A critical civil society perspective on the development, potential impact and implementation of the ‘Global Action Plan for Healthy Lives and Well-being for All’

On 24 September 2019, at a side event to the United Nations High-Level Meeting on Universal Health Coverage (UHC), twelve multilateral health, development and humanitarian agencies launched the ‘“Global Action Plan for Healthy Lives and Well-being for All” (GAP) to better support countries to accelerate progress towards the health-related Sustainable Development Goals through strengthened collaboration and coordination.

Since then, there has been not much news about the GAP and its implementation. In times of COVID-19, when the challenges of international health cooperation are multiplied by the pandemic, it is time to look at the GAP again. Can it make a difference?

The ‘Watch the GAP’ civil society task group is part of the “Kampala Initiative” to advance cooperation and solidarity for health equity within and beyond aid. The group recognizes the need to pay close attention to the implementation of the GAP and developed this analytical paper to inspire civil society to advocate for more space for engagement with the GAP and to closely follow its role in strengthening coordination among signatory agencies at global and country level.

Stronger Collaboration, Better Health? Watch the GAP!
Series of webinars on 19/26 October

One year after the GAP’s launch, at a webinar hosted by the Kampala Initiative, we engage, together with civil society partners, into a more in-depth discussion on the GAP and its implementation so far, together with key stakeholders, and also referring to a GAP progress report published on 14 September. See the announcement of our series of webinars on the webinars page of the Kampala Initiative.

“Watch the GAP” analytical paper, July 2020

With the paper “Watch the GAP! A critical civil society perspective on the development, potential impact and implementation of the ‘Global Action Plan for Healthy Lives and Well- being for All’”, the task group intends to draw the interest of a broader civil society audience to the Global Action Plan and to start a conversation about if the GAP has the potential to make a difference in the work of the involved agencies and, if yes, if it will be for the better or worse.

In our paper, we review how this global plan fits with national health policies and ownership, and global health governance. We provide some reflections on the GAP and civil society and subsequently, we look at the GAP as a normative instrument and compare it with the track record of some of the GAP’s signatory agencies. We ask whether the GAP will make any difference to the existing power imbalance and determinants of health and, if so, if it is for better or worse. Finally, we link the GAP to the current COVID-19 pandemic which has proved a very relevant case and opportunity for global health actors to align around a common goal.

Our conclusion is as little surprising as the GAP itself: it’s all in the doing. And yes, our initial analysis as presented in this paper, underlines our assessment that the implementation of the GAP needs – and deserves – to be critically watched by civil society. In this sense, this paper shall be a starting point for ‘Watching the GAP’.

Background and references: Watch the GAP!

The Global Action Plan (GAP)

On 24 September 2019, at a side event to the UN High-Level Meeting on Universal Health Coverage, 12 multilateral health, development and humanitarian agencies launched a joint plan “to better support countries over the next 10 years to accelerate progress towards the health-related Sustainable Development Goals (SDGs).”

Developed over 18 months, the “Global Action Plan for Healthy Lives and Well-being for All” (GAP) outlines how these agencies will “collaborate to be more efficient and provide more streamlined support to countries to deliver universal health coverage and achieve the health-related SDG targets.”

Under the GAP, the 12 agencies make four specific, core commitments:

  1. To engage with countries better to identify priorities and plan and implement together;
  2. To accelerate progress in countries through joint action under specific accelerator themes and on gender equality and the delivery of global public goods;
  3. To align in support of countries by harmonizing operational and financial strategies, policies and approaches; and
  4. To account, by reviewing progress and learning together to enhance shared accountability.

The seven “accelerator themes” in the Global Action Plan are:

  1. Primary health care
  2. Sustainable financing for health
  3. Community and civil society engagement
  4. Determinants of health
  5. Innovative programming in fragile and vulnerable settings and for disease outbreak responses
  6. Research and development, innovation and access
  7. Data and digital health

The accelerator themes “represent catalytic opportunities for the signatory agencies to collectively better leverage existing resources, expertise, reach and capacities in areas that are common challenges in many countries and cut across the agencies’ mandates.”

GAP signatories and governance

The 12 signatory agencies to the GAP are: Gavi, The GFF, the Global Fund, UNAIDS, UNDP, UNFPA, UNICEF, UNITAID, UN Women, World Bank Group, WFP and WHO. The GAP was signed by the heads of these organizations.

Every organization has nominated a “Sherpa” as key representative in the GAP process. The names of these Sherpas are not publicly available, but can be requested at the GAP Secretariat.

At a national level, “consistent with the principle of national ownership, countries will coordinate the agencies’ joint work at country level and ensure that the work takes into account the country context and existing coordination mechanisms and that the work is focused on agreed actions.”

At the global level, the work of the agencies’ Sherpa group is coordinated by the Global Action Plan Secretariat, which is hosted by WHO.

Global-level work under specific accelerator themes may be coordinated by one or more of the signatory agencies acting as accelerator theme co-leads.

