This paper takes a critical look at South Africa's prospects for meeting the Millennium Development targets for child survival. It asks the question: is a return to comprehensive primary health care (PHC) needed right now, as many have been saying? The time is long overdue for energetically translating the rhetorically rich promises of the PHC approach to reality, turning dormant policies into action. The main actions should centre around the development of comprehensive, well-managed programmes involving the health sector, other sectors and communities. The process needs to be structured into functioning district systems. In most countries these need to be considerably strengthened, particularly at the household, community and primary care levels.
Equity in Health
A bleak picture has been painted in the Situational Analysis of Children in South Africa 2007–2008, a report compiled by the UN Children’s Fund that looks at the standard of living of children in South Africa. It shows that poverty and crime continue to wreak havoc in the lives of this country’s children. It confirmed the view that South Africa will most likely not reach its Global Millennium Goal of reducing child mortality by two-thirds by 2015. Of every 1,000 children born in KwaZulu-Natal, 99 die before they reach the age of five. Gauteng’s mortality rate is still at about 63 deaths per 1,000 births; in Western Cape the ratio is 40 per 1,000.
The Millennium Declaration is a statement of principles about the kind of future that world governments seek; a future that they envisage to be more equitable and more responsive to the socially most vulnerable. The Millennium Development Goals represent the operational targets by which we may judge their actions. The reduction of the U5MR by two-thirds by 2015 is one of the Millennium Development Goals (MDG4). The reduction in U5MR can, however, be achieved through a diversity of policy interventions, some of which could leave the children of the poor worse off. A celebrated MDG4 success can, thus, be a Millennium Declaration failure. Health policy informed by composite outcome measures that take account of both the U5MR and the distribution of the burden of mortality across social groups would help to overcome this.
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.
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.