Campaign’s focus has changed to achieving SDG 3, with a focus on UHC, through formalizing community health workers as a cadre.”

“This shift should prolong the life of the Campaign until 2030,” says Redick.

These contextual shifts that organizations like the 1mCHW Campaign have to make in order to fit within the new SDG framework also include numerous other factors that must be taken into account in order for the new agenda to succeed.

Implementation must be country-specific

“One of the biggest [problems] was that the MDGs were very broad, and the indicators weren’t contextualized for countries; there wasn’t an established mechanism for data collection and evaluation at the country level,” says Redick, “and this ultimately affected how — or if — they were achieved.”

This is something the SDGs are surely trying to overcome — the new development framework boasts over 140 indicators, with sub-indicators to help monitor the achievement of each goal. Furthermore, the UN has already started to take steps to adequately monitor and evaluate SDG implementation and completion through it’s newly minted statistical commission.

“There is the opportunity for success,” says Redick, “but there needs to be adequate financial support for countries.”

Financing for development must be harmonized

The UN has estimated that the new goals could cost as much as $172.5 trillion over the next fifteen years. As a result, new means of mobilizing resources must be considered, something that has already been discussed during last month’s Financing for Development Conference in Addis Ababa, Ethiopia.

“With financing, especially for countries, there is a lot of fragmentation between governments, program providers, and donors,” says Redick. “They’re not in sync with each other, and it’s caused a lot of issues.”

“One thing that could happen, possibly through the Global Financing Facility, is to make sure that organizations donating money to countries are really focused on being harmonized with country priorities, so they’re not financing programs that duplicate efforts, and so there isn’t intra-country competition for health service delivery funding.”

Leveraging data is crucial

According to Redick, leveraging data is also a crucial building block in guaranteeing the success of the SDGs.

“I think data, especially in global health, is underutilized, and there’s a lot of potential, especially for improving health service delivery and program management,” says Redick. “With the emergence of mHealth tools, we have a lot of opportunities to collect data.”

But, issues of standardization and data sharing are still rampant.

“WHO has all these minimum data sets for health workers, but there’s very little enforcement or use of those minimum data sets; a lot of organizations have their own indicators they want — or need — to collect,” says Redick.

“Furthermore, there’s a lot of protectiveness globally around data sharing. A lot of countries may not want to share their data, so before we can concurrently move towards changing our decision-making model, we need to encourage a community and society open to sharing data. The SDGs provide an opportunity for that, but it’s going to be a very slow shift — it’s not going to happen quickly by any means.”

Ultimately, all of these factors are different working components that go into strengthening health systems. Thus, as we embark on our new global development framework, it is necessary that these components are effectively addressed and resolved, so that SDG 3, along with the other SDGs, can truly be achieved.



Fostering multi-stakeholder collaboration

Fostering multi-stakeholder collaboration

By Kevin Steinberg

There are two potentially historic deals on the world’s negotiating table this year: the UN’s Sustainable Development Goals (SDGs), focused on extreme poverty and global development, and the Paris 2015 Convention on Climate Change. For decades to come, these two agreements will help shape and direct global efforts to address some of the world’s most vexing challenges like health, poverty, education, equality and environmental sustainability. However, effective treaty outcomes are necessary but not sufficient to address these systemic issues successfully — only a collective response from governments, businesses, civil society and the public has the potential to re-shape the way our common future will unfold.

Over the past 20 years, I have had the privilege of working on complex, multi-faceted social issues from a variety of perspectives, from both from the private sector and the social sector, as well as alongside world leaders and grass-roots activists. Challenges like climate change and those raised by the SDGs are too systemic, interrelated and complex for any single nation, organization or sector to address alone. Some of the greatest past successes as well as some of the most promising upcoming opportunities to address them stem from collaboration across different players and sectors. In addition to pressing negotiators for aggressive targets, concerned efforts must be made to nurture the multi-stakeholder partnerships that will ultimately help meet them.

In recent years, there have been several shining examples of successful cross-sector collaborations, such as the Global Alliance for Vaccines and Immunization (GAVI). Launched in 2000, it brought together a coalition of governments, UN agencies, private sector companies and civil society organizations to launch and fund a renewed effort to combat preventable childhood diseases. For decades prior, there had been limited global progress on delivering basic vaccines in developing countries. However, in the last 15 years, this collaboration has overseen the vaccination of over half a billion children and has saved seven million lives.

