SIMASHE country action knowledge-sharing hub 

Country Pathfinders

Under the WHO Special Initiative for Multi-country Action on the Social Determinants of Health Equity (SIMASHE), a group of countries from the Americas, Eastern Mediterranean and Western Pacific regions paved the way for undertaking WHO-supported action to advance health equity. The commitment to implement actions at national, regional and local levels started with agreements between WHO Regional and Country Offices and ministerial counterparts. Countries engaged with their own history of action for health equity, drawing on the evidence for action from the WHO Commission on Social Determinants of Health, the five action areas of the Rio Political Declaration, the impact of the COVID-19 pandemic and rising inequalities, the work of their regional Commissions on Social Determinants of Health, and analyses of health equity and the social determinants. These Country Pathfinders started multi-level work in 2021 and 2022, most often beginning work in small-area jurisdictions to pilot system changes through “pioneer local areas”. Their work evolved synergistically, with experts, evidence and experiences from the countries informing the 2025 “World Report on the Social Determinants of Health Equity”.

Alignment of the knowledge-hub to the world report

After approximately three years in the field, this group has organized and formalized its actions along six interlinked strategic entry points (see the SIMASHE knowledge-sharing diagram below), for sharing with each other and with other countries. These entry points relate to the recommendations of the “World Report on the Social Determinants of Health Equity, Action Area 4: Bringing About Change Through New Governance Approaches”, and provide a solid starting point for implementing the recommendations. Governance is important for supporting comprehensive, whole-system change through the other three action areas in the report:

• Action Area 1: Address economic inequality and invest in universal public services
• Action Area 2: Tackle structural discrimination and the determinants and impacts of conflict, emergencies and migration
• Action Area 3: Steer mega-trends towards health equity: climate change and digitalization.

Interlinked strategic entry points for SIMASHE action and knowledge sharing

Purpose and structure

The SIMASHE Knowledge-Sharing Hub serves as a platform to disseminate information on actions taken to address the social determinants of health equity, drawing primarily from the experiences of Country Pathfinders. It comprises six subsections, each consisting of different areas of processes that have emerged as important to Country Pathfinders. The information and examples provided aim to present potential entry points for showcasing effective approaches and inspiring action. The knowledge presented is also informed by the scoping work of WHO and its partners.

Each subsection provides two types of example: those from Pathfinder countries (“Examples from SIMASHE”) and those from other WHO or core partner-related initiatives and projects (“Examples from related work and initiatives”). These examples illustrate the specific steps actors in the field take at various levels, and offer a broader perspective on options to inspire action for health equity. As many of the Country Pathfinders started work at the local level, many examples refer to the experiences of these pilot actions.

Bringing About Change Through New Governance Approaches

It is important to approach each strategic entry point as part of a comprehensive set of actions. No single action can effectively promote and sustain health equity on its own. A thorough transformation requires a holistic approach that considers all processes influenced by the various strategic entry points. However, identifying key processes within each entry point can be helpful when trying to initiate change, as plans can be informed and based on the available resources, capacities and stages of transformation within different contexts.

As part of Phase 2 of the initiative, actions are still being developed and documented by the Country Pathfinders. Additionally, there may be actions not addressed within these countries, and potential actions could be pursued beyond this framework. Action areas 1–3 from the world report provide alternative entry points for action on the social determinants of health equity. As SIMASHE advances, new strategic entry points and dimensions are also expected to emerge.

The SIMASHE knowledge-sharing hub aims to create a dynamic experience where various stakeholders can contribute by sharing insights to advance health equity at all levels. If you would like to enhance the platform with your contributions, please reach out to us at: valentinen@who.int