coverage(UHC)underpins, and is key to the achievement of serve to inform the hlf, which will also receive a global all the other targets and the development of strong resilient Sustainable Development Report from the United Nations health systems. Achieving the UHC target will require an Department of Economic and Social Affairs. Follow-up and integrated approach to the provision of health services review will possibly focus on a small number of themes each that minimizes fragmentation and the competing agendas year with the intention of covering all SDgs over a period that characterized the MDG period. Comprehensive in of 4 years. Every 4 years, starting in 2019 and under the scope, the health targets build upon a wide array of recent auspices of the United Nations General Assembly the hlpf World Health Assembly(WHA) and Regional Committee will review overall progress and provide high-level political resolutions, WHO and other global plans of action and guidance on the Sdg agenda and its implementation. 4 urrent country health strategies Review mechanisms will also be established at regional and national level, and are likely to be more active and relevant Tracking progress was vital in maintaining momentum than was the case for the MDgs owards the mDGs and in identifying areas that required greater efforts. It will be no less important in the context of This World Health Statistics report represents an initial the SDGs. The 2030 Agenda places considerable emphasis effort to bring together available data on the sdg health on the systematic follow-up and review of SDG-related and health-related indicators to provide an assessment of plementation at country, regional and global levels. the situation in 2016 and to take stock of data gaps. Data Health-related monitoring will occur in the context of are presented on the proposed indicators for health targets overall assessment of progress towards the SDGs, and will in goal 3 and selected health-related targets in other SDg need to be comprehensive comprising the monitoring of: targets, revealing the crucial linkages between health and (a) overall progress towards SDG 3;(b) the UHC target; the other SDGs. The two-page summaries in Annex A c)other health targets; and(d) health-related targets in provide more detailed information on the epidemiological other goals-all of which will be undertaken with a strong situation, set out what is needed to achieve the 2030 emphasis on equity. targets, and indicate what is currently known about the key aspects of equity and the extent of data gaps for each target. March 2016. the United Nations Statistical Commission discussed the proposed global indicator framework of its In addition, this report presents summary measures of health nter-agency and Expert Group on SDg Indicators(IAEG- such as life expectancy to assess the situation and trends SDGs). 2 IAEG-SDGs members represent 28 national which can be used to monitor health goal-level progress statistical offices, with United Nations agencies acting as UHC is one of the health targets. As stated above because observers and the United Nations Statistical Division as it underpins the achievement of all other health targets the secretariat. The United Nations Statistical Commission under SDG 3, a separate section presents statistics on a greed"as a practical starting point"with the global UHC service-coverage index and on measures of financial indicator framework proposed by the lAEG-SDGs"subject protection using the WHo/World Bank UHC monitoring to further technical refinement "3 framework. Finally, as equity is central to the realization of the SDGs, special attention is given to describing the The indicator framework will be presented for adoption statistical situation disaggregated by key demographic, to the High-Level Political Forum(HLPF) for Sustainable geographic and socioeconomic characteristics Development, under the auspices of the United Nations Economic and Social Council in mid-2016. The indicator The report does not address issues related to monitoring the framework comprises 230 indicators, including several global partnership that will be crucial in advancing the 2030 dozen requiring further development. The framework is Agenda. Future monitoring will have to include the extent focused on indicators for the 169 SDG targets, and does not to which a revitalized global partnership is delivering the include goal-level or thematic indicators that cut across goals means of implementation. SDG 17 is specifically devoted to assess the overall achievements of the 2030 Agenda. to strengthening the means of implementation and a set of indicators has been drawn up to monitor progress in A complex and intensive reporting, follow-up and review achieving that end This also includes monitoring the extent process is planned, and will include an annual SDG Progress to which data are disaggregated by relevant inequality Report by the United Nations Secretary-General with dimensions and the extent to which countries are making support from the United Nations system. The report will progress in implementing a regular census and succeed in achieving high levels of birth and death registration on2015(http:/ 2 Report of the mmission,8-11March2016(http:/unstats etary-General. A/70/684. 15 January 2016. New York /unsd/statcom/47th-session/documents/2016-2-IAEG-SDGs-Rev1-Epdf, /0/684&Lang=E, accessed 9 April 2016) 3 Report of the Commission on its 47 2016.New 5 Tracking univer York(ny):UnitedNationsStatisticalCommission2016(http://sd.isd.org/events/47th- session-of-un-statistical-commission/, accessed 9 April 2016) 如H6m05 WORLD HEALTH STATISTS: 2016
