The UK’s Global Health Framework: How do we translate ambition into reality?

The UK government recently launched its Global Health Framework, which signifies bold ambition for the UK’s role in global health.

“Working together towards a healthier world” highlights four objectives for progress: strengthening global health security, reforming global health architecture, strengthening country health systems, and advancing UK leadership in science and technology.

The framework creates an opportunity for a more coherent approach to the UK’s global health work, providing a basis for cross-department engagement, which can be implemented by ministers across government.

The 2030 deadline for Sustainable Development Goal 3: Good Health and Well-being is fast approaching. As 2023 marks the halfway point for the Sustainable Development Goals (SDGs), urgent action is needed to address health inequities. The polycrisis of Covid-19, the rising cost of living, conflict, and climate change has widened disparities in access to high-quality healthcare, routine immunisations and financial security.

The facts are startling. Between 2020 and 2021 there was only a 1% decrease in deaths from malaria in the WHO Africa region, and deaths are still 9% higher than pre-pandemic numbers. Nearly three-quarters of all annual deaths are now caused by non-communicable diseases (NCDs), a percentage that has steadily increased. After many decades of progress on global health, recent years have seen stagnation – or in some cases a reversal – of progress on several health targets, endangering the likelihood of achieving Universal Health Coverage by 2030.

In the face of these challenges, the framework is a welcome first step, but funding and urgent action are needed to make the ambition of the framework a reality.

Connecting the dots

Consolidating existing departmental work on global health into one framework, with a focus on universal health coverage and strong health systems, is welcome. The framework reiterates commitments outlined in the Women and Girls Strategy and Ending Preventable Deaths of Mothers Babies and Children Approach paper on taking a leading role to defend and promote sexual and reproductive health and rights (SRHR) in light of opposition to gender equality, and to reduce maternal and child mortality. It also commits to support for health in humanitarian contexts and responding to the impacts of climate change.

Although the framework recommits the UK to leaving no one behind, it fails to convey how disability inclusion will be mainstreamed throughout their global health work, including through water, sanitation and hygiene (WASH), SRHR and nutrition. The framework also falls short on how they will support advocacy, inclusion and meaningful participation of people with disabilities at all levels and collect and disaggregate health data by disability – all of which are commitments in the Foreign Commonwealth and Development Office’s (FCDO) Disability Inclusion and Rights Strategy. It similarly neglects some key targets of SDG3, such as those addressing non-communicable diseases, which is particularly significant for older people who are at greater risk.

While the framework has an ambitious plan for cross-departmental involvement to improve global health, it does not do enough to build on, strengthen and provide detail about how these existing areas of work will be operationalised and implemented in practice.

Making the framework a reality

The Global Health Framework was announced without new funding to reach these goals, despite multiple cuts over recent years to global health spending. To match the scale of ambition, it is critical that concrete, additional UK funding – alongside a return to the UK’s 0.7% UK aid commitment and focused efforts on domestic resource mobilisation – translates the framework into reality.

The framework is not accompanied by any transparent monitoring mechanism, so it is also unclear how plans will be operationalised or progress evaluated. This absence is particularly felt in relation to improving health equity or the ‘leave no one behind’ agenda, where clear, measurable, disaggregated indicators are needed.

Coherent, cross-departmental implementation will only be successful if the monitoring is similarly coherent in design. If monitoring is only conducted through the processes related to the International Development Strategy, this could inevitably mean that progress in departments beyond FCDO and non-UK aid sources is not adequately incorporated and evaluated. As such, we call on the UK to establish a transparent monitoring and evaluation mechanism for the delivery of this framework.

What next?

Although the framework is not the full cross-government strategy on global health that we would like to see, it is a welcome and much-needed step in addressing the UK’s coordinated approach to global health efforts. It reaffirms the UK’s commitment to the right to health and offers a much-needed extension of the first and last cross-government strategy for global health (2011–2015).

While we were disappointed that there was no consultation for those who have experienced health inequities first-hand and organisations working actively on global health issues to inform the creation of this framework, we are looking forward to supporting its implementation and contributing to the creation of a longer-term strategy that will support our collective ambition to improve good health and well-being for all. This should include a clear delivery and implementation framework, as well as an action plan for how the UK will work with partners to achieve the stated goals.

Ultimately, it will take community ownership as well as strong partnerships between governments, providers, development partners, civil society, communities, and researchers to provide the necessary evidence and work towards the achievement of universal health coverage.