Health systems components

Investments in resilient and sustainable systems for health lay the foundation for the effective and equitable delivery of HIV, tuberculosis (TB) and malaria programmes, other essential health services and the achievement of universal health coverage. As a key partner of the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund), UNDP supports investments in strengthening systems for health. UNDP is increasingly requested by governments to provide technical assistance in core functional areas of health system strengthening, such as procurement and supply chain management or financial management systems.

These investments in building enabling processes, capacities and policy environments for health yield cross-cutting benefits in terms of improving health outcomes and advancing countriesʼ achievement of the health-related Sustainable Development Goals (SDGs). This includes e orts to enhance the sustainability and resilience of health systems that enable governments to accelerate progress towards universal health coverage and withstand the impact of global health crises and other emerging threats. The COVID-19 pandemic has underscored the vital role of health systems, revealing the costs of inadequate systems, processes and capacities as countries have had to cope with increased demands while maintaining the delivery of essential health services. The pandemic response has likewise illuminated the value of previous investments in building strong community systems for, for example, health, procurement and supply chain management systems, or health management information systems, which countries could adapt to mitigate the impact of COVID-19.

This section outlines the key focus areas in which UNDP works with governments, the Global Fund, the World Health Organization and other health and development partners to build resilient and sustainable systems for health. This includes guidance and examples based on UNDPʼs experiences supporting country systems in the areas of : i) health management information systems; ii) procurement and supply chain management; iii) financial management; iv) human resources for health; and v) community systems strengthening, as well as cross-cutting investments in vi) anti-corruption, transparency and accountability, vi) environmental sustainability and vii) harnessing innovation and digital solutions for health.

Examples

Case Study: Building resilience through strengthened ICU care

Strengthening the Intensive Care Unit ICU care in Afghanistan

In Afghanistan, Intensive Care Units (ICUs) play a crucial role in providing emergency care, particularly in regions affected by conflict, disasters and public health crises. With support from the Global Fund, UNDP upgraded ICUs in Kandahar, Logar, and Balkh provinces, enhancing emergency care and infectious disease treatment for over 500 patients monthly. These improvements included renovating ICU wards and installing oxygen plants that deliver oxygen directly to patients’ beds while also generating backup supplies in cylinders. These measures enable the ICUs to provide intensive care services to patients in need.

These investments provide the infrastructure, equipment and healthcare capacity to improve critical care, manage infectious diseases and chronic illnesses, improve maternal and neonatal health and respond to emergencies and disasters. Crucially, this also ensures a more integrated healthcare network, enabling telecommunication links between departments and boosting the long-term readiness of facilities to respond to crises. With hundreds of patients now receiving care each month from the upgraded ICUs, this approach helps safeguard communities, bolster health systems and build resilience against future health emergencies.

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The role of a health information system (HIS) is to ensure the production, analysis, dissemination and use of reliable and timely data by decision makers at all levels of the health system. A well-functioning HIS provides information on which to base programme decisions, to support the development of solid national health policies, strategies and plans, to monitor progress of interventions against national priorities and to contribute to reliable procurement and supply of health products through accurate data on needs and usage. Information is also essential for effective health system governance and regulation, health research, human resources development, health education and training, service delivery and financing.

At the policy level, decisions informed by evidence contribute to more efficient use of resources and, at the delivery level, they provide information about the quality and effectiveness of services. A well-functioning HIS should, among other core functions:

• generate and compile information from service delivery points to district level routine information systems, disease surveillance systems, laboratory/procurement information systems, hospital patient administration systems and human resource management information systems
• detect events that threaten public health security
• analyse, synthesize and communicate information for use in planning and implementation.

The COVID-19 pandemic has further underlined the crucial role of health information systems in enabling countries to effectively respond to disease outbreaks. Weaknesses in surveillance systems and capacities to collect, manage and utilize data, particularly at the community level, undermine the delivery of life-saving health services, most notably in the face of global health threats.

UNDP’s approach

Many countries in which UNDP supports systems for health, particularly through its partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund), are low-income countries or are characterized by challenging operating environments. These tend to have young or fragmented health information systems (HIS), sometimes set up in an ad hoc way in response to different donor requirements. UNDP works to assess what is in place and how this can be strengthened to form a sustainable HIS. Working closely with national entities, UNDP’s support includes work to:

• assess the country requirements based on the national health strategy and priorities
• support the development of national health information strategies
• support the integration and harmonization of data management systems, to reduce silos
• implement electronic patient management systems and/or District Health Information Systems (DHIS) and promote their interoperability with electronic Logistics Management Information Systems (LMIS)
• support the assessment of where information and communications technology (ICT) can deliver better data and information for decision makers
• assess needs for other elements of a comprehensive HIS, such as logistics management information systems or human resource management information systems
• strengthen data literacy of the health workforce
• strengthen reporting and communication of results at all levels of the health pyramid
• support the development of study protocols and implementation of related databases and research projects.

When UNDP serves as interim Principal Recipient of the Global Fund programmes in a country, support to health management information systems is often a key area for capacity development, in line with national priorities and the Global Fund guidelines for strengthening data systems. This includes doing so through capacity-building to enable health sector personnel to move beyond a focus on data solely for reporting, to the active use of real-time data in decision-making at all levels, such as in the management and evaluation of programmes and the formulation of budgets. UNDP likewise supports countries with the development of applications to the Global Fund to ensure inclusion of activities to strengthen national HISs, including those to promote enhanced integration across data systems. Examples of focus areas that can be included in the Global Fund funding applications are:

• routine information systems (the establishment, maintenance and strengthening of national health information systems, district HISs, mobile platforms for community-level data collection and reporting, and support for human resources for data systems)
• programme and data quality (activities related to assessments of programme and/or data quality, as well as monitoring of quality improvement activities)
• evaluations, reviews, data analysis and use
• surveys and studies
• administration and financing of data systems
• civil registration and vital statistics systems.

Tools and guidance

To support comprehensive improvements to HIS, UNDP aligns its focus with international standards and recommendations developed by the World Health Organization (WHO). The WHO UHC Technical Brief: Strengthening Health Information Systems, for instance, details seven strategic areas for actions that are required to strengthen national HIS:

• Improve governance. HIS strengthening requires an enabling environment and robust collaboration between health and other sectors, including the information and communications technology (ICT) sector.
• Invest in data sources and capacities. These investments strengthen health information, workforce skills and capacities for using health statistics and data.
• Align stakeholders in support of HIS. Development partners and national institutions should make sure that their investments are complementary. Data, monitoring and accountability should be integrated into one plan and one budget for the health sector, and should be aligned with the health Sustainable Development Goals.
• Use the digital revolution. The power of ICT innovation can help improve the availability, completeness, timeliness, quality and use of data for decision-making in health. Minimizing the burden of data collection, analysis and reporting through eHealth strategies can improve health service delivery and management.
• Strengthen the capacity for systems and applications to be reusable. The use of scalable, affordable and open access software systems should be promoted and common health information architecture, standards, guides, tools and solutions to data management and analysis should be developed.
• Use data to improve policy and service delivery. With a focus on equity, disaggregated data and access to needs-based, good–quality services, health information should be provided to decision makers at all levels for improving health policy, systems and services.
• Strengthen accountability and reporting of results. There should be national oversight mechanisms for key indicators of national health targets and goals and mechanisms for regular transparent reviews to assess progress against national health sector targets.

A number of tools are also available to strengthen monitoring and evaluation (M&E) systems for health programmes and systems, as a distinct but interconnected component of broader HIS strengthening. Most notably, in the context of the Global Fund programmes, stakeholders should refer to the guidance and tools made available on the Global Fund website, which includes information related to national M&E system assessments, data systems for HIV surveillance and DHIS-2 strengthening.

For additional guidance related to UNDP’s support to strengthen electronic logistics management information systems and their interoperability within HISs, visit the Logistic management information systems (LMIS) page. Further details on digital solutions that UNDP has employed to strengthen systems for health information, M&E and logistics data can be found on the Real-time data solutions page.

Purpose

The role of a health information system (HIS) is to enable the use of reliable and timely data by decision makers at all levels of the health system. The HIS is therefore reliant on, and is only as good as, the quality of data collected. High-quality and up-to-date data are necessary for countries to respond quickly to public health crises and ensure the effectiveness of ongoing health service delivery. This includes making information available on vulnerable groups and key populations most affected by health issues, to ensure that services can be effectively tailored to the needs and unique barriers to health access faced by those communities. The strength of the HIS also ensures that when an emergency health situation arises, decision makers are aware of it early and can divert the necessary resources to prevent epidemics.

In many countries, the quality of data gathered at health facilities and the capacity to analyse and use these data remain inadequate to support decision-making that will accelerate the achievement of universal health coverage. Most countries have health facility registries and service-use reporting forms; they maintain medical record rooms and may have health information units overflowing with data. Despite this abundance of data, many still find it challenging to collect high-quality data in a timely manner, produce disaggregated data and use them for policy and planning.

Among the challenges is the fact that data may be incomplete or of poor quality or that there may be duplication and fragmentation of data across reporting systems developed by different users. This makes it difficult to connect the resources invested to the results achieved. Data needs and demands are also changing with the rise in non-communicable diseases. More technical skills in key areas such as epidemiology, biostatistics and database management are needed, as well as skills to analyse statistics across different programmes and sectors. Responsibility for data entry, verification, validation and management is distributed across various individuals, professions, units, departments and facilities at the different levels of the HIS. Programmatic or patient care data are often collected and managed separately from health products or stock data. Staff rotation is another concern in relation to maintaining appropriate standards, as such a situation affects data quality. In addition, data quality is rarely seen as a priority and the resources available are limited.

UNDP’s approach

As Principal Recipient of the Global Fund grants, UNDP is highly committed to improving health data quality, analysis and use to support decision-making within health programmes and systems. UNDP provides capacity development and good practice support during data collection and data management processes. More specifically, UNDP supports ministries of health and other partners at various levels of health information chains in their processes to:

• assess regularly the quality of project data through internal routine tools and external processes
• formulate and implement a health data quality development plan
• facilitate high data quality standards at all levels of the health information system
• develop tools and methods for data collection and use
• strengthen the capacity of health information system professionals in data collection, management and analysis
• strengthen the data flow at all levels of the health pyramid.

Tools and guidance

Further information on core data components that constitute a health information system (HIS), to inform the entry points for capacity development, can be found in this UNDP guidance note.

UNDP’s technical assistance to strengthen data collection and use for better health outcomes considers the capacities required across the interconnected components of national HISs. This includes the following six components of HISs defined by the World Health Organization (WHO), as detailed in the Framework and Standards for Country Health Information Systems (2012):

1. Health information system resources. These consist of the legislative, regulatory and planning frameworks required to ensure a fully functioning HIS and the resources that are required for such a system to be functional, such as personnel, financing, and information and communications technology (ICT).
2. Indicators. A core set of indicators and related targets are the basis for an HIS plan and strategy. Indicators need to encompass determinants of health, health system inputs, outputs, outcomes and health status.
3. Data sources. These should include population-based approaches (censuses, surveys and civil registration), institution-based data (individual records, service records and resource records) and additional information from occasional health surveys, research and information produced by community-based organizations.
4. Data management. This includes the collection, storage, quality assurance, flow, processing, compilation and analysis of data.
5. Information products. Data must be transformed into information that will become the basis for evidence and decision-making.
6. Dissemination and use. The value of health information can be enhanced by making it readily accessible to decision makers.

Additional resources from WHO, the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) and other global health partners can be found under key resources below. They include tools to inform the selection of data collection indicators, facilitate data quality reviews and strengthen processes and capacities for data analysis and use to achieve national health priorities.

Digitalizing the health management information system in Zimbabwe

Digital solutions that allow for real-time data collection and visibility have the potential to enhance all aspects of health information management and the functioning of the overall health system. In Zimbabwe, the digitalization process was prompted by the rapid growth in programmes for HIV and other epidemics in the early 2000s and the limited capacity of health workers to manually process large volumes of patient information. The transition away from paper-based reporting, and the genesis of the modern national health information and surveillance system, began in 2010 with the national roll-out of District Health Information System 1.4 (DHIS-1.4), an electronic platform for aggregate reporting of health data from the district level upwards.

Moreover, recognizing the need for a tool to capture and monitor detailed patient-level data, the Ministry of Health and Child Care (MoHCC) resolved to establish an electronic patient management system (ePMS) in 2013, which initially focused on the collection of HIV and tuberculosis treatment data at health facilities based on the urgent need. While the roll-out of the computerized system helped to enhance data collection and accuracy of reports under specific disease programmes, fragmentation and timeliness issues remained across the broader health information landscape. To enhance the transmission of routine health information collected through DHIS-1.4, MoHCC sought to upgrade to District Health Information System version 2 (DHIS-2), starting in 2013. As an online system connected to a central server, DHIS-2 not only improved the timeliness of health information reporting, but also allowed for greater access to real-time data across all levels of the health system, from the national level to the health facility level. Most critically, the electronic system introduced the potential for the gradual integration of all health information systems into a single platform, reflecting a shift towards more integrated programme management. Building on this progress, MoHCC will work with partners to eventually bring DHIS-2 and the ePMS into an electronic health records platform that is currently being rolled out.

MoHCC has promoted the continued growth of the electronic information ecosystem to address information needs across the health system. Whereas the initial priority was to enhance information systems for high-level decision-making, MoHCC has increasingly invested in systems for data disaggregation and use at lower levels of service delivery, building on the systems and infrastructure already in place. This has been accompanied by a focus on developing policy frameworks and human resource capacity for the effective use of the data in the delivery of health services. Electronic systems now include those for rapid disease notification, laboratory services and patient information. Efforts to build data skills among the health workforce, along with investments in information and communications technology (ICT) infrastructure, have helped to drive and reinforce the development of all systems.

Since 2010, UNDP has invested substantially in health management information system activities through grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund), with a focus on strengthening governance, ICT systems and human resource capacity for data collection and use. In line with the areas emphasized by national ICT and monitoring and evaluation (M&E) policy guidelines, UNDP has supported the national health management information system, particularly through the following interconnected outcomes:

More information on UNDP’s multifaceted support to the health management information systems in Zimbabwe can be found in the UNDP Brief: UNDP and Global Fund Support to Strengthen the National Health Management Information System

UNDP Djibouti: the use of new technologies for data collection and management

UNDP has amassed a wealth of experience in providing technical assistance to national entities supporting national capacities for monitoring and leveraging emerging data sources for real-time monitoring in countries where UNDP is an interim Principal Recipient of grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund).

In Djibouti, UNDP supported the Ministry of Health (MoH) to introduce a mobile data collection and management tool in 2020 to address data collection and activity monitoring challenges faced under the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) malaria programme. Specifically, within the context of Djibouti’s indoor residual spray campaign and adjustments made amid the COVID-19 pandemic, the programme faced challenges linked to delayed data availability, manual transcription errors and data duplication across activities. These issues meant a lack of complete and reliable data to guide decision-making and ensure quality control.

UNDP sought out technological solutions that could help to resolve some of these gaps. Among the solutions identified was the KoBo Toolbox and UNDP supported MoH to adopt this free, open-source suite of tools for data collection and analysis, and specifically designed for use in challenging environments. Through the KoBo Collect application, the tool offers a series of features to facilitate the data manipulation process from collection to analysis and visualization. Health authorities download the application to mobile phones or tablets to collect data from the field and upload it to a server for analysis. UNDP helped to train teams in charge of data collection on how to use the form, and conducted a pre-test exercise and debriefing. The graphic below outlines the implementation process used to launch the Kobo system for tracking indoor residual spray under the MoH 2020 malaria campaign.

The KoBo Toolbox has allowed MoH and UNDP to proactively monitor indoor residual spray activities through online applications that produce timely data, to troubleshoot implementation challenges and to inform or share decision-making with communities, without physically being present at the project sites. The real-time monitoring has improved the exchange and sharing of data by health authorities, supporting more regular problem identification, analysis and responses. The system also offers an online analytics module for conducting basic data analysis, which has helped to motivate staff to reach set targets.

Presentation (French): UNDP Djibouti, Jan 2021: Mobile Data Collection and Management Using KoBo Toolbox

UNDP is taking a lead globally to support countries in the most challenging operating environments to procure health products and strengthen national supply chain systems, in close collaboration with other partners. 

Overview

UNDP supports countries in some of the most challenging operating environments to procure health products and strengthen national supply chain systems, working in close collaboration with other partners. UNDP’s expertise, built through more than 15 years of implementing procurement and supply chain management (PSM) support services under donor grants, is being used to support ongoing reforms of national procurement strategies and operational policies, and to optimize national supply chain systems for health products.

UNDP builds on its support to governments’ procurement of health products as an entry point to improve and build resilience in PSM systems in countries. While supporting the timely procurement of quality-assured medicines and other health products, UNDP works with governments, in coordination with the World Health Organization and other partners, to help enhance national capacities and systems for the adequate PSM through transparent and accountable mechanisms.

It helps countries to achieve value-for-money in procurement and supply chain activities, it guarantees the quality of the products and services provided, and it sustainably improves the performance of national procurement and supply chain systems using both donors and domestic funds.

UNDP’s approach

UNDP’s approach to procurement and supply chain management capacity development is built on a participatory and inclusive process. It seeks to address capacity gaps at all levels of the supply chain, including selection, quantification, procurement, storage, distribution, logistics management and the use of health products, with a cross-cutting emphasis on meeting quality assurance standards, fostering enabling legal and regulatory environments, and promoting environmental sustainability in PSM.

UNDP supports situation analyses and national supply chain maturity assessments to enable the development of national PSM strategies and improvement plans. The approach engages the contributions of technical partners to define the national priorities and develop integrated solutions for national supply chains.

UNDP strongly encourages the establishment of national coordination platforms under the leadership of national authorities (e.g. the ministry of health or supply chain entities) to steer the implementation of supply chain transformation projects and monitor progress and performance. All national and international stakeholders should be part of the coordination mechanism. As a member of the coordination platform, UNDP will support the implementation of prioritized activities in close collaboration with national counterparts to strengthen national leadership and management. It likewise provides project management support to ministry of health counterparts to lead the capacity development projects, measure progress, identify risks and propose mitigation measures.

Potential activities through which UNDP might assist national and subnational actors across the supply chain include technical assistance to:

• define the relevant specifications and appropriate quality standard requirements for selected products
• quantify needs based on reliable programmatic and logistic information
• carry out sourcing and supply planning and conduct procurement processes
• store and distribute health products while monitoring their quality
• establish logistic information systems with analytic capabilities for stock visibility and security and logistic data reliability, for informed supply planning decisions
• design solutions for “last-mile” delivery up to the most hard-to-reach populations
• strengthen policies and regulatory frameworks, including on intellectual property, to remove potential barriers to equitable access to affordable medicines and other health products.