2 WORLD HEALTH STATISTICS: 2016 coverage (UHC) underpins, and is key to, the achievement of all the other targets and the development of strong resilient health systems. Achieving the UHC target will require an integrated approach to the provision of health services that minimizes fragmentation and the competing agendas that characterized the MDG period. Comprehensive in scope, the health targets build upon a wide array of recent World Health Assembly (WHA) and Regional Committee resolutions, WHO and other global plans of action and current country health strategies.1 Tracking progress was vital in maintaining momentum towards the MDGs and in identifying areas that required greater efforts. It will be no less important in the context of the SDGs. The 2030 Agenda places considerable emphasis on the systematic follow-up and review of SDG-related implementation at country, regional and global levels. Health-related monitoring will occur in the context of overall assessment of progress towards the SDGs, and will need to be comprehensive, comprising the monitoring of: (a) overall progress towards SDG 3; (b) the UHC target; (c) other health targets; and (d) health-related targets in other goals – all of which will be undertaken with a strong emphasis on equity. In March 2016, the United Nations Statistical Commission discussed the proposed global indicator framework of its Inter-agency and Expert Group on SDG Indicators (IAEGSDGs).2 IAEG-SDGs members represent 28 national statistical offices, with United Nations agencies acting as observers and the United Nations Statistical Division as the secretariat. The United Nations Statistical Commission agreed “as a practical starting point” with the global indicator framework proposed by the IAEG-SDGs “subject to further technical refinement”.3 The indicator framework will be presented for adoption to the High-Level Political Forum (HLPF) for Sustainable Development, under the auspices of the United Nations Economic and Social Council in mid-2016.2 The indicator framework comprises 230 indicators, including several dozen requiring further development. The framework is focused on indicators for the 169 SDG targets, and does not include goal-level or thematic indicators that cut across goals to assess the overall achievements of the 2030 Agenda. A complex and intensive reporting, follow-up and review process is planned, and will include an annual SDG Progress Report by the United Nations Secretary-General with support from the United Nations system. The report will 1 Health in 2015: from MDGs to SDGs. Geneva: World Health Organization; 2015 (http:// www.who.int/gho/publications/mdgs-sdgs/en/, accessed 9 April 2016). 2 Report of the Inter-Agency and Expert Group on Sustainable Development Goal Indicators. E/CN.3/2016/2/Rev.1. 19 February 2016. Presented to the Forty-seventh session of the United Nations Statistical Commission, 8–11 March 2016 (http://unstats. un.org/unsd/statcom/47th-session/documents/2016-2-IAEG-SDGs-Rev1-E.pdf, accessed 18 April 2016). 3 Report of the Commission on its 47th session. Draft decisions. 11 March 2016. New York (NY): United Nations Statistical Commission; 2016 (http://sd.iisd.org/events/47thsession-of-un-statistical-commission/, accessed 9 April 2016). serve to inform the HLPF, which will also receive a Global Sustainable Development Report from the United Nations Department of Economic and Social Affairs. Follow-up and review will possibly focus on a small number of themes each year with the intention of covering all SDGs over a period of 4 years. Every 4 years, starting in 2019 and under the auspices of the United Nations General Assembly, the HLPF will review overall progress and provide high-level political guidance on the SDG agenda and its implementation.4 Review mechanisms will also be established at regional and national level, and are likely to be more active and relevant than was the case for the MDGs. This World Health Statistics report represents an initial effort to bring together available data on the SDG health and health-related indicators to provide an assessment of the situation in 2016 and to take stock of data gaps. Data are presented on the proposed indicators for health targets in goal 3 and selected health-related targets in other SDG targets, revealing the crucial linkages between health and the other SDGs. The two-page summaries in Annex A provide more detailed information on the epidemiological situation, set out what is needed to achieve the 2030 targets, and indicate what is currently known about the key aspects of equity and the extent of data gaps for each target. In addition, this report presents summary measures of health such as life expectancy to assess the situation and trends which can be used to monitor health goal-level progress. UHC is one of the health targets. As stated above, because it underpins the achievement of all other health targets under SDG 3, a separate section presents statistics on a UHC service-coverage index and on measures of financial protection using the WHO/World Bank UHC monitoring framework.5 Finally, as equity is central to the realization of the SDGs, special attention is given to describing the statistical situation disaggregated by key demographic, geographic and socioeconomic characteristics. The report does not address issues related to monitoring the global partnership that will be crucial in advancing the 2030 Agenda. Future monitoring will have to include the extent to which a revitalized global partnership is delivering the means of implementation. SDG 17 is specifically devoted to strengthening the means of implementation and a set of indicators has been drawn up to monitor progress in achieving that end. This also includes monitoring the extent to which data are disaggregated by relevant inequality dimensions and the extent to which countries are making progress in implementing a regular census and succeed in achieving high levels of birth and death registration. 