Concept and Methodologies in estimation and forecasting of Triple Billion targets and improving the WHO Results Framework

Overview

Over the past six years, WHO has carefully established, and WHO Governing Bodies have approved a transparent, and rigorous approach to track progress in improving population health at country, regional, and global levels. The WHO Results Framework and the Triple Billion targets have ushered in a new era of accountability for progress and equity at WHO. These targets:

• Reflect the Constitution of WHO and the United Nations Sustainable Development Goals (SDGs) and make these commitments actionable and measurable;
• Were developed and refined through extensive expert consultation, and were fully approved by the Executive Board and World Health Assembly;
• Enable tracking of progress according to country priorities and address the importance of improvement in all countries regardless of population size, population health situation, and levels of development;
• Facilitate a focus on equity, with disaggregation by gender, age, and location.

The Triple Billion approach:

• Facilitates advocacy for ambitious improvements in global health;
• Emphasizes a clear country focus and triggers action for measurable impacts;
• Highlights data gaps;
• Measures health improvement and increases accountability.

The Triple Billions are designed to better monitor and manage, and to galvanize the attention of the world in a clear, and understandable way that motivates change. They are based on 46 indicators that emanate from the SDGs and World Health Assembly (WHA) Resolutions and reflect the approved priorities of Member States. The methods chosen for monitoring progress in achieving the Triple Billion targets have undergone extensive review and consultations with experts, regions, and countries. In 2017, the Director General empaneled an Expert Reference Group (ERG) and Task Force to rigorously assess means of tracking progress on each of the billions, resulting in an in-depth methodological approach to track GPW 13, published as the Methods for impact measurement. Reports of ERG can be accessed here and here.

The continuity between GPW13 and GPW 14 is essential and critical. This will require adherence to five important criteria: (a) Principle: make clear WHO’s commitment to achieving measurable impact in countries; (b) Context: consider the challenges posed by the COVID-19 pandemic and stalling progress in global health; (c) Strategy, objectives and approaches: take specific actions to steer the world back on track and shape the future we desire; (d) Outputs: define how WHO, as the Secretariat, will monitor its contributions and outputs; and (e) Outcomes: recalibrate the triple billions to improve population health outcomes. As with all frameworks, further improvements are possible and necessary. Three areas of improvement are particularly important:

1. Bridging the gaps in data and improving the accuracy and timeliness of data at the country level;
2. Aligning the results framework with the delivery for impact approach, increasing partnerships with countries, and addressing health problems that have the highest potential for improvement;
3. Refining measurement methods based on ongoing feedback from Member States, experience in implementation, and expert review.

To optimize the WHO Results Framework, the Secretariat proposes to take the following steps on impact and output measurement:

Impact Measurement

1. Healthy Life Expectancy (HALE) remains unchanged as the overarching measure of improvement in mortality, morbidity, and the impacts from associated risk factors, quantifying expected years of healthy life for populations.
2. The Triple Billion targets, to be achieved by 2025 (with GPW13 extension) and by 2028 (GPW 14) and 2030 (end of SDGs), will be amended from two aspects:
   1. Recalibrate or refresh the Triple Billion targets based on forecasting and scenario specific assessment of outcome indicators at the country level.
      • X billion more people will enjoy better health and well-being.
      • Y billion more people will benefit from universal health coverage.
      • Z billion will be better protected from health emergencies.
   2. Improve existing indices and related indicators using standard and agreed criteria (tbd)
      • Improve UHC index as recommended by Member States and IAEG-SDG
      • Expand the list of outcome indicators to reflect progress made by technical programmes and countries in data collection and new and emergent areas and determinants of health.
      • Provide standard tools for countries and regions to identify priority area and indicators and to make targeted actions to drive change and maximize impact.

The three levels of the impact measurement in GPW13 succinctly reflect what WHO and its wide-ranging technical programmes aim to achieve: improving the well-being of global populations as measured by HALE, a singular health metric summarizing the levels of mortality and morbidity among populations. The use of HALE in impact measurement aligns with the WHO’s Constitution’s commitment to achieving the highest attainable standard of health for all populations. The 46 outcome indicators reflect the three areas of WHO’s core work: promote, protect, and provide health to the Member States. More importantly, the triple billion targets are highly effective summaries of the ultimate impacts of WHO’s contributions. While the targets are set at the global level, it is also critical to recognize that the triple billion targets have a clear country focus as they are aggregates of indicator-specific contributions from each country, a yardstick many Member States have consistently gone back to in order to evaluate their countries’ contribution and to benchmark against the performance at regional and global levels. The Triple Billion targets also streamline the management and monitoring of the included outcome indicators and make the organization and communication of population health interventions and its impact much more practical and effective.

WHO will lead a focused, accountable, time-bound and additionally funded approach to improve data accuracy, timeliness, and availability at country level, feeding into a more timely and complete data architecture enabling faster progress.

Output Measurement

1. Add delivery milestones and track progress using the delivery dashboard.
2. Revise the Output Scorecard, reducing the dimensions from six to five:
• Leadership function
• Global goods
• Technical support to countries
• Gender, equity, and human rights
• Value for money (removing "Achievement of results" as it will be featured in impact measurement)
3. Continue with focused qualitative case studies to capture experiences and progress in countries effectively.