Global Health Sector Strategy on Sexually Transmitted Infections

Draft for Consultation
Global Health Sector Strategy on Sexually
Transmitted Infections 2016–2021
Introduction and context
This draft global health sector strategy on STIs for 2016–2021 has been developed for discussion
during a series of multi-stakeholder consultations from March to December 2015. The strategy
builds on the Global strategy for the prevention and control of sexually transmitted infections 2006–
2015, and will be closely aligned with the post-2015 health and development agenda and targets,
and the drive towards universal health coverage. The updated strategy also builds on the evaluation
of the 2006–2015 global strategy, which recommended:

Strengthening financing mechanisms for STI services and strengthening human resource
capacity;

Scaling up STI interventions, in particular for vulnerable and key populations;

Increasing access to services by integrating the prevention and management of STIs into the
broader agendas of HIV, reproductive health and other key platforms;

Strengthening surveillance and improving knowledge of prevalence, etiology and antimicrobial
resistance;

Accelerating access to innovations through the development of point-of-care diagnostic tests
and new preventive interventions such as vaccines, microbicides and health promotion
methods.
The strategy outlines a vision, goals and actions for the global health sector. It defines the essential
quality-assured STI services to meet people’s needs, and proposes actions to address the underlying
determinants of STI epidemics, including the inequities that put people at greater risk for infection
and block access to effective prevention and treatment services. It describes how to ensure
equitable coverage of services and maximum impact with a particular focus on key populations,
recommends strategies to minimize the risk of financial hardship for those requiring the services,
and embraces innovation to drive rapid progress. Many of the priority actions highlighted draw on
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the strong body of evidence generated by the implementation of the 2006–2015 STI strategy and
responses around the world.
The strategy also sets targets for expanding, enhancing and accelerating the STI response. These are
aligned with related global health strategies and plans, including those for sexual and reproductive
health, maternal and newborn health, adolescent health, HIV, noncommunicable diseases, viral
hepatitis, blood safety, and tuberculosis.
A shortened version of this draft strategy has been made available in various language versions to
support the online consultation. This document does not represent a comprehensive or near-final
version of the strategic approach required to drive an effective health sector response to STIs
through 2016–2021. It provides a basis for discussion.
Why a stronger STI response should be a global priority
Infections with sexually transmitted pathogens impose an enormous burden of morbidity and
mortality worldwide (see box) by compromising the quality of life, sexual and reproductive and child
health, and indirectly by facilitating the sexual transmission of HIV and causing cellular changes that
precede some types of cancers. STIs rank among the top five disease categories for which adults
seek health care in middle- and low-income countries and are a substantial strain on the budgets of
both national health systems and households.
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The hidden toll of STIs
It is estimated that almost 400 million people aged 15-49 years acquire one of four STIs each year: Chlamydia
trachomatis (146 million), Neisseria gonorrhoeae (51 million), syphilis (5 million), or Trichomonas vaginalis (239
million).* The prevalence of some viral STIs is similarly high, with an estimated 417 million people infected with
herpes simplex type 2, and approximately 291 million women harbouring the human papillomavirus (HPV). The
prevalence of these STIs varies by region and gender. These epidemics have a profound impact on the health and
lives of children and adults worldwide:

fetal and neonatal deaths — syphilis in pregnancy leads to over 300 000 fetal and neonatal deaths each year,
and places an additional 215 000 infants at increased risk of early death;

cervical cancer — the human papillomavirus (HPV) infection is responsible for an estimated 530 000 cases of
cervical cancer and 275 000 cervical cancer deaths each year;

infertility — STIs such as gonorrhoea and chlamydia are important causes of infertility, especially in subSaharan Africa;

HIV risk — the presence of an STI, such as syphilis or herpes simplex virus infection, greatly increases the risk
of acquiring or transmitting HIV infection (by up to 50% in some populations);

