Summary: Roadmap for health and well-being in Central Asia (2022–2025)

ROADMAP FOR HEALTH AND WELL-BEING IN CENTRAL ASIA (2022–2025): SUMMARY An important lesson learned from the ongoing COVID-19 pandemic has been the added value of countries working together to protect lives and achieve shared health and well-being goals. Currently, Central Asian countries (CACs)’s share the priorities of building back better from the COVID-19 pandemic, achieving the 2030 Sustainable Development Goals (SDGs) and closing their gaps in health and well-being with the European Union (EU) and WHO European Region. To achieve these goals, CACs have co-created the Roadmap for Health and Well-being in Central Asia (2022–2025) (hereinafter, the Roadmap) in a  process facilitated by the WHO Regional Office for Europe and supported by development partners. The Roadmap aligns the efforts of CACs and partners to pursue political, investment and technical objectives that deliver on the core priorities of the European Programme of Work (2020–2025) – “United Action for Better Health in Europe” (EPW), target the root causes of ill health, address key weaknesses of CACs’ health systems and drive transformative partnerships for change in Central Asia. 2The added value of the Roadmap CACs co-created the Roadmap using a novel approach established by the WHO Regional Office for Europe to facilitate subregional cooperation for health and well-being. This approach enables CACs to synergize resource mobilization and facilitate partnerships for transformative change that will create political capital for health and broaden investment opportunities in Central Asia. These opportunities focus on the most prominent, high impact areas of shared priority for improving the health and well-being of Central Asia’s current and next generation. The Roadmap is a powerful, politically neutral health instrument that allows CACs to cooperatively respond to the intersecting crises of epic proportions affecting them, including the COVID-19 pandemic, the climate crisis and the conflict and political instability in the WHO European Region, predominantly resulting from the crisis in Ukraine. Therefore, the Roadmap is a human-centred cornerstone for health and well-being that will help CACs heal social fractures and accelerate their delivery on global, regional and national commitments for health and well-being (Fig. 1). Fig. 1. An overview of the global, regional, subregional and national commitments in Central Asia that this Roadmap honours and accelerates achievement toward. Global commitments United Nations: SDGs WHO: Global Action Plan for Healthy Lives and Well-Being for All (GAP) Subregional commitments Roadmap for Health and Well-being in Central Asia (2022–2025) Regional commitments WHO European Region: European Programme of Work (2020–2025) – “United Action for Better Health in Europe” National commitments CACs’ health and well-being goals 3Cooperative action is needed now for health and well-being in Central Asia I In response to the 2018 United Nations General Assembly resolution: “Strengthening regional and international cooperation to ensure peace, stability and sustainable development in the Central Asian Region”, CACs are expanding ongoing efforts to promote peace and stability and foster economies that centre health and well-being. CACs are moving towards subregional cooperation that promotes security, development and prosperity. II Health and well-being are inherently linked to the economic, social and environmental dimensions of sustainable development. Coherent action is urgently needed at all levels among all sectors to address the widening gaps in health and well-being between CACs and the EU and WHO European Region. These gaps place countries increasingly at risk of rescinding the health and well-being progress they were making before the COVID-19 pandemic. III The Roadmap reflects the desire of CACs’ 75.1 million people to have their health and well-being needs met. These needs and expectations include: 1) the guarantee of their right to universal access to quality care without fear of financial hardship; 2) effective protection against health emergencies; and 3) their ability to thrive in healthy communities where public health actions and appropriate public policies secure a better life in an economy of well-being. CACs have significant progress to make on nearly all SDG 3 targets SDG 3 intends to ensure healthy lives and promote well-being for all at all ages. All CACs have achieved SDG 3.1 (maternal mortality). Kazakhstan and Uzbekistan have also achieved SDG 3.2 (new-born and child mortality), and