UNDP has also been able to leverage its global procurement architecture and expertise to support health procurement efforts within national COVID-19 response plans, in coordination with other agencies. It has helped countries to procure quality-assured products, including personal protective equipment, medical equipment, test kits and ventilators, including through funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) COVID-19 Response Mechanism.

Cross-cutting tools, processes and frameworks for strengthening procurement and supply chain management systems

This section provides guidance and tools to build capacities at all stages of the procurement and supply chain management (PSM) cycle. Some examples of tools, approaches and resources in cross-cutting areas of PSM strengthening, such as human resources, innovation and sustainability, can be found below.

Human resources for procurement and supply chain management

UNDP recognizes that a knowledgeable, skilled, motivated workforce is crucial for implementing procurement and supply chain management (PSM) strategies and plans. Human resources for health strategies are a fundamental part of developing resilient PSM systems and should encompass sustainable solutions for the education, recruitment and retention of human resources for PSM.

In several countries, UNDP has strengthened human resources through a scaling-up of on-the-job and formal training sessions, including through professional certification programmes for health workers in PSM-related areas, such as accreditation from the internationally recognized Chartered Institute of Purchasing and Supply (CIPS) and supply chain leadership programmes with partner organizations.

UNDP has also developed online introductory training courses on PSM, accessible in four United Nations languages. The training sessions are intended to support the capacity development of health system personnel and partners by increasing understanding of the importance of PSM to ensure the uninterrupted supply of life-saving medicines and other health products.

UNDP can additionally support countries to mobilize expertise and technical assistance to reinforce human resources through international consultants where relevant. To strengthen its capacity to effectively support partners worldwide, UNDP has established a pre-approved health PSM roster of experts and senior experts, who are ready to provide consultancy services for sustainable development in PSM, specifically pertaining to the health sector. The health PSM roster contains qualified individual consultants based on competencies and value-for-money principles that may be called upon to be contracted and deployed to provide specific technical advice and short-term consultancies for periods of time, normally not exceeding 12 months.

Innovations in procurement and supply chain management

UNDP seeks out and uses the latest innovation and technology for health, which is central to supporting resilient and sustainable systems for health. UNDP is involved in piloting and implementing several innovations in the supply chain. These include:

• Upstream innovation for sustainable procurement, such as engaging manufacturers through its long-term agreements, optimizes medicine packaging to reduce waste and freight costs.
• Supporting mobile phone-based or other electronic logistic management information systems (eLMIS) allows the tracking of inventory, the consumption of data and the monitoring of cold chain temperature for vaccines at the most peripheral storage level. Read more
• The Solar for Health initiative leverages solar energy to ensure the sustainable provision of electricity to pharmaceutical warehouses and health facilities. This guarantees not only the functioning of cold chain equipment but also the storage of health products at controlled temperature and electricity for computer-based warehouse management systems and LMIS, among other things.
• Promoting the adoption of the Global Data Standards (GS1) improves the traceability of health products along national supply chains, through joint efforts with other agencies of the Interagency Supply Chain Group (ISG). This also improves supply chain security and reduces the risk of falsified health products being introduced into the national supply chain.
• Global partnerships to facilitate coordination and learning on the latest technologies for procurement and supply chain management (PSM). UNDP is participating with other agencies in global coordination mechanisms, such as the Interagency Supply Chain Group (ISG) and Sustainable Procurement in the Health Sector (SPHS), to introduce innovations and the use of technologies in PSM.

Additional initiatives can be found in the ‘Innovation and digital technologies’ section, include the application of Smart Facilities to strengthen the sustainability of physical infrastructure in supply chains.

A procurement architecture to create value for money

UNDP’s principles for guiding health procurement are:

1. provide the best value for money;
2. embody fairness, integrity, and transparency;
3. engage in effective international competition.

UNDP has developed and continues to manage a procurement architecture designed to facilitate the timely supply of affordable quality assured pharmaceutical and other health products to meet the needs of national programmes using donor grants and domestic funds for health procurement supported by UNDP through a value-for-money service proposition. The UNDP health procurement architecture comprises several partnerships and sourcing agreements with other United Nations agencies, manufacturers and other commercial entities to provide the most cost-efficient procurement system for each health product category.

As a result, UNDP health procurement has achieved competitive prices for health products. These savings are reinvested to support increased health service coverage or strengthen national supply chain systems. Similarly, UNDP’s capacity-building for in-country procurement processes and operations aims to achieve efficiencies to be reinvested to strengthen other areas of the procurement and supply chain management cycle.

UNDP is also working to reduce monetary and environmental costs related to transport, health care waste, and packaging. This likewise promotes value for money in health procurement for recipient countries. Increasingly, this type of approach is meant to be transferred and applied in country-led procurement processes supported by UNDP.

Policy considerations for the selection of essential medicines:

• “Access to essential medicines depends on four factors: rational selection, affordable prices, sustainable financing and reliable health systems.
• The selection of essential medicines, preferably linked to standard clinical guidelines, is a crucial step in ensuring access to health care and promoting rational use by health professionals and consumers.
• Official adoption of the essential medicines concept identifies priorities for government involvement in the pharmaceutical sector in general, and for medicine supply in the public sector and medicine benefits as part of health insurance in particular.
• Systematic and transparent procedures for defining the national list(s) of essential medicines, on the basis of evidence-based treatment guidelines should be established”

Source: World Health Organization (2002). The Selection of Essential Medicines.

UNDP’s approach

When UNDP acts as interim Principal Recipient of grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund), UNDP supports ministries of health in the selection of quality-assured medicines and diagnostic products, recommended in the current national guidelines, the World Health Organization (WHO) Standard Treatment Guidelines and/or the WHO Essential Medicines List.

Similarly, for other health products such as bednets, insecticides and condoms, the selection is based on the WHO recommendations for use and the national guidelines. In collaboration with other partners, UNDP also supports the selection of diagnostic technologies and equipment for the improvement of central and peripheral laboratories towards optimization of diagnostic services and according to the national laboratory strategy.

Countries with low and lower–middle income may engage UNDP’s support through financing agreements for the procurement of anti-cancer medicines and other medicines for non-communicable diseases using state funds. This includes support to clarify clinical needs and specifications for health products, including to determine the most appropriate strengths and formulation. Financing agreements between UNDP and countries for health procurement entails consultations with the country counterparts to define detailed specifications of required health products and to select the most appropriate technologies. UNDP advises countries on product selection based on the scientific evaluation of health products done by the WHO relevant committees.

Among the United Nations agencies, WHO is also mandated to support countries in the development of evidence-based guidelines and the review of national essential medicines lists.

The results of a quantification exercise help programme managers to:

• identify the funding needs and gaps for procurement of the required commodities;
• leverage the sources, amounts, and timing of funding commitments to maximize the use of available resources;
• advocate for additional resources, when needed;
• develop a supply plan to coordinate procurements and shipment delivery schedules to ensure a continuous supply of commodities.

Source: John Snow, Inc. (2017). The Supply Chain Manager’s Handbook.

UNDP’s approach

UNDP has supported quantification activities for malaria, tuberculosis and HIV health products for national quantification committees in all countries funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) since 2002. UNDP encourages the use of standardized quantification tools developed by partners. UNDP also provides expertise during national quantification committee meetings and the training of personnel responsible for forecasting the needs for medicines, diagnostics and laboratory items for the three diseases.

For countries receiving the Global Fund grant funds, strengthening quantification processes is a key element to ensure that the right quantities of health products are procured to prevent overstock or products being out of stock. Support may include the review of the quantification process and the terms of references of national quantification committees.

UNDP offers technical assistance on quantification to countries beyond those receiving the Global Fund funds as well, by mobilizing partners with quantification expertise or directly by including this need in service level agreements with UNDP.

Strategic objectives for good pharmaceutical procurement include:

• selection of reliable suppliers of high-quality products
• procurement of the most cost-effective pharmaceutical products in the right quantities and that meet quality standards
• mitigation of possible risks
• timely delivery
• achievement of the lowest possible total cost (which includes the price, cost of analysis and transport).

Source: World Health Organization (2014) Model Quality Assurance System for Procurement Agencies (MQAS)

To be effective, a procurement agency should ensure that the following principles are applied:

• Prequalified products are purchased from approved manufacturers or suppliers.
  Procurement and purchasing procedures are transparent.
• Activities follow formal written procedures throughout the process, including explicit criteria for awarding contracts.
  Procurement includes an independent contract review.
• Purchasing is based on the defined procurement policy of the procurement agency.
• Purchasing and tender documents list all pharmaceutical products by their international non-proprietary name or national generic name.
• Suppliers are selected and monitored through a process that takes into account product quality, service reliability and performance, delivery time, ethics, legal status, financial viability and minimum order quantities.
• Intellectual property rights are respected in accordance with best practice and national law.

Source: World Health Organization (2014) Model Quality Assurance System for Procurement Agencies (MQAS)

UNDP’s approach

Support to countries for health procurement can be provided by UNDP for several categories of medicines for infectious diseases such as HIV, tuberculosis (first-line drugs) and for non-communicable diseases, such as cancer and cardiovascular diseases, and other related medicines. All the procurement of pharmaceuticals and other health products is performed in full compliance with the UNDP Quality Assurance Policy for Health Products. Furthermore, UNDP’s offer can include procurement for a broad range of laboratory and hospital equipment as well as solar panels and related equipment. In 2020, UNDP supported procurement in the context of national responses to the COVID-19 pandemic, including securing and supplying live-saving personal protective equipment, diagnostics and hospital equipment to countries globally. UNDP has delivered COVID-19 related products valued at over $213 million to 140 country offices.

UNDP has two decades of experience procuring and managing health products for large-scale HIV, tuberculosis and malaria programmes funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund). In many countries, UNDP also receives requests from governments to procure health products using state funds. Service-level agreements between UNDP and countries can either relate exclusively to procurement operations or include capacity development in selected procurement and supply chain management (PSM) areas, such as the strengthening of quantification processes, the establishment of a national procurement agency and the infrastructural and functional improvement of central and peripheral warehouses. Training and certification curricula for the staff of procurement units from ministries of health and governmental agencies are also included in the offer.

UNDP uses its health procurement support as an entry point for developing capacity in different areas of the PSM cycle, including on the procurement function. As an example, in Sudan, UNDP provided capacity-building on procurement through the formal training of staff from the national procurement department and through on-the-job training by posting out UNDP staff to the Ministry of Health. In countries such as Angola and Bolivia, UNDP has provided technical assistance on procurement planning processes. UNDP has also provided support for strengthening national procurement systems to countries in Eastern Europe and Central Asia, which have signed service-level agreements for health procurement with UNDP. In Ukraine, procurement operations with state funds have been linked to a four-year plan to establish and develop the capacity of the national procurement agency within the Ministry of Health. The ultimate objective is to reform and build a cost-efficient, transparent procurement system, build the structural and human resource capacity and progressively hand over procurement activities.

Tools and support mechanisms

UNDP jointly with the Chartered Institute of Purchasing and Supply (CIPS) has established a training and certification curriculum tailored to UNDP staff and staff from the procurement units of ministries of health, national medical stores and non-governmental organizations.

Building on its experience managing procurement operations to support Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) recipient countries, UNDP has set up a consolidated international procurement architecture comprising several partnerships and sourcing agreements with other United Nations agencies, manufacturers and other commercial entities. In recent years, UNDP has used this architecture to procure on average around $350 million a year in pharmaceuticals and other health products for countries. This includes both direct procurement by UNDP and procurement by partners for specific categories of products, such as for drug-resistant tuberculosis and reproductive health.

UNDP’s long-term agreements with suppliers of medicines for HIV and tuberculosis have resulted in significant economies of scale. For example, in 2017, UNDP achieved a landmark cost for first-line antiretroviral drugs – the fixed-dose combination of Tenofovir, Lamivudine and Efavirenz (TLE) – of $75 per patient per year (Free Carrier (FCA) incoterm or International Commercial Terms price). The savings from pooled procurement for the antiretroviral fixed-dose combination of TLE, which accounted for $55 million in 2017, allowed UNDP to pilot measures for environmentally sustainable procurement.

In 2016, UNDP started procuring other health products including medicines for non-communicable diseases (NCDs), such as for cancer, cardiovascular diseases, diabetes, chronic respiratory diseases, and other non-infectious diseases. In many countries, UNDP receives requests from governments to procure these products using state funds.

UNDP’s Solar for Health initiative has also resulted in the establishment of health sector long-term agreements with suppliers to provide solar technologies and equipment for PSM infrastructure.

UNDP’s approach

UNDP has expertise in the assessment of national supply chains with the identification of needs and their prioritization. UNDP can offer support in the development of supply chain strategies and in infrastructure projects to address storage and supply chain needs from the central to peripheral levels.

UNDP’s Solar for Health Initiative is used to build additional resilience and connectivity in the supply chain, equipping warehouses and health facilities with solar panels and therefore ensuring electricity for cold chain, controlled temperature storage and computer-based electronic warehouse management systems and logistics management information systems. As part of its Smart Facilities initiative, UNDP also offers a range of other digital solutions to strengthen the sustainability and efficiency of infrastructure. It likewise draws on technical solutions implemented in other sectors, including those identified through the UNDP-Singapore Global Centre for Technology, Innovation and Sustainable Development

Overall support is provided through expert advice in areas such as:

• the development of quality assurance and good storage practices training programmes;
• the procurement and calibration of temperature recording loggers;
• the procurement and installation of cooling units;
• the development of self-inspection programme;
• the support to outsource storage and distribution to a service provider for storage and distribution.

Examples

Over the years, UNDP has participated in various projects devoted to improving inventory management and storage conditions of health products.

Supply chain assessments

Sustainable and resilient health systems require a functional supply chain system, including the adequate management of central-, regional- or district-level stores. UNDP has been involved in supporting the assessment of national supply chains systems, including in Chad, Equatorial Guinea, Sudan, Tajikistan, Zambia and Zimbabwe.

Supply chain strategies

In some countries, UNDP has also taken an active role in the development of supply chain strategies under the leadership of the national authorities and in facilitating the collaboration of supply chain partners, such as in South Sudan, Sudan and Burundi. Such strategies are critical to defining priorities among the identified needs, establishing work plans and related budgets, coordinating inputs from different partners and optimizing available resources to strengthen the national supply chain.

Health infrastrcture works

UNDP has a track record of experience in managing infrastructure projects to improve storage capacity and conditions. In particular, UNDP has conducted extension of storage capacity projects at different levels of the supply chain (central, regional, peripheral) in numerous countries.

These projects have included support to build a new national warehouse Guinea-Bissau and renovate a malaria products warehouse in Bolivia. In Sudan, Kyrgyzstan and Turkmenistan, UNDP has provided support to strengthen national warehousing and to equip and renovate storage facilities at different levels of the supply chain for pharmaceutical and other health products. All infrastructural/warehousing projects are considered holistically and are often coupled with the provision of equipment (e.g. shelves, pallets, forklifts, ventilation/air-conditioning systems, warehouse management information systems) to ensure good storage conditions in terms of temperature, humidity, cleanliness, pest control and light exposure and stock security.

As a part of this comprehensive offer, UNDP has also installed solar panels on medical warehouses in Angola, Sudan, Zambia and Zimbabwe, among other countries, to ensure continued power supply for cold chain equipment and controlled temperature storage conditions.

Infrastructure projects are combined with capacity development in the implementation of good storage practices, related to personnel, premises and facilities, storage requirements, returned goods, dispatch and transport, and product recall. For example, technical assistance on storage and inventory management at the central level has been provided in Guinea-Bissau and South Sudan. As an interim Principal Recipient of the Global Fund to Fight AIDS, Tuberculosis and Malaria grants in some countries, UNDP country office specialist(s) systematically participate in national technical procurement and supply chain management working groups involved in the monitoring of health product stock levels and supply chain strengthening.

Case Study: Resilience and Sustainable Infrastructure for Stronger Supply Chains in Mozambique

In 2019, UNDP began supporting Mozambique’s Ministry of Health (MoH) with health infrastructure development to improve the storage of medicines and health products and the disposal of medical waste, under the National Logistics Pharmaceutical Plan. Through a financing agreement under the Global Fund HIV and tuberculosis grant, UNDP and the MoH established and renovated central and regional medical warehouses.

The Chimoio regional warehouse was inaugurated in July 2021 to provide a secure storage and distribution point and consistently supply quality medicines and health products in Manica province, including at the last mile. The warehouse serves 139 Health Facilities covering a population of about 2,298,753 in the Manica province (Source: Centre for Medicines and Medical Products, CMAM). This fully equipped, 2,278 m² warehouse was also the first in Mozambique to install a containerized incinerator to manage biomedical waste. In June 2023, UNDP and the MoH reopened the Beira Central Warehouse in Sofala province, which was damaged by Cyclone Idai in 2019. This warehouse can withstand winds of up to 200 km/h. The initiative increases access to quality health products in remote areas affected by disasters, as part of UNDP’s broader work to promote inclusion, resilience and sustainability.

Photo: Beira Central Warehouse, after renovation in March 2023

Operated by CMAM, the Beira Central Warehouse supplies 4 provinces in the Central Region of the country: Sofala, Manica, Tete and Zambezia. This includes supplying the Central Hospitals of Beira and Quelimane cities, serving 187 Health Facilities and covering a population of approximately 2,674,787 in these provinces (Source: CMAM). The warehouse includes:

• A maximized and optimized racking system with more than 5,000 pallets
• Flexi stackers for improved product handling and storage management
• Enhanced security systems with up-to-date computer, data, and security systems
• An 800% increase in electricity production, up to 1000 kVA, providing a reliable source of power.
• Storage capacity of 42 m³ of clean water and 36 m³ of rainwater for the operation and maintenance of the facility’s safety.

In recent years, UNDP Mozambique has established new partnerships with the Islamic Development Bank to expand health centres in response to COVID-19. UNDP Mozambique is also working alongside the MoH and Gavi, the Vaccine Alliance to strengthen waste management policies. Discussions have started to provide options for the establishment of Smart Facilities for Health at various points of the supply chain in the coming years, which would improve the sustainability and reliability of health services.

A in-country health product distribution system should achieve the following objectives:

• maintain an uninterrupted supply of health products to the end users;
• keep medicines and other health products in good conditions throughout the distribution chain;
• ensure secured transport conditions to prevent diversion, losses of health products due to spoilage and expiry;
• contribute to stock visibility across the supply chain and facilitate tracking and traceability of products with accurate inventory records;
• optimize storage points according to public health objectives;
• use available transportation resources as efficiently as possible, including considering opportunities for public private partnerships with third party logistics;
• provide regular operational information for forecasting health products needs.