the physical, psychological and social consequences of STIs severely compromise people’s quality of life.
Adequate control and/or elimination of STIs will contribute to reducing disease and human suffering.
* Most recent estimates are for 2012.
Complications due to STIs have a profound impact on sexual and reproductive health and
disproportionately affect women, especially in resource-poor settings. In addition to causing acute
infection, some STIs greatly increase the risk of HIV acquisition. Syphilis infection during pregnancy
results in hundreds of thousands of fetal and neonatal deaths each year, as well as multi-organ
malformations in affected newborns (congenital syphilis syndrome). Gonorrhoea and chlamydia
infections are major causes of pelvic inflammatory disease, adverse pregnancy outcomes and female
infertility, as well as stillbirths, neonatal deaths and congenital malformations. Other sexually
transmitted pathogens such as the human papillomavirus (HPV) and the hepatitis B virus are
responsible for large numbers of cervical and other genital cancers, and hepatic cancers,
respectively.
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Figure 1:
:
Figure 2:
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There are great opportunities for progress
Since the Global strategy for the prevention and control of sexually transmitted infections 2006–
2015 was endorsed at the 2006 World Health Assembly, the vast majority of countries have updated
their STI policies and guidelines. A large proportion of countries have adopted the recommended
syndromic approach for STI management. All regions have endorsed and adopted the 2007 WHO
Strategy on the global elimination of congenital syphilis, which increasingly is being implemented
alongside programmes to eliminate mother-to-child transmission of HIV.
There has been an appreciable decline in the incidence of Haemophilus ducreyi (chancroid), in
syphilis and gonococcal rates, and in their sequelae such as neonatal conjunctivitis, an increase in
pregnant women screened for syphilis and increased access to HPV vaccination (the latter mainly in
high-income countries, however). An escalated response would sustain and build on these
achievements.
However, there is a risk that weak political will and widespread stigma associated with sexual health
issues is leading to increased neglect of STI services in some countries. Sufficient allocations of
funding and human resources have been slow to materialize. And many of the social and
institutional determinants of STI vulnerability and risk are not being addressed adequately. Those
determinants include gender inequalities, the criminalization of certain behaviours and activities,
including sex work, gender-based violence and violence related to sexual orientation, and stigma and
discrimination, including in health care settings.
Huge opportunities exist to strengthen and expand services for the prevention and control of STIs,
and to create enabling environments that facilitate a greater impact for STI responses. New methods
and tools are available for strengthening and refining STI strategic information systems. Effective,
proven and affordable technologies and interventions are at hand for preventing, diagnosing and
managing STIs. Access to services can be expanded and made more equitable by integrating the
prevention and management of STIs into existing primary health care, reproductive health and HIV
services. Countries can seize the potential of new technologies and approaches by using them more
extensively and strategically. And they can boost those advances by pursuing further innovations,
such as new vaccines, microbicides and point-of-care diagnostic tests, with greater resolve.
A strategy fit for the era of Sustainable Development Goals
Most of the tools for reaching the 2030 targets are in-hand, and potentially vital innovations are on
the horizon. Using them to full effect, however, will require quickly increasing investments in the STI
response, focusing resources on the most effective programmes and on the populations and
geographical locations where need is greatest, and linking STI interventions to mutual benefit with
other health services.
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With limited resources available, countries need to plan carefully and develop compelling
investment cases to justify the allocation of additional domestic and external resources for reaching
the targets. Investment cases need to define and cost the package of interventions and services
required based on the country context, decide on the most strategic use of resources, argue for the
most cost-effective interventions, outline the most appropriate allocation of resources across the
different levels of the health system, and identify potential and reliable sources of funding.
Required over the next six years are refocused strategies, innovations that can boost impact, and a
renewed commitment to under-write these efforts with adequate investments.
The WHO global health sector strategy on STIs 2016–2021 strategy builds a case for such
investments, identifies four strategic directions to focus country programmes and WHO’s actions,
and outlines the range of priority interventions and strategies that can achieve the greatest impact
— in and beyond the public health realm. Crucially, the strategy is designed to contribute to
attaining universal health coverage and to the achievement of key Sustainable Development Goals.
A response that succeeds in ending the STIs epidemic would make very significant contributions to
improving maternal, newborn health, women’s and men’s sexual and overall health, HIV outcomes
and, by extension, the achievement of key Sustainable Developmental Goals. Ensuring financial
security and health equity are key concerns in the Sustainable Development Goals, and universal
health coverage provides a framework for addressing them.
This STI strategy defines the essential services and interventions that people should receive, and
identifies ways to assure and improve the quality of services and programmes. It recommends
priority actions to expand coverage of services and to ensure equity and maximum impact, and
proposes strategies to achieve financial sustainability and minimize the risk of financial hardship for
people requiring the services. The strategy makes a strong case for expanding the provision of good
quality STI care more widely into primary health care, sexual and reproductive health and HIV
services. It emphasizes opportunities to increase coverage by working collaboratively with other
government sectors, and with community-based organizations and private providers.
In sum, the strategy promotes a long-term, sustainable response that will be bolstered by
strengthened health and community systems, by tackling the social determinants of health that
drive the epidemic and hinder responses, and by protecting and promoting human rights and gender
equity as guiding principles and essential elements of the health sector response. The potential
benefits transcend the specific disease challenge and extend across and beyond the health sector.
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The strategy’s structure
The 2016–2021 global health sector strategy on STIs builds on the achievements and lessons of past
efforts, including the Global strategy for prevention and control of sexually transmitted infections
2006–2015 and the Reproductive health strategy to accelerate progress towards the attainment of
international development goals and targets. It is aligned with other global and regional health
strategies and plans, including those for HIV, sexual and reproductive health, maternal and child
health and noncommunicable diseases.
The strategy describes the priority actions that countries need to take and the support that WHO will
provide in order to scale up a global response that capitalizes on the enormous opportunities for
ending the STI epidemics as major public health concerns. The four strategic directions are:
SD1. Essential, quality services and interventions
SD2. Achieving equity and impact: Populations and locations
SD3. Innovation for acceleration
SD4. Financing for sustainability
A crosscutting section focuses on the creation of enabling environment for delivery and impact, and
discusses strategic information for advocacy and investment, and the strengthening of systems,
partnerships and linkages. Strategy implementation is addressed in the final section.
The vision, goal, targets and guiding principles
The strategy outlines a vision, goals and actions for the global health sector, including: defining
essential STI services to meet people’s needs; describing how to ensure effective and equitable
coverage of services and maximum impact with a particular focus on key populations; proposing
strategies to minimize the risk of financial hardship for those requiring the services; and embracing
innovation to drive rapid progress. These efforts should benefit everyone at risk for STIs: children,
adolescents and adults; rich and poor; women and men; and all key populations.
The vision
Zero new STI infections, zero STI-related deaths and zero discrimination in a world where people
living with STIs are able to live long and healthy lives.
The goal
End the STI epidemics as major public health concerns, and ensure healthy lives and promote
wellbeing for all people at all ages.
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The global targets for 2030
A concerted effort to rapidly scale up effective interventions and services can achieve the goal of
ending the STI epidemics by reaching this ambitious set of targets:

90% reduction of T. pallidum incidence (2015 baseline).

90% reduction in N. gonorrhoea incidence (2015 baseline).

≤50 cases of congenital syphilis per 100 000 live births in 100% of countries.

80% (?) human papillomavirus (HPV) vaccine coverage.
Milestones for 2020
In order to spur and measure progress towards the 2030 targets, the following milestones for 2020
are proposed:

80% of countries with 95% of pregnant women screened for syphilis and 90% screened for HIV
with free, prior and informed consent, and 95% of pregnant, infected women receiving
effective treatment.

85% of key populations have access to a full range of STI & HIV services, including condoms.

100% of countries provide STI services or referrals to such services in all primary, HIV,
reproductive health, family planning and ante- and post-natal care services.

80% of countries deliver HPV vaccines as part of the NIP.

80% of countries report on antimicrobial resistance in N. gonorrhoea.
The broader impact
By saving millions of lives directly and indirectly, and by improving the health and wellbeing of even
greater numbers of people, an expanded and more effective STI response will contribute
significantly to reaching universal health coverage, achieving several Sustainable Development Goals
and targets, and realizing people’s overall right to health. The impact will be bigger if those
improvements are underpinned by strong health and community systems, are accompanied by
strengthened responses in other health areas, and address the social and regulatory factors that
increase STI risk and impede access to STI services.
By ending or reversing the STI epidemics, the strategy will contribute to the achievement of other
health-related targets by 2030, including:

reducing the global maternal mortality ratio to less than 70 per 100,000 live births;

ending preventable deaths of newborns and children under 5 years of age;

eliminating hepatitis B;
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
reducing by one third premature mortality from noncommunicable diseases through
prevention and treatment, and promote mental health and wellbeing;

ensuring universal access to services for sexual and reproductive health care, family planning,
information and education, and the integration of reproductive health into national strategies
and programmes; and

