Introduction
The Regional Health Alliance comprises 16 multilateral health, development and humanitarian agencies who are signatories to the Global Action Plan on Healthy Lives and Well-being. Its aim is to identify ways in which agencies can better work together to support countries meet the targets of the health-related Sustainable Development Goals (SDGs). The Alliance examines new ways of working through adoption of a whole-of-government approach to improve public health and looks at opportunities to implement population-level interventions as advocated in the Global Action Plan.
The Global Action Plan was launched in September 2019 at the United Nations General Assembly. Its implementation is focused on delivering concrete results in countries and accelerating progress towards the SDGs through improved collaboration among these 12 signatory agencies – Gavi, the Vaccine Alliance; the Global Financing Facility for Women, Children and Adolescents (the GFF); The Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund); the Joint United Nations Programme on HIV/AIDS (UNAIDS); United Nations Development Fund (UNDP); United Nations Population Fund (UNFPA); United Nations Children’s Fund (UNICEF); UNITAID; United Nations Entity for Gender Equality and the Empowerment of Women (UN Women); the World Bank Group; World Food Programme (WFP) and the World Health Organization (WHO).
The specific objectives of the Regional Health Alliance are to:
translate the commitments of GAP signatory agencies into action taking into account the specific population health needs and the context of this Region;
enhance coordination and collaboration to accelerate implementation of the health-related SDGs, leveraging regional resources and opportunities for joint initiatives and innovative ways of implementation;
facilitate the delivery of aligned and coordinated relevant technical support and policy discussions through Resident Coordinators and other networks;
enable proactive operational research and knowledge development on best practices, factors for success, ways to tackle challenges and pilot/scale-up innovations;
establish shared accountability mechanisms and review progress in implementing joint actions, identify bottlenecks and take actions to resolve contentious issues.
At the first Regional Health Forum on 5 March 2020, partners began to develop a joint workplan identifying key deliverables and actions across 7 accelerator themes of the Global Action Plan:
primary health care
sustainable financing for health
community and civil society engagement
determinants of health
innovative programming in fragile and vulnerable settings for disease outbreak responses
research and development, innovation and access
data and digital health.
The workplan resulted in the establishment of working groups on the 7 accelerator themes and expert groups to address issues such as gender and monitoring and evaluation and agreement to meet regularly to share information, assess progress, conduct joint planning and conduct missions to priority countries.
Related link
Joint workplan
Action |
Deliverables |
Lead |
Support* |
Due Date |
Primary health care |
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Review the role of primary health care in leading equitable recovery in the COVID-19 pandemic response |
Country review of the response to COVID-19 from a PHC perspective |
WHO (lead) |
UNAIDS |
End of 2023 |
Technical cooperation plans (deep dives) for PHC reform for 4 countries |
WHO (lead) |
UNAIDS |
End of 2023 |
|
Developing primary health care oriented ‘models of care’ |
Regional implementation guide for model of care to strengthen PHC for UHC |
WHO (lead) |
UNAIDS |
Mar-22 |
Country model of care planning and management |
Mar-22 |
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Reports of pilots in occupied Palestinian territory, Pakistan and Sudan |
Mar-22 |
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Operationalize the WHO regional framework for effective engagement with the private health sector |
Online training on the role of the private health sector in fighting COVID-19 and achieving Health for All. The goal of the online training is to help in creating behavioural and policy changes that support the establishment of an eco-system for effective private sector engagement (PSE) in COVID-19 response and beyond. |
WHO (lead) |
UNAIDS |
End of 2023 |
Mapping countries of the Region in terms of their readiness for PSE and the identifying entry points and opportunities to initiate/improve PSE through policy dialogue workshops/meetings |
End of 2023 |
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Develop priority benefits packages |
Online platform to assist countries in developing national priority benefits packages. |
WHO (lead) |
UNAIDS |
End of 2023 |
Training module on developing priority benefits packages (PBP) |
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Guidelines for adapting the regional list of essential health services to the local context |
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Assessment of the impact of PBPs in countries that have already implemented the packages |
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Information system for primary health care/family practice facilities |
Develop and implement regional information system for primary health care/family practice facilities |
