Putting health at the centre of the Sustainable Development Agenda
The ultimate success of the Sustainable Development Goals (SDGs) will be measured by their impact on the prosperity and well-being of people and the planet, and by the extent to which no one is left behind. Three years since their launch, it is clear that the pace of progress will have to be accelerated if the SDGs are to be achieved by 2030. Relevant actors at the global, regional, national and local levels need to unite to realise their historic commitment to health and well-being for all.
Recognising this challenge, Germany’s chancellor, Angela Merkel, Ghana’s president, Nana Akufo-Addo, and Norway’s prime minister, Erna Solberg, wrote a joint letter to the Director General of the World Health Organization (WHO), Dr Tedros Adhanom Ghebreyesus, requesting that he lead the development of a Global Action Plan for Health and Wellbeing for All. In consultation with 10 other United Nations organisations active in global health, WHO took up the challenge. A framework for this Action Plan was presented by Dr Tedros at the World Health Summit and the Grand Challenges conference in Berlin on 16 October 2018.
The German Federal Ministry of Health (BMG) and the German Federal Ministry for Economic Cooperation and Development (BMZ) are jointly committed to supporting the further elaboration and implementation of the Global Action Plan by involving stakeholders from civil society, public and private sectors to create broad ownership, particularly in partner countries of German development cooperation.
Expectations for the Action Plan: A BMZ consultation with parliamentarians and civil society
BMZ kicked off its stakeholder consultations on the Global Action Plan with an evening event on October 9 at the Permanent Representation of Hesse in Berlin which over 50 parliamentarians and civil society representatives attended. Following a welcome address by Hans-Peter Bauer, BMZ Deputy-Director General democracy, human rights, gender equality and social development, and a keynote by Jan Hendrik Schmitz Guinote, Advisor at WHO, Dr. Christoph Benn, Senior Advisor at the Global Fund to fight AIDS, Tuberculosis and Malaria, facilitated a panel discussion amongst Karin Geiffert, Representation of German Medical Students, Georg Kippels, Member of Parliament, Jens Martens, Global Policy Project and Marwin Meier, World Vision.
There was agreement that a strong push, ‘disruptive’ thinking and innovative approaches will be needed to accelerate implementation of the health-related SDGs. Panellists highlighted the need for adequate financing and cautioned that stronger cohesion and coordination between global and national health actors is imperative to overcome the fragmentation that currently characterises the health sector.
The discussion was recorded by a graphic artist (see graphic below) to be shared with all participants, as well as with the panellists of the high-level event which followed one week later at the Wold Health Summit.
The Global Action Plan at the World Health Summit
On 16 October 2018 a ministerial panel at the World Health Summit focused on the Global Action Plan for health lives and wellbeing for all. Ilona Kickbusch, Director of the Global Health Center at the Graduate Institute of International and Development Studies in Geneva and Co-Chair of UHC2030, facilitated a discussion between Dr Tedros, Director General of WHO, and representatives of African and European ministries of health and the BMZ. Kickbusch reminded participants that the Global Action Plan represents a historic commitment to unite for health: ‘In these times of fragmentation, we need to come together and create a new movement of global solidarity. What better topic is there to unite us than health? Health makes a difference for so many other SDGs – it is pivotal and at the center of the 2030 Agenda.’
The session began with statements from two of the three governments whose request to Dr Tedros led to the development of an action plan: Germany and Ghana. Babette Stier, Deputy Director General for European and International Health Policy at Germany’s BMG, emphasised the central role that WHO will need to play to make the Global Action Plan a success. ‘WHO is the only international organisation with universal political legitimacy in global health,’ she explained. This is why Germany, Ghana and Norway took the initiative to ask Dr Tedros in partnership with other stakeholders to draw up an action plan for healthy lives and well-being for all. ‘By now we can see that the joint development itself has strengthened and will further foster cooperation among international health organisations. This is a great achievement.’
Kwaku Agyeman-Manu, Ghana’s Minister of Health, spoke of the need for cross-sectoral partnerships to attain SDG 3. ‘Although only 13 of 169 SDG goals and targets are health-related, other SDG areas, such as education, gender equality, agriculture and human rights, strongly influence the attainment of the health goals. This calls for greater collaboration and an overall policy shift from verticalisation to integration. To achieve SDG3 we need urgency, we need purpose and, above all, we need leadership.’
Dr Tedros reflects on the meaning of SDG 3
Next, Kickbusch turned to Dr Tedros, thanking him for taking part in the session despite his very full schedule and the fact that he had just returned from Sudan. She invited him to share how he had received the three countries’ request, how he had worked with other organisations to address it, and what the outcome was.
