Study reveals gaps in state accountability for 2030 Agenda health indicators

Global health governance in the context of the 2030 Agenda was the subject of a study that analyzed the accountability of states in relation to the health indicators of the Sustainable Development Goals (SDGs). Published in the journal BioMed Central (BMC), the study, conducted by Fiocruz through Fiocruz Strategy for the 2030 Agenda (EFA 2030) researchers Rômulo Paes-Sousa and Ana Luisa Jorge Martins, used the Voluntary National Reviews (VNRs) as a tool to assess the compliance of national indicators with the global indicator framework, exploring the strategic priorities of states and global health governance from 2016 to 2020.

The Voluntary National Reviews (VNR) are documents drawn up by UN member states as part of the monitoring and review of the implementation of the 2030 Agenda and the Sustainable Development Goals (SDGs). These reports are presented voluntarily during the United Nations High-Level Political Forum (HLPF), providing a platform for countries to share their progress, challenges and learnings in implementing the SDGs.

Worrying results

The results of the study highlight a worrying discrepancy in the frequency of reviews on different health-related topics. Although there has been an increase in the use and consistency of health indicators over the years studied, with an emphasis on infectious diseases and maternal and child health, other important domains have been under-represented. Crucial areas such as universal health coverage and health system indicators received little attention in the VNRs

Another alarming aspect revealed by the study is the lower accountability of high-income states. This group of countries showed a worrying tendency to report less on health indicators compared to lower-income countries.

Conclusions: Technical capacities versus governance deficits

The VNRs reveal an intriguing paradox where growing technical capacity coexists with significant governance deficits. This can be attributed to both the statistical capacities and political preferences of the states. The predominant use of proxy indicators in the VNRs oversimplifies the presentation of official indicators, compromising the goal of innovating statistically to measure complex SDG issues.

Governance as a complex health regime

In line with the design of the study on the 2030 Agenda's global health as a complex governance regime, it is suggested that comprehensive research be carried out on each health regime cluster. This method aims to uncover disputes, identify patterns and clarify the preferences of states in specific thematic areas.

VNRs: Adaptability and learning mechanisms

Functioning as an accountability mechanism for the governance of the Agenda, the VNRs highlight the adaptability of states and their short-term learning capacities. However, the discretionary selection of indicators by states, allowed by the proposed contextual adaptation of the SDGs and the lack of attention to the guidelines' request to review all SDG indicators, reveals a critical flaw in the VNRs as an accountability mechanism.

This study underlines the need for greater oversight and transparency in the presentation of health indicators, emphasizing that true statistical innovation and effective governance will only be achieved if all states make an equitable and comprehensive commitment to the 2030 Agenda.