achieving universal health coverage, including financial risk protection, access to quality
essential health-care services and access to safe, effective, quality and affordable essential
medicines and vaccines for all.
The guiding principles
The following principles guide the strategy:
1. Universal health coverage.
2. Government stewardship and accountability.
3. Evidence-based interventions, services and policies.
4. Protection and promotion of human rights, gender equality and health equity.
5. Partnership, integration and linkage with relevant sectors, programmes and strategies.
6. Meaningful involvement of people living with STIs, key populations and affected communities.
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STRATEGIC DIRECTION 1: Essential, quality
services and interventions
Define a set of core interventions
Each country needs to define a set of essential STI interventions and services that should be made
available to those in need. Priority should be given to identifying and selecting high-impact
interventions that cover the full continuum of prevention, diagnosis, treatment and care. As
resources and capacity increase the scope of interventions and services can be expanded
progressively, with the aim of further improving STI and broader health outcomes.
Countries need to make choices on which interventions to prioritize, how best they can be
combined, and the sequence in which they might be introduced or scaled up. The evidence shows
clearly that combination packages achieve greater impact than discrete, individual interventions.
Although the core set of interventions and services will vary by country, based on epidemic dynamics
and country context, each of the following intervention areas should be covered:
o
reduction of STI vulnerability and risk;
o
reduction of STI transmission;
o
STI diagnosis;
o
management of STIs and related sequelae;
o
monitoring of microbial resistance strains; and
o
monitoring and evaluating interventions.
The core package needs to be regularly reviewed to ensure that, as new evidence emerges and new
technologies and approaches are developed, innovations are rapidly integrated and opportunities
are seized.
Reduce vulnerability and risk, especially among key populations
Reaching the STI targets by 2030 will require major reductions in risk behaviour, new approaches for
delivering more effective and combined prevention, testing and treatment interventions to those
who need them. Much of that progress hinges on reducing people’s vulnerability and risk for STIs,
especially for women and the key populations that are most at risk for infection. A successful STI
response has to deal with the underlying determinants of STI epidemics, including the inequities that
put people at greater risk for infection and undermine the potential impact of prevention and
treatment services. Those determinants include gender inequality and gender-based violence, rights
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violations (including the criminalization of certain behaviours), and stigma and discrimination
(including in health care settings).
Effective interventions for reducing STI vulnerability and risk hinge on awareness building and
targeted risk reduction communication, and on increased access to and use of sexual and
reproductive health services. Progress in those respects requires effective actions to reduce stigma
and discrimination in health care settings and the community; initiatives to prevent and manage
gender-based violence and violence related to sexual orientation or identity; and interventions that
empower women and stigmatized populations.
Priority actions for countries

Tailor and focus risk reduction interventions to the needs of populations that are most affected.

Address the key factors that place people at greater risk for STI infections and that impede access to
effective STI services.

Increase awareness and coverage of prevention services among adolescents and link those activities
with services for prevention of unintended pregnancy and of HIV infection.
Priority actions for WHO

Update guidance for key populations on STI vulnerability and risk reduction interventions.

Produce updated guidance on prevention and management of gender-based and sexual violence,
with a focus on adolescents, young women and children.

Provide guidance for increasing the involvement of boys and men in reducing STI vulnerability and
risk.

Work with partners to promote new initiatives on reducing risk and increasing resiliency among
adolescent girls and young women.
Prevent STI transmission and acquisition
Combination prevention is the most effective approach for prevention of STIs. It requires ensuring
access to vital information, commodities (such as condoms) and services (such as medical male
circumcision, testing, treatment and care) within a human rights framework. Alongside that,
behaviour change interventions are critically important for STI/HIV prevention and include the
promotion of consistent use of male and female condoms, reduction in the number of sexual
partners, increased uptake of HIV/STI testing, delayed sexual debut, as well as the promotion of
sexual wellbeing. Many of these interventions have the dual advantage of also preventing
unintended pregnancies. Focusing the interventions appropriately for key populations, adolescents
and pregnant women is a priority. In addition, when community knowledge about STIs is
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strengthened and stigma and discrimination are reduced, use of services related to STI tends to
improve.
Priority actions for countries

Prioritize implementation of high impact prevention interventions most relevant to the country’s
epidemics, particularly where implementation and/or uptake are lagging .

Promote the use of condoms for dual protection against STIs and unintended pregnancy, including
for adolescents.

Utilize maternal and child health and family planning clinics as additional outlets for provision of
care and distribution of condoms to women who could be at risk of STIs.

Make greater use of social marketing programmes to increase demand and supply of qualityassured, affordable STI services and condoms in traditional and non-traditional outlets.

Supplement condom distribution with community-based distribution and outreach services for
most-at-risk populations.
Priority actions for WHO

Update STI prevention guidance, including rapidly integrating new evidence-based health sector
interventions into STI prevention packages for different epidemic contexts, giving particular
attention to key populations, adolescents, and women.

Promote effective male and female condom programmes, including setting global standards and
facilitating procurement.

Advocate for increased commitment, resources and actions to eliminate STI infections in newborns.
Achieve early diagnosis of STIs and linkage to treatment
Early diagnosis of STIs, including those without symptoms, is the best opportunity for effective
medical treatment and support, and for preventing further transmission. Screening for STIs,
however, remains rare in resource-constrained settings.
Each country will need to select the most appropriate combination of diagnostic approaches based
on the nature and dynamics of its STI epidemics, the affected populations and its health system.
Special efforts are required for the detection and management of asymptomatic infections in key
populations, adolescents and young adults, and pregnant women, such as case finding or screening,
with enhanced interventions for reaching sexual partners. Specific attention must go towards
ensuring the quality of diagnostic tools and services to minimize the risk of misdiagnosis. New pointof-care diagnostic technologies and new diagnostic approaches would offer major opportunities for
rapidly expanding STI diagnosis and linking people to treatment and care.
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Throughout, patient confidentiality must be respected and counselling must be available, along with
effective commodities and medicines for managing STIs. The potential impact is far-reaching.
Prompt diagnosis and effective management of STIs breaks the chain of transmission and prevents
the development of complications and long-term sequelae of STIs.
Priority actions for countries

Procure, introduce and expand use of WHO prequalified diagnostics.

Implement quality assurance and quality improvement measures to lower the risk of misdiagnosis,
and reduce delays between collecting specimens, laboratory testing, sharing the results, and access
to treatment.

Implement strategies for detecting and managing asymptomatic infections in key populations,
pregnant women and adolescents, such as case finding or screening, with enhanced interventions
for reaching sexual partners.
Priority actions for WHO

Regularly update consolidated guidance on STIs and HIV testing approaches, strategies and
diagnostics, incorporating the latest innovations, with particular focus on early diagnosis.

Strengthen the WHO prequalification programme to ensure rapid access to quality STI diagnostics.

