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.
Eduardo Pisani, Director General of IFPMA – the International Federation of Pharmaceutical Manufacturers and Associations.
As our heads of state prepare to meet later this month in New York at the United Nations General Assembly (UNGA) to adopt the Sustainable Development Goals (SDGs), including the vision of Universal Health Coverage, I will allow myself a moment to appreciate the magnitude of the promise we are making to future generations.
The adoption of the SDGs gives governments and those of us involved in the health community a chance to embrace a vision as fundamental as the Declaration of Human Rights when it was adopted by the UNGA in 1948. It is one of the few occasions where we are not over-dramatizing the point – the next generation will judge us on whether we measured up to the challenge.
I am sure many of us will feel the magnitude of this moment. However, I am also in no doubt that after the meeting we will have to roll up our sleeves and get down to work. From the innovative pharmaceutical industry’s perspective, we are in a good shape to lead the way in some areas; in others we will need to get stuck-in and work through the difficult questions in partnership with others.
Valuable lessons from the legacy of the MDGs
Since the launch of the Millennium Development Goals (MDGs) in 2000, those of us working in global health have learned a lot.
We have learned it is possible for the world to come together in the pursuit of shared goals for a common good. Our sector has a considerable track record in this area but though we can measure up with the best of them (Ref UN Global Compact), we won’t be able to rest on our laurels.
We have learned that just in fifteen years we can halve the global deaths attributed to some of the world’s biggest killers such as TB or malaria. However, with chronic diseases increasingly threatening low- and middle-income countries, these advances may be short-lived. We need new strategies in face of the influx of these chronic, and to a large extent preventable, diseases. And so, in addition to discovering and researching new treatments, innovative pharmaceutical companies are looking to creative ways of leveraging the knowledge and expertise of local governments, industry and civil society, using new technologies to reach the greatest amount of people possible.
A great example is Be [email protected], Be Mobile, a multi-sectoral partnership we’re contributing to that uses mobile phones to tackle chronic diseases, spearheaded by the International Telecommunications Union and WHO, and supported by NGOs, the private sector and the African and Asian development banks.
Lastly, with the Ebola outbreak, we have very recently learned what it means to be unprepared, to come up short in the face of a crisis and see health systems collapse under pressure, and how quickly the repercussions can be felt around the world. While our pipelines are yielding new treatments and vaccines to contain this disease, we are reminded once again of the importance of resilient health systems in face of future epidemics. This is where the powerful concept of Universal Health Coverage comes in.
Universal Health Coverage at the heart of sustainable development
Universal Health Coverage (UHC) is at the core of the SDG for health, promising all the right to basic health care without financial hardship. UHC means a parent living in a rural India can reliably provide insulin for their child living with diabetes, it means a woman in Colombia will be screened for breast cancer so she can begin treatment before it is too late, it means a health center in Guinea that receives a patient infected with Ebola virus has the capacity to prevent further transmission in the community and to its health care workers. It means more than access to medicines alone.
With 400 million people lacking access to basic health care and many millions more lacking regular access to essential medicines, no one would say guaranteeing health as a right for all is an easy feat. To promote a mission as grand as UHC, we will likely find ourselves in partnerships that move beyond the vision of the SDG for health and the global health community, also tackling challenges around water and sanitation, urban living, education and climate change through convening fora such as the United Nations Global Compact.
As such, it is no accident that the 17th goal of the SDGs is one dedicated entirely to the promotion of partnerships. Whereas partnerships in the health sector are by no means a new phenomenon, partnerships looking forward will be characterized not only by their ability to sustainably serve the needs of populations, but also by an increased linking up of diverse sectors. As stated by the OECD in its 2015 Development Co-operation Report, “with the growing diversity of partners involved in development co-operation, it is more important than ever to avoid duplication of effort and fragmentation.”
Excellent examples of multi-sectoral partnerships already underway include GAVI, a global vaccine alliance between public, private and civil society sectors which has delivered 500million vaccines to children over 15 years; 4 Healthy Habits, an initiative between the pharmaceutical industry and the International Federation of Red Cross and Red Crescent Societies (IFRC) to promote healthy behaviours at community-level and fight chronic diseases; and the Global Health Innovative Technology (GHIT) Fund, a partnership between the government of Japan, the Bill and Melinda Gates Foundation and the Japanese pharmaceutical industry to research and develop new medicines to combat infectious tropical diseases. As the common thread throughout, the pharmaceutical industry supports efforts towards UHC. In 2014, we identified a set of guiding principles in the areas we believe our industry can contribute, and with the adoption of the SDGs we are galvanized. The SDGs will require pooling resources, expertise and working together across sectors as well as with governments and civil society like never before; luckily, we are not starting from scratch.
There is increasing recognition that providing quality health coverage is a key contributor to the wealth and economic productivity of countries. As I look ahead to this next generation of targets, I am confident that though challenges remain, we are well placed to rise to the occasion. Achieving these new goals and closing the gaps in health coverage will take commitment and creative thinking, as well as cross-sectoral partnerships, and this is enthusiastically welcomed by myself and my colleagues in this industry.