Triono Soendoro, senior adviser to Ministry of Health, Indonesia


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  • Perlu dimasukkan dimensi manusia, seperti choice Perlu dikawinkan antara yang telah disampaikan oleh presiden
  • • Leave No One Behind. We must ensure that no person – regardless of ethnicity, gender, geography, disability, race or other status – is denied basic economic opportunities and human rights. • Put Sustainable Development at the Core . We must make a rapid shift to sustainable patterns of production and consumption, with developed countries in the lead. We must act now to slow the alarming pace of climate change and environmental degradation, which pose unprecedented threats to humanity. • Transform Economies for Jobs and Inclusive Growth . A profound economic transformation can end extreme poverty and promote sustainable development, improving livelihoods, by harnessing innovation, technology, and the potential of business. More diversified economies, with equal opportunities for all, can drive social inclusion, especially for young people, and foster respect for the environment. • Build Peace and Effective, Open and Accountable Institutions for All. Freedom from violence, conflict, and oppression is essential to human existence, and the foundation for building peaceful and prosperous societies. We are calling for a fundamental shift – to recognize peace and good governance as a core element of wellbeing, not an optional extra. • Forge a New Global Partnership . A new spirit of solidarity, cooperation, and mutual accountability must underpin the post-2015 agenda. This new partnership should be built on our shared humanity, and based on mutual respect and mutual benefit
  • Triono Soendoro, senior adviser to Ministry of Health, Indonesia

    1. 1. Health &Development AgendaTriono Soendoro, MD., Ph.DMember of National Committee, Post-MDG2015 office of the President &Chair, Post-MDG 2015 Agenda, MoH
    2. 2. 2A NEW GLOBAL PARTNERSHIPEradicate Poverty& TransformEconomies throughSustainableDevelopment
    3. 3. Session Outline1. The consultation process (NY,London, Monrovia, Jakarta, Bali –from July 2012 – (final report)2. Botswana: Feb 20133. Bangkok (SEARO): March 20134. Final Report: April-June 20135. The Way Forward
    4. 4. Ban Ki Moon & Co-Chairs• I look forward to the Panel’srecommendations on a global post-2015 agenda with “sharedresponsibilities for all countries andwith the fight against poverty andsustainable development at its core.”(25/7/2012)
    5. 5. The Journey: Dev. Agendahow the various sectors (evenwithin health) collaborate and“compete” with each other&how health has eventually beenincluded
    6. 6. Health & Others: Competes..• 11 thematic group including health, led byBotswana and Sweden, supports from WHOand UNICEF• Address 3 issues: unfinished agenda ofMDGs; emerging threats - health transition nglobalization; health in the post 2015 developagenda• Final report: submitted to the UN-SG in May30 and discuss in the UN-GA in Sept 2013
    7. 7. Serial Consultation: Wants..• Overarching, aspirational healthgoals;• Stick with focused, targeted MDG-likegoals; and• Supports a tiered approach with ahierarchy of health goals and sub-goals.
    8. 8. Intensive DialogueFrom MDGs 2000 to Post MDGs2015 development agenda:• What to keep,• What to amend, and• What to add
    9. 9. Botswana: 4-6 March 2013• Participants – 50 high level persons includingministers, members of the HLP, chiefs of IGOs,INGOs, private sectors, and high level experts.• The culmination of 6 months extensiveconsultation on how health should be addressedin the post 2015 development agenda• Web-based with 150,000 visitors, 13 face to facewith 1,500 pants and more than 100 paperssubmitted to 3 proposed targets - HLE, UHC, MDG++
    10. 10. Post-2015: The Goals1. Long healthy lives: is an end goal, influencedby health but also by many other aspects ofdevelopment2. Universal Health Coverage: contribution ofhealth to the end goal, supported in manypapers3. Continued Health MDGs, with equity element4. Several specific goals proposed, e.g. Universalaccess to sexual and reproductive rights orimprovements in mental health.Equity and human rights as central elements
    11. 11. Post-MDG 2015 Agenda:Shape, Themes, Contents?Bangkok: Mid-March13
    12. 12. VISION: Bangkok (mid-March)• Vision: “Ending Poverty by promotingequitable development, sustainable growthwith equity through strengthenpartnership”….• Vision: Human Well-being for all by 2030?• Vision: The fulfillment of the constitutiveelements of human Well-being for all by2030?• Remember: Health for all by 2000?12
    13. 13. Our Challenges: Framework?• Human Well-being: human as the central forthe development (overaching).• Thus, how to attain the constitutive elementsof HUMAN: Vision.• Shift: human as resources (OBJ) to humanas human-being (SBJT)• Poverty, promote equitable development,sustainable, environment, education, healthetc are the instruments (object), not the(subject) for the development13
    14. 14. 14The Constitutive Element: VisionHuman
    15. 15. The Linkage: As Systems• Requires careful consideration, bothhealth vis a vis other developmentareas, and of the various elementswithin the health agenda as aSYSTEMS.• It is clear: the new framework mustaddress the limitations of the MDGs15
    16. 16. SystemsA system is something that:• maintains its existence and• functions as a whole• through the interaction of itsparts. 
    17. 17. Thus, Systems Thinking• looks at the whole andthe parts and• the interactions amongthe parts• studying the whole inorder to understand theparts
    18. 18. Non-Systems Thinking• Reductionism, which is theusual scientific (technical,managerial) approach,looks at the parts in orderto try to understand thewhole.• >400 years (descartes)• Now, we have to shift ourway of thinking,fragmentation?
