My friend Larry Gostin has long emphasized that accountability and governance are central to global health policy. Writing in JAMA in 2020 on Universal Health Coverage (UHC), which Larry called the most important target of the Sustainable Development Goals (SDGs), he said: “Good governance requires evidence-based targets, monitoring and measuring outcomes, transparency, honesty, and accountability. It is impossible to know if health systems are meeting population needs without carefully evaluating outcomes, based on full transparency.”

Larry foresaw the Achilles heel of the SDGs and UHC: that planning without accountability was not a recipe for results. Past the midway point in the SDGs, we see that Larry was right. The most recent World Health Statistics found that none of the health-related SDGs was on track, and Universal Health Coverage is advancing at half the pace needed to reach the 2030 goal.

We need to GSD (Get Shit Done!) on the SDGs.

Getting Shit Done will require better data to support countries in setting priorities, taking stock of progress, and identifying and overcoming obstacles. It will also require innovation — to identify those innovations already reaching millions of people and scale them up to the tens or hundreds of millions of people required to speed up SDGs.

But above all, GSD will require governance reform, as this is where the most fundamental incentives that shape United Nations (UN) agencies come from. Unfortunately, UN governance — and specifically World Health Organization (WHO) governance — is not very results focused. The pinnacle of WHO governing bodies meetings, the World Health Assembly, is comprised of dozens of fragmented resolutions, many of which are on technical topics, with limited accountability.

WHO’s most recent investment case promises 40 million lives saved, refreshes the “triple billion” SDG-based targets (including 6-5-7 billion targets for healthier populations, UHC, and health emergencies respectively), and outlines 15 outputs for the WHO secretariat to support countries to achieve these outcomes. This is a good start, but until WHO governing bodies meetings become an honest stock-take of progress against these plans, we will not have a results-based system of global health governance. Unless WHO’s Member States demand more accountability for results, the world will fail to reach the health-related SDGs and UHC.

Larry has been a great supporter of WHO through the years, but he has always emphasized accountability and governance. This is how to Get Shit Done. That is why I am proud to call him a friend.