Consultation on the Draft Options Paper on the Global Coordination

Submission on the Draft Options Paper on the Global Coordination Mechanism on NCDs

AUSTRALIA

Australia appreciates the opportunity to comment on the draft Options Paper on the functions of the Global Coordination Mechanism on NCDs (the GCM/NCD), as mandated in Decision EB148(7).

The paper is an important next step in taking forward the recommendations of the 2020 final evaluation of the GCM/NCD and in guiding Member State consideration of the future of the mechanism at WHA74. High-level comments on the paper are outlined below.

High-Level Comments

The Options paper is a clearly articulated, well-structured document that seeks to address the principle recommendation of the GCM/NCD final evaluation.

As indicated in the final evaluation report, the value of the GCM/NCD at the country level has been difficult to quantify, and we encourage the WHO to ensure that each Option has a clear and measurable agenda.

Both 2017 and 2020 evaluations noted an ‘absence of an explicit results framework with clearly defined objectives’. This must be prioritised in any future work on the GCM/NCD. It is important that monitoring methods have the capacity to identify specific results and practical changes in policy or practice that stem from inputs.

We would also appreciate greater clarity on the role of Member States, the WHO, and partners under each Option.  As the GCM is currently a Member State-led mechanism, we would appreciate more information on how Member States would be expected to engage under Options 2 and 3, not only in the transitioning phases, but also for any long-term engagement strategies that would be created, that include details on aim, inputs, outcomes and structure.

Clear outlines on how each recommendation from the evaluation report will be implemented under each Option should also be added, along with consideration of whether financial implications will differ significantly across the three.

Noting also the different resource implications under each Option, if possible, we would appreciate further information on how each of the Options may impact staff at the regional and country level.

We appreciate the paper’s consideration of the various pros and cons under each Option. Recognising that not all the pros and cons listed carry equal weight and/or risk, we recommend that the paper identifies those that are consistent across the three Options, as well as those that are unique. A risk assessment of the cons, highlighting both risk of occurrence and severity would be beneficial, along with further analysis on options for mitigating cons. Comments from Brazil

In the context of the current consultations on the Global Coordinating Mechanism for Non- Communicable Diseases (GCM/NCDs), the Permanent Mission of Brazil would like to convey the following comments on the draft options paper for the GCM/NCDs:

Brazil deems important to resume the work of the Mechanism, under the leadership of Member States, based on lessons learned since its inception, in 2014. In Brazil's view, the work of the Mechanism should be made more efficient and further aligned to other relevant initiatives by the WHO Secretariat in the field of noncommunicable diseases.

According to the Ministry of Health of Brazil, the continuity and strengthening of the “Global Coordinating Mechanism on NCDs”, under the guidance of Member States, is desirable and justifiable, both by the high burden of NCDs in the world and the need to (i) strengthen health systems; (ii) resume treatment and care of people living with NCDs; and (iii) pay due attention to the people living with NCDs in face of the COVID-19 pandemic.

In this light, the Permanent Mission requests the WHO Secretariat to take due note of Brazil's preference for the continuity and strengthening of the GCM/NCDs.

The Permanent Mission of Brazil remains at the disposal of the WHO Secretariat for any further information or clarification. Introduction Decision EB148(7) requests “the Director-General, in response to the recommendations of the final evaluation of the WHO global coordination mechanism on the prevention and control of noncommunicable diseases, to develop, in consultation with Member States and relevant stakeholders, an options paper on the global coordination mechanism, for further guidance by the Seventy-fourth World Health Assembly”1.

In response, this paper sets out options on the WHO global coordination mechanism on the prevention and control of noncommunicable diseases (GCM/NCD or ‘the Global Mechanism’). The proposed options have been informed by the following key documents: • final evaluation of the GCM/NCD - full report2 , • mid-point evaluation of the implementation of the NCD-GAP 2013–2020 – full report3, • preliminary evaluation of the GCM/NCD4, • the differentiation of the updated roles and responsibilities of the NCD-related Departments at WHO Headquarters which have resulted from the WHO transformation (see table below). The three options set out in this document are aligned with the principle recommendation contained in the executive summary of the final evaluation of the GCM/NCD5. For ease of reference, the principle recommendation is reproduced in the box below.

PRINCIPLE RECOMMENDATION The GCM/NCD is, to date, the first and currently the only formal Member State-led mechanism within the WHO Secretariat aimed at facilitating multistakeholder engagement and cross-sectoral collaboration in the area of NCDs. Its unique mandate rests primarily in its engagement capacity and its potential to create links between multisectoral actors, including Member States, non-State actors, United Nations actors and other technical programmes, at the global, regional and national levels. As the functions originally envisaged for the GCM/NCD remain valid and relevant contributions to the NCD-GAP, the Thirteenth General Programme of Work, 2019–2023 and the Sustainable Development Goal targets to 2030, these functions should be continued. However, the mechanism needs to evolve towards, or possibly be replaced by, a more targeted and action-oriented model, or alternative approach, in closer collaboration with relevant internal and external actors. Options in this regard include: (a) a strengthened, more focused approach to delivery of the vital functions through the GCM/NCD, with a clear role and responsibility within WHO’s internal NCD organizational architecture to avoid duplication of efforts. In this scenario, Member States also need to play a stronger role in the mechanism; (b) discontinuation of the mechanism and establishment of a new operating model within WHO to ensure the functions are effectively carried forward. This could involve the functions of the GCM/NCD, and its external engagement/linkage dimensions, being undertaken by a WHO Department. In this scenario, there also needs to be a clear role and responsibility within WHO’s internal NCD organizational architecture and, possibly, an avenue for Member States’/non- State actors’ leadership/contribution on specific issues.

1 https://apps.who.int/gb/ebwha/pdf_files/EB148/B148(7)-en.pdf 2 https://www.who.int/publications/m/item/final-evaluation-of-the-global-coordination-mechanism-on-the-prevention-and-control-of- noncommunicable-diseases-volume-1-report 3 https://www.who.int/publications/m/item/mid-point-evaluation-of-the-implementation-of-the-who-global-action-plan-for-the-prevention- and-control-of-noncommunicable-diseases-2013-2020-(ncd-gap) 4 https://www.who.int/docs/default-source/documents/evaluation/preliminary-evaluation-ncds.pdf?sfvrsn=b5737024_2 5 https://apps.who.int/gb/ebwha/pdf_files/EB148/B148_7Add2-en.pdf

1 The three options set out in this paper are assessed with a view to ensure that the functions currently assigned to GCM/NCD can be delivered efficiently and effectively over the next 10 years, in support of the implementation of the extended duration of the NCD-GAP until 2030 and WHO’s NCD Implementation Roadmap 2023-2030 (under development). This document provides an assessment of the recommended options for future arrangements of the GCM/NCD, as presented in final evaluation report. The main purpose of this document is to enable Member States, UN organizations and non-State actors to provide their views on this draft paper during the intersessional period leading up to WHA74, before a final options paper is submitted to WHA74 for decision by Member States.

Context The terms of reference (ToR) for the GCM/NCD were developed by Member States through an intergovernmental process. Member States reached consensus at a Formal Meeting of Member States in 2014 and subsequently noted the ToR at WHA676. The ToR states that the envisaged lifespan of the GCM/NCD is set from 2014 to 2020, in line with the NCD-GAP, and that a final evaluation will be presented for consideration at the World Health Assembly in 2021 to assess the effectiveness of the GCM/NCD, its added value and its continued relevance to the achievement of the 2025 voluntary global targets, including its possible extension.

Please refer to the GCM/NCD’s ToR for a detailed description of the Global Mechanism’s scope, purpose, functions and composition, including overarching principles and approaches, responsibilities for its Participants and for GCM/NCD Secretariat.

6 https://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_14Add1-en.pdf?ua=1 7 Department of Global NCD Platform, Department for Noncommunicable Diseases, Department for Mental Health and Substance Use, Department for Health Promotion, Department for Social Determinants of Health, Department of Environment, Climate Change and Health, Department for Nutrition and Food Safety.

2 An overview of the updated roles and responsibilities of the NCD-related Departments at WHO Headquarters mapped against the shared responsibility in implementing the functions originally included Commented [1]: Is it possible to show how the various in the ToR for the GCM/NCD is presented in the Annex. departments involved in NCD-related work are connected eg, through a functional organisation structure or a similar Since the period of the NCD-GAP now extends to 2030 (to align with the 2030 Agenda for Sustainable diagram? This may help in envisioning the relationship Development), accompanied by an ‘implementation roadmap 2023–2030’ as requested by Member between departments and can be put in the annex as well. States at EB1488, any new arrangements proposed in respect of the functions of the GCM/NCD should also be formulated with an equivalent timeframe and with due consideration to the value of the GCM/NCD’s supportive role to WHO’s evolved NCD programme and context.