UNDP’s approach

UNDP offers expertise to countries to conduct assessments of existing national supply chains’ maturity and to identify interventions for capacity-strengthening related to distribution chains. Within its broader support for the formulation of supply chain strategies, UNDP helps to design and operationalize distribution systems. This support is also complemented by infrastructure and pilot projects to improve logistic management information systems, which are essential to plan, monitor and review distribution cycles at different levels of the supply chain.

As part of the development of supply chain strategies, UNDP helps to address distribution needs, support national counterparts to design the optimal distribution system according to the country context and convene players to agree on comprehensive work plans. This helps to strengthen national distribution supply systems that are either managed by the central medical store or outsourced. UNDP also supports the selection of key performance indicators to track the optimization and performance of distribution and transport systems.

UNDP has also promoted the use of digital data loggers and other innovative tools in the distribution chain of several countries to ensure the effective monitoring of temperatures and product tracking during transport.

The rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community.

World Health Organization

The World Health Organization advocates the following key interventions to promote more rational use:

• establishment of a multidisciplinary national body to coordinate policies on medicine use;
• use of clinical treatment guidelines;
• development, regular update and use of national essential medicines list, in line with clinal guidelines;
• regular availability of timely and accurate inventory data for informed decision-making;
• establishment of drug and therapeutics committees in districts and hospitals;
• inclusion of problem-based pharmacotherapy training in undergraduate curricula;
• continuing in-service medical education as a licensure requirement
• supervision, audit and feedback;
• use of independent information on medicines to health care providers;
• public education about use of medicines;
• avoidance of perverse financial incentives;
• use of appropriate and enforced regulation;
• sufficient government expenditure to ensure continued availability of essential medicines and staff.

Source: World Health Organization (2002). Promoting Rational Use of Medicines: Core Components – WHO Policy Perspectives on Medicines. No. 005.

UNDP’s approach

While the World Health Organization (WHO) is the lead agency mandated to provide technical assistance in the area of rational use of medicines and pharmacovigilance, UNDP’s service level agreements with governments to strengthen pharmaceutical management can include aspects related to rational use and pharmacovigilance. UNDP can also support the strengthening of the regulatory agencies and systems in regulating, controlling and monitoring the use of authorized medicines in the countries. As part of national strategic laboratory plans, UNDP has solid experience in contracting for installation, calibration and maintenance services of complex diagnostics for tuberculosis and HIV.

For countries funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), and according to the Global Fund policies for procurement and supply chain management, UNDP supports the rational use of medicines by ensuring that countries follow WHO evidence-based treatment guidelines. The WHO guidelines recommend the use of the most appropriate and evidence-based medicines, including the indication of formulation, dosage, administration route and treatment duration.

Pharmaceutical management support includes the prescribing and dispensation of medicines and checking patient adherence to treatment measures and resistance surveillance. Patient adherence to treatment is normally assessed routinely within health programmes and during external national programme reviews. Notification of adverse drug reactions is promoted within national pharmacovigilance systems.

Similarly, for diagnostics and other health products, the correct use is ensured by adopting WHO guidance and recommendations for use at different levels of the health system. UNDP can support the development of strategies for improving adherence to treatment. For diagnostics technologies, UNDP supports countries to install, calibrate and set up a maintenance plan for equipment and train staff on this. In Zimbabwe, for example, UNDP provided technical assistance to the National Regulatory Agency to upgrade the national pharmacovigilance system from a paper-based to an electronic system for reporting adverse drug reaction.

UNDP’s approach to the optimal use of health products includes upfront reduction of waste by engaging with manufacturers to optimize packaging, e.g. carton-less bottles, and working on waste management including for specific pharmaceutical categories.

Key concepts

UNDP’s approach

Upon governments’ requests, UNDP can provide support for identifying and assessing health products in accordance with World Health Organization (WHO) and international standards. It can also mobilize a pool of international experts to assist the regulatory authorities in the identification, assessment and prequalification of health products, in accordance with WHO and international standards. The same experts can be mobilized to provide training sessions in quality assurance to counterparts (regulatory authorities or central medical stores) in countries based on specific requests submitted by the authorities.

UNDP also provides support to the development of infrastructure and capacities in national quality control laboratories in several countries, in close collaboration with the WHO prequalification programme for quality control laboratories. In order to ensure that the quality of health products is maintained in the supply chain, UNDP also promotes the use of appropriate vehicles and containers for the transport of health products and the use of data loggers for controlling the storage and distribution of medicines. This implies the training of staff on the use, collection and analysis of data.

Tools and guidance

The health procurement performed by UNDP for donor grants complies with quality assurance policies established by the donor for specific health product categories. For other health product categories and for government-funded health procurement, UNDP has defined its own quality assurance policy for health products for medicines, medical devices including diagnostic products and personal protective equipment (PPE). The UNDP QA policy is based on WHO norms and standards and is aligned with the policies of other key stakeholders (the Global Fund to Fight AIDS, Tuberculosis and Malaria, the United Nations Children’s Fund – UNICEF, the United Nations Population Fund – UNFPA, Doctors Without Borders – MSF, International Committee of the Red Cross – ICRC, etc.).

UNDP has also developed a quality assurance planning tool, to help to carry out assessments at the country level throughout the supply chain cycle. This includes looking at all the aspects in the procurement and supply chain management (PSM) cycle that relate to ensuring the quality of the medicines and health products, from selection to use and waste management. The application of this tool is designed to be carried out in coordination with the national regulatory authority, WHO and other partners involved in health PSM in the country. The end result is the identification of gaps and the definition of activities to address and prioritize the identified needs, coordination of financial resources, and elaboration of an operational plan to strengthen the quality assurance in the national supply chain.

UNDP support to quality assurance: country examples

Zimbabwe obtained prequalification status from the World Health Organization (WHO) for its chemical laboratory to perform quality control (QC) in 2014 and it is in the process of getting its microbiology laboratory WHO-prequalified. UNDP is also supporting Sudan and Afghanistan to upgrade their QC laboratories to meet the WHO prequalification status.

In Kyrgyzstan and Uzbekistan, UNDP supported the national regulatory authority laboratories in assessment of their readiness to be included on the list of QC laboratories meeting requirements from the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) (ISO/IEC 17025) as well as in submission of questionnaires on the technical proficiency of QC drug testing laboratories for the Global Fund attestation. Both laboratories have been included in the list of ISO 17025 QC laboratories compliant with the Global Fund quality assurance requirements.

In Zimbabwe, UNDP is also providing support to the national regulatory authority to address the priorities identified in the institutional development plan developed jointly with WHO. UNDP plans to provide further support on the development of quality assurance systems in national procurement agencies.

Governments should strengthen national level policy and institutional coherence between trade and intellectual property, the right to health and public health objectives by establishing national interministerial bodies to coordinate laws, policies and practices that may impact on health technology innovation and access.

United Nations (2016). Report of the United Nations Secretary-General’s High-Level Panel on Access To Medicines

The COVID-19 pandemic has further revealed the significance of enabling policies and regulations for equitable health access. It has seen a vast increase in urgent legislative action to control and reduce the pandemic. Well-designed laws can help build strong health systems, evaluate and approve safe and effective drugs and vaccines, advance human rights and enforce actions to create healthier and safer public spaces and workplaces.

UNDP’s approach

UNDP provides support in low- and middle-income countries to conduct assessments and create enabling policy, legal and regulatory environments to influence access to essential medicines and other health technologies. This includes by convening comprehensive and multisectoral reviews of policies, laws and regulations that affect health technologies, disseminating best practices and providing advisory services and technical assistance as needed. UNDP draws on networks of expertise, including for health policies, laws and regulations relevant for ministers of health and regulators of medicine and other health technologies, competition and intellectual property authorities and other relevant authorities and stakeholders.

Through partnerships such as the Access and Delivery Partnership and the Global Health Innovative Technology (GHIT) Fund, UNDP supports both research and development and access to new health technologies for malaria, tuberculosis and other neglected diseases in developing countries. UNDP specifically supports the building of national capacities for enabling legal, policy and regulatory frameworks for the introduction of new health products for these diseases.

UNDP works closely with the World Health Organization and other United Nations agencies on the development of knowledge products and guidance to increase innovation and access to health technologies. Several publications have been developed to guide countries to adopt and develop national policies, laws and regulations to increase access to affordable quality-assured health products. See more under key resources below. Collaboration has also included joint efforts to inform the establishment of strong legal frameworks that promote health equity in countries’ management of the COVID-19 pandemic, including through the creation of the COVID-19 Law Lab.

The work performed by UNDP in policies and regulations is integrated into the national strategic plans for the pharmaceutical sector and the laboratory networks established by the countries’ ministries of health. Procurement of medicines and other health technologies is performed by UNDP in compliance with national laws and regulations.

Examples

UNDP is working in close collaboration with partners and national authorities to strengthen the national supply chain management system for health products in Zimbabwe, including with the national medicines regulatory authorities on quality monitoring and control. This support has formed part of UNDP’s broader health systems strengthening interventions implemented through its partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).

Initially, UNDP’s support to the government on procurement and supply chain management (PSM) entailed a range of interconnected activities including:

• carrying out a comprehensive assessment of the national pharmaceutical supply chain system in 2013 and using the findings to develop a costed action plan;
• working with the the Ministry of Health and Child Care, the Global Fund Country Coordination Mechanism and key partners to mobilize funding to implement the endorsed costed action plan regularly reviewed;
• working with the the Ministry of Health and Child Care and partners in developing strong quantification processes for health products through a robust and inclusive quantification working group using well established quantification tools;
• strengthening health products quality assurance processes and capabilities of the Medicines Control Authority of Zimbabwe (MCAZ);
• working with the National Pharmaceutical Company (NatPharm)—the central medical store—and in coordination with other development partners to develop their capacity and enhance stock management and optimize their services to the health care system since 2011;
• carrying out a comprehensive assessment of the medical laboratory supply chain system in 2016 and developing a costed action plan for implementation during 2018-2020;
• developing a viral load reagent rental agreement strategy for HIV viral load testing with key suppliers of in-vitro diagnostics equipment

Together, this support has promoted the population’s increased access to quality assured essential medicines and other health products for malaria, HIV and tuberculosis, and beyond, and improved the quality of health services.

Additional examples of the support provided for different aspects of the supply chain are described below.

Inventory and distribution: The capacity of both NatPharm and the Ministry of Health and Child Care to store and manage inventory and distribute essential medicines has been developed through:

• the renovation and building of new NatPharm regional storage warehouses in key provinces such as the regional store in Masvingo;
• the renovation or construction of new pharmacy stores to improve storage conditions at the Ministry of Health and Child Care service delivery points;
• the provision, installation and end-users training for two pharmaceutical grade incinerators for waste disposal located in NatPharm stores;
• the development of a national waste management plan and standard operating procedures
• collaboration with the Ministry of Health and Child Care and partners to build an eLMIS to ensure supply chain real-time data visibility
• improvements to cold chain storage and distribution systems through the provision of cold room compressors in the central warehouse, refrigerated trucks and data loggers;
• the provision of new trucks to NatPharm to imporve the health products distribution services to health facilities;
• equipment of health facilities with solar power systems ensuring sustainable sources of electricity for cold chain and controlled temperature to store vaccines, medicines and diagnostic tests, and to provide back-up power to the electronic health information system at the health facility level
• the provision and maintenance of laboratory equipment.

Procedures and systems for inventory management. The infrastructural support has been complemented by improvement of warehouse organizational and operational processes and the development of standard operating procedures for inventory management with the support of a supply chain expert embedded in the NatPharm management team, for technical assistance. Together with other health partners, UNDP is supporting the Zimbabwe Assisted Push System (ZAPS). The system standardizes processes for primary health-care facilities in terms of ordering and receiving the products. The ZAPS support makes essential medicines more evenly available to facilities and hospitals and improves accuracy of supply chain information. The ordering team leaders from the district travel to each health facility should agree on the ordering interval, support the counting of all stock, record losses and adjustments, record days out of stock, calculate quantities required for each product and place orders with NatPharm. The completed orders for all health facilities in the catchment area are sent to the nearest NatPharm branch for processing and the subsequent delivery of orders to individual facilities.

Human resources for PSM. Staff from NatPharm and the Ministry of Health and Child Care have engaged in online postgraduate PSM training, which led to international qualifications. In addition, staff from NatPharm and the Ministry of Health and Child Care have completed training and assessment to obtain accreditation from the Chartered Institute of Purchasing & Supply.

Quality assurance. UNDP has been working with the Medicines Control Authority of Zimbabwe (MCAZ) since 2010 to develop capacity to provide quality assurance of all health products being procured. Through financial support from the Global Fund, UNDP, with partners, has supported MCAZ to improve the infrastructure, equip and develop the capacity of its chemistry laboratory, and obtain the status of a quality control (QC) testing laboratory prequalified by the World Health Organization (WHO) in 2014. MCAZ now acts as a QC laboratory for nationally procured and distributed medicines, and also for other countries in the region that do not yet have a WHO-prequalified laboratory. Since the WHO prequalification of chemistry laboratory, UNDP has been using MCAZ QC testing services to test and monitor the quality of the pharmaceutical products procured with Global Fund grants, in line with the Global Fund quality assurance policy for pharmaceutical products. Consequently, acknowledging the demonstrated competency of MCAZ, UNDP has established a long-term agreement with MCAZ to conduct the QC of medicines for other countries where UNDP acts as interim Principal Recipient for Global Fund grants and/or provides health procurement support.

Pharmacovigilance system strengthening. The pharmacovigilance system was also upgraded for the reporting of adverse drug reactions, from a paper-based to an electronic system through international technical assistance in 2017.

Continued support for the management of health products through UNDP’s long-term partnership with national institutions, the provision of technical assistance and mobilization of donor investments to complement domestic funding for PSM activities has enabled Zimbabwe to demonstrate capacity and leadership towards achieving good-quality pharmaceutical services to the population.

Overview

Robust financial management systems and capacities are required to plan, direct and control financial resources so that the objectives of national health programmes can be effectively and efficiently achieved. In addition to managing the short-term cashflow needs, financial management includes budgeting, systems, procedures and controls to protect financial assets, and ensuring there is sufficient relevant and reliable information for good decision-making.

Financial management must be prioritized within the overall programme management responsibilities of an entity implementing a health programme, with close coordination between financial planning and budgeting, and between the planning and delivery of programmatic results. Likewise, systems for financial management and reporting of donor-funded health programmes must be integrated into national public financial management systems to ensure their sustainability.

UNDP takes a multifaceted approach to strengthen the financial building blocks of the health system that make it possible to deliver services of high quality. At the national level, UNDP works with governments to strengthen national public financial management systems for health and develop the capacities of national entities to sustainably manage and generate domestic and international health financing. This includes support to generate and evaluate accurate financial information, including from the private sector, to inform health policies and identify sustainable models to scale health services.

At the programmatic level, UNDP provides technical assistance to national institutions and civil society organizations to strengthen financial management capacities for effective implementation of large-scale health programmes, including those funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). UNDP provides end-to-end technical support for financial management to implementing entities on issues including planning, budgeting and forecasting, revenue generation, expenditure, monitoring and controls, reporting, and audit and assurance.

The pages in this section provide guidance and further details of UNDP’s support to governments and other health partners across each of these dimensions of financial management for national health systems and programmes, including HIV, tuberculosis and malaria programmes funded by the Global Fund. For further guidance on UNDP’s technical support to sustainable health financing, refer to the “Sustainable Finance” section. Additional tools and more detailed guidance on financial management processes for UNDP-managed Global Fund programmes can be found in the UNDP-Global Fund and Health Implementation Guidance Manual.

UNDP’s approach

Through its interconnected support to promote sustainable financing models and improve institutions, policies and processes that govern the use of public funds for health at the national level, alongside work to enhance financial management capacities and processes in the implementation of national disease programmes, UNDP’s capacity-building approach provides mutually reinforcing entry points to help countries progress towards universal health coverage. Strong financial management in programmes ensures that existing resources for health are efficiently used to maximize health outcomes, while enhanced public financial management and sustainable financing ensures that these outcomes can be scaled and sustained in the long term. Financial management involves much more than accounting for income and expenditure. It includes all aspects of planning, organizing, directing and controlling financial activities. UNDP therefore works in close partnership with health system actors to ensure accurate and timely financial data contribute to making critical and evidence-based decisions for health-related goals.

UNDP’s entry points for support include processes and capacities for financial management, financial data for accountability and decision-making and financial risk management.

1. Processes and capacities for financial management

As part of its financial capacity-building activities for government and civil society organization partners, including as interim Principal Recipient of grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) in countries facing challenging operating environments, UNDP does the following:

• It takes into account existing assessments and findings for financial management: UNDP has developed comprehensive capacity assessment tools to help governments identify how closely existing financial management policies and procedures meet current and expected financial management needs. Using these tools helps to establish a baseline and a clear understanding of what financial management systems can achieve.
• It supports selection of performance indicators and measurable milestones on financial management to support sustainable transitions of health programmes from donors to national entities and systems.
• It supports the development and implementation of a capacity development plan to facilitate short, medium, and long-term interventions with a focus on building sustainable financial systems for health.
• It provides technical assistance, mentoring and training on financial management for public health actors at all levels of the health system.

2. Financial data for accountability and decision making

Good decision-making to achieve health programme objectives requires timely, relevant and reliable financial data. In both government and non-government sectors, it is critical to set clear goals and establish systems and controls to report on them. Beyond optimizing programme performance, the ability to demonstrate financial results of key interventions within the health sector facilitates the prioritization and scaling- up of effective measures. UNDP’s support to enhance financial accountability recognizes that financial information requirements need to reflect the fundamental accountability structures of the health system. In a highly centralized system, the information system should track expenditure over the whole of the health system, and feed information into the centre.

Fiscal transparency in the public sector strengthens governance and accountability and should also result in improvements in programme performance to support better health outcomes. To strengthen the linkage between financial reporting and improved health programme performance, UNDP:

• supports national entities to assess the current financial management system and consider the options to meet national and international reporting requirements;
• assists national entities to strengthen their financial systems and consolidate financial data, including real-time data to improve monitoring and decision-making;
• leverages customized digital technology and commercial software to help national partners, including ministries of finance, strengthen public financial management systems for the health sector.

3. Financial risk management

Financial control and risk management are central to the effective management of a health system. UNDP helps countries to assess risk factors and ensure risk management is embedded in strategic planning for health programmes as well as in routine daily practices for health implementation activities. Through its partnership with the Global Fund and role as interim Principal Recipient of grants in challenging operating environments, UNDP has also helped to reduce the risk of corruption and fraud by strengthening financial management, working together with national entities to better manage grants, set up web-based accounting systems, and introduce robust control frameworks.