Support operational research to identify effective, efficient, safe and acceptable STI diagnostic
approaches.
Manage symptomatic patients
Each primary point-of-care for persons with STIs should follow an up-to-date management protocol
for people with symptomatic STIs and for their sexual partners, based on global guidelines. Primary
point-of-care outlets are varied and include primary health care clinics, sexual and reproductive
health services, and services that provide care and management of persons living with HIV. Coverage
of treatment services can be increased by working collaboratively with other health programmes,
government sectors (education, occupational health, migration, etc), as well as with communitybased organizations and private health care providers.
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Priority actions for countries

Update implementation plans for guiding effective and sustainable scale up of STI management,
based on latest evidence.

Adapt national STI management guidelines to address major co-infections and comorbidities,
notably HIV.

Ensure that effective STI management commodities and medicines are available when people seek
care for STIs.

Ensure procurement of quality-assured drugs.
Priority actions for WHO

Regularly update consolidated STI management guidelines that include clinical, operational and
programmatic guidance that will guide rapid and sustainable treatment scale up.
Reach sex partners and offer them treatment
Partner notification is integral to effective STI prevention and care. Approaches for informing sex
partners and offering them counselling and treatment vary according to circumstances and include
patient referral (whereby patients are encouraged to contact their sex partners themselves),
provider referral (the health care provider notifies the partner and arranges treatment), contractual
patient-provider referral (a two-step approach that links patient and provider referral methods), and
expedited partner therapy (the diagnosed patient takes the prescriptions or medication to his/her
partner without prior examination of the partner). The selected strategy has to be rights-based and
sensitive to gender inequalities, while ensuring and expediting partners’ access to treatment.
Reducing waiting times and waiving user fees are additional methods for encouraging sex partners
(especially when asymptomatic) to proceed with treatment. In general, partners should be treated
with the same medicines as the index patient unless they are pregnant, lactating or allergic to
specific medicines.
Priority actions for countries

Safeguard patient confidentiality; ensure linkage to counselling and treatment.
Priority actions for WHO

Provide and update evidence-based guidelines for partner notification, diagnosis and treatment.
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Package interventions for maximum impact
The overall public health impact of these core interventions can be boosted by combining them with
other initiatives, specifically: the global campaign to eliminate mother-to-child transmission of HIV
and syphilis; wider introduction of the vaccine against the human papillomavirus; and strategies to
confront the emergence of gonococcal antimicrobial resistance.
Eliminate mother-to-child transmission of syphilis and HIV
A number of countries have committed to eliminate mother-to-child transmission of syphilis
(‘congenital syphilis’). Pilot projects and country experiences confirm that the elimination of
‘congenital syphilis’ is feasible with concerted, timely efforts that achieve serological diagnosis of
syphilis and effective single- or multi-dose treatment of all seropositive pregnant women. In many
countries the elimination of mother-to-child transmission of syphilis is linked to a dual elimination
campaign (elimination of mother-to-child transmission of HIV and syphilis) and a few countries have
begun implementing a triple elimination campaign (elimination of mother-to-child transmission of
HIV, syphilis and hepatitis B).
Priority actions for countries

Screen all pregnant women for syphilis, and ensure that those who are seropositive receive either
single- or multi-dose treatment, as appropriate.

Link this intervention strategically to the drive to eliminate the mother-to-child transmission of HIV.

Strengthen monitoring of these interventiosn to validate elimination.
Priority actions for WHO

Provide guidance on monitoring and evaluation for validating elimination of mother-to-child
transmission.

Update guidance on the use of rapid tests for syphilis or dual tests for syphilis and HIV.
Utilize the human papillomavirus and hepatitis B vaccines
A vaccination programme using new vaccines against the HPV could dramatically reduce cervical
cancers caused by that virus, while the hepatitis B vaccine has been proven to be safe and effective
in preventing hepatitis B infection (see the Global health sector strategy on viral hepatitis, 2016–
2021). Countries should urgently consider introducing or expanding such vaccination programmes.
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HPV vaccines targeting the adolescent population present a great opportunity for strengthening
adolescent health programmes.
Priority actions for countries

Urgently consider introducing a vaccination programme against HPV as part of a comprehensive
approach to cervical cancer prevention.

Countries that have not yet introduced hepatitis B vaccination into their national infant
immunization programmes should do so urgently, and ensure timely delivery of the birth dose of
hepatitis B vaccine to prevent perinatal transmission of hepatitis B infection.
Priority actions for WHO

Assess schedules and dosages for immunization policies, and advise on the most effective methods
for protecting high-risk groups, as well as boys.

Support operational research in countries for the introduction of HPV vaccine and for linking it to
adolescent health programmes.
Control the spread and impact of gonococcal antimicrobial resistance
Gonorrhoea is one of the most common STIs worldwide and it has a significant effect on morbidity
and mortality. Over the past decades, N. gonorrhoeae has developed resistance to almost all
medicines used to treat the infection. The emergence of similar resistance to the current thirdgeneration cephalosporins is highly likely, which raises the prospect of untreatable gonococcal
infections. WHO has strengthened the Gonococcal Antimicrobial Surveillance Programme (GASP) by
establishing a network of laboratories to coordinate gonococcal antimicrobial resistance monitoring
and provide data to inform treatment guidelines. WHO has also developed an action plan to control
the spread and mitigate the impact of antimicrobial resistance on N. gonorrhoeae. Other STI
pathogens with potential antimicrobial resistance include Treponema pallidum, herpes simplex virus
and Haemophilus ducreyi. These are linked to the overall global antimicrobial resistance action plan.
Priority actions for countries

Implement strategies and interventions to monitor antimicrobial resistance trends, including
strengthening national laboratory network capacities.

Adapt national treatment guidelines to resistance patterns and implement interventions to limit the
spread of antimicrobial resistance.
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Priority actions for WHO

Increase support for the Antimicrobial Surveillance Programme and other efforts to monitor
antimicrobial resistance and contain the spread of untreatable gonorrhoea.

Support efforts to update treatment guidelines for gonorrhoea.