Option 1 - Strengthened Operating Model

What this Option considers

The GCM/NCD has evolved over the years, with the support of the GCM/NCD Secretariat, and has adapted to organizational transformations and to changes across the global NCD landscape. However, the final evaluation highlights both the need for and the opportunity to continue evolving by making a number of further changes to its operational model. The proposed changes to the operating model, which build on lessons learned from GCM/NCDs’ 6 years of activities should effectively address the recommendations of its final evaluation. The evolved operating model will define the long-term vision for the GCM/NCD for 2030, including the added value of the global mechanism to the 5 functions (Figure 1) and the strategic priorities and signature solutions. The main elements of this Option include: • Extension of the GCM/NCD’s mandate until 2030, in line with NCD-GAP 2013-2030 and under the leadership of Global NCD Platform department; • The possibility of Member States to either extend or modify its current ToR according the evolved WHO, NCD and SDG contexts; • A revised vision for the GCM/NCD, supported by a theory of change (Figure 2); improvements to planning processes according to the updated roles and responsibilities across WHO’s, and enhancements to GCM/NCD’s governance arrangements. Commented [2]: Will a similar framework be • Mid-point and final evaluations of the extended mandate of the GCM/NCD (2021-2030) to assess the developed for Option 2, under the auspices of the GNP? effectiveness of the new GCM/NCD operating model, its added value and its continued relevance. Assumptions This Option builds on the recommendations of the final evaluation of GCM/NCD, as follows:

• A strengthened engagement and partnership-based GCM/NCD will further add value to its mandate by defining a clear theory of change, results framework and outcomes that best support the WHO NCD Action Plan 2013-2030, and the NCD implementation roadmap 2023– 2030; • The new operating model will strengthen its value as a participatory multistakeholder engagement and knowledge collaboration mechanism within WHO, with a focus on further leveraging meaningful and effective contributions from its diverse Participants to the implementation of national NCD responses.

8 https://apps.who.int/gb/ebwha/pdf_files/EB148/B148(7)-en.pdf

3 Pros and Cons

PROs CONs 1. Enhances WHO’s work towards engaging with NSAs 1. If Member States decide that the ToR needs to be on the prevention and control of NCDs supporting the modified, then Member States would have to launch differentiated roles and responsibilities of WHO an intergovernmental process to be redrafted ToR. Departments contributing to the NCD agenda. 2. Implementation of focused approaches for capacity 2. If Member States decide that the ToR needs to be building on multisectoral and multistakeholder modified, implementation may be affected by a lack of engagement that supports Governments to develop clarity from, or consensus among, Member States and implement ambitious national NCD responses, during the intergovernmental negotiations to agree on forging multi-stakeholder partnerships and alliances a new ToR. that mobilize and share knowledge, assess progress, provide services and amplify the voices of and raise awareness about people living with and affected by NCDs. 3. Reinforces WHO’s commitment to working in 3. Resource-intense commitment from WHO HQ, RO and partnership with Governments, civil society and the country offices to coordinate planning with GCM/NCD private sector, as a catalyst and facilitator of support activities national NCD responses as mandated by the UN General Assembly. 4. No disruption of ongoing GCM/NCD activities and 4. Resource-intense commitment from Member-States engagement with GCM participants, reducing and GCM/NCD Participants to finalize Theory of potential reputational risk to WHO’s visibility and Change, with related key performance indicators and credibility with NSAs coordinate planning and collaboration with GCM activities 5. Continued and enhanced alignment and strategic 5. Resource-intense commitment from GCM/NCD collaboration with the UN Inter-Agency Task Force on Secretariat to adjust, implement and sustain the new NCD through strengthened collaborative planning operating model within the purpose and functions of the GNP 6. Sustained and enhanced engagement capacities of 6. Time and resource from WHO Secretariat to conduct the GCM/NCD across its participants, including and present mid-term and final evaluations (2021- through a new engagement strategy. 2030) 7. Strengthens WHO’s relevance as a trusted partner in a 7. Risk that there could be a continued perception of complex and evolving socio-economic development duplication of functions across WHO and various landscape entries points for Member States and NSAs to engage with WHO

Figure 1: Alignment of the proposed GCM/NCD Outcomes with the 5 Functions

4 Figure 2- Proposed Theory of Change/Results Framework9

Option 2 - Hybrid model - building on the foundations of the GCM/NCD

What this Option considers

The final evaluation states that “as the functions originally envisaged for the GCM/NCD remain valid and relevant contributions to the NCD-GAP, the GPW13 and the SDG targets to 2030, these functions should be continued” and “new means to maintain and, where possible, strengthen efforts to deliver the important functions of the GCM/NCD need to be considered”. This option seeks the absorption of the functions and activities of the GCM Secretariat into WHO’s Global NCD Platform (GNP). This would ensure alignment with the establishment of GNP, in response to the WHO Transformation agenda, as a WHO department to coordinate and mobilize meaningful and effective commitments and contributions from UN organizations, and non-State actors.

The main elements of this Option include: • Discontinuation of a formal WHO Member State-led, participatory-based mechanism aimed at facilitating multistakeholder engagement, cross-sectoral coherence, information sharing and knowledge collaboration in the area of NCDs; • Under this option, GNP would assume the following functions:

o GNP as an operational backbone for knowledge collaboration and dissemination of innovative multi-stakeholder responses at country level: Raising awareness and promoting knowledge collaboration among Member States and non-State actors, and to co-create, enhance and disseminate evidence-based information to support Governments on effective multisectoral and multistakeholder approaches (e.g. global multistakeholder meetings and dialogues, Knowledge Action Portal on NCDs (KAP), NCD Voices in the Decade of Action webinar series; and other multistakeholder convening platforms).

9 Figure 1 demonstrates how the GCM/NCD would evolve to use strategic inputs to drive its activities and outputs which, in turn, will support the achievement of defined outcomes and overall goals, which are specific to and build on the Global Mechanism’s vision and its added value across the 5 WHO-wide functions originally envisaged for the GCM/NCD

5 o GNP as an enabler for global stocktaking of multistakeholder action at country level, and co-designing and scaling of innovative approaches, solutions or initiatives to strengthen effective multisectoral and multistakeholder action (e.g. successful approaches to multisectoral and multistakeholder actions on NCDs; NCD campaigns, commitments and contributions of NSAs, NCD Lab on ‘PLWNCDs’, ‘NCDs and the Next Generation’, and ‘Women and Girls and NCDs’).

o GNP as a global facilitator for strengthened capacity of Member States and civil society to develop national multistakeholder responses for the prevention and control of NCDs (e.g. guidance on establishing national coordination mechanisms for NCDs; roadmap for supporting Member States in their decision-making on private sector engagement for NCDs, NCD Sprints, Health Literacy Development Programme)

o GNP as convener of civil society, including people living with NCDs, to raise awareness and build capacity for their meaningful participation in national NCD responses (e.g. PLWNCDs Initiative, Youth Engagement, Civil Society Working Group).

Pros and Cons

4. Integrated into GNP department with targeted and action- 4. Will require very clear outputs that demonstrate contribution oriented function in collaboration with relevant internal common results, in accordance with the new roles and and external actors responsibilities of the new Departments

5. Continued alignment and strategic collaboration with 5. May impact ability to continue engaging formally with UNIATF Member States and NSAs to strengthen national ownership and capacity, and delivery of the NCD agenda 6. Alignment of GCM/NCD Secretariat outcomes and activities 6. May be perceived as a “one-size-fits-all" approach to coherent to the current and relevant mandate of the GNP NCD action on many fronts, with multiple actors and across different levels 7. Maintain current human resources of the GCM/NCD 7. May cause disruption to some of GCM/NCDs’ ongoing Secretariat activities and relations with GCM participants

6 Option 3 - Discontinuation and absorption of functions elsewhere within WHO Secretariat

What this Option considers

This option considers discontinuing the global mechanism, as structured by Member States in its ToR, and distributing or establishing the functions and activities of the GCM/NCD Secretariat elsewhere within the WHO Secretariat, given that formats or elements of the current functions and activities can be implemented across relevant WHO Departments and Units.

