Health Development Strategies: the MDGs and introduction to post 2015 agenda

Joyce L. Browne, MD MSc

PhD fellowJulius Global Health, Julius Center for Health Sciences and Primary Care, UMC Utrecht, The Netherlandswww.globalhealth.eu J.L.Browne@umcutrecht.nl

Learning objectives

• To assess the status of the Millennium Development Goals (MDGs) in 2013.

• To illustrate lessons learned from the MDGs that can be applied in post-2015 strategies.

• To provide an overview of post-2015 strategies and the discussion on the Sustainable Development Goals (SDGs)

Millennium Development Goals

The UN Millennium Declaration

2000: UN Development Summit adopted UN Millennium Declaration [A/Res/55/2]• 6 values

• Freedom, equality, solidarity, tolerance, respect for nature, shared responsibility.

• 7 key objectives• Peace, security and disarmament, development and poverty

eradication, protection of the environment, human rights, democracy, good governance, protection of vulnerable people, special needs Africa, strengthening UN.

• 11 development targets -> MDGs (2001)

2001: The Millennium Development Goals (MDGs)

8 goals

18 targets

48 indicators

MDG 1: Eradicate extreme hunger and poverty

Target 1A: • Halve the proportion of people living on less than $1 a dayTarget 1B: • Achieve decent employment for Women, Men, and Young

People.Target 1C: • Halve the proportion of people who suffer from hunger.

Target 2A:• By 2015, all children can complete a full course of primary

schooling, girls and boys.

MDG 2: Achieve universal primary education

Target 3A: • Eliminate gender disparity in primary and secondary education

preferably by 2005, and at all levels by 2015

MDG 3: Promote gender equality and empower women

Target 4A: • Reduce by two-thirds, between 1990 and 2015, the under-five

mortality rate

MDG 4: Reduce child mortality rates

Target 5A: • Reduce by three quarters, between 1990 and 2015, the

maternal mortality ratioTarget 5B: • Achieve, by 2015, universal access to reproductive health

MDG 5: Improve maternal health

Target 6A: • Have halted by 2015 and begun to reverse the spread of HIV/AIDS.Target 6B: • Achieve, by 2010, universal access to treatment for HIV/AIDS for all those

who need it.Target 6C: • Have halted by 2015 and begun to reverse the incidence of malaria and

other major diseases.

MDG 6: Combat HIV/AIDS, malaria, and other disease.

Target 7A: • Integrate the principles of sustainable development into country policies and programs;

reverse loss of environmental resources.Target 7B: • Reduce biodiversity loss, achieving, by 2010, a significant reduction in the rate of loss.Target 7C: • Halve, by 2015, the proportion of the population without sustainable access to safe

drinking water and basic sanitation (for more information see the entry on water supply).Target 7D: • By 2020, to have achieved a significant improvement in the lives of at least 100 million

slum-dwellers.

MDG 7: Ensure environmental sustainability

Target 8A-F includes: • Open trading and financial system; • Debt problems of developing countries; • (in co-operation with pharmaceutical companies) provide access to affordable

essential drugs in developing countries;• (in co-operation with the private sector) make available the benefits of new

technologies, especially information and communications

MDG 8: Develop a global partnership

The health-related MDGs

MDG 4 Child mortality

MDG 5 Maternal mortality

MDG 6 HIV/AIDS, malaria and other diseases

1. Global mobilization on a set of priorities• Countries, civil society, private sector

involvement• Increases in international aid spending,

especially for health and education

Impact of the MDGs

• OECD (Organization for Economic Co-operation and Development)’s Development Assistance Committee (DAC) is a forum for 29 members to discuss issues related to aid, development and poverty reduction in developing countries.

• Since introduction of MDGs: massive increase in DAC countries pooled aid to health (red line) and international organization’s aid to health (pink line) .

Health funds 1971-2009

OECD, http://www.oecd.org/dataoecd/26/39/49907438.pdf

1. Global mobilization on a set of priorities• Countries, civil society, private sector• Increases in health and education aid

2. Establish measurable, monitored and time-bound objectives

Impact of the MDGs

Health-MDGs performance

MDG 4: child mortality

• Globally: mortality rate <5 years dropped 41% (87 -> 57/1,000 live births)

• Target for 2/3 reduction will likely not be reached

• Major causes of child mortality: pneumonia, diarrhea, malaria and malnutrition. Majority of <5 mortality is in the first year of life.

