Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health
Final report – September 2017
WHO Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health (GSAP), Mexico City, 2-3 May 2017
Meeting report
1 Summary
This report captures preparations and proceedings of a 2-day meeting, including pre-consultations, presentations, break out working groups, panel discussions, interactive brainstorming, and individual exercises, all focusing on how to mark quantifiable progress on the implementation of the new Global Strategy and Action Plan on Ageing and Health (GSAP), during the WHO Working Group Meeting to Review and Recommend Indicators on its implementation. It achieved the meeting’s 2 objectives:
(1) Identify a concise set of quantifiable progress indicators for each “strategic objective in the strategy” and “preparations have advanced towards planning for a Decade of Healthy Ageing during 2020–2030.”
(2) Outline a process of consultation and agreement during 2017 on the proposed quantifiable progress indicators, enabling data collation, review and reporting to Member States, by the GSAP mid-term review in 2018.
The main results include a list of indicators covering the GSAP’s 5 strategic objectives (Annex 1) indicating whether these are suitable for the mid-term report in 2018 (shortest list) or a for a more expanded list for reporting in 2020. Participants also recognized that some indicators for certain topics require more development.
2 Mandate
The mandate is fully documented in the Concept Note prepared to develop the Working Group, and the Background Paper circulated in advance of the Meeting. The Government of Japan spearheaded Member States’ request to develop a strategy in 2014. The importance to ensure that the GSAP is monitored by quantitative indicators of progress, and that these build on existing indicators to the extent possible, was requested by Government of Mexico during the consultation process, specifically during the WHO Global Consultation meeting in October 2015 and during the WHO Executive Board
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health discussions in January 2016. The Government of Japan lead the overall consultation process and negotiations to finalize the proposed text, with several other champion countries.
In May 2016, WHO’s 194 Member States adopted The Global Strategy and Action Plan on Ageing and Health (GSAP) and an associated World Health Assembly resolution (A69/R3), in May 2016. The GSAP outlines milestones to be collectively reached during 2016-2020, including:
“One of the first milestones identified for this five-year period is therefore the development of a set of core quantifiable process indicators related to the action plan’s objectives…these will be used to measure subsequent progress and contribute to accountability.”
Furthermore, the resolution ADOPTS the GSAP and REQUESTS the Director-General, to implement 9 key tasks, including:
“to report on mid-term progress on implementation of the Global strategy and action plan on ageing and health, reflecting agreed quantifiable indicators . . . to the Seventy-first World Health Assembly [by 2018].”
3 Preparation and Format for Indicators
Preparation . Prior to the meeting on 2-3 May 2017, the WHO secretariat first reviewed and summarized existing indicators on ageing and health from the following sources: WHO Programme Budget area 3.2 Ageing and Health, with a focus on organizational wide indicators; the six WHO regional frameworks on ageing and health highlighting commitments, and where explicit, indicators to monitor progress. These were cross checked with the commitments to advance the GSAP’s 2 goals and 5 strategic themes, and presented within spreadsheets summarizing each proposed indicator including details on definitions, unit of analysis, how calculated, data availability, ease to monitor and whether associated with a target.
Second, these were discussed and reviewed for comprehensiveness, policy coherence, and innovations expected, by senior staff within the Ageing and Life Course Department, WHO HQ; by the WHO Ageing and Life Course Focal Points in each of the 6 Regional Offices; and by the WHO HQ Ageing Forum (constituting staff drawn from some 20 departments including condition or disease specific programs, health information and statistics, and those addressing determinants of healthy ageing, including health systems and multi-sectoral actions). Discussions highlighted the effort should find an efficient balance between existing indicators, and the need for new indicators and new ways of working, given the new concept of healthy ageing, and that within the GSAP, it is stipulated that efforts must expand beyond bio-medical approaches, and beyond addressing acute conditions of younger populations. Given the need to balance competing priorities, it was proposed that the Working Group consider criteria to select indicators.
Third, an older person (close to age 80, male, former health professional) was invited to review the materials and make suggestions, detailed with the Background Paper and summarized here:
“The GSAP is a very good document, yet most people who need to implement it, will not have the opportunity to read it. However, what WHO will measure will be known by Ministries of Health and many other stakeholders. I have two suggestions, for a final set of progress indicators and what a progress report should include:
•
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health
• The GSAP makes clear that processes should involve older adults and those who represent them. Several issues are raised, including whether older adults are encouraged to remain and/or become providers of formal and informal care – this would be part of developing the empathy and solidarity, to shift away from “who gives and who receives care” to the “co-management of fulfilling needs and optimizing functional ability” • The GSAP recognizes that “there is no single system” of health, or long-term care “that can be applied in every setting, nor even in countries with similar resource constraints”. It also recognizes that systems should be based on “an explicit partnership between older people, families, communities, other care providers, and both the public and private sectors.” A progress report might therefore need more than a core set of “quantifiable process indicators” to provide meaningful information whether at mid-term and for the final report. Thailand’s intergenerational model of care, is an interesting example. Several suggestions are offered, including: Qualitative information, narratives; approaches to highlight innovations planned and unplanned; and adding missing stakeholders – for example to ensure Universal Health Coverage is inclusive of older adults, the GSAP does not highlight the importance of health insurance schemes, whether national, sub-national, public or private.”
