Holistic solutions needed to achieve the health MDGs

A. Bermejo and E. Ireland

With just five years to go before the deadline for meeting the Millennium Development Goals (MDGs) that were set in 2000, this year is critical for world leaders to reassert their commitment to improve the health of people in developing countries. Although the goals are already perilously off-track, the imminent United Nations’ MDG Review Summit in New York is an opportunity to make a difference.

The key health-related MDGs set the target date of 2015 for reducing the number of children that die before their fifth birthday, for increasing the number of women who survive childbirth, and for halting the spread of HIV/AIDS, malaria and tuberculosis (TB).

Unless more is done, people like Meena are unlikely to hear about, let alone see, any improvements in healthcare. An 18-yearold woman from Tamil Nadu in India, Meena knows nothing of the promises made to her and millions of others like her because she is busy trying to make ends meet and bring up her two boys alone. Widowed after her husband died of AIDS, she is living with HIV and is expecting another child. For Meena, just getting by and keeping herself and her family healthy is a daily struggle.

It’s easy to be cynical that these global commitments can’t or won’t be achieved but if they are it could mean the difference between life and death for Meena. She would be able to access HIV treatment for herself and ensure her baby is born HIV-free. She could get chemically-treated bednets from her local health centre to protect against malaria. Her children could be immunised and prevented from dying of childhood diseases.

The world’s leaders, from developed and developing countries alike, need to hold to their promises and agree to an ambitious action plan with clear, concrete and time-bound commitments to put the health-related MDGs back on track, seeing to it that these goals can truly be met by 2015. This requires them to ensure that the voices of women like Meena are heard whenever policies and decisions about the health-related MDGs are made. They also need to invest in building up strong health and community systems that can deliver good quality health care to all who need it and to allocate more and better aid for health to ensure the resources are made available.

Progress can be made and lives can be changed if the commitment is there. Key interventions for malaria, HIV control and measles immunisation have already cut child deaths from 12.5 million in 1990 to 8.8 million in 2008. In the same year an estimated 4 million people living with HIV had access to life-saving antiretroviral treatment (a tenfold increase since 2003) and 2.3 million people were cured of TB. These may be promising signs of progress but the major international agencies all confirm how far off-track the health-related MDGs still remain.

According to UNICEF’s 2008 report tracking progress in maternal, newborn and child survival, at the current rate it will be 2045 before we sufficiently reduce infant mortality. And there has been very limited change in the high levels of maternal mortality in Sub-Saharan Africa in the past two decades. As for reducing the incidence of HIV/AIDS, UNAIDS states that for every two people placed on treatment for HIV a further five become infected with the virus. Moreover, half a million people with HIV died of TB in 2008. Many of these lives could have been saved had they been tested for this secondary infection and received access to treatment.

The latest MDG report produced by the UN says that Sub-Saharan Africa is the region faring the worst for every one of the health-related goals, while under-five mortality remains high in South Asia. These two regions have made the least progress towards meeting the maternal health targets. And HIV prevalence continues to rise in Eastern Europe and Central Asia, with Sub- Saharan Africa still being the most heavily affected region.

As the UN’s findings illustrate, progress towards the MDGs has been inadequate and deeply uneven. World leaders have already failed to meet their commitment to provide universal access to treatment for people living with HIV by 2010, but they still have a unique opportunity to come together and make a concerted push to achieve the MDGs by 2015. They can do this if they recognise the critical need to address the issues in a comprehensive and holistic way that builds on the synergies and links apparent in all the health-related MDGs. For too long, the health goals have been treated as individual aspirations, but the reality is the targets are inseparable.

Meena, who is living with HIV and needs access to antenatal care services and wants to get healthcare for her children, doesn’t make distinctions. She deserves a comprehensive package of services that can address all of her and her family’s healthcare requirements. As an HIV-positive pregnant woman she must have access to good quality antenatal care and safe delivery services that will prevent her from transmitting HIV to her unborn child. She will need antiretroviral drugs to keep her healthy, and she will not only require postnatal care but she will also need access to treatments that can keep her child healthy throughout the early years of its life, including immunizations and medication for common childhood infections.

