1. VALIDATING HIAP INDICATORS WITHIN THE PLAN OF ACTION Dr. Orielle Solar Dr. Patricia Frenz Expert Consultation for Implementation of the PAHO Plan of Action on HiAP PAHO, Washington DC March 31, 2015

2. OBJECTIVE AND OVERVIEW BACKGROUND OF THE REGIONAL PLAN OF ACTION 1 2 3 To present a proposal on validating the indicators within the Regional Plan of Action on HiAP to facilitate implementation in countries for discussion during the Expert Consultation. ANALYSIS OF THE HiAP INDICATORS: EXPLANATORY NOTES CONCEPTUAL FRAMEWORK FOR ANALYZING THE HiAP INDICATORS

3. HIAP: WHAT DOES IT MEAN? Core Tenets: “ an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity” Definition: IMPROVED HEALTH & WELLBEING WITH EQUITY & SOCIAL JUSTICE The Helsinki Statement on HiAP 2013 1.PRIORITIZE HEALTH & EQUITY 2.EFFECTIVE POLICY COHERENCE 3.POLITICAL WILL AND FORESIGHT WHO CONSTITUTION – ALMA ATA – OTTAWA –ADELAIDE –RÍO +20 - HELSINKI

4. DISTINCTIVE LESSONS ON INTERSECTORAL ACTION FROM THE AMERICAS… Source: Solar & Cunill (2015) ↗ A wealth of intersectoral policies for health, but….some have very different foundations: ₋ Political basis: democratization, citizen´s rights (SILOS, social protection) ₋ Technical basis: efficiency and effectiveness (single window) ↗ Heterogeneity regarding the health sector’s role, the view of health and the degree of intersectorality. ↗ Different visions of integrality regarding intersectoral action: ₋ Coordination of services to insure that users have access to an array of services. ₋ A new way to address multidimensional social problems, emphasizing social transformation and interrelated human rights. ₋ Social protection policies (traditional poverty and social vulnerability) ₋ Integral rights-based approaches to social protection ₋ Local municipal social development initiatives

5. LEADERSHIP IN INTERSECTORAL INITIATIVES Social Policy (not Health) Health sector Presidency Local level Healthy municipalities and communities, Argentina Intersectoral and participatory Dengue control, Cuba Intersectoral School and Health program, México Programa Belo Horizonte Ciudadanía, Brasil Programa Bolsa de Familia, Brasil Sistema Chile Solidario, Chile Chile Crece Contigo, Chile Sistema Elige Vivir Sano, Chile Estrategia de Cero a Siempre, Colombia Plan Nacional del Buen Vivir 2009- 2013, Ecuador Comisión Intersectorial de Salud, El Salvador Source: Solar & Bernales 2014

6. Programa Bolsa de Familia, Brasil Sistema Chile Solidario, Chile Estrategia de Cero a Siempre, Colombia Chile Crece Contigo: Sistema de Protección Integral de la Infancia, Chile Programa Nacional de Municipios y Comunidades Saludables, Argentina Estrategia Intersectorial y Participativa de Control del Dengue, Cuba Plan Nacional del Buen Vivir 2009-2013, Ecuador Programa Belo Horizonte Ciudadanía, Brasil COMMON SOCIAL OBJECTIVE Source: Solar & Bernales 2014 Address an environmental problem Programa Intersectorial Escuela y Salud, México Sistema Elige Vivir Sano, Chile Comisión Intersectorial de Salud, El Salvador

7. …REGIONAL PLAN PLAN OF ACTION ON HIAP Source: PAHO 2014. ↗The Americas is the first World Health Organization region to establish a Regional Action Plan on HiAP in September 2014. The purpose to define clear steps for implementation of the approach in countries. ↗Established though extensive consultation with countries and experts and sanctioned by the Member States. HiAP a mechanism and practical tools to enable public authorities and representative politicians at all levels to understand health impact and ensure accountability for the health and equity consequences of public policy decisions.