Monitor possible emergence of antimicrobial resistance to treatments for Treponema pallidum,
herpes simplex virus and Haemophilus ducreyi.
Ensuring quality of interventions and services
The quality of interventions and health services should be ensured, so that investments achieve
greatest impact and significant risks are averted. Achieving this is closely related to the broader
objective of health systems strengthening (discussed in the enabling environment section) and to
patients’ experiences of STI services. At an individual level, the quality of care can be assessed based
on the ability of the healthcare delivery system to provide safe, effective and patient-centred care in
an efficient, timely and equitable manner. Rapid expansion of programmes to improve coverage
should neither compromise the quality of services, nor contribute to inequities in access to services
and health outcomes.
Strengthen the continuum of prevention, diagnosis, treatment and care
STI strategies are most effective when people are able to access and benefit from a full continuum of
quality-assured services, especially people who are at high risk for infection yet hard to reach with
interventions (see Figure 3). Countries should monitor the integrity of their prevention, diagnosis
and care cascade to determine where barriers exist, outcomes are suboptimal and people are lost to
follow-up, so that remedial actions can be implemented. Services should be organized to minimize
‘leakages’, to maximize retention along the cascade and adherence to prevention and care
interventions.
Major challenges include: acceptability and uptake of effective prevention interventions, targeting
diagnosis to maximum effect and minimizing incorrect diagnoses, linking people to appropriate
prevention and treatment services as early as possible, and ensuring treatment adherence. There is
a need also to reduce the prescription of antimicrobials by laypersons or by people themselves, a
practice that conceals symptoms without halting the infection, delays timely access to health
services, and causes microbial resistance to antibiotics.
The most effective services are those delivered in ways that are patient-friendly, that respect
people’s rights and that address their varying needs without judgment or prejudice. The involvement
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of community groups and networks has also been shown to be effective, especially for reaching and
serving key populations. Strengthened laboratory capacity also helps to ensure accurate diagnoses
and supports enhanced surveillance of STIs and monitoring of microbial resistance. A strong
continuum of services also requires a supportive institutional and social environment, as well as
coordination between different sectors (including the private sector and community-based
providers) and across various levels of health service delivery.
Figure 3.
Priority actions for countries

Integrate key indicators for the various steps of prevention and control into national STI monitoring
and evaluation systems.

Analyse the prevention and control cascade to determine the quality of services, identify major
weaknesses and decide on remedial actions.
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Priority actions for WHO

Facilitate the collection of national data on the cascade and report on major findings.

Through the analysis of national data, identify common weaknesses in the cascade, review evidence
on possible interventions to address the weaknesses and integrate effective interventions and
approaches into WHO guidance, with an emphasis on strengthening operational and programmatic
guidance.

Promote the WHO cascade monitoring and evaluation framework as a key component of national
STI monitoring and evaluation systems.
Link and integrate services and programmes
Greater integration and linking of STI services and programmes with those for other relevant health
areas (including for HIV, family planning, maternal and neonatal care, sexual health, immunization,
and noncommunicable diseases, and other sectors such as school health education programmes
targeting adolescents and occupational health) have the potential to reduce costs, improve
efficiency and lead to better outcomes. Appropriate models of integration and linkage will depend
on the country context and health system, and should be informed by operational research. These
may include working with pharmacies to rationalize the advised use and selling of over-the-counter
antibiotics to treat STIs.
Priority actions for countries

Identify opportunities and appropriate models for integration and linkage between STI and related
health areas, based on country context and operational research.

Expand the integration of STI services into existing primary health care, reproductive health and HIV
care programmes.

Strengthen links and collaboration between prevention and control measures for STIs with those for
other mother-to-child transmitted diseases, and for cancer and noncommunicable disease
programmes.
Priority actions for WHO

Provide operational and programmatic guidance on possible models of linkage and integration and
propose indicators and methods for measuring effective linkage.
19
Implement quality assurance and improvement programmes
Quality of care can be enhanced by ensuring that quality-assurked commodities are procured, and
that services adhere to national and international norms and standards, are continuously monitored
and improved, and are made more accessible and acceptable to patients’ needs and preferences.
Indicators and mechanisms for monitoring the quality of commodities and for the organization and
delivery of services should address such issues as waiting lists, facility waiting times, frequency of
visits, and competencies and supervision of health care workers.
Priority actions for countries

Establish and implement national norms and standards, based on international guidelines and other
standards, monitor their implementation and apply quality improvement measures where
deficiencies are identified.

Ensure the procurement of quality-assured medicines, vaccines, diagnostics and condoms, including
through the use of the WHO prequalification systems.

Establish mechanisms to continuously monitor service utilization and acceptability and the
preferences and needs of patients, communities and health care workers.
Priority actions for WHO

Emphasize quality assurance and quality improvement principles, approaches and indicators in
WHO guidance.

Support capacity building of national regulatory authorities, quality control laboratories, and
manufacturers or other private companies, to ensure the quality of medicines including generics.

Strengthen the WHO prequalification programme to encourage manufacturers to apply for
prequalification of medicines, diagnostics and devices, and to facilitate the rapid assessment of new
applications.

Regularly report on quality improvement along the STI prevention, care and treatment cascade.
20
STRATEGIC DIRECTION 2: Achieving equity and
impact: Populations and locations
Access to effective STI services should be equitable and free of discrimination or neglect. Yet this can
be challenging. As with HIV, large proportions of people at high risk for STIs do not use prevention
methods and services effectively, remain undiagnosed, or do not use or adhere to treatment
therapies. This is partly because STIs occur with high frequency among marginalized populations
(such as sex workers, men who have sex with men and prison inmates) and among adolescents, all
of who commonly experience difficulties in accessing or remaining linked to health services and to
STI services in particular.
Reaching the STI targets will only be possible by focusing suitable, high-impact interventions and
services for populations who are most at risk for STIs and in places where most STI transmission is
occurring. Recent innovations in technology and delivery methods make it easier for countries to
identify key populations and service gaps, and to achieve equitable provision of high-impact services
and interventions. It also requires addressing the underlying factors — such as discrimination and
criminalization, poverty, drug dependence and poor mental health — that help generate such health
inequities. This is best achieved by involving people most affected by STIs actively in developing
strategies and programmes. The respect of human rights is a critical aspect of all these approaches
and methods.
This section focuses on understanding countries’ epidemics, identifying priority populations, and
designing and targeting services accordingly
Focus on geographic locations with highest disease burden and
transmission
Countries need to focus their efforts on locations with the highest disease burden and transmission.
Achieving the milestones and targets for STI services requires that countries “know their epidemics”
– by achieving reliable estimates of the sizes and distribution of populations most at risk for
infection, understanding where they are, their behavioural patterns and other factors that put them
at risk, and reaching them with quality-assured prevention and control services. Geographical
mapping can help countries design and implement the most efficient and effective responses.
Strategic information systems should provide sub-national and disaggregated data to monitor
epidemic trends and to map the locations and core groups among which most transmission of STIs is
occurring. This will enable resources and services to be allocated accordingly where the greatest
impact can be achieved.
21
Priority actions for countries

Use innovative survey methods, modelling and mapping tools, involving local communities and key
populations, to develop accurate estimates of key population sizes and detailed understandings of
sub-national epidemics.

Use those data to improve the focus and impact of STI programmes and interventions.

Ensure that data collection methods yield high-quality information, meet ethical standards and do
not pose risks for communities and health care workers involved.
Priority actions for WHO

Provide guidance on methods for estimating the sizes of key populations and on setting programme
targets for services for key populations.

