Can the Global Action Plan for Health breathe life back into SDG3?

BERLIN — The new Global Action Plan for Healthy Lives and Well-being for All, which commits 12 multilateral agencies to better coordinate their activities in a bid to revitalize the 2030 Agenda for health, was the star of the recently concluded World Health Summit in Berlin.

The plan grew out of a call from the leaders of Germany, Norway, and Ghana at least year's summit for more effective collaboration between global health bodies, streamlining institutional efforts toward Sustainable Development Goal 3, which promises healthy lives and well-being for everyone.

It took less than a year for the 12 institutions, under the direction of the World Health Organization, to put together a plan, which they launched at the United Nations General Assembly in late September.

The goal at this year's WHS was to position the global action plan within the constellation of existing global health plans and to begin explaining what its pledge "to accelerate country progress on the health-related Sustainable Development Goals" might practically involve.

It is an effort that could completely reorient the work of major multilateral health institutions, including the Global Fund and UNICEF. Peter Sands, the Global Fund's executive director, said it could "change the mindset and norms about how development partners are going to work with countries."

Although its launch at this year’s General Assembly was overshadowed by the High-Level Meeting on Universal Health Coverage, Maike Voss, an associate in the global issues division of the German Institute for International and Security Affairs, told Devex it could be just as important.

"The global action plan is the umbrella of the umbrella," she said. "For me, UHC is a model of a health system and the action plan is how to bring all the actors and everything in this health system together."

But some participants at WHS cautioned that would only happen if the plan’s architects ramped up their engagement with country-level officials, civil society, and the marginalized communities that are most in danger of being left out of interventions.

The plan calls for the 12 agencies to better align themselves around country-led strategies to reach SDG 3, with a specific focus on seven key themes that include primary health care, sustainable financing and community, and civil society engagement.

"It's a menu of things [that] countries, agencies, organizations can look at and work on together," Alex Harris, head of global policy and advocacy at the Wellcome Trust, explained during a workshop.

The idea is that the multilateral agencies would work to align their programs and investments behind the country's own priorities. For example, Ghana held a country dialogue around the plan in April, where national leaders and representatives from civil society and development agencies identified strengthening its primary health care system and ensuring its sustainability as its two key priorities.

"It's where the countries say, 'We have a need and no one is filling that need,'" Seth Berkley, CEO of Gavi, the Vaccine Alliance, explained during WHS's closing panel.

Within the global action plan framework, the multilaterals would attempt to work together to meet that need, rather than potentially launching duplicative responses.

"When I look at the 12 agencies, I doubt we [Gavi] will work with all 12 of them or work with them equally," Berkley said. But "we will reach out and say, 'Where are there places we can make synergies?'"

Those synergies might then result in cost savings that can be reinvested in other health programs. Jane Ruth Aceng, Uganda's health minister, said the action plan would be a success if it helped her simply to determine exactly how much money the 12 multilaterals are spending on health activities in her country.

But for a plan that is meant to be guided by national strategies, some said there is still significant outreach that needs to be done at the country level.

"Governments need to know what the gaps are," said Princess Nothemba Simelela, advisor to the WHO director-general on strategic programmatic priorities. "We make huge assumptions that we'll be dealing with national governments that know what the gaps are."

And while efforts to engage communities and civil society are highlighted as one of the seven "accelerators" that the 12 multilaterals are supposed to prioritize, there was concern that they weren't engaged enough in the process of drafting the plan.

"There's a huge task in investing in a social participation model to ensure there is input," Rosemary Mburu, executive director of the health advocacy organization Waci Health, told Devex. "It's a role [the global action plan] can fulfill, though perhaps they're not doing that, yet. I think the agencies really need to come and place social participation high."

That engagement might ultimately reveal that the seven accelerators — which also include determinants of health, innovative programming, research and development, and data and digital health — do not actually reflect country priorities. Voss pointed to the absence of accelerators around shoring up the health workforce or addressing antimicrobial resistance — two critical issues across much of the global south.

Global action plan advocates said it is malleable and that they are still looking to engage other actors, including the private sector and bilateral institutions.

But they also emphasized the urgency that propelled the plan from conceptualization to creation in less than a year.

"We're conscious of the fact that there is only 10 years to reach SDG 3," Simelela said. "We need to create that urgency. There should be no fear, we should just jump in and see how it goes."