WHO (lead) |
UNAIDS |
End of 2023 |
Support UN country teams (UNCTs) in accelerating action on strengthening primary health care to ensure UHC |
Provide joint support to all UNCTs in this topic area |
WHO (lead) |
UNAIDS |
End of 2023 |
Conduct a joint desk review of the country specific content of UNDAF/UNSDCF regarding the topic of this accelerator so that support can be targeted |
End of 2024 |
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Plan for joint missions to countries as possible |
End of 2025 |
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Regularly monitoring and reporting of progress of work by the accelerator working group |
Share quarterly updates including minutes of meetings with the RHA coordinating team |
WHO (lead) |
UNAIDS |
End of 2023 |
Health financing |
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Establish guiding principles for sustainable financing in the region, considering regional specificities (e.g., Refugees/IDPs/Migrants, Conflict Setting, etc.), emphasizing the learnings from COVID-19 pandemic |
Guiding Principles of what works and what does not work in health financing reform for the region and at selected representative country levels. |
WHO |
World Bank |
End 2023 |
Generate local evidence and facilitate policy dialogues on HF for UHC and Health-Related SDGs and develop related HF Strategies, involving: MOH, MOF, MOP, MOSD and other stakeholders |
3 country analytical reports on strategic options for HF for UHC, considering COVID-19 |
WHO |
World Bank |
End 2023 |
Promote more health for the money (VfM) by supporting the establishment of HTA agencies for undertaking economic evaluation and informing benefit design at country level |
Evidence-generation to enhance value for money using economic evaluation studies, conducted on specific topics at country level (e.g., NCDs and COVID-related) |
WHO |
|
End 2022 |
Support MSs in resources tracking (including health programs and PHC) |
PHC resource tracking conducted in selected countries |
WHO |
|
End 2022 |
Improve regional and country level understanding of root causes and policy options to address poor budget execution in the health sector in LMICs among health and budgetary stakeholders alike |
Case studies synthesized for selected countries with the purpose of informing causal mechanisms on how budget execution processes affect health financing and service delivery, identify patterns with regards to bottlenecks and gather lessons on which measures were most effective to address these issues |
WHO |
IMF |
End 2023 |
Support UNCTs in accelerating action on health financing to ensure UHC |
Provide joint support to all UNCTs in this topic area |
WHO |
|
End 2023 |
Conduct a joint desk review of the country specific content of UNDAF/UNSDCF regarding the topic of this accelerator so that support can be targeted |
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Plan for joint missions to countries as possible |
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Regularly monitoring and reporting of progress of work by the accelerator working group |
Share quarterly updates including minutes of meetings with the RHA coordinating team |
WHO |
|
End 2023 |
Community and civil society engagement |
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Map existing networks, practices and planning resources |
Active CSO/NGO networks mapped and engaged in community engagement activities |
UNICEF (lead) |
UNFPA |
Mid 2022 |
Functional community engagement network platforms, approaches, and tools available in each country |
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Empower communities by enhancing health literacy; mobilize assets and strengths to develop community capacities |
Facilitate opportunities for civil society advocacy and feedback mechanisms to leverage local, regional and national platforms for community engagement |
WHO (lead) |
UNAIDS |
End of 2022 |
Support community-based participatory research approaches to assess and monitor community and civil society engagements and capacity-building at both national and regional level |
End of 2023 |
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Establish and build trust with communities and institutions |
Systematize faith engagement and build capacity of religious leaders and networks to ensure that they are able and motivated for two-way engagement with community members |
UNICEF (lead) |
UNFPA |
Mid 2022 |
Community engagement strategy |
Adapt and operationalize the Minimum Standards of community engagement |
UNICEF (lead) |
UNFPA |
Mid 2022 |
Scale- up digital engagement platforms to enhance participation, inclusion, and two-way communication. |
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Support UNCTs in accelerating action on community and civil society engagement |
Provide joint support to all UNCTs in this topic area |
WHO (lead) |
|
End of 2023 |
Conduct a joint desk review of the country specific content of UNDAF/UNSDCF regarding the topic of this accelerator so that support can be targeted |
||||
Plan for joint missions to countries as possible |
||||
Regularly monitoring and reporting of progress of work by the accelerator working group |
Share quarterly updates including minutes of meetings with the RHA coordinating team |
WHO (lead) |
|
