Research Article: Assessing process, content, and politics in developing the global health sector strategy on sexually transmitted infections 2016–2021: Implementation opportunities for policymakers

Date Published: June 27, 2017

Publisher: Public Library of Science

Author(s): Andy Seale, Nathalie Broutet, Manjulaa Narasimhan

Abstract: Andrew Seale and colleagues discuss the development of a global strategy to counter sexually transmitted infections.

Partial Text: In May 2016, the World Health Assembly (WHA) adopted a global health sector strategy on sexually transmitted infections (STIs) for 2016–2021 [1] that outlines 2020 and 2030 targets and builds on what was learned from implementing the Global Strategy for Prevention and Control of Sexually Transmitted Infections: 2006–2015 [2,3]. The new strategy was adopted alongside linked global health sector strategies on HIV and viral hepatitis [4,5].

While there are no standard evaluation tools available for measuring the potential success of newly adopted global public health policies and strategies, there are numerous frameworks that can help guide implementation and assessment. This paper adapts Marsh and McConnell’s policy assessment framework [8] (Table 1) to help inform both the organisation of this paper and, potentially, guide future assessment and evaluation undertakings at the national level.

In 2014, when the process to develop a new global strategy for STIs started, the context for vertical, communicable, disease-focused programmes at WHO was considerably challenging. The organisation was focused on the following: WHO reform and making sense of the Millennium Development Goals (MDGs), preparing for the “post-2015 era” to be later elaborated in the 2030 Agenda for Sustainable Development, strengthening health systems and Universal Health Coverage (UHC), and reprofiling the importance of noncommunicable diseases [9]. In addition, WHO had been criticised in the context of a poorly managed West African Ebola outbreak [10].

The global strategy-development stakeholder consultation process was well documented throughout [16]. Member States themselves were appreciative of the strategy development process and there were several opportunities to engage and shape the strategy over a 2-year period. During Executive Board and WHA deliberations, many Member States expressed confidence in the final documents that had been informed by extensive Member State and stakeholder inputs [17]. A number of briefings organised between the January 2016 Executive Board meeting and the May WHA were particularly important to ensuring a sense of ownership among Member States and unanimous adoption of the strategies.

At different moments during strategy implementation it will be necessary to pull focus on different challenges, opportunities, or bottlenecks that may be characterised as either political, process, or technical in nature. For example, volatile, hostile, or apathetic political contexts might require the prioritisation of work at a political level.

The global strategy’s 2020 coverage targets and 2030 coverage and impact targets provide a strong framework for evaluating progress towards eliminating STIs as public health concerns. Yet, given that the context for this work is both politicised and highly dynamic, it is important that evaluation looks beyond coverage and impact targets, otherwise important opportunities to drive comprehensive action and to evolve policies to changing contexts may be overlooked. This paper proposes that expanded assessment includes deliberate analysis of the political context and policy process alongside assessment of progress towards targets and the extent to which technical priorities have been taken on board. The questions proposed in Box 1 can be easily adapted to national-level realities as an additional evaluation and strategy development tool. Both individually and together, exploration of the 3 domains highlighted in this paper can lead to a number of benefits, including increased access to utilisation of quality-integrated services and improved programme efficiency and value for money. Ultimately, it is hoped that these benefits substantially reduce STI incidence as well as improve health, human rights, and quality of life.



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