A new vehicle to accelerate the UN Sustainable Development Goals
Authors: Lorraine Sherr, Lucie Cluver, Chris Desmond, Elona Toska, Larry Aber, Mandeep Dhaliwal, Douglas Webb, Justina Dugbazah
Journal: The Lancet Global Health (2020)

The UN Sustainable Development Goals (SDGs) are unquestionably visionary. But with only a decade left until 2030, the UN Secretary General has announced that we are at a crossroads in the achievement of the 2030 agenda for sustainable development,1UNReport of the secretary general on SDG progress 2019: special edition. United Nations, New York2019Google Scholar and member states have released a political declaration to demand accelerated implementation.2UNResolution adopted by the general assembly on 15 October 2019—political declaration of the high-level political forum on sustainable development convened under the auspices of the general assembly.https://undocs.org/en/A/RES/74/4Date: 2019Date accessed: October 31, 2019Google Scholar Yet delivering 169 targets across 17 interconnected goals is a major challenge for any government. For low-resource and humanitarian settings, the challenge is even more acute. Additionally, clear mechanisms for delivering solutions that can address an integrated agenda do not exist. This crisis in delivery could have severe consequences for the next generation. Africa's adolescents (aged 11–18 years) are the fastest growing population group in the world, estimated to reach half a billion by 2050. This population group represents huge potential and future capacity but is among those most left behind by the SDGs—as such it is an excellent case for investment. Achieving a range of global goals for adolescents in Africa would have widespread effects, but a new vehicle is needed to implement these goals. Use of development accelerators might be this fundamental change in approach. Promoted by the UNDP, accelerators are conceptualised as pragmatic actions that have a simultaneous cumulative effect across a range of goals.3UNDPSDG accelerator and bottleneck assessment. United Nations Development Programme, New York2017Google Scholar Emerging evidence shows that accelerators can be a reality for adolescents—for example, in South Africa, cash transfers to poor households reduced sexual risk behaviour in adolescents (SDG 5) as well as a range of other SDGs.4Cluver L Boyes M Orkin M Pantelic M Molwena T Sherr L Child-focused state cash transfers and adolescent risk of HIV infection in South Africa: a propensity-score-matched case-control study.Lancet Glob Health. 2013; 1: e362-e370Summary Full Text Full Text PDF PubMed Scopus (174) Google Scholar Evidence suggests even greater potential for beneficial effects by use of accelerator synergies (combinations of two or three accelerators that deliver greater reach and resonance) compared with singular accelerators. When good parenting or school feeding were combined with cash transfers, beneficial effects were magnified for nutrition, cognitive development, education, and safety.5Sherr L Macedo A Tomlinson M Skeen S Cluver L Could cash and good parenting affect child cognitive development? A cross-sectional study in South Africa and Malawi.BMC Pediatr. 2017; 17: 123Crossref PubMed Scopus (22) Google Scholar A 2019 demonstration-of-concept paper tested whether multiple SDGs could be improved simultaneously in one of Africa's most left-behind populations—adolescents living with HIV. The paper noted that three accelerators taken together (safe schools, good parenting, and cash transfers) had a combination effect across seven SDG targets within the goals of health (SDG 3), education (SDG 4), gender equality (SDG 5), and violence prevention (SDG 16).6Cluver L Orkin F Campeau L et al.Improving lives by accelerating progress towards the UN sustainable development goals for adolescents living with HIV: a prospective cohort study.Lancet Child Adolesc Health. 2019; 3: 245-254Summary Full Text Full Text PDF PubMed Scopus (82) Google Scholar, 7Mannel J Willan S Shahmanesh M Seeley J Sherr L Gibbs A Why interventions to prevent intimate partner violence and HIV have failed young women in southern Africa.J Int AIDS Soc. 2019; 2225380Google Scholar The next global priorities are to find accelerator synergies for the SDGs, appraise cost-effectiveness, provide pragmatic objectives with high value for money, and feed directly into country-level strategies for implementing the SDGs.8Remme M Vassall A Lutz B Luna J Watts C Financing structural interventions: going beyond HIV-only value for money assessments.AIDS. 2014; 28: 425-434Crossref PubMed Scopus (42) Google Scholar The UK Research and Innovation Global Challenges Research Fund Accelerate Hub has been set up to achieve these priorities. The hub is a shared research initiative across UN agencies, the African Union, non-governmental organisations, and donors, with joint south–north academic leadership. The hub follows previous successful approaches, such as the joint learning initiatives, by incorporating a wide range of global agencies but being free-standing to ensure generation of independent evidence. This approach incorporates an early career development section so that countries will benefit not only from the findings but also from the human resources created in the process. Importantly, the hub is co-led by adolescents in advisory groups across west, east, south, and central Africa (table).6Cluver L Orkin F Campeau L et al.Improving lives by accelerating progress towards the UN sustainable development goals for adolescents living with HIV: a prospective cohort study.Lancet Child Adolesc Health. 