Assumptions

This option builds on the following:

• the assumption that there is limited added value of the GCM/NCD’s participant-based mechanism, and therefore the need to discontinue its unique mandate which, as stated by the final evaluation, “primarily rests on its engagement capacity and its potential to create links between multisectoral actors, including Member States, non-State actors, United Nations actors and other technical programmes, at the global, regional and national levels”10; • the need to put in place arrangements that ensure the functions currently performed by the GCM/NCD Secretariat continue to be performed effectively and efficiently by other parts of the WHO Secretariat. Pros and Cons

PROS CONS 1. May streamline administrative operations and activities 1. Reputational risk to WHO in enacting the sunset clause across WHO Departments included in the ToR of the GCM/NCD, taking into account that this is a Member State-developed mechanism in response to sensitive discussions at the UN General Assembly in 2011 2. May reduce perception of duplication across NCD 2. The breadth of expertise in the GCM/NCD to "connect the related departments dots" at the highest levels of government on the most complex NCD issues may not be called upon directly 3. May streamline resource allocation across NCD related 3. May be incorrectly perceived that WHO will not continue departments to partner with and advocate for the inclusion of civil society in country-led efforts to achieve the NCD-related SDGs

4. WHO to continue supporting Member States in 4. GMC/NCD’s track record will be lost. developing multistakeholder activities

5. WHO to continue developing partnerships across 5. Impact negatively on WHO’s competencies to build individual NCDs and risk factors, and assist in improving comprehensive multistakeholder approaches to mutual accountability for the NCD-related SDGs in such interconnected NCD challenges. partnerships 6. Less resource-intense commitment from WHO and 6. Will cause disruption to GCM/NCDs’ ongoing activities and Member States relations with GCM participants

10 Paragraph 34, https://apps.who.int/gb/ebwha/pdf_files/EB148/B148_7Add2-en.pdf

7 Annex Updated roles and responsibilities of the NCD-related Departments at the WHO Headquarters mapped against the shared responsibilities of implementing the functions originally included in the terms of reference of GCM/NCD

Original function of the GCM/NCD Post-WHO Transformation Agenda

1 Advocating and raising awareness: - Governance role (UNGA, WHA) led by ADG/UCN and ADG/HEP, supported by NCD Advocating for and raising awareness of Department the urgency of implementing the WHO - Governance role (ECOSOC) led by Secretariat of the UNIATF in GNP Department Global NCD Action Plan 2013–2020; - 2030 Sustainable Development Agenda now includes SDG 3.4 mainstreaming the prevention and - Global NCD investment cases led by SDH Department control of noncommunicable diseases in - Global surveillance and monitoring led by NCD Department the international development agenda; - Raising the priority given to addressing the deadly interplay between COVID-19 and NCDs and giving due consideration to the is led by WIN Working Group on COVID-19 and NCDs co-chaired by NCD and HPR prevention and control of Departments noncommunicable diseases in discussions - Raising the priority given to addressing the deadly interplay between COVID-19 and NCDs on the post-2015 development agenda; across the UN system through the Task Force - Efforts to integrate NCDs into the new strategy of the Global Fund are coordinated by the NCD Department - New implementation roadmap for NCD GAP 2023-2030 is being developed under auspices of the TEN/NCD and the coordinating leadership of the NCD Department - Monthly Spotlight and Hardtalk Webinars to advocate, capacity build and disseminate new technical guidance (led by the NCD Department) - Coalition of Heads of State and Government on NCDs and the promotion of Mental Health and Wellbeing led by GNP Department - WHO Civil Society Working Group on NCDs led by GNP Department - Global stocktaking of country multisectoral and multistakeholder success stories led by GCM/NCD Secretariat - Global stocktaking and repository of NCD advocacy campaigns led by GCM/NCD Secretariat - Webinar series: ‘NCD Voices in the Decade of Action to advocate, capacity build and disseminate the voices and priorities of marginalized groups or individuals led by GCM/NCD Secretariat - WHO global multistakeholder meetings to build capacity of national NCD focal points led by GNP Department 2 Disseminating knowledge and - Knowledge Action Portal on NCDs led by GCM/NCD Secretariat information: Disseminating knowledge - Capacity building through multistakeholder meetings, dialogues and workshops for and sharing information based on national NCD focal led by the GCM/NCD Secretariat scientific evidence and/or best practices - Consultations, workshops and knowledge collaboration with and for PLWNCDs led by the regarding the implementation of the GCM/NCD Secretariat WHO Global NCD Action Plan 2013–2020, - Webinar series: ‘NCD Voices in the Decade of Action to advocate, capacity build and including health promotion, prevention, disseminate the voices and priorities of marginalized groups or individuals led by control, monitoring and surveillance of GCM/NCD Secretariat NCDs - Platform of Communities of Practice (e.g. Global Initiative on Childhood Cancer and Self Care Interventions) led by GCM/NCD Secretariat - GCM/NCD newsletter for GCM Participants for information sharing and knowledge collaboration led by GCM/NCD Secretariat - Regular and ad-hoc meeting/webinars of the Task Force and development and dissemination of relevant publications 3 Encouraging innovation and identifying - STAG on NCD led by ADG/HEP and ADG/UCN barriers: Provide a forum to identify - TAGs on Diabetes, Research and Innovation led by NCD Department barriers and share innovative solutions - STAG on Healthier Populations led by ADG/HEP and actions for the implementation of the - Forums have established across the NCD-related technical Departments (e.g. Hard Talk, WHO Global NCD Action Plan 2013–2020; Spotlight webinars, national strategic dialogues, etc) - Regular and ad-hoc meeting/webinars of the Task Force and development and dissemination of relevant publications - Knowledge Action Portal on NCDs led by GCM/NCD Secretariat - Development of tools and guidance for meaningful engagement of PLWNCDs led by the GCM/NCD Secretariat

8 Original function of the GCM/NCD Post-WHO Transformation Agenda

- NCD Sprints workshops focused on a multistakeholder, participatory approach to address contextual NCD challenges at Regional and National levels led by GCM/NCD Secretariat - NCD Labs virtual platform supporting submissions that harness innovative solutions to accelerate progress towards SDG 3.4 and promote WHO’s normative guidance and standards (e.g. NCDs and Next Generation, Women and Girls, PLWNCDs) led by GCM/NCD Secretariat - Guidance to Member States for health literacy development on NCDs and mental health conditions led by GCM/NCD Secretariat - Implementation of health literacy demonstration project on NCDs and mental health conditions across WHO Regions led by GCM/NCD Secretariat - Policy brief on addressing the commercial determinants of health at country level for effective NCD responses led by GCM/NCD Secretariat 4 Advancing multisectoral action: Advance - Multi-sectoral strategies, alliances and partnerships have been mainstreamed across the multisectoral action by identifying and NCD-related Departments (e.g. Global Diabetes Compact led by the NCD Department, promoting sustained actions across Third Billion Strategy led by the HEP Division, driving forward action across the UN system sectors that can contribute to and by the UN NCD Task Force in GNP) support the implementation of the WHO - Multi-stakeholder alliances and multi-sectoral actions have been mainstreamed across the Global NCD Action Plan 2013–2020; NCD-related Departments (e.g. through the Norway-funded county projects, Strategic Roundtables are organized in countries under the coordination leadership of the NCD Department and support to UNCTs through EU, Russian and Gulf Health Council financing). - NCD Multisectoral Action Repository – analysis of successful approaches to multisectoral action for NCDs, including those that address their social, economic and environmental determinants led by GCM/NCD Secretariat. - Guidance to Member States on establishing national NCD multisectoral and multistakeholder coordination mechanisms led by GCM/NCD Secretariat - Development of a roadmap and tools to support Member States in their decision-making regarding private sector engagement for NCDs led by GCM/NCD Secretariat - WHO toolkit for behavioural change communication campaigns on NCD risk factors for children and adolescents led by GCM/NCD Secretariat - Implementation of health literacy demonstration project on NCDs and mental health conditions across WHO Regions led by GCM/NCD Secretariat - Platform for the coordination of the implementation of the recommendations of the HLC on NCDs final report led by GNP 5 Advocating for the mobilization of - UN Multi-partner Trust Fund for NCDs and mental health has been established with cross- resources: Identifying and sharing UN Steering Group and a Secretariat, with the hub in the UN NCD Task Force Secretariat information on existing and potential by the GNP Department sources of finance and cooperation - Actions to support efforts to generate domestic revenue streams through the taxation of mechanisms at the local, national, tobacco products, alcoholic beverages and sugar-sweetened beverages are coordinated regional and global levels for the by the HEP Division in close collaboration with the UN NCD Task Force implementation of the WHO Global NCD - Actions to establish global and domestic funding streams for NCD Signature solutions Action Plan 2013–2020 (Childhood cancer, Cervical Cancer, Global Diabetes Compact, surveillance and monitoring, HEARTS, tobacco, physical activity, air pollution, nutrition) are led by the NCD- related Departments - Dialogues with private sector are conducted bin all technical areas asks and commitments - Engagement strategy with GCM Participants to leverage resources and expertise to advance the implementation of WHO GAP-NCD agenda led by GCM/NCD Secretariat

9 Government of Canada’s response for the Web-based Consultation: World Health Organization (WHO) Draft Options Paper on the Global Coordination Mechanism on Non-communicable diseases (GCM-NCD)

Overview Comments

Canada thanks the WHO for this opportunity to comment and express its views regarding the way forward for the Global Coordination Mechanism on NCDs (GCM-NCD).