    19. 19. Analytical Thinking“We have been taught how tosolve problems, but hardly howto define them.”Jamshid Gharajedaghi
    20. 20. Pro-Cons: Systems Thinking• Rationalize target settingand help develop a limitedset of numeric targets thatare adaptable at countrylevel and relevant globally.• Hierarchy of more sector-and program specificgoals, targets andindicators can reflectexisting agreements(including the currentMDGs) and incorporateelements of the new healthagenda• Difficult to adapt,fragmentation to becomeintegrated – systemsthinking.• Dichotomous thinking:preventive promotive vscurative.• Changes our perception,concepts: academic,practitioners, etc• Health systemsimprovements: hard tounderstand
    21. 21. The Content (Bali Consult..)• The content of post-2015 developmentagenda encompasses a set of importantissues.• These issues are overarching and relatedin one or other ways to sustainabledevelopment as the “interlinking” theme.21HLPEP 4th meeting; Bali 25-27 March 2013
    22. 22. Content (GOALS): 15…• Poverty and inequality• Food security• Education• Health• Governance andtransparency• Employment and livelihoodsecurity• Environmental sustainability• Water and energy• Peace, security, and socialprotection• Cities and urbanization• Access to technology• Gender and youth• Ocean and seas• Disaster risk reduction• Sustainable consumptionand production patterns• …etc
    23. 23. Bangkok Recommendations• Maximizing health at all stages of life asoverarching health goal with two specifichealth sector goals, i.e., acceleratingprogress of MDGs 4, 5 and 6, and reducingburden from NCDs• UHC is the health sector key contributionand include ‘Universal access to qualitycomprehensive essential health serviceswithout financial barriers’
    24. 24. SustainableWellbeing for All(Wealth, healthy lives,education, nutrition,environment, etc.)UHCAccess to qualitycomprehensiveessential primary careservices (including allMDG++ and NCDs),financial risk protectionHealth sectorcontributionOther sectorcontributionsPost 2015 Development Agenda:MODELContributions of the health & other sectors
    25. 25. The Frame of Goals (April)• MDGs 1-6– Halve poverty– Provide basic needs• MDGs 7-8– Enviromental stability– Aid• Raise level of ambition– End poverty– Leave no one behind• Use Resource Wisely– Manage as best– Beyond Aid(partnership)• Transformation– All inclusive– Fair, equal,accountable(Keep, Adapt, Add)
    26. 26. Goals & Targets: Health• Promote qualityhealth care• Maximizehealthy lives andwell-being• Maximize healthat all stages oflife• Reduce child death <5%• All children, adolescent,pregnant women are fullyvaccinated• Universal access to sexual &reprod health services• HIV, malaria, TBC, Diarrhea• Universal coverage of andaccess to health servicesacross all wealth quintiles• Reduce mortality of NCD by25% by 2025• Etc……
    27. 27. Session: Final Report1. Botswana – Feb 20132. Bangkok (SEARO) – March 20133. Post MDG-2015 developmentconsultation process – (Jul 12 –May 2013 – semi final report)4. Final report: June 2013
    28. 28. Our Vision & Responsibility“To end extreme poverty in all itsforms in the context of sustainabledevelopment and to have in placethe building blocks of sustainedprosperity for all”
    29. 29. Partnerships (Bali)• Multi-stakeholder partnerships, nolonger fragmented• Enables innovation, convinceadvocacy for good policies (HiAP?),secure funding• Implementation and scaling up toreach larger population
    30. 30. Five Principles: Goals1. Leave No One Behind.2. Put Sustainable Development at theCore3. Transform Economies for Jobs andInclusive Growth.4. Build Peace and Effective, Open andAccountable Institutions for All.5. Forge a New Global Partnership.
    31. 31. Global Goals & National Plans• An approach for unifying global goals.• Enable every nation to realize its ownhopes and plans• Choose an appropriate level ofambition for each target• Input on what is realistic andachievable target at all level
    32. 32. Goal 4: Ensure Healthy Lives• Focus on health outcomes; requiresuniversal acces to basic health caremeans:1. Reaching more people for essentialservices2. Broadening range of integratedservices3. Affordable4. Avoid discrimination
    33. 33. Goal 4: Cont’nd• Ensure equity: interconnected(interaction social, econ & envir)• Investing more in health: promotionand prevention (vaccination)• Strengthening health system: healthworkers, nutritious food, safe waterand sanitation, etc
    34. 34. Goals, Targets, and IndicatorsTerm How it is Used in the Report Example from MDGsGoals Expresses an ambitious, butspecific, commitment. Alwaysstarts with a verb/action.(ENSURE HEALTHY LIVES)Reduce child mortalityTargets1,2,3 Quantified sub-components thatwill contribute in a major way toachievement of goal. Should be anoutcome variable.Reduce by two-thirds,between 1990 and 2015(<5 mortality rate)Indicators Precise metric from identifieddatabases to assess if target isbeing met (often multiple indicatorsare used).• Under-5 mortality rate• IMR• Proportion of 1-yearolds immunized (UCI)
    35. 35. Target: 1,2, and 31. Candidates for global minimumstandards, including ‘zero’goals;2. Indicators to be disaggregated;3. Targets require further technicalwork to find appropriate indicators
    36. 36. Health: Target 1,21. End preventable infant and under-5 deaths.2. Increase by x% the proportion of children,adolescents, at-risk adults and older peoplethat are fully vaccinated.3. Decrease the maternal mortality ratio to nomore than x per 100,000.4. Ensure universal sexual and reproductivehealth and rights.5. Reduce the burden of disease from HIV/AIDS,tuberculosis, malaria, NTD and priority NCD 3
    37. 37. The Way Forward• Set of Goals or Goals: to be debated,discussed, and improved (until…2015?)• Select targets at global level, national levelor even local level• Setting global minimum standard forselected indicators (“data revolution”)• Setting disaggregate for relevantindicators• Develop & formulate “agenda for HiAP”