Non-government players were critical to the formation of GAVI. A $750m commitment from the Bill and Melinda Gates Foundation provided core seed funding for the initiative, and the effort was launched in Davos during the 2000 Annual Meeting of the World Economic Forum, where cross-sectoral global leaders pledged their partnership. The World Economic Forum itself, the international organization where I spent many years working to engage the private sector on global issues, has long been recognized as a leader in fostering these types of multi-stakeholder collaborations.

Another multi-stakeholder partnership, the Global Fund to Fight AIDS, TB and Malaria has, since 2002, raised and disbursed over $30bn, making it the world’s largest financing mechanism of its kind. Prior public health efforts had largely focused on bringing donor and recipient countries together, often using prevalence of disease as the primary criterion for distributing aid. Conceived as a partnership between the public sector, business and civil society, the Global Fund’s central premise was to disburse funding based on innovation and impact, adopting what some called an “investment & accountability” model modelled after the private sector.

As the Global Fund was being launched, I was working for the global consultancy McKinsey & Company, one of the first private sector firms to get involved. I recall the early, optimistic discussions amongst private sector companies and large foundations eager to contribute; I also recall skepticism from many sides about the motives of private sector participants, questioning whether pharmaceutical companies or consultancies had conflicting interests, or whether development should be funded by large foundations unaccountable to the public. In the end, unlike the global development organizations that preceded it, the Global Fund’s governing board was and remains comprised not only of representatives from government and international organizations, but also private sector and foundation voices.

Outside of the public health sphere, multi-stakeholder collaborations have also become increasingly common. Progress towards the eight UN Millennium Development Goals, which in 2000 aimed to halve extreme poverty rates amongst other targets, have likewise been accelerated through reinforcing efforts from governments, business and civil society. The UN refers to 700 million freed from extreme poverty between 1990 to 2010, with a primary driver being hundreds of millions of new private sector jobs created in China and India in particular. Meanwhile, formal UN entities like the Global Compact are evolving to invite and encourage business collaboration for a sustainable economy, and groups like Action/2015 are linking hundreds of NGOs in the global development effort.

While these successes show how strong relationships between the public, private and social sectors can bring positive change, there is a new force that is just starting to be unleashed. As we confront ever-greater climate and poverty challenges, the collective power of ordinary people will also become increasingly vital. Thankfully, it’s also evolving to meet the challenge: around the world, people are being connected across boundaries of geography, culture and language as new technologies, models and organizations are helping them demand change and take action. Increasingly, citizen involvement is driving governments and negotiators to make difficult choices and adopt needed reforms.

During last September’s UN General Assembly week, an unprecedented coalition of private, public and social sector players partnered to gather more than 400,000 people to march through New York’s Central Park in support of climate action. Innovative new organizations like Here Now, a movement accelerator focused on climate, clean energy and sustainable solutions, have focused on partnering with like-minded organizations to reach millions of people through online channels. This past April on Earth Day, it helped over 200 partners including 20 major businesses; over 45 NGOs; 75 artists, filmmakers and musicians; globally recognized celebrities and politicians; and thousands of citizens across five continents, to reach 265 million people with the message that #ClimateChangeIsReal and so are the solutions to address it.

The struggle is also playing out in the business arena. Groups like the B Team, founded in 2013 by Sir Richard Branson and Jochen Zeitz, are inviting business leaders to not only change their companies, but ask their consumers to join broader reform efforts. In New York last September, the New York Declaration on Forests had over 20 global food companies join governments, civil society and indigenous peoples to commit to halving deforestation by 2020 and ending the practice by 2030.

And, the push for consumer action is creating partnerships between political, business and philanthropic actors. This year in their annual letter to foundation supporters, Bill and Melinda Gates called for the public to join Global Citizen, a public movement aspiring to connect tens of millions of like-minded people to urge governments, non-profits and companies to commit to addressing extreme poverty. The world’s leading philanthropists calling on the public to join a crusade traditionally driven by the world’s largest organizations is noteworthy in its bottom-up approach.

Purpose, the public benefit corporation where I now serve as president, has been assisting several of the above multi-stakeholder partnerships to find ways for the public to harness their power and engage on the world’s most pressing challenges. In 2015, as the official UN delegates wrestle with climate and development treaties, there is greater opportunity than ever before for ordinary people to be represented with them at the table alongside business, governments and NGOs. The new cross-sector organizations, approaches and interventions need your support and commitment. Act now, add your voice, and take your seat at the table.