In considering the future of the GCM-NCD, Canada’s perspective is anchored by the call to multisectoral action as a fundamental principle of the 2011 UN Political Declaration of the High- level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. The 2011 Political Declaration’s recognition of “the essential need for the efforts and engagement of all sectors of society to generate effective responses for the prevention and control of non-communicable diseases” is as important today as it was when the Declaration was first adopted. This was reaffirmed in the 2018 UN Political Declaration of the Third High-level Meeting of the General Assembly on the Prevention and Control of Non- communicable Diseases.

This call to multisectoral action remains one of the most novel and challenging elements of the commitments made in the UN NCD Political Declarations. We recognize that the GCM/NCD is the only formal Member State-led mechanism for multi-stakeholder engagement that currently exists. The expectations were high for the GCM-NCD at the time of the development and adoption of the WHO Global Action Plan for NCD Prevention and Control 2013-2020. However, achieving Member State consensus in establishing the GCM-NCD and in mobilizing support to realize its mandate have proven to be difficult. Canada’s view is that the full promise of integrated multisectoral action has not been realized through the GCM-NCD in its current form. While acknowledging the contributions of the GCM-NCD in the domain of knowledge translation, we remain concerned about the GCM-NCD’s ability to fulfil its role in mobilizing nonstate actor expertise and resources for NCD action, especially beyond the most developed countries.

Canada’s own engagement with GCM-NCD has been limited, and the high-level nature of its work to-date has limited practical applicability in Canada. We hope that as multisectoral efforts at the global level continue to evolve, mobilization of civil society will advance beyond knowledge translation towards new interventions, mechanisms and contexts.

Further, Canada’s view is that the GCM-NCD needs to be closely integrated and well-aligned with the activities and priorities of the units within the WHO Secretariat with lead responsibility for NCDs. As well, the work of the GCM-NCD needs to more actively include Member States, and span all WHO Regions. We also remain concerned about the lack of clarity and transparency on the funding of the GCM-NCD, both overall and for specific initiatives and projects. Member States’ financial and in-kind contributions to the GCM-NCD should be reported both historically and going forward.

Recommendation and Options

Canada welcomes the WHO Secretariat’s analysis of the Final Evaluation of the GCM-NCD and related recommendations. We strongly agree with the recommendation that “the mechanism needs to evolve towards, or possibly be replaced by, a more targeted and action-oriented model, or alternative approach, in closer collaboration with relevant internal and external actors.”

Canada does not support an indefinite mandate for the GCM-NCD at this point, but rather agrees that Option (a) be adopted for a finite period to see if it can achieve a more focused approach to delivery of the GCMs current function, greater integration with WHO’s internal NCD architecture, and a stronger role for Member States.

Canada would alternatively support Option (b) wherein the functions of the GCM be fulfilled through a new operating model from within the WHO’s organization. The GCM-NCD could be absorbed in the NCD Platform while preserving the important multi-stakeholders commitments/contributions to support successful implementation of GAP on NCDs.

Engagement As the mechanism is Member State-led, we would welcome further details on the implications of the different options on Member States’ role and engagement, including potential impacts on transparency.

Canada strongly encourages the WHO Secretariat to provide Member States with regular updates on efforts to engage the expertise and resources of all of sectors, in order to mobilize effective and innovative action on NCDs in diverse contexts, including the least resourced.

We would also welcome further information on how the options proposing greater integration with the WHO may result in implications with respect to FENSA.

Resources Canada remains concerned that WHO’s NCD-related units are inadequately resourced to fulfil their critical scientific and normative functions. In order to support Member States’ assessment and decision-making moving forward, Canada recommends including the financial implications, and more specifically the financial figures, for the different options being proposed.

Background – Canada’s Domestic Efforts

Canada’s own domestic engagement of non-state actors and partners in NCD action continues to adapt and evolve. The Public Health Agency of Canada has recently launched the Healthy Living and Healthy Communities Fund (HCCF) to support interventions that focus on behavioural risk factors (physical inactivity, unhealthy eating, and tobacco use) with the aim of preventing the main chronic diseases of diabetes, cardiovascular disease and cancer. Priorities for the HCCF program, which builds on the former Multi-sectoral Partnerships to Promote Healthy Living and Prevent Chronic Disease (MSP), include an expanded focus on addressing health inequalities; encouraging multi-sectoral participation in chronic disease prevention; and exploring new ways to address the risk factors for chronic disease. Comments from Finland

We would like to thank for the opportunity to provide comments on the GCM draft options. Finland considers the continuation of coordinated multisectoral and cross-sectoral engagement in NCDs important, and has sought to evaluate the options in light of what might best serve that purpose and the continuity of work. We would therefore be initially supportive of exploring the option A, thus continuation of the current operating model.

Unfortunately, our delegation will not be able to participate in the online consultation today 1 April but we remain engaged in the process and look forward to providing any further comments as necessary.

Comments from Germany

Germany thanks the Secretariat for having drafted this Options Paper and the opportunity to give feedback. The Options Paper identifies 3 options for a way forward. Option 3 – discontinuation of the GCM and absorption of functions elsewhere within the WHO Secretariat – is Germany’s preferred option.

While still convinced of the added value of multistakeholder engagement and creating and maintaining links between multisectoral actors, Germany is of the opinion that the GCM is no longer necessary to guarantee these functions. The objectives of the GCM are, or should be part of the standard operating procedures of the WHO Secretariat.

There are good examples of important components of the broad NCD-agenda, where the objectives of the GCM are already incorporated:

- SAFER, a WHO-led initiative in the domain to reduce harmful alcohol consumption, comprising NGOs (e.g. NCD Alliance and the Global Alcohol Policy Alliance), UNDP and the UN Interagency Taskforce on NCDs. - In the domain of tobacco control, Member States, NGOs and international governmental organisations are structurally linked via the the WHO FCTC and WHO’s Tobacco Free Initiative. - On 14 April WHO will launch the Global Diabetes Compact, bringing together various types of organisations around a major noncommunicable diseases. These are just a few examples demonstrating that multistakeholder engagement and creating and maintaining links between multisectoral actors has become part of WHO’s dna, and rightly so. Against this backdrop we don’t see added value in continuing the GCM.

Comments from Iran (Islamic Republic of)

Thanks for sharing Draft GCM-NCD options paper. As you know, play the stronger role of Member States is critical to strengthen GCM/NCD, and prevention and control of non-communicable diseases.

The key transformations including; The establishment of two Divisions: (i) UHC/Communicable & Non- communicable Diseases, the establishment of the Global NCD Platform (GNP), and the establishment of new Departments according to the responsibilities in relation to WHO’s NCD program were valuable reform in GCM-NCD.

According to main elements mentioned in page 3, Iranian non-communicable diseases committee (INCDC) insist on extension of the NCD’s mandate until 2030 by considering SDG contexts, and Mid-point and final evaluations.

In page 4, proposed GCM/NCD Outcomes are related to each of five functions, and we couldn’t consider them separately. Attention to local level besides country level (mentioned in page 5) could be provide valuable outcomes. In Iran, we developed provincial level committee on prevention and control NCDs, that covered district level for evidence based decision making and conducting appropriate interventions according to local priorities.

As you emphasize on Multi-stakeholder engagement in annex of the report, we believed that, in addition to governmental sector, non-governmental sector, and private sector could be accompanied with brilliant outcome. Also, resource mobilization is critical issue in this way.

In addition to valuable points of report, I suggest attention to NCDs, and COVID-19 pandemic in GCM- NCD options paper. Unfortunately, NCDs services have been affected by emergency situation of this pandemic. Your report could be motivating member states to manage present dramatic situation, efficiently. Comments from Norway

We thank you very much for the opportunity to provide comments to the draft options paper for the GCM/NCD pursuant to decision EB148(7).

