1. Health &
Development Agenda
Triono Soendoro, MD., Ph.D
Member of National Committee, Post-MDG
2015 office of the President &
Chair, Post-MDG 2015 Agenda, MoH

2. 2
A NEW GLOBAL PARTNERSHIP
Eradicate Poverty
& Transform
Economies through
Sustainable
Development
http://www.un.org/sg/management/pdf/HLP_P2015_Rep
ort.pdf

3. Session Outline
1. The consultation process (NY,
London, Monrovia, Jakarta, Bali –
from July 2012 – (final report)
2. Botswana: Feb 2013
3. Bangkok (SEARO): March 2013
4. Final Report: April-June 2013
5. The Way Forward

4. Ban Ki Moon & Co-Chairs
• I look forward to the Panel’s
recommendations on a global post-
2015 agenda with “shared
responsibilities for all countries and
with the fight against poverty and
sustainable development at its core.”
(25/7/201
2)

5. The Journey: Dev. Agenda
how the various sectors (even
within health) collaborate and
“compete” with each other
&
how health has eventually been
included

6. Health & Others: Competes..
• 11 thematic group including health, led by
Botswana and Sweden, supports from WHO
and UNICEF
• Address 3 issues: unfinished agenda of
MDGs; emerging threats - health transition n
globalization; health in the post 2015 develop
agenda
• Final report: submitted to the UN-SG in May
30 and discuss in the UN-GA in Sept 2013

7. Serial Consultation: Wants..
• Overarching, aspirational health
goals;
• Stick with focused, targeted MDG-like
goals; and
• Supports a tiered approach with a
hierarchy of health goals and sub-
goals.

8. Intensive Dialogue
From MDGs 2000 to Post MDGs
2015 development agenda:
• What to keep,
• What to amend, and
• What to add

9. Botswana: 4-6 March 2013
• Participants – 50 high level persons including
ministers, members of the HLP, chiefs of IGOs,
INGOs, private sectors, and high level experts.
• The culmination of 6 months extensive
consultation on how health should be addressed
in the post 2015 development agenda
• Web-based with 150,000 visitors, 13 face to face
with 1,500 pants and more than 100 papers
submitted to www.worldwewant2015.org/health
with 3 proposed targets - HLE, UHC, MDG++

10. Post-2015: The Goals
1. Long healthy lives: is an end goal, influenced
by health but also by many other aspects of
development
2. Universal Health Coverage: contribution of
health to the end goal, supported in many
papers
3. Continued Health MDGs, with equity element
4. Several specific goals proposed, e.g. Universal
access to sexual and reproductive rights or
improvements in mental health.
Equity and human rights as central elements

11. Post-MDG 2015 Agenda:
Shape, Themes, Contents?
Bangkok: Mid-March13

12. VISION: Bangkok (mid-March)
• Vision: “Ending Poverty by promoting
equitable development, sustainable growth
with equity through strengthen
partnership”….
• Vision: Human Well-being for all by 2030?
• Vision: The fulfillment of the constitutive
elements of human Well-being for all by
2030?
• Remember: Health for all by 2000?
12

13. Our Challenges: Framework?
• Human Well-being: human as the central for
the development (overaching).
• Thus, how to attain the constitutive elements
of HUMAN: Vision.
• Shift: human as resources (OBJ) to human
as human-being (SBJT)
• Poverty, promote equitable development,
sustainable, environment, education, health
etc are the instruments (object), not the
(subject) for the development
13

14. 14
The Constitutive Element: Vision
Human

15. The Linkage: As Systems
• Requires careful consideration, both
health vis a vis other development
areas, and of the various elements
within the health agenda as a
SYSTEMS.
• It is clear: the new framework must
address the limitations of the MDGs
15

16. Systems
A system is something that:
• maintains its existence and
• functions as a whole
• through the interaction of its
parts.

17. Thus, Systems Thinking
• looks at the whole and
the parts and
• the interactions among
the parts
• studying the whole in
order to understand the
parts

18. Non-Systems Thinking
• Reductionism, which is the
usual scientific (technical,
managerial) approach,
looks at the parts in order
to try to understand the
whole.
• >400 years (descartes)
• Now, we have to shift our
way of thinking,
fragmentation?

