The Financing for Development outcomes emphasize the importance of international development cooperation and partnerships in the health sector.
The leading example for facilitating better alignment between existing multi-stakeholder partnerships to strengthen health systems in developing countries is the International Health Partnership Plus (IHP+). IHP+ partners include developing countries, donor countries and international agencies, such as the Global Fund and Gavi, the Vaccine Alliance. The 2014 (and latest available) IHP+ monitoring report found that development partners are increasingly aligning and continue to participate in accountability processes at country level. It also found that governments are improving financing and to some extent financial management of the health sector, but that there is stagnation or decline in use by development partners of national financial management systems and in predictability of their funding.
The strengthening of national health systems is a priority for development partners in health. Disparities in progress towards universal health coverage (UHC), both across and within countries and across different dimensions of UHC, point to the inherent challenge for both countries and development partners to sequence and coordinate health system strengthening (HSS) efforts. External support to HSS has frequently been poorly coordinated despite effective development cooperation commitments, leading to duplication of effort and, in some cases, competing visions of health system priorities.
In this context, UHC2030 has started to stimulate discussions on how to develop a consensus for HSS priorities and improving coordination and alignment of support with national priorities. A draft paper is being finalized which proposes a shared vision for HSS to achieve UHC. Specifically, the paper proposes a framework for thinking about health system performance and policy entry points. Based on this, it identifies key directions and principles for how countries and partners can collectively move forward with an effective HSS agenda. The paper, once finalized in early 2017, is expected to be a key reference document for UHC2030, while also serving as a broader reference for collaboration on the HSS and UHC agenda. UHC2030 is also establishing working groups to look at specific issues of coordination around HSS.
Total health expenditure per capital amounts to USD 1.251 in 2013. While total health expenditure has clearly increased significantly from 2002, most of the increase in absolute terms has been in HIC and UMICS. Vast differences in per capita spending between countries remain. On average, per capita spending in low income countries amounted to USD 102 in 2013 (more than doubling from USD 49 in 2002), as compared to USD 3112 in high income countries.
The Addis Agenda commits to substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially LDCs and SIDS, in line with SDG target 3.c. The WHO’s World Health Statistics 2016 estimates the global health workforce to be slightly above 43 million workers, including 20.7 million nurses/midwives, 9.8 million physicians and approximately 13 million other health workers. Relative to population density, the WHO Africa Region and WHO South-East Asia Region, which bear the greatest burdens of preventable disease, have the lowest density of health workers compared to the wealthier regions of Europe and the Americas by a significant magnitude.
In May 2016, the 69th World Health Assembly endorsed the Global Strategy on Human Resources for Health: Workforce 2030 and adopted resolution (WHA69.19) in support of its implementation. In September 2016, the Report of the High Level Commission on Health Employment and Economic Growth was launched at the margins of the 71st UN General Assembly. The Commission’s report makes ten recommendations, making the case for more and better investment in the health workforce.
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They are (1) Optimize the health workforce to accelerate progress towards UHC and the SDG; (2) Anticipate and prepare for future needs of health systems, harnessing the rising demand in health labour markets to maximize job creation and economic growth; (3) Build institutional capacity to implement this agenda; and (4) Strengthen data on HRH for monitoring and ensuring accountability of implementation of national strategies and the Global Strategy itself.
The Global Strategy put forward the concept of National Health Workforce Accounts (NHWA) to create a harmonized, integrated approach for annual and timely collection of health workforce information, improve the information architecture and interoperability, and define core indicators in support of workforce policy and planning and global monitoring.
The NHWA concept was presented and endorsed at the Measurement and Accountability for Results in Health Summit in June 2015. Thereafter, WHO engaged with a technical advisory group, over a period of one year, to produce a NHWA Handbook that elaborates the concept and presents key health workforce indicators organized in 10 modules based on a health labour market framework for universal health coverage. NHWA reporting, as mandated by resolution WHA69.19, will support assessing progress on milestones presented in the Global Strategy’s monitoring and accountability framework. It will also support monitoring the indicators for MoI target 3.c (health worker density and distribution).
The Report of the High Level Commission on Health Employment and Economic Growth (the Commission), launched at the margins of the 71st UN General Assembly in September 2016, points to the health sector as a leading labour and economic sector, particularly so for women. For example, across a sample of 123 countries, women constitute 67 per cent of employment in the health and social sector. Women’s participation in the informal health care economy is substantial, though largely unquantified. The Commission report makes 10 recommendations and five immediate actions that give the necessary political and intersectoral momentum to the implementation of the Global Strategy on Human Resources for Health: Workforce 2030. It speaks to the opportunity to invest in and transform the global health workforce, as a means to concretely drive towards the goals of full and productive employment to all and gender equality.
As one of the immediate next steps, ILO, WHO and OECD developed a five-year action plan (2017-2021) for consultation with Member States. The WHO Executive Board in its 140th session adopted Decision EB140(3) requesting the Director General to finalize the five-year action plan, in collaboration with ILO and OECD, for consideration by the 70th World Health Assembly in May 2017. It also requested WHO to work with Member States to adopt measures focusing on the key recommendations of the Commission, including the development of intersectoral plans and investment in transformative education, promoting decent job creation in the health and social sectors and mutual benefit from the international mobility of health workers.
Parties to the Convention met for the biennial Conference of the Parties in November 2016 (COP7) to discuss a broad range of topics related to the implementation of the WHO Framework Convention on Tobacco Control (WHO FCTC) and to guide future implementation of the WHO FCTC. These included technical areas such as regulations of the contents of tobacco products and tobacco product disclosures; control and prevention of waterpipe tobacco products and electronic nicotine delivery systems; tobacco advertising, promotion and sponsorship; sustainable alternatives to tobacco growing and liability.
The Conference of the Parties also addressed cross-cutting issues such as preventing tobacco industry interference; gender specific approaches to and the use of the human rights framework in tobacco control, achieving the non-communicable disease global target on the reduction of tobacco use and impact assessment of the WHO FCTC. Furthermore, Parties adopted a new framework of measures to strengthen implementation of the Convention through coordination and cooperation. This includes ensuring the necessary financial resources for the implementation work, in line with Article 26 of the Convention.
The COP also considered various options for funding international tobacco control and requested for additional work on this area, including in relation to considering an international fund for tobacco control; a financing dialogue to facilitate collection of extra-budgetary funds for the COP work plan and budget and to raise awareness of Parties’ implementation needs in order to mobilize resources for the implementation of the Convention at country level.
At COP7, Parties also adopted the Delhi Declaration, calling upon Parties to actively pursue the achievement of SDG Target 3.a, including the strengthening of national capacity for tobacco taxes in accordance with Article 6 of the WHO FCTC in an effort to reduce consumption of tobacco products and improve revenue collection and domestic resource mobilization to meet the commitments contained in the Addis Ababa Action Agenda and support the implementation of SDGs.