Working towards achieving the Sustainable Development Goals: a WHO toolkit WHO/DGO/SPI/18.1 © World Health Organization 2018 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial- ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/ igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. Working towards achieving the Sustainable Development Goals: a WHO toolkit. Geneva: World Health Organization; 2018 (WHO/DGO/SPI/18.1). Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/ about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this pub- lication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not men- tioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this pub- lication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Contents Acknowledgements iv Introduction 1 Health systems in the Sustainable Development Goal era 1 Using the toolkit 3 Action line 1. Intersectoral action by multiple stakeholders (see Annex 1) 4 Highlighted tool: Health in all policies: training manual 4 Action line 2. Strengthening health systems for universal health coverage (see Annex 2) 5 Highlighted tool: Healthy systems for universal health coverage – a joint vision for healthy lives 5 Action line 3. Respect for equity and human rights (see Annex 3) 6 Highlighted tool: Innov8 approach for reviewing national health programmes to leave no one behind: technical handbook 6 Action line 4. Sustainable financing (see Annex 4) 7 Highlighted tool: eLearning course on health financing policy for universal health coverage 8 Action line 5. Scientific research and innovation (see Annex 5) 9 Highlighted tool: The world health report 2013: research for universal health coverage 9 Action line 6. Monitoring and evaluation (see Annex 6) 10 Highlighted tool: SCORE for health data technical package 10 References 11 Annex 1. Recommended tools for action line 1 – intersectoral action by multiple stakeholders 14 Annex 2. Recommended tools for action line 2 – strengthening health systems for universal health coverage 20 Annex 3. Recommended tools for action line 3 – respect for equity and human rights 30 Annex 4. Recommended tools for action line 4 – sustainable financing 31 Annex 5. Recommended tools for action line 5 – scientific research and innovation 33 Annex 6. Recommended tools for action line 6 – monitoring and evaluation 36 Annex 7. Recommended tools for action lines 1–6 (combined) 44 iii Working towards achieving the Sustainable Development Goals Acknowledgements Paul Rosenberg and Christopher Dye developed this publication. The toolkit is the result of a consultative process drawing on the expertise and experiences of many WHO colleagues. The following people provided generous input and feedback: Rabindra Abeyasinghe, Hala Abou-Taleb, Shambhu Acharya, Giuseppe Annunziata, Maria Emilia Aragon de Leon, Nima Asgari-Jirandeh, Britta Baer, Nick Banatvala, Darryl Barrett, Anjana Bhushan, Christine Brown, Dean Chambliss, Snezhana Chichevalieva, Adrienne Cox, Vânia De La Fuente Núñez, Katia de Pinho Campos, Luke Elich, Isabel Espinosa, Nils Fietje, Ann-Kira Fortune, Jun Gao, Vittoria Gemelli, Ogtay Gozalov, Ahmadreza Hosseinpoor, Mark Jacobs, Matthew Jowett, Humphrey Karamagi, Takeshi Kasai, Mina Kashiwabara, Wasiq Mehmood Khan, Marija Kishman Hristovska, Theadora Koller, Monica Kosinska, Joseph Kutzin, Ailan Li, Vivian Lin, Frederiek Mantingh, Natela Menabde, Bettina Menne, Zafar Mirza, Fukushi Morishita, Anna Cichowska Myrup, Maria Neira, Aasa Nihlén, Dorit Nitzan, Thomas O’Connell, Kathryn O’Neill, Jonathon Passmore, Elizabet Paunovic, Hanne Bak Pedersen, Maria Pena, Micaela Pereira, Galina Perfilieva, Michaela Pfeiffer, Kalpeshsinh Rahevar, John Reeder, Ian Roberts, Nathalie Roebbel, Cris Scotter, Hai-Rim Shin, Katherine Silburn, Agnès Soucat, Ryoko Takahashi, Yoshihiro Takashima, Ronald Tamangan, Nicole Valentine, Martin Vandendyck, Menno Van Hilten, Rui Miguel Vaz and Martin Weber. The Bill & Melinda Gates Foundation provided financial support. iv A WHO toolkit Introduction More than two years after the 2030 Agenda for Sustainable Development was adopted, many countries are still setting Sustainable Development Goal priorities and developing strategies that can achieve them. The 2030 Agenda for Sustainable Development proposes a bold new vision for global development, but it does not provide a specific roadmap on how to achieve it. Decisions about setting priorities, implementation, funding and all the actions that lie between the status quo and success rest in the hands of domestic decision-makers. This toolkit supports countries in adopting principles of sustainable development across health programmes and in building more comprehensive health systems. The tools support the development of health systems that are more equitable, more affordable, more measurable, more testable and more synergistic with health-related programmes beyond the traditional health system. The toolkit seeks to enable countries to seize new opportunities presented by the 2030 Agenda for Sustainable Development and to deliver greater gains for health. Health systems in the Sustainable Development Goal era The 2030 Agenda for Sustainable Development introduced a more complete set of goals, built on common principles of social inclusion, shared prosperity and sustaining the planet’s natural systems (1). It envisions a new dynamic between the Sustainable Development Goals in which good