Format for indicators . Updated spreadsheets for each goal and strategic objective, along with the Background Paper that highlighted commitments made by Member States in the Resolution, were circulated to Working Group members to review, modify and improve. Information on each indicator and check list for review, was provided using the following format:
1 Define progress indicator 2 Define numerator/denominator 3 How is it calculated 4 What is the unit of analysis (eg. for Secretariat indicators country office/regional/HQ or for Member States countries, national, ministries...) 5 Is it a new or existing indicator; if existing, is there a baseline in a sufficient set of countries? 6 If it is an existing indicator can we update by early 2018? 7 If it is a new indicator can we get a baseline by early 2018? 8 What are the potential difficulties in collecting data by early 2018? 9 Does it relate to the plan of action 2016-2020 goal 1. Five years of evidence-based action to maximize functional ability that reaches every person? 10 Does it relate to the plan of action 2016-2020 goal 2. By 2020, establish evidence and partnerships necessary to support a Decade of Healthy Ageing from 2020 to 2030? 11 Is there a target by 2018 or should there be a target by 2020? 12 Regions that include this indicator in regional framework 13 Please add additional categories if needed
Each participant was encouraged in advance of the Working Group meeting, to consider fit with their region, national policy, or whom they represent; consider criteria for selection; and add additional indicators that would best capture the GSAP objectives and action plan.
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health
4 Participants and Agenda
The working group took place on 2-3 May 2017 in Mexico City, co-organized by WHO, PAHO and the Country Office. Representatives and experts from Ministries of Health, including representatives of Ministries of Health selected by WHO’s Regional Offices (China, Lebanon, Mauritius, Mexico, Netherlands, Thailand), other interested champion countries (Canada, Japan), civil society (HelpAge International), other institutions, and other UN agencies (UN DESA, UNFPA), were invited. Two representatives recommended by Regional Offices were unable to attend, yet had the opportunity to provide comments in advance. See list of participants for details (Annex 2).
Participants found the background materials comprehensive as a basis to start deliberations. The agenda (see Annex 3) offered presentations, discussions, evaluation and brainstorming exercises and included short, pre-assigned reflections by strategic theme.
5 Proceedings
On Day 1, participants discussed in plenary policy coherence and accountability across national, regional and global levels, concerning the global strategy and action plan’s 2 goals and 5 strategic objectives. The approach to set criteria for selecting indicators was informed by a cross national review and individual country experiences.
5.1 Sharing national approaches – best practices critically reviewed. A presentation drew from a review of 15 national policies on ageing and health, and identified to what extent accountability mechanisms were included, and whether monitoring of progress was made explicit through quantitative indicators aligned to those of the global strategy. Participants, including from UNDESA and UNFPA, agreed that this national review will be useful to inform the MIPAA +15 processes in 2018.
Three detailed country presentations from Thailand, Japan and Mexico offered insights on the specific approach to monitoring implementation of nationally agreed on processes and targets addressing ageing and health. Highlights relevant for the global effort are noted in Table 1.
Table 1. Key issues reflecting on these national efforts, for global monitoring
Thailand - monitors - included target and results based on surveys national plan every 5 - link, and upgrade data base on older adults – health and other sectors years - ensure data base is accessible to public and other institutions Japan – multiple - ensure age disaggregation across life course reporting mechanisms - include measures of distribution that enable equity and equality (disparity) analyses at national and sub - support data collection and exchange useful for local government and to promote cross national levels sectorial collaborations Mexico – multiple - ensure progress indicators are complemented by new WHO framework for action with sources of data and outcome indicators addressing high, declining and significant declines in intrinsic capacity reporting mechanisms and functional ability - include to what extent older adults benefit from financial coverage for health services - gauge how much are countries investing in long term care services linked to older adults’ independence (unpaid and paid services are about the same in Mexico)
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health
5.2 Criteria to select indicators. Discussion on criteria to select indicators focused on balancing accountability, fairness and what is measurable. Proposed criteria include:
- a concise, quantifiable set (less than 30, more than 5) - be clearly linked to the responsibility of WHO (mostly often, the Member State, and when appropriate, the secretariat) either directly or indirectly through the enabling environment it creates; OR be clearly representing nationally representative views, needs and aspirations of older adults - monitor commitments made in the WHA Resolution endorsing the GSAP and Member State commitments - provide meaningful information on each strategic objective that will identify if progress is on track - for the mid-term indicators, privilege ease of data collection; whereas for the end of action plan (coinciding with a baseline for 2020), encourage innovation and reporting on older adults’ experiences. - presentation using the format noted in the background paper.
5.3 Long list of potential indicators . In three break out groups, participants reviewed, improved and proposed indicators, for each of one the 5 strategic objectives, then reported back in plenary, followed by a critical reflection (see Table 2). In plenary, discussion focused on what is important, what could be measured, and consolidation of best ideas. This was repeated 5 times, for each strategic objective. Based on these detailed suggestions, an inclusive, long list of potential indicators were assembled overnight.
Table 2. Highlights from critical reflections, on discussion for each strategic objective, Day 1
Strategic area Critical Reflect ion s Commitment “Be clear on who has leadership for healthy ageing” “Encourage private investments, yet guided by government regulations” Age Friendly “Cooperation between government and NGOs is a pre-condition in this area” Environments “Some indicators might address multiple issues” Health systems “Differences in health systems across countries is a challenge – common outcome measures of IC and FA will be very important as well as these progress indicators” “More work is needed on standardized training approaches” Long term care “Capture gender roles and enable understanding of how equitable implementation is” “Ensure we can identify where capacity is being built up” Measurement, “need good information systems – yet data needs to be useful at local levels” monitoring, research “we are deciding on what to measure as impact, but not how each country will implement actions”
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health
On day 2 , participants reviewed the consolidated long list projected on a screen. Led by China, these were examined in light of the agreed on criteria, and edits and adjustments were made in plenary. With these adjustments, about 75 indicators were listed for all strategic objectives, classified by sub-objective.