Applying a coherent focus on strategic, operational and financial risk factors, UNDP does the following:

• It works with the management of health programmes to focus on identifying actual and potential threats and opportunities, assessing the impact of those risks and prioritising them;
• It selects appropriate financial tools to mitigate risk, including different payment modalities such as direct payments on behalf of implementing partners and reimbursement to implementing partners to enable their implementation in high-risk environments. The direct cash transfer modality can be used for institutions with adequate capacity to manage and report on the utilization of advances. This modality also plays a role in the strengthening of national financial accounting and reporting systems.
• It supports national entities to make informed decisions about the level of risk that they want to take in order to effectively pursue their objectives;
• It helps to set up appropriate risk management frameworks and internal controls, including financial management systems, to counter threats and take advantage of opportunities.

Purpose

Effective planning is key to ensuring clear, relevant organizational goals are established and achieved in the process of building resilient financial management systems.

Planning involves understanding and documenting the expected role of the finance function in contributing to the achievement of a government’s or organization’s goals. This includes appreciating the strategic role that the finance function can play in achieving broader health and development goals, as well as ensuring the recording and reporting of day-to-day transactions.

Having recognized the role of the finance function, planning involves ensuring that the expected outputs are reflected in the structure of the finance department and identifying the number of people and the skills needed to perform this function.

UNDP’s approach

Through a good understanding of countries’ national priorities, UNDP is able to work closely with governments and stakeholders to document clear goals that contribute to implementing and monitoring improvements in financial systems for health.

To facilitate the planning process, UNDP assists stakeholders of health programmes to conduct financial analyses. This process has helped to identify the optimal financial management structure for health programmes in Africa, Asia and the Caribbean.

Within this approach, UNDP:

• leverages its experiences assisting countries and projects to plan health programmes and systems. It provides access to experiential knowledge, technical guidance and innovative tools/methodologies for financial management
• utilizes existing capacity assessment tools that help to identify areas for capacity development in planning for health systems, in addition to the United Nations Harmonized Approach to Cash Transfers (HACT) framework described below.
• works with government health systems as well as civil society organizations to establish development milestones and indicators, including training needs to measure improvements in financial planning.

Purpose

Budgeting and forecasting enable resources to be allocated and tracked so as to achieve programmatic and financial objectives.

Budgeting is a process usually undertaken before the beginning of the financial year, to create a plan or estimate of the expected incomes and expenditures in the upcoming financial year. The budgeting process is usually collaborative, enabling budget assumptions to be agreed on and stated.

Budgeting processes can also provide an opportunity for stakeholders to agree on resource allocations, identify efficiencies and determine practical methods to manage and prioritize the strategic goals of the organization based on available resources.

Forecasting can assist in preparing forecasts of cash inflows and outflows as well as a “sensitivity analysis”, understanding the areas in which a small percentage change can have significant overall impact.

UNDP’s approach

UNDP has worked with several ministries of health to develop detailed operation and finance manuals and standard operating procedures, which detail the budgeting process and include the processes for approval and subsequent budget monitoring and modification.

UNDP has assisted health programmes to improve budgeting and forecasting systems in Africa, Asia and the Caribbean. In particular, UNDP:

• works with ministries of health to improve national budget systems and procedures and support preparation of budgets for health programmes.
• provides technical support to budget and cost national strategic plans, including identifying available resources and critical gaps.
• supports countries to demonstrate a clear linkage between national health strategies, disease programmes and financial resources, budgets and forecasts.
• works with civil society organizations and governments to design and implement robust budgeting systems supported by a systematic approach for cost allocation and cost recoveries.
• develops manuals, guidelines and standard operating procedures to conduct a meaningful variance analysis and where appropriate, feed into remedial actions.
• establishes clear policies for project-specific costs, including: salary scales and entitlements suitable for attracting and retaining critical project staff; travel and subsistence; standardized training costs; vehicle usage and costings; consulting fees and scale rates; and apportionment of overhead costs.
• promotes innovative approaches to tailor existing information technology systems and technologies that interface with existing financial management systems for easy-to-use budget input and forecasting.
• helps to identify areas for strengthening in budgeting and forecasting for health systems, using an established capacity assessment tool.
• works with government health systems and projects and civil society organizations to establish development milestones and indicators, including training needs to measure improvements in effective budgeting and forecasting.

Purpose

Revenue generation strategies identify resources to be mobilized to enhance sustainability. These approaches also help to build resilience.

Revenue generation in health systems focuses on developing detailed investment cases to advocate for additional funding, providing a detailed analysis of the imposition of a particular charge or tax. Funding could be from within countries’ own available funding or from external sources.

When a country is experiencing an economic downturn, a strong case may need to be made that budget cuts within other government departments are not applied with the same vigour in the health system. Revenue generation should also ensure that patients payments for medicines and other services are captured completely within the existing finance systems.

UNDP’s approach

To support revenue generation for health programmes, UNDP does the following:

• It supports ministries of health to build political commitment to improve financial revenue generation for health programmes.
• It works closely with the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) to support the development of investment for increased funding to the health sector, and specific disease programmes. This includes through the development of investment cases for non-communicable diseases and expanding innovative financing for HIV and health.
• It works with in-country partners to consider the best “blend” of financing to deliver services and consider the options for government financing and partners, to make the optimal investment in national programmes.
• It looks at existing and future sourcing for health finance, and together with partners, prepares detailed analyses of the impact of: health insurance; a disease-specific payroll tax; sugar and/or tobacco consumption taxes; and/or out of pocket charges as a deterrent to accessing services.
• It works with governments and civil society organizations to develop systems and processes that increase the accountability and transparency within a health system or project. This can directly result in enhancing the ability to attract and work with donors and partners, to build the confidence of decision makers and parliamentarians and increase accountability to the general public and end users.
• It develops capacities of national entities in fragile settings to sustainably manage domestic and international health financing and to deliver health programmes.

Examples

Health Investment Cases

Health investment cases empower governments with data-driven insights on the economic and social impact of diseases, while illustrating the financial and health benefits of investing in prevention and control measures. Developed through collaborative, country-led processes, these cases equip policymakers with the tools to implement cost-effective policies that enhance governance, financing, and health service delivery. By providing evidence-based data, they support policies that reduce inequalities, foster inclusive governance, and strengthen sustainable health systems.

Since 2015, UNDP, WHO, and partners have worked with national governments to develop 85 investment cases across 56 countries, driving 130 government actions as of 2024. These actions include Ghana’s 2023 tobacco tax reform, which increased taxes on tobacco, alcohol, and sugar-sweetened beverages; Uganda’s 2022 expansion of diabetic retinopathy treatment, ensuring access in all regional hospitals; and Colombia’s 2020 enhancement of tobacco warning policies, introducing stronger graphic health warnings on tobacco products. With 50 additional cases underway, these initiatives continue to mobilize multi-sectoral partnerships, shape health policies, and improve health outcomes, positioning health as a cornerstone of sustainable development. Learn more here.

Purpose

Financial management systems should ensure expenditures are incurred in a transparent manner and promptly recorded.

Expenditure systems and processes are an important part of budget execution. It is important to have policies, procedures and internal control systems for incurring expenditures that comply with approved work plans and budgets and optimize value for money. These systems should likewise enable the timely recording and safeguarding of records and supporting documents.

There should also be an internal control system that covers segregation of duties, so that the requisitioner is separate from the purchaser and the person who makes the payments.

UNDP’s approach

UNDP has assisted health programmes to improve expenditure systems by working with ministries of health to improve national systems and procedures to initiate, approve and report expenditure for health programmes. It uses a capacity assessment tool to help identify needs and measures to strengthen policies and procedures for expenditure management in health systems.

In particular, UNDP provides technical support to civil society organizations and governments to:

• design and implement robust expenditure systems, including transparent recording of shared costs.
• develop manuals, guidelines and standard operating procedures to authorize and approve expenditures.
• develop codes of conduct to avoid occurrence or perceptions of conflicts of interest; methods for procurement and document thresholds; standard operating procedures for requests for tenders and procedures for bid evaluation; procedures that are transparent and competitive, and; mechanisms for accountability and tracking of contracts and commitments and ensuring specified goods and services are received.
• ensure adherence to established policies for project specific costs
• develop milestones and indicators, including training needs to measure improvements in the timely and accurate recording of expenditure.

Purpose

Monitoring and routine controls reduce the risk of losses through fraud and suboptimal decision-making. The controls also create an environment which discourages corruption and enables instances of fraud and the to be detected.

Routine controls are the detailed internal controls that are embedded within the operations of the organization. They consist of prevention and detection/monitoring controls. Prevention controls restrict an unintended activity from occurring. Detection controls aim to identify activities that have occurred but were not planned.

Controls can also be considered as organizational, physical and personnel based. Organization controls set the structure of the entity and ensure the adequate segregation of duties to minimize fraud and collusion. Physical controls ensure the safeguarding of assets, the authorization and approval of transactions and the presence of accounting controls. Personnel controls include ensuring the recruitment of suitably qualified personal, adequate supervision and management oversight.

UNDP’s approach

UNDP has assisted health programmes, including those funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), to improve monitoring and routine controls. This includes by:

• sensitizing health personnel on the importance of monitoring and routine controls to reduce the risk of losses through fraud and bad decision-making
• developing specific tools, methodologies and good practices in response to high corruption risks within the health sector (refer to the section on anti-corruption for health to learn more about UNDP’s approach to corruption prevention).
• working with ministries of health to improve existing national systems and procedures with robust systems of monitoring and routine controls within health programmes

• where weak controls are identified, working with national partners to develop an action plan and propose interim alternative arrangements, alongside the implementation of measures to support the long-term goal of strengthening overall financial controls
• providing technical support to civil society organizations and governments to 1) design and implement cost-effective monitoring and controls systems ensuring compliance with national legislation as well as international best practice; and 2) develop manuals, guidelines and standard operating procedures to establish routine internal controls for inducting new staff and training existing staff members using a capacity-assessment tool to help identify areas for strengthening monitoring and internal controls within health systems
• identifying capacity-development milestones and indicators, including training needs, to measure improvements in the internal control environment facilitating training sessions and workshops for finance and non-finance staff working within health programmes, including on donor requirements, systems and routine controls.

Guidance

Typical controls for financial management should include:

Controls over cash and bank

• dedicated bank accounts (or sub-activities) where appropriate
• physical controls over petty cash, including restricting the amount of petty cash held
• at least two signatories required for payments
• preparation of monthly bank reconciliations
• review of bank reconciliations
• regular petty cash counts

Controls over fixed assets

• system for identifying fixed asset needs
• systems to ensure physical security of assets
• procedures to monitor use of assets, particular vehicles and computers and highly sensitive diagnostic equipment
• insurance of assets in case of theft or damage
• maintenance of fixed assets register
• procedures for asset acquisition, transfer and disposal
• periodic asset verification and reconciliation to fixed assets register

Segregation of duties

• Segregation of duties should ensure that no single individual has sole responsibility for any single transaction from authorisation to completion and review.
• While acknowledging that this may be challenging in small or rural settings, segregation of duties is an important tool for the deterrence and the detection of misuse of funds or assets.

Purpose

Timely, regular and accurate reporting results in better decision-making and improved regulatory compliance.

Reporting allows management to make good decisions based on up-to-date and relevant information. Reporting of expenditure against budget allows remedial action to be taken to address delays, budget overruns and reprogramming of activities.

Reporting to other government entities or donors not only ensures compliance with legal and regulatory obligations, but also provides accurate data that may attract additional funding.

UNDP’s approach

UNDP has assisted health programmes to improve reporting systems by working with ministries of health and civil society organizations to improve existing national systems and procedures and establish a system of timely and accurate reporting within health programmes. In particular, UNDP’s support includes:

• assisting organizations to realize the benefits of timely and accurate reporting, not just to result in increased compliance with reporting deadlines, but to facilitate better decision-making.
• leveraging innovative IT systems and technologies, which interface with existing systems, to provide easy-to-read financial reports.

• enhancing systems for real-time reporting to support accountability and transparency, as well as faster and more accurate decision-making.
• working with finance and other senior management to design a chart of accounts (used for data users to better understand and articulate their data needs), as one of the essential pre-requisites for financial accounting and reporting to facilitate fast, flexible data analysis.
• helping to design reports that are readily understood by all, including non-financial managers, exception reports, and detailed financial reports for use mainly by finance managers, as poorly designed financial reports often remain underused, with finance departments investing time in reports that do not fully meet the internal (management) and external (donors) needs.
• assessing the main challenges to timely and accurate reporting, to identify practical solutions and measures to overcome bottlenecks.

Purpose

Robust internal audit systems increase the reliability of financial systems and reports.

Internal auditing is an independent, objective assurance and consulting activity designed to add value and improve an organization’s operations. It helps an organization accomplish its objectives by bringing a systematic, disciplined approach to evaluate and improve the effectiveness of risk management, control and governance processes. An internal audit department considers systems and processes within and outside the finance department. In addition to compliance with established policies and procedures, they consider wider issues such as organization reputation, opportunities for growth and risk management.

An external audit adds credibility and reliability to financial reports by giving stakeholders an independent opinion of the financial statements for a given period.

An audit may be defined as an opinion by the auditor on whether the financial statements are prepared, in all material respects, in accordance with the relevant applicable financial reporting framework. Ideally, an audit should be conducted in line with International Standards on Auditing to enable the auditor to give their audit opinion. An unmodified audit opinion is often referred to as an unqualified opinion or clean opinion. This is where the audit report states that the financial statements present fairly in all material respects or give a true and fair view. A qualified opinion in the audit report is given when the auditor believes there is a material misstatement or is unable to obtain sufficient evidence on a particular matter or matters in a specific area.

UNDP’s approach

UNDP assists health programmes to improve audit and assurance processes by:

• developing internal audit tools and terms of reference and strengthening audit committees to improve the transparency of audit and assurance systems
• developing and implementing terms of reference for both external and internal audit work within health systems

• drawing on global experience, tailored to the country context, to provide advice and good practices on internal audit processes (e.g. an internal audit person or department should report direct to a senior government official or chief executive officer of a civil society organization, to be sufficiently independent of the health system)
• working with management to establish a plan to address the weaknesses and support successful implementation of audit recommendations.

Health systems can only function with health workers; improving health service coverage and realizing the right to the enjoyment of the highest attainable standard of health is dependent on their availability, accessibility, acceptability and quality.”

World Health Organization (2016), Global Strategy on Human Resources for Health

Overview

Human resources are an integral part of the health system, providing the link between the theoretical health services provision and the actual performance of the health service. The health workforce includes those who provide direct health services such as doctors and nurses and those who support the health services such as hospital managers, provincial and district managers, and accountants reporting on health budgets.

The health sector is not only labour-intensive, but it also depends on a precise application of the knowledge and skills of its workforce to ensure patient security and health. The mere availability of health workers is not sufficient; only when they are evenly distributed and accessible to the population, when they possess the required competencies, are motivated and empowered to deliver good-quality care, and when they are adequately supported by the health system does this translate into effective service coverage.

Many countries face difficulties in the education, deployment, retention and performance of their health workforce. In particular, many experience a high turnover of skilled health personnel because they migrate to countries offering better remuneration, better working conditions, opportunities for postgraduate education and training, and better standards of living. Ad hoc interventions consistently fail to correct workforce imbalances in health care. It takes years to educate and train health professionals and thus a long-term approach needs to be taken. Human resource decisions have long-lasting effects and are often difficult to reverse. This means that, rather than respond reactively, a strategic approach is needed that supports the development of a more resilient health system.

Improvements in community systems for health should likewise be considered alongside strategies to build capacities of the national health workforce. Community health workers are a critical channel for health service delivery to vulnerable and marginalized groups and for reaching communities disproportionately impacted by public health threats, including the COVID-19 pandemic. Learn more in the “Community systems strengthening” section.

UNDP’s approach

UNDP works closely with the World Health Organization (WHO) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) to build national capacity to aim for sufficient staffing and skill levels; adequate structures, roles and responsibilities; plans for addressing human resource gaps; and effective staff retention and staff development strategies. This includes supporting ministries of health to:

• strengthen capacity for effective policymaking governing human resources
• strengthen workforce planning for both the short and long term, through support to developing retention strategies and human resources for health strategies
• increase the supply and competencies of human resources through education and training in multiple areas such as programme implementation, monitoring and evaluation, and finance
• improve motivation and retention through monetary or non-monetary incentives, such as staff development programmes, for example by enabling staff within national procurement agencies to be certified by the Chartered Institute of Procurement & Supply
• strengthen communications, leadership and mentoring through leadership programmes for ministry of health staff.

UNDP also helps to leverage digital solutions and build capacities of ministries of health in the use of information and communications technology (ICT) as one way to improve the impact on human resources for health interventions. ICT investments can focus on software and systems to contribute to issues such as workforce planning, professional development and improving the working environment. Most notably, ICT can support the analysis of where health workers are most required, the development of e-learning modules to motivate and improve on-the-job learning, electronic health records improving links between health workers and patients, and improving morale, payroll management and performance management.

Guidance and examples

Strong policy frameworks are key to ensuring effective health workforces, by providing the political and strategic basis to plan, finance and implement priorities in the short, medium and long term. A strong national human resources for health policy can help to promote the availability of health workers in sufficient quantity and quality, at all levels and at the right place at the right time and ensure that they are well motivated to perform their functions. The goals of the human resources for health policy should be consistent with the broader national health objectives.

A human resources strategic plan should elaborate on what the policy will achieve and how it will be implemented and financed. It should follow from a comprehensive analysis of the human resources situation and challenges affecting the recruitment, development and retention of the health workforce. It is also important to consider that skilled health workers are unable to deliver services effectively without appropriate support personnel (accountants, information technology support officers, etc.) as well as physical capital such as adequate facilities, equipment and consumables such as medicines. Thus, health systems and the supporting human resources for health strategies need to balance these three vital demands – human resources, physical capital and consumables.

The World Health Organization (WHO) offers guidance and tools to support the situation analysis, planning, and policy-making processes to strengthen the planning and governance of human resources in the health sector.

Overview

Community systems strengthening has a strong focus on capacity-building and on strengthening human and financial resources, with the aim of enabling communities and community actors to play a full and effective role alongside government health and social welfare systems. Community groups and networks often face a range of barriers that limit their effectiveness and their ability to take a systems approach. This includes a lack of resources, capacity and support, and challenging legal, social and policy environments.

The goal of community systems strengthening is to achieve improved health outcomes by strengthening the capacity of individuals and civil society to advocate for, participate in and influence health governance and delivery at global, national and regional levels. This includes sharing tools, innovative approaches, insights and good practice across a broad range of organizations and networks.

The contribution made by communities to health has not always been recognized or supported and there is now renewed interest in strengthening capacity and linkages to develop community health systems as a valuable resource in their own right. This is particularly the case in the response to AIDS, tuberculosis and malaria, for which community models have been shown to improve outcomes related to access, coverage, adherence, viral suppression, retention in care and survival.