Turkmenistan and Uzbekistan have achieved SDG 3.7 (sexual and reproductive health-care services). Challenges remain to achieve all other SDG 3 targets across Central Asia. Notably, major challenges remain to achieve SDGs 3.3 (communicable diseases) and 3.4 (noncommunicable diseases) and significant challenges remain to achieve SDG 3.6 (road safety) and SDG 3.9 (environmental health hazards). Challenges also remain to achieve SDGs 3.2, 3.5 (substance abuse), 3.8 (Universal Health Coverage) and 3.a (tobacco control) (Table 1). More information on SDG 3 and its targets can be found on the UN’s Overview of SDG 31. Table 1. Selected targets and indicators to track CACs’ progress on achieving SDG 3. Country SDG 3 Target 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.a Kazakhstan G G O R Y O Y Y Y Y Kyrgyzstan G Y R O Y O Y Y O Y Tajikistan G Y R R Y O R O O N/A Turkmenistan G R O R Y O G Y Y N/A Uzbekistan G G O O Y Y G Y Y Y Notes. Green (G): Target achieved; Yellow (Y): Challenges remain; Orange (O): Significant challenges remain; Red (R): Major challenges remain; White (N/A): Data unavailable. The status assigned to each target was determined by an analysis in the Sustainable Development Report. All data used to create the Sustainable Development Report are based on Sachs et al. (2022)’s publication2. 1 Goal 3: ensure healthy lives and promote well-being for all at all ages [website]. In: United Nations Department of Economic and Social Affairs/ SDG Knowledge/Sustainable Development Goals/The 17 Goals. New York: UNDESA, Division for Sustainable Development Goals; 2022 (https:// sdgs.un.org/goals/goal3, accessed 26 October 2022). 2 Sachs, J., Kroll, C., Lafortune, G., Fuller, G. and Woelm, F. (2022) Sustainable Development Report 2022. Cambridge: Cambridge University Press; 2022 (https://doi.org/10.1017/9781009210058, accessed 26 October 2022). 4Closing CACs’ gaps in health and well-being: putting health equity at the heart of recovery Health and well-being in CACs cannot move forward when so many of their citizens are falling behind. It is an overarching objective of the WHO Regional Office for Europe to collaborate with CACs to close their significant gaps in health and well-being by realizing the EPW and implementing the Roadmap. Doing so is not just a moral imperative and matter of fairness: rather, it is also a strategy to mend social fractures, restore trust in public bodies and build a better future for the next generation. Health and well-being outcomes are highly varied among CACs, with each country performing differently depending on the indicators considered (see the Compendium). For this reason, cooperation at the subregional level is ideally suited to address common challenges and help CACs efficiently pool resources, share expertise and collectively work towards improving their health and well-being. Moreover, subregional cooperation will help CACs collectively address the significant health and well-being gaps between them and the EU and WHO European Region (Fig. 2 and the Compendium (Table 1)). Fig. 2. Overview of the health and well-being gaps between CACs and the EU and WHO European Region. AVERAGE LIFE EXPECTANCY (FEMALE/MALE) CENTRAL ASIA: 74.93/69.11 EU: 83.83/78.45 WHO EUROPEAN REGION: 81.29/75.07 PERCENTAGE OF DEATHS AND DALYS ATTRIBUTED TO COMMUNICABLE DISEASES (CENTRAL ASIA/EU) % DEATHS: 13.04%/5.55% % DALYS: 18.15%/4.04% INFANT, UNDER-FIVE AND MATERNAL MORTALITY 6.45, 5.38 AND 4.10 TIMES HIGHER IN CENTRAL ASIA THAN THE EU, RESPECTIVELY PERCENTAGE OF HEALTH EXPENDITURE COVERED BY OOPS CENTRAL ASIA: 58.02% EU: 21.60% WHO EUROPEAN REGION: 29.82% TOTAL NUMBER OF HOSPITAL BEDS PER 100 000 POPULATION CENTRAL ASIA: 546.86 EU: 638.16 WHO EUROPEAN REGION: 566.62 HOUSEHOLD AND AMBIENT POLLUTION MORTALITY PER 100 000 POPULATION CENTRAL ASIA: 96.62 WHO EUROPEAN REGION: 30.00 Notes. DALYs: Disability-adjusted life years; EU: European Union; OOPs: Out-of-pocket payments. 