4 Critical milestones towards coherent, efficient and inclusive follow-up and review at the global level. Report of the Secretary-General. A/70/684. 15 January 2016. New York (NY): United Nations; 2016 (http://www.un.org/ga/search/view_doc.asp?symbol=A%20 /70/684&Lang=E, accessed 9 April 2016). 5 Tracking universal health coverage: first global monitoring report. Geneva and Washington (DC): World Health Organization and World Bank; 2015. (http://www.who. int/healthinfo/ universal_health_coverage/report/2015/en/, accessed 9 April 2016)
14 IMPLICATIONS OF THE SDGS FOR HEALTH MONITORING A CHALLENGE AND AN OPPORTUNITY FOR ALL COUNTRIES Tracking progress towards the health-related MDGs led to 2.1 Scope- an agenda for all countries substantial developments in monitoring capacity. Notable advances included the focus on a small set of indicators The Sdgs are not solely focused on developing countries and targets, and the increased investment in health data Thus, while some targets and indicators may be more for priority health programmes. At the same time, major relevant for developing countries, SDG monitoring should efforts were directed at compiling statistics on progress in principle cover all. At present, there are multiple regular at regional and global levels. It can be argued that without global mechanisms for health monitoring and reporting, but the galvanizing influence of the mDgs on promoting most are focused on specific health topics(such as annual measurement and the development of monitoring systems reports on tuberculosis or malaria) or on a limited numbers the world would not be in a position to track progress of countries (for example regional WHO reports or the with the degree of confidence that is now possible. The Health at a Glance series of the Organisation for Economic MDG monitoring effort also brought key issues to the fore, Co-operation and Development-oECD) The WHo World encouraging political leaders in several countries to make Health Statistics series, supported by the web portal Globa public commitments to achieving specific targets in areas Health Observatory(GHO), is currently the only regular such as maternal and child mortality. Such commitments United Nations mechanism that presents comparable not only put pressure on governments to deliver, but also data on a large range of health topics from all countries. 2 provide a way for civil society parliaments and the media Because many countries still do not have adequate health to hold health providers to account nformation systems data availability and quality varies example, only 70 co The 2030 Agenda differs from the MDGs in several ways, currently provide WHo with regular data on mortality by with important implications for global, regional and country age, sex and cause of death which are required for more health monitoring. Key differences include the broader than a dozen SdG indicators there are also important data scope of the 2030 Agenda in terms of the health targets set, as well as the emphasis placed on equity the links 1 Health at a Glance provides the latest comparable data and trends on different aspects between health and other sectors, and the centrality of country monitoring and review. This section discusses the 2 The Global Health Observatory (GHO) is WHo's portal providing access to data and main differences and their implications for monitoring ysesformonitoringtheglobalhealthsituationSeehttp://www.who.int/ghovenv accessed 16 April 2016 MONITORING HEALTH FOR THE SDGs
MONITORING HEALTH FOR THE SDGs 3 2 Tracking progress towards the health-related MDGs led to substantial developments in monitoring capacity. Notable advances included the focus on a small set of indicators and targets, and the increased investment in health data for priority health programmes. At the same time, major efforts were directed at compiling statistics on progress at regional and global levels. It can be argued that without the galvanizing influence of the MDGs on promoting measurement and the development of monitoring systems the world would not be in a position to track progress with the degree of confidence that is now possible. The MDG monitoring effort also brought key issues to the fore, encouraging political leaders in several countries to make public commitments to achieving specific targets in areas such as maternal and child mortality. Such commitments not only put pressure on governments to deliver, but also provide a way for civil society, parliaments and the media to hold health providers to account. The 2030 Agenda differs from the MDGs in several ways, with important implications for global, regional and country health monitoring. Key differences include the broader scope of the 2030 Agenda in terms of the health targets set, as well as the emphasis placed on equity, the links between health and other sectors, and the centrality of country monitoring and review. This section discusses the main differences and their implications for monitoring. 