Support countries to develop their strategic information systems and map their STI epidemics and
responses.
Reach key populations with appropriate services
Reaching key populations with the most appropriate interventions will be critical for ending STI
epidemics in countries. Actions are needed to overcome or remove barriers that prevent key
populations from accessing the STI and broader health services they need, such as age of consent
laws, criminalization of behaviours such as sex work and sex between men, and institutionalized
stigma and discrimination. The STI response also needs to reflect the fact that different populations
may require different sets of interventions and different types of services. WHO and partners have
developed guidelines and implementation tools that define essential packages of interventions and
service delivery models for different key populations, including sex workers, people who inject
drugs, men who have sex with men, transgender people and prisoners.
22
Priority actions for countries

Identify key populations, vulnerable to and most affected by STIs, and prioritize implementation of
tailored service packages to meet their needs, including links to a broader package of appropriate
health services.

Monitor access to, and uptake and quality of HIV and STI health services for key populations.

Include multisectoral actions to reduce stigmatization and discrimination in national STI strategies,
policies and programmes.

Involve community-based organizations and peer networks in the planning and delivery of services
to improve the reach, quality and effectiveness of STI services.

Integrate evidence-based gender-equality interventions into national STI action plans or strategies.

Provide services that are appropriate for adolescents and review laws and policies on consent to
improve access.

Include comprehensive sexual health education in school curricula for adolescents.
Priority actions for WHO

Build on existing guidance to better define essential packages and service delivery models for
specific populations and specific settings, including for adolescents and key populations

Update guidance on the implementation of programmes to address gender-based violence,
violence against women and the management of adult, adolescent and child survivors of rape.

Collaborate with UNESCO, UNICEF and UNFPA to design a package for preventing and managing
STIs that meets the needs and realities of young people.
Target special settings
There are specific settings where vulnerability and risk are high and where access to basic STI
services might be severely compromised, such as in prisons and detention centres, refugee camps
and settings of humanitarian concern. Countries should ensure that services provided to individuals
in these settings are equivalent to those available to the broader community.
Priority actions for countries

Implement the comprehensive package of STI interventions for prisoners and prison settings as
developed by the United Nations Office on Drugs and Crime and WHO.

Incorporate contingency plans for essential STI services into national STI plans to ensure continuity of
STI services in settings of humanitarian concern.
23
Priority actions for WHO

Work with UNHCR to ensure that guidance on the delivery of STI services in settings of humanitarian
concern is regularly updated to be consistent with global guidelines.

Work with the United Nations Office on Drugs and Crime to regularly update guidance on STI services
for prisoners and prison settings.
24
STRATEGIC DIRECTION 3: Innovation for
acceleration
Achieving the strategy’s targets will require going beyond existing technologies and service delivery
approaches. The current package of STI interventions and services needs to be augmented steadily
with new, evidence-based technologies and approaches for prevention, diagnosis, treatment and
service delivery. However, the existence of effective technologies and interventions does not
automatically lead to their widespread use. Along with affordability factors, misgivings and
incomplete understandings may discourage wide adoption. Such hurdles can be overcome with
robust operational research, by communicating the evidence base, and by providing technical and
other support for rapid implementation, and monitoring and evaluating performance and use.
Optimize STI prevention
The main technologies for preventing STIs have changed little in recent times. Although male and
female condoms have been proven to be effective against unintended pregnancies and STIs, low
acceptance and incorrect or inconsistent use mean that their potential benefits are not being
realized. Innovations that could boost the STI response include:

Male and female condoms that employ new designs and materials to increase acceptability
and reduce costs (particularly of female condoms), and new marketing methods to boost their
demand and use.

Multipurpose technologies for preventing STIs and unintended pregnancies – especially
female-controlled technologies – and that are more effective and less user-dependent, that
do not interfere with sexual pleasure, and that provide additional health benefits.

Effective messaging for adolescents, in particular adolescents boys, on dual protection
(prevention of pregnancy and of STIs and/or HIV).

A bigger range of STI vaccines should be developed and available for preventing the
acquisition of STIs, especially herpes simplex virus infection, Chlamydia trachomatis and N.
gonorrhoeae.

A major scale-up of human papillomavirus and hepatitis B vaccination programmes.

Strengthened operational research for the introduction of vaccines.
25
Optimize STI diagnostics
New and improved diagnostics technologies, strategies and approaches would lead to earlier and
more accurate diagnosis, and strengthened patient monitoring. A major barrier to advancing STI
control and prevention is the lack of reliable, low-cost, point-of-care tests. Opportunities for
innovation include:

Point-of-care diagnostic tests and/or self-testing technologies that are more rapid, reliable
and simpler to use will enable more extensive early diagnosis of infections, including the
detection of asymptomatic infections, and allow patients to receive diagnosis and treatment
in a single visit.

Development of a multidiagnostic platform, which would enable simultaneous diagnosis of
several STIs at the same time, in particular C. trachomatis, N. gonorrhoeae, syphilis, HIV and
antimicrobial resistance

Diagnosis for pelvic inflammatory disease.

Operational research to guide the most effective methods for introducing rapid tests in
countries, and to identify major challenges and opportunities related to them.
Optimize medicines and treatment regimens
Despite major advances in the safety, potency and acceptability of medicines and regimens, there
remain areas where improvements are required and possible.

More robust regimens to reduce the risk of drug resistance.

New, more effective drugs for treating syphilis, N. gonorrhoeae and herpes simplex virus.

Reducing the number of treatment doses to reduce toxicities and costs.

Research on communication and use of new technologies, and systematic community-based
support to improve treatment adherence.

Support operational research to identify effective, efficient, safe and acceptable STI
diagnostic and treatment approaches.
Optimize service delivery
Overall impact is boosted when service delivery approaches fit the realities and needs of potential
beneficiaries (especially hard-to-reach priority populations), minimize inefficiencies, use simplified
and standard protocols, and fully engage communities. There are opportunities for further
innovation in all those respects, including through:
26

Periodic presumptive treatment, a short-term strategy that focused on controlling certain
STIs in specific key populations.

Decentralization and task-shifting, including for earlier, accurate diagnosis and effective
linkage to treatment and care.

Community-based service delivery, including effective and more acceptable models for
reaching key populations, with comprehensive services.

Research for strengthening understandings of health-seeking behaviour.

User-friendly services for adolescents that are better-suited and more acceptable to
adolescents.