5.4 Short list of progress indicators. Each participant received this long list and were asked to: select which indicators should be included for each strategic area using the criteria; propose edits if needed; and identify whether the indicator is appropriate for mid-term 2018 reporting; and or end of action plan reporting (2020); and whether this indicator required additional development for potential use for the Decade for Healthy Ageing . Fifteen completed reviews were collected.
These were collated over lunch time. Participants were given back their individual reviews so that each could refer to it during further discussions. The results were projected on the screen, indicating how many participants selected the indicator, for what time period, and whether it required further development. Understanding individual reviews was an essential step to ensure that the process captured insights at individual, group, and plenary levels.
Three parallel sub-groups reviewed and refined the individual review results – group A focused on objectives 1 and 2; group B on objectives 3 and 4, and group C, objective 5. Each group presented in plenary their suggestions for a short list. Led by Canada, these were discussed in plenary and a short list proposed. The secretariat was asked to review a few proposed indicators in light of existing WHO requirements.
A main outcome of the meeting, achieved through consensus, taking stock of individual views, is a short list of 35 proposed indicators, including 13 considered appropriate for mid-term reporting (Annex 1).
5.5 Update on outcome indicators . Participants also were provided an update on the identification of outcome measures for healthy ageing – intrinsic capacity (IC) and functional ability (FA) - distinct from the identification of indicators under discussion in this working group. Important insights from Mexico and HelpAge enriched the discussions, including ways to combine information on health status, impairments, and functioning, and ensure that the information is useful in community settings to make practical decisions that reflect older adults’ needs and values. Participants agreed that the WHO International Classification for Functioning, Disability and Health, should ground IC and FA.
5.6 GSAP Mid-term report . The secretariat is mandated in the WHA Resolution report on mid-term progress of the GSAP. Clearly, this progress report should include quantifiable indicators, as well as other information. Led by Mauritius, in plenary, participants considered what should be its format and contents. To support this discussion, an overview of three recent mid-term reports, of other WHO strategies that focus on individuals rather than diseases (e.g., the WHO Global Disability Action Plan 2014-2021; Progress on Comprehensive implementation plan in Maternal, Infant And Young Child Nutrition; and Department of Maternal, Newborn, Child And Adolescent Health – progress report
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health
2014-15), was provided. Drawing on these examples, participants proposed that these areas should be covered in the GSAP mid-term, as cross cutting themes complementing the 5 strategic objectives. This also serves as steps towards a Decade for Healthy Ageing :
-Development of guidance and tools -Building capacity and scaling up country action -Awareness creation and advocacy -Building the evidence base and monitoring progress
Participants discussed what would be appropriate given that this is the first WHO GSAP, and that many countries are now just starting to think through what can be done. Participants agreed that the full mid- term report should efficiently summarize the quantitative progress indicators; however, that the report should not be overwhelming in terms of what has not been accomplished. It should be encouraging, and highlight progress, where further support is needed. It could certainly note what will be evaluated by the end of the action plan.
Post meeting, WHO secretariat Governing Bodies confirms that the official report to the WHA in May 2017 is about 600 words in the 6 official languages, and will cover quantifiable progress indicators and key highlights. An expanded report covering the areas identified by this Working Group, will also be made available via the WHO website, if resources allow, in 6 official languages, prior to the WHA in May 2017.
5.7 Setting up the decade of Heathy Ageing . An interactive group discussion, led by Thailand, identified an approach to mark progress towards setting up the decade of Heathy Ageing, including milestones, partners, resources, and what else would be important. The brainstorming resulted in several key areas to pursue:
(1) Pre-conditions
- Identify Member States, older people and “heros”, who would be champions, in at least 10 countries - clarify expectations for / from Member States concerning – policies, activities, networks, symbols to set up public communication, political interest and broader agenda - consider pre conditions for different sets of countries (low, middle and high income countries) - understand how this contributes to Madrid 15+ review - if a UN Decade, needs another resolution with a concept note (review best practices/lessons learn from previous Decades including UN year of older persons or UN wide activities such as NCDs chronic disease initiative) and support from civil society groups
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health
(2) Establish other partnerships
- importance of involving different sectors, supporting innovation, technologies - financing / resources to enable this - UN group could be set up to help think through and support this whether or not a UN or WHO decade - UN open working on ageing – what opportunities or lessons learned
(3) Align with SDGs
- influence and align decade with SDGs, and other plans, including evidence and arguments; this should be a short policy document prepared with other UN agencies, whether or not a UN or WHO decade - clear objectives, with consultation with older people – including targets by 2030. This would complement the GSAP that currently does not have targets. - Clarify and make specific the key themes – build in role of older people from the start; consider population dynamics, key themes such as migration in relation to care givers - Address and overcome why healthy ageing is not in current SDGs, what can be done to influence SDGs soon; the practical effort to initiate a City group on age disaggregated data and ageing is one concert step toward greater influence at country level.
(4) Strengthening national institutions to prepare for decade – milestones could include:
2017 proposal and discussion with new DG need metrics for healthy ageing – to get consensus quickly July 2017 political forum ( Within WHO considered premature as new DG takes office on 1 July) Regional population conferences and Commission on Population and Development 2018 latest for consultations 2019 Draft proposal (if UN, should be earlier) 2020 Final proposal and approval
A mind map of the discussions, from Mexico, outlined the following components: Concept notes, prerequisites, process, milestones, objectives, gaining support, and looking at previous failures – see Figure 1.
These suggestions could complement and or be incorporated within the efforts that the WHO Ageing and Life Course Department and network of WHO Regional focal points are putting together addressing 10 steps toward the Decade.