The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) Strategy 2023-2028 acknowledges community responses and systems as crucial, diverse, dynamic and highly adaptable. The Global Fund has pioneered work in community systems by strengthening and investing in strategies that maximize the participation of key populations, community organizations and networks in the design, delivery, monitoring and evaluation of services and activities aimed at improving health. The Global Fund’s approach to nature of interactions that exist between disease control programmes, primary health care and communities.

UNDP’s approach

UNDP’s expertise in institutional development and, in planning, financial management, monitoring and evaluation and its wide-ranging technical expertise in health and human rights, make it the ideal partner for community systems strengthening. In addition, and importantly, UNDP is well positioned to facilitate civil society’s participation in policymaking and decision-making at regional, national and sub-national levels.

UNDP is often called upon to support development coordination mechanisms at the country level, assist countries to formulate their national development strategies and align them with the Sustainable Development Goals. This is facilitated by long-standing UNDP partnerships at the highest levels of government, with law-making bodies such as parliaments and with civil society organizations.

UNDP, with its breadth of expertise and country presence, is unique within the United Nations Development System to help countries to connect the dots on the most complex sustainable development issues. The organization also has very strong organizational capacity, demonstrated over many years, and mechanisms in place to rapidly amplify messages across countries and regions. Given this and its reputation as an impartial partner, UNDP helps governments to convene across line ministries and development partners to promote whole-of-government and whole-of-society responses vital for transformational change. This includes ensuring that civil society is able to participate in a meaningful way in policy-making and decision-making mechanisms and forums.

UNDP has extensive experience in community systems strengthening for health, building on its early focus on enhancing community conversations for HIV. UNDP draws on strong technical expertise at global and regional levels and has the capacity to convene a wide range of stakeholders, including from the United Nations family. UNDP’s strategic plan (2022–2025) speaks to how development challenges are increasingly complex, requiring ever greater collaboration across sectors and partners to deliver impacts at scale and to utilize limited resources efficiently. This makes UNDP uniquely positioned to facilitate community engagement and representation with government.

The following page provides further details on key programme areas and opportunities to strengthen community systems.

Tools and guidance

The following UNDP information notes offer additional background and considerations to inform community systems strengthening:

• Defining key concepts. This offers guidance on: What do we mean by community? What is the difference between a community-led and a community-based organization? What is civic space? What do we mean by community systems for health?
• The role of community systems. This describes the unique added value of communities in national health responses and how community systems fit within the priorities of global health frameworks.
• Considerations for strengthening community systems.This details key enabling factors to consider when planning work with communities to strengthen systems.

Much of UNDP’s work to strengthen community systems builds on its partnership with the Global Fund, including through its role as interim Principal Recipient of grants from the Global Fund to Fights HIV, Tuberculosis and Malaria (Global Fund). The Global Fund has developed a set of four measurement frameworks that cover HIV/AIDS, tuberculosis, malaria and health system strengthening. Each of the measurement frameworks include a community systems strengthening module and each of these contains four interventions aimed at strengthening community systems. The community systems strengthening interventions provide the opportunity and funding to enable communities and community-based organizations to maximize their contributions to the AIDS, tuberculosis and malaria responses and address any gaps that may impede this.

Additional tools and guidance from partners can be found in the key resources below.

Examples

Purpose

Community system strengthening is about strengthening systems. It is about investing in the system pillars that enable community organizations and key population networks and groups to maximize their contribution to all aspects of health programming. Strengthening community systems also means investing in an environment that is enabling for communities and community organizations and ensuring that there is a place at the table for civil society organizations to be consulted on health-related decisions at every step.

Intervention areas

There are five main interventions that UNDP deploys for community systems strengthening: 1) strengthening an enabling environment for health; 2) strengthening institutional capacity, planning and leadership; 3) strengthening community-led monitoring and research; 4) strengthening community-led advocacy; and 5) strengthening community linkages, collaboration and coordination.

Overview

Anti-corruption, transparency and accountability measures are central components of health systems strengthening for universal health coverage.

Corruption in the health sector diverts resources, leads to negative health outcomes, threatens people’s lives and undermines citizen trust in public institutions. It also reduces the quality of health services and products, increases their costs, limits access to them, causes waste of financial and non-financial resources, leads to poorer staffing, and human rights violations and aggravates inequities. According to Transparency International, corruption in the health sector causes losses of over $500 billion every year, more than the amount of resources needed for universal health coverage. In 2018, the World Bank estimated that in some countries, as much as 80 per cent of non-salary health funds do not reach health facilities because of corruption. The poorest and most vulnerable populations in society are ultimately the ones to suffer the consequences.

Corruption in the health sector can take several forms. Transparency International defines six in particular. 1) Informal payments from patients; 2) embezzlement and theft; 3) absenteeism; 4) corrupt service provision activities, such as overcharging and false treatment reimbursement claims; 5) favouritism; and 6) manipulation of data. Among the key corruption risks in the sector are weak or non-existent rules and regulations, over-regulation, lack of accountability, low salaries and limited offer of services ( i.e., more demand than supply). The large amounts of funds exchanging hands and the multiplicity of stakeholders involved in decision points during each transaction lead to ample opportunity for corruption to thrive.

Crisis such as the COVID-19 pandemic further exacerbate the risk of corruption, particularly when country systems are fragile and there are limited or no effective oversight, audit and accountability mechanisms. In particular, conditions such as flexibility in responses, the simplification of procurement controls, the rapid flow of large funds, and the need for urgent responses instigated by the crisis create increased opportunities for corruption and fraud in the health sector.

UNDP’s approach

Through its Global Anti-Corruption Initiative (GAIN) and regional anti-corruption programmes, UNDP provides policy and programme support on anti-corruption, transparency, and accountability across sectors in more than 80 countries annually, working with a broad range of partners. Building on its governance expertise and health systems strengthening portfolio, UNDP is well positioned to advance integrated work in health, development and good governance.

For more than a decade, UNDP has harnessed these experiences to develop and support countries to apply methods and good practices to map corruption risks, develop strategies to address them, and sustain partnerships to tackle corruption in the health sector.

This work is done in partnership with a broad range of stakeholders at the global, national and regional levels, including international financing institutes, civil society organizations, the United Nations Office on Drugs and Crime UNODC, the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), the World Health Organization (WHO) and the World Bank.

UNDP’s particular emphasis as a partner includes supporting the implementation of risk-based frameworks for corruption prevention, strengthening fiduciary control and internal audit systems in national institutions, and promoting social accountability, including through the use of digital technology.

UNDP’s entry points and Examples

Supporting the implementation of risk-based frameworks for corruption prevention

Building on lessons that emerged through the UNDP Anti-Corruption and Integrity in the Arab Countries (ACIAC) programme and regional expert group consultations in 2015-2016, UNDP developed the Conceptual Framework for Corruption Risk Assessment at Sectoral Level. Through the framework, UNDP has supported several countries to customize and apply a targeted approach to corruption prevention based on an understanding of risk, equipping partners with the conceptual underpinnings to focus on corruption as a starting point for more comprehensive governance reforms.

For more information and guidance on UNDP’s corruption risk management methodology, visit the following page.

Strengthening fiduciary controls and internal audit systems in national institutions

As part of its work to strengthen systems for health, UNDP’s technical assistance to ministries of health entails capacity development of systems and processes for financial management, oversight, audit, and accountability. Building institutional capacities in these areas plays a key role in reducing opportunities for corruption risks to emerge within health programmes and service delivery. It moreover enables the maximization of health benefits from public resources and builds public trust in the system. More broadly, UNDP proactively supports national institutions to integrate anti-corruption, transparency and accountability measures into national development plans and processes, including strategies specific to the health sector.

Promoting social accountability, including through the use of digital technology

UNDP works to strengthen social accountability in service delivery, oversight in health policymaking, and the monitoring and evaluation of services. This includes through the use of innovation and technology platforms that enable citizen monitoring and strengthen access to public information, to help expose and reduce corruption. More broadly, UNDP works to empower civil society organizations to independently engage with government, including through participation in multi-stakeholder anti-corruption and health fora and the design of national strategies for good governance in health.

Resources and partnership platforms

Guidance based on experiences at the global, national and regional levels

With its operational presence in countries and diverse experiences supporting countries to plan and implement anti-corruption, transparency and accountability measures, UNDP contributes to the global evidence base on effective strategies to fight corruption. It likewise plays a convening role to facilitate the exchange of good practices and lessons learned across countries and among different sectors. Over the years, UNDP has produced a wide range of knowledge products on corruption, including methods specific to the health sector. Examples are the study ‘Fighting Corruption in the Health Sector, Tools, Methods and Good Practices (2015)’. The first draft of the ‘Conceptual Framework for Corruption Risk Assessment at the Sectoral Level’ (2018), which was published by UNDP’s Regional Bureau for Arab States which has further guidance under development and the guidance note on ‘Integrating Transparency Accountability, and Anticorruption in Socioeconomic Impact Analysis, Needs Assessment and Response to the COVID-19 Pandemic’ (2020), published by the UNDP Global Anti-corruption team.

Promoting risk management within health programmes

Proactive risk management is a cornerstone of UNDP’s programme management approach in supporting countries to implement large-scale national health programmes, including through its role as interim Principal Recipient of Global Fund grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) in countries facing significant capacity constraints. UNDP has developed robust systems and tools to help countries identify and manage potential risks, and ensure ethics and integrity are in place in processes for programme management. Further guidance and tools on UNDP’s approach to risk management in the context of Global Fund grants can be found in the UNDP-Global Fund and Health Implementation Guidance Manual.

Global partnership to fight corruption in health

In 2019, UNDP, the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and the World Health Organization (WHO) – and subsequently the World Bank as well – formed the steering committee of the Coalition for Accountability, Transparency and Anti-Corruption in Health (CATCH), a dynamic network that brings together a multiplicity of partners (e.g. health, development and humanitarian agencies; governments; civil society and, private sector organizations; people from academia and citizens) to tackle corruption in the health sector. CATCH aims to build the evidence base on how to tackle corruption, enhance collaboration and coordination among stakeholders, foster partnerships across and between countries and support countries to mobilize resources for anti-corruption efforts, hence reducing countries’ vulnerability to corruption. UNDP plays a lead role in the workstream to implement corruption risk assessments at the country level, to help generate bespoke corruption prevention solutions.

Some joint knowledge products to date CATCH has collaborated on a number of activities. In September 2019, CATCH hosted a high-level side-event at the UN General Assembly, where the need for safe spaces to host open and honest conversations on the difficult realities that surround corruption was discussed. The WHO Special Bulletin on ACTA highlights outcomes from research. CATCH published a joint blog on COVID-19 and ACTA, hosted two webinars in Nov-Dec 2020 to train UNDP Country Offices on the corruption risk management methodology (see the “Corruption risk methodology” page for recordings), and continues to prioritize fundraising efforts to advance its workstreams

Some joint knowledge products of CATCH to date include a WHO special bulletin on anti-corruption, transparency and accountability (ACTA) for health, a joint blog on COVID-19 and anti-corruption, transparency and accountability, and two webinars hosted by UNDP on its corruption risk management methodology (see the “” page for recordings).

CATCH: Key Workstreams

Video: Why a global network for anti-corruption, transparency, and accountability for health?

The coalition helps to unify multisectoral approaches to corruption and identify shared problems that demand collective action and can drive outputs that are implemented at the country level, supported by the research and policy communities. Among the priority areas that have emerged from multi-stakeholder consultations is the need for risk-based approaches to anti-corruption for health. UNDP plays a lead role within this workstream, helping to inform implementation approaches and provide technical assistance to support countries to leverage risk assessments tailored to health systems.

To date, CATCH has collaborated on a number of activities. In September 2019, CATCH hosted a high-level side-event at the UN General Assembly, where the need for safe spaces to host open and honest conversations on the difficult realities that surround corruption was discussed. The WHO Special Bulletin on ACTA highlights outcomes from research. CATCH published a joint blog on COVID-19 and ACTA, hosted two webinars in Nov-Dec 2020 to train UNDP Country Offices on the corruption risk management methodology, and continues to prioritize fundraising efforts to advance its workstreams.

Purpose

Challenges that have hindered the effectiveness of anti-corruption efforts in past decades have included the following:

• Good governance and public sector reforms are too broad and avoid tackling corruption directly.
• Anti-corruption interventions in health programmes are often disconnected from national health systems and the country context.
• Anti-corruption communities are disconnected from public health communities, with no common language between them.
• Anti-corruption communities focus mainly on punitive approaches and post-event detection, and preventive approaches are focused on awareness and implementing excessive controls.

Sectorial and preventive strategies to fight corruption need to be further strengthened to enhance the overall effectiveness of anti-corruption. A well-established approach to engage in prevention in a specific context is to conduct risk assessments, as addressing risks is one of the key components of prevention. In the field of anti-corruption, risk assessment can broadly be defined as the analysis and study of the likelihood and impact of specific corrupt acts for the purpose of mitigating them. It distinguishes itself from other corruption assessment approaches in that it focuses on the potential for – rather than the perception, existence or extent of – corruption.

UNDP’s approach

Based on gaps in traditional anti-corruption approaches and building on its longstanding engagement with governments, civil society organizations and other partners on corruption prevention initiatives over the years, UNDP developed a comprehensive risk-based methodology to help advance countries’ corruption prevention efforts: the UNDP methodology for corruption risk management. Starting in 2016, it first piloted the approach in six countries and territories in the Middle East and North Africa. It continues to share lessons, develop tools and guidance, and train countries to implement risk-based approaches to corruption in other regions, in partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), the World Health Organization (WHO) and the World Bank.

The framework uses a corruption risk assessment to help countries identify vulnerable “decision points” in the health system, or other sectors, based on the likelihood and impact of corruption at each point. The assessment is conducted through national multi-stakeholder teams. Following training on the methodology, country stakeholders are able to map decision points and identify respective stakeholders and action points through a function-based approach combined with process mapping. The resulting risk heat maps allow for prioritization of corruption risk mitigation measures and the development of a sectoral implementation plan.

The experiences implementing this approach to date have underscored that:

• The integrated corruption risk methodology helps to align and coordinate efforts of donor agencies and different health system functions to address corruption along the entire continuum of health service delivery, which is a key factor for sustainability.
• Preventive approaches minimize the sensitivity of countries to the topic, as it addresses risks of potential acts rather than focusing on punitive measures.
• Application through multi-stakeholder teams creates country ownership, ensures response to national priorities and improves access to information without jeopardizing confidentiality and sovereignty. It also builds national capacities and offers a platform for continuity of the process.
• A flexible two-pronged approach that entails direct interventions for immediate response combined with long-term strategic engagement on corruption helps country teams to respond to pressing needs while not losing strategic focus.

Additional benefits include the creation of a common language among stakeholders between and within sectors, the integration of health system strengthening efforts with specific programme needs and the promotion of country ownership.

Guidance and resources

This section provides a high-level overview of key steps in the process of applying UNDP’s corruption risk management approach, which can be adapted to different contexts and objectives. Full details on the activities, tools and concepts entailed in each step can be found in a forthcoming guide. A case study on the experience and lessons from Tunisia, the first country to roll out this approach and achieve results in the health sector in particular, can be found here. Additional guidance can be found in the webinar recordings in the key resources below. If you are a government partner or another stakeholder engaged in implementing a UNDP-supported health programme and would like to initiate this process in your country, please contact support.healthimplementation@undp.org for further information and guidance.

Overview

Climate change is the greatest health threat of the 21st century, with environmental factors accounting for a quarter of the global burden of disease (The Lancet 2018; World Health Organization 2016). At the same time, the health sector is a major contributor to the global climate crisis and environmental degradation. If the global health sector were a country, it would be the fifth largest emitter of greenhouse gases in the world (Health Care Without Harm 2020). These multi-directional linkages between health and planet underscore the need for integrated action that simultaneously safeguards human health and the natural environment, a focus called for by the trans-disciplinary field of ‘planetary health.’

With its large policy and programmatic portfolios on health, environment, climate change mitigation and adaptation, governance, and other connected areas, UNDP is uniquely placed to support multi-sectoral policies and programmes on planetary health to respond to the complex and growing health burden caused by climate change, pollution, environmental degradation and threats to biodiversity, in partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), the World Health Organization (WHO), the United Nations Environment Programme (UNEP), Global Environment Facility (GEF) and others.

UNDP’s approach

UNDP’s framing on planetary health is operationalized through two primary areas:

1. supporting multi-sectoral policies to respond to the growing burden of environmental threats including pollution and climate change, with a particular focus on the most vulnerable.
2. building resilience in the health sector, including through integration of measures for sustainability in health programmes.

UNDP’s approach to environmental sustainability in the health sector is aligned with the priorities of key partners, including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), Gavi, the Vaccine Alliance (Gavi) and the World Health Organization (WHO). The Global Fund encourages partner countries to develop and strengthen comprehensive, sustainable, climate-smart procurement, supply and waste management systems that support the avoidance, reduction and management of health-care waste, including health-care waste that is generated under Global Fund grants (GF RSSH Information). Gavi is committed to scaling up its investments in proven interventions for climate-resilient health systems, including by helping countries to reduce their footprint related to health care, as underlined in its 2021–2025 Strategy.

UNDP works closely with WHO, particularly drawing on its expertise in building climate-resilient health systems and helping countries to track national progress in protecting health from climate change. This includes joint efforts to integrate health into the implementation of nationally determined contributions to the Paris Agreement. It likewise partners with civil society organizations, research institutes and foundations to expand research and multi-stakeholder participation, including youth, in movements linking health and climate. UNDP also helps to connect investments and expertise from environmental funding mechanisms such as the Global Environment Facility and Green Climate Fund with those of health-specific financing partners.

Along with the World Bank and the United Nations Department of Economic and Social Affairs (DESA), UNDP is a co-convener of the WHO-led Health and Energy Platform of Action, which mobilizes political commitment, support and resources to ensure universal access to clean and sustainable energy to protect health.

Resources and examples

UNDP sustainable procurement in the health sector programme

UNDP hosts the secretariat and participates in the United Nations Informal Interagency Task Team on Sustainable Procurement in the Health Sector (SPHS). The taskforce brings together seven United Nations agencies (UNDP, United Nations Environment Programme – UNEP, United Nations Children’s Fund – UNICEF, United Nations Population Fund – UNFPA, United Nations High Commissioner for Refugees – UNHCR, United Nations Office for Project Services – UNOPS, World Health Organization – WHO) and three multilateral health financing institutions (Gavi, the Vaccine Alliance – Gavi, Global Fund to Fight AIDS, Tuberculosis and Malaria – Global Fund, Unitaid). The annual cumulative purchasing power of the taskforce for health products is around $5 billion, which gives opportunities to influence and pilot business models for improving environmental, social and economic sustainability. With increased health spending during the pandemic, this figure has risen two-fold in the last 2 years.

