NCDs and MNCH overlap in a number of areas. Conditions in the womb can expose foetuses to a range of health challenges and puts them at increased odds of developing hypertension, diabetes, chronic renal impairment, and heart disease, along with mental health conditions, due both to predisposition and intergenerational transmission [10, 11]. Births of premature children, not fully grown, and to a mother that is overweight or has diabetes represent over 50% of all births globally [10]. The interventions to address both conditions remain largely at the primary health care level, which can act as the point for education, awareness, screening and treatment and has been identified as central to achieving UHC. The framing of NCDs as conditions that can be acquired has enabled dialogue and support through social protection measures, including interventions for key populations such as women and children. Social protection measures are often mandated in national constitutions [12] and provide a more holistic and coordinated approach to addressing social, economic, and environmental factors that facilitate poor NCD and MNCH outcomes. The ‘life course approach’ is a helpful unifying framework for joint action on MNCH and NCDs. It stresses the overlapping stages, transitions, and settings where large improvements can be made to promote health, recognising that all stages of life are intertwined [13].

The UNGA high-level meetings established that there are similar underlying challenges plaguing each health sector area and that mechanisms to monitor and report back are critical to ensuring national prioritization. It has also shown that investment in human capital, resilience building and one-health approaches need to underpin disease-specific plans. The launch of the Global Action Plan for Healthy Lives and Well-being for All signalled this shift with 13 agencies coming together to align ways of working and provide a more streamlined approach to health and development frameworks and programme implementation. Where do the NCD and MNCH agendas sit in the health and development architecture and how can a new more coordinated health ecosystem support accountability on investment and policy implementation?

Integration, linkages and synergies among different health programmes, whether HIV/AIDS, TB, MNCH, sexual and reproductive health, UHC, or NCDs, have long been advocated for [14, 15]. As a more recent health focus area with less developed health systems infrastructure in place and diverse interventions, NCDs have been identified as an area that can balance horizontal and vertical planning, budgeting and health service implementation to achieve synergistic benefits [14].

With positive progress on women's and children’s health closely linked to gender equality and humanitarian recovery, the ‘Every Woman Every Child’ movement launched by the UN Secretary-General himself, and the UN MNCH Global Strategies emphasise various levels of accountability; contexts, settings, risks and crises; and the need for conceptual policy and programme opportunities that bring actors from all sectors [16]. It galvanized political leadership with 776 commitments recorded, totalling over US$186 billion, and saw domestic spending on MNCH increase, with a quarter of financial commitment makers coming from low-income countries, the private sector and non-governmental organizations [17,18,19]. The building blocks for this achievement have been strong monitoring and tracking, along with accountability components founded in a human rights approach [20]. The 60 indicators, all commitments—financial, policy, as well as the service and delivery—are aligned, tracked, and reported on, leading to concrete policies, plans and strategies with budgets [21]. Tracking existing country commitments to health and human rights, along with opportunities for existing or enabling legislation, have also been monitored to ensure the continuity of commitment. This approach has also been seen as necessary to empower and promote well-being [22, 23].

Accelerating health commitments, specifically those set out in SDG 3 will be supported through the implementation of the Global Action Plan on Health and Well-being for All. This identifies seven areas of focus: primary health care, sustainable finance, fragile settings, determinants of health, community and civic engagement, gender equality, research and development, and data and digital—which has translated into implementation in 37 countries [24]. Focusing on selected areas of action, provides an opportunity for synergy, ensuring primary health care essential services include MNCH and NCD interventions, strengthening country data that can capture needed areas for the policy or programmatic implementation, and scaling up innovations [25].

Yet, there has also been a call by the Independent Accountability Panel of the Every Woman Every Child movement for the institutionalization of an Independent Review Mechanism that reports on health across the SDGs. As the mandate of the Independent Accountability Panel ended in 2020 after 5 years of annual reporting on progress and monitoring commitments to hold stakeholders accountable, the need to reframe health as a central feature of achieving the SDGs and linking it to a framework of rights was called for. The independent review mechanism would report and input into the high-level political forum (HLPF) on sustainable development. The HLPF meets annually at the UN headquarters in New York, with member states, representatives from civil society, the private sector, and other stakeholders coming together to review progress on the SDGs. The forum takes place over 8 days, three of which are ministerial level. Once every 4 years the HLPF is held in the plenary of the UN General Assembly at the level of the Head of State and government.

The HLPF encourages country reporting through voluntary national reviews. An accountability mechanism—as laid out by the Independent Accountability Panel—can support accountability in several ways: It can look at legal foundations; it can support the design and structures of pathways that are critical for operationalizing accountability (by enabling political, economic and sociocultural adjustments); it can promote organizational processes that better serve citizens such as health assemblies [26], health facility charters [27], and channels that citizens can participate in such as community scorecards; as well as social audits and budgeting [28].

There are an increasing number of countries that provide information on their progress towards the SDGs within the High-Level Political Forum, with 126 countries or territories reporting since 2016 [29]. For countries, the reporting process is often linked to the UN Sustainable Development Framework, which is the central framework for joint monitoring, review, reporting and evaluation of the UN development system’s impact on a country towards achieving the 2030 Agenda [30]. Of the 134 UN Country Team offices, 53 of them have cross-agency frameworks according to the website, with more in development [31, 32]. Of the 53 with frameworks, 51 provided voluntary reports during an annual HLPF. As such, these reporting mechanisms will continue to strengthen, with the opportunity to align to WHO country cooperation strategies and the Global Action Plan for Health and Wellbeing—all of which will set overarching priorities for countries—and feed into strategies and budgeting for long-term national development and sustainability, such as Sri Lanka’s experience (Box 1).