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Commentary

Maha El Rabat,¹ Abdulla Assaedi,² Omer Suleiman³ and Ruth Mabry⁴

¹Professor of Public Health, Cairo University, Egypt. ²International Public Health Expert, Muscat, Oman. ³International Public Health Expert, Sudan. ⁴International Public Health Expert, Muscat, Oman. (Correspondence to: Ruth Mabry: This e-mail address is being protected from spambots. You need JavaScript enabled to view it )

Citation: El Rabat M; Assaedi A; Suleiman O; Mabry R. Vision 2023: midterm push forward plan for Health for All by All in the WHO Eastern Mediterranean Region. East Mediterr Health J. 2022;28(12):853–855. https://doi.org/10.26719/emhj.22.088
Received: 07/02/22; accepted: 19/10/22

Copyright © Authors 2022; Licensee: World Health Organization. EMHJ is an open access journal. This paper is available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

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Introduction

Vision 2023: Health for All by All in the WHO Eastern Mediterranean Region was presented to WHO/EMRO Member States during the 65th Session of the Regional Committee in October 2018. A year later, the WHO strategy for the Eastern Mediterranean Region, 2020–2023: turning Vision 2023 into action was presented to the 66th Session (1). This regional vision aligns with WHO’s global strategy and the 13th Global Programme of Work, with its triple billion targets that aim to get WHO Member States on track to meet the health-related Sustainable Development Goals (SDGs). The 68th Regional Committee adopted the Vision 2023 midterm review and push forward recommendations and plan (2) and called on Member States to accelerate progress towards achieving Vision 2023 (3).

Health for All by All, the slogan for Vision 2023, reflects the principles of right to health, equity, and community participation embedded in the Alma Ata Declaration (4). While these principles are explicitly mentioned in the regional documents, the Vision 2023 slogan adds the phrase ‘by All’ to emphasize the solidarity, role and responsibility of governments, individuals, communities, academia, and all stakeholders in protecting people’s health.

Between February and August 2021, we had the privilege as external experts to conduct a mid-term review and push forward plan as members of a taskforce established to identify successes, gaps, challenges, and opportunities during the implementation of Vision 2023 and to propose actions for a way forward. This work formed the basis for Vision 2023 midterm push forward plan which recommended re-alignment of actions to achieve the envisioned results (2). In this commentary, we highlight three lessons learned halfway through implementing Vision 2023.

1. People-centred community-based responses that build trust and support vulnerable groups are critical to achieving Universal Health Coverage

Despite strong political commitment by WHO/EMRO Member States to expand Universal Health Coverage (UHC), more aggressive efforts are needed if 100 million more people in the Eastern Mediterranean Region (EMR) are to benefit from good quality health services without financial hardship by 2023, which is the most tangible goal of Vision 2023. This commitment is evident from improvements in some SDG 3 indicators such as increase in the use of family planning, reduction in adolescent pregnancy and birth rates, increased immunization coverage, and increase in the density of healthcare workers (5).

Progress is being made on integration of communicable diseases, noncommunicable diseases and maternal and child health services into primary health care (PHC) in the EMR. However, the impact of this progress is not yet reflected in the SDG 3.8 indicator, where the UHC service coverage index in the region is currently 57, on a scale of 0 to 100, a marginal increase in the past four years and with disparities within and between countries (5). Low investment in health, a serious shortage of health workforce, lack of infrastructure, and inadequate integration of essential health services into PHC are key challenges to achieving Vision 2023. However, good examples of addressing one of the most critical issues, increasing domestic financing for health, are the social health insurance law and the new health insurance system being piloted in Egypt, the development of finance and analysis metrics for the national health accounts project in Jordan, and the localization of the UHC essential health package in all provinces of Pakistan (6). Expanding UHC is only possible by focusing on primary health care and an expansive mobilization for health, recalling the principles of health equity, solidarity, and inclusiveness of the Alma Ata Declaration and the PHC reforms outlined in the 2008 World Health Report (7).

2. A comprehensive public health approach is critical when addressing emergencies

Almost half of the countries in the region are undergoing protracted crisis, conflict, or some type of humanitarian emergency, which have been compounded by infectious diseases, noncommunicable diseases, reproductive health problems, and others. This difficult operational setting requires an agile and effective response to cope with the current challenges, including the COVID-19 pandemic. While much attention has been drawn to COVID-19 response during the initial period of Vision 2023, achievements included the development of national action plans for health security, based on WHO-led joint external evaluations; strengthening epidemiological surveillance for influenza; and establishment of national rapid response teams (2). The pandemic has kept health high on the political agenda and provided an impetus for countries to use novel approaches such as introduction and/or expansion of digital platforms to ensure continuity of essential health services (2). Countries should seize this moment to accelerate efforts towards strengthening their public health workforce, including the engagement of ad hoc health related workers. Developing a collective and cohesive regional public health agenda is critical for re-aligning health priorities to achieve Vision 2023, including, among others, NCDs and mental health, particularly for the fragile, vulnerable, and conflict settings. Building resilient health systems should not only be in line with global discussions on pandemic preparedness and response, but these discussions must take into account the region-specific context and collective interests, demands, needs, and priorities (8).

3. Intersectoral and community partnership is key to protecting and promoting health and addressing the determinants of health

Progressing more rapidly on the health-related SDGs, for which we are currently offtrack, requires developing a robust and more cohesive regional public health agenda that uses regional capacities and a health-in-all-policies approach to address health risks and determinants (9). The report by the regional Commission on Social Determinants of Health outlines key actions to address health inequities (10). In many countries, taking a whole-of-government/society approach focusing on the community level and active partnership with civil society was found critical for a COVID-19 response (2). Some case studies from the regional Healthy Cities Network demonstrated how community-wide efforts reduced the spread of infection in the region (11). It is through such broad participatory approaches that we can respond to the multiple threats to health and build healthy societies (8). Leveraging partnerships, such as the Regional Health Alliance of 15 regional health and development agencies (12), can help prevent fragmentation and promote stronger engagement to maximize complementarity. Working in multidisciplinary teams, broadening partnerships, and adopting equity-focused participatory approaches – the “by All” of the Vision 2023 – form the basis for addressing the broad range of health priorities expressed by the health-related SDGs (8).

Conclusion

Strengthening solidarity and building cooperation among countries of the region require adequate attention and allocation of resources by national authorities to appropriately manage their national priorities. It also means countries should monitor, document and share data, achievements, progress, lessons learned, and good practices on implementing Vision 2023 and progress towards achievement of the SDGs health agenda. Through such active engagement, using the ‘Health for All by All’ approach can have a positive impact on the health of the population in the EMR. The WHO regional office must continue to play the role of a catalytic leader and a strong platform to advance the needed public health actions, strengthen solidarity, and promote equity in the EMR.

Acknowledgement

This commentary is based on the work conducted by the authors as external experts on the WHO Vision 2023, health for All by All – midterm push forward taskforce in the WHO/EMRO. The taskforce was established to identify successes, gaps, challenges, and opportunities during implementation of Vision 2023 and propose actions for a way forward. The views expressed in the paper are those of the authors and do not necessarily reflect those of the WHO.

Funding: None

Competing interests: The co-authors served as external consultants and members of the EMR Vision 2023 – mid-term push forward taskforce, supported by senior WHO/EMRO and WHO headquarters staff.

References

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