5Lessons learned from the multiple crises of epic proportions affecting CACs The multiple, intersecting crises affecting CACs, including the COVID-19 pandemic, the climate crisis and the crisis in Ukraine, have devastating effects on health and well-being. Lessons learned from these crises demonstrate the importance of partnership, unity and investing in primary health care (PHC) to improve health and well-being, advance health equity and justice and promote peace and stability (Fig. 3). Fig. 3. A summary of lessons learned from the multiple crises of epic proportions affecting CACs. To improve responses to current crises and prepare for future emergencies, CACs should strenghten: Please see the Roadmap and Compendium for more information on the lessons learned • PHC to better maintain essential health services during emergencies; • UHC and health financing policies; • social protection systems for vulnerable and marginalized populations; • IHR capacities and compliance • the digital transformation of health care; • access to WASH services and IPC; • health governance and HRH; • the procurement of medicines and medical supplies, especially in rural areas; • access to sexual and reproductive health services; • public health and risk communication; and • access to food supplies to prevent exacerbated food insecurity. Notes. HRH: Human resources for health; IPC: Infection, prevention and control; PHC: Primary health care; WASH: Water, sanitation and hygiene. The Roadmap’s political, investment and technical objectives The Roadmap builds on CACs’ individual health and well-being goals and synergizes their efforts to: 1) implement the EPW; 2) achieve the SDGs; and 3) close the gaps in health and well-being between CACs and the WHO European Region and EU. To achieve these goals, the Roadmap establishes three, interrelated objectives: political, investment and technical (Fig. 4). Fig. 4. Overview of the political, investment and technical objectives of the Roadmap. Health is a political choice: An investment in development and growth Integrate efforts of countries and partners on core health priorities Increase investments in health by countries and partners Synergize resource mobilization by countries and partners Develop critical points of health systems across CACs Implement initiatives to close Central Asia’s gaps in health and well-being with the WHO European Region and EU INVESTMENT OBJECTIVE TECHNICAL OBJECTIVE POLITICAL OBJECTIVE 6What is the Roadmap? The Roadmap is: • an innovative, multilateral approach that promotes synergistic action for health and well-being across Central Asia to accelerate responses to ongoing crises, close the gaps in health and well-being between CACs and the EU and WHO European Region and build back better health systems that are resilient to future health emergencies; • a country-owned framework that identifies areas for synergistic, subregional action based on the self-defined health and well-being priorities of CACs; • an EPW implementation tool for CACs that respects prior global, regional, and local commitments across the subregion and helps the CACs achieve the SDGs; and • a mechanism to rebuild CACs’ economies and promote an environment in which people thrive in their communities and have their health and well-being needs met. The Roadmap identifies: • health and well-being priorities for each country in Central Asia, supported by country-specific analytical briefs and evidence; • High Impact Action Areas and Reform Initiatives for subregional synergistic action. The Roadmap has four key accelerators for effective implementation, namely to: • keep health atop the political agendas of CACs and their partners; • build a strategic alliance for health and well-being in Central Asia; • synergistically mobilize resources and support for joint projects; and • promote policy and action coherence for SDG achievement. Transformative partnerships for change in Central Asia Strategic partnerships are essential to progress health and well-being. The Roadmap outlines the roles of the WHO Regional Office for Europe and development partners in Central Asia. Partners contribute vital perspectives, expertise and resources that will help CACs implement the Roadmap and realize their individual and collective goals in health and well-being. Therefore, the Roadmap defines the WHO Regional Office for Europe’s trajectory of engagement in CACs and calls on the ongoing support of leading subregional partners to ‘deliver as one’ to achieve the subregion’s shared health and well-being goals and the health-related SDGs. This will require the facilitation of fair and effective interagency cooperation, including joint advocacy, analysis, policy coordination and country support aimed at synergizing efforts and experiences across CACs. Notably, there are no subregional organizations in Central Asia primarily focused on improving health and well- being. Consequently, there is a dire lack of a subregional strategy for health and well-being that is driven by CACs and progresses their shared goals and priorities. Therefore, the Roadmap – primarily focused on health and well- being – is an essential tool to drive transformative partnerships for change in Central Asia as the first country-owned, subregional policy for health and well-being with the political capital to enable the integration and cohesion of CACs’ efforts with clear objectives and joint direction. 