2.1 Scope – an agenda for all countries The SDGs are not solely focused on developing countries. Thus, while some targets and indicators may be more relevant for developing countries, SDG monitoring should, in principle, cover all. At present, there are multiple regular global mechanisms for health monitoring and reporting, but most are focused on specific health topics (such as annual reports on tuberculosis or malaria) or on a limited numbers of countries (for example, regional WHO reports or the Health at a Glance series of the Organisation for Economic Co-operation and Development – OECD).1 The WHO World Health Statistics series, supported by the web portal Global Health Observatory (GHO), is currently the only regular United Nations mechanism that presents comparable data on a large range of health topics from all countries.2 Because many countries still do not have adequate health information systems data availability and quality varies greatly between countries. For example, only 70 countries currently provide WHO with regular data on mortality by age, sex and cause of death which are required for more than a dozen SDG indicators. There are also important data 1 Health at a Glance provides the latest comparable data and trends on different aspects of the performance of health systems in OECD countries. See: http://www.oecd.org/ health/health-systems/health-at-a-glance-19991312.htm, accessed 22 April 2016. 2 The Global Health Observatory (GHO) is WHO’s portal providing access to data and analyses for monitoring the global health situation. See: http://www.who.int/gho/en/, accessed 16 April 2016. IMPLICATIONS OF THE SDGs FOR HEALTH MONITORING – A CHALLENGE AND AN OPPORTUNITY FOR ALL COUNTRIES
gaps for indicators other than mortality This is a challenge Data disaggregation presents a major challenge for many for all countries, including high-income countries, and is a countries and for global and regional monitoring Household particular concern with regard to disaggregated data surveys are the primary source of disaggregated health data on demographic and socioeconomic characteristics and can be used to identify disadvantaged populations. However, 2.2 Contents-all major health areas are they often lack the sample sizes required to allow for the included computation of reliable subnational statistics beyond the provincial or regional level, or to measure health indicators The SDGs cover a much broader set of topics than in smaller disadvantaged or difficult-to-survey populations the MDGs, notably with regard to health. The SDG 3 such as migrants, mobile populations and minorities. Data targets cover virtually all major health topics, including from health facilities and administrative sources can be reproductive, maternal, newborn and child health, infectious used to fill the local information gap but the quality of diseases, NCDs, mental health, road traffic injuries, UHC, such data still requires considerable improvement in many environmental health consequences and health systems countries. In several situations special data collection efforts strengthening. In addition, many other SDGs include health- are required related targets and indicators such as targets for nutrition water,sanitation, air quality and violence, as well as for the key determinants of health such as education and poverty. 2.4 Multisectoral data- health-related risk factors and determinants In order to accommodate a much broader range of health and health-related issues, country, regional and global Because the SDgs address the full range of economic, monitoring systems will have to adapt This will mean, at environmental and social factors that underpin sustainable the very least, undertaking data collection in an integrated development, monitoring progress towards them requires a manner, and avoiding the fragmentation and duplication high degree of integrated analysis Health-related targets in of investment and effort that often characterized MDg- the SDGs must be included in health monitoring, including elated efforts. At the same time data analyses will need risk factors for health that are the primary domain of other to assimilate multiple areas of health and provide clearly sectors(for example water and sanitation, air quality articulated syntheses for diverse audiences. Progress and and nutrition). Determinants of health that have a major performance review processes will provide an opportunity indirect influence on health, such as income/wealth, to take a more holistic approach to the interpretation of education, gender, peace and security should also be results on a wide range of targets and indicators and to considered. because the health sector often does not have translate comprehensive analysis into effective action. primary responsibility for tracking these determinants, effective monitoring will depend upon more integrated Finally, closer collaboration between health and other and collaborative approaches. In addition, monitoring sectors will be required to ensure that health monitoring should aim to track multisectoral action. While this may be takes into account data on determinants and risk factors for measured through quantitative process indicators outside of health, and that other sectors give due attention to health the global SDG indicator framework, qualitative information statistics. Health stakeholders will need to work closely with is often required to obtain a clear picture of what is really the statistical community to enhance the quality of health happening monitoring, ensure strong inputs from other sectors and align with the overall SDg monitoring processes. 