Dr Tedros said that he was glad she mentioned his trip to Sudan, as he would like to share something that happened to him there. ‘At a cardiac centre I met this 13-year old boy. He had first been diagnosed with malaria, then with sickle cell anaemia and finally with heart disease. Without treatment he would have died. But he was operated on at this cardiac centre – a public-private partnership between an Italian NGO and the government – and it was effective. When I looked at him he was smiling back at me.’
As Dr Tedros paused to collect himself, you could hear a pin drop in the packed auditorium. ‘We have everything. This boy has nothing,’ he continued, ‘But he had this smile. So for me, this boy is SDG 3: Helping those who need support. Leaving no one behind.’
According to Dr Tedros, the first phase of the preparation of the Action Plan was concluded successfully, but there are challenges ahead. ‘Global coordination is good, but we also need coordination at the country level: unity amongst partners to support countries according to their priorities.’ He called upon every organisation, including WHO, to reassess if it was ready to stop thinking in silos and prepared to align, accelerate and account. ‘The letter I received asks for more than a new strategy. It demands a change in mindset.’
BMZ commits to putting health and people first
Following an input from France’s Minister of Higher Education, Research and Innovation, the representative of BMZ, Parliamentary State Secretary Norbert Barthle, echoed Dr Tedros’ humble and reflective tone in relation to the achievement of the 2030 Agenda. ‘We all need to re-examine our briefs and reflect critically on our work’, he said, ‘and this is what my ministry is currently doing. If we look back on the past three years we must recognise that we are not on course. We need to step up our efforts.’
He explained that the ministry has developed a scenario for the current legislative term to improve sustainable development. This is based on three principles: ownership by partners, expansion of partners’ domestic financial revenues for sustainable financing, and a rights-based approach for the most vulnerable. Barthle reported back from the BMZ’s consultations with civil society representatives the preceding week and their request for a strong push for acceleration. He lauded World Bank President Jim Kim’s human capital perspective which regards the smartest investments as those being made in good health services and education. In this same spirit, said Barthle, BMZ is committed to putting health and people first.
Where do we go from here?
Following statements in support of the Global Action Plan by the Ministers of Health of Ecuador and Uganda, Kickbusch asked the speakers: ‘What next?’
Anna Babette Stier, BMG, pointed out that German support to the WHO will be stepped up by an additional 115 million Euros for the next four years and made it clear that Germany would advocate for the Action Plan at the G7 and as a member of the WHO Advisory Board.
Norbert Barthle, BMZ, said that his ministry would work to get as many UN members states as possible on board to support the Action Plan, as well as actors not directly involved in health, such as the World Food Programme, the International Monetary Fund and the International Labour Organization. He further announced technical and financial assistance for countries to implement the Global Action Plan.
Dr Tedros thanked the speakers at the session, as well as the 10 UN signatory organisations for their contributions to the consultations on the Action Plan. ‘I see that our start was too slow, that we need to speed up,’ he said. ‘Ownership at country level is crucial. For me your inputs have made a difference. Saying thank you is a song of the heart.’
Bill Gates, Erna Solberg and Angela Merkel add their voices in support of the Global Action Plan
Later that evening about 1000 World Health Summit participants joined a similar number of delegates at the Grand Challenges conference at Berlin’s Estrel Hotel for a joint keynote address by Bill Gates, Co-Chair of the Bill and Melinda Gates Foundation, Dr Tedros, Director General of the WHO, Erna Solberg, Prime Minister of Norway, and Angela Merkel, Chancellor of Germany.
Bill Gates focused his comments on the importance of innovation: ‘We need science and we need tools, he said. ‘But the tools we have today are not enough to face the challenges of the future. This makes the work of innovation more critical than ever.’ He also praised the optimism and commitment of leaders like Erna Solberg and Angela Merkel who are stepping up and joining forces with others in support of the SDGs.
Dr Tedros picked up on these themes, noting the unprecedented commitment which the Global Action Plan represents and the fact that it is bringing the global health community together in a new way. ‘It’s a great pleasure to see so many of us united in hope that health becomes the platform for sustainable development, for ending poverty and for peaceful and inclusive societies.’
Erna Solberg spoke next, expressing hope that the Global Action Plan ‘will be a guide and inspiration for other SDG efforts. It acknowledges that reaching health-related goals requires action across sector boundaries, because everything is connected with everything else.’ She went on to note that the ‘SDGs are ambitious, but reaching them is possible.’
In her comments, Angela Merkel, the German Chancellor, underscored the necessity of moving forward together to tackle the great challenges of our time. ‘In times in which the principle of multilateralism is under pressure and put to the test, it is more important than ever that we come together to work for health, against pandemics, for a clean environment and for sufficient nutrition for all.’ This sentiment clearly resonated with the WHS and Grand Challenges participants who had gathered in the hotel atrium. The Chancellor’s description of the realisation of the right to health and well-being as a ‘task for humanity’ spoke to both the importance of their efforts and to the need to pursue them collaboratively.
Anna von Roenne, October 2018