Participants

Co-Chairs:

Jean-Bernard Parenteau, Global Affairs Canada; Dr Patrick Kuma-Aboagye, Ministry of Health, Ghana.

Participants:

Kristen Chenier, Ayah Nayfeh, Global Affairs Canada; Dr Polydor Mbongani Kabila, Democratic Republic of the Congo; Lynda Wardhani, Ministry of Foreign Affairs, Indonesia;  Eleonora Mei, Ministry of Finance and Treasury, Italy; Jin Hashimoto, Ministry of Foreign Affairs, Japan; Gerald Manthalu, Ministry of Health, Malawi; Jennie van de Weerd, Ministry of Foreign Affairs, Netherlands,  Paul Fife, NORAD, Norway;  Dr Aamer Ikram, Pakistan; Magnus Lennartsson, Ministry of Foreign Affairs, Sweden; Samrita Sidhu, Jo Scott-Nicholls, FCDO, United Kingdom; Birgitte Hagelund, DG International Partnerships, the European Commission; Susan Mochache, African Constituency Bureau for the Global Fund; Dr Lwazi Manzi, AU PPPR Commission, South Africa; Katy Kydd Wright, Global Fund Advocates Network; Cecilia Senoo, Hope for Future Generations;  Dr Ahmed Ogwell Ouma, Lori Sloate, United Nations Foundation; Clare Battle, Wellcome; Anurita Bains, UNICEF; Dr Susan Sparkes, WHO; Akudo Ikpeazu, WHO-AFRO.

Guests:

Dr Bruce Aylward, WHO.

Secretariat: Linda Muller.

How WHO is supporting countries to advance the Lusaka Agenda

Bruce Aylward, WHO Assistant Director-General (ADG), Universal Health Coverage, Life Course, reported on a 15 May meeting between the Lusaka Agenda Working Group (LAWG) Co-Chairs’ team and WHO ADGs and their teams, to discuss how WHO is supporting countries in advancing the Lusaka Agenda. Noting the alignment of the Lusaka Agenda with WHO’s General Programme of Work 14 (GPW14), and indeed references to the Lusaka Agenda in this global health strategy, Bruce noted that WHO has mapped how it is/would be supporting work to advance each of the five shifts. Broadly speaking WHO has identified three key roles that WHO can play to support countries:

  • Its role as a global repository and standard-setter for health-related data, including its facilitation and development of common metrics for primary health care and health systems strengthening. 
  • Its convening role – the 12-13 June AFRO Technical Consultation on the Lusaka Agenda is an  example of this. 
  • Its work to support a one plan, one budget, one M&E framework in countries. 

Meeting participants appreciated Bruce joining the call, noting that the role of WHO is critical and that expectations of the organization are high. 

There will be a follow-up meeting between WHO ADGs and the Lusaka Agenda Co-Chairs on 25 June, before the sunsetting of the working group and secretariat.

Co-Chair’s update

LAWG Co-Chair Jean-Bernard Parenteau began by recalling the six LAWG success indicators by end-June (see meeting slides) and presented an update received from the 3G Secretariats on the joint committee working group (JCWG) and pathfinder country processes.

JCWG: The time-limited JCWG was discussed at April’s Global Fund Strategy and Board meetings and will be discussed at the 5 June Gavi Governance Committee meeting, the 6-7 June Gavi Board meeting and the 2 July GFF Trust Fund Committee meeting. The 3Gs continue to work towards finalizing the terms of reference of the JCWG.

Pathfinder countries: The 3Gs have created a “factbase” that maps Gavi, GFF and Global Fund investments, existing partnerships and initial options for collaboration and will gauge in-country interest and vision of success for engagement, including bringing in other country implementers and regional institutions (e.g. Africa CDC, civil society organizations). Workplans will be developed in Q3 2024, implementation tracked and success metrics monitored from Q4 2024 onwards. AFRO’s 12-13 Technical Consultation on the Lusaka Agenda provides an opportunity to socialize and secure buy-in to the pathfinder process and gauge interest from in-country stakeholders and regional players.

Objective 1: Anchoring Lusaka Agenda conclusions on the agendas of global health initiative (GHI) boards and the African Union (AU): reflections from working group members

Dr Lwazi Manzi, Head of Secretariat of the AU PPPR Commission, reported that the AU decisions, endorsed by African Heads of State and Government at their Summit in February, have now been published. This includes a decision to “support the establishment of an accountability mechanism within the AU architecture to ensure the effective implementation of the Lusaka Agenda in Africa”. This has the potential to be a game-changer for African countries and for Lusaka Agenda implementation on the continent.  Lwazi stressed the key role of Africa CDC in taking forward this mechanism and underscored that implementation of the Lusaka Agenda on the continent must be led by African countries.