health and the other 16 Goals are closely connected and interdependent. Progress towards one goal should contribute to the achievement of others. One way to apply this vision to health would be to expand the definition of the health system. Classically defined, health systems deliver essential health-care services and public health functions. A more comprehensive vision for health systems would consider non-traditional systems that also produce good health, incorporating relationships with agriculture, education, energy, the environment and other sectors represented by the other 16 Goals. Harnessing the full potential of the 2030 Agenda for Sustainable Development requires building more comprehensive systems that can deliver better health. To better align the efforts of WHO programmes with this more comprehensive approach, WHO has proposed six main lines of action (2). The six main lines of action introduce a framework to focus action on building better, more connected systems for health enabled by the principles of sustainable development. World health statistics 2017: monitoring health for the SDGs (2) more thoroughly details the six main lines of action. The six main lines of action refer to six focus areas (Table 1). The first two lines focus efforts at the system level. Strengthening the health system and achieving universal health coverage builds a platform on which all other health targets can be pursued. It is also well established that factors beyond the health system, such as education, employment or environmental exposure, significantly influence health 1 Working towards achieving the Sustainable Development Goals over the life-course (9, 10). Building and institutionalizing synergy between health- related systems and the health system create a more comprehensive system for health that can integrate disease prevention, health promotion and health services to produce benefits across all of the health-related targets and beyond. Table 1. Top tools for building more comprehensive systems for health Focus Main line of action Top tool Building better 1. Intersectoral action by Health in all policies: training manual (3) systems for multiple stakeholders health 2. Strengthening health Healthy systems for universal health cov- systems for universal erage – a joint vision for healthy lives (4) health coverage Enabling 3. Respect for equity and Innov8 approach for reviewing national factors human rights health programmes to leave no one behind: technical handbook (5) 4. Sustainable financing eLearning course on health financing policy for universal health coverage (6) 5. Scientific research and The world health report 2013: research innovation for universal health coverage (7) 6. Monitoring and SCORE for health data technical package (8) evaluation The final four lines of action focus on factors enabling better systems for health. First, health systems must focus on becoming more equitable. Pursu- ing equitable access and use of health services and equitable health outcomes is essential to ensure that no one is left behind and to enable greater progress towards achieving the Sustainable Development Goal targets. Second, health planners must focus on sustainable financing and ensuring that health services are affordable for all. Universal health coverage is among the main goals of the health agenda of the Sustainable Development Goals and is premised on financial protection in health along with equitable access and use. Third, the Sustainable Development Goals present an opportunity for countries to test the new vision for sustainable development and to chart their own course towards achieving the health targets. Countries need to mobilize domestic research and innova- tion to test the most effective ways to achieve their goals and produce technolo- gies across sectors that can respond to domestic health needs. Finally, progress in health must be measurable, and with the burden of measurement shifting to domestic sources, this requires strengthening health information systems and analytical capacity to monitor health and its determinants. The enabling factors proposed by the six main lines of action are among many key qualities of more comprehensive health systems. They do not comprise 2 A WHO toolkit an exhaustive list. More comprehensive systems should also be resilient, adapt- able and sustainable, among other qualities. Moreover, although they are organ- ized as discrete areas of work, the lines of action are also interdependent, as are the tools highlighted in this toolkit. For example, achieving greater health equity requires sustainable financing to reach vulnerable populations and to address the social and environmental determinants of health. It requires monitoring and research to identify populations being left behind and the most effective path- ways to improve equity. Using the toolkit This toolkit offers selected tools that support readers in aligning their work with the 2030 Agenda for Sustainable Development. The toolkit is intended for use by all stakeholders working on the targets for health of the Sustainable Devel- opment Goals at the country level. It is intended for disease specialists, policy- makers, civil society, generalists and others. The goal in creating this toolkit is to enhance programmes and improve health across all sectors and disciplines. The toolkit supports the development of more broadly defined