We have the following points:

• We agree that there is a need to rationalize current NCD-structures within WHO as there are too many overlapping structures/functions after the WHO transformation reform. It would be useful to know to what extent the functions of the GCM already are (in practice) integrated into the GNP (and whether this is the most evident/feasible option). • It is crucial that the chosen option places the mechanism for strengthening multisectoral/stakeholder collaboration above WHO department level, in order to facilitate coordination across departments (cross-sectoral action) (as also advised for countries’ NCD platforms) (option 3 does not allow for this). • It would be useful with some more discussion about to what extent option 2 (and 3) would impact on the (relative) ability of member states, civil society and industry to collaborate with and influence the work of the GCM secretariat. If an integrated part of the WHO secretariat (no longer MS-led), would countries for example have to go through regional WHO offices to collaborate with the GCM secretariat in HQ? Would it make it more/less difficult for nonstate actors to collaborate? • The evaluation highlighted the lack of concrete results from the work of the GCM and the need to make it more result-driven with targeted action. This is emphasized in option 1 if the GCM is to continue, but it should also be highlighted in option 2, in our view. Even if the GCM functions would fall under the GNP, it would still be important to ensure more concrete results and development of a result-framework. • If the GCM is to be integrated in GNP (option 2) or discontinued (option3), which current functions/activities are most likely to be negatively affected? (would be useful with more clarity here). • According to the evaluation, GCM seems to have focused mostly on facilitating multistakeholder engagement, but less on how to strengthen multisectoral collaboration, which is crucial to address the NCD burden (while the extent to which the private sector/industry should be involved is a more controversial issue). Would be useful with some more discussion about how the new options would strengthen cross-sectoral collaboration for NCDs, both internally in WHO, with other agencies, and within member states implementing NCD strategies. • We would like further clarity whether the WHO Internal Network for accelerating progress towards the NCD-related SDGs, WIN/NCD, can take on the some of the responsibilities of the GCM especially regarding coordination at the supra-departmental level. • How does the GCM support countries in terms of preventing and managing perceived or actual conflict of interest in the development, implementation and monitoring of national NCD- strategies? What sort of guidelines are applied? If none, does the GCM Secretariat plan to develop such NCD specific COI guidelines for national multistakeholder collaborations? (The WHO framework of engagement with nonstate actors (FENSA) is regulating WHO’s collaborations with nonstate actors, but not national public health authorities’ multistakeholder engagements. The WHO has developed guidelines for managing COIs within national nutrition programmes and policies (not yet adopted by the WHA), and the SUN Movement has developed guidelines for management of COIs within countries’ national nutrition platforms. To what extent does the GCM draw on this guidance?) Comments from Oman

Please refer to your email dated March 16, 2021.

We have discussed the subject matter with the Department of NON- COMMUNICABLE DISEASES and they have confirmed they do not have any comments as mentioned in their email below.

This is for your kind information.

Comments from Russian Federation

Thank you for the opportunity to comment on the draft options paper for the GCM/NCD prepared pursuant to decision EB148(7).

The Russian Federation supports enhancing necessary actions by WHO and its Member States to collaboratively address SDG 3.4 through a more diverse set of stakeholders, engagement models and partnerships, where appropriate. We believe that the establishment of the GCM/NCD within WHO, has been a unique and key component to support coherent and coordinated multisectoral and multistakeholder approaches supporting the Global NCD Action Plan and SDG3.4.

Taking into account the principle recommendation contained in the executive summary of the final evaluation of the Global Mechanism especially that the «GCM/NCD is, to date, the first and currently the only formal Member State-led mechanism within the WHO Secretariat aimed at facilitating multistakeholder engagement and cross-sectoral collaboration in the area of NCDs» and that its functions «continue to be relevant in supporting the implementation of the NCD-GAP and are well aligned with GPW13 and target 3.4 of SDG 3» and also « the GCM/NCD has also proven effective in incorporating NCDs into COVID-19 response activities» the Russian Federation supports Option 1 as a «strengthened operating model» .

Since the period of the NCD-GAP now extends to 2030 and accompanied by an «implementation road map 2023 to 2030», the Global Mechanism’s unique value as a participatory multistakeholder engagement and knowledge collaboration mechanism needs to be sustained with a strengthened role for Member States in its governance. It is important that Member States extend its current ToR until 2030, to align with evolved NCD and SDG context, and that we will have an opportunity to do a mid- point review. This option also allows us to strengthen WHO's relevance as a trusted partner.

We appreciate that Option 1 provides opportunity to continue placing the Global Mechanism as a unit within the WHO Global NCD Platform Department, and that it offers proposals for a revised Theory of Change, a streamlined results framework, enhanced participatory governance and attention to aligning the GCM/NCD with the updated roles and responsibilities of the NCD-related Departments at the WHO Headquarters. The Russian Federation looks forward to continuing to refine these elements jointly with the WHO Secretariat, Member States and GCM Participants.

Comments from Sweden

On behalf of the Swedish Ministry of Health and Social Affairs, I have a few brief comments regarding the consultation on the draft Options paper for GCM.

In general, Sweden wants to underline the importance of streamlining work to avoid silos and extensive reporting requirements for MS. In addition, it is important to encourage active participation from MS to ensure that issues are addressed in a coherent manner. Environmental health and its connection to NCDs is something that Sweden would welcome a stronger emphasis on in the document, and also the prerequisites needed to create health-promoting environments with decreased risks of health hazards in the environment (chemical and others).

The cross-sectoral aspects of addressing NCDs could also be made clearer in the document, perhaps by including references to work in other sectors and the need for increased knowledge and data from other sectors and scientific communities.

Comments from Switzerland

Under the GPW13, NCDs prevention and control functions and activities have been “ventilated” across various WHO organizational entities (departments, sections, units, etc.), with however no clear division of tasks and with some risks of duplication and redundancies. We therefore think that a “rationalization” process should be initiated in this regard, beyond the GCM/NCDs issue.

The GCM/NCDs was set up at a time when there was a huge need to raise awareness on NCDs (including building the case for investment and fostering political commitment) and it perfectly contributed to raise awareness using a dedicated (standalone) mechanisms to this end. Some years later, the NCDs agenda has moved forward and the functions/focus needed are a bit different. For example, each WHO entity working on NCDs has now its own “system” for or focus on awareness raising, resource dissemination or knowledge sharing and information. A as consequence, the core functions are still valid but keeping them in an ad’hoc separate structure does not make sense anymore.

Based on the above and keeping in mind the need for further rationalization and streamlining (including in terms of administrative support, secretariats, etc.), we would favour option 3. While still keeping the 5 core functions of the current GCM/NCDs scheme which are very relevant and needed, it offers a good opportunity to integrate/anchor these functions into existing ones. For example, the knowledge dissemination information function (including the KAP) could be still located within the GNP, while multisectoral action could be “anchored” in the NCDs Department. Comments from Turkey

Thank you for the e-mail on consultation on GCM Draft Options Paper. We examined the paper and we would like to share our view on the options.

Considering the threaths that NCDs pose at global and national level, we are not up for discontinuation of this global mechanism yet we do not believe it should be a strengthened operating model as well. Therefore believing that absorption of the functions and activities of the GCM Secretariat into WHO’s Global NCD Platform (GNP) would result in better and more effective output, our tendency is towards option 2- hybrid model.

Introduction

Decision EB148(7) requests “the Director‐General, in response to the recommendations of the final Commented [A1]: The United States commends and evaluation of the WHO global coordination mechanism on the prevention and control of encourages additional action by WHO and Member States to noncommunicable diseases, to develop, in consultation with Member States and relevant stakeholders, broaden the conversation around NCDs to include a more diverse set of stakeholders and partnerships. We believe that an options paper on the global coordination mechanism, for further guidance by the Seventy‐fourth the GCM should add value as a neutral platform focused on World Health Assembly”1. bringing diverse expertise to bear for practical, evidence- based action, and serve as a concrete example of effective implementation of the Framework of Engagement with non- In response, this paper sets out options on the WHO global coordination mechanism on the prevention State actors. and control of noncommunicable diseases (GCM/NCD or ‘the Global Mechanism’). The proposed options have been informed by the following key documents:  final evaluation of the GCM/NCD ‐ full report2 ,  mid‐point evaluation of the implementation of the NCD‐GAP 2013–2020 – full report3,  preliminary evaluation of the GCM/NCD4,  the differentiation of the updated roles and responsibilities of the NCD‐related Departments at WHO Headquarters which have resulted from the WHO transformation (see table below). The three options set out in this document are aligned with the principle recommendation contained in the executive summary of the final evaluation of the GCM/NCD5. For ease of reference, the principle recommendation is reproduced in the box below.