End of 2023 |
Health determinants |
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Develop regional network for knowledge-sharing on social determinants of health |
Development of regional knowledge-sharing platform for country experience on social determinants of health |
WHO (lead) |
UNAIDS |
2022 |
|
Document and report on experiences at country and regional level on social determinants of health across sectors |
|
|
End of 2022 |
Capacity building and training |
Training workshops on key tools on social determinants of health (including gender equity assessment tool, HEAT, Innov8) |
WHO (lead) |
UNAIDS |
End of 2022 |
Training workshop on framing health issues for non-health partners – joint policy and planning for health |
End of 2023 |
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Capacity-building on monitoring health equity at national level |
End of 2023 |
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Technical support at country level to support integrated action on social determinants of health |
Technical support to assess areas of action to integrate social determinants of health in ongoing work at country level |
WHO (lead) |
UNAIDS |
End of 2022 |
Partnership development and stakeholder engagement |
Support policy dialogue at country level to promote the engagement of relevant stakeholders to support action on social determinants of health |
WHO (lead) |
UNAIDS |
End of 2022 |
Support UNCTs in accelerating action on addressing the determinants of health |
Provide joint support to all UNCTs in this topic area |
WHO (lead) |
|
End of 2023 |
Conduct a joint desk review of the country specific content of UNDAF/UNSDCF regarding the topic of this accelerator so that support can be targeted |
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Plan for joint missions to countries as possible |
|
|
|
|
Regularly monitoring and reporting of progress of work by the accelerator working group |
Share quarterly updates including minutes of meetings with the RHA coordinating team |
WHO (lead) |
|
End of 2023 |
Innovative programming in fragile and vulnerable settings and for disease outbreak responses |
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Enhanced coordination at regional level among all lead and support organizations |
Minutes of regular meetings and other relevant documents |
WHO (lead) |
IFRC |
End of 2022 |
Strengthening information management in vulnerable and fragile settings to inform planning and monitoring of operations |
Review and revise agency-specific tools as needed and streamline at country and regional levels |
WHO (lead) |
IFRC |
End of 2022 |
Capacity-building on implementing the HDPNx among national health authorities and health partners |
Annual health training course on HDPNx for health |
WHO (lead) |
IFRC |
End of 2023 |
Monitoring of HDPNx operationalization |
HDPNx country profiles updated annually |
WHO (lead) |
IFRC |
End of 2023 |
Develop joint analytical report on priority subjects in emergency countries |
Analytic reports on model of health care service, etc. |
|
|
|
Capacity-building on refugee and migrant health among national health authorities and health partners |
Annual refugee and migrant health training course |
|
|
|
Support UNCTs in innovative programming in fragile and vulnerable settings |
Provide joint support to all UNCTs in this topic area |
WHO (lead) |
IFRC |
End of 2023 |
Conduct a joint desk review of the country specific content of UNDAF/UNSDCF regarding the topic of this accelerator so that support can be targeted |
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One joint mission each year. Develop terms of reference for joint missions based on a focused need / mission report and proposed action plan with monitoring and evaluation indicators |
WHO (lead) |
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Regularly monitoring and reporting of progress of work by the accelerator working group |
Share quarterly updates including minutes of meetings with the RHA coordinating team |
WHO (lead) |
IFRC |
End of 2023 |
Research and development, innovation and access |
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Support countries to identify a consensus on research priorities in the context of comprehensive agendas focusing on enablers towards achievement of health-related SDG targets |
Conduct research priority setting exercises in 4 countries |
WHO (lead) |
UNAIDS |
End of 2023 |
Capacity-building on implementing research methods and ethics in priority countries |
Promote learning and training activities on research methods and ethics in science and technology utilizing UNESCO and WHO toolkits |
WHO (lead) |
UNICEF |
End of 2023 |
Update the identified innovative and key health technologies to be brought to scale, as linked to country support plans |
Facilitate country dialogue to identify health priorities that potentially require innovation |
WHO (lead) |
UNAIDS |
End of 2023 |
Research on child marriage in humanitarian settings identifying drivers and prevalence |
Report on prevalence and drivers of child marriage in humanitarian settings |
UNFPA (lead) |
UN Women |
End of 2023 |
Research on disabilities in emergencies |
Coordinate access to assistive devices and supply chain innovations |
UNFPA (lead) |
IOM |
End of 2023 |
Support UNCTs in research and development, innovation and access |
