Progress on the health-related Sustainable Development Goals in Eastern Mediterranean Region countries: getting back on track in the time of COVID-19

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Editorial

Henry Victor Doctor,¹ Ruth Mabry,² Chodziwadziwa Whiteson Kabudula,³ Arash Rashidian,⁴ Rana Hajjeh,⁵ Syed Jaffar Hussain,⁶

and Ahmed Al-Mandhari ⁷

¹Coordinator, Information Systems for Health, Department of Science, Information and Dissemination, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt. ²Independent Public Health Researcher and formerly Technical Officer, SDGs/Gender, Equity and Human Rights, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt. ³MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa. ⁴Director, Department of Science, Information and Dissemination, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt. ⁵Director of Programme Management, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt. ⁶World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt. ⁷Regional Director, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt. (Correspondence to: Arash Rashidian: This email address is being protected from spambots. You need JavaScript enabled to view it.).

Citation: Doctor HV; Mabry R; Kabudula CW; Rashidian A; Hajjeh R; Hussain SJ; et al. Progress on the health-related Sustainable Development Goals in Eastern Mediterranean Region countries: getting back on track in the time of COVID-19. East Mediterr Health J. 2021;27(6):530–534. https://doi.org/10.26719/2021.27.6.530

Copyright © World Health Organization (WHO) 2021. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

On 16 June 2021, the World Health Organization (WHO) launched its first report on the ‘Progress on the health-related Sustainable Development Goals (SDGs) and targets in the Eastern Mediterranean Region’ (1). This report presents for the first time a snapshot of the progress made in addressing the health-related SDG targets and indicators in the Region. It is an important mid-way report in recognizing the achievement, and most importantly, the challenges in reaching health-related objectives among the 17 SDGs adopted by the United Nations (UN) General Assembly in 2015 in the Eastern Mediterranean Region (2,3). WHO commitment to SDGs has been re-emphasized in its Thirteenth General Programme of Work and in the Regional Vision, ‘Health for All by All’ (4).

The report uses data reported by Member States and global estimates from WHO and other UN agencies from January 2010 to September 2020 (5,6). In total, 50 health-related SDG indicators (across 9 out of 17 SDGs) are analyzed and presented. The report shows that availability of data for health-related SDG indicators varied considerably for the period, with huge gaps across indicators for cause-specific mortality, hepatitis prevalence, health financing and access to medicine indicators. Notably, the striking result is that the Region is not quite on track in meeting the health-related SDGs (7). Progress was made on only half of the 50 indicators reported between 2015 and 2019, before the COVID-19 pandemic (Table 1).

The regional profile has glimmers of hope. There has been a decline in the reported number of new cases of HIV/AIDS and TB; improvements in routine vaccination coverage; sustained high proportion of births attended by skilled health workers; fewer malnourished children; and an increasing access to improved drinking-water and sanitation. However, the Region still has a long way to go in reducing maternal, child and neonatal mortality. Expansion of vaccination coverage remains suboptimal. Progress in reducing the overall rates of HIV and malaria cases has stalled. Mortality rates due to noncommunicable diseases (NCDs) and pollution indicate no signs of a reduction. In addition to these concerns, the lessons learnt from the COVID-19 pandemic demonstrate (8,9) an uphill struggle for most countries in their quest for SDGs if the pace of investment in health and action remains at the current rate.

Timely high-quality data are critical in order to monitor progress on the SDGs at the regional, national and subnational levels. Insufficient data meant that progress for one in four indicators could not even be reported for the Region. Data availability is a major concern and demands significant improvement in health information systems (HIS) in countries of the Region (10,11). The development of a Regional Strategy (2021–2025) to strengthen HIS aims to address these concerns. Jointly developed in collaboration with national HIS stakeholders, the strategy outlines a comprehensive plan in improve HIS and create a more robust system for monitoring progress in health and ensure sufficient evidence to inform policies. But investing in HIS alone will not ensure progress on the health-related SDGs – action is required on many fronts including implementation of interventions to address existing health challenges.

The way forward is challenging but by working together countries and partners in the Region can accelerate progress. Hence key decisions and actions are inevitable. Good governance processes with strong leadership, including high level political commitment, multi-sectoral partnership, and a whole-of-society approach, are needed to meet the Sustainable Development Agenda. Those responsible for the health sector (i.e. SDG3 targets) should work with other sectors to address the determinants of health like poverty (SDG1), education (SDG4), gender equality (SDG5), climate change (SDG13) and health-related risks like nutrition (SDG2) and water and sanitation (SDG6) (12,13). Establishment of coordinating or steering committees, with decision making power, that include key stakeholders are among effective ways that countries adopt for meeting SDGs. Successful examples of a whole-of society approach in controlling the COVID-19 pandemic are observed in a few countries of the Region (14) and maintaining and expanding such initiatives is the key in achieving WHO’s vision for the Region (15).

It is for this reason that the WHO Regional Office for the Eastern Mediterranean embraced the Global Action Plan for Healthy Lives and Well-being (GAP), signed by 12 health and development partners (16). At least eight countries in the Region are using this approach to accelerate progress on the health-related SDGs. This plan also served as the background for the establishment of the Regional Health Alliance, launched in December 2020 (17). The outcomes of this collaboration as a strategy to accelerate progress towards health-related SDGs at country and regional levels are visible.

As seen in the response during the pandemic, placing health at the top of the agenda means putting essential health services and universal health coverage at the forefront (18–20). The COVID-19 pandemic has uncovered many inequities and gaps in our health systems. In addition, the pandemic has all the hallmarks that suggest the progress towards SDGs might be hampered still further. Ensuring functioning health systems and effective governance mechanisms are at the forefront of efforts towards SDGs.

The delivery of health services must be complemented by a commitment to health at the highest levels of government. This means ensuring sustainable financial investment in basic health services and public health measures, including building resilient health systems to advance universal health coverage (UHC) (21). In addition, good governance is also reflected in laws and regulations. A commitment to the right to health also requires the means for its implementation. For example, NCDs are a major burden in the Region and the provision of health services will do little to address this when the key risk factors are behavioural, tobacco use, unhealthy diet and physical inactivity. Comprehensive approaches, including the implementation of regulations as outlined in the WHO ‘Best Buys’ (22), can markedly change the epidemiological profile of these diseases in the Region by 2030. As such, countries should “do something, do more, and do better” (23). Moreover, addressing gender equality and health inequities is essential if the Region is going to meet the health-related SDGs. Currently, the Region faces some of the greatest gender disparities and the health inequities between and within countries are vast. For the first time, the findings of the Regional Commission on the Social Determinants of Health outlined some of the major health inequities particular to the WHO Eastern Mediterranean Region.

At the global and regional levels, COVID-19 poses major challenges to health and well-being, thwarting progress to meet SDGs (24) and the WHO triple billion targets. While we are observing an increase in NCD burden and a greater number of immature deaths, the pandemic has demonstrated that communicable disease threats are real and might be expanding in coming years. Nevertheless, if necessary interventions are implemented and the necessary data are collected, processed and synthesized, progress towards health-related SDGs will not only be reliably measured, but would support countries’ efforts to promote health and well-being (25). However, achieving this requires concerted efforts at the country, regional and global levels. The report, as noted above, provides a strong standing for developing a regional action plan that involves all key partners, and guide the efforts towards SDGs.

References

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