UNDP’s Sustainable Health Procurement programme strives to promote sustainable production and consumption practices by ensuring products and services purchased have the lowest environmental impact and contribute towards positive social results. The UNDP approach to sustainable health procurement also leads towards considerable cost benefits and resource efficiencies in health procurement.

UNDP is committed to sustainable procurement as a gradual approach through working in partnership with manufacturers and other partners and by strategically leveraging the health procurement architecture as a market mechanism for change. This will foster a market transition towards more sustainable production, procurement and consumption practices for health products. Among many others, UNDP has organized five Global manufacturers fora in five different regions (Philippines 2018, Tanzania 2019, Saud Arabia 2020, Colombia 2021 and United Kingdom 2022). The Global manufacturers forum has become a popular event for policy makers, manufacturers, academia, CSOs and suppliers of health commodities and equipment to gather and share expectations, lessons and feedback.

In 2020, UNDP launched the  Sustainable Health Procurement Guidance Note, as part of the Sustainable Health in Procurement Project, and has been developing different approaches to include sustainability in its health procurement practices. The main strategy comprise: optimizing medicines packaging; reducing CO2 emissions by optimizing health product procurement transport scenarios; and influencing suppliers in long-term agreements with UNDP to introduce sustainability in their business models through the monitoring and review of sustainability criteria. These sustainability approaches to procurement are carried out closely with national counterparts; the work at the country level serves as a basis for countries to start embedding sustainable practices in their own procurement activities.

Additionally, UNDP worked with Healthcare Without Harm to develop and launch the chemicals of concern to health and environment guidance document. This document includes a list of chemicals of concern to human health and the environment. The list is based on systematic evidence reviews from authoritative sources, which identify chemical and material hazards of concern that are carcinogenic, mutagenic, endocrine disrupting and reproductive hazards (health hazards) and bio- accumulative and persistent to the environment and/or listed in International Environ­mental instruments (Conventions)

Pharmaceutical packaging optimization

Rethinking the necessities of packaging helps to reduce waste, optimize shipments and save costs which can be reinvested in health activities and in strengthening national supply chains.

UNDP is engaged in packaging optimization of health products and further investigating areas for innovation of product  waste management. The packaging reduction project is conducted in partnership with manufacturers and freight forwarders to identify areas of opportunity, redesign packaging specifications and to calculate metrics to measure the impacts through capacity enhancement, reduced emissions and cost savings achieved.

UNDP has worked extensively with antiretroviral manufacturers and national regulatory authorities on packaging optimization to reduce product waste and increase cost-effectiveness. In 2016-2017, it piloted a Reduced Packaging Initiative piloted in Zimbabwe, South Sudan, and Equatorial Guinea. The new packaging resulted in a 55 per cent increase in shipping capacity per container and an additional reduction of 57 per cent of CO₂ per unit for the Zimbabwe trade lane. Up to US$1.20 million in savings have been generated for 2.5 million packs delivered under the UNDP Reduced Packaging Initiative. Work is ongoing to extend this approach to other countries and to a wider range of antiretrovirals procured through UNDP. This entails substantive work with national regulatory authorities to ensure compliance with labelling requirements.

With increased experience and lessons learned on medicines packaging optimization, UNDP’s approach can be adapted and replicated by national procurement systems and by other players involved in health procurement.

CO2 emissions reporting and reduction

Monitoring, measuring, reporting health product transport’s CO2 footprints and rethinking procurement planning and transport help reduce environmental impact and gain cost efficiencies.

UNDP is committed to reducing its CO2  footprint, including the CO2 footprint of health procurement to reduce the impact of climate change. Since 2015, UNDP has been collecting CO2 data as part of long-term agreements with specified antiretrovirals first line suppliers to measure, monitor and reduce CO2 impacts in partnership with freight forwarders. All collected data is captured as business intelligence analytics and visualized through a dashboard that is monitored on a quarterly basis. The UNDP procurement planning capacity engagement and data provided by UNDP country offices is also used to switch to more efficient freight options that provide reduced emissions per shipment, resulting in significant CO2 reductions and freight cost savings.

Environmental and social sustainability scorecard initiative and call-off criteria for tendering

Leveraging its global health procurement architecture, UNDP’s environmental and social sustainability initiative incrementally builds a dialogue and a demand for sustainable pharmaceutical production and procurement.

UNDP is committed to working in partnership with manufacturers to meet demand for better social and environmental due diligence in pharmaceutical manufacturing and procurement. The UNDP environmental and social sustainability scorecard initiative leverages the UNDP health procurement architecture within its signed long-term agreements and contract management process. By strategically selecting health products of high volumes, this approach encourages manufacturers to follow sustainability manufacturing criteria under the UNDP Sustainable Health Procurement Programme, as part of the ongoing procurement contracts.

UNDP has designed an environmental and social sustainability scorecard  initiative, which, as specified within the suppliers’ contract, requires manufacturers to provide comprehensive information, data and supporting documentation about manufacturing facilities.

The information is compiled in a UNDP sustainability scorecard and is regularly reviewed to identify opportunities to include environmental sustainability within pharmaceutical manufacturing facilities and processes. Through the collection of relevant data on suppliers’ environmental practices, it is possible to establish and monitor the baseline of adopted environmental criteria. A continuous two-way dialogue is opened with manufacturers to discuss challenges and potential for improvements in pharmaceuticals manufacturing, therefore setting incremental industry best practices.

Sustainable Health in Procurement Project (SHiPP)

UNDP together with Health Care Without Harm (HCWH) implemented the Sustainable Health in Procurement Project (SHiPP). The first phase of the project addressed the intersection between health, human rights and the environment in 10 countries (Argentina, Brazil, China, India, Moldova, South Africa, Tanzania, Ukraine, Vietnam and Zambia). SHiPP was designed to promote procurement practices that consider environmental and social impacts, as well as cost-efficiency and affordability when defining how processes can be sustainable, and to mainstream gender and human rights including anti-corruption, transparency and accountability.

Through the SHiPP, countries have adopted new standards and guidelines to promote sustainability in the health sector. For instance, Brazil has developed a plan to ban mercury medical devices; India has established guidelines and criteria for Bio-Medical Waste and Infection Control Management; and South Africa approved an acquisition plan for biogases and air quality monitoring.

Purpose

Pharmaceutical waste management is regarded to be an integral part of supply chain management and the product life cycle, as a result of the use and/or expiry of health products. Inadequate and inappropriate handling of health-care waste can have serious public and global health consequences and a significant impact on the environment. Governments can better protect public and planetary health by reducing the volume and toxicity of the wastes produced and by implementing a range of environmentally and socially sound waste management and disposal options. Solutions exist to develop and popularise technologies, products and concepts that will help drive countries to a zero waste, low-carbon, toxics-free, circular economy.

Pharmaceutical waste includes expired, unused, spilt and contaminated pharmaceutical products, prescribed and proprietary drugs, vaccines and sera that are no longer required, and, due to their chemical or biological nature, need to be disposed of carefully. The category also includes discarded items heavily contaminated during the handling of pharmaceuticals, such as bottles, vials and boxes containing pharmaceutical residues, gloves, masks and connecting tubing.“

Source: World Health Organization, 2014. Safe Management of Wastes from Health-care Activities, 2nd edition.

While there is currently no international convention that directly covers medical waste management, several environmental conventions have important implications for health-care waste. These include 1) the Basel Convention, which aims to protect human health and the environment against the adverse effects from the generation, management, transboundary movement and disposal of hazardous and other wastes; 2) the Stockholm Convention, a global treaty to protect human health and the environment from highly dangerous, long-lasting chemicals; 3) the Rotterdam Convention, which promotes shared responsibilities and cooperation among parties in international trade of certain hazardous chemicals to protect human health and the environment from potential harm; and 4) the Minamata Convention, which addresses measures to reduce the human environmental impact of mercury. Countries’ legislation and regulations for health care waste should be aligned with these conventions to ensure compliance with international environmental and health standards. The UNDP Health Care Without Harm questionnaire (2017) is available to support health procurement stakeholders’ compliance with environmental conventions. 

UNDP’s approach

As part of support from the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), UNDP helped to conduct rapid assessments of national set-ups for managing health-care waste, with a view to understand the  environmental impacts and safety concerns, in Belarus, Bosnia and Herzegovina, Kyrgyzstan, Tajikistan, Uzbekistan and Zimbabwe. These assessments resulted in the development of the Healthcare Waste Management Toolkit Package for practitioners and policy makers.

The assessments also recommended the development of national strategies for waste management, to strengthen and improve existing systems to coordinate the financial sustainability of routine and new activities for waste management. Some of the assessments led to the development of country-level guidelines, tools and infrastructural projects to improve health-waste management.

In Zimbabwe, UNDP provided infrastructural support to the country’s health procurement and supply chain management system which included the installation of two pharmaceutical-grade incinerators at the central and regional levels to facilitate the disposal of pharmaceutical waste. Prior to this, it helped to put in place equipment, standard operating procedures and training of staff related to the deconditioning and disposal/recycling of plastic and cardboard packaging. On the normative side, UNDP provided technical assistance to the Ministry of Health and Child Care to develop the Pharmaceutical Waste Management Plan for Pharmaceuticals and Health Products.

UNDP has also provided support for the installation of incinerators for pharmaceutical waste in Afghanistan, Chad, São Tomé and Principe, Sudan, and Zambia, and for training on their use.

In Eastern Europe and Central Asia, where UNDP supports several governments with the procurement of medicines, UNDP’s technical assistance includes support to assess and provide lessons on waste management practices at the dispensation level. 

In 2020, amid the COVID-19 pandemic, UNDP commissioned Engineers Without Borders to conduct a rapid assessment of the prevailing health care-waste systems and legal frameworks, to inform the development of a generic strategy to improve health-care waste management in consultation with relevant stakeholders across the globe. As part of inter-agency support to COVID-19 vaccine readiness and deployment plans, UNDP is working with the World Health Organization and the United Nations Children’s Fund (UNICEF) to help countries scale environmentally and socially sustainable disposal of immunization waste.

Upstream reduction of health product waste

UNDP undertakes two main axes of work to reduce waste production upstream. One is to strengthen areas of the procurement and supply chain cycle, such as quantification, inventory control, logistics management information systems,, and procurement and distribution planning in supported countries. Building capacity in procurement and supply chain management helps reduce overstocking and product expiry, which result in the waste of financial resources and an increased need for pharmaceutical waste management.

UNDP also engages with antiretroviral manufacturers to optimize medicine packaging and reduce resulting waste. This practice, which has been piloted in a few countries, will be incrementally applied to other categories of medicines for which UNDP pools demand and procures on behalf of supported countries. The optimization of packaging to reduce upstream waste, requires coordination with manufacturers and national regulatory authorities to comply with international and national standards for medicine labelling. With increased experience and lessons learned, UNDP’s piloted approach for optimizing medicine packaging could be adapted and replicated by national procurement systems.

Tools and guidance

UNDP has developed the Health-care Waste Management Toolkit, based on several rapid country assessments of health-care waste management set-ups in 2015, to support the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), UNDP and other practitioners and policymakers. The toolkit consists of:

Part A – Rational for Environmental Safeguard Policies
Part B – Waste Stream Concept Development

The UNDP/SPHS Sustainable Procurement Guidance Note (2020) is a useful resource for integrating sustainability strategies in health procurement processes. It details steps of the sustainable health procurement approach, creation of an action plan and integration of the action plan into procurement planning, solicitation design, contract management and responsible supplier engagement.

UNDP’s partner Health Care Without Harm offers a range of health-care waste management resources, including guidelines and assessment tools, on its website. Additional guidance, including from the Global Fund and the World Health Organization (WHO), are available below.

Overview

Health facilities need power. Clinics, maternity wards, operating rooms, medical warehouses, and laboratories rely on electricity to power the lights, refrigerate vaccines, and operate life-saving medical devices. An inability to carry out these essential services puts lives at risk. All too often, particularly in remote areas, health facilities face significant power shortages. A World Health Organization (WHO) review revealed that 25 per cent of health facilities in sub-Saharan Africa had no access to electricity, while only 28 per cent of health facilities and 34 per cent of hospitals had what could be called “reliable” access to electricity (without prolonged interruptions in the past week).

In 2017, UNDP spearheaded the Solar for Health (S4H) initiative as a means of connecting two vital sectors – energy and health – to help countries advance universal health coverage while protecting the environment. Through the initiative, UNDP supports countries to install solar photovoltaic systems at health centers and storage facilities located in poor and hard-to-reach areas.

This helps to ensure constant and cost-effective access to electricity for uninterrupted health services, while also mitigating the impact of climate change and advancing multiple Sustainable Development Goals (SDGs). Broader development benefits of solar energy can also include the creation of green jobs and the development of local manufacturing and markets for solar power. By training women as solar technicians to install and maintain solar panels, the initiative also helps countries advance SDG 5 on gender equality and women’s empowerment.

S4H builds on the much larger investment and knowledge generated by UNDP’s robust energy portfolio focused on expanding access to clean energy, including the promotion of renewable energy and energy efficiency, in more than 82 countries. The lack of access to clean energy has significant and wide-ranging impacts on people’s health across the world. UNDP focuses on three key pillars of the health-energy nexus: electrification of rural health centres, clean cooking, and enabling cities to switch to sustainable transport. These have been further elaborated under the Energy for Health work areas.

UNDP’s approach

To date, and largely funded through the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund), as well as Innovation Norway and the European Union humanitarian fund, UNDP has supported the solar electrification of some 1,000+ health centres and storage facilities in 15 countries (Zimbabwe, Sudan, Zambia, South Sudan, Namibia, Liberia, Libya, Malawi, Yemen, Angola, Nepal, Uganda, Chad, Lebanon and Eswatini). UNDP has also supported research on the ground to assess which innovative finance mechanisms can help scale these activities in Malawi, Zimbabwe, Liberia, Namibia and Zambia..

The objectives of S4H are to promote high-quality health services; contribute to climate-resilient health systems; and reduce health sector carbon emissions. Key elements of UNDP’s support to countries through S4H include:

• supply of solar equipment and support for installation
• maintenance, technology transfer, and institutional capacity development
• solar energy promotion and awareness raising
• regulatory and policy framework setting for solar energy provision
• understanding of the climate change – energy – health interlinks
• developing innovative finance mechanisms

UNDP continues to build on the lessons and results from implementation of S4H in these countries to help others conceive, plan and implement solar energy photovoltaic systems based on the needs arising from unreliable or unavailable electricity to health system facilities. The energy needs of the health sector are often exponential. Thus, S4H is designed to ensure flexibility, meaning that it can be initiated with relatively small contributions and scaled up as funding becomes available and additional needs are identified.

In addition, as part of national COVID-19 vaccine readiness and deployment plans led by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), UNDP is working with government and United Nations partners to scale reliable energy solutions for vaccination across the COVID-19 cold chain. This includes building on S4H experiences to deploy solar technologies to support the transport and last mile distribution of vaccines and green the underlying infrastructure for vaccination.

Resources and examples

Additional details on the objectives and support that UNDP provides to countries under Solar for Health (S4H) can be found in this Information Note.

Sustainable financing for S4H

In 2019-2020, UNDP commissioned KOIS and Diff-er to conduct a feasibility study to design a sustainable financing mechanism to accelerate the Solar for Health (S4H) programme in prioritized countries, and to provide UNDP and the local governments with information to determine further financing and implementation options of the proposed S4H financing model. The study looked at a demand-side analysis, supply-side analysis, and the design of the S4H financing structure in five countries: Namibia, Liberia, Malawi, Zimbabwe, and Zambia.

Through the S4H initiative, solar power systems are facilitating strong, reliable and resilient health services, even in some of the most challenging contexts. 

• In Yemen, 72 Health facilities, powered by solar, are providing vaccines and other medicines, schools are able to continue, and small businesses can run late into the night.
• In Chad, in 2020 solar power systems were installed in 150 health facilities with a focus on pre- and antenatal care for women, childbirth and medication storage, and also to help them respond adequately to public health issues such as malaria, and now, COVID-19.

Supporting countries to harness innovation is central to UNDP’s approach to strengthening resilient and sustainable systems for health. UNDP views innovation as a critical driver to do development differently and better. Innovation for development is about identifying more effective solutions that add value for the people affected by development challenges. UNDP’s approach embraces an expansive definition of innovation as a break from previous practice that has significant positive impact, shifting the focus away from the introduction of specific technologies, to helping partners identify, test, and scale new ways of working based on the sustainable and measurable impact brought about by the new technology or process. 

Within its health and development portfolio, UNDP leverages innovation at the policy and programme level to help achieve more inclusive service delivery and support countries to transform systems to attain universal health coverage. These efforts range from introducing and scaling innovative ways of reaching people, to identifying innovative financing instruments in support of sustainable health outcomes. 

In health as in other spheres of development, technology plays a tremendous role in leapfrogging development dividends. However, technology is part of a chain of dynamic collaborations among invested, trusted and diverse stakeholders. A mobile phone app for health logistics management is not enough to ensure more effective decision-making, nor is the development of a new health technology enough to guarantee increased access to medicines for key populations. 

Recognizing that innovation is not just cutting-edge technology but requires changing the status quo, UNDP invests in an integrated approach to foster innovation as a means of scaling and sustaining positive impact. This is based on the understanding that: 

• Innovation is not an end in itself. It is about using the most relevant and up-to-date concepts and means available to create better development results. 
• Innovation needs to have an impact and create value for the end-user. 
• Innovation is about continually examining our work as a development partner to make it more effective, legitimate, and nationally-owned. 
• Innovation also entails retiring concepts that do not provide clear evidence of impact. 

Entry points for innovation 

UNDP supports innovation in multiple forms and contexts. This includes: 

• Mission-driven innovation: Mission-driven innovation tackles complex development issues through concrete and measurable “missions” that are ambitious and foster multi-disciplinary collaboration. They motivate and unite diverse groups in society to work towards a big goal over time, that often transcends electoral cycles. With its wide country presence and role as an integrator, UNDP is uniquely placed to support innovation that goes beyond incremental improvements to those which help to drive broader systems change. This includes through the work driven by its Strategic Innovation Unit and Accelerator Lab Network. 

• Improvement-oriented innovation: Driving new agile ways of working to improve the efficiency and effectiveness of development programmes, both within UNDP and with the partner countries. This includes experimenting with new capacities, tools and regulations that often lead to more cost, time and resource efficiencies in programme, policy and operation design and services. 
• Bottom-up solutions: Leveraging local collective intelligence about successful solutions to drive systems change and organizational learning. UNDP plays a key role in connecting, promoting and mainstreaming cutting edge ideas to decision-makers for large scale impact. 
• Anticipatory innovation: Addressing potential future risks and liabilities by designing experiments to explore them today. This is particularly relevant for frontier technologies and their impact on economies, on human freedom and our well-being. It also entails building new mental models and capacities (e.g. foresight, impact modelling, systems thinking) to understand emerging futures by shifting perceptions and creating future-oriented ambitious programmes. 