Provide joint support to all UNCTs in this topic area |
WHO (lead) |
IOM |
End of 2023 |
Conduct a joint desk review of the country specific content of UNDAF/UNSDCF regarding the topic of this accelerator so that support can be targeted |
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Plan for joint missions to countries as possible |
||||
Regularly monitoring and reporting of progress of work by the accelerator working group |
Share quarterly updates including minutes of meetings with the RHA coordinating team |
WHO (lead) |
IOM |
End of 2023 |
Data and digital health |
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Strengthening CRVS systems in the region, including birth and death registration |
Capacity building in 4 low-income countries to implement rapid mortality surveillance for excess mortality measurement and epidemic awareness in the context of Covid-19 |
WHO |
UNFPA |
2022 |
Development of health information system (HIS) including CRVS regional strategy and strategic framework to improve CRVS in the Arab countries |
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Assist countries to integrate migration health data into national HIS |
Development of technical package on integration of migration health data into national HIS |
WHO |
UNCHR UNRWA IOM UNFPA UNICEF League of Arab States African Union UNPULSE |
2023 |
Regional workshop on integration of migration health data into national HIS |
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Assist countries in developing national strategies for digital health |
National stakeholder workshops on digital health strategies in at least 2 countries |
ITU |
UNICEF |
2022 |
Promoting use of digital health technology and artificial intelligence in linkage of information using digital platforms |
Joint collaborative work, with special application of digital health technology and AI on linking information digital platforms on COVID-19 |
ITU |
UNICEF |
2022-2023 |
Support UNCTs in data and digital health |
Provide joint support to all UNCTs in this topic area |
WHO |
UNCHR UNFPA UNICEF UNPULSE |
|
Conduct a joint desk review of the country specific content of UNDAF/UNSDCF regarding the topic of this accelerator so that support can be targeted |
||||
Plan for joint missions to countries as possible |
||||
Regularly monitoring and reporting of progress of work by the accelerator working group |
Share quarterly updates including minutes of meetings with the RHA coordinating team |
WHO (lead) |
ESCWA |
End of 2023 |
Gender equality |
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Develop tools and guidance on gender mainstreaming for RHA actions |
Guidance on accelerating and advancing gender equality in activities planned in the RHA Joint Action Plan 2022-2023 as well as SDG3+ GAP activities planned at country level |
UN Women (lead) |
IOM |
End of 2023 |
Regularly monitoring and reporting of progress of work by the accelerator working group |
Share quarterly updates including minutes of meetings with the RHA coordinating team |
UN Women (lead) |
IOM |
End of 2023 |
RHA Secretariat |
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Regular monitoring to review progress |
Hold regular meetings of the Coordination Team to review progress of work of all working groups |
RHA Secretariat |
RHA Coordination Team |
End of 2023 |
Follow-up work of the accelerating work groups by attending meetings, facilitate cross sharing of information and supporting documentation on progress |
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Coordinate support and sharing of information to UNCTs, SDG3+ GAP Secretariat and with other regions, the Regional Collaborative Platform and other regional UN thematic working groups |
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Advocate work of the RHA |
Report on the implementation of an annual communication plan |
RHA Secretariat |
RHA Coordination Team |
End of 2023 |
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Progress report
Read more about implementation of the Global Action Plan in the Region
{tab=Country progress reports}
Djibouti
Country context
Djibouti was selected as one of the pilot countries for the national implementation of the Global Action Plan for Healthy Lives and Well-being for All in March 2019. At this time, the Government of Djibouti was in the process of developing their Vision 2035. The Ministry of Health was keen on accelerating progress towards universal health coverage by strengthening measures to improve access to health care, ensure availability of sufficient human resources and strengthen the health infrastructure. .
Key achievements
A national consultation took place from 1 to 13 October to discuss the “accelerators” of the Global Action Plan. The Ministry of Health, with the support of the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) country offices in Djibouti, organized a series of workshops that led to a national consultation with 100 key stakeholders, including health-related sectors, international partners, civil society and the private health sector. The purpose of the consultation was to determine ways to strengthen the health system, in particular by focusing on four themes (PHC, human resources for PHC, financing health systems, data management and health informaation) related to GAP accelerators.