PRINCIPLE RECOMMENDATION The GCM/NCD is, to date, the first and currently the only formal Member State‐led mechanism within the WHO Secretariat aimed at facilitating multistakeholder engagement and cross‐sectoral collaboration in the area of NCDs. Its unique mandate rests primarily in its engagement capacity and its potential to create links between multisectoral actors, including Member States, non‐State actors, United Nations actors and other technical programmes, at the global, regional and national levels. As the functions originally envisaged for the GCM/NCD remain valid and relevant contributions to the NCD‐GAP, the Thirteenth General Programme of Work, 2019–2023 and the Sustainable Development Goal targets to 2030, these functions should be continued. However, the mechanism needs to evolve towards, or possibly be replaced by, a more targeted and action‐oriented model, or alternative approach, in closer collaboration with relevant internal and external actors. Options in this regard include: (a) a strengthened, more focused approach to delivery of the vital functions through the GCM/NCD, with a clear role and responsibility within WHO’s internal NCD organizational architecture to avoid duplication of efforts. In this scenario, Member States also need to play a stronger role in the mechanism; (b) discontinuation of the mechanism and establishment of a new operating model within WHO to ensure the functions are effectively carried forward. This could involve the functions of the GCM/NCD, and its external engagement/linkage dimensions, being undertaken by a WHO Department. In this scenario, there also needs to be a clear role and responsibility within WHO’s internal NCD organizational architecture and, possibly, an avenue for Member States’/non‐ State actors’ leadership/contribution on specific issues.

1 https://apps.who.int/gb/ebwha/pdf_files/EB148/B148(7)‐en.pdf 2 https://www.who.int/publications/m/item/final‐evaluation‐of‐the‐global‐coordination‐mechanism‐on‐the‐prevention‐and‐control‐of‐ noncommunicable‐diseases‐volume‐1‐report 3 https://www.who.int/publications/m/item/mid‐point‐evaluation‐of‐the‐implementation‐of‐the‐who‐global‐action‐plan‐for‐the‐prevention‐ and‐control‐of‐noncommunicable‐diseases‐2013‐2020‐(ncd‐gap) 4 https://www.who.int/docs/default‐source/documents/evaluation/preliminary‐evaluation‐ncds.pdf?sfvrsn=b5737024_2 5 https://apps.who.int/gb/ebwha/pdf_files/EB148/B148_7Add2‐en.pdf

The three options set out in this paper are assessed with a view to ensure that the functions currently assigned to GCM/NCD can be delivered efficiently and effectively over the next 10 years, in support of the implementation of the extended duration of the NCD‐GAP until 2030 and WHO’s NCD Implementation Roadmap 2023‐2030 (under development). This document provides an assessment of the recommended options for future arrangements of the GCM/NCD, as presented in final evaluation report. The main purpose of this document is to enable Member States, UN organizations and non‐State actors to provide their views on this draft paper during the intersessional period leading up to WHA74, before a final options paper is submitted to WHA74 for decision by Member States.

Context The terms of reference (ToR) for the GCM/NCD were developed by Member States through an intergovernmental process. Member States reached consensus at a Formal Meeting of Member States in 2014 and subsequently noted the ToR at WHA676. The ToR states that the envisaged lifespan of the GCM/NCD is set from 2014 to 2020, in line with the NCD‐GAP, and that a final evaluation will be presented for consideration at the World Health Assembly in 2021 to assess the effectiveness of the GCM/NCD, its added value and its continued relevance to the achievement of the 2025 voluntary global targets, including its possible extension.

In 2019, the WHO transformation agenda, and its overall goal of ensuring that WHO is fit for purpose to fulfil its mandate and address the priorities agreed with Member States in a rapidly changing global health environment, required changes across the three levels of the Organization to ensure that country needs and country impact were at the centre of WHO’s work. The key transformations that occurred at WHO Headquarters in regard to WHO’s NCD‐related areas of work were the following: Commented [A2]: Given that some of these are recent (January 2021) announcements, we recommend that the  The establishment of two Divisions: (i) UHC/Communicable & Noncommunicable Diseases with report include more information on the resulting new the Management of NCDs and NCD surveillance, collaborating closely with the Healthy structure of NCDs work at WHO, which could include links to Populations Division and the Data, Analytics & Delivery Division, and (ii) the UHC/Healthier appropriate locations on the WHO website. Populations Division with NCD risk factors;  The establishment of the Global NCD Platform (GNP), a Department under the Office of the Deputy Director‐General, to coordinate and mobilize meaningful and effective commitments and contributions from UN organizations, and non‐State actors (NSAs) to support the overall strategic directions and priorities of WHO’s work on SDG target 3.4 and other NCD‐related SDGs;  An internal coordinating mechanism for WHO’s work on the prevention and control of NCDs was established under the auspices of DDG (WHO Internal Network for accelerating progress towards the NCD‐related SDGs, referred to as WIN/NCD); 7  The establishment of new Departments , differentiating the roles of responsibilities of each Commented [A3]: We would appreciate further Department in relation to WHO’s NCD programme, and has led to the implementation of a new, information on how these departments function together, WHO‐wide operating model to implement WHO’s programme for the prevention and control of and how they fit within the overall WHO structure after the transformation. Can WHO share an organigram? NCDs. Commented [A4]: As part of this WHO‐wide operating model, we note the importance of coordination and engagement with WHE and the Global Health Cluster on NCDs in humanitarian settings. We also note the adaptation 6 https://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_14Add1‐en.pdf?ua=1 of the PEN for humanitarian settings. 7 Department of Global NCD Platform, Department for Noncommunicable Diseases, Department for Mental Health and Substance Use, Department for Health Promotion, Department for Social Determinants of Health, Department of Environment, Climate Change and Health, Department for Nutrition and Food Safety.

An overview of the updated roles and responsibilities of the NCD‐related Departments at WHO Headquarters mapped against the shared responsibility in implementing the functions originally included in the ToR for the GCM/NCD is presented in the Annex. Since the period of the NCD‐GAP now extends to 2030 (to align with the 2030 Agenda for Sustainable Development), accompanied by an ‘implementation roadmap 2023–2030’ as requested by Member States at EB1488, any new arrangements proposed in respect of the functions of the GCM/NCD should also be formulated with an equivalent timeframe and with due consideration to the value of the GCM/NCD’s supportive role to WHO’s evolved NCD programme and context.

Option 1 ‐ Strengthened Operating Model Commented [A5]: The GCM/NCD is a unique formal Member State‐led mechanism aimed at facilitating What this Option considers multistakeholder engagement and cross‐sectoral collaboration in the area of NCDs. Its functions should be retained and its participatory efforts strengthened as The GCM/NCD has evolved over the years, with the support of the GCM/NCD Secretariat, and has opposed to eliminated. adapted to organizational transformations and to changes across the global NCD landscape. However, the final evaluation highlights both the need for and the opportunity to continue evolving by making a number of further changes to its operational model. The proposed changes to the operating model, which build on lessons learned from GCM/NCDs’ 6 years of activities should effectively address the recommendations of its final evaluation. The evolved operating model will define the long‐term vision for the GCM/NCD for 2030, including the added value of the global mechanism to the 5 functions (Figure 1) and the strategic priorities and signature solutions.

The main elements of this Option include: Commented [A6]: Suggest providing more information on how this option takes into account the new GNP. Should  Extension of the GCM/NCD’s mandate until 2030, in line with NCD‐GAP 2013‐2030 and under the Member States prefer option 1, how will the GCM and GNP leadership of Global NCD Platform department; work together to avoid duplication of work and minimize  The possibility of Member States to either extend or modify its current ToR according the evolved any gaps in effort? WHO, NCD and SDG contexts;  A revised vision for the GCM/NCD, supported by a theory of change (Figure 2); improvements to planning processes according to the updated roles and responsibilities across WHO’s, and enhancements to GCM/NCD’s governance arrangements.  Mid‐point and final evaluations of the extended mandate of the GCM/NCD (2021‐2030) to assess the effectiveness of the new GCM/NCD operating model, its added value and its continued relevance. Commented [A7]: Information on the resource implications would be helpful. Assumptions This Option builds on the recommendations of the final evaluation of GCM/NCD, as follows:

 A strengthened engagement and partnership‐based GCM/NCD will further add value to its mandate by defining a clear theory of change, results framework and outcomes that best support the WHO NCD Action Plan 2013‐2030, and the NCD implementation roadmap 2023– 2030;  The new operating model will strengthen its value as a participatory multistakeholder engagement and knowledge collaboration mechanism within WHO, with a focus on further leveraging meaningful and effective contributions from its diverse Participants to the implementation of national NCD responses.