Working group members provided feedback on the 3Gs update on the JCWG and pathfinder country processes, calling for rapid work to develop the JCWG terms of reference and composition. There was a call to ensure representation is at a senior level, with individuals who can speak for their governments/organizations and to consider linkages to pathfinder countries. Several LAWG members, while appreciating how discussions are advancing at the board level, expressed frustration that Gavi and Global Fund country teams are unaware of the Lusaka Agenda and how 3Gs are proposing to advance it. There was also a suggestion that countries who have been deeply involved in the Future of Global Health Initiatives and Lusaka Agenda processes be considered pathfinder countries. Of note, the intention of the Lusaka Agenda is for the shifts to be implemented in all countries, in different ways, and on different timelines. That pathfinders will play a role in capturing lessons learned to inform countries that may take longer to implement the shifts.

Meeting participants reported on ways in which they are advancing the Lusaka Agenda in their work, at global, regional and country levels, including with national counterparts and development partners. Several LAWG members reported that they are raising the Lusaka Agenda in strategic dialogues with 3G Secretariat leadership and with leadership of the World Bank and other financing partners. Members underscored the importance of continuing to engage also with 3G board leadership and using the upcoming replenishments as a moment to drive change.

Objective 2: Moving towards global arrangements for ongoing collaboration

Sunsetting the Lusaka Agenda Working Group and secretariat

Canada is finalizing arrangements with the UN Foundation to support activities related to the Lusaka Agenda post-June, with a focus on supporting African leadership and engagement. In frank recognition that the work is not done, that Lusaka Agenda implementation is a long-term process, several working group members suggested convening informal check-ins over the reminder of the year, noting that these would need to be convened by partners in the absence of secretariat support.  

Exploring arrangements for collaboration in the medium term

The working group welcomed the emergence of a set of objectives for ongoing collaboration, noting that these provide a useful foundation for moving forward. The objectives are to:

  • Ensure umbrella coordination of partner-led streams of activity related to Lusaka Agenda implementation.
  • Coordinate global advocacy and accountability activities around the implementation of the Lusaka Agenda (to complement regional efforts within and beyond Africa).
  • Facilitate strategic dialogue and collaboration to explore wider implications of the Lusaka Agenda conclusions for health financing and development assistance for health.

On a no-objection basis, the working group requested the sub-group continue working informally beyond the sunsetting of the working group and secretariat at the end of June, to refine thinking on objectives and governance arrangements (informed by further analysis and consultation as needed). Working group members urged the sub-group to consider the pros and cons of different types of arrangements, including both an informal, agile partnership mechanism and a more formal approach embedded within an existing organization.

The sub-group will strive to develop a refined proposal by Q4 2024, recognizing the need to build a clear case that can provide a foundation for attracting the champions and resources needed to make the arrangements a reality.

Addendum: 29 May Informal Lusaka Agenda Working Group breakfast in the margins of the WHA

LAWG Co-Chair Patrick Kuma-Aboagye convened an informal breakfast of working group members in Geneva for the World Health Assembly. As an important step in building national leadership on the Lusaka Agenda, four Ghanaian health leaders joined the meeting: Ms Elizabeth Ofori Agyare, Member of Parliament; Dr Hafez Adam, External Aid coordinator; Dr Da Costa Aboagye, CEO Health Insurance, and Ms Eva Okai, Director Finance National Health Insurance.

One participant valued the organic nature of the Lusaka Agenda process, with it providing a platform for countries to take the shifts forward, underscoring that if countries are empowered, the Agenda will move forward naturally, without needing to be driven. The important role of parliaments and civil society was stressed. Several participants noted their commitment to stay with the Agenda for the long-haul. Another participant noted that systemic change will require donors to increase their risk appetite, pointing out that GHIs are very risk averse, at the behest of the donors. Informal, ongoing collaboration between friends of the Lusaka Agenda will be useful and necessary to ensure momentum is not lost and thought is still needed as to what shape this could best take. Informal convenings will be part of this process and UNF and UNICEF proposed to convene friends of the Lusaka Agenda in the margins of UNGA in September.

Several members noted the political nature of the Lusaka Agenda, requiring attention from the very highest levels in countries, including through mechanisms such as the AU and G7.

There were several calls to ensure the Lusaka Agenda does not create new processes at country level and the conversation moves beyond the 3Gs to include, inter alia, the World Bank and bilateral partners. Several partners flagged that we cannot take for granted the work on the Gavi/Global Fund/GFF JCWG and pathfinder countries processes will move forward quickly and effectively, and concern was expressed that the sustainability issue is at risk of being lost. The important role of civil society in improving health outcomes – as advocates, as service providers, and for holding governments to account was stressed.