The GPW: Making the Impossible Work of the World Health Organization Possible

This post was written by Elizabeth Montgomery Collins, MD, MPH, DTM, Global Health Council individual member and delegate to the 71st World Health Assembly in Geneva, Switzerland. 

In 2000 the United Nations (UN) marked a new era in global development policy by adopting eight highly ambitious Millennium Development Goals (MDGs) to be achieved by 2015 to address the world’s most basic development needs, ranging from fighting extreme poverty to fighting HIV/AIDS.  Building on the MDGs’ success, the UN subsequently extended its global development agenda by adopting the Sustainable Development Goals (SDGs), which represent an even broader and more audacious attempt to eliminate poverty, hunger, and disease from the world.  The SDGs are so ambitious, in fact, that many of the 17 goals appear to be virtually impossible to attain.

So, how will the world accomplish these very specific levels of achievement by 2030?

As with the MDGs, achieving the SDGs will require a combination of local, regional, and global action.  Member States are expected to continue the initiatives that enabled them to achieve many of the MDGs, and the UN, through its various subsidiary organizations, will no doubt continue to push for advancement on all fronts; but the question remains:  How, specifically, will the World Health Organization (WHO), as the official UN body charged with overseeing international health policy and progress, tackle those objectives relating to health on the SDG list—in particular, SDG 3, which seeks to “ensure healthy lives and promote well-being for all at all ages”?

WHO Director-General, Dr. Tedros Ghebreyesus (Dr. Tedros), proposes to make this seemingly impossible goal a reality by implementing the step-by-step plan set forth in the 13th General Programme of Work (GPW 13) for 2019–2023.  In GPW 13, Dr. Tedros seeks to transform the vague exhortations of SDG 3 into a concrete, measurable plan of action.

And, he fast-tracked the plan for approval.

In January 2018, after input from UN Member States, other UN bodies, WHO staff, non-State actors, and an Expert Reference Group, GPW 13 was presented as a draft to the WHO Executive Board (EB) at WHO headquarters in Geneva, Switzerland.  With some revisions, the EB adopted GPW 13 for consideration as resolution EB142.R2.  Following discussions of the 46-page draft document A71/4 as provisional agenda item 11.1 in May 2018, the Seventy-first World Health Assembly (WHA71) delegates formally approved GPW 13, one full year in advance of its proposed implementation date.

Many countries made strong statements in support of GPW 13 during the plenary session of WHA71, including Singapore, Jamaica, Poland, and the Republic of Korea, with Denmark stating that “we want these ambitions to be translated into implementable policies.”

In accepting GPW 13 as resolution WHA71.1, the Member States also requested that the Director-General use GPW 13 to form budgets, keep Member States informed of progress, provide contextual guidance and support regarding the plan to regional and country offices, and apprise WHA75 attendees in 2022 of any intention to extend the plan an additional two years, to 2025, in order to align with the UN’s larger strategic plan cycle.

GPW 13 is a plan of work not just for the Secretariat of the WHO, but also for each UN Member State, as well as the various other stakeholders that seek to achieve the SDGs’ objectives.  In fact, the document makes it clear that it is intentionally drafted in almost impossibly ambitious terms because, as Dr. Tedros declared, “it must be.”  And because no single entity can accomplish the goals on its own, GPW 13 by design invites assistance from the private sector and other strategic partners.

This roadmap, subtitled “Promote health, keep the world safe, serve the vulnerable” lays out three strategic priorities that will lead us to the overarching goal of healthy lives and well-being for all:  universal health coverage (UHC), health emergencies, and healthier populations.

Achieving Universal Health Coverage

The primary objective for this priority is to have 1 billion more people benefitting from universal health coverage.  This number was calculated to achieve SDG target 3.8 of UHC for all by 2030; to do that, at least 1 billion more people will need to have access to essential health services in each five-year period between 2015 and 2030.  The focus is on infectious diseases, noncommunicable diseases, and basic provision of reproductive, maternal, newborn and child healthcare.  Another central aim of the plan is to ensure that out-of-pocket healthcare expenses do not cause catastrophic financial hardship or increase poverty among families, households, and countries.  In order for coverage to be truly universal, WHO will particularly emphasize healthcare access for women and children, and people who have disabilities or difficulty accessing care due to poverty, stigmatization, location, or other challenges.  It is estimated that the investment necessary to create an educated workforce to achieve UHC will account for 50% of the WHO’s total budget for SDG 3.