8 https://apps.who.int/gb/ebwha/pdf_files/EB148/B148(7)‐en.pdf

Pros and Cons

PROs CONs 1. Enhances WHO’s work towards engaging with NSAs 1. If Member States decide that the ToR needs to be on the prevention and control of NCDs supporting the modified, then Member States would have to launch differentiated roles and responsibilities of WHO an intergovernmental process to be redrafted ToR. Departments contributing to the NCD agenda. 2. Implementation of focused approaches for capacity 2. If Member States decide that the ToR needs to be building on multisectoral and multistakeholder modified, implementation may be affected by a lack of engagement that supports Governments to develop clarity from, or consensus among, Member States and implement ambitious national NCD responses, during the intergovernmental negotiations to agree on forging multi‐stakeholder partnerships and alliances a new ToR. that mobilize and share knowledge, assess progress, provide services and amplify the voices of and raise awareness about people living with and affected by NCDs. 3. Reinforces WHO’s commitment to working in 3. Resource‐intense commitment from WHO HQ, RO and partnership with Governments, civil society and the country offices to coordinate planning with GCM/NCD private sector, as a catalyst and facilitator of support activities national NCD responses as mandated by the UN General Assembly. 4. No disruption of ongoing GCM/NCD activities and 4. Resource‐intense commitment from Member‐States engagement with GCM participants, reducing and GCM/NCD Participants to finalize Theory of potential reputational risk to WHO’s visibility and Change, with related key performance indicators and credibility with NSAs coordinate planning and collaboration with GCM activities 5. Continued and enhanced alignment and strategic 5. Resource‐intense commitment from GCM/NCD collaboration with the UN Inter‐Agency Task Force on Secretariat to adjust, implement and sustain the new NCD through strengthened collaborative planning operating model within the purpose and functions of the GNP 6. Sustained and enhanced engagement capacities of 6. Time and resource from WHO Secretariat to conduct the GCM/NCD across its participants, including and present mid‐term and final evaluations (2021‐ through a new engagement strategy. 2030) Commented [A8]: Recommend considering the 7. Strengthens WHO’s relevance as a trusted partner in a 7. Risk that there could be a continued perception of development of this proposed new engagement strategy as complex and evolving socio‐economic development duplication of functions across WHO and various a component of the work for both options 1 and 2. landscape entries points for Member States and NSAs to engage with WHO Commented [A9]: Could the Secretariat elaborate on efforts to address this challenge?

Figure 1: Alignment of the proposed GCM/NCD Outcomes with the 5 Functions

Figure 2‐ Proposed Theory of Change/Results Framework9

Option 2 ‐ Hybrid model ‐ building on the foundations of the GCM/NCD

What this Option considers

The final evaluation states that “as the functions originally envisaged for the GCM/NCD remain valid and relevant contributions to the NCD‐GAP, the GPW13 and the SDG targets to 2030, these functions should be continued” and “new means to maintain and, where possible, strengthen efforts to deliver the important functions of the GCM/NCD need to be considered”. This option seeks the absorption of the functions and activities of the GCM Secretariat into WHO’s Global NCD Platform (GNP). This would Commented [A10]: We would appreciate further ensure alignment with the establishment of GNP, in response to the WHO Transformation agenda, as a information about the GNP structure, staffing, priorities and WHO department to coordinate and mobilize meaningful and effective commitments and contributions work to consider the relative value of moving the GCM from UN organizations, and non‐State actors. functions into that area as compared to “strengthening the GCM”. The GCM is also intended to be a participatory process – how would NSAs, MS and the Secretariat The main elements of this Option include: effectively collaborate together should the functions move into the GNP?  Discontinuation of a formal WHO Member State‐led, participatory‐based mechanism aimed at facilitating multistakeholder engagement, cross‐sectoral coherence, information sharing and Commented [A11]: The GCM is a unique participatory knowledge collaboration in the area of NCDs; vehicle at WHO. We would appreciate clarification that option 2 should not imply a less participatory approach to  Under this option, GNP would assume the following functions: NCDs at WHO or otherwise reduce the diversity of engaged stakeholders. o GNP as an operational backbone for knowledge collaboration and dissemination of innovative multi‐stakeholder responses at country level: Raising awareness and promoting knowledge collaboration among Member States and non‐State actors, and to co‐create, enhance and disseminate evidence‐based information to support Governments on effective multisectoral and multistakeholder approaches (e.g. global multistakeholder meetings and dialogues, Knowledge Action Portal on NCDs (KAP), NCD Voices in the Decade of Action webinar series; and other multistakeholder convening platforms).

9 Figure 1 demonstrates how the GCM/NCD would evolve to use strategic inputs to drive its activities and outputs which, in turn, will support the achievement of defined outcomes and overall goals, which are specific to and build on the Global Mechanism’s vision and its added value across the 5 WHO‐wide functions originally envisaged for the GCM/NCD

o GNP as an enabler for global stocktaking of multistakeholder action at country level, and co‐designing and scaling of innovative approaches, solutions or initiatives to strengthen effective multisectoral and multistakeholder action (e.g. successful approaches to multisectoral and multistakeholder actions on NCDs; NCD campaigns, commitments and contributions of NSAs, NCD Lab on ‘PLWNCDs’, ‘NCDs and the Next Generation’, and ‘Women and Girls and NCDs’).

o GNP as a global facilitator for strengthened capacity of Member States and civil society to develop national multistakeholder responses for the prevention and control of NCDs (e.g. guidance on establishing national coordination mechanisms for NCDs; roadmap for supporting Member States in their decision‐making on private sector engagement for NCDs, NCD Sprints, Health Literacy Development Programme)

Pros and Cons

PROs CONs 1. Aligns with the differentiated roles and responsibilities of 1. Planning in support of those functions must be undertaken in WHO Departments contributing to the NCD agenda full synergy with planning of the WHO departments and functional units that are responsible for progressing the NCD‐ GAP and driving achievement of its objectives by 2030 (including WHO units beyond the traditional NCD space). 2. Continued and enhanced support to WHO’s work 2. Reputational risk to WHO in enacting the sunset clause strengthening the capacity of governments, at the level of included in the ToR of the GCM, taking into account that this is National NCD Directors, and NSAs to develop multisectoral a Member State‐developed mechanism in response to and multistakeholder engagement that supports national sensitive discussions at the UN General Assembly in 2011. NCD responses and to fulfil the integrated priorities and outcomes of the GPW13 3. Less resource‐intense commitment from WHO and 3. Discontinuation of a formal Member State‐led Member States to coordinate planning and activities multistakeholder engagement mechanism in place to support the implementation NCD‐GAP 2030 as per intention of Member States in 2013 4. Integrated into GNP department with targeted and action‐ 4. Will require very clear outputs that demonstrate contribution oriented function in collaboration with relevant internal common results, in accordance with the new roles and and external actors responsibilities of the new Departments 5. Continued alignment and strategic collaboration with 5. May impact ability to continue engaging formally with UNIATF Member States and NSAs to strengthen national ownership and capacity, and delivery of the NCD agenda Commented [A12]: Would appreciate further 6. Alignment of GCM/NCD Secretariat outcomes and activities 6. May be perceived as a “one‐size‐fits‐all" approach to coherent information on this statement. Engagement across sectors to the current and relevant mandate of the GNP NCD action on many fronts, with multiple actors and across and stakeholders is critical in this area. different levels 7. Maintain current human resources of the GCM/NCD 7. May cause disruption to some of GCM/NCDs’ ongoing Secretariat activities and relations with GCM participants Commented [A13]: Could the Secretariat elaborate on which activities?

Option 3 ‐ Discontinuation and absorption of functions elsewhere within WHO Secretariat Commented [A14]: Key functions of the GCM will continue to be relevant and important, whether they are What this Option considers housed within a “strengthened GCM” or “hybrid” model. We would not consider a dissolution to meet the aims of the NCDs Global Action Plan with its extended timeline. This option considers discontinuing the global mechanism, as structured by Member States in its ToR, and distributing or establishing the functions and activities of the GCM/NCD Secretariat elsewhere within the WHO Secretariat, given that formats or elements of the current functions and activities can be implemented across relevant WHO Departments and Units.