health systems to become more equitable, more affordable, more measurable, more testable and more synergistic with health-related programmes beyond the traditional health system. It highlights a selection of WHO tools that align with and enable work along the six main lines of action. Table 1 shows the six main lines of action and the proposed tools. The tools presented in this toolkit have been selected from a compendium of WHO and joint publications compiled from public WHO web resources (see Annexes 1–7). For each line of action, this toolkit highlights one tool. A tool can be defined as a means for accomplishing a task or purpose, and for the purposes of this toolkit, tools are intended to provoke new thinking and action to take advantage of the opportunities presented by the 2030 Agenda for Sustainable Development. They provide entry points, and as such they are not meant to be comprehensive or exclusive. Instead, this toolkit should open new pathways along which various other tools need to be introduced. All stakeholders can use the toolkit and its tools to enhance their work on the Sustainable Development Goals. For each of the six lines of action, the toolkit outlines key areas for advancing the agenda for health of the Sustainable Devel- opment Goals. It then suggests how to use the selected tools to address these needs. For three lines of action, the toolkit and selected tools offer resources that can be readily used without additional assistance. The other three lines of action offer tools that are optimally used in a facilitated workshop or with technical assistance but that can also be used independently as information products. The toolkit is designed to function in coordination with other WHO resources developed to support Member States in their work related to the Sustainable Development Goals. For instance, it works alongside a course on the Sustainable 3 Working towards achieving the Sustainable Development Goals Development Goals developed by the WHO Country Coordination Unit and the United Nations System Staff College designed for WHO staff. The online course provides a primer on the principles of the Sustainable Development Goals and how Member States can benefit from working on the Sustainable Development Goals, and the toolkit promotes the tools to operationalize this vision and realize the benefits. It should also be viewed as a complementary resource to the strate- gies and resolutions adopted by WHO regional bodies. Action line 1. Intersectoral action by multiple stakeholders (see Annex 1) The 2030 Agenda for Sustainable Development envisions a more comprehensive approach to development. It proposes that harnessing the synergy between interconnected systems, rather than disjointed projects and programmes, will accelerate the gains that can accrue to health and all other aspects of development. Although ample evidence indicates the influences of social and environmental determinants on health outcomes along the life-course (9), the persistent challenge for health sector actors has long been developing programmes with other government agencies to leverage these connections and improve health outcomes. Health sector actors need to develop the skills and strategies necessary to make the most of this synergy by working across government sectors. Highlighted tool: Health in all policies: training manual Building synergy between health and health-related systems to accelerate gains in health and health equity is central to the vision for health of the Sustainable Development Goals. Nevertheless, despite a long history of proposing intersec- toral collaboration in health, it frequently remains one of the great untapped opportunities to advance health through upstream disease prevention and health promotion. The 2030 Agenda for Sustainable Development does not give guid- ance on how this should be done either. The Health in all policies: training manual (3) proposes to empower country- level WHO staff members and health ministry leadership with the skills and strategic approaches needed to implement intersectoral and health in all policies initiatives. Intersectoral action takes different forms with many names. Health in all policies is a type of intersectoral work seeking to systematically integrate health concerns into the policies and processes of all other government sectors. This training, while specifically oriented towards health in all policies, offers con- cepts and skills that are necessary for any type of intersectoral work. These skills are broadly useful for advancing health in the Sustainable Development Goals. The skills and tools necessary to develop domestic intersectoral programmes also support intersectoral action at the international level through health diplo- macy. Issues affecting health ranging from climate change to medicines and food security are often negotiated in the international arena as well, and health 4 A WHO toolkit diplomacy is needed to ensure that health is given priority at the highest politi- cal levels (11). The manual is most effectively used in a workshop format with a skilled facilitator. The programme guides trainees through the process of identifying opportunities in which health in all policies might be effective and explains negotiation tactics and strategies to navigate these processes from beginning to end. Among the many strengths of the training is the potential for