2.5 Country monitoring-data gaps and .3 Equity-the need for disaggregated data The 2030 Agenda puts considerable emphasis on ountry follow-up and review processes as the basis fo Much of the focus on the mdgs was based on aggregate accountability With so many global SDG indicators such nal and national achievements. going follow-up and review will inevitably be challenging for forward, and in order to reflect the SDGs emphasis on many countries, especially those facing major data gaps equitable development, there is a need for much greater Strengthening country health information systems should disaggregation of data, including statistics disaggregated therefore be a priority In future the overall data picture by sex, age, income/wealth, education, race, ethnicity, may improve as a result of innovative approaches based migratory status, disability and geographic location, or on information and communication technology and the by other characteristics, in order to identify and track trend towards"open data"-that is, the release of data by disadvantaged populations within countries. SDG Target government agencies, businesses, non-profit organizations 18 specifically calls for countries to increase the availability researchers and other private entities that can be easily of data disaggregated by all relevant inequality dimensions. accessed and used by all Open data is not only facilitating WORLD HEALTH STATISTS: 2016
4 WORLD HEALTH STATISTICS: 2016 gaps for indicators other than mortality. This is a challenge for all countries, including high-income countries, and is a particular concern with regard to disaggregated data. 2.2 Contents – all major health areas are included The SDGs cover a much broader set of topics than the MDGs, notably with regard to health. The SDG 3 targets cover virtually all major health topics, including reproductive, maternal, newborn and child health, infectious diseases, NCDs, mental health, road traffic injuries, UHC, environmental health consequences and health systems strengthening. In addition, many other SDGs include healthrelated targets and indicators such as targets for nutrition, water, sanitation, air quality and violence, as well as for the key determinants of health such as education and poverty. In order to accommodate a much broader range of health and health-related issues, country, regional and global monitoring systems will have to adapt. This will mean, at the very least, undertaking data collection in an integrated manner, and avoiding the fragmentation and duplication of investment and effort that often characterized MDGrelated efforts. At the same time, data analyses will need to assimilate multiple areas of health and provide clearly articulated syntheses for diverse audiences. Progress and performance review processes will provide an opportunity to take a more holistic approach to the interpretation of results on a wide range of targets and indicators, and to translate comprehensive analysis into effective action. Finally, closer collaboration between health and other sectors will be required to ensure that health monitoring takes into account data on determinants and risk factors for health, and that other sectors give due attention to health statistics. Health stakeholders will need to work closely with the statistical community to enhance the quality of health monitoring, ensure strong inputs from other sectors and align with the overall SDG monitoring processes. 2.3 Equity – the need for disaggregated data Much of the focus on the MDGs was based on aggregate global, regional and national achievements. Going forward, and in order to reflect the SDGs’ emphasis on equitable development, there is a need for much greater disaggregation of data, including statistics disaggregated by sex, age, income/wealth, education, race, ethnicity, migratory status, disability and geographic location, or by other characteristics, in order to identify and track disadvantaged populations within countries. SDG Target 17.18 specifically calls for countries to increase the availability of data disaggregated by all relevant inequality dimensions. Data disaggregation presents a major challenge for many countries and for global and regional monitoring. Household surveys are the primary source of disaggregated health data on demographic and socioeconomic characteristics and can be used to identify disadvantaged populations. However, they often lack the sample sizes required to allow for the computation of reliable subnational statistics beyond the provincial or regional level, or to measure health indicators in smaller disadvantaged or difficult-to-survey populations such as migrants, mobile populations and minorities. Data from health facilities and administrative sources can be used to fill the local information gap, but the quality of such data still requires considerable improvement in many countries. In several situations special data collection efforts are required. 