19. Analytical Thinking
“We have been taught how to
solve problems, but hardly how
to define them.”
Jamshid Gharajedaghi

20. Pro-Cons: Systems Thinking
• Rationalize target setting
and help develop a limited
set of numeric targets that
are adaptable at country
level and relevant globally.
• Hierarchy of more sector-
and program specific
goals, targets and
indicators can reflect
existing agreements
(including the current
MDGs) and incorporate
elements of the new health
agenda
• Difficult to adapt,
fragmentation to become
integrated – systems
thinking.
• Dichotomous thinking:
preventive promotive vs
curative.
• Changes our perception,
concepts: academic,
practitioners, etc
• Health systems
improvements: hard to
understand

21. The Content (Bali Consult..)
• The content of post-2015 development
agenda encompasses a set of important
issues.
• These issues are overarching and related
in one or other ways to sustainable
development as the “interlinking” theme.
21
HLPEP 4th meeting; Bali 25-27 March 2013

22. Content (GOALS): 15…
• Poverty and inequality
• Food security
• Education
• Health
• Governance and
transparency
• Employment and livelihood
security
• Environmental sustainability
• Water and energy
• Peace, security, and social
protection
• Cities and urbanization
• Access to technology
• Gender and youth
• Ocean and seas
• Disaster risk reduction
• Sustainable consumption
and production patterns
• …etc

23. Bangkok Recommendations
• Maximizing health at all stages of life as
overarching health goal with two specific
health sector goals, i.e., accelerating
progress of MDGs 4, 5 and 6, and reducing
burden from NCDs
• UHC is the health sector key contribution
and include ‘Universal access to quality
comprehensive essential health services
without financial barriers’

24. Sustainable
Wellbeing for All
(Wealth, healthy lives,
education, nutrition,
environment, etc.)
UHC
Access to quality
comprehensive
essential primary care
services (including all
MDG++ and NCDs),
financial risk protection
Health sector
contribution
Other sector
contributions
Post 2015 Development Agenda:
MODEL
Contributions of the health & other sectors

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. Goals & Targets: Health
• Promote quality
health care
• Maximize
healthy lives and
well-being
• Maximize health
at all stages of
life
• Reduce child death <5%
• All children, adolescent,
pregnant women are fully
vaccinated
• Universal access to sexual &
reprod health services
• HIV, malaria, TBC, Diarrhea
• Universal coverage of and
access to health services
across all wealth quintiles
• Reduce mortality of NCD by
25% by 2025
• Etc……

27. Session: Final Report
1. Botswana – Feb 2013
2. Bangkok (SEARO) – March 2013
3. Post MDG-2015 development
consultation process – (Jul 12 –
May 2013 – semi final report)
4. Final report: June 2013

28. Our Vision & Responsibility
“To end extreme poverty in all its
forms in the context of sustainable
development and to have in place
the building blocks of sustained
prosperity for all”

29. Partnerships (Bali)
• Multi-stakeholder partnerships, no
longer fragmented
• Enables innovation, convince
advocacy for good policies (HiAP?),
secure funding
• Implementation and scaling up to
reach larger population

30. Five Principles: Goals
1. Leave No One Behind.
2. Put Sustainable Development at the
Core
3. Transform Economies for Jobs and
Inclusive Growth.
4. Build Peace and Effective, Open and
Accountable Institutions for All.
5. Forge a New Global Partnership.

31. Global Goals & National Plans
• An approach for unifying global goals.
• Enable every nation to realize its own
hopes and plans
• Choose an appropriate level of
ambition for each target
• Input on what is realistic and
achievable target at all level

33. Goal 4: Ensure Healthy Lives
• Focus on health outcomes; requires
universal acces to basic health care
means:
1. Reaching more people for essential
services
2. Broadening range of integrated
services
3. Affordable
4. Avoid discrimination

34. Goal 4: Cont’nd
• Ensure equity: interconnected
(interaction social, econ & envir)
• Investing more in health: promotion
and prevention (vaccination)
• Strengthening health system: health
workers, nutritious food, safe water
and sanitation, etc

35. Goals, Targets, and Indicators
Term How it is Used in the Report Example from MDGs
Goals Expresses an ambitious, but
specific, commitment. Always
starts with a verb/action.
(ENSURE HEALTHY LIVES)
Reduce child mortality
Targets1,2,3 Quantified sub-components that
will contribute in a major way to
achievement of goal. Should be an
outcome variable.
Reduce by two-thirds,
between 1990 and 2015
(<5 mortality rate)
Indicators Precise metric from identified
databases to assess if target is
being met (often multiple indicators
are used).
• Under-5 mortality rate
• IMR
• Proportion of 1-year
olds immunized (UCI)

36. Target: 1,2, and 3
1. Candidates for global minimum
standards, including ‘zero’goals;
2. Indicators to be disaggregated;
3. Targets require further technical
work to find appropriate indicators

37. Health: Target 1,2
1. End preventable infant and under-5 deaths.
2. Increase by x% the proportion of children,
adolescents, at-risk adults and older people
that are fully vaccinated.
3. Decrease the maternal mortality ratio to no
more than x per 100,000.
4. Ensure universal sexual and reproductive
health and rights.
5. Reduce the burden of disease from HIV/AIDS,
tuberculosis, malaria, NTD and priority NCD 3

38. The Way Forward
• Set of Goals or Goals: to be debated,
discussed, and improved (until…2015?)
• Select targets at global level, national level
or even local level
• Setting global minimum standard for
selected indicators (“data revolution”)
• Setting disaggregate for relevant
indicators
• Develop & formulate “agenda for HiAP”