On 14 September, we published an article on health and the Sustainable Development Goals by Eduardo Pisani, Director General of IFPMA – the International Federation of Pharmaceutical Manufacturers and Associations. Today, Echo Collins-Egan, ACCESS Health International’s Country Manager in Morocco, gives her opinion.
It is 2015 and we have reached the deadline. The Millennium Development Goals (MDGs), which we aimed to achieve by this year, have a new incarnation.
The Sustainable Development Goals (SDGs) represent a renewed and revitalized global effort to come together and face our common human challenges. There is so much to applaud about both the how and the what of these new goals. The United Nations has sought to address many of the criticisms aimed at the MDGs in terms of both creation and content. The SDGs have been arrived at through a thorough consultation process involving non-governmental organizations, academia, the private sector and, of course, governments. They place a new emphasis on topics such as gender equality, the importance of partnerships and the part that business and industry have to play. Although the Millennium Development Goals were, in theory, universal they were tacitly considered to be objectives for low and middle income countries to aim for with the financial aid of richer nations. The Sustainable Development Goals help undermine the age old paradigm that there are developed and developing countries. Instead these new Goals will apply to all of us.
The advantage of such a joint declaration of global intention is that it acknowledges all the pillars that must be simultaneously erected to make development work for the people it is built for. Education is no good without health, a healthy justice system no use without gender equality. And none of these will be relevant if climate change catches up with us. I call them pillars because they must be strengthened together to be able to support sustainable development. Ignore one of these pillars and the others will struggle to stabilize. As the SDGs state we must find integrated solutions to our collective problems; that means across sectors and across countries. The down side of all this of course is scale. Each of the Goals represents a thousand challenges and a thousand complexities. In other words the problems in poverty eradication, gender equality, economy and health are sometimes overwhelming in their size and scope. We could accuse the SDGs of being too aspirational or too vague. To arrive at global objectives which we can all agree upon is difficult, that they be actionable and accountable seems almost impossible. Yet there is no way around the fact that we have to try. The Goals are an expression of that unavoidable reality, we must come together to solve our common problems. They serve the very real purpose of focusing the development sectors’ minds. They help drive funding and streamline our efforts.
Ultimately however the question has to be how we translate our ambitions into action. How we make those actions accountable. How we measure their impact. ‘We will also build upon the achievements of the Millennium Development Goals and seek to address their unfinished business.’ We need to think about why we did not achieve all our previous goals by 2015 and how we can improve upon them this time around.
Sometimes it can feel as though these Global Challenges, Partnerships, Projects, Alliances and Goals are something vague and somehow separate from those of us working in the development sector, in the field or even in local government. I work for a global healthcare organization in Morocco and often find myself asking how we can link these global objectives to the practical realities faced by the four hundred million people in the world who still lack access to good quality healthcare. This globalized world has become a smaller place but one whose complexities are more obvious than ever. We have more information and the means of communicating it; we are living in a moment where we have more tools than ever before to help us close the gap between ambitious global vision and local on the ground realities.
I, like Eduardo Pisani, want to focus on two of the Sustainable Development Goals:
Goal 3. Ensure healthy lives and promote well-being for all at all ages and specifically its sub point 3.8 Achieve universal health coverage, including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
And Goal 17. Strengthen the means of implementation and revitalize the global partnership for sustainable development
As someone who spends a lot of her time thinking about Universal Health Coverage I welcome the inclusion of this goal. The concept of Universal Health Coverage has gained astounding momentum over the last few years and helped pushed the agenda for more accessible healthcare service for all. But what does it mean? Like the SDGs themselves, we could accuse Universal Health Coverage of being a vague pipe dream which although worthy, is almost impossible to achieve (or define!). But like the goals it also provides a platform for us as an industry to reflect on the multifaceted challenges we face if we are to one day offer access to quality essential healthcare services for all.
Which leads me to Goal 17. There is something deeply insightful that one of the Goals revolves around the concept of partnerships. It is one of the first lessons I learned about development: nothing can be achieved without strong complementary partnerships. We cannot have Goal 3 without it. Goal 17’s sub points cover precisely the areas I see are needed all around me every day and they demonstrate that these Goals are about implementation. Finance; Technology; Capacity Building; Systemic Issues; Multi-stakeholder partnerships; Data, monitoring and accountability. Music to my colleagues’ and my ears.
To make both these Goals a reality we need practical tools that support the kinds of partnerships that will help us achieve this dream. Mario Pezzini, director of the OECD Development Center emphasised the need for knowledge-sharing platforms for policymakers to dialogue and develop common strategies to achieve the Sustainable Development Goals.
I would like to briefly talk about one such platform that I have had the honor to work with. The Joint Learning Network for Universal Health Coverage (JLN) is for me an example of what partnerships can help us achieve when it comes to health and development. The Joint Learning Network connects practitioners and policymakers across countries to help bridge the gap between theory and the practical ‘how to’ of implementing reforms to achieve universal health coverage. Practitioners and policymakers from member countries set the agenda and technical priorities. Technical Facilitators frame the issues based on international experience and harvest the tacit knowledge of members. Network members participate in a variety of joint learning activities to share their experiences, learn from one another, and co-produce new knowledge. Technical Facilitators work closely with members of the network to develop and adapt new knowledge products focused on the ‘how to’ of health reform implementation. Members so far include Ghana, Kenya, Indonesia, India, Philippines and many more.
It is an active community of people trying to convert a big goal into a day-to-day reality. Last month, we helped organize a workshop for costing of health services for provider payments in Bangalore, India. An essential but often challenging topic for countries on the path to Universal Health Coverage. Participants from ten countries learned about different costing methodologies, how to manage costing data and how to use that data to reform provider payments. But most crucially they were trained to become trainers themselves, to go back to their countries and share the lessons learned with others. A month later, costing workshops are being organized in almost all the countries that participated.
Platforms such as these allow for an understanding that each country has unique contexts and challenges but that working together makes us stronger.
I would advocate for many more such networks and the resources to support them.
Ultimately the Sustainable Development Goals are an expression of hope. They represent a grand vision rather than a work plan. It is our leaders who will sign this declaration but it is the millions of us on the ground who must really act, in partnership, to make these goals a reality. So let’s get to work.