The following examples further illustrate the multi-faceted ways through which UNDP leverages innovation for increased impact in health and development: 

Scaling access to innovations for HIV and TB prevention, testing and treatment 

• Access and Delivery Partnership across West and Central Africa: Since 2013, UNDP, WHO, the Special Programme for Research and Training in Tropical Diseases (TDR) and PATH have collaborated through theAccess and Delivery Partnership (ADP) in advancing the use of new health technologies in low- and middle-income countries. For instance, work under the ADP contributed to the safe introduction to new treatments for DR-TB, based on WHO treatment guidelines. ADP supported the establishment of a regional working group of national TB programmes and pharmacovigilance authorities from 27 countries across West and Central Africa, and facilitated South–South knowledge exchange, trainings and study visits to build capacity on Active TB-drug safety monitoring and management (aDSM). The working group developed key resources and documents related to aDSM implementation for clinicians and programme managers, as well as a model national guideline on aDSM for countries to adapt to their own contexts. As a pilot, a national aDSM guide was developed for Senegal. 

• Pre-exposure Prophylaxis (PrEP) in Zimbabwe: In 2021, more than 1.6 million people worldwide were receiving oral pre-exposure prophylaxis (PrEP) for HIV, which remains well short of the 2025 target of 10 million people. UNDP is supporting countries to increase access to PrEP for the most vulnerable communities, as part of its larger efforts to improve and expand coverage of HIV prevention for key populations and their sexual partners who now account for 70 percent of new HIV infections worldwide.
  
  

Bridget Ngorima shares a light moment with Beauty Dhliwayo before her HIV test at the CeSHHAR clinic in Mutare, Zimbabwe.
Photo: UNDP Zimbabwe/Cynthia R. Matonhodze

In 2021, in Zimbabwe, UNDP in partnership with the Global Fund, the Ministry of Health and NGOs reached 3,300 female sex workers with PrEP. This was done through a combination of fixed sites providing prevention services, and outreach conducted by NGO partners such as the Centre for Sexual Health and HIV/AIDS Research Zimbabwe (CeSHHAR). In addition, in November 2022, Zimbabwe became the first country in Africa to announce regulatory approval for long-acting injectable cabotegravir as PrEP for HIV prevention, paving the way for the provision of more safe and highly effective prevention options.  

• New PrEP initiative in Pakistan: In Pakistan, UNDP with support from the Global Fund and in partnership with local community-based organizations, the Government, UNAIDS and WHO launched a new PrEP initiative in June 2022. The initiative is also working closely with key population communities to provide PrEP through networks of peer outreach workers and drop-in centers. In addition, government health care workers stationed at existing antiretroviral (ART) treatment centers are being trained in delivering safe and effective PrEP services. 
• Rapid HIV and syphilis test across Western Pacific: In the Western Pacific, geographic isolation significantly hinders testing for HIV and other sexually transmitted infections (STIs). The majority of HIV and STI cases are detected during health care visits using laboratory-based diagnostic testing, yet populations are often scattered across a multitude of remote small islands, many with either limited or no access at all to clinical health services. People are often forced to travel great distances to seek testing, treatment and care. Additionally, test turnaround times can be lengthy, requiring patients to return on a separate date for test results, resulting in substantial loss to follow-up. Under the Multi-Country Western Pacific HIV/TB grant, UNDP and partners have rolled-out use of a rapid HIV and syphilis test across the region to reach key and vulnerable populations including those living on remote islands. A crucial component of the initiative was to provide training for the community and non-governmental organizations involved in the programme that are conducting outreach with key populations. 
• Multi-month dispensing of anti-retroviral medicines in Belize: Multi-month dispensing of anti-retroviral medicines is a modality that aims to improve HIV treatment retention and adherence support among people living with HIV. Providing them with medication for up to 3-6 months minimizes their trips to the health facilities/hospitals and helps ensure continuity of treatment. In Belize, the COVID-19 pandemic posed a strong challenge for retention of people living with HIV, which can partly be explained by the unwillingness of some of them to travel to clinics due to fear of COVID-19 infection. The Ministry of Health and Wellness introduced multi-month dispensing and the CSO Hub provided home delivery of medications to address treatment retention challenges.  

Leveraging technology to improve health services and access 

• Mass screening to eliminate TB in Micronesia
  In 2023, UNDP partnered with the Micronesia Department of Health and Social Affairs, Chuuk state authorities, World Health Organization and Centers for Disease Control and Prevention to conduct a mass tuberculosis (TB) screening in Chuuk state, including with portable chest X-rays assisted by artificial intelligence (AI) software.
  
  Supported by the Global Fund, the screening reached more than 12,000 people at higher risk of TB in Weno Island and selected villages in Chuuk Lagoon. The screening led to the diagnosis of 176 people with active TB and 2,170 people with latent TB. Nearly all people with active TB started treatment. Of those with latent TB, 95 percent started preventive treatment with the support of local community health workers. The campaign also screened for leprosy and diabetes, leading to the diagnosis of 400 people with diabetes. As part of this screening campaign, 8,000 people received leprosy prevention medication, in addition to the more than 2,000 people protected from leprosy through preventive TB treatment for people with latent TB (3HP).
  
  

Photograph from a workshop in Nadi, Fiji in August 2023, which provided hands-on training on the new x-ray systems for health workers from the Federated States of Micronesia, Fiji, Kiribati, the Republic of Marshall Islands, Samoa, Tuvalu and Vanuatu.

The new X-rays have several advantages. Battery operated and relatively small, they can be transported by hand to remote communities that lack radiology services. Combined with AI-assisted software, the X-ray system enables health workers to quickly detect anomalies in chest X-ray images, which could be TB. After confirming with a radiologist remotely, health workers promptly refer patients to further testing and treatment, which encourages adherence to medical advice.

As a result of the mass screening, Micronesia’s TB case notification rate increased from 49 to 212 per 100,000 people from 2022 to 2023, quadrupling the number of people effectively diagnosed and treated. In particular, the detection of latent TB is essential during the elimination phase of TB response, which underlines the importance of mass screening as a strategy.

• Testing behavioural insights and video technology to improve treatment access in Moldova: UNDP partnered with the Ministry of Health, Labour and Social Protection, Act for Involvement (AFI), the Center for Health Policies and Studies (an implementer of Global Fund projects in Moldova), and the Behavioural Insights Team (United Kingdom) to test the effects of virtually observed treatment compared with directly observed treatment on patients’ adherence to the TB treatment regimens. Altogether, 175 people affected by tuberculosis were included in the research, with patients randomly assigned to one of two groups: the treatment of one group of patients was routinely directly observed (DOT—directly observed treatment) and the other group was observed remotely (VO—video observed treatment). Preliminary results show that the adherence level for VOT was 87%, double that of the control group, DOT—43%. People who received VOT reported saving time and money compared with their peers who went to the local clinic to take the medicines in front of the medical staff. Results also showed that VOT reduced patients’ exposure to stigma. Thanks to the results obtained in the study and with the support of the Global Fund, another 10 districts will pilot video observance of tuberculosis treatment. Read more here. 
• Supporting open-source innovations in the COVID-19 response: UNDP’s Global Center for Technology, Innovation and Sustainable Development has developed a COVID-19 Open-Source Digital Toolkit. The Toolkit features free-to-download tools that have been proven in other communicable disease and public health challenges – and which are also driving governments around the world. The tools address disease monitoring; prevention and containment; diagnosis; and recovery efforts. It also launched the COVID-19 Detect and Protect Challenge to create a repository of 350+ fully-fledged innovations that can be built and implemented locally. 

Instigating systems change 

• Creating enabling legal, rights and policy environments for health: Driven by an approach that helps countries to harness bottom-up innovation, UNDP supports innovative platforms, for example, that bring key populations and civil society together with judiciaries and policymakers in the design of legal, rights and policy frameworks for health. Incorporating human-centered design principles into efforts to enhance legal environments for health helps to ensure that policies are designed according to the lived realities and needs of those for whom they are meant to serve. 

• A risk-management approach to testing and scaling corruption prevention measures in the health sector: Corruption in the health sector remains a critical obstacle to the achievement of national development objectives, contributing to weak health systems and the diversion of fundamental health resources from those who need them. Mainstream approaches to corruption have tended to focus on generic, and generally technical governance reforms rather than explicit anti-corruption measures or have otherwise been characterized by an overemphasis on legalistic responses and law enforcement efforts. Recognizing the added value of risk management for corruption prevention, and the need for tools adapted to sector specific contexts and challenges, UNDP in the Arab States has defined new methodologies based on its experiences in operationalizing a corruption prevention agenda. UNDP has helped numerous countries, such as Tunisia and Morocco, to successfully design action-oriented corruption risk assessments targeted to their political and institutional realities and unique needs. It has achieved notable results applying this approach at the sub-national level by testing small-scale, focused interventions in public hospitals, which have helped to inform national policy responses. This prevention-based approach using the language of “risk” and grounded in scientific method has also helped to shift attitudes towards corruption in the health sector by framing it as an institutional rather than ethical issue. 

Innovative finance 

• Tobacco control social impact bond: UNDP is working with partners to launch the world’s first social impact bond for tobacco control, to support tobacco farmers in Zambia. The project aims to demonstrate the capacity of an innovative finance tool to help farmers switch from tobacco-leaf cultivation to alternative crops and livelihoods that are healthier, environmentally-sustainable, and more profitable, thereby attracting increased private investment in an issue threatening progress towards multiple SDGs. 

• Impact investing for planetary health: Impact investment is an important vehicle for the engagement and ownership of the private sector in the process of SDG implementation. UNDP’s work to support planetary health helps to address gaps and promote synergies between SDGs related to health and the environment. The positive impact of its  Solar for Health initiative on health access and reductions in CO2 emissions, for example, illustrates the important social and environmental returns of investments that simultaneously address the health of humans and the planet. To build on these efforts, UNDP is exploring sustainable business models and innovative financing options in several countries, such as blended finance or social impact bonds, that will support ministries of health and social services to generate increased private investments in Solar for Health. 
• Investment cases to support co-financing of non-communicable diseases (NCDs): As an intervention that can help countries realize significant health savings and development gains across multiple sectors, NCD prevention is a strategic area for mobilizing private sector investments. UNDP is working closely with WHO, the NCD Alliance, ministries of health and ministries of finance and other partners to develop national NCD investment cases, to prioritize action, mobilize resources from multiple sectors and develop innovative solutions in different countries. This health investment approach is prevention-centred, focuses on the population level, engages all sectors, and identifies how economic gains accrue to private and public sectors. Read more about the value of co-financing across sectors in the UNDP Guidance Note Financing across sectors for sustainable development. 

Harnessing existing public sector innovation to enhance health outcomes 

Innovative initiatives outside the health sector can also have important health outcomes.  

For example: 

• Access to Information programme in Bangladesh: The  Access to Information (a2i)  programme of the Bangladesh Prime Minister’s Office, with technical assistance from UNDP and USAID, has been looking at service delivery challenges, focused especially at meeting the needs of rural communities. One identified challenge is the limited number of medical personnel in rural areas, so a2i launched a telemedicine service that has improved access to health services for rural communities by introducing virtual consultations and connecting patients to doctors in urban settings. 
• Increasing citizen participation in the design and delivery of public services in Kazakhstan: In Kazakhstan, UNDP is supporting the government to increase citizen participation in the design and delivery of public services in Kazakhstan, including through real-time citizen-generated data. This builds on the country’s introduction of the “Listening State” concept in 2019, a constructive dialogue between the state/ government and its citizens as a key principle for public services delivery. In the context of health service delivery, mechanisms that make citizens co-designers of public services can be invaluable to help governments understand the needs and experiences of those meant to benefit from the services. 

Measuring impact: a key enabler for innovation 

A key focus of UNDP’s approach is supporting partners to take innovations to scale: to identify new tools or techniques that work and expand or adapt them to different contexts. The capacity to define and measure the impact of innovation is crucial to determining what works and what does not, allowing for quick iteration and the ability to shift courses along the way based on evidence. Strong mechanisms to continually evaluate the impact of innovation and monitor for unintended consequences not only help to ensure that initiatives are on the right track, but also help to de-risk investments in new solutions by starting small and testing their results before scaling. This emphasis on measurement and evaluation is reflected in the focus of UNDP’s innovation for health initiatives, from its investment in numerous feasibility studies to help partners understand the potential for new financing modalities, to its joint efforts with partners to define metrics for health interventions whose impacts are long-term and complex, such as legal reforms to protect human rights and health access. 

Potential of data and digital transformation

Digital technologies and improved health data provide promising opportunities for innovation and acceleration of progress towards the health-related SDGs and for building more resilient systems for health. But 3.5 billion people still lack access to the internet and the opportunities it provides, highlighting the importance of programming, policy and legal frameworks that facilitate equitable access, protect privacy, reduce disinformation and narrow the digital divide.

The achievement of universal health coverage of quality, accessible and affordable health services is primarily dependent on well-functioning and robust health systems of a country. In recent years, outbreaks of Ebola and the Covid-19 pandemic have exposed and stressed weaknesses and gaps in health systems thereby increasing inequities in health and development worldwide.

Each country needs accurate and reliable data to plan and deliver quality health services, from primary care in rural communities to addressing health crises and pandemics. Ministries of Health rely on data to plan, monitor and implement timely health interventions; inform decision-making; and collaborate across sectors and regions to better serve communities.

Digital transformation provides concrete opportunities to tackle health system challenges, with a potential to enhance availability, accuracy and timeliness of data, and the coverage and quality of health services, including those at the last mile, to help achieve the SDG-3 goals and targets. Digital health interventions may be used, for example, to enhance the capacity of health workers and give them more immediate access to clinical protocols, and allow more people to access medical services through telemedicine consultations. Digitized medical-commodity supply chains can optimise pipelines and procurement, leading to increased availability of medicines and vaccines, reducing waste and corruption risks, and yielding significant cost savings overall. Inexpensive, widely available digital platforms and social media can enhance outreach to key and vulnerable populations in contexts where widespread stigma and discrimination, violence and harassment, punitive laws, policies and practices, and criminalization of behaviours puts them at heightened risks and undermine their access to services.

The approach

UNDP support to countries in building inclusive, ethical and sustainable digital societies is guided by its Strategic Plan 2022 – 2025 and Digital Strategy 2022 – 2025, which reiterate its commitment to support digital transitions using a rights-based approach. Central to UNDP’s mission are inclusion and the protection of human rights. In its pursuit of digital development, UNDP continues to advocate for and implement ‘intentionally inclusive’ methodologies that prioritize people-centered design.

As digital technology rapidly evolves, UNDP’s approach to digital remains rooted in clear principles based on experience and international frameworks that put people and planet first. UNDP advocates for open digital standards to unlock scale, reusability and interoperability. Leveraging digital public goods can unlock transformative solutions and digital infrastructures to enable a more equitable and transparent future, with a strong emphasis on protecting rights and preventing misuse.

UNDP’s HIV and Health Strategy 2022-25 seeks to work towards reducing inequalities (to leave no one behind) by increasing access to services (to reduce digital divide and improve health outcomes). As part of our digital health initiatives, we support governments and partners to develop, scale and implement digital health policies and programmes to reduce inequalities and exclusion that affect health and drive epidemics, promote effective and inclusive governance and build resilient systems for health.

In line with these efforts, the UNDP Digital Health for Development Hub is a one-stop shop with technical, advisory and partnership support for scaling up digital health solutions. aims to assist countries to identify, adapt and scale up appropriate digital solutions that strengthen health systems, while supporting effective and inclusive governance for digital health and addressing the inequalities that fuel disease and pandemics. The Hub exemplifies UNDP’s strategic focus on transformative drivers for sustainable development.

UNDP Offer on Digital Health is aligned with principles of its Digital Strategy

In recent years, UNDP has successfully introduced and scaled up digital health innovations in countries around the world. UNDP supports the implementation of digital health initiatives across 62 countries, focusing on COVID vaccine delivery, medical supply chains, HIV, TB, maternal and child health as well as communicable and non-communicable disease service delivery.

The Global Dashboard for Vaccine Equity, launched by UNDP, WHO and the University of Oxford in 2021 combines the latest data on the global roll-out of COVID-19 vaccines with relevant socio-economic information, and provides actionable insights for policymakers to better understand the importance of vaccine equity for socioeconomic recovery.

In Ghana, UNDP is working with the Food and Drugs Authority with the roll-out of the Med Safety mobile app to monitor drug safety designed to encourage reporting of harmful side effects of health products, including medicines and vaccines, by consumers, patients and health care professionals. In Burundi, Chad, Djibouti and Guinea-Bissau, the UNDP-Global Fund partnership in collaboration with governments have rolled out and scaled mobile technology to digitize HIV, tuberculosis and malaria data to map, track, prevent and treat health outbreaks in real-time. The national tuberculosis programme in Moldova, in partnership with UNDP, is scaling up a mobile application which allows tuberculosis patients to video record themselves taking medicines at a time of the day and location convenient for them.

In Colombia, the prep-Colombia.org platform is used for initial screening, setting up medical appointments, keeping records of follow-up appointments and sharing the results of laboratory tests. It also allows doctors to generate different metrics such as level of acceptance, initial continuation, prevalence of toxicity and HIV status. All this is combined with training on combination prevention strategies reaching more than 20,300 people. This innovative approach has made it possible to guarantee the continuous provision of services, obtain good adherence to treatment, and support individuals despite the challenges posed by the COVID-19 pandemic.

Joan Alfaro, a 22-year-old Colombian social leader. Photo: Francisco Villa

In India, UNDP has supported the government to develop and implement a digital platform called CoWIN that currently underpins one of the largest and more successful COVID vaccination program in the world. The system, which has over one billion beneficiaries registered, is designed to provide much flexibility and ‘ease-of-use’ to the users. For example, text resizing options have been included in CoWIN webpages to benefit people with visual challenges. People with disabilities or those who are unable to self-register (for any reason) can go directly to the immunization facilities and they are registered on-spot and provided vaccination accordingly. In rural areas, there are over 250,000 government common service centres across the country that help citizens to register on CoWIN (people with disabilities, people without any internet connection, etc). As a result, vaccination coverage in rural and hard-to-reach areas is higher than the national average.

Challenges and risks of data and digital health programmes

While the potential of data and digital transformation for health is widely recognized, the ‘digital divide’ across and within countries, particularly for the poor and most marginalized, threatens to reinforce exclusion. Data privacy protection is crucial in a world where more health data is being generated – and potentially commodified – every day. Already, millions of existing digital identities are vulnerable to fraud and public exposure of personal information because they are stored in unsecured systems. In addition, billions of people do not have a digital identity and are not represented in the electronic data systems used to augment service delivery and monitor and collect data. Currently, the ownership and use of many forms of data are governed only by default norms and rules, and many jurisdictions at many levels are working to ensure that advances in innovation are accompanied by data policies that protect users.

