A health gap and a wealth gap

A decade ago, the UN came up with eight development goals, but progress has been slow.

In September 2000, close to 150 world leaders convened by the United Nations committed their governments to achieving eight development targets by 2015, the Millennium Development Goals (MDGs). Of these, three deal directly with health: to reduce child mortality, to improve maternal health, and to combat HIV/AIDS, malaria and other diseases. Two-thirds through the 2000-15 period, progress has been uneven. 

The UN’s most recent report on the MDGs points out that there has been tangible progress in two areas: an increase in interventions targeted specifically at individuals in poor countries, and the expansion of programmes that deliver services directly to those who need them most.

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By contrast, there has been far less progress towards targets that require structural changes and sustained, predictable funding – that is, political will.

The report found “poor performance” in most countries on reducing maternal mortality, for example, while there has been a dramatic reduction in deaths from measles and malaria.

“A decrease in maternal mortality would be a wonderful indicator that you have a health service that is working,” says Mohga M. Kamal-Yanni, a health expert with Oxfam International. But for that to happen, donors need to provide support for the budgets of poorer countries’ health sectors, she says – something that many donors feel wary of because of the fear that funds, once they are part of another country’s budget, will be harder to track and more likely to disappear.

“It is a big mental shift away from thinking ‘this is our money and our project’ to ‘this is your project’,” Kamal-Yanni says.

She also stresses the importance of donors consulting finance ministries to ensure that budget support for the health sector will not result in cuts in health funding from other budget sources – in other words, to make sure that the support is additional to what is already there.

Despite these concerns about accountability and additionality, the European Commission has recognised the importance of budget support and is leading the world’s other top donors – the United States and Japan – in providing support.

Fact File

THE HEALTH MDGs

Goal: Reduce child mortality
Target: Reduce by two-thirds the mortality rate among children under five (with 1990 as the reference year).
Goal: Improve maternal health
Targets: Reduce by three-quarters the maternal mortality ratio (with 1990 as the reference year); achieve universal access to reproductive health.
Goal: Combat HIV/AIDS, malaria and other diseases
Targets: Halt and begin to reverse the spread of HIV/AIDS; achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it; halt and begin to reverse the incidence of malaria and other major diseases.
Other aims
Three other MDGs also include individual targets related to health: to halve the proportion of people who suffer from hunger; to halve the proportion of people without sustainable access to safe drinking water and sanitation; and to provide access to affordable, essential drugs in developing countries.
Next September, at the beginning of its annual session, the United Nations General Assembly will hold a plenary meeting to review progress on the eight MDGs. In the coming weeks, UN member states are to decide on a format for the summit proposed by Ban Ki-moon, the UN’s secretary-general.
The UN is encouraging its member states to send their leaders to the conference as a political signal that they remain committed to the MDGs. Ban is concerned that progress toward meeting the goals has been too slow.
The MDGs are expected to be high on the agenda of the next EU-US summit in May 2010. In February, EU development ministers are likely to hold an informal debate about the topic.
The MDGs, and Europe’s leadership role in achieving them, are to be discussed by member foreign ministers in May and by EU leaders at their summit in June.

Child mortality

Between 1990 and 2007, the mortality rate for children under five years dropped from 93 to 67 per 1,000 live births. But that still means that around nine million children died last year from causes that were largely preventable or treatable. Progress has also been uneven, with little headway made in sub-Saharan Africa.

The UN is, however, hopeful that targeted interventions will reduce child mortality significantly in coming years. Such interventions include immunisation, the provision of vitamin A, the use of insecticide-treated bed nets and encouraging mothers to breast-feed exclusively.

The provision of anti-retroviral treatment for pregnant women is also helping to prevent transmission of HIV to their babies.

Maternal health

Of the eight MDGs, least progress has been made in reducing maternal mortality. Overall progress has been slow and close to non-existent in sub-Saharan Africa, where half of all such deaths occur.

The UN estimates that well over half a million women and girls – 99% of them in developing countries – die every year during pregnancy, childbirth or in the six weeks after giving birth.

The differences between rich and poor, both within and between countries, are enormous. Developed regions register nine such deaths for every 100,000 live births; 14 countries register at least 1,000 maternal deaths per 100,000 live births.