This is a guest blog by Greg Paton, Policy Manager, NCD Alliance
This past December representatives from various UN agencies met in New York to discuss UN wide collaboration on Non-communicable Diseases (NCDs). The release of the meeting’s report last week drew little attention from the global health world. This is understandable given the gauntlet of NCD themed ministerial meetings, stakeholder dialogues and civil society hearings in 2011 which culminated with the High-Level Meeting (HLM) on NCDs and nearly 50 side events in New York last September.
The World Health Organization (WHO), tasked by member states to coordinate the UN wide response to NCDs, has large expectations to live up to. The responsibility of implementing the long list of actions set out in the HLM Political Declaration is made no easier by the fact that barely a handful of member states have pledged additional resources to strengthen WHOs NCD work. The organizations well publicized budget woes have forced the NCD Department to make difficult decisions amongst a backdrop of shrinking resources and the loss of key staff positions. Richard Horton, Editor of the Lancet, recently gave voice to the concerns whispered by many: ‘It will consult member states. Discussion papers will be written. Options Documents will be drafted…Unless the [WHO] Director-General makes NCDs a signature initiative; there is little likelihood that gains made at the UNGA will be sustained, let alone advanced”.
Declining budgets are not the only reason for concern. One of the biggest shortcomings in many countries response to NCDs has been the difficulty in getting non-health ministries to step up their efforts (and resources) for NCDs. The early days of the HIV/AIDS epidemic faced similar challenges – according to a UNAIDS publication detailing the history of the AIDS epidemic, UN staff in the early 1990s “tried hard to take a multisectoral stance but, as part of WHO, they inevitably had to work with ministries of health that were wary that multisectoralism would take power and money away from them. The concept of multisectoralism was accepted by countries but rarely put into operation.” The HIV/AIDS community has made great strides since then, driven by the establishment of UNAIDS to lead the international response and the Three Ones Principle (one HIV/AIDS plan, one coordinating board and one M&E system) to lead the national response. Major progress in the fight against NCDs will require replicating the success of the AIDS community in bringing a diverse group of partners to the table, including UN agencies, government ministries, civil society, people living with NCDs and the private sector.
This is why December’s meeting of UN agencies, if properly followed up, will come to be regarded as a key turning point in the global fight against NCDs. It could set off a chain of actions second in importance only to the HLM itself. It was a similar process initiated by UN agencies in 1989 that paved the way for an effective UN wide response to the HIV/AIDS epidemic. According to the UNAIDS publication, this process was a key factor in greater cooperation and multisectoralism on HIV/AIDS at national level.
It is therefore critical that both member states and civil society have a strong stake in the follow-up to this meeting and that UN agencies show leadership in turning the promises made on paper into action. The agencies that did not attend should be reminded of their commitment to act, as set out in the HLM Political Declaration. Many of the meetings outputs could be of major significance to the global NCD response. Highlights include:
- Integration of NCDs into National UN Frameworks: UN agencies committed to a joint initiative headed by the UNDP and WHO to formalize integration of NCDs into UN Development Assistance Frameworks (UNDAF). This would start with the 20+ countries scheduled to launch new frameworks in 2012-2013. These frameworks serve as national roadmaps for the work of UN country offices and are developed by recipient governments based on national priorities. They are often backed by major resources – in November the UN announced funding of $375.7 million for the Philippines UNDAF. This would be supported by training and additional technical assistance for UN country teams to strengthen their capacity to implement NCD programmes.
- Acknowledgement of the need for a UN wide roadmap for NCDs: Many organizations, including the NCD Alliance, agree that a new UN agency on NCDs would create further disease silos and is not the answer to addressing the NCD crises. If done correctly, developed in consultation with key stakeholders, and backed with adequate resources, such a roadmap could have a major impact and provide a framework for scaled up responses at country level. It could also ensure that NCDs are included in the post 2015 MDG framework.
- Increased integration of NCDs into UN agency programmes: All of the agencies in attendance committed to exploring the development of joint NCD projects and each agency shared a list of possible project areas. This has major resource implications if UN agencies integrate NCDs into their planning processes and programs. The UNDP alone has an annual budget of over $6 billion dollars, as does the World Food Programme. The core UN budget, which doesn’t factor in most of the agencies who attended the meeting, is over $13 billion dollars annually. Even if no new money is pledged, mainstreaming NCD interventions into the projects those funds currently support could have a major impact.
- A network to coordinate the UN response to NCDs: Participants agreed to establish an informal network to coordinate NCD activities among UN agencies. Several years ago, NCDs were rarely recognized as a development issue in mainstream global health circles. Many donor organizations still mistakenly believe that the causes and impact of NCDs have little bearing on poverty. This informal network is therefore an important first step in changing this. The WHO was requested to send a letter to all UN agencies at the meeting outlining details for this collaborative arrangement. Participants also agreed that following an initial period, ‘it may be opportune to formalize arrangements in the establishment of an UN Ad‐Hoc Coordination Mechanism on NCDs’. This is the first time UN agencies have suggested the possibility of a formal cooperation mechanism on NCDs. Civil society and NCD advocates should monitor this closely and ensure that such a mechanism would have inclusive representation.
By bringing together UN agencies to help define the post HLM landscape, WHO has shown strategic leadership and initiated an important first step in what has the potential to be a game changer in the future fight against NCDs. Whether the potential will be reached is a question of debate, but if the AIDS experience is anything to go by, a UN wide plan of action with buy-in and ownership from key UN agencies will be an essential factor.