Various tools can help address the challenges and risks associated with the adoption of data and digital health solutions. This includes the health technology assessment (HTA), a multi-disciplinary process that evaluates the value of health technology at different points in its lifecycle, including the technology’s properties, effects and impacts. It aims to inform policymakers and influence decision-making in health care, with a focus on how best to allocate funding for health programmes and technologies. Components of an HTA include validation of technical aspects (i.e., accuracy of the product or system), clinical considerations (i.e. contribution towards improving or maintaining a specific health condition) and systems compatibility (i.e. connection and/or integration into health service provision and health systems, including medical records). HTAs can be applied to different types of interventions, such as piloting tests, medicines, vaccines, procedures and programmes.

Digital health technologies have impacted privacy in various ways. More people have access to patient information, including medical caregivers, researchers, and administrators in the health care system and, in many cases, employers and government agencies outside it. Patient information is more accessible because it is increasingly stored in digital form and so it can be transmitted more easily than in paper form. Patient information is held for very long periods of time, and the longer it remains in existence, the greater the opportunities for abuse. Privacy concerns are enhanced by the fact that the collected medical records provide a storehouse of information that can be used in a variety of ways other than those intended when the information was first collected. These records can also be used for the marketing of particular drugs, or for the denial of medical health insurance coverage.

Examples of risks associated with increased collection and digitalization of health data include:

• Data breaches, violations in privacy and confidentiality for groups that are subject to punitive or criminal laws – leading to unjust detention, violence or death in some cases
• ‘Function creep’ – use of data beyond the initially intended use
• Artificial Intelligence reproducing and amplifying racial or other bias – when an algorithm is trained on biased data, it is likely to reinforce patterns from the dominant category of the data it was trained with. Vulnerable groups have a long history of being absent or misrepresented in existing datasets
• Misinformation spread through social media

To address those risks and concerns when designing, implementing and monitoring digital health and data solutions, UNDP has issued ‘Guidance on the rights-based and ethical use of digital technologies in HIV and health programmes.’ The Guidance outlines key ethical, technical and human rights considerations for countries adopting digital technologies for HIV and health. It also presents a practical checklist and recommendations for governments, private sector companies and donor agencies to support countries in their decision-making on the adoption of digital technologies in HIV and health programmes.

UNDP supports governments to harness the power of technology to digitalize national logistic management information systems (eLMIS) for improved storage, delivery and access to vaccines, medicines and other health products.

In India, UNDP is supporting the Ministry of Health and Family Welfare to digitalize vaccine supply chains with mobile technology. India is transforming the way vaccines are delivered to people, including vulnerable and migrant populations, for COVID-19 and the world’s largest universal immunization programme.

Electronic Vaccine Intelligence Network (eVIN)

eVIN is a smartphone and cloud technology-based app that digitizes information on vaccine supplies across India. Developed with support from Gavi, the Vaccine Alliance, eVIN enables vaccine handlers to report on available stocks, consumption levels and movement. It also has a SIM-enabled temperature logger for remote monitoring of storage temperatures, which are kept lower to preserve vaccines.

Data is stored in a cloud server that provides web-based dashboards and data analytics for programme managers and policymakers to view the information in real-time. This end-to-end visibility of key supply chain data allows stakeholders to effectively manage supplies and make decisions that ensure quality vaccines reach people on time.

COVID-19 Vaccine Intelligence Network (CoWIN)

The success of eVIN enabled India’s government to rapidly deploy CoWIN during the height of the COVID-19 pandemic. CoWIN was the country’s digital COVID-19 platform, which enabled patients to book appointments for vaccination and receive their vaccine certificates. It also provided vaccinators with a platform to manage vaccination sessions, develop reports and monitor progress, while allowing programme managers to monitor vaccine utilization, coverage and wastage throughout the system.
UNDP provided technical and implementation support for CoWIN. CoWIN reached more than 950 million people and enabled the expansion of vaccine coverage, including adolescents between 15 and 17 years. It registered over 36 million new beneficiaries and has supported the provision of a third vaccine dose to people above the age of 60, health workers and frontline workers.

Electronic Immunization Registry (U-WIN)

After the success of eVIN and CoWIN, India turned to its universal immunization programme, which is the world’s largest. In 2023, the programme will reach 29 million pregnant women and 26 million newborns annually to protect against 12 vaccine-preventable diseases, including tetanus, diphtheria, polio and hepatitis B.

To reach millions of people, India’s government designed U-WIN, a digital platform to e-register and track the vaccination status of all expectant mothers and children across India. U-WIN provides a streamlined information source, including a database accessible to all states and Union Territories for decision-making. U-WIN will also enable people to receive vaccinations anywhere in the country, ensuring that migrants can access them. In addition, the system will allow people to schedule appointments and track their vaccination history.

eVIN, CoWIN and U-WIN demonstrate how digital technologies improve supply chains and vaccine delivery, both for pandemic response and a stronger and more resilient system for health in the future.

Learn more about the project and its results by visiting the UNDP India: eVIN project page . For more information about other eLMIS solutions that UNDP supports based on country needs, visit the eLMIS page.

This is an eight-minute video that explains how eVIN works and how India has adopted this technology
across the entire vaccine supply chain to strengthen the country’s immunization programme.

A Data Revolution for Medical Supply Chains in Indonesia

Indonesia has a large population spread across many islands, which makes delivering vaccines more challenging. During the COVID-19 pandemic, UNDP and the Ministry of Health strengthened vaccination drives using SMILE, which was piloted in 2018 with Government of Japan support. SMILE is a mobile and web-based application that provides real-time visibility on vaccine stocks and storage temperatures and enables programme managers to monitor deliveries down to the last mile. It supports health officials to overcome constraints of infrastructure, data management and human resources, which often result in overstocking and stock-outs of vaccines. By making data readily available, SMILE facilitates decisions on vaccine distribution to reduce waste and address inequities in vaccine coverage.

To date, SMILE has facilitated the distribution of 454 million doses of COVID-19 vaccines to over 12,000 health facilities nationwide. Additionally, temperature loggers installed at 5,000 health facilities have maintained vaccine efficacy, thanks to support from Gavi, the Vaccine Alliance. Vaccine stock-outs have been reduced by 36% and over-stocking by 56%. Vaccine stock wastage has been reduced by more than 90%.

Following its use for COVID-19 vaccines, SMILE is now supporting national vaccination campaigns to increase children’s routine immunization coverage, which declined during the pandemic.

From SMILE to ME-SMILE

UNDP’s SMILE Project has been working with the ministries of health and the environment and forestry on an internet based medical waste management information system. Piloted in three health facilities, ME-SMILE uses Internet of Things technologies to track the waste removal process, including collection, sorting and disposal. Dozens of health workers received training to input data, enabling real-time analysis during the waste management process.

The digital tracking system allows health facilities and authorities to identify current streams and determine total waste generated and help reduce carbon footprint. ME-SMILE reduced waste processing time from three hours to 30 minutes, while providing health facilities with more accurate data to plan future disposal capacity.

UNDP and the health ministry are scaling up ME-SMILE in 2023, initially involving 30 major hospitals in four provinces. The long-term goal is to implement ME-SMILE in all 3,000 hospitals by 2025, ensuring the safe management of approximately 3,000 tons of medical waste daily and reporting waste management data from all facilities to the national level.

UNDP’s approach

Among the applications of digital technologies that UNDP promotes in the health sector are those aimed at strengthening real-time capture, monitoring, and use of data within national HIV, malaria, tuberculosis and other health programmes. This support ranges from the digitalization of national health information systems, such as through the roll-out of the electronic district health information system (DHIS-2), and the use of mobile technologies within disease surveillance and tracking systems. UNDP likewise helps countries to identify and adapt open-source digital tools suitable for resource constrained contexts, including those to support disease monitoring, prevention, diagnosis, and recovery efforts in COVID-19 and beyond. This page provides some examples of digital health technologies that have supported countries to leverage data to enhance the coverage and quality of disease prevention and treatment efforts. Visit the Health information systems section for more information on UNDP’s broader capacity development support to strengthen health management information systems.

UNDP’s support to data systems and tools in the health sector is informed by its digital strategy to harness the potential of digital transformation for development, as well as guided by core Principles for Digital Development. It is important to ensure that amidst the heightened interest in the potential benefits of digital health, all people enjoy the benefits of innovation and that digital technologies help to reduce inequalities. To achieve this, UNDP is committed to ensuring that efforts in utilizing digital technologies are anchored in the values and obligations defined by the United Nations Charter and the Universal Declaration of Human Rights.

Cross-border platform to prevent tuberculosis

As part of the UNDP-managed Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund) multi-country tuberculosis grant for migrants, refugees and returnees in Afghanistan, Iran, and Pakistan, UNDP is working with Dure Technologies on a digital application (app) and dashboard to monitor and provide tuberculosis continuum of care. The app captures data on client registration, risk assessment, specimen collection, referral and linkages, sample testing, treatment initiation, treatment adherence, cross border case transfer, and contact tracing. It is able to support cross-border tracking of lost follow up cases through a quick response (QR) code.

Digital solutions for malaria prevention in Chad

UNDP supports Chad’s National Malaria Control Programme (NMCP) with malaria prevention for millions of people through a Global Fund grant. Key approaches include the routine and mass distribution of long-lasting insecticide-treated bed nets (LLINs) and seasonal malaria chemoprevention (SMC), a series of preventive medicines given to children under five years during the rainy season, when malaria transmission is highest.

During the 2022 SMC campaign, UNDP and NMCP digitized data collection to more efficiently deliver preventive medicines to children. Before the use of digital tools, information on the number of eligible and treated children was recorded by hand, which can lead to data discrepancies. During the digitized SMC pilot, community health workers collected data using the District Health Information System (DHIS2) SMC Tracker installed on tablets, which enabled them to quickly track children’s treatments and ensure that every eligible child received the correct dose.

Data was then automatically transmitted to the national DHIS2, where discrepancies and trends can be spotted quickly. In total, UNDP and NMCP trained more than 1,300 community health workers across 13 health districts and 184 health facilities in the Lac and Batha regions on digital data collection in the first phase of implementation. The pilot reached 200,000 children and yielded valuable lessons, such as creating instant message groups to share tips and troubleshoot problems among health workers.

Community Health Workers use a tablet with an application to do malaria chemoprevention for children under 5 and pregnant women in the village of Matafo near Bol in Lac Chad province, Chad, 17 October 2022

Digital solutions extended to the mass LLIN campaign, which will reach more than 18 million people with 11.6 million LLINs by the end of 2023. Using KoboToolbox, community health workers recorded the number of LLINs delivered to each household. Each tablet came with Mobile Device Manager, a software programme that tracks their location and usage to prevent loss and promote accountability during the campaign.

Following collection, the data was uploaded to DHIS2 for national reporting. UNDP also entered the data into a dedicated dashboard, which was developed to visualize information on LLIN distributions, such as the number of households targeted and reached.

Digitization and digitalization significantly enhance data management, accountability and problem-solving to increase the effectiveness of malaria prevention in Chad. Real-time data helped identify areas that delayed LLIN distributions due to shortages, inaccessible roads or insecurity. In the town of Goré, Logone Oriental, programme managers adapted the campaign to resume distributions when safe conditions returned.

In May 2023, Chad’s NMCP received the Alliance for Malaria Prevention annual award for leadership. This award recognized its role in planning, coordinating and implementing a nationally led malaria prevention campaign, including the completion of the large-scale digitalization pilot and the first phase of full implementation on time.

Harnessing technological innovation and green solutions for the health system infrastructure

Purpose

Inspired by the concept of smart cities, UNDP launched “Smart Facilities” in 2016 as an initiative to integrate technological innovation and renewable energy solutions into physical infrastructure. Smart Facilities applies solutions across four interdependent technology pillars to infrastructure such as office buildings, namely 1) energy and mobility; 2) big data and the internet of things; 3) information and communications technology (ICT), business intelligence and artificial intelligence; and 4) security.

Solutions that Smart Facilities provide

Issues that Smart Facilities seek to address

Building on lessons learned from operationalizing Smart Facilities within United Nations premises, UNDP is now working with governments, the private sector and other partners to apply the model to public sector infrastructure in a range of sectors, including health. Harnessing the power of smart technologies with the growing global need to be more energy efficient presents a key opportunity to contribute to the global decarbonization objectives of the 2030 Agenda.

The Smart Facilities model likewise offers a means to strengthen local economies. The initiative leverages local small and medium-sized enterprises for long-term sustainability of Smart Facilities and builds their technical capacities in the process. It aims to build a pipeline of local capacity to shape green, digital, new technology-driven infrastructure solutions, including a focus on youth apprenticeship.

UNDP’s approach

The implementation of Smart Facilities consists of a seven-step process that has been refined over the years:

This process ensures a comprehensive assessment of the site, a well-refined process for identifying local partners, a thorough technical review, a detailed installation plan and capacity building process, and continued monitoring and reporting to identify further business opportunities.

As part of its support to COVID-19 national vaccine deployment plans, UNDP offers a number of Smart Facility solutions to strengthen vaccine distribution efforts. These solutions cut across all stages of the cold chain to complement and reinforce existing components of vaccine storage, tracking, energy sources, monitoring, and security in both mobile and stationary infrastructure. They include, for example, vehicle grid integration, satellite communications, renewable energy, logistics management information system (LMIS) mobile applications for tracking and Internet of Things (IoT) sensors for temperature monitoring.

Smart Facilities for Health are based on a user-centered approach to design and capacity development, grounded in a recognition that innovation
and digital solutions require co-creation and user ownership to be relevant and lasting. This includes a diverse community of
engineers, local private sector service providers, facility managers, healthcare providers and patients.

By relying on partnerships with local small and medium-sizes enterprises, these Smart Facilities help to transform short-term vertical responses to acute crises into long-term solutions to buttress and extend health systems, including enabling digital health solutions and reaching underserved communities well into the future. As such, investment in local technical capacity lays the foundation for a new fourth Green Industrial Revolution.

UNDP continues to explore opportunities to scale Smart Facilities for health for COVID-19 response efforts and beyond.

With a focus on providing essential solutions for fixed infrastructure throughout health systems, such as health facilities, medical warehouses and laboratory and diagnostic settings, the Smart Facilities entail the application of interconnected renewable energy, internet connectivity, IoT and physical and cybersecurity elements. UNDP particularly seeks to leverage smart infrastructure solutions to build on its existing support to build more resilient and sustainable systems for health, including through its partnership with Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). Plans for Smart Facilities for health supported by the Global Fund are underway in Afghanistan, Djibouti, Guinea-Bissau, and South Sudan.

Despite longstanding efforts and significant investments, the world remains off -track for achieving the Sustainable Development Goal target of ending malaria by 2030. Malaria persists where sustainable development is slowest. Countries with a high malaria burden experience a 1.3% annual loss in economic growth, and their GDP per capita grows up to five times more slowly than in countries with little or no malaria. Inverting the vicious cycle requires new, integrated ways of collaborating; and thinking holistically about development and comprehensive multisectoral action is essential. Conventional malaria interventions are faced with a system challenge.

In many settings, the root causes of malaria extend beyond the confines of the healthcare sector, reaching into realms such as social and economic inequities, poor housing, environmental degradation, agricultural practices, and water and waste management. Yet, the global response to malaria has traditionally centered on the health sector and vector control, often neglecting the broader determinants of the disease.

Man cleans a creek of debris outside his house in the town of Guayaramerín, Bolivia,
where there are outbreaks of malaria, and periodic flooding brings an increase in mosquitoes.
Photo: UNDP Bolivia/Miguel Samper

Using data, case studies and practical tools, the Comprehensive Multisectoral Action framework provides guidance for policymakers, programme managers and funders to adapt their approaches to addressing malaria. This framework advocates a shift from a health-sector-centric approach to a comprehensive, coordinated, and multisectoral response. It aims to harness integrated action, commitment, and expertise across key sectors to combat malaria effectively.

Tools and Examples

Pathfinding for Comprehensive Multisectoral Action Tool

The Pathfinder Endeavour is a collaboration between UNDP, WHO, UN-Habitat, the Roll Back Malaria Multisectoral Working Group and others. It aligns directly with UNDP’s Strategic Plan for 2022-2025, emphasizing collaboration across the revitalized UN-system to achieve transformative change.

To achieve the goals of malaria elimination, improved population health, and reduced inequities concerted simultaneous actions across multiple sectors and all SDGs are necessary. This comprehensive multisectoral approach encompasses political, institutional, social, economic, environmental, climatic, and health-related factors that intersect to drive the vicious cycle of malaria. It recognizes that addressing these multifaceted issues calls for collaboration that transcends individual sector interests. It also promotes political, technical, and public accountability through direct and real-time engagement with citizens.

Through this approach, Pathfinder helps unlock synergies and co-benefits across multiple sectors, transforming malaria elimination into a shared responsibility rather than a health-sector-only concern. While selective multisectoral action has been common, there is no universal blueprint for fully integrated efforts. To bridge this gap, the Pathfinder accelerates progress by learning from real-life cases, focusing on areas and populations that are furthest behind, and identifying new ways to collaborate around shared co-benefits that complement existing structures and resources. This comprehensive, multisectoral view is essential to breaking the cycle of malaria and poverty, ensuring that global health goals and sustainable development objectives are achieved in tandem.

The Pathfinder Endeavour provides a structured process for sustainable results on the ground in real-life situations. The onus is on local systems, governments, and communities in four initial countries with three districts in each that are among the furthest behind in malaria elimination and in achieving the SDGs. The process fosters cross-learning with international peers through the five-step path to becoming malaria-smart, ensuring interventions align with existing structures and resources. Over four phases spanning three years, it facilitates exploration, hands-on experience, and systematic documentation of innovative approaches, paving the way for sustainable results, scale-up, and replication. As of April 2025, the initiative has entered the pre-project phase in four countries – Madagascar, Uganda, Cameroun, and Ghana.

Example of Multisectoral Action

Malaria and poverty are intricately linked, with nearly half of households in malaria-prone areas spending over 40% of their income on healthcare, pushing billions deeper into poverty. Despite new vaccines, progress in reducing cases has stalled, and climate change, conflict, and displacement are worsening the situation. Countries like Sri Lanka, Azerbaijan, and Tajikistan have shown that integrating sustainable development practices with malaria interventions—such as improving living conditions and water management—can drive success. UNDP, alongside key partners, is promoting a multisectoral approach that addresses the root causes of malaria while advancing health, economic, and social development. To meet global targets by 2030, bold, integrated actions and increased funding are essential to create a malaria-free and more equitable world. Learn more here