Leading aid models focus on economic growth and poverty reduction, but the well-being approach aims for more comprehensive change, said a new group studying the problem. Well-being requires us to go beyond the macro statistics on growth, poverty and inequality and get a more fine-grained understanding of the distributions of resources and relationships that constitute the barriers to successful development in particular contexts. This is what development policy must engage in. The work of the group brought together four major bodies of thinking about development, each of which has been adopted with some success by developing countries and development agencies: theories of human need, Nobel laureate Amartya Sen’s ‘development as freedom’, the ‘participation’ and ‘livelihoods’ frameworks, and the work of social psychology on subjective well-being.
Equity in Health
Health security must be addressed with great urgency, and health-system strengthening is one of the surest routes to health security. We are not secure when the difference in life expectancy between the poorest and the richest countries exceeds 40 years, or when annual governmental expenditure on health ranges from US$20 per person to well over $6000. We are not secure when more than 40% of the population in sub-Saharan Africa is living on less than a dollar a day. Medicine has never before possessed such sophisticated treatments and procedures for curing disease and prolonging life. Yet, each year, nearly 10 million young children and pregnant women have their lives cut short, largely by preventable causes. Economic development will not automatically protect people who are poor or guarantee universal access to health care. Health systems will not automatically gravitate toward greater fairness and efficiency. International trade and economic agreements will not automatically consider effects on health. Deliberate policy decisions are needed in all these areas.
Estimates suggest that achievement of the Millennium Development Goal targets would require Kenya, Lesotho and Zambia to spend more than 40% of their gross domestic product on health by 2015. This can only be achieved if donor countries honour their commitment to developmental assistance. But, by 2010, the G8 countries will have only delivered US$3 billion of the US$21.8 billion committed in 2005 for Africa. the authors assert that it is difficult to convince politicians and bureaucrats about the long-term benefits of social interventions when they are focused on biomedical interventions that impact their status in the short term. Africa. It is difficult to attribute causation to social interventions for long-term outcomes. It is also difficult to conduct randomized controlled trials of social interventions designed to reduce inequities, generalize findings from one research context to another, or generate evidence for the cost-effectiveness of the social interventions. Given the scarcity of resources, such evidence is sorely needed.
Africa is confronted by a heavy burden of communicable and non-communicable diseases. Cost-effective interventions that can prevent the disease burden exist but coverage is too low due to health systems weaknesses. This editorial reviews the challenges related to leadership and governance; health workforce; medical products, vaccines and technologies; information; financing; and services delivery. It also provides an overview of the orientations provided by the WHO Regional Committee for Africa for overcoming those challenges. It cautions that it might not be possible to adequately implement those orientations without a concerted fight against corruption, sustained domestic and external investment in social sectors, and enabling macroeconomic and political (i.e. internally secure) environment.
Health security must be addressed with great urgency, and health-system strengthening is one of the surest routes to health security. The world is not secure when the difference in life expectancy between the poorest and the richest countries exceeds 40 years, or when annual governmental expenditure on health ranges from US$20 per person to well over $6000. It is not secure when more than 40% of the population in sub-Saharan Africa is living on less than a dollar a day. We will not be able to reach the health-related MDGs unless we return to the values, principles, and approaches of primary health care. There are striking inequities in health outcomes, access to care, and what people pay for care. Many health systems have lost their focus on fair access to care, their ability to invest resources wisely, and their capacity to meet people's needs and expectations.
The objectives of this document were to: build awareness of the ways in which an economic downturn may affect health spending, health services, health-seeking behaviour and health outcomes; make the case for sustaining investments in health; and to identify actions – including monitoring of early warning signs – that can help to mitigate the negative impact of economic downturns. Leaders in health must be prepared to speak out – unequivocally and on the basis of sound evidence – to make the case for health at times of crisis. Country-specific analysis is essential to guide policy and assess the potential impact on different populations and institutions. Counter-cyclical public spending provides a means of reviving economies. Aid will play a key role in providing a boost that many low-income countries cannot finance alone. The challenge is to ensure that spending is genuinely pro-poor and that, where possible, it has a positive impact on health. Primary health care provides an overarching approach to policy at a time of financial crisis. Its continuing relevance lies in its value base – stressing the importance of equity, solidarity and gender; through inclusiveness – and the objective of working towards universal coverage and pooling of risk; through a multisectoral approach to achieving better outcomes; and through utilising the assets of all health actors in the private, voluntary and nongovernment sectors.
Progress in basic social indicators slowed down last year all over the world. at the present rate it does not allow for the internationally agreed poverty reduction goals to be met by 2015, unless substantial changes occur, according to the 2008 Basic Capabilities Index (BCI), calculated by Social Watch. Out of 176 countries for which a BCI figure can be computed, only 21 register noticeable progress in social indicators relative to 2000. another 55 countries show some progress, but at a slow rate, while 77 countries showed stagnation or decline in social indicators. Information is insufficient to show trends for the remaining 23. As the impact of the food crisis that started in 2006 begins to be registered in the statistics coming in, indicators are likely to deteriorate in the coming months. Contrary to frequent claims that poverty is diminishing in the world, the index computed by Social Watch shows a persistent shortfall in basic needs even in conditions of economic growth.
Théodore MacDonald's latest book, ‘Removing the Barriers to Global Health Equity’, presents an urgent call to bolster international organisations and cooperation in healthcare. Its shocking findings demonstrate how profitable it has become for corporate interests to undermine the UN Universal Declaration of Human Rights, this week celebrating its 60th anniversary. The book indicates steps which can be taken to avert disaster, involving a much higher level of international cooperation than the world has known before. The book provides a meticulously critical analysis of the written record and sharply probing interviews with key figures in UN agencies. It will be officially launched on 21 January.
Overall, child well-being as improved by 34% since 1990, but progress is slow. Leaders must consider how children are doing and how their decisions impact them. Children are doing worse in sub-Saharan Africa than any other region. Africa scores 35 in the Index, reflecting the high level of deprivation in primary schooling, child health and child nutrition. It is also making the slowest progress, improving child well-being by only 20% over 1990-2006. However, progress has been very mixed; some countries in Africa have done incredibly well, while others did spectacularly badly. Countries like Malawi cut child deprivation in half, enrolling more than 90% of primary school children. Some of the poorest children in Africa live in countries suffering from conflict and poor governance, such as Zimbabwe, Somalia and the Democratic Republic of Congo.
In this paper, the author argues that, contrary to popular belief, numerous Poverty Reduction Strategy Papers (PRSPs) and aid programmes do not adequately address the MDGs. The paper analyses the substance of 22 developing countries’ PRSPs and the policy frameworks of 21 bilateral programmes. Major findings of the analysis include noting that economic growth for income poverty reduction and social sector investments (education, health and water) are important priorities in most of the PRSPs, yet decent work, hunger and nutrition, the environment and access to technology tend to be neglected. PRSPs also emphasise governance as an important means of achieving the MDGs, but they focus mostly on economic governance rather than on democratic (participatory and equitable) processes.