Service linkages and integration, including clearly identifying which services would draw
mutual benefit from strategic linking or integration, and innovative mechanisms and
procedures for linkage or integration.
27
STRATEGIC DIRECTION 4: Financing for
sustainability
Countries face the challenge of investing in an expanded programme to achieve the targets for 2030
and beyond while ensuring long-term sustainability of funding — all in a context where development
priorities are shifting and external financial support might decline. The trend of increasing domestic
funding of STI programmes needs to continue even though some low-income countries, especially
those with a heavy burden, will need substantial external support to ensure rapid scale-up.
Financing for a sustainable STI response requires action in three areas: raising sufficient funds to pay
for STI programmes, including through public and private domestic funding and external sources;
establishing equitable mechanisms to pool funds for financial risk protection; and optimizing the use
of resources by reducing costs and improving efficiencies. Health system financing has a major
impact on programme coverage, equity and health outcomes.
Develop innovative financing and funding approaches
Existing international and domestic funding commitments are not enough to achieve the 2030
targets outlined in this strategy. Additional sources of funding will be required to fund sustainable
scale-up of programmes and fill funding gaps resulting from shifting donor priorities. Countries will
need to develop and implement financial transition plans as they move from externally to
domestically funded programmes.
Priority actions for countries

Develop financial transition plans with special focus on the transition needs of programmes and
services most reliant on external funding (for example programmes for key populations), and
negotiate bridging arrangements with donors if necessary.

Develop new funding channels, such as a health promotion fund, with a negotiated portion of the
revenue earmarked for STI programmes and related services.

Advocate for (greater) STI resource allocations within sector-wide funding mechanisms.
Priority actions for WHO

Advocate for a fully funded STI response that marshals both domestic and external financial
support.

Support countries to develop investment cases and funding proposals to mobilize funding, and
support the development of national health financing plans that incorporate STI programmes.

Support operational research on innovative, sustainable health-financing mechanisms.
28
Provide financial risk protection
Preventing and controlling STIs is, in principle, relatively easy and affordable in most settings. Many
STI services are provided free of charge, and countries increasingly also use supportive
arrangements (such as decentralizing services) to minimize the indirect costs for people using
services. However, in many places user fees continue to be imposed. As with other out-of-pocket
expenses (formal and informal), such fees undermine service use, result in inequities in service
access, weaken linkages to treatment, and increase risks of treatment failure. Moreover, they
constitute unnecessary financial burdens on households.
Financial risk protection for people with STIs will depend on a broader robust and fair national health
financing system. WHO supports countries to review their systems based on their health needs and
country context. The WHO Health Accounts Country Platform provides countries with a harmonized,
integrated platform for annual and timely collection of health expenditure data, with the aim of
protecting the population from catastrophic health expenditure and reducing inequities in health.
Priority actions for countries

Phase out out-of-pocket payments (including ‘informal’ user charges) and reduce other financial
barriers to accessing STI and other health services.

Provide universal protection against health-related financial risk. Public compulsory health financing
systems, including general taxation and compulsory health insurance, are the most equitable and
efficient systems for reducing health-related financial risk.

Achieve greater health equity by consolidating existing pooled funds into larger pools, thereby
avoiding fragmented health insurance systems.

Ensure that people’s contributions to health insurance systems reflect their abilities to pay, with
subsidies (financed from government tax revenue) available for poor and vulnerable people.

Ensure that financial risk protection schemes are universal, covering all populations, including those
who are criminalized and marginalized.
29
Priority actions for WHO

Provide guidance and technical support to establish robust and fair health financing systems,
including the design and implementation of national compulsory health insurance.

Promote the WHO Health Accounts Country Platform and support adoption by countries.

Support operational research to identify major financial barriers to accessing and utilizing STI
services.
Reduce prices and costs and improve efficiencies
Fiscal pressures require that countries select the most effective STI interventions and approaches,
target those activities to the populations and places where they will have greatest impact, reduce
the prices of medicines and other health commodities, and increase the efficiency of services.
Priority actions for countries

Develop and pursue comprehensive strategies to reduce prices of STI vaccines, diagnostics and
treatment drugs, including by making full use of flexibilities of the Agreement on Trade-Related
Aspects of Intellectual Property Rights (TRIPS), and various WHO mechanisms.

Safeguard and expand the availability of generic products, and reduce barriers in product markets.

Increase savings through improved planning and more efficient procurement and distribution
systems.

Achieve greater efficiency and avoid waste, e.g. through integrating or linking relevant health
services to share resources and avoid duplication; procuring and using medicines and diagnostics
that meet international standards of quality, safety and efficacy; and improving management and
coordination mechanisms across all relevant stakeholders (including external donors and partners).
Priority actions for WHO

Provide strategic information on prices and manufacturers of STI medicines, diagnostics and other
commodities including through the WHO Global Price reporting Mechanism and the Regulatory
Status database.

Provide support to countries to strengthen their capacity to negotiate price reductions with
manufacturers and to use the flexibilities of the TRIPS Agreement.

