Feature story on WHO delivery case study
Estimates suggest that, if our trajectory is unaltered, the goal of one billion people with UHC by 2023 will be short by 730 million people.
This shortfall rises to 840 million with setbacks due to COVID-19.
In 2017, Dr Tedros had just been elected Director-General of WHO, with a vision to refocus the Organization towards impacts in countries.
But he faced a challenge: with fewer than 13 years left for Member States to achieve the Sustainable Development Goals (SDGs), wide gaps remained, and progress had to be accelerated urgently.
WHO’s guidance shaped policy agendas around the world, and it was a trusted partner of ministries of health. But the Organization also faced criticism about its impact.[1]
This case study presents WHO’s journey to transform itself into an Organization that is closely focused on having a meaningful impact on the lives of billions around the world.
Building the foundation: defining success
First, Dr Tedros and his team of senior leaders put together a new strategy focused on measurable impacts on health outcomes in countries.
It was inspired by WHO’s “3 by 5” initiative launched in 2003 to ensure that 3 million people with HIV were on antiretroviral therapy by 2005.
The new strategy extended the concept of measurable goals throughout WHO’s work to strengthen access to effective, affordable health services, to address other determinants of health and to increase protection from health emergencies.
To consolidate the SDG targets into manageable strategic priorities that cut across disease-specific siloes, they were reframed into three outcomes for realistic numbers of people — a critical step to ensure public engagement.
The team consulted extensively to ensure that the goals were measurable, meaningful and data driven. These ultimately became the Triple Billion targets:
The Healthier Populations Billion — target was coined to capture factors that impact health but are outside health systems and the provision of effective, affordable health services, such as climate, diet and safe sanitation.
The team created an index of 16 indicators and proposed a target of 1 billion people living healthier lives by 2023.
The Universal Health Coverage (UHC) Billion — target combines financial protection and equitable access to services, to reflect the fact that access to services that impoverishes families is not truly UHC.
A target of 1 billion additional people benefiting from UHC by 2023 was based on analyses that showed that 3 billion more people needed coverage over the next 15 years.
The Health Emergencies Billion target — focuses on individuals in health emergencies.
An index was constructed from three sub-concepts:
- Prepare (measured as capacity in accordance with the 2005 International Health Regulations),
- Prevent and Detect (measured as vaccination against high-priority pathogens) and
- Notify and Respond, starting from the time between first detection of an outbreak and WHO notification, with every country making incremental progress.
A lot has been learnt from the COVID-19 pandemic to improve tracking of progress and performance.
Summary of the Triple Billion targets
Dr Tedros knew he had to go beyond describing global progress to describing the role that WHO was playing.
WHO’s work was previously measured from a set of domain-specific indicators (e.g., number of countries that had passed anti-tobacco legislation), an approach that tended to create thematic siloes.
Instead, an innovative scorecard method was designed to better capture the multi-dimensional ways in which WHO influences progress, including the cross-cutting goals of impact, gender awareness and value for money. Case studies were created to capture the full complexity of WHO action at country level.
The Triple Billion targets were thus set and became the core strategy for WHO’s 13th General Programme of Work.[2].
Regions in turn articulated their regional strategies within the framework.
For example, in 2021, the European Region adapted the Billions to its specific burden of disease, focused on noncommunicable diseases and environmental determinants of health.
The Programme Budget 2020–2021 was developed according to what was required to deliver on the Triple Billion targets.
Budgets and operational plans, with a sharp focus on delivering tailored support to countries and strengthening the leadership and normative roles of WHO, further showed how WHO would influence delivery of the 12 cross-cutting outcomes that underpin the Triple Billion targets.
This new approach was designed to bring teams together and ensure that transversal and integrated approaches to primary health care, health systems and social determinants of health would shift from siloed programming.
For the first time, WHO had a simple, clear framework for measuring the world’s progress towards the health-related SDGs.[3]
From planning to execution: driving delivery
Now that the groundwork had been laid, the real work could begin to ensure that the Triple Billion targets would be more than just a slogan.
