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The next era for health – will it be any different?

At the end of September – amidst the frenzy of the Pope and Putin in New York – the Sustainable Development Goals (SDGs) were agreed as the framework for 2016-2030.

Most of what we have said and done in global health from 2000 until 2015 has been framed by the Millennium Development Goals (MDGs). So it’s going to be fascinating to watch how we all adapt to the new era.

Ambitious goals

Many people have criticised the SDGs as too broad compared with the fewer targets in the MDGs. They are certainly more comprehensive, having been actively negotiated by all governments.

They are also more ambitious. Ending all preventable deaths aims to get all countries below 25 under-five deaths per 1,000 births.

As with the MDGs, this will require concerted global efforts to support those countries where health access is worst and mortality rates high. The Every Woman Every Child new Global Strategy aims to support this.

Also more ambitious is the condition that targets have to be achieved in every sector of society. Many countries are already below or can easily achieve 25/1000 but will find it very hard to do it for the poorest and for excluded groups. This is why equity needs to be embedded in all the indicators, not just warm words from the UN General Assembly.

Equal healthcare

One of the most ambitious targets in the SDGs, and very different in style to the MDGs, is 3.8 Universal Health Coverage (UHC). Even if they do not realise it, governments have now committed to organise their health system to provide essential services for everyone, not to allow people to be excluded or to be pushed into poverty by the way they pay for it.

I took part in many meetings on this, including the launch of an important new book from the World Bank, Going Universal, which identifies how many countries are building UHC from a “bottom up” approach.

Another UHC meeting was hosted by the Japanese government, at which Prime Minister Shinzo Abe confirmed that Japan is making UHC a priority for its hosting of the G7 next year. The event was co-hosted by the Global Fund to Fight AIDS, TB & Malaria and one question this posed is how should donors support UHC?

Supporting the systems

Of course, the Global Fund, Gavi, the new Global Financing Facility and other donor funds for specific health topics can argue that they support UHC by supporting aspects of the health services.

The same is true for many other vertical initiatives funded by donors. But we need to have a proper debate about this – how to actually support health system changes such as improving financing, expanding human resources and strengthening health information systems.

It might be time to reawaken an idea that never took off: the Health Systems Funding Platform which aimed to combine multilateral funds to support health systems. And also to revitalise one that has been far too low profile lately: the International Health Partnership + which tries to get donors supporting national health plans and not their own uncoordinated projects.

 

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