• Questions: which regions are on track? Which regions are not? What could be explanations for this?

MDG 5: maternal mortality

• Globally: maternal mortality has been one of the worst performing indicators, and only in the past few years received increased attention.

• Yet, MDG5 lags the most behind, and will likely not be reached.

• Major causes of maternal mortality: sepsis (infection), hemorrhage (severe bleeding) hypertensive disorders in pregnancy and unsafe abortion. e.

• Questions: which regions are on track? Which regions are not? What could be explanations for this?

MDG 6: HIV/AIDS, Malaria, Tb

• Globally number of newly infected HIV patients continues to fall (21% decrease between 2001-2011)

• 1.8 infections were prevented in sub-Saharan Africa. The sharpest decline was reached in the Caribbean (43%). Because of successful mother-to-child transmission prevention programs, child infection has reduced significantly.

• The majority (60%) of people between 15-24 in low- and middle income countries infected, are women. Young girls seem more vulnerable because of factors as gender inequality and physiological factors.

• Questions: which regions are on track? Which regions are not? What could be explanations for this? What could be gender en physiological factors that increase the vulnerability of women?

MDG 6: HIV/AIDS, Malaria, Tb

1. Global mobilization on a set of priorities• Countries, civil society, private sector• Increases in health and education aid

2. Establish measurable, monitored and time-bound objectives• Overall progress: substantial, but variable

across goals, targets, regions, countries, and within countries.

• Lessons from the MDGs can be learned for post-2015 Development Agenda

Impact of the MDGs

However.. There are shortcomings to the MDGs

• Conceptualization and execution• Ownership• Equity

Lancet and LIDC (2010): The MDGs: a cross-sectoral analysis and principles for goal setting after 2015

Shortcoming 1: conceptualization and execution

1. Important themes are missing:• Of the original Millennium Declaration: Peace, security

and disarmament, human rights• New emerging themes: Climate change, economic

development

2. Goals, targets and indicators are narrowly defined, without identification and exploitation of cross-links• E.g. only primary education, agriculture, nutrition• Measurability of (some) indicators

3. Do not promote efficient horizontal and multi-sectorial approach embedded in health systems.

Shortcoming 1: conceptualization and execution

1. Important themes are missing:• Of the MDs: Peace, security and disarmament, human

rights• Climate change, economic development

2. Goals, targets and indicators are narrowly defined, without identification and exploitation of cross-links• E.g. only primary education (where is secondary

education?), agriculture (availability of healthy food, agriculture as an important pillar for economic development), nutrition (nutrition links to many themes, like health, economic development through a healthy workforce, and peace and security in the absence of scarcity.

• Measurability of (some) indicators

3. Do not promote efficient horizontal and multi-sectorial approach embedded in health systems.

Shortcoming 1: conceptualization and execution

1. Important themes are missing:• Of the MDs: Peace, security and disarmament, human

rights• Climate change, economic development

2. Goals, targets and indicators are narrowly defined, without identification and exploitation of cross-links• E.g. only primary education, agriculture, nutrition• Measurability of (some) indicators

3. Do not promote efficient horizontal and multi-sectorial approach embedded in health systems.• “Silo-approach”, striking example: shiny well-funded

HIV-clinic next a worn-down public hospital.

Shortcoming 2: ownership

1. Meaningful national ownership developing countries?• Drafting process: donor and/or expert

driven?

• Underrepresentation of developing countries

• Underrepresentation of civil society

2. Leadership on specific MDGs• Especially MDG5 (maternal health)• Process of setting national targets (≠

global targets)

“Equity is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically.

Health inequities therefore involve more than inequality with respect to health determinants, access to the resources needed to improve and maintain health or health outcomes. They also entail a failure to avoid or overcome inequalities that infringe on fairness and human rights norms.” - WHO

Shortcoming 3: equity

Shortcoming 3: equity

1. Aggregation of data vs. disaggregation• Disaggregation means: assessing the

data and progress separately for important subgroups. For example: socio-economic status, gender.