7The Roadmap’s Action Areas and Reform Initiatives: Shared priorities for health and well-being across Central Asia CACs have compiled 11 Action Areas and 32 Reform Initiatives to prime the Roadmap’s implementation (Table 2). CACs identified these action areas and reform initiatives by analysing: 1) individual CACs’ health and well-being progress markers and indicators; 2) the gaps in health and well-being between CACs and the EU and WHO European Region; 3) the national health and well-being priorities of individual CACs; and 4) statements from CACs’ Ministers of Health. Therefore, Table 2 reflects the areas of health and well-being where transformative change through united action is sought by CACs the most. Ultimately, the Roadmap calls on the ongoing support of its stakeholders to ‘deliver as one’ by targeting their political, investment and technical resources toward these action areas and reform initiatives to accelerate united action on the subregion’s shared health and well-being priorities, realize the EPW and achieve the health-related SDGs. Table 2. An overview of the Roadmap’s eleven High Impact Action Areas and 32 Reform Initiatives. ACTION AREA 1: Strengthen primary health care (PHC) Initiative 1.1 Strengthen models of PHC Initiative 1.2 Enhance PHC capacities across Central Asia Initiative 1.3 Improve PHC performance measurement and management ACTION AREA 2: Improve health governance and human resources for health (HRH) Initiative 2.1 Improve HRH governance Initiative 2.2 Develop sustainable and integrated HRH planning and delivery capacities Initiative 2.3 Strengthen CACs’ engagement with the private sector ACTION AREA 3: Advance the digital transformation of health care Initiative 3.1 Strengthen the capacities of CACs’ data and health information systems to inform impactful policy and action Initiative 3.2 Improve governance of the digital transformation of health care in CACs ACTION AREA 4: Increase investments to improve financial protection and health equity Initiative 4.1 Strengthen health financing policies for UHC ACTION AREA 5: Reduce the burden of communicable diseases Initiative 5.1 Reduce the burden of tuberculosis, HIV/AIDS, viral hepatitis and sexually transmitted infections Initiative 5.2 Eliminate vaccine-preventable diseases and reduce immunization inequity ACTION AREA 6: Reduce the burden of noncommunicable diseases (NCDs) Initiative 6.1 Reduce the burden of cardiovascular disease Initiative 6.2 Accelerate action on diabetes prevention and control Initiative 6.3 Accelerate action on cancer prevention and control 8ACTION AREA 7: Strengthen health security Initiative 7.1 Implement the International Health Regulations Monitoring and Evaluation Framework (IHR MEF) assessment and develop national action plans for health security Initiative 7.2 Develop key IHR core capacities in line with national action plans for health security Initiative 7.3 Strengthen border health capacities Initiative 7.4 Establish the Central Asia One Health Initiative Initiative 7.5 Ensure the readiness and timely deployment of medical countermeasures to emerging pathogens Initiative 7.6 Improve emergency training for the health workforce Initiative 7.7 Strengthen laboratory capacity and improve the quality and biosafety of laboratory services Initiative 7.8 Strengthen infection prevention and control (IPC) capacities at national and facility levels ACTION AREA 8: Mitigate, detect and respond to health emergencies Initiative 8.1 Build subregional emergency response workforces and emergency management systems Initiative 8.2 Prevent epidemics and pandemics Initiative 8.3 Detect, assess and report public health events under IHR Initiative 8.4 Guarantee rapid, effective and coordinated responses and recovery ACTION AREA 9: Create healthy and green environments Initiative 9.1 Establish a subregional initiative for climate, environment and health Initiative 9.2 Improve access to WASH (water, sanitation and hygiene) services Initiative 9.3 Establish a subregional initiative for road safety ACTION AREA 10: Combat antimicrobial resistance (AMR) Initiative 10.1 Promote intersectoral AMR leadership and governance Initiative 10.2 Improve human and institutional capacity for AMR ACTION AREA 11: Incorporate behavioural and cultural insights (BCIs) Initiative 11.1 Establish a subregional initiative for BCIs Document number: WHO/EURO:2022-5906-45671-65602 © World Health Organization 2022. 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