8. REGIONAL PLAN WITH 12 HIAP INDICATORS: NUMBER OF COUNTRIES WITH…. Source: PAHO 2014. Frame planned action (3) Facilitate assessment and engagement(2) Build Capacity (1) Specific strategies engage those w/inequities Formally Exchange Information Policies to address 2 priority SDH Equity profiles w/at least 2 SDH Mecanisms to engage community and Civil Society Recognized institutes – w/ HiAP courses

9. CHALLENGES: IMPLEMENTATION WITH INDICATORS Validity Reliability +

10. OUR TASK AND METHOD The task: To present a proposal on validating the indicators within the Regional Plan of Action on HiAP to facilitate implementation in countries for discussion in the meeting Our approach: To strengthen the content validity through a document review (including global declarations and frameworks, regional case studies, regional consultation and recent work by Solar & Cunill and Solar & Bernales based on systematic literature reviews). The products: –Classification of the indicators using an analytical framework of intersectoral action –Explanatory notes for each indicator WHO CONSTITUTION – ALMA ATA – OTTAWA –ADELAIDE –RÍO +20 - HELSINKI

11. ANALYTICAL FRAMEWORK FOR INTERSECTORAL ACTION Source: Orielle Solar, Nicole Valentine, Ketan Shankardass, Patricia O'Campo et. al. (2014)

12. THE FRAMEWORK´S PURPOSE TO CHARACTERIZE ADVANCES IN FOUR PRIORITY AREAS RELATED TO SUCCESSFUL HIAP 1.To achieve success in reduction of inequities, a group of indicators characterizes the approach to equity; 2.Inclusion of health sector´s needs and priorities in other sectors; 3.Inclusion of health as an objective or goal of other sectors; 4.The quality of the HiAP approach.

13. FOR STARTING HIAP Central government political will Local government political will, associated with transfer of resources and descentralization Local level autonomy to formulate and implement strategies Evidence generation and knowledge transfer Governmental support networks at different levels Support of international organizations Sustained political will at all levels Institutional backing (combination of short-term budget and long-term increases in human capital) Territorial structures to sustain processes Comunication y sensibilization of local teams Social participation and community engagement and interest Generating technical collaborating networks PARA SUSTAINING HIAP FACILITATING FACTORS FOR HIAP Source: Solar & Bernales 2014

14. First group: Favorable conditions for HiAP First group: Favorable conditions for HiAP Second group: Identify and document HiAP initiatives Second group: Identify and document HiAP initiatives Fourth group: Train and develop knowledge and capacity for HiAP Fourth group: Train and develop knowledge and capacity for HiAP Third group: Monitor & evaluate HiAP policies and programs Third group: Monitor & evaluate HiAP policies and programs CLASSIFYING THE 12 INDICATORES TO MONITOR AND EVALUATE IMPLEMENTATION OF HIAP IN THE AMERICAS

15. REGIONAL PLAN WITH 12 HIAP INDICATORS: NUMBER OF COUNTRIES WITH…. Source: PAHO 2014. Frame planned action (3) Facilitate assessment and engagement(2) Build Capacity (1) Specific strategies engage those w/inequities Formally Exchange Information Policies to address 2 priority SDH Equity profiles w/at least 2 SDH Mecanisms to engage community and Civil Society Recognized institutes – w/ HiAP courses

16. VALIDATION: EXPLANATORY NOTESNOTES Indicator name Associated objective Strategic line of action Definition Ilustrative example Justification Computation method Data collection and sources Baseline & Goals Periodicity Comments & limitations Source: Solar & Frenz 2015. Advocacy and benchmarking tool Documentation tool The country documents the key elements, accordingly it qualifies as “yes” or “not yet” in terms of accomplishment.

17. FOR EXAMPLE, TO DOCUMENT THE EXISTENCE OF A MULTISECTORAL NETWORK THAT EVALUATES IMPACTS OF PUBLIC POLICIES Requirement/ Key elementDocumentation Name of the network (webpage). Indicate if the network is national or subnational Date constituted (document if available) Objective, theme or problem (focus on disease, prevention, health and wellbeing, SDh or sustainable development) Working groups that form the network Sectors and actors that participate in the working groups Entity that convenes or coordinates (Ministry of Health, other ministries, NGO, university) Organization and functioning: meetings and other mechanisms Reports on policy impacts, needs and priorities for HiAP(weblink) existe) Mechanisms contemplated to influence public policy decision makers

18. Monitoring Health in All Policies Social determinants impact on health equity and the processes of redress What factors in broader society are impacting on health equity, and what is being done to address this? Monitoring health equity Health outcomes by socioeconomic position How large are inequalities between social groups? Monitoring intersectoral factors influencing universal health coverage Determinants contribution to coverage inequalities What factors in broader society are contributing to incomplete coverage of health services? Monitoring of intersectoral barriers and determinants affecting health, with an equity focus

19. MOVING FORWARD This proposal will be discussed in the working groups and we will include the recommendations.