Significant progress towards reducing child and maternal mortality is being made, but to meet the Millennium Development Goals (MDGs) 4, 5 and 6, strategies aimed at reaching the world’s most inaccessible, marginalised and vulnerable populations will be required, according to Ethiopia’s Minister of Health and the heads of four leading global health organisations – the GAVI Alliance, UNAIDS, the Global Fund to Fight AIDS, TB and Malaria and UNICEF. Many countries are committed to achieving the MDGs but rely largely on donor support for its national health plan to continue its progress. Increased funding has seen improved immunisation rates, more programmes against malaria (by providing insecticide-treated bed nets) and the expansion of anti-retroviral access to two million in sub-Saharan Africa have contributed to an improving health picture for the continent, with reductions in mortality and morbidity rates.
Equity in Health
Why a renewal of primary health care (PHC), and why now, more than ever? Globalization is putting the social cohesion of many countries under stress, and health systems are clearly not performing as well as they could and should. People are increasingly impatient with the inability of health services to deliver. Few would disagree that health systems need to respond better – and faster – to the challenges of a changing world. PHC can do that.
This report is based on a master set of data that has been compiled by an inter-agency and expert group on Millennium Development Goal (MDG) indicators, led by the Department of Economic and Social Affairs of the United Nations Secretariat, in response to the wishes of the General Assembly for periodic assessment of progress towards the MDGs. The group consists of representatives of the international organisations whose activities include the preparation of one or more of the series of statistical indicators that were identified as appropriate for monitoring progress towards the MDGs. This report summarises progress towards the Goals in each of the regions. However, any such synthesis inevitably masks the range and variety of development experiences in individual countries since the goals were adopted.
In its report, the Commission calls for increased public finance for programmes and policies to support the social determinants of health, including child development, education, improved living and working conditions and health care, recognising the failure of markets to supply vital goods and services equitably. It also calls for progressive taxation at the national level, a major increase in aid, improved aid quality and greater debt cancellation. It sees an urgent need for a global economic system that supports renewed government leadership to balance public and private sector interests, and identifies quantifying the impact of supra-national political, economic, and social systems on health and health inequities within and between countries as an important research need. Stronger global management of integrated economic activity and social development is needed as a more coherent way to ensure fairer distribution of globalisation's costs and benefits. The entrenched interests of some social groups and countries are seen as ‘barriers to common global flourishing’, and transnational companies should become accountable to the public good, not just to private profit.
This World Health Organisation report takes a broad look at inequality and health. The report issues a call to arms, stressing the need to tackle the inequitable distribution of power, money and resources through better governance, transparency, support for civil society and more equitable economic policies. Some claim the report offers a way out of the ‘sterile debate’ about whether poor health causes poverty, or vice versa. Critics point out that it downplays the link between income (as opposed to inequality) and health. One example of the correlation between money and health is from South Africa, where the health of older people improved after receiving pensions at the age of 65. But whether people are well or sick also depends on factors and policies that lie far beyond the remit of any health minister. For example, the Health Ministry may try to encourage handwashing, but it is unlikely to happen unless there is running water - which is beyond the Ministry’s control.
Publish What You Fund is the Global Campaign for Aid Transparency, which brings together leading NGOs and NGO coalitions to draft a first set of consultation materials – the Publish What You Fund principles, which were released in July 2008. These five principles are designed to be signed by all public and private bodies engaged in funding and delivering aid: 1. Information on aid should be published proactively. 2. Everyone can request and receive information on aid processes. 3. Information on aid should be timely and accessible. 4. Information on aid should be comparable. 5. The right of access to information about aid should be promoted. The principles will be reviewed in the run-up to the Accra High Level Forum, following an initial consultation period.
The Final Report of the Commission on Social Determinants of Health sets out key areas of daily living conditions and of the underlying structural drivers that influence them in which action is needed. It provides analysis of social determinants of health and concrete examples of types of action that have proven effective in improving health and health equity in countries at all levels of socioeconomic development. Part 1 sets the scene, laying out the rationale for a global movement to advance health equity through action on the social determinants of health. It illustrates the extent of the problem between and within countries, describes what the Commission believes the causes of health inequities are, and points to where solutions may lie. Part 2 outlines the approach the Commission took to evidence, and to the indispensable value of acknowledging and using the rich diversity of different types of knowledge. Parts 3, 4, and 5 set out in more detail the Commission s findings and recommendations. The chapters in Part 3 deal with the conditions of daily living the more easily visible aspects of birth, growth, and education; of living and working; and of using health care. The chapters in Part 4 look at more structural conditions social and economic policies that shape growing, living, and working; the relative roles of state and market in providing for good and equitable health; and the wide international and global conditions that can help or hinder national and local action for health equity. Part 5 focuses on the critical importance of data not simply conventional research, but living evidence of progress or deterioration in the quality of people s lives and health that can only be attained through commitment to and capacity in health equity surveillance and monitoring. Part 6, finally, reprises the global networks the regional connections to civil society worldwide, the growing caucus of country partners taking the social determinants of health agenda forward, the vital research agendas, and the opportunities for change at the level of global governance and global institutions that the Commission has built and on which the future of a global movement for health equity will depend.”
This review examines the impact of global health initiatives (GHIs) on health equity, focusing on low- and middle-income countries. It is a summary of a literature review commissioned by the WHO Commission on the Social Determinants of Health. GHIs have emerged during the past decade as a mechanism in development assistance for health. The review focuses on three GHIs: the US President’s Emergency Plan For AIDS Relief (PEPFAR), the World Bank’s Multi-country AIDS Programme (MAP) and the Global Fund to Fight AIDS, TB and Malaria.
The public health sector in South Africa has come under criticism over poor services and the failure to implement government policies effectively. The past 14 years have seen a widening gap between the private and the public health care sectors with the latter struggling to provide quality service, thus making it difficult for most South Africans who don’t belong to medical aid schemes to access quality health care. Advocate Khaya Zweni, a lawyer with the Human Rights Commission (HRC), says most are not happy with the service offered by public health care institutions. Following numerous complaints from the public, the Human Rights Commision conducted a survey in more than 90 public health institutions countrywide. Dr Anban Pillay, the Department of Health's cluster manager for health economics, believes that the problems in health delivery could be dealt with if the department is allocated a bigger budget by Treasury. ‘The problem with the public sector relates to a lack of funding. That lack of funding needs to be corrected. We are currently at the 11% of government expenditure on health care. We need to get around 15%. That’s what the government needs to do,’ Pillay said.
The United Nations Children’s Fund (UNICEF) and the World Health Organisation (WHO) is urging increased support for breastfeeding mothers since the practice has been shown to slash deaths by more than 10% in infants in developing countries. Despite advances in the past 15 years, only 38% of infants under six months of age in the poorer nations are exclusively breastfed, a practice which could curb infant mortality. Various studies have shown that the number of months which mothers breastfeed – especially exclusively – can be extended by education and support. The practice can reduce the number of deaths caused by acute respiratory infection and diarrhoea, as well as other infectious diseases. It also improves mothers’ health and strengthens the bond between mother and child. ‘There is a double message here: it is not enough to say that breastfeeding is an ideal source of nourishment for infants and young children; mothers also need support to make optimal breastfeeding practices a reality,’ WHO Director-General Margaret Chan said.