Table 1

Achievements, challenges and opportunities in implementing HHSDGs reported by key informants from LMICs

DomainsInitial achievementsGaps and challengesOpportunities
Political commitment
  • High-level political commitment in all countries.

  • National development agendas being aligned with SDGs.

  • Priority goals identified and publicly proclaimed.

  • Development of SDG roadmap, frameworks and strategies.

  • Need for sustained political commitment.

  • Perception as outsider’s agenda rather than national priority.

  • SDG actions not backed by governance and institutional reforms.

  • Lack of supportive legal and regulatory environment.

  • Coherent development priorities for accelerated implementation of SDGs.

  • Revisit national development priorities and choices to better align with SDGs.

Financial commitment
  • SDGs aligned with pre-existing plans ensuring funding.

  • Development partners and donors providing support in several LMICs.

  • Strategies to increase domestic financing on health, for example, earmarked taxes on tobacco, alcohol and fast food.

  • Limited government funding and fiscal space with low allocation to health.

  • High donor dependence in some LMICs.

  • Strictly sectoral budgets, limited budgeting capacities.

  • Increasing healthcare costs due to rise in NCDs.

  • Develop shared SDG agenda and align resources of all partners to ensure efficient utilisation.

  • UHC is an SDG3 target and useful platform for collaboration across actors.

Institutional set-up
  • High-level oversight bodies and institutional arrangements identified in most countries.

  • Increasing focus on multisectoral institutional arrangements.

  • Unclear institutional roles, responsibility and accountability.

  • Limited understanding of working across sectors despite commitment.

  • Lack of institutional capacity at subnational level for implementation.

  • Empower and capacitate local governments for SDG implementation.

  • Scope for intersectoral convergence through multistakeholder engagement.

Stakeholder engagement
  • Most common stakeholders include ministry of planning, bureau of statistics and ministry of health.

  • Other related ministries and public departments are increasingly being involved in many countries.

  • Involvement of civil society organisations and private sector is inadequate.

  • Academic institutions and universities not adequately engaged in research activities to support SDG implementation.

  • Increasingly involve non-state actors.

  • Governments should listen to voices of the vulnerable and less privileged.

Multisectoral collaboration
  • Several countries have set up multisectoral SDG councils external to MOH; others have adopted cluster approach.

  • Multilateral and bilateral agreements exist between MOH and other ministries in some countries.

  • Formal mechanisms for collaboration do not exist between different ministries or within MOH in some countries.

  • Collaborative mechanisms exist on paper, but implementation is often inadequate at multiple levels.

  • Lack of sustained multisectoral collaboration due to weak institutions.

  • Benefit from experience of good practices accumulating in this area.

  • Academic institutions should provide local solutions through implementation research.

Role of development partners
  • UN agencies led by UNDP, WHO and others technically and financially support SDG implementation.

  • World Bank and bilateral donors support SDGs through advocacy, and technical and financial assistance.

  • Development partners may dominate the SDG agenda in some countries.

  • Some LMICs may become dependent on development partners for financial assistance.

  • Governments should provide leadership to bring development partners to the table for a coherent and coordinated response.

Monitoring and evaluation (M&E)
  • Planning ministries and bureaus of statistics are the responsible bodies in most countries.

  • List of targets and indicators identified for M&E in most countries.

  • Possible sources of data collection identified and being integrated.

  • Framework for monitoring SDGs not approved in some countries.

  • Monitoring SDG implementation is difficult due to weak databases and management challenges.

  • HHSDG indicators not captured by health information systems.

  • Quality of data collected is questionable, and analysis and use suboptimal.

  • Provide legal cover through legislation to ensure regular and reliable M&E.

Capacity development
  • Most countries are engaged in needs assessment but not beyond that.

  • Organised efforts towards capacity development for SDGs have not been reported by participating countries.

  • Academia should proactively engage in needs assessment and capacity building.

Communication strategies
  • In few countries, information is communicated by government or UN agencies to public through online platforms, press, celebrities and social media on 2030 Agenda.

  • Communication is limited to within government departments in most countries.

  • Defined mechanism for communicating information to citizens on SDGs does not exist in most countries.

  • Use native languages, school educational system, and mass and social media.

  • Orient and involve health workers to promote SDGs.

Equity and accountability
  • Equity is high on the agenda and most countries have identified vulnerable groups that include women, children, poor and migrants.

  • Social protection, health insurance and public health programmes are being implemented to reduce inequities often as part of UHC.

  • Need to focus better on monitoring equity and accountability from SDG perspective.

  • Lack of disaggregated data is a major impediment in monitoring equity.

  • Growing private sector and dual practice poses a challenge to policies on equity.

  • Accountability channels are not well developed or functional in most LMICs.

  • Strengthen and integrate information systems to provide disaggregated data for monitoring equity.

  • Use equity data for fair allocation of resources.

  • ECD, Early Childhood Development; HHSDGs, health and health-related sustainable development goals; LMICs, low-income and middle-income countries; MOH, Ministries of Health; SDG, sustainable development goal; UHC, universal health coverage; UN, United Nations; UNDP, United Nations Development Programme.