2.4 Multisectoral data – health-related risk factors and determinants Because the SDGs address the full range of economic, environmental and social factors that underpin sustainable development, monitoring progress towards them requires a high degree of integrated analysis. Health-related targets in the SDGs must be included in health monitoring, including risk factors for health that are the primary domain of other sectors (for example, water and sanitation, air quality and nutrition). Determinants of health that have a major indirect influence on health, such as income/wealth, education, gender, peace and security, should also be considered. Because the health sector often does not have primary responsibility for tracking these determinants, effective monitoring will depend upon more integrated and collaborative approaches. In addition, monitoring should aim to track multisectoral action. While this may be measured through quantitative process indicators outside of the global SDG indicator framework, qualitative information is often required to obtain a clear picture of what is really happening. 2.5 Country monitoring – data gaps and capacity The 2030 Agenda puts considerable emphasis on country follow-up and review processes as the basis for accountability. With so many global SDG indicators such follow-up and review will inevitably be challenging for many countries, especially those facing major data gaps. Strengthening country health information systems should therefore be a priority. In future, the overall data picture may improve as a result of innovative approaches based on information and communication technology and the trend towards “open data” – that is, the release of data by government agencies, businesses, non-profit organizations, researchers and other private entities that can be easily accessed and used by all. Open data is not only facilitating
broader scrutiny, but also allowing for the use of different 2.6 Regional and global monitoring kinds of data mechanisms and estimates National statistical offices will lead the country SDg While global monitoring will continue to be vital to the monitoring processes. Enhanced collaboration between overall SDG monitoring effort, the 2030 Agenda envisages health and other sectors with statistical offices will be a greater role for regional monitoring and reporting vitally important in constructing a coherent narrative mechanisms. Most discussions on regional monitorin regarding national health status and trends. According to processes for the SDGs are still ongoing. Globally, the the proposals of the United Nations Statistical Commission, United Nations Secretary-General has been mandated to the global indicators will be the core of all other sets of produce an annual progress report on the SD gs to support indicators, based upon internationally agreed standards follow-up and review at the HLPf. the report is to be of collection, analysis and reporting In addition, Who based on data produced by national statistical systems and Member States will develop indicators(and targets for information collected at the regional level. It is expected the indicators) at regional, national and subnational levels, that the global reporting of progress on the 2030 Agenda according to national priorities and requirements, and will be based on global and regional aggregates of data on standardized in accordance with international guidelines. indicators as compiled by international agencies based on their respective existing mandates and/or expertise. United The need for global reporting has often led to the Nations agencies will continue to play a critical role in the overburdening of countries with reporting requirements validation of data and statistics produced by countries related to programme-specific monitoring and grant mechanisms. It is therefore essential that reporting be global and regional reviews cannot be conducted without focused on informing national review processes. The SDG comparable data for the indicators. Most health indicators agenda offers an opportunity to rationalize global reporting are well developed with good metadata and proven uirements In health, the global reference list of 100 methods of data collection, analysis and use. In particular, health indicators provides an example of an initial multi- the indicators inherited from the mdg era, and other agency effort to reduce the reporting burden on countries indicators used to measure progress within governing and improve the quality of what is reported. Such initiatives bodies in the United Nations system, are well developed should be accompanied by further harmonization and others are more difficult to quantify because of the scarcity alignment of international reporting requirements, and by of underlying data efforts to maximize the use of country mechanisms For the health targets, many existing reporting systems can be used Given the large data gaps, and the lack of timely data for to monitor individual targets many indicators, it is often necessary to use statistical models to obtain a picture of the global and regional Closer collaboration between health and statistical situation, including comparable statistics for use by constituencies in countries (and globally) is essential. countries. These estimates differ from country-reported Health investments can play a vital role in supporting the data which are often not adjusted or do not refer to the strengthening of country statistical capacity while statistical same year(s). Further efforts should be made to reconcile offices can do much to support the health sector, notably in data provided at the global level with the data published the area of high-quality data collection and analysis. Public by national statistical authorities and, where possible, to health and academic institutions also have a role to play, resolve or carefully explain any discrepancies. Improving working in collaboration with ministries of health and other the situation with regard to estimates will require major stakeholders. Recent global initiatives in this area include investments to support interaction between United the establishment of a Health Data Collaborative in which Nations agencies and countries, with a focus on capacity global health actors have joined forces with the aim of strengthening in developing countries. It is important to providing more effective and efficient support to countries bear in mind that better data and standardized analyses are in strengthening country health statistical capacity to the best way to minimize discrepancies between reported monitor progress towards the SDGs. statistics and estimates 1 Report of the Inter-Agency and Expert Group on Sustainable Development Goal tionsStatisticalCommission8-11March2016(http:/unstats in.org/unsd/statcom/47th-session/documents/2016-2-AEG-SDGs-Rev1-E-p accessed 18 April 2016). 