5.8 Support to countries to enable mid-term review. A subsequent panel discussion on support needed to collate and collect the indicator set, with all ministry representatives (Canada, China, Japan, Mauritius, Mexico, and Thailand,) was moderated by UNDESA. Panel discussion highlights:
- insure that indicators are very clearly identified so that there is no room for mis-interpretation - assign responsibility for data collection within countries and ensure verification - promote that countries have a database on older persons and technical support to ensure it is widely accessible - make connections so that focal points within Ministries of Health know who they can consult with within the WHO country office - countries with Federal systems should make clear how they have consulted with sub-national partners.
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health
Figure 1. Mind map of discussions on setting up a Decade for Healthy Ageing
Tools and methods to enable data collection, verification, and analysis were proposed. This can include a WHO survey data collection tool via the WHO Regions:
- Existence of focal points for ageing and health in countries within the region - Existence of strategies / policies / plans on ageing and health in countries within the region - Other proposed indicators for mid-term review that reflect government actions or enabling conditions
This tool could facilitate data collection in multiple languages and on a regular basis; very relevant, data once collected can be integrated into a global, web-based repository that WHO has recently developed.
5.9 Completion of consultation on proposed short list of indicators. Building on this, Japan led a plenary session to brainstorm and propose how the consultation process for these proposed indicators could be completed during 2017 and enable data collation to be initiated and completed by February 2018. A key questions is what type of feedback is desirable from Member States. In discussion WHO governing bodies procedures, this time frame is adjusted as follows:
Mid May, 2017 : process evoked at the Ageing and Health partners’ meeting, Geneva Late May, 2017: process and initial proposal informally discussed during World Health Assembly June, 2017: proposal reviewed within Department of Ageing and Life Course July, 2017: draft meeting report and recommendations circulated to meeting participants and ageing and life course focal points in Regional Offices August, 2017: feedback from meeting participants and regional offices; final consolidation by WHO Secretariat to 10 indicators for mid term reporting; preparation of data collection tool October 2017: final report and request for data collection to Regional Offices
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health
January 2018: all data for the 2018 mid-term Report gathered and verified; draft 600 word version of mid term report for comments February 2018: 600 word version of mid term report submitted to WHO Governing Bodies, for the World Health Assembly in May 2018 March 2018: Full version of mid term report circulated for comments April 2018: Full version of mid term report translated and available via WHO website
5.10 Closure. The working group concluded reviewing the main recommendations, and agreed that the meeting objectives were achieved in full, that is:
The 2 day working group meeting:
(1) Identified a concise set of quantifiable progress indicators for each “strategic objective in the strategy” and “preparations have advanced towards planning for a Decade of Healthy Ageing during 2020–2030.” (2) Outlined a process of consultation and agreement during 2017 on the proposed quantifiable progress indicators, enabling data collation, review and reporting to Member States, by the GSAP mid- term review in 2018.
6 Reflection
The Working Group also provided a valuable networking opportunity, and set the stage for further cooperation through an international consortium on healthy ageing metrics, that will involve international, national and community based institutions and experts along with WHO, staff and Member States. It also increased a shared understanding of the concept of healthy ageing, highlighting different perspectives on what needs to be done and measured, and how information can be used to support decision making and improve the lives of older persons so that they can be and do what they value.
All participants, found that the meeting was “genuinely transparent, well prepared, and engaging” (quoting UN DESA representative who summarized participants’ views). The meeting also demonstrated how the three levels of WHO secretariat ( Country Office - Mexico, PAHO – Regional Office, and WHO Headquarters) can effectively and efficiently work together to support Member States advance a common agenda. All participants also expressed their gratitude of the involvement of representatives from several Mexican national authorities, including the hosting of the working group dinner by the National Institute of Geriatrics.
7 Annexes
1- Short list of Proposed indicators including those for mid-term and for end of action plan (prior to WHO secretariat comments and consolidation from across regions and HQ) 2- Participants 3- Agenda
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health Annex 1
Proposed process related indicators to monitor implementation of the WHO Global Strategy and Action Plan on Ageing and Health 2016-2020 Working Group, Mexico City, 4-5 May 2017
MID TERM (2018) with numbers (13) and END OF ACTION PLAN (2020) with letters (22 additional): total 35
Strategic objective 1: Commitment to action on Healthy Ageing in every country
1.1 Establish national frameworks for action on Healthy Ageing Potential process related indicators For Mid- For 2020/ term 2018 Baseline for (numbers Decade in bold) (letters) 1 Number of countries/194 with a focal point on ageing and health in the Ministry X X of Health.
2 Number of countries/194 with national plans or strategies aligned to Healthy X X Ageing #
# For countries that do not have national plans, but have sub-national plans or strategies, these countries are welcomed to report : Number of sub-national units with plans or strategies aligned to Healthy Ageing , from the total number of sub- national units (e.g. states, provinces, lands, cantons, etc.) within that country
- Sub indicator: that involved older people in the development of the ageing and health strategy/policy/action plan. - Sub indicator: countries that have resources allocated to implement action plans. - Sub indicator: that promote equity through the distribution of resources and investments in light of age groups and socio-demographic characteristics - Sub indicators: that are monitored and evaluated for implementation within a time period that provides accountability A Number of countries/194 that have established units/departments for promoting ageing X and health aligned to Healthy Ageing in ministries of Health and/or other relevant ministries.
1.2 Strengthen national capacities to formulate evidence-based policies
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health 3 Number of countries/194 with a national multi- X X stakeholder forum/committee* on ageing and health, to Includes former facilitate the translation of research on healthy ageing into indicator for policy/programs/practice aligned to Healthy Ageing . 2.2.1
(*involving representation of older people, civil society, NGOs, academia, national statistics, and relevant policy makers, within national policy dialogues / consultations to develop or update policy and health action plans) Sub indicators Sub indicator: informed by national evidence syntheses for 2020 with Sub indicator: with sub national plans involving sub-national clear definitions actors
1.3 Combat ageism and transform understanding of ageing and health 4 Number of countries/194 with national legislation and enforcement strategies X X against age-based discrimination.
B Number of countries/194 that have raised awareness about ageism in the last 24 X months (2018-2020) as part of the Global Campaign to Combat Ageism or as part of national campaigns. C Number of countries/194 with nationally representative data on older peoples’ self- X reported experience of age-discrimination
Strategic objective 2: Developing age-friendly environments
2.1 Foster older people’s autonomy 5 Number of countries/194 with legislation/regulations/programs that support X X older adults to access assistive devices* from the WHO Priority Assistive Products List **.
# For countries that do not have national legislations, but have sub-national legislation/regulations/programs, these countries are welcomed to report: Number of sub-national units with legislation/regulations/programs that support older adults to access assistive devices* from the WHO Priority Assistive Products List**, from the total number of sub-national units (e.g. states, provinces, lands, cantons, etc.) within that country.
* Any external product (including devices, equipment, instruments or software), especially produced or generally available, the primary purpose of which is to maintain or improve an individual’s functioning and independence
**
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health http://www.who.int/phi/implementation/assistive_technology/EMP_PHI_2016.01/en/
D Number of countries/194 that have enacted legal provisions for the prevention of and X to take action against elder abuse.
E Number of countries/194 with nationally representative data on older peoples’ self- X reported knowledge of their rights (health, social and others)
Sub-indicator: with mechanisms in place to support the rights of older people
2.2 Enable older people’s engagement F Number of countries with nationally representative data on X To be developed peoples’ self-reported involvement as volunteers (across all ages). - exclude forced voluntary work
2.3 Promote multisectoral action 6 Number of countries/194 that have a national program in place to X X Refine support activities in line with the WHO Global Network for Age- definition of friendly Cities and Communities * Sub demonstrated indicators activities in *http://www.who.int/ageing/GNAFC_sharepoint/en/ line with http://www.who.int/ageing/publications/age_friendly_cities_guide/en/ WHO GNACC Sub indicator: taking action on older persons and emergencies
G Number of countries/194 with more than 5% of the total X Under population living in municipalities undertaking activities in line development with the WHO Global Network for Age-friendly Cities and to take into Communities * account the distribution of cities and
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health communities
Threshold % to be discussed
Strategic objective 3: Aligning health systems to the needs of older populations
3.1 Orient health systems around intrinsic capacity and functional ability 7 Number of countries/194 with national policies in X X To be developed place to support comprehensive assessments* of the and reported on health and social care needs of older people Sub by 2020 based indicators on WHO # For countries that do not have national legislations, but guidelines have sub-national legislation/regulations/programs, these countries are welcomed to report: Number of sub- national units with policies in place to support comprehensive assessments* of the health and social care needs of older people, from the total number of sub-national units (e.g. states, provinces, lands, cantons, etc.) within that country.
Sub indicator: with health systems facilitating these assessments at primary / front line care level for example via universal health coverage Sub indicator: including intrinsic capacities Sub indicator: including functional ability
8 Number of countries/194 providing palliative care as X X Sub indicators part of benefit package available to older adults, by 2020 without financial burden (e.g. within Universal Health Coverage) other tracer Some Sub indicator(s) to Sub indicator: coverage of other health services (to tracer indicators support IC and those in need) that are crucial to address and maintain indicators FA to be intrinsic capacities and functional ability: tracer to be identified, indicators include: gathered aligned with by the UHC strategies, - Hypertension treatment coverage secretariat once available
- Restorative surgery coverage: cataract, knee and hip * Note: replacement Additional tracer indicators - Rehabilitation service coverage are suggested as less than 10% of older people - *coverage of palliative care and other tracer indicators require disaggregated by age, socio economic status and place of palliative care as
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health residence. defined by WHO. To be further developed: care packages with interventions to maintain IC and FA that include rehabilitation and long term care.
3.2 Develop and ensure affordable access to quality older person centred and integrated clinical care H Number of countries/194 with a plan* to increase health X Requires tools to system’s capacity to deliver person centered integrated assess health health and social care for older people. system’s capacity to *based on an assessment of their health system deliver
I Number of countries/194 where person centered integrated X To be refined in health and social care is available for older people, at home line with ICOPE or in institutions, without financial burden guidelines
Sub indicator: Patient safety for older people – unintended harm from five or more long term medications*
3.3 Ensure a sustainable and appropriately trained, deployed and managed health workforce Potential indicators Mid- 2020/Baseline Comments term Decade 2018 (in bold) J Number of countries/194 that have integrated core X WHO to refine competencies* for Healthy Ageing in national and provide competency frameworks guidance on assessment tools *covers diverse professions including physicians, and definition of nurses, and others core competencies *covering and reflecting an assessment of the current and anticipated workforce needs for ageing
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health populations
K Number of countries/194 that have integrated core X WHO to refine competencies for Healthy Ageing in continuing with professional professional development. associations, and approach of # For countries that do not have a national approach, secretariat to but have sub-national approaches, these countries are support to welcomed to report: Number of sub-national units Member States that have integrated core competencies for Healthy Ageing in continuing professional development, from the total number of sub-national units (e.g. states, provinces, lands, cantons, etc.) within that country.
*covers diverse professions including physicians, nurses, and others,
Sub indicator: that are assessed / evaluated
Strategic Objective 4: Developing sustainable and equitable systems for providing long-term care (home, communities, institutions)
4.1 Establish and continually improve a sustainable and equitable long-term-care system Potential indicators Mid- 2020/Baseline Comments term Decade 2018 (in bold) 9 Number of countries/194 that have a national plan X X to develop or maintain a system of long-term care consistent with Healthy Ageing principles (either Sub indicators stand-alone or integrated within an ageing and by 2020 with health plan aligned to Healthy Ageing ) updated terms
# For countries that do not have a national approach, but have sub-national approaches, these countries are welcomed to report: Number of sub- national units that have a sub-national plan to develop or maintain a system of long-term care consistent with Healthy Ageing principles, from the
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health total number of sub-national units (e.g. states, provinces, lands, cantons, etc.) within that country.
Sub indicator: covering home, community and institutional care Sub indicator: covering family, other informal and organized caregivers L Number of countries/194 with clearly assigned X responsibility for the development of a sustainable system of long-term care*
*implementation, resourcing, financing, regulation and evaluation M Number of countries/194 with nationally representative X To be developed coverage of long term care services *.
* those in need to have effective services without financial burden whether at home, communities or institutions
4.2 Build long term care workforce capacity and support caregivers (paid and unpaid) 10 Number of countries/194 providing support mechanisms for X Sub indicators all care givers* in long term care provision, such as offering by 2020 respite care and accessible training and information resources
Sub indicator: nationally representative data on care givers self- reported access to and benefit from such support
* Within International Standard Classification of Occupations (532: personal care workers in health services) http://www.ilo.org/wcmsp5/groups/public/---dgreports/--- dcomm/---publ/documents/publication/wcms_172572.pdf
N Number of countries/194 that have formulated national standards X Sub indicators and support implementation for training of care givers* in long by 2020 term care provision
Sub indicator: paid care workers Sub indicator: unpaid care workers
* as above
O Number of countries/194 that have laws or regulations protecting X rights of care givers*, e.g. with application to nationals and non- nationals
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health Sub indicator: gender responsive policy for care givers
* as above
4.3 Ensure the quality of person-centred and integrated long-term care P Number of countries/ 194 with national standards* for X WHO to support long-term care in place the development of standards # For countries that do not have a national approach, but have sub-national approaches, these countries are welcomed to report: Number of sub-national units with sub-national standards* for long-term care in place, from the total number of sub-national units (e.g. states, provinces, lands, cantons, etc.) within that country.
* scope needs to be defined
Q Number of countries/ 194 with guidelines and protocols X for the implementation, monitoring and evaluation of long-term care standards
Strategic objective 5: Improving measurement, monitoring and research on Healthy Ageing
5.1 Agree on ways to measure, analyse, describe and monitor Healthy Ageing 11 Number of countries/194 with cross-sectional, nationally X X WHO to representative data on Healthy Ageing collected since develop 2010, data in public domain Sub standards; sub indicators indicators for Sub indicator: reporting on the health needs* of older adults 2020 Sub indicator: assessing Healthy Ageing as per WHO metrics Target: 155 *To be clearly defined by 2020 reflecting need and unmet countries need (80% of Member States) 12 Number of countries/194 with longitudinal, nationally X representative surveys of Healthy Ageing
(cohort or panel, data in public domain)
R Number of countries/194 with national database (registry) on X Determine if older people this indicator and its sub Sub indicator: accessible to public electronically indicators can
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health Sub indicator: linking data across different sectors become a sub indicator for 5.1.1 and or 5.1.2
S Number of countries/194 using the WHO International X Officially Classification of Functioning, Disability and Health* endorsed by WHO in 2001 *( http://www.who.int/classifications/icf/en/ ) use by health statistic or national statistics offices To be aligned with ICF reporting
5.2 Strengthen research capacities and incentives for innovation Potential indicators Mid- 2020/Baseline Comments term Decade 2018 (in bold) T Number of countries/194 with a platform for knowledge X WHO to refine exchange* between decision makers, older people, sub indicators health workers, and researchers
Sub indicator: innovation/identification of new research areas (priorities) Sub indicator: translation/adaptation of research findings in practices Sub indicator: knowledge exchanges at sub national and local levels Sub indicator: incentives for innovation U Number of countries/194 with a Healthy Ageing X WHO to research plan catalyze global and regional Sub indicator: addressing research ethics efforts Sub indicator: addressing research capacities (people, institutions, networks). Sub indicator: addressing national funding for research/research synthesis on priority topics Sub indicator: dissemination of research/research synthesis outputs
5.3 Conduct research and synthesize evidence on Healthy Ageing 13 Number of countries/194 with national situation X X WHO to develop assessments related to Healthy Ageing since 2010 with partners indepth and rapid assessment tools
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health V Number of countries/194 evaluating interventions to gauge X Needs further impact on functional ability, for people with different development levels of intrinsic capacity
Sub indicator: link to built environment and mobility in aging
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health Annex 2
WORKING GROUP MEETING TO REVIEW AND RECOMMEND INDICATORS ON THE IMPLEMENTATION OF THE GLOBAL STRATEGY AND ACTION PLAN AND HEALTH 3-4 May 2017 Hotel Royal Reforma Mexico City / Mexico
LIST OF PARTICIPANTS
Ms Simone POWELL CANADA Seniors' Health Promotion and Business Integration Division Simone.Powell@phac- Public Health Agency of Canada aspc.gc.ca
Prof. Xiaoning HAO CHINA Director of Public Health and Risk Management [email protected] National Health Development Research Center (NHDRC) of National Health and Family Planning Commission, Beijing
Prof. Naoki KONDO JAPAN Department of Health Education and Health Sociology, School of Public Health [email protected] University of Tokyo
Dr Hiroshi MURAYAMA JAPAN Institute of Gerontology [email protected] The University of Tokyo p
Dr Yosuke INOUE JAPAN Carolina Population Center [email protected] University of North Carolina
Dr Ibrahim KOODORUTH MAURITIUS Department Social Studies [email protected] University of Mauritius
Dr Luis Miguel GUTIÉRREZ ROBLEDO MEXICO Director General gutierrezrobledoluismiguel Instituto Nacional de Geriatría, Mexico City @gmail.com
Dr Marcela AGUDELO MEXICO Health Information Specialist marcela.agudelo.botero@g Insituto Nacional de Geriatría, Mexico City mail.com
Dr Amalia Elisa Ayala Montoya MEXICO Family and Community Health [email protected] WHO Country Office, Mexico
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health Mr Ivan CASTELLANOS MEXICO P&D Officer [email protected] UNFPA Mexico Dr Carmen GARCÍA PEÑA MEXICO Research Director [email protected] Instituto Nacional de Geriatría, Mexico City
Dr Rafael LOZANO MEXICO Director, Centro de Investigación en Sistemas de Salud [email protected] National Institute of Public Health, Mexico City
Ms Sharon SEGURA J. PAHO Consultant, Healthy Life Course [email protected] Family, Gender, and Life Course, Washington D.C.
Dr Ekachai PIENSRIWATCHARA THAILAND Director, Bureau of Elderly Health [email protected] Department of Health Ministry of Public Health, Bangkok
Ms Rachel ALBONE UK HelpAge International [email protected] London
Dr Karoline Schmid USA Inter-regional Advisor, Division on Social Policy and Development [email protected] UNDESA, New York
Dr Ritu Sadana WHO HQ Senior Advisor [email protected] Ageing and Life Course, Geneva
Ms Minxia (Laura) LUO SWITZERLAND University of Zurich [email protected]
MEMBERS OF THE WORKING GROUP – UNABLE TO ATTEND THE MEETING
Dr Patricia CHEMOR MEXICO National Population Council and PPD [email protected] Mexico City Dr Nabil M KRONFOL LEBANON Co-Founder and Treasurer, Center for Studies on Ageing; [email protected] President and Founder, the Lebanese HealthCare Management Association, Beirut
Mr Frederik LAFEBER NETHERLANDS Department of long-term care, Ministry of Health, Welfare [email protected] and Sport
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health Annex 3
Final Agenda update: 4 May 2017 Twitter: #healthyageing
Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health
– Working Group meeting 3-4 May 2017 –
The concept note on this meeting outlined 2 objectives:
(1) Identify a concise set of quantifiable progress indicators for “each strategic objective in the strategy” and “the extent to which preparations have advanced towards planning for a Decade of Healthy Ageing during 2020–2030.” (2) Outline a process of consultation and agreement during 2017 on the proposed quantifiable progress indicators, and start data collation and collection towards the mid-term review reporting in 2018.
This includes progress indicators for each strategic objective:
SO 1 Commitment to action on Healthy Ageing in every country, including national focal points and frameworks for action on Healthy Ageing
1.1 Establish national frameworks for action on Healthy Ageing 1.2 Strengthen national capacities to formulate evidence-based policies 1.3 Combat ageism and transform understanding of ageing and health
SO 2 Developing age-friendly environments, including fostering older people’s autonomy
2.1 Foster older people’s autonomy 2.2 Enable older people’s engagement 2.3 Promote multisectoral action
SO 3 Aligning health systems to the needs of older populations, including developing and ensuring affordable access to quality older person-centred and integrated clinical care
3.1 Orient health systems around intrinsic capacity and functional ability 3.2 Develop and ensure affordable access to quality older person centred and integrated clinical care 3.3 Ensure a sustainable and appropriately trained, deployed and managed health workforce
SO 4 Developing sustainable and equitable systems for providing long-term care, including building workforce capacity and support to caregivers whether in homes, communities or institutions
4.1 Establish and continually improve a sustainable and equitable long-term-care system 4.2 Build workforce capacity and support caregivers 4.3 Ensure the quality of person-centred and integrated long-term care
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health SO 5 Improving measurement, monitoring and research on Healthy Ageing , including strengthened research capacities and incentives for innovation. 5.1 Agree on ways to measure, analyse, describe and monitor Healthy Ageing 5.2 Strengthen research capacities and incentives for innovation 5.3 Conduct Research and synthesize evidence on Healthy Ageing
Day 1: 3 May - Setting us up to succeed together
8:30-9:00 Registration (Hotel Royal Reforma, Mexico City, Mexico, meeting room: Principal)
9:00-9:45 Session 1: Objectives, Introductions, Expectations
Chair: Luis Miguel GUTIÉRREZ-ROBLEDO
Welcome: Sharon SEGURA (5 min)
Mandate, Milestones & Objectives: Ritu Sadana (20 min) See Concept Note for meeting, Global Strategy and Action Plan on Ageing and Health 2016-2020 & WHO Resolution
Expectations & Participant Introductions (20 min)
9:45-11:15 Session 2: Setting us up to succeed: criteria for quantifiable process indicators for global monitoring of implementation
Chair: Ritu SADANA
What do some 15 National policy / strategies on ageing and health include on progress indicators / accountability mechanisms – Laura LUO (20 min)
Approach to progress indicators:
Thai strategy on ageing and health - Ekachai PIENSRIWATCHARA (7 min)
Japanese strategy on ageing and health - Hiroshi MURAYAMA (7 min)
Mexican strategy on ageing and health - Luis Miguel GUTIÉRREZ- ROBLEDO (7 min)
Short Reflections (2-3 min): what criteria should guide us? - HelpAge International – Rachel ALBONE - Mexico - Rafael LOZANO - UN City Group on Ageing - Karoline SCHMID
Discussion - agree on key criteria – round one
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health 11:15-11:45 Coffee break
11:30- 12:30 Session 3: Potential indicators: for Strategic objective 1 - Commitment to action on Healthy Ageing
Overview & Clarification (5 min) – see background note and sheet 1
3 small groups – conversation on what is important and what could be measured (30 min)
Group report back (5 min total)
Reflection – are we on track: Xiaoning HAO, China (up to 5 min)
12:30 -13:30 Lunch
13:30-14:15 Session 4: Potential indicators: for Strategic objective 2 - Developing age- friendly environments
Overview & Clarification (5 min) - see background note and sheet 2
3 small groups – conversation on what is important and what could be measured (30 min)
Group report back (5 min total)
Reflection – are we on track: Simone POWELL, Canada (up to 5 min)
14:15-15:00 Session 5: Potential indicators: for Strategic objective 3 - Aligning health systems to the needs of older populations
Overview & Clarification (5 min) - see background note and sheet 3
3 small groups – conversation on what is important and what could be measured (30 min)
Group report back (5 min total)
Reflection – are we on track: Naoki KONDO, Japan
15:00-15:30 Coffee break
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health 15:30 – 16:45 Session 6: Potential indicators: for Strategic objective 4 - Developing sustainable and equitable systems for providing long-term care
Overview & Clarification (5 min) - see background note and sheet 4
3 small groups – conversation on what is important and what could be measured (30 min)
Group report back (5 min total)
Reflection – are we on track: Ibrahim KOODORUTH, Mauritius (5 min)
16:45-17:30 Session 7: Potential indicators: for Strategic objective 5 - Improving measurement, monitoring and research on Healthy Ageing
Overview & Clarification (5 min) - see background note and sheet 5
3 small groups – conversation on what is important and what could be measured (30 min)
Group report back (5 min total)
Reflection – are we on track : Carmen GARCÍA PEÑA, Mexico (5 min)
19:00 Dinner hosted by the Mexican National Institute of Geriatrics, at Fonda "El Refugio"
Day 2: 4 May – Achieving working group objectives
9:00-9:15 Session 8: Recap Day 1 and set out Day 2
Discussion - Revise criteria for selection of short list – Round two
9:15-9:45 Session 9 Towards identifying quantifiable indicators and fit with Criteria – plenary review part 1
Chair: Xiaoning HA
Review/discuss proposed, consolidated list for each strategic objective from day 1 discussions – to finalize long list for individual rating in session 11 (30 min)
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health
9:45-10:15 Session 10: Potential Indicators: for progress towards planning for a Decade
Chair: Ekachai PIENSRIWATCHARA
Overview & Clarification (5 min) - see background note & sheet decade
Interactive group discussion – milestones, partners, resources, and what is important (30 min)
Reflections (up to 5 min): Ivan CASTELLANOS, UNFPA Yosuke INOUE, Japan
10:15-11:15 Session 11: Towards identifying quantifiable indicators and fit with Criteria –individual ratings part 2
Individual ratings of proposed long list of indicators based on updated criteria (60 min including coffee break)
- Indicators, whether for mid-term, 2020 baseline, or further development
11:15 – 11:45 Session 12: Update on developing indicators on Healthy Ageing Outcomes - Intrinsic Capacity and Functional Ability
Chair: Rafael LOZANO
Overview: Ritu SADANA (10 min)
Reflections: Luis Miguel GUTIÉRREZ-ROBLEDO, Rachel ALBONE
Discussion
11:45 - 12:30 Session 13: Identifying elements of what the mid-term progress review report should contain
Chair: Ibrahim KOODORUTH
Brainstorm exercise in plenary – what should mid-term report contain
Review structure & contents of 3 recent WHO strategies’ mid-term reports
- Consider format and contents for 2018 GSAP mid term report
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health
12:30-14:00 Lunch
14:00- 15:30 Session 14 Towards identifying quantifiable indicators and fit with Criteria – part 3
Chair: Simone POWELL
Results of individual rating exercise - Laura LUO
Review and refine in 3 small groups by strategic themes (45 min)
Review proposed short list and agree on indicators for further consultation - Plenary (30 min)
15:30 – 15:45 Coffee Break
15:45 – 16:15 Session 15: Identify support required to collate and collect core indicator set to enable mid-term review
Chair: Karoline SCHMID
Review data collection support WHO could offer Member States
Panel Reflections (3-4 min): Xiaoning HAO, Ibrahim KOODORUTH, Ekachai PIENSRIWATCHARA, Naoki KONDO, Luis Miguel GUTIÉRREZ-ROBLEDO and others
Discussion
16:15 – 16:45 Session 16: Propose consultation process to be completed in 2017, towards an agreed on core indicator set and initiation of data collation and collection
Chair: Naoki KONDO
Brainstorm exercise – inclusive and manageable within time frame
Reflections: Member States: Simone POWELL Non-Governmental Organizations: Rachel ALBONE PAHO/ Other UN Agencies: Sharon SEGURA, Karoline SCHMID
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Final Report of Working Group Meeting to Review and Recommend Indicators on the Implementation of the Global Strategy and Action Plan on Ageing and Health
16:45 - 17:00 Session 17: Agreement on recommendations and next steps
Chair: Ritu SADANA
Key recommendations on both meeting objectives Outline of meeting report Roles and process to draft and finalize meeting report during May-July 2017
17:00-17:10 Closure – Mexican National Institute of Geriatrics WHO Country, Regional and Headquarter Statements
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