But how could such a large, multi-layered organization effectively support Member States?
To answer this question, Dr Tedros invited experts in implementation to assess WHO’s readiness to deliver.
They found that, while it had a clear vision, strong political commitment and effective communication on the Billions, it lacked a central team dedicated to achievement of the targets and that clearer processes were necessary to prioritize actions and monitor progress.
To address these gaps, Dr Tedros established the Delivery for Impact Department, with the mandate to bring a specific focus to delivery of the Billion targets.
The team started a global routine labelled “ stocktakes “, which brought together senior leaders to discuss progress and correct the course if necessary.
Between 2020 and 2021, five stocktakes were run, each indicating overall progress, highlighting countries in greatest need and charting a path based on evidence-based country success stories.
BOX: Tracking the Triple Billion targets: What have we learnt?
Healthier Populations Billion target.
- Before COVID-19, our estimates suggested that 900 million more individuals would be enjoying better health by 2023.
- However, the progress is uneven and is due primarily to advances in a handful of middle-income countries.
- In addition, we now know that, to stay on track to the SDGs, we must exceed the original target and reach over four billion people by 2025.
UHC Billion targets.
- Estimates suggest that, if our trajectory is unaltered, the goal of one billion people with UHC by 2023 will be short by 730 million people.
- This shortfall rises to 840 million with setbacks due to COVID-19.
- This rate of progress is less than 20% of what is necessary to reach the SDG target, presenting a major risk to health outcomes globally.
Health Emergencies Billion target.
- Although the original target is almost reached, COVID-19 has taught us that no country is truly prepared for a pandemic.
- More dynamic measures are necessary, ensuring that all sectors, citizens and communities are engaged.
- These insights are considered in the universal health preparedness reviews, which provide a peer-to-peer approach to reviewing Member States’ pandemic preparedness against objectively verifiable benchmarks.
For each indicator under each billion target, WHO developed data-driven scenarios, so that countries could see their current trends and the acceleration required to meet the targets.
The scenarios were developed from a range of data, including the rate of change necessary to meet global targets and the best rate of change seen in benchmark countries.
WHO also clarified the policies and interventions linked to each indicator, for easier assessment of what to implement and towards which impact. Some of the work built on established technical packages, such as MPOWER for tobacco control. For others, such as obesity, work is at an earlier stage.
Focus was also placed on building WHO capacity to support Member States.
Country teams can now access on demand a tailored package of training, peer-to-peer activities, tools and methods for moving from planning to execution.
Since 2021, 30 countries have been supported in undertaking their own “stocktakes” to prioritize and review their solutions and progress towards the Triple Billion targets.
All this effort is geared towards a single goal: identifying and supporting countries in greatest need through combined technical, political, innovation and delivery support.
For example, the new “obesity acceleration” plan was based on identification of countries in which actions could bear the most fruit. Similar efforts are under way to strengthen the ability of country offices to support governments in tackling climate change, addressing malnutrition or strengthening primary health care and health financing systems, with the goal of reaching more than 50 countries.
Sustaining change: building on these foundations
The architecture for ensuring impact has been established. It is now time to embed it into the culture of the Organization.
Global evidence highlights the importance of continually building momentum through celebrations of success, effective communication and capacity-building to meaningfully shift culture and practice.
As WHO continues on its transformative journey, it must go beyond focusing on numbers to the actions that those numbers indicate.
This will be done by further specifying WHO’s unique contribution to the Billion targets and by ensuring that its teams focus on activities that accelerate impact.
Support to strengthen data systems in Member States can also help fill the data gaps that impede policy actions and tracking of the SDGs.
Clear understanding of local needs must be maintained to ensure that WHO’s action is adapted to local contexts.
A key challenge is embedding delivery into the management and governance of the Organization.
Only by building accountability for results can WHO enhance the trust of its Member States, and only by enhancing trust can it garner more desperately needed resources to accelerate progress towards the Triple Billion targets and the SDGs.
References
See the original publication
Originally published at https://www.who.int.