During the making of the GAP, a “Civil Society Advisory Group” (CSAG) was set up and hosted within the UHC2030 Civil Society Engagement Mechanism (CSEM) and acted as an entry point for interested civil society organizations to the GAP process. Currently the CSAG is reconsidering its role and mandate.

Why to watch the GAP? Starting points

During the making of the GAP (2018-19), civil society organizations criticized shortcomings of the process, in particular related to transparency and representation. After the launch of the GAP, there has been no public analysis of the GAP and its implications.

At the civil society workshop on “How to advance cooperation and solidarity within and beyond aid” that took place in Kampala, on 15-16 November 2019 to launch the Kampala Initiative, the “GAP case” was dealt with by the thematic working group on “Aid supporting or distorting national Health Policies, Systems and Processes”.

The case was introduced to the group as follows: “The GAP has the potential to further strengthen the power of the big actors and distort national processes, structures and policies. The development of the GAP also shows the challenge of representation of civil society in global processes and the divergence of positions and interests within civil society.”

In its assessment of the case, the group agreed that various aspects of the GAP, its making and implementation deserve civil society attention:

At a global level

  • The process of the development of the GAP as an example of global health governance (various civil society comments available; process already well documented)
  • The product/document itself, its narrative and ambitions, as a practical demonstration of power imbalances and power dynamics in the field of aid.
  • Governance issues of GAP implementation (roles and responsibilities, transparency and accountability, timelines, etc.)
  • GAP and global health governance, e.g. where is the added value of GAP in the global processes especially in inter- and intra-coordination of the intergovernmental agencies?
  • Does the GAP provide entry points for mainstreaming questionable policies by some of the engaged agencies (e.g. privatization, Public Private Partnerships?) And/or can the GAP be referred to as as a normative instrument to improve “aid effectiveness”? Best practices contributing to health equity, mutual learning?
  • Engagement of civil society institutions (CSAG?) and related issues of governance and power imbalance within civil society
  • Is it a duplication of the existing global health strategies, ie the SDG3 or rather a tandem that support the achievement of the agenda by 2030?

At a national level

  • Country ownership as lip service? Or how is it implemented?
  • Accountability?
  • (How) is the GAP integrated in existing mechanisms?
  • How can aid systems through GAP align with the existing plans, processes, monitoring and reporting structures of the aid recipient countries without creating parallel donor systems?
  • Does the GAP change the power balance dynamics within the agencies and between the agencies and government/civil society
  • Can the GAP and the related commitments of the agencies be used for addressing shortcomings of a signatory agency?
  • GAP and NGOs, civil society organizations and communities: How is civil society conceptualized in the GAP? Does the GAP lead to a further “NGOization” of civil society? Who benefits? Who is at the table? Who is heard?
  • Does the GAP rather support or disturb national political processes of negotiating health policies between the Government and civil society

“Watch the GAP” Task Group

At the civil society workshop in Kampala, the working group dealing with the GAP case concluded to launch, as part of the Kampala Initiative and for an initial period of two years (2020-21), a “Watch the GAP” Task Group.

Agreed tasks

  • Critically analyse the “Global Action Plan for Healthy Lives and Well-Being for all” and follow its implementation and its political and practical implications from a civil society perspective, allowing debate and dissent.
  • Inform civil society and an interested audience about the GAP (webinars, publications).
  • Provide a platform for sharing and strategizing among civil society institutions following the GAP at national level (in various countries) and global level.
  • To achieve these tasks: Interact with GAP representatives at all levels without claiming to “represent civil society”.

Agreed initial set of activities / expected results

  • Watch the GAP” task group is set up and launched
    > in the making; new members are welcome
  • Key target groups are informed about “Watch the GAP”, leading into interaction
    > Interaction has started; webinar on 8 September 2020
  • A GAP analytical paper is prepared and published
    > GAP paper July 2020
  • GAP implementation is watched and commented at national (pilot) and global level
    > ongoing

Task group governance and tools

  • “Watch the GAP” is a task group set up within the overall structure of the Kampala Initiative (as a formal KI working group), with a small core team coordinating its activities, facilitating group work, providing an entry point for newcomers, informally representing the team towards external institutions and reporting on its activities to the task group members and a broader audience.
  • Interested civil society colleagues (institutions and individuals) are welcome to join the task group if they endorse the group’s tasks as outlined above and commit to engage actively in the group’s work (to do so, please submit an expression of interest to the task group coordinators.
  • A list of task group members will be administered by the core team.
  • All publications related to the task group shall either be based on a broader drafting and endorsement process and published with the list of endorsing organizations/individuals or published by individual task group members in their name only and, if adequate, referring to their membership in the group.

The “Watch the GAP”  task group of the Kampala Initiative is currently (2022) not active.

Contacts

  • Myria Koutsoumpa, Wemos, The Netherlands
    (Coordinator: E-mail)
  • Thomas Schwarz, MMI Network, Switzerland
    (Geneva contact: E-mail)
aid beyond aid Health Cooperation Kampala Initiative