2015 Global reference list of 100 core health indicators. Geneva: World ganization;2015(http://apps.whoint_/iris/bitstream/10665/173589/1/whoHis 4 HSI_2015.3 eng pdf?ua=l, accessed 9 April 2016). 3 The Health Data Collaborative is an informal, inclusive partnership of agencies, govemments, philanthropies, donors and academics. (See org/unsd/statcom/47th-session/documents/2016-2-lAEG-SDGs-Rev1-Epdf ealthdatacollaborative. org/, accessed 9 May 2016) MONITORING HEALTH FOR THE SDGs
MONITORING HEALTH FOR THE SDGs 5 broader scrutiny, but also allowing for the use of different kinds of data. National statistical offices will lead the country SDG monitoring processes. Enhanced collaboration between health and other sectors with statistical offices will be vitally important in constructing a coherent narrative regarding national health status and trends. According to the proposals of the United Nations Statistical Commission, the global indicators will be the core of all other sets of indicators, based upon internationally agreed standards of collection, analysis and reporting.1 In addition, WHO Member States will develop indicators (and targets for the indicators) at regional, national and subnational levels, according to national priorities and requirements, and standardized in accordance with international guidelines. The need for global reporting has often led to the overburdening of countries with reporting requirements related to programme-specific monitoring and grant mechanisms. It is therefore essential that reporting be focused on informing national review processes. The SDG agenda offers an opportunity to rationalize global reporting requirements. In health, the global reference list of 100 health indicators provides an example of an initial multiagency effort to reduce the reporting burden on countries and improve the quality of what is reported.2 Such initiatives should be accompanied by further harmonization and alignment of international reporting requirements, and by efforts to maximize the use of country mechanisms. For the health targets, many existing reporting systems can be used to monitor individual targets. Closer collaboration between health and statistical constituencies in countries (and globally) is essential. Health investments can play a vital role in supporting the strengthening of country statistical capacity, while statistical offices can do much to support the health sector, notably in the area of high-quality data collection and analysis. Public health and academic institutions also have a role to play, working in collaboration with ministries of health and other stakeholders. Recent global initiatives in this area include the establishment of a Health Data Collaborative in which global health actors have joined forces with the aim of providing more effective and efficient support to countries in strengthening country health statistical capacity to monitor progress towards the SDGs.3 1 Report of the Inter-Agency and Expert Group on Sustainable Development Goal Indicators. E/CN.3/2016/2/Rev.1. 19 February 2016. Presented to the Forty-seventh session of the United Nations Statistical Commission, 8–11 March 2016 (http://unstats. un.org/unsd/statcom/47th-session/documents/2016-2-IAEG-SDGs-Rev1-E.pdf, accessed 18 April 2016). 2 2015 Global reference list of 100 core health indicators. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/173589/1/WHO_HIS_ HSI_2015.3_eng.pdf?ua=1, accessed 9 April 2016). 3 The Health Data Collaborative is an informal, inclusive partnership of international agencies, governments, philanthropies, donors and academics. (See: http://www. healthdatacollaborative.org/, accessed 9 May 2016.) 2.6 Regional and global monitoring – mechanisms and estimates While global monitoring will continue to be vital to the overall SDG monitoring effort, the 2030 Agenda envisages a greater role for regional monitoring and reporting mechanisms. Most discussions on regional monitoring processes for the SDGs are still ongoing. Globally, the United Nations Secretary-General has been mandated to produce an annual progress report on the SDGs to support follow-up and review at the HLPF. The report is to be based on data produced by national statistical systems and information collected at the regional level. It is expected that the global reporting of progress on the 2030 Agenda will be based on global and regional aggregates of data on indicators as compiled by international agencies based on their respective existing mandates and/or expertise.4 United Nations agencies will continue to play a critical role in the validation of data and statistics produced by countries. Global and regional reviews cannot be conducted without comparable data for the indicators. Most