The UN MDG Review Summit presents the world’s leaders with a moment to recognise an individual’s right to health and an opportunity to put this at the heart of their efforts to meet the health-related MDGs. The Summit needs to shake up the debate and agree to actions that will lead to a comprehensive response to the health MDGs. To do this, there are three key actions they should agree to take. First, ensure that the most affected communities are meaningfully involved in policy and decision-making processes that affect their access to healthcare. Second, invest in building up strong health and community systems that can deliver good quality health care to all who need it. And third, allocate more and better aid for health.

In the absence of functioning, reliable and accessible health services in the countries which are most off-track with the health MDGs, local communities have stepped into the breach. World leaders must recognise and respond to this by developing clear guidelines and an ambitious action plan to ensure the meaningful engagement of civil society in the development of national health policies, plans and strategies on an ongoing basis. They should also provide political and financial support to enable civil society to hold governments accountable for delivering the services that are needed for the health-related MDGs to be achieved.

It is obviously not possible to provide healthcare without doctors, nurses and midwives, yet this is exactly what is being attempted in most of the developing world. In these situations, the role of communities in supporting the delivery of health care services becomes critical. We hope world leaders will respond by: (i) providing technical and other support to make high-quality, fully- costed and funded health workforce plans a reality; (ii) committing to support the global target for training, and retaining at least 3.5 million new health workers in countries with an acute shortage; and (iii) recognising the critical role of community systems in increasing access to healthcare and providing sufficient investment and political commitment to bring health and community systems more closely together.

Perhaps the starkest challenge facing world leaders aiming to achieve the health-related MDGs by 2015 is the critical resource gap between what is currently available and that which is truly needed if the health-related MDGs are to be met.

Recent research conducted by Action for Global Health, a network of European NGOs working on the health-related MDGs, revealed that up to $456 billion is needed to deliver a comprehensive response to the health MDGs. To fill this gap, it is vital that when world leaders come together for the UN MDG Review Summit we see:

■ Donor governments follow Belgium and the UK’s lead in keeping legally-binding their long-standing commitment to allocate 0.7 percent of GNI as official development assistance (ODA);

■ African governments reaffirming their commitment to spend at least 15 percent of their national budgets on health;

■ Donor agencies allocating their ‘fair share’ to meet the $20 billion needed for the Global Fund to Fight AIDS, TB and Malaria to scale up access to HIV prevention, treatment, care and support;

■ All development partners, whether donor agencies or recipient governments, taking concrete actions that demonstrate their commitment to delivering ODA for health as effectively as possible, in line with the principles of aid effectiveness and the commitments set down within the International Health Partnership and Related Initiatives.

Even if all of these commitments are made and upheld we will still fail to meet the funding gap for better global health. We also suggest that the MDG Review Summit make a universal commitment to support the establishment of an international financial transaction tax as one of the mechanisms that will generate the necessary scale of resources needed to meet the health-related MDGs by 2015. It is anticipated, for example, that the introduction of a globally agreed ‘Robin Hood Tax’, which is a tiny tax on banks of approximately 0.05 percent, could generate anything up to $400 billion per year – more than enough to fill the shortfall of funding needed to meet the health-related MDGs.

The UN MDG Review Summit needs a new commitment to delivering a comprehensive approach to put the health MDGs back on track. We look forward to their seizing this opportunity and agreeing a set of clear, concrete and ambitious actions to ensure that every person who needs access to healthcare, no matter who they are or what they need, is able to see this basic right realized by 2015.

About the author:

Alvaro Bermejo is Executive Director of the International HIV/AIDS Alliance. Elaine Ireland is Global Health Advocacy Officer for the International HIV/AIDS Alliance and Action for Global Health


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