Post-2015 Consensus: Health Viewpoint, Webb
Webb agrees that critiquing the proposed Sustainable Development Goals is a desirable, even essential, exercise. However, the cost-benefit analysis has some intrinsic limitations. First, it fails to recognize the important complementarities between health targets, cannot capture synergies and has difficulties in assessing the value of human rights-based approaches. It is also clear that BCR analysis cannot easily be used for a set of targets combining objectives that represent intermediate outcomes. The targets themselves would be better arranged in a format where there is actually a hierarchy of objectives, consisting of outputs, intermediate outcomes, impacts and the goal itself, and expressed in results based language.
The second point is the inevitable interactivity and indeed interdependence between the proposed goals; the apparent synergies between the proposed Sustainable Development Goals are much stronger than those between the MDGs. It is also true that investing in social spending will achieve many of the desired health outcomes targeted in the SDGs. The growing interest in co-financing models increasingly delegitimizes a siloed approach to BCR where only costs elements within a single sector are factored in.
Finally, the most worrying assertion from the assessment paper is that universal health coverage should be rated as ‘uncertain’ due to the lack of data. The dangers of being restricted to data driven targets according to BCR calibrations at this stage become obvious. So important is UHC that for some time it warranted being the forerunner of the health goal itself.