health indicators are well developed with good metadata and proven methods of data collection, analysis and use. In particular, the indicators inherited from the MDG era, and other indicators used to measure progress within governing bodies in the United Nations system, are well developed. Others are more difficult to quantify because of the scarcity of underlying data. Given the large data gaps, and the lack of timely data for many indicators, it is often necessary to use statistical models to obtain a picture of the global and regional situation, including comparable statistics for use by countries. These estimates differ from country-reported data which are often not adjusted or do not refer to the same year(s). Further efforts should be made to reconcile data provided at the global level with the data published by national statistical authorities and, where possible, to resolve or carefully explain any discrepancies.4 Improving the situation with regard to estimates will require major investments to support interaction between United Nations agencies and countries, with a focus on capacity strengthening in developing countries. It is important to bear in mind that better data and standardized analyses are the best way to minimize discrepancies between reported statistics and estimates. 4 Report of the Inter-Agency and Expert Group on Sustainable Development Goal Indicators. E/CN.3/2016/2/Rev.1. 19 February 2016. Presented to the Forty-seventh session of the United Nations Statistical Commission, 8–11 March 2016 (http://unstats. un.org/unsd/statcom/47th-session/documents/2016-2-IAEG-SDGs-Rev1-E.pdf, accessed 18 April 2016)
2.7 Review g data for improved society and others of national government performance implementation It is likely therefore that the SDgs, in addition to being the subject of country-level monitoring of specific health Countries will develop their own review processes which targets, will be used to initiate and /or drive debate regarding should be based on objective assessments that include a country s position on health, or on factors that impact quality statistics as well as complementary qualitative health. Regional and global reviews can also be used information that captures the complexity of the agenda and to enhance learning and improve implementation. Fo may offer insights into why progress is or is not being made. example, regional mechanisms such as WHo Regional SDG progress assessments are likely to be comprehensive Committee meetings could conduct voluntary peer reviews and complex, and thus have the potential to become very of country progress, much along the lines of the proposed unwieldy. One of the biggest challenges faced will be functioning of the HLPf keeping the focus on the "big picture "of the SDGs, rather than the details related to individual targets. The health Furthermore, regional mechanisms could provide sector can contribute to the overall SDg review process by syntheses to be used in a global review at the WHA. In formalizing its own review of progress and performance in turn, the Wha could conduct regular evidence-based health and health-related areas, and feeding a synthesis of reviews of global progress, taking into account regional uch assessments into overall reviews syntheses and discussing the implementation and financing implications. The WhA could also play a role One of the many benefits derived from augmented in providing inputs into the overall global follow-up and monitoring during the mdg era was greater scrutiny by civil review process for the SDGs WORLD HEALTH STATISTS: 2016
6 WORLD HEALTH STATISTICS: 2016 2.7 Review – using data for improved implementation Countries will develop their own review processes which should be based on objective assessments that include quality statistics as well as complementary qualitative information that captures the complexity of the agenda and may offer insights into why progress is or is not being made. SDG progress assessments are likely to be comprehensive and complex, and thus have the potential to become very unwieldy. One of the biggest challenges faced will be keeping the focus on the “big picture” of the SDGs, rather than the details related to individual targets. The health sector can contribute to the overall SDG review process by formalizing its own review of progress and performance in health and health-related areas, and feeding a synthesis of such assessments into overall reviews. One of the many benefits derived from augmented monitoring during the MDG era was greater scrutiny by civil society and others of national government performance. It is likely therefore that the SDGs, in addition to being the subject of country-level monitoring of specific health targets, will be used to initiate and/or drive debate regarding a country’s position on health, or on factors that impact health. Regional and global reviews can also be used to enhance learning and improve implementation. For example, regional mechanisms such as WHO Regional Committee meetings could conduct voluntary peer reviews of country progress, much along the lines of the proposed functioning of the HLPF. Furthermore, regional mechanisms could provide syntheses to be used in a global review at the WHA. In turn, the WHA could conduct regular evidence-based reviews of global progress, taking into account regional syntheses and discussing the implementation and financing implications. The WHA could also play a role in providing inputs into the overall global follow-up and review process for the SDGs