scalability and support. Attendees of one-off workshops often need ongoing support to put new skills into practice. The workshop can take a training-of-trainers approach, with the potential to build a network of in-country actors across civil society that can support government actors. The manual also has many companion resources, including numerous adaptations and similar training publications that can support customized training as well as case study resources, including the recent publication Progressing the Sustainable Development Goals through health in all policies: case studies from around the world (12). In the sustainable development era, health in all policies remains the ideal, but it needs to be supported by more evidence demonstrating the most effective pathways to improve health through multisectoral action. In this way, the 2030 Agenda for Sustainable Development is not only an agenda for action but also a research agenda. Research will help to define how government agencies should work together and which investments and programmes can produce the great- est benefits. Action line 2. Strengthening health systems for universal health coverage (see Annex 2) The 2030 Agenda for Sustainable Development changes the focus of the Millennium Development Goals era on selecting specific priorities in health in favour of a more comprehensive view of health and development. Progress across a much broader vision of health and health-related systems requires a well- functioning health system that can support affordable services across all areas of health. Strengthening the health system is imperative to achieving universal health coverage by ensuring that a full range of high-quality, people-centred essential services can reach everyone affordably. Highlighted tool: Healthy systems for universal health coverage – a joint vision for healthy lives Strengthening health systems involves a coordinated effort to improve access to high-quality health services, medicines and technologies, sustainable financ- ing and health system governance. Underpinning these main pillars of health system function is a mix of processes and resources including the health work- force, infrastructure, commodities, quality management, health information systems and accountability. WHO offers a range of analytical, diagnostic and 5 Working towards achieving the Sustainable Development Goals guidance tools to support countries in improving performance across all of these dimensions. WHO tools bring these aspects of strengthening health systems together into a coherent vision for coordinated improvement of performance and progress towards universal health coverage. Healthy systems for universal health coverage – a joint vision for healthy lives (4) is a publication by WHO and the World Bank for the UHC2030 platform. In fewer than 30 pages, it offers an important primer on the shared vision for strengthening systems as an instrument for achieving universal health coverage. It is divided into key policy considerations for health services, governance and financing with descriptions no longer than a paragraph each. It is a brief, help- ful overview that should give readers a sufficient grasp of the issues to engage effectively with more specific tools for planning, strategy or specific domains of strengthening health systems. Users looking for a more comprehensive explo- ration of planning and strategy for the health system should see Strategizing national health in the 21st century: a handbook (13). The health system is at the core of more comprehensive systems for health. This toolkit addresses equity, financing, health information systems and research, but these qualities are not meant to be an exclusive set. Strengthening health sys- tems to deliver on the health aspects of the Sustainable Development Goals also requires that they be resilient and sustainable among other qualities. The health workforce, infrastructure, medicines, technologies and governance are key com- ponents of the joint vision and any strengthening strategy. They are not covered in this toolkit but are strongly associated with the qualities of more comprehen- sive health systems. Action line 3. Respect for equity and human rights (see Annex 3) Emerging from the learned experience of implementing the Millennium Devel- opment Goals, there is a clear consensus that equitable development is not only a matter of social justice but that inequity has constrained progress across all domains of development (14). As a result, millions were left behind from the gains achieved in the Millennium Development Goals era, invisible in national averages that hide the unevenness of social progress. Closing the gaps in health outcomes within and between societies is therefore essential to achieving the health-related targets of the Sustainable Development Goals and to progressively realizing universal health coverage. Highlighted tool: Innov8 approach for reviewing national health programmes to leave no one behind: technical handbook The Innov8 approach for reviewing national health programmes to leave no one behind: technical handbook (Innov8) (5) evolved from the real experiences of government responses to health inequity. Health inequities arise from the societies in which people live – aspects of identity, policies, places and how people live their lives. They are systematic in nature and difficult to disentangle 6