Addressing Health Emergencies

The goal is to better protect 1 billion more people from health emergencies.  The WHO has committed to a new vector control strategy, cooperated with the Coalition for Epidemic Preparedness Innovations (CEPI), and begun work with Member States to form a Health Reserve Force prepared to immediately respond to health-related emergencies.  The architects of GPW 13 recognize that the methods ultimately adopted for measuring readiness and improvements in rapid response mechanisms will need to be developed in consultation with its myriad partners, and that people who are living in conflict zones or who have been displaced will be among the most challenging groups to protect.

Promoting Healthier Populations

To ensure that 1 billion more people enjoy better health and well-being, WHO is pursuing its agenda across 5 tracks:  increasing human capital throughout the entire lifespan, preventing and fighting non-communicable diseases (NCDs) including mental health conditions, accelerating elimination of the most impactful infectious diseases, knocking out antimicrobial resistance, and crushing climate change effects on health.  Perhaps the most difficult goal to measure, the assessment of this priority will be a composite estimate derived from adding multiple SDG life-improving targets, and scoring “life improving interventions” vs. “no intervention” scenarios, to see how much progress is made when improvements are attempted.  In particular, the WHO will seek to discourage unhealthy behaviors and marketing (particularly towards children) involving tobacco, harmful alcohol use, unhealthy diets, and inactivity.

Dr. Anders Nordström, Ambassador of Global Health for the Swedish Ministry of Foreign Affairs and former WHO Acting Director-General, pointed out at the Panel Discussion of the 13th General Programme of Work hosted by The Graduate Institute of International & Development Studies, that the factors which differentiate GPW 13 from the dozen that came before it, are that “now we have the SDGs” and “in this GPW…we have a goal, a number:  3 billion— and this pushes us to measure”.  In other words, GPW 13 establishes specific objectives that will make measurement and incremental progress achievable, and serve as stepping stones toward achieving the ultimate goal of SDG 3, one billion people at a time.

The WHO seeks to accomplish all this by making strategic shifts in leadership, driving public health impact in every country, and focusing “public health goods” (i.e. norms, standards, conventions, regulatory recommendations, assessment reports, open databases, etc.) on impact.

The WHO will also make organization shifts, reshaping its operating model to drive, measure, and manage impact at the country, regional, and global levels; transforming partnerships, communications, and financing; strengthening systems, health information systems, and processes; and changing the work culture.  Collectively these will entail incidental improvements such as paying interns a wage for the first time, paving the way for more representation by developing countries, increasing the number of women in leadership roles, and creating a more transparent, collaborative, and seamless WHO, unified and acting as one with the UN.

As Dr. Tedros stated in his speech at the Opening of the Seventy-first World Health Assembly “our new GPW or strategic plan is not about reinventing the wheel. It’s about making a bigger impact than we already make.”

Although the plan’s efficacy will be difficult to implement and measure, the WHO intends to focus on outcomes and impact.  One interesting way they might check progress towards their overall mission is to measure healthy life expectancy around the globe.

Because all components of the plan interact with and build upon each other, I believe the GPW has the potential to create exponential improvements in healthcare outcomes as each goal advances, culminating in healthier people living in a safer world, five to seven years from now.  That in fact may be the primary benefit of striving for the impossible:  even if we fall short of some of our marks, we can likely still make remarkable progress.

I commend Dr. Tedros’ leadership on establishing GPW 13 and encouraging states to “walk the talk” on these objectives.  The WHO must, through inspirational leadership, motivate individuals, families, communities, nations, and regions to address all of these items at the earliest junctures possible, for individuals at the earliest age possible, while aiming for the highest quality of healthcare and health possible.  One of the most important steps in making the SDGs a reality will be the creation of higher education centers to provide the necessary training of healthcare workers worldwide.  Partnering to build, distribute, and appropriately pay a capable health workforce will contribute substantially to the triple-billion goals.  If the WHO can enlist the help of academia for expertise, the private sector for resources, and civil society for input, including from children and adolescents, the world’s citizens may indeed enjoy healthier and happier lives, and reap the physical and emotional benefits of a health-focused world built from the GPW 13 blueprint.

When Dr. Ilona Kickbusch, Director of the Global Health Centre of The Graduate Institute-Geneva and moderator of the Introduction to the WHA: a briefing for delegates held just before the WHA 71 kicked off, asked about society’s current mindset in relation to the WHO’s master plan, Loyce Pace, President and Executive Director of the Global Health Council, answered emphatically that “[t]he shift from healthcare to health is something that the public can understand.  Civil society is ready for an emphasis on health…and the public wants to access more health.”

Adding, “We are ready.”

In his WHA71 Closing Speech, Dr. Tedros laid out the challenge that ultimately stands before us: “Now it’s time to implement it.  We have no time to lose.  Five years is no time.”