Recommendations
- Update the Minimum Service Package.
- Update the health map.
- Develop the proximity of care.
- Improve the quality of services.
- Redefine the community outreach strategy.
- Increase public trust.
- Strengthen prevention and health promotion.
- Establish a strategy for developing human resources for health.
- Optimize the use of available human resources.
- Strengthen the regulation and efficiency of the pharmaceutical sector.
- Strengthen integration and coordination with the private sector.
- Establish/strengthen health regulations through professional associations.
- Establish a health financing strategy.
- Strengthen public financial management.
- Strengthen coordination with the Caisse Nationale de la Sécurité Sociale.
- Extend health financial coverage for the population.
- Improve the quality of raw data.
- Strengthen the health information system.
- Increase the availability of data.
- Complete digital transformation.
Egypt
Country context
Egypt was selected as one of the pilot countries for national implementation of the Global Action Plan for Healthy Lives and Well-being for All in March 2019. Despite significant improvements in health-related SDG indicators such as maternal mortality and under-5 mortality, greater effort is needed. Subnational disparities remain substantial in the most disadvantaged areas of the country, progress has been uneven and too many people are being left behind. Egypt is one of 3 pilot countries that implemented the PHC Measurement and Improvement Initiative (PHCMI) and one of 12 countries piloted to focus on improving PHC.
Key achievements
Planned activities
Planned activities include:
- enhancing health governance for PHC at central and local levels to advance progress towards UHC;
- supporting development of a digitalized master PHC facility list;
- supporting capacity-building for PHC facilities serving children;
- supporting transitional arrangements for PHC facilities to support continuation of essential health services during the COVID-19 pandemic including triage, referral, supply chain, safety, monitoring and infection control;
- recruiting experts to support coordination mechanism of health partners, develop data and digital health, alignment of national health strategies to achieve UHC;
- deploying tools to assess PHC services and ensuring harmonization of PHC service packages.
Jordan
Country context
Jordan was selected as one of the global pilot countries for the national implementation of the Global Action Plan for Healthy Lives and Well-being for All in March 2019. PHC forms the foundation of the Jordan health system is an identified policy priority under existing health sector strategies. PHC gaps in country include fragmentation of overall health system, limited recognition of PHC as first point of contact, and weak system for managing PHC performance measures and health indicators. Accelerating progress towards UHC in Jordan requires strengthening the performance of health system and improving the availability and accessibility of health services to make them more effective and efficient in preventing, detecting and managing illness earlier in the communities.
Key achievements
PHC was proposed as the priority accelerator theme since Jordan is already a pilot for the PHCPI Initiative, a partnership initiative dedicated to transforming primary health care. Bringing together signatories of the Global Action Plan, along with other health and development partners would facilitate in identifying bottlenecks and reform the models of care. Strengthening PHC also has the potential to jointly support accelerating progress towards UHC, strengthening health systems performance, improving the availability, accessibility and experience of services and making services more effective and efficient.
Planned activities
In light of lessons learned about access to PHC services during the COVID-19 lockdown, WHO will discuss with Government how health humanitarian and development partners can better align their support to the health-related SDGs, encourage in-depth multi-stakeholder discussions at country level, support specific thematic discussions, facilitate identification and synthesis of collective actions, feed actions into new strategies and proposals to emphasize the importance of strengthening essential health care services (country mid-term plans, joint instruments) and support presentation of findings at global and regional levels.
Lebanon
Country context
Lebanon was selected as one of the global pilot countries for the national implementation of the Global Action Plan for Healthy Lives and Well-being for All in March 2019.
Key achievements
Beginning in May 2019, a series of meetings were conducted with all health and development partners and the Ministry of Public Health. All partners agreed on an action plan for all 7 accelerator themes (PHC, health financing, community and civil society engagement, determinants of health, fragile and vulnerable settings, research and development, innovation and access and data and digital health). Through this consensus-building exercise to develop a road map in Lebanon fed into the development of new Common Country Analysis and UN Sustainable Development Cooperation Framework (UNDAF) in January 2020. In July 2020, an update to the implementation of the Global Action Plan was agreed upon between partners to facilitate progress on the SDGs.
