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.

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

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.

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).

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.

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.

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: