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1 Summary 2 Mandate 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 1 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: • 2 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. 3 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
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