Strengthen WHO’s prequalification programme to safeguard and expand availability of generic
products.
30
31
An enabling environment for delivery and impact
A comprehensive and expanded response that reaches diverse populations in many different
settings requires a set of solid building blocks: accurate data and analysis; transparent accountability
mechanisms; strong, well-supported health and community systems; the systematic promotion of
health equity, gender equality and human rights; and effective collaboration between partners.
Improve strategic information for advocacy, planning and impact
A robust strategic information system is a prerequisite for advocating, funding, strategic planning
and implementing more effective interventions, and for monitoring and improving those
interventions and providing evidence of impact. It is essential for countries to “know their
epidemics” so that the most current strategic information on the nature of the STI epidemic and the
country context guides national responses. Knowing the epidemic thus includes understanding
where, how and among whom new infections are occurring. It also requires identifying the factors
that facilitate the risk of STI transmission or limit access to and use of STI services.
Such a system needs to collect routine, disaggregated data (including for key populations), which
requires linking or integrating and then synthesizing data from different data collection systems.
Currently, most national STI surveillance systems are based mainly on universal case reporting.
There is a great need to strengthen national, regional, and global STI surveillance and monitoring
systems in order to arrive at more accurate estimates of STI burdens overall and within particular
populations, including adolescents.
Setting national targets and identifying indicators for monitoring and evaluating the national
programme will enable countries to clearly assess and regularly report on the status of the response,
and to use those assessments for further programme improvements. Regular programme reviews
help ensure that national strategies, plans and resource allocation reflect actual country needs as
they evolve.
It is vitally important to use the augmented strategic information to inform policy makers and key
opinion leaders about the burden and consequences of STIs. More effective strategies are need to
advocate for specific, evidence-based intervention options and cost-effective approaches, and to
articulate the policy and legal reforms that would enhance STI prevention and control efforts.
Assure global and country accountability
Given the range of partners and stakeholders that join forces in an effective response, and the
extent of their activities, well-functioning and transparent accountability mechanisms are vital.
Those mechanisms need to feature strong civil society participation. The accountability process
32
benefits from strong leadership and governance that features genuine engagement with relevant
stakeholders; clear national targets that reflect the Sustainable Development Goals and other
pertinent global commitments; appropriate indicators on the availability, coverage, quality and
impact of interventions to track progress; and transparent and inclusive assessment and reporting
procedures.
Strengthen health systems
The keystone of an effective STI response is a strong health system that is capable of providing
reliable, effective and equitable people-centred care in both the public and private sectors. The
hallmarks of such a system are: efficient service delivery models that meet patients’ variable needs;
a sufficient and well-trained workforce; a robust health-information system; reliable and affordable
access to essential medical products and technologies; adequate health financing; and strong
leadership and governance. Currently, very few health systems command all those features. Vital
and feasible improvements include:
o
equipping health workers with the skills and commodities to rapidly expand prevention,
testing and treatment of STIs;
o
health financing systems, financial protection schemes and other mechanisms (such as
voucher systems) that enable people to access essential, quality-assured services without
suffering financial hardship; and
o
service delivery methods and approaches (including marshalling private sector providers and
pharmacies into the STI response) that provide equitable and effective services for all,
particularly for key or neglected populations.
Support community systems
The involvement of community and other civil society structures and networks is a hallmark of
successful health responses, especially in places and populations affected by stigmatization and
discrimination. While the importance of these stakeholders is increasingly acknowledged, actual
support still lags. At a minimum, legal and regulatory frameworks should facilitate stronger
collaboration and partnerships between community groups and the public and private sectors. Other
improvements include greater support for capacity development (e.g. to strengthen participation in
programme planning, service delivery, and monitoring and evaluation) and increased investment in
community-based peer support and outreach programmes.
Promote healthy policies and laws
When properly enforced, laws and policies that protect and promote human rights can reduce
people’s vulnerability to and risk of STI infection, expand access to health services and enhance their
reach, quality and effectiveness — including for women and other populations that are at high risk
33
of infection yet encounter difficulties accessing services (such as adolescents, men who have sex
with men, transgender people, prisoners and sex workers). Laws and policies that empower and
promote equality for women and girls provide an important platform for efforts to protect them
from STIs, while legal reforms that empower key populations can also lead to more effective and
sustainable STI interventions. Yet an array of legal, institutional and other barriers continues to
prevent such key populations from accessing effective health services.
The health sector has a unique role in fostering institutional and community environments in which
all people can safely access health services. The sector can do so by helping ensure that policies,
laws and regulations across various sectors support national health responses, particularly by
countering gender inequity and protecting and promoting the human rights of key populations.
Priority actions include the removal of legal, regulatory and policy barriers that stigmatize or that
hinder equitable access to STI and supportive services – including the decriminalization of sex work –
and using public health evidence to shape pro-health laws and actions.
Engage and link partners
A broad-based approach that engages multiple partners will help strengthen policy coherence,
programme coordination and implementation, and address the various factors that affect the
outcomes of STI responses. It is also important for mobilizing resources, achieving accountability and
strengthening human rights protections that benefit all, including key populations. Opportunities for
such partnerships and collaborations exist across the health sector and other relevant government
sectors. Strong engagement with civil society, including the faith-based sector, and especially at
community level is vital for ensuring that essential services are accessible to all populations.
Strategies for linking the provision of STI services across the private and public health care sectors
could increase the availability and quality of those services.
A wide range of mutual benefits flows from closer integration and/or linking of STI services with
other relevant health interventions, especially those for other infectious diseases (including HIV),
noncommunicable diseases and mental health. Partnerships with other government services (e.g.
substance dependence, mental health, law enforcement and correctional services, etc.) would make
it easier to engage and reach priority populations. Structured linkages with private sector and civil
society service providers would also help extend coverage while improving quality assurance.
34
Strategy implementation: Accountability,
monitoring and evaluation
Effective implementation of the strategy depends on concerted action from all stakeholders in the
health sector response to STIs, including strong partnerships to ensure policy and programme
coherence. Linkages across various disease-specific programmes need to be established and
strengthened, and monitoring and evaluation efforts should reflect those linkages and partnerships.
Collaboration with other partners
WHO has an important convening role in bringing together different constituencies, sectors and
organizations in support of a coordinated and coherent health sector response to STIs. In addition to
its Member States, the WHO Secretariat works closely with other key partners, including bilateral
donor and development agencies and initiatives, funds and foundations, civil society, technical
institutions and networks, the commercial private sector and partnership networks.
Monitoring, evaluating and reporting
Implementation of the strategy will be monitored at three levels, using existing mechanisms:



Monitoring and evaluating of progress towards global goals and targets;
Monitoring and evaluating the response at country level; and
WHO’s framework for results-based management.
Monitoring and reporting of progress towards global goals and targets
At the global level, regular reviews are planned to assess progress on the various commitments and
targets. These reviews will build on the data that countries report through various monitoring and
evaluation mechanisms.
Progress at global and regional levels towards the targets set out in this strategy will be regularly
assessed. Benchmarking — or comparisons between and within countries — will also be used to
assess performance in reaching targets. The strategy is designed to be sufficiently flexible to
incorporate additional priorities or fill newly identified gaps in the health sector response to STI. To
that end, WHO will continue to work with its partners to provide support to countries for the
harmonized and standardized collection of core indicators, and in the preparation of global and
regional reports. Regular reporting of the data is proposed.
WHO will develop a suitable monitoring and accountability framework for the strategy in
consultation with key stakeholders. It will also monitor and share data on the uptake of its STI
35
guidelines, as well as on progress in implementation of the strategy, in order to highlight barriers
and promote best practices.
Monitoring and evaluating the response at country level
Progress in implementing the health-sector response to STIs is to be assessed with indicators on
availability, coverage outcome and impact, while taking into consideration other relevant
recommendations for monitoring implementation. Progress towards the health-related Sustainable
Development Goals will be tracked and reported.
Indicators for monitoring the strengthening of health systems derive from a common platform for
monitoring and evaluating national health strategies, known as the Country Health Systems
Surveillance platform, coordinated by WHO. Instruments are also available for measuring progress in
implementing policy, legal and structural measures for enhancing the HIV and STI responses.
WHO’s framework for results-based management
Workplan implementation is monitored through a mid-term review at the end of the first year of
each biennium. Progress towards the achievement of the organization-wide expected results is
reported at the end of each biennium.
36