Assumptions

This option builds on the following:

 the assumption that there is limited added value of the GCM/NCD’s participant‐based mechanism, and therefore the need to discontinue its unique mandate which, as stated by the final evaluation, “primarily rests on its engagement capacity and its potential to create links between multisectoral actors, including Member States, non‐State actors, United Nations actors and other technical programmes, at the global, regional and national levels”10;  the need to put in place arrangements that ensure the functions currently performed by the GCM/NCD Secretariat continue to be performed effectively and efficiently by other parts of the WHO Secretariat. Pros and Cons

response to sensitive discussions at the UN General Assembly in 2011 2. May reduce perception of duplication across NCD 2. The breadth of expertise in the GCM/NCD to "connect the related departments dots" at the highest levels of government on the most complex NCD issues may not be called upon directly 3. May streamline resource allocation across NCD related 3. May be incorrectly perceived that WHO will not continue departments to partner with and advocate for the inclusion of civil society in country‐led efforts to achieve the NCD‐related SDGs 4. WHO to continue supporting Member States in 4. GMC/NCD’s track record will be lost. developing multistakeholder activities 5. WHO to continue developing partnerships across 5. Impact negatively on WHO’s competencies to build individual NCDs and risk factors, and assist in improving comprehensive multistakeholder approaches to mutual accountability for the NCD‐related SDGs in such interconnected NCD challenges. partnerships 6. Less resource‐intense commitment from WHO and 6. Will cause disruption to GCM/NCDs’ ongoing activities and Member States relations with GCM participants

10 Paragraph 34, https://apps.who.int/gb/ebwha/pdf_files/EB148/B148_7Add2‐en.pdf

Annex Updated roles and responsibilities of the NCD‐related Departments at the WHO Headquarters mapped against the shared responsibilities of implementing the functions originally included in the terms of reference of GCM/NCD

Original function of the GCM/NCD Post‐WHO Transformation Agenda

1 Advocating and raising awareness: ‐ Governance role (UNGA, WHA) led by ADG/UCN and ADG/HEP, supported by NCD Advocating for and raising awareness of Department the urgency of implementing the WHO ‐ Governance role (ECOSOC) led by Secretariat of the UNIATF in GNP Department Global NCD Action Plan 2013–2020; ‐ 2030 Sustainable Development Agenda now includes SDG 3.4 mainstreaming the prevention and ‐ Global NCD investment cases led by SDH Department control of noncommunicable diseases in ‐ Global surveillance and monitoring led by NCD Department the international development agenda; ‐ Raising the priority given to addressing the deadly interplay between COVID‐19 and NCDs and giving due consideration to the is led by WIN Working Group on COVID‐19 and NCDs co‐chaired by NCD and HPR prevention and control of Departments noncommunicable diseases in discussions ‐ Raising the priority given to addressing the deadly interplay between COVID‐19 and NCDs on the post‐2015 development agenda; across the UN system through the Task Force ‐ Efforts to integrate NCDs into the new strategy of the Global Fund are coordinated by the NCD Department ‐ New implementation roadmap for NCD GAP 2023‐2030 is being developed under auspices of the TEN/NCD and the coordinating leadership of the NCD Department ‐ Monthly Spotlight and Hardtalk Webinars to advocate, capacity build and disseminate new technical guidance (led by the NCD Department) ‐ Coalition of Heads of State and Government on NCDs and the promotion of Mental Health and Wellbeing led by GNP Department ‐ WHO Civil Society Working Group on NCDs led by GNP Department ‐ Global stocktaking of country multisectoral and multistakeholder success stories led by GCM/NCD Secretariat ‐ Global stocktaking and repository of NCD advocacy campaigns led by GCM/NCD Secretariat ‐ Webinar series: ‘NCD Voices in the Decade of Action to advocate, capacity build and disseminate the voices and priorities of marginalized groups or individuals led by GCM/NCD Secretariat ‐ WHO global multistakeholder meetings to build capacity of national NCD focal points led by GNP Department 2 Disseminating knowledge and information: ‐ Knowledge Action Portal on NCDs led by GCM/NCD Secretariat Disseminating knowledge and sharing ‐ Capacity building through multistakeholder meetings, dialogues and workshops for information based on scientific evidence national NCD focal led by the GCM/NCD Secretariat and/or best practices regarding the ‐ Consultations, workshops and knowledge collaboration with and for PLWNCDs led by the implementation of the WHO Global NCD GCM/NCD Secretariat Action Plan 2013–2020, including health ‐ Webinar series: ‘NCD Voices in the Decade of Action to advocate, capacity build and promotion, prevention, control, disseminate the voices and priorities of marginalized groups or individuals led by monitoring and surveillance of NCDs GCM/NCD Secretariat ‐ Platform of Communities of Practice (e.g. Global Initiative on Childhood Cancer and Self Care Interventions) led by GCM/NCD Secretariat ‐ GCM/NCD newsletter for GCM Participants for information sharing and knowledge collaboration led by GCM/NCD Secretariat ‐ Regular and ad‐hoc meeting/webinars of the Task Force and development and dissemination of relevant publications 3 Encouraging innovation and identifying ‐ STAG on NCD led by ADG/HEP and ADG/UCN barriers: Provide a forum to identify ‐ TAGs on Diabetes, Research and Innovation led by NCD Department barriers and share innovative solutions ‐ STAG on Healthier Populations led by ADG/HEP and actions for the implementation of the ‐ Forums have established across the NCD‐related technical Departments (e.g. Hard Talk, WHO Global NCD Action Plan 2013–2020; Spotlight webinars, national strategic dialogues, etc) ‐ Regular and ad‐hoc meeting/webinars of the Task Force and development and dissemination of relevant publications ‐ Knowledge Action Portal on NCDs led by GCM/NCD Secretariat ‐ Development of tools and guidance for meaningful engagement of PLWNCDs led by the GCM/NCD Secretariat

Original function of the GCM/NCD Post‐WHO Transformation Agenda

‐ NCD Sprints workshops focused on a multistakeholder, participatory approach to address contextual NCD challenges at Regional and National levels led by GCM/NCD Secretariat ‐ NCD Labs virtual platform supporting submissions that harness innovative solutions to accelerate progress towards SDG 3.4 and promote WHO’s normative guidance and standards (e.g. NCDs and Next Generation, Women and Girls, PLWNCDs) led by GCM/NCD Secretariat ‐ Guidance to Member States for health literacy development on NCDs and mental health conditions led by GCM/NCD Secretariat ‐ Implementation of health literacy demonstration project on NCDs and mental health conditions across WHO Regions led by GCM/NCD Secretariat ‐ Policy brief on addressing the commercial determinants of health at country level for effective NCD responses led by GCM/NCD Secretariat 4 Advancing multisectoral action: Advance ‐ Multi‐sectoral strategies, alliances and partnerships have been mainstreamed across the multisectoral action by identifying and NCD‐related Departments (e.g. Global Diabetes Compact led by the NCD Department, promoting sustained actions across Third Billion Strategy led by the HEP Division, driving forward action across the UN system sectors that can contribute to and by the UN NCD Task Force in GNP) support the implementation of the WHO ‐ Multi‐stakeholder alliances and multi‐sectoral actions have been mainstreamed across the Global NCD Action Plan 2013–2020; NCD‐related Departments (e.g. through the Norway‐funded county projects, Strategic Roundtables are organized in countries under the coordination leadership of the NCD Department and support to UNCTs through EU, Russian and Gulf Health Council financing). ‐ NCD Multisectoral Action Repository – analysis of successful approaches to multisectoral action for NCDs, including those that address their social, economic and environmental determinants led by GCM/NCD Secretariat. ‐ Guidance to Member States on establishing national NCD multisectoral and multistakeholder coordination mechanisms led by GCM/NCD Secretariat ‐ Development of a roadmap and tools to support Member States in their decision‐making regarding private sector engagement for NCDs led by GCM/NCD Secretariat ‐ WHO toolkit for behavioural change communication campaigns on NCD risk factors for children and adolescents led by GCM/NCD Secretariat ‐ Implementation of health literacy demonstration project on NCDs and mental health conditions across WHO Regions led by GCM/NCD Secretariat ‐ Platform for the coordination of the implementation of the recommendations of the HLC on NCDs final report led by GNP 5 Advocating for the mobilization of ‐ UN Multi‐partner Trust Fund for NCDs and mental health has been established with cross‐ resources: Identifying and sharing UN Steering Group and a Secretariat, with the hub in the UN NCD Task Force Secretariat information on existing and potential by the GNP Department sources of finance and cooperation ‐ Actions to support efforts to generate domestic revenue streams through the taxation of mechanisms at the local, national, tobacco products, alcoholic beverages and sugar‐sweetened beverages are coordinated regional and global levels for the by the HEP Division in close collaboration with the UN NCD Task Force implementation of the WHO Global NCD ‐ Actions to establish global and domestic funding streams for NCD Signature solutions Action Plan 2013–2020 (Childhood cancer, Cervical Cancer, Global Diabetes Compact, surveillance and monitoring, HEARTS, tobacco, physical activity, air pollution, nutrition) are led by the NCD‐ related Departments ‐ Dialogues with private sector are conducted bin all technical areas asks and commitments ‐ Engagement strategy with GCM Participants to leverage resources and expertise to advance the implementation of WHO GAP‐NCD agenda led by GCM/NCD Secretariat