Coherent action and close coordination are required at all levels of government, as well as across all stakeholders, including NGOs, civil society, academia, and the private sector, for better leveraging the shared gains across the continuum of health. In addition, as countries face significant coordination issues when dealing with multiple international partners, each with its own mandate and priorities, greater collaboration and more coherent approaches are required among United Nations agencies and other global health organizations to help countries tackle the complex challenges of the 2030Agenda.
3.1 Collaborative
governance and
accountability for
multisectoral and
multistakeholder
action to accelerate
NCD responses
The challenge
How do we …fenhance policy coherence among government health and non-health agencies to scale up the NCD best buyinterventions? fengage non-State actors to collaborate
towards preventing and controlling NCDs and mental healthconditions?
fbest utilize WHO and the broader United Nations system capabilities to strengthen engagement, advocacy and support for multisectoral and multistakeholderaction?
Governance and leadership are the main building blocks of health systems.12 Governance
refers to institutional arrangements and management processes to set the overall direction through policy development and planning, as well as coordination mechanisms. Effective governance for NCDs at the national level requires multisectoral and multistakeholder cooperation and coalitions to catalyse political action and help translate high-level NCD commitments into actionable national plans, strategies andprogrammes. The WHO Independent High-level Commission on NCDs defined a multisectoral approach as the Health in All Policies, whole-of-government and intersectoral or cross-sectoral action for policy coherence and a coordinated public sector response to the NCD challenge. In contrast, multistakeholder approaches refer to whole-of-society action, including both governments and non-State actors. According to the WHO Framework of Engagement with
12 Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action. Geneva: World Health Organization; 2007.
Non-State Actors (FENSA),13 the main categories
of non-State actors are NGOs, philanthropic foundations, academic institutions and the privatesector.
Scaling up national responses to address NCDs, mental health and environmental pollution (the five-by-five approach) will require building national capacities to increase institutional recognition of NCDs, and acknowledgement of the need for multisectoral action through the establishment of high-level coordinationmechanisms.
Multistakeholder collaboration and partnerships, when appropriate, will allow governments and non-State actors to pool their resources – financial, technical and human – with a mutually shared goal of bringing heightened and focused attention to NCD prevention and control. Partnerships may also become an important consolidator and disseminator of knowledge andinformation.
The solutions
fA Health in All Policies approach confirms that health is the most important aspect of our well-being. Therefore, all government ministries should be part of multisectoral cooperation. The question should be not how other sectors can help health, but how health can help other sectors to reach theiroutcomes.
fStrong leadership at the highest level across health, government and society is needed to develop national multisectoral and multistakeholder plans of action, and build local capacities for financial, human and regulatory change. Establishing national coordination mechanisms at the highest level is a goodstart.
fWell-coordinated multisectoral and multistakeholder collaborative efforts have
fA simple phased approach to scaling up NCD interventions needs to encompass planning, implementation andaccountability.
fThe resources to strengthen institutional capacity to respond to NCDs should target NCD-specific units in ministries of health, as well as sectorwide organizational units, to build their capacity to address NCD- related requirements in human workforce planning, health financing, and health informationsystems.
fRecognizing the complex multidisciplinary nature of interventions to address NCDs, Member States need to increase investments in implementation research for guidance on how to adopt and adapt, implement, and evaluate evidence-based interventions based on their uniquecontexts.
fNCDs need to be better integrated across the life-course, communicable diseases, and mental health at the primary health carelevel.
Parallel session highlights
fFiscal measures for health are potential accelerators for NCD prevention and financing SDG responses, particularly in low- and middle-income countries. These are triple-win interventions that benefit public health, equity and domestic revenuegeneration.
fThe economic returns of investing in NCD prevention and management vastly outweigh the costs: on average, every US$ 1 invested in the WHO best buys will yield a return of at least US$ 7 by 2030. MPOWER measures, particularly increasing tobacco taxes, are the most cost-effective tools for attaining the NCD target. Increasing alcohol taxes is the most promising revenuesource.
fPromoting multisectoral coordination and multistakeholder dialogue at national level is a crucial way to address NCD risk
fA framework of engagement with the private sector has to be adapted to the national context, and must be implemented in a way that avoids industry interference, which may promote products and choices that are detrimental tohealth.
fLessons learned from investment cases should be shared at countrylevel.
fMinistries of health and finance should be well aligned in terms of their understanding of economic arguments from the investment cases to advance health through improved policy-making.
fDiscussions should take place on the best ways forward in strengthening multisectoral action aligned with the Global Action Plan for Healthy Lives and Well-being for All (SDG 3 Global Action Plan), with a focus on achieving SDG target 3.4.
fReduction of consumption of health-harming products can be achieved at country level through taxation andregulation.
fAction is needed to protect policy-making and taxation of health-harming products from industryinterference.
fExamples should be provided of strengthened collaboration and commitment among national entities, United Nations agencies and non-Stateactors.
fStrengthening the health system response to NCDs is critical to achieving UHC and SDG target 3.4.
fEvidence-based, cost-effective interventions for NCD prevention and control are available, but implementation is challenging and uneven between and within countries, particularly in low- and middle-incomecountries.
fThere is a need to look through a health system lens when developing a research agenda, as many NCD interventions occur at the intersection of individual health services and population-based public health interventions, with implications for the core function of service delivery, as well as upstream challenges in policy-making and systemsreform.
fImplementation research is key to supporting health system transformation to achieve both UHC and SDG target 3.4. It works by providing a useful set of theories, approaches and tools to turn the WHO best buys and other recommended interventions into implementedprogrammes.
fMoving evidence-based interventions, such as the WHO best buys for NCDs, into policy and practice may look different in each Member State, as contextual factors need to be incorporated into the design of interventions and implementationprocesses.