Way forward
Sustainable financing
- Support policy dialogue for sustainable financing by providing resources for country dialogue and technical support through jointly funded operations and enhance health financing and dialogue between ministries of health and finance.
- Analyze the proposed law on UHC by optimizing work done under human capital index and demographic dividend.
PHC
- Conduct a situational analysis of current PHC service provision and propose midterm strategy to identify areas/who is being left behind, why, and prioritize integration with other sectors.
- Develop a midterm strategy to enhance the currently available PHC package of services by including prevention and health promotion services, palliative, rehabilitative and mental health services with a focus on the following: vaccine preventable infections (special immunization activities reaching the most vulnerable and underserved communities and vaccination coverage surveys), maternal and newborn health, adolescent friendly services, mental health integration in PHC, antimicrobial resistance; epidemiological surveillance; nutrition surveillance and services.
- Work on remuneration mechanisms and capacity-building of health workers, human resources for health, HRH strategy development, conduct nationwide capacity-building workshops.
- Establish or maintain essential human resources, including a functional payroll to retain health workers during the current crisis, and sustain capacity to absorb and utilize domestic and international resources effectively and transparently.
- Provide support to strengthen health systems for PHC and public hospitals by mobilization of health workforce development to improve coverage, quality and equity, including in fragile and vulnerable settings.
- Improve quality of care at PHC and public hospitals (quality supply chain strengthening, standardization, performance indicators, quality management indicators, infection prevention and control, accreditation, monitoring of effective use of essential commodities).
Morocco
Country context
Morocco was selected as one of the global pilot countries for the national implementation of the Global Action Plan for Healthy Lives and Well-being for All in March 2019. The Global Action Plan for Heathy Lives and Well-being provided a platform for country dialogue that would be owned by the government and under high political leadership. The United Nations system in Morocco has a track record of joint programmes HIV, migration, SDG monitoring, evaluation of public policies and bridging the implementation. The Government has demonstrated commitment to UHC and PHC and following World Health Day 2019 a Royal Letter was issued emphasizing the importance of PHC reform. Morocco has implemented the first phase of the PHCMI Initiative and is preparing for the second. The country is also supporting public private dialogue and partnership for the implementation and mutual accountability of the national multisectoral strategy for the prevention and control of NCDs; a multisectoral charter to fight NCDs was signed on 8 April 2019 with 17 signatory government and nongovernmental institutions, including the private sector.
Key achievements
In June 2019, under the High Patronage of HM the King and in the presence of the head of government, a high-level policy dialogue was held engaging the minister of health, senior government officials, civil society and other national stakeholder groups and supported by the African Development Bank (ADB), the European Union, World Bank and WHO. It aimed to establish a roadmap for a new national health financing strategy that is socially affordable, economically supported and emerges from a national consensus. The main recommendations focused on strengthening health financing through new financing arrangements such as strengthening public-private partnership, adopting performance monitoring and a strategic purchasing approach, separating health financing function from healthcare provision, strengthening regulation and governance of the medical coverage system and establishing a platform for institutional dialogue between decision makers and stakeholders (health care providers, beneficiaries, civil society, etc.).
As part of the high-level policy dialogue a side meeting was arranged to enable country dialogue on 3 other accelerator themes (community and civil society engagement, determinants of health, and data and digital health). Several panels highlighted the country’s achievements and challenges in the 3 thematic areas and identified potential collective actions that could be taken with support from the agencies including strengthening community and civil society participation in health promotion and disease prevention; developing and updating the legal framework and regulatory instruments for engagement of both civil society and the private sector; establishing a platform for institutional dialogue between decision-makers and stakeholders, including health care providers, service users and civil society organizations; strengthening partnerships with civil society to reach key vulnerable populations; and strengthening coordination and intersectoral collaboration on digital health.
In December 2019, a second high-level policy dialogue engaging senior government officials, civil society and other national stakeholders under the High Patronage of HM The King the was organized to take stock of progress and achievements in PHC and to devise recommendations for the future national PHC strategy.