2019; 3: 245-254Summary Full Text Full Text PDF PubMed Scopus (82) Google ScholarTableStructure of the UK Research and Innovation Global Challenges Research Fund Accelerate Hub for Africa's adolescentsWork package aim and methodologyDesired outcomeWork package tasksLeadsWork package 1Impact, co-creation, and capacity buildingImproved policy and services for 20 million African adolescents and their childrenAdolescent co-design, policy consultation, and engagement; trained service providers (34 countries); capacity-sharing for early-career African researchersEvelyn Gitau (African Population and Health Research Center Kenya); Prof Kevin Marsh (African Academy of Sciences; Africa Oxford Initiative)Work package 2Observational cohorts across AfricaIdentification of accelerators and combinationsQuasi-experimental analyses, new data generation, and cost-effectiveness analysesElona Toska (University of Cape Town); Heidi Stöckl (London School of Hygiene & Tropical Medicine)Work package 3Innovation laboratoryIdentification of cross-context transportability, sequencing, and mergingInterdisciplinary workshops and collaborative projects; merging existing interventionsChris Desmond (University of KwaZulu-Natal); Prof Elleke Boehmer (University of Oxford)Work package 4Randomised trialsIdentification of accelerator combinations through experimental and moderator studiesAccelerator synergies across child developmental stagesKate Orkin (University of Oxford; Busara Kenya); Prof Alan Stein (University of Oxford; University of Witwatersrand)Work package 5From evidence to scaleCost-effectiveness and investment cases, scaling and adapting actions across AfricaCosting and cost-effectiveness analysis of identified interventions; facilitating adolescent engagement and examining adolescent acceptabilityMarisa Casale (University of the Western Cape); Prof Olayinka Omigbodun (University of Ibadan) Open table in a new tab This initiative is the first to identify development accelerators with data-driven insight. The nature of looking at outcomes across SDGs requires a new way of working: across academic disciplines and beyond single sectors of government operating independently. These new collaborations have the potential to identify innovative and unexpected combination interventions. The UK Research and Innovation Global Challenges Research Fund Accelerate Hub will also examine further questions to support national policy provision. Are accelerators grouped by type (such as individual-level and community-level provision), and do combinations need to be built across or within these groups? What actions or additions are needed to make an intervention into an accelerator, to understand deceleration, and to apply the evidence at scale? For example, at another stage of life, early childhood nutrition interventions might not work in isolation, but when combined with improved quality of childcare these interventions have long-term benefits on employment, achievement, and health. Putting the accelerator framework into operation has implications far beyond Africa's adolescents. In 2020, the 75th anniversary of the UN includes a commitment to identify solutions that close the gap between the aspirations of the SDGs and current trajectories. This commitment recognises that, for many countries, the SDGs are currently unreachable because the so-called decade of action demands that integrated approaches be scaled up; however, financial and structural barriers and diverting challenges, such as the COVID-19 outbreak, impede action. By enabling member states to achieve as many SDG targets as possible in a cost-effective way, accelerators could be a workable vehicle to get them there. This work was funded by UK Research and Innovation Global Challenges Research Fund Accelerating Achievement for Africa's Adolescents Hub (grant ref: ES/S008101/1). CD reports personal fees from University of KwaZulu-Natal during the conduct of the study. LC reports editorial fees from Taylor and Francis; and grants from the UK Research and Innovation Global Challenges Research Fund, Nuffield Foundation, UK AID, Janssen Pharmaceutica NV and Janssen Pharmaceutica (PTY) LTS South Africa, International AIDS Society, UNICEF Eastern and Southern Africa, John Fell Fund, European Research Council, Philip Leverhulme Trust, and the UK Economic and Social Research Council. ET reports funding from UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement, and by the Department of Health Social Care through its National Institutes of Health Research [MR/R022372/1]; the European Research Council under the European Union's Horizon 2020 research and innovation programme (grant agreement number 771468); and the International AIDS Society through the CIPHER grant [2018/625-TOS]. The paper arises from the Global Challenges Research Fund Hub on accelerating achievements for Africa's adolescents (principal investigator LC, co-directors LS and CD). All other authors sit on the hub strategic advisory committee. The views expressed in written materials or publications do not necessarily reflect the official policies of the International AIDS society. Research reported in this publication was supported by the Fogarty International Center, National Institute on Mental Health, and National Institutes of Health under award number K43TW011434. The content is solely the responsibility of the authors and does not represent the official views of the US National Institutes of Health.