With new UN development goals, focus shifts away from infectious disease

With new UN development goals, focus shifts away from infectious disease

By Justine Calma

Earlier this month, after nearly three years of planning and negotiations, 193 member states of the United Nations agreed upon ambitious new global development goals for the next 15 years, with “ending poverty in all its forms everywhere” at the top of the list.

The Sustainable Development Goals, or SDGs, continue efforts first mapped out in 2000 with the Millennium Development Goals, which expire later this year.

The new goals reflect a changed landscape for top global health priorities, with an emphasis on the rising threat of non-communicable diseases like heart disease and cancer over that of infectious diseases like HIV and malaria. And so the goals have some in the international public health community concerned that years of progress on infectious disease control could become undone and leave the world vulnerable to epidemics.

“The difference with infectious disease is they can go from being, in the case of Ebola, nonexistent to something that affects tens of thousand or millions of people…in a very short time frame,” said Dyann Wirth, chair of the immunology and infectious diseases department at Harvard University.

If the global health community becomes overconfident in its ability to tackle infectious disease because of the success it has met in the last 15 years, Wirth cautioned, “we could lose that progress very rapidly.”

The 17 SDGs include just one goal for health: to ensure healthy lives and promote wellbeing for all at all ages. That goal encompasses a number of specific health-related targets ranging from reducing child and maternal mortality to decreasing deaths from chronic diseases, environmental degradation and traffic accidents.

These targets reflect a global rise in non-communicable diseases, which were responsible for 68 percent of all deaths in 2012, up from 60 percent in 2000. Cardiovascular diseases alone killed 2.6 million more people in 2012 than in the year 2000, according to the World Health Organization.

And on some levels, this can be seen as a good thing. Non-communicable chronic health problems are leading causes of death in high-income countries, whereas infectious disease kills more people in low and middle-income countries.

“The last 20 years have been fantastic for global health compared to most of history and that’s despite the immense challenges of the AIDS epidemic,” said Charles Kenny, senior fellow at the Center for Global Development. “The challenge for the next 20 years… is going to be bigger because people are dying of more complicated things.”

But the danger with infectious diseases is in their ability to spread any time there’s a change in environment, like when people lose access to vaccines or viruses develop antimicrobial resistance.

Tuberculosis, for example, is the second leading cause of death from an infectious agent after HIV. The mortality rate for tuberculosis fell by 45 percent between 1990 and 2013, according to the World Health Organization. More recently, however, Doctors Without Borders has reported an alarming resurgence of tuberculosis, with close to half a million people developing drug-resistant strains of the disease a year.

An attempt was made earlier this year to include another development goal that would mitigate the consequences an infectious disease epidemic would have on global security.

In March, Dr. Ilona Kickbusch, director of the global health program at the Graduate Institute of International and Development Studies, Geneva, published a proposal in The Lancet for an 18th Sustainable Development Goal that would address global health security, and by extension, infectious disease. There will be other epidemics and health security crises beyond the recent Ebola outbreak, the proposal contended, citing resistance to antimicrobial medicines used to treat infections as one major threat.

Drug resistance “is a very deep and basic threat,” said Kickbusch. “I think it is comparable with issues of sustainable development if medicine as we know it is not possible anymore.”

To Kickbusch and her coauthors, the SDGs presented an opportunity to create an effective global health security framework that could protect against rapidly spreading risks like antimicrobial resistance. Goal 18, however, did not make it into final documents. The proposal came after member states had already been in discussion for years and were nearing adoption of the 17 existing goals.

Still, the push was successful in making sure the final agenda better addresses new global health threats and explicitly mentions antimicrobial resistance, which was not mentioned in previous drafts.

The previous eight Millennium Development Goals included three separate health goals, including one that specifically tackled HIV/AIDS, malaria and other diseases.

“Many health advocates were disappointed that you had three out of eight Millennium Development Goals focused on health and this time around there’s one health goal out of 17,” said Kickbusch.

On the other hand, she said, many determinants of health are connected to other goals, like ending poverty and stopping climate change.

Others who work in global health were optimistic about the new health goal. In the past, the response to AIDS was not always clearly linked to other sectors and the broader health agenda, said Marielle Hart, Policy Manager with the International HIV/AIDS Alliance.