Pakistan
Country context
Pakistan has been selected as one of the global pilot countries for the implementation of the Global Action Plan for Healthy Lives and Well-being for All , with a focus on PHC and health financing accelerators themes. Pakistan is the fifth most populous country in the world, with a population of around 212 million in 2018. The health system is facing many challenges; government spending on health is low at under 1% of gross domestic product with high out-of-pocket expenditure, health workforce shortages and maldistribution, lack of health information, policy and planning dilemma, medicine and vaccine availability and in addition faces the issue of the “inverted health care delivery pyramid” in which PHC is not functioning at an optimal level with the result that most health services in the country are concentrated in tertiary and secondary hospitals. Pakistan’s UHC index is 45 out of 100. The focus of WHO support is to strengthen PHC to correct the inverted health care delivery pyramid which will also address other health system issues.
Key achievements
The GAP agencies are learning from and building on existing collaborations in Pakistan, such as the, National Immunization Support Project through which GAVI and the World Bank have already aligned financing. Discussions among the agencies on providing joint support for scaling up PHC in line with the National Health Vision began in July 2019, led by the WHO Country Office. These deliberations focused on the design and financing of expanded UHC benefit packages for different settings.
Additional opportunities for joint support were identified and discussed after presentations to the GAP PHC accelerator working group and the GAP Sherpa group in January 2020, including scaling up PHC interventions in demonstration districts; engaging private physicians in a family practice approach; strategic realignment of human resources for health; mapping and aligning federal and provincial resources; strengthening public financial management; and reforming the Lady Health Worker Programme based on development of a strategic framework and investment case. Other opportunities include strengthening existing health coordination mechanisms, such as the Population, Nutrition and Development Partners Forum and the federal and provincial inter-ministerial health committees.
As Gavi, the Global Fund, GFF and the World Bank open new funding windows over the next year, these signatory agencies and other partners, such as the Global Polio Eradication Initiative, are exploring opportunities for alignment to support health systems strengthening and delivery of essential health services at the primary care level. As a direct result of discussions on the GAP, the Global Fund, Gavi, GFF, UNICEF, the World Bank and WHO have planned a joint appraisal mission to strengthen PHC and health financing by aligning financing, technical assistance and support for priorities identified by Pakistan’s federal and provincial ministries of health. The mission, which has been delayed by the COVID-19 pandemic, will be led by the Government of Pakistan with support from WHO and UNICEF as co-leads of the GAP PHC accelerator working group and Gavi, the Global Fund and the World Bank as co-leads of the GAP finance accelerator working group.
Somalia
Country context
In December 2019, GAP Signatories identified Somalia as one of 12 pilot countries for the national implementation of the Global Action Plan for Healthy Lives and Well-being for All (GAP) focusing joint efforts in primary health care. Three decades of civil war and instability, coupled with natural disasters such as drought and floods, have weakened Somalia’s health system and contributed to it having some of the lowest health indicators in the world. Of the country’s 15 million people, 26–70% live in poverty, depending on the region, and an estimated 2.6 million people have been internally displaced. The country’s UHC index is 25 out of 100.
Key achievements
The Somali Government is committed to taking advantage of current opportunities to strengthen health and social development, including an improved security and political situation and the potential to leverage humanitarian funds to address longer-term health and development needs. There is also a growing number of development partners interested in health, a large private health sector and a network of non-governmental and civil society organizations with potential for improving access to health care; improved data; recent progress in mass immunization; and forthcoming financing rounds of major global health funders, including signatory agencies, that increase opportunities for health sector development. The Somali National Development Plan for 2019-2024 and the Somali UHC Roadmap launched in September 2019 identify primary health care as the main approach to improving health outcomes in the country.
On the sidelines of a GFF workshop in Addis Ababa October 2019, discussions took place among signatory agencies about opportunities for enhanced collaboration with Somalia to accelerate progress towards UHC through PHC.
In January 2020, WHO undertook a mission to discuss further support needed. Signatory agencies were invited to join the mission, and Gavi, UNICEF, the World Bank and bilateral donors were closely engaged. Following the mission and further discussions in the country and among members the PHC accelerator working group and multilateral and bilateral partners, 5 priority areas for enhanced collaboration emerged:
- Establishing a health coordination mechanism.
- Improving access to a high-quality essential package of health services.
- Strengthening emergency preparedness and response through UHC.
- Strengthening the role and capacity of the Ministry of Health.
- Harnessing the private sector for UHC.
Information resources
Report of the second annual Regional Health Alliance meeting, December 2021 |