A long way to go: reaction to the High Level Policy Forum session on SDG 3

The High Level Policy Forum (HLPF) session reviewing the progress of Sustainable Development Goal (SDG) 3 finished one hour ago.

My initial reflection is not only do we have a long way to go, we’re already falling badly behind.

It appears the momentum developed under the Millennium Development Goals has not been kept up and transferred to the SDGs.

As Dr Nata Menabde (Executive Director of WHO Office at the UN) stated, SDG 3 – to ensure healthy lives and promote well-being for all at all ages – is interwoven with many others, such as the poverty, nutrition and gender goals. Ambassador Laura Flores (Permanent Representative of Panama to the UN, Member of UNFPA Executive Board) reminded us out 14 of the 17 SDGs are directly linked to SDG 3 – meaning that the progress of health is key to achieving the SDGs as a whole.

At the heart of SDG 3, as the key driver for achieving the broad objectives, is universal health coverage (UHC). Yet despite its importance the UHC goal (3.8) is slipping against an already demanding timeline.

The HLPF presents an opportunity for a stocktake. And in the case of SDG 3.8 the signs at not good.

Adequate and equitable finance is the priority

All governments should report on how they are financing and structuring health services to reach those furthest from good-quality coverage first. Out-of-pocket payments for quality health services must be reduced and measured (in line with Indicator 3.8.2 – the proportion of household income spent on healthcare).

The recent WHO assessment of SDG 3 progress found the average national percentage of total government expenditure devoted to health was 11.7% in 2014. This figure drops dramatically in low-income countries. That’s why at the HLPF 2017, Save the Children is calling for governments to ensure fair and mandatory public financing to build UHC with equity considerations.

However, as Michael Myers (Managing Director, Rockefeller Foundation) told us, “equity doesn’t just happen.” It has to be an intention of policy-makers. That view is echoed by the Nigerian statement promoting equity to be built into primary healthcare (PHC) access: “the health of a nation depends on rights.”

Data is critical

A message made by all of the speakers, but none louder than Ambassador Flores was: “a driver of SDG3 success will be timely and disaggregated data.” This type of data allows evidence-based decision-making, which leads to increased efficiency of resources.

In a week that the HLPF shares with the Family Planning Summit in London it’s apt that the HPLF report on the progress of SDG highlights the lack of data for maternal mortality of girls under 15 years of age as a stark example of the challenge.

Another example is WHO’s estimate that only half of its 194 Member States register at least 80% of deaths with associated information provided on cause of death.

When it comes to monitoring SDG 3.8, on average only 50% of countries have at least one data source for SDG indicator 3.8.2 since 2005. This is too little and too old to be at all useful. In addressing this, governments must move beyond irregular surveys to ongoing monitoring and reporting on progress. And they must improve health management information systems and the quality and coverage of vital registration.

Accountability

For better or for worse, much of the success of SDG 3 will depend on politics, or more specifically political will. For Michael Myers, it’s the organisation of resources both national and globally that is the political determinant for delivering effective universal health systems.

National governments must push beyond rhetoric to committed implementation of SDG 3 with UHC at the centre. Governments must be held accountable to this through SDG 3, a commitment they have repeatedly made; civil society must be allowed to hold governments to account.

It is important to remember that responsibility of SDG delivery does not only lie with the national governments of low- and middle-income countries but with donors as well. Donor accountability and reporting on the impact of funding streams on country health systems must improve, in particular the lack of flexible funding to allow investment in core health services.

The key message missing in the session today was one of urgency. When this session reconvenes we will be another year closer to the 2030 deadline.

Let’s hope there’s much more progress to report on.