“Now that we have an overarching health goal with AIDS as at target, we hope that we will have a more comprehensive, integrated approach to health in the next 15 years,” she said.

Although the sustainable development agenda does not explicitly outline a separate goal on infectious disease, its sub-targets include a bold statement to “end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.”

The broader health goal also calls for universal health coverage and access to quality and affordable medicines and vaccines.

“We made the case that having a strong health system that is universally accessible is an absolute prerequisite to help a country deal with an infectious disease outbreak,” said Simon Wright, Head of Child Survival with the nonprofit Save the Children.

All 17 goals will be formally adopted this September during the United Nations General Assembly.

Justine Calma is a 2015 GroundTruth-Kaiser Family Foundation global health reporting fellow.

This story is presented by The GroundTruth Project.


4 reasons business should get involved in the global development goals

4 reasons business should get involved in the global development goals

By Kathy Calvin, President and CEO, the United Nations Foundation

Something major recently happened at the United Nations that matters to all of us: Countries around the world agreed on the document to be adopted in September on the global development goals and noted the need for partnership on the first page of text, calling for “the participation of all countries, all stakeholders, and all people.”

“Partnership” appears alongside “people,” “planet,” “prosperity” and “peace” in the document — a clear statement that the UN and its members recognize that partnership can’t be an afterthought of our development agenda; it has to be a core part of it.

It’s simple: To translate the next set of global goals from words into a world where everyone has opportunity and no one is left behind will require a range of sectors and communities to get involved. The private sector especially has an important role to play. It has unique resources, ideas, expertise, technology and human talent to contribute.

Here are four reasons why businesses everywhere — from small start-ups to large multi-nationals – should join the effort to achieve our global development goals.

  1. The global goals matter to business.

The new global goals for 2016-2030, known as the Sustainable Development Goals, set an ambitious agenda to end extreme poverty, promote opportunity for all, and protect the planet — achievements that will improve global stability and expand prosperity. As smart business leaders recognize, this is good for the world and good for business. A survey by the UN Global Compact found that 93 percent of CEOs believe sustainability is important to their future business success.

The process to create the global goals included consultation with the private sector, and the next development agenda includes issues that matter to businesses, from expanding access to energy to promoting effective institutions. Making sure people have access to jobs, health care, adequate nutrition and thriving environments is not just a moral imperative — it’s an economic opportunity.

  1. We need private sector engagement to help make progress.

Government aid is important, but it’s not enough by itself. The private sector is an engine for economic growth, job creation, and innovation, which will be essential to empowering people to move from poverty to prosperity. To succeed, we need to unlock private sector investments and harness the sector’s know-how, technologies and human capital.

  1. This is not your grandfather’s development sector.

The new global goals are made for the 21st century, based on a 21st century model of how to do development. They are concrete, measurable, and driven by data — aspects the business community understands.

Additionally, the doors to partnership with the development community are open like never before. A Devex Impact survey of development professionals found that 91 percent of respondents view business as a positive force in development. The development sector is ready to hold ourselves accountable, partner with the private sector, and deliver results.

The UN is also embracing private sector engagement in our shared global agenda as it makes sure it is fit for purpose in this new era.

  1. It’s the right thing to do.

Business is a member of the international community and has an obligation, like all of us, to be a responsible actor. Each of us needs to play a role in creating a world where everyone has opportunity, no one is left behind, and the planet can flourish.

So how can you get involved in achieving our global goals?

Speak out: Raise your voice about why the global goals matter, and why the private sector needs to participate.

Build a business case: Help build the case for why the global goals are important to your business and the broader business community.

Engage your networks: Spread the word about the global goals among your employees and networks.

Internalize the global goals: Learn about the global goals and integrate them into your plans, products, and services.

Partner: Get involved by working with other organizations – from governments to civil society groups to other companies – that are also engaged in global problem-solving.

Many businesses are already taking action. For example, Dell has launched an EntrepreneursUNite petition to promote entrepreneurship in support of the goal on economic growth and employment. Philips is leveraging its business in integrated ways to advance progress on goals related to health, energy, and sustainable consumption and production. And companies such as Unilever and Novozymes have elevated and embedded sustainability as key parts of their business strategies.

Now we need to keep the movement growing.

While the global goals are ambitious, they are also achievable if we come together and act. The bottom line is building a stronger, healthier, more prosperous world will require and reward the participation of every sector.