2. MDGs promote an approach to focus on easiest-to-reach populations?

MDGs conclusion

• Important global mobilizer to focus efforts; obtain and measure results; and to improve lives and wellbeing.

• Reflecting on MDGs strengths and weaknesses, informs the post-2015 Agenda.

• Post-2015: Sustainable Development Goals (SDGs).

Post-2015 and the SDGs

Rio+20

June 2012: Meeting of world leaders, governments, private sector, NGOs and other groups• Sustainable development

through:• Economic development• Environmental

sustainability • Social inclusion (fairness)

High-level Panel

Process

• Inclusive consultation• Meetings with key stakeholders

(governments, civil society, business, academia, youth, etc)

• Involvement of the public

• Global conversation on the post-2015 SDGs(http://bcove.me/9mxyo5w6)

Transformative principles of the universal post-2015 agenda

• Leave no one behind.• Put sustainable development at the core.• Transform economies for jobs and inclusive

growth. • Build peace and effective, open and

accountable institutions for all.• Forge a new global partnership.

Sustainable Development Goals

Sustainable Development Goals

SDG 4: Ensuring Healthy Lives

Road ahead

• 2013-2014: Open Working Group: recommendations road aheadExpert Working Group on Financing of the SGDs

• 2015:Summit meeting for member states to agree on new goals and mobilize global action

• 2016:Implementation of new agenda

Recorded lecture: Mr. Anne Poorta, policy officer Ministry of Foreign Affairs, The Netherlands

PROPOSED GOALS AND TARGETS ON SUSTAINABLE DEVELOPMENT FOR THE POST2015 DEVELOPMENT AGENDA

Zero Draft, 3 June 2014

1. End poverty everywhere 2. End hunger, improve nutrition and promote sustainable agriculture 3. Attain healthy lives for all 4. Provide quality education and life-long learning opportunities for all 5. Attain gender equality, empower women and girls everywhere 6. Ensure availability and sustainable use of water and sanitation for all 7. Ensure sustainable energy for all 8. Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all 9. Promote sustainable infrastructure and industrialization and foster innovation 10. Reduce inequality within and between countries

Proposed Sustainable Development Goals to be attained by 2030

11. Make cities and human settlements inclusive, safe and sustainable 12. Promote sustainable consumption and production patterns 13. Tackle climate change and its impacts 14. Conserve and promote sustainable use of oceans, seas and marine resources15. Protect and promote sustainable use of terrestrial ecosystems, halt desertification, land degradation and biodiversity loss 16. Achieve peaceful and inclusive societies, access to justice for all, and effective and capable institutions 17. Strengthen the means of implementation and the global partnership for sustainable development

Proposed Sustainable Development Goals to be attained by 2030

Zero Draft: Proposed goal 3. Attain healthy lives for all (1)

• 3.1 by 2030 reduce the global maternal mortality ratio to less than 70 per 100,000 live births

• 3.2 by 2030 end preventable newborn, infant and under-five deaths

• 3.3 by 2030 end the epidemics of HIV/AIDS, tuberculosis, malaria, and neglected tropical diseases

• 3.4 by 2030 reduce substantially morbidity and mortality from non-communicable diseases (NCDs) through prevention and treatment, promote mental health and wellbeing, and strengthen prevention and treatment of narcotic drug, alcohol, and substance abuse

• 3.5 by 2030 halve deaths from road traffic accidents

• 3.6 achieve universal health coverage (UHC), including financial risk protection, access to essential health care services, and access to safe, effective and affordable essential medicines and vaccines for all

• 3.7 by 2030 substantially reduce the number of deaths and illnesses from air (indoor and outdoor), water and soil pollution

• 3.a strengthen implementation of the Framework Convention on Tobacco Control in all countries who have ratified the Convention and urge countries that have not ratified it to ratify and implement it

• 3.b support research and development of vaccines and medicines for the communicable diseases that primarily affect developing countries, provide access to affordable essential medicines, and support developing countries’ use of TRIPS flexibilities

• 3.c increase substantially the recruitment, development and training and retention of the health workforce in developing countries, especially in LDCs

Zero Draft: Proposed goal 3. Attain healthy lives for all (2)