This article focuses on a number of countries in Africa that have made improvements in their health outcomes and that are on their way to meeting their health Millennium Development Goal (MDG) targets, including Tanzania, Kenya and Rwanda. Infant mortality fell by over 40% in Tanzania, from 99 deaths per 1,000 live births in 1999 to 58 in 2007-08, which suggests that the country can reach its Millennium Development Goal (MDG) target by 2015. Under-five mortality has also declined, from 146 deaths per 1,000 live births to 91. After a period of stagnation during which infant and child mortality rates deteriorated and life expectancy dropped, Kenya has recently made very significant progress, reversing its negative health trends between 2003 and 2007. The 2008 Kenya Demographic and Health Survey (DHS) reveals remarkable declines in infant and under-five mortality rates in this period (from 77 to 52, and from 115 to 74, per 1000 live births, respectively). After the 1994 conflict, which took a great toll on the health sector, Rwanda entered the 21st century with one of the weakest health systems in the world. Yet today it shows some very strong health results. Assisted childbirths rose from 39% in 2005 to 52 percent in 2008; while under-5 mortality fell by a third, from 152 deaths per 1,000 live births in 2005 to 103 in 2008. And the use of modern contraception has increased from 10% to 27% in just three years.
Equity in Health
According to this paper, the world is off track in meeting the Millennium Development Health Goals. It urges world leaders and other stakeholders to accelerate progress to reach the goals set to improve maternal and child health. It calls for rapid expansion of antiretroviral coverage for women with HIV in order to reduce maternal mortality, rapid expansion of antiretroviral treatment for all men and women with HIV, the integration of services to prevent HIV transmission to infants and to achieve rapid paediatric HIV diagnosis across all sexual and reproductive health services and all services for newborns. Governments are urged to provide support to implement the most effective antiretroviral regimens to prevent HIV transmission to infants and scale up efforts to diagnose HIV in children, expand ART for children and the paper argues that expanded funding for the Global Fund is required to bring it in line with its most ambitious scenario of USD$20 billion for the next three years.
According to this report, in 2008, an estimated 390 000–510 000 cases of multi-drug resistant tuberculosis (MDR-TB) emerged globally (best estimate, 440 000 cases). Among all incident TB cases globally, 3.6% are estimated to have MDR-TB. The report notes that more data on drug resistance has become available and estimates of the global MDR-TB burden have been improved. Even in settings gravely affected by drug resistance, it is possible to control MDR-TB, although new findings presented in this report give reason to be cautiously optimistic that drug-resistant TB can be controlled. While information available is growing and more and more countries are taking measures to combat MDRTB, urgent investments in infrastructure, diagnostics, and provision of care are essential if the target established for 2015 – the diagnosis and treatment of 80% of the estimated MDR-TB and extensively drug-resistant TB cases – is to be reached.
Drawing on evidence of what has worked in 50 countries, this report provides an eight-point MDG action agenda to accelerate and sustain development progress over the next five years. The eight points focus on supporting nationally-owned and participatory development; pro-poor, job-rich inclusive growth including the private sector; government investments in social services like health and education; expanding opportunities for women and girls; access to low carbon energy; domestic resource mobilisation; and delivery on Official Development Assistance commitments. From the abolition of primary school fees leading to a surge in enrolment in Ethiopia to innovative health servicing options in Afghanistan reducing under-five child mortality, the report brings forward concrete examples that have worked and can be replicated, even in the poorest countries, to make real progress across the Millennium Development Goals. Rapid improvements in both education and health, the report illustrates, have occurred in countries where there were adequate public expenditures and strong new partnerships, where economic growth is job-rich and boosts agricultural production, where robust social protection and employment programmes are in place, and where development is country led, with an effective government in place.
The pandemic threat of the H1N1 or ‘swine flu’ virus has now passed, according to World Health Organization (WHO) Director-General, Margaret Chan. The virus has largely run its course, said Chan, though she added that WHO continues to recommend the use of remaining pandemic vaccines as their efficacy has not decreased. The announced closing of the pandemic period means that the names of the WHO’s Emergency Committee, which decided when to declare the pandemic and when it could be considered ended, are now public. This new information should help answer some of the more critical questions being asked about WHO’s influenza response, such as whether conflicts of interest within the body’s expert advisory group led to an exaggeration of the risks of the H1N1 virus.
This document details the main strategic directions for the work of the World Health Organization (WHO) in the African Region for the period 2010–2015 and considers regional responses to the global health agenda, including new policies and tools for programmes related to the Millennium Development Goals (MDGs). WHO’s strategic directions recognise the socio-economic dimension of health development and propose orientations to address the most serious health problems faced by people in Africa, as well as their key determinants. The document focuses on WHO’s mandate and its core functions, articulating its role in addressing Africa’s public health priorities, while giving space to other stakeholders involved in strengthening the implementation capacity of national health systems under the leadership of governments. Successful implementation of the strategic directions will require strong leadership, accountability and efficient use of resources. Those countries that have made progress towards achieving the MDGs are urged to share best practices with other countries in the region. According to WHO, boosting the capacity of health systems and improved monitoring and evaluation should enable the scaling up of proven and cost-effective health interventions and pave the way towards accelerated implementation of programmes aimed at achieving health MDGs.
The Adelaide Statement was developed by the participants of the Health in All Policies International Meeting, held in Adelaide, Australia from 13–15 April 2010. Its aim is to engage leaders and policy-makers at all levels of government, including local, regional, national and international governments. It emphasises that government objectives are best achieved when all sectors include health and well-being as a key component of policy development and that the social determinants of health should be considered when addressing public health issues. Although many other sectors already contribute to better health, significant gaps still exist. The Adelaide Statement outlines the need for a new social contract between all sectors to advance human development, sustainability and equity, as well as to improve health outcomes. This requires a new form of governance with joined-up leadership within governments, across all sectors and between levels of government. The Statement highlights the contribution of the health sector in resolving complex problems across government.
In the lead up to the African Union Summit, held from 19 to 27 July 2010 in Uganda, Save the Children has joined a broad coalition of civil society groups from across Africa and around the world to call on African leaders to deliver four key commitments that will save the lives of mothers and children. Civil society recommend that leaders at the Summit should commit to putting a plan in place. Every African country must develop and implement an accelerated national plan for reducing maternal, newborn and child deaths. Stakeholders should make sure that the resources are available. Every African country should meet and exceed its 2001 promise in Abuja, Nigeria to spend at least 15% of the national budget on health care. Additionally, a meaningful portion of this budget must specifically dedicated to maternal, newborn, and child health. Thirdly, health worker shortages should be addressed. Countries must recruit, train and retain more doctors, nurses, and midwives to help reduce the overall gap of 800,000 health workers in Africa by 2015. Fourthly, the coverage gap between rich and poor must be addressed. Countries must ensure health care, including emergency obstetric care, is accessible for the poorest people and is free at the point of use for pregnant women and children under five.
Civil society campaigners attending the African Union Summit, held from 19 to 27 July 2010 in Kampala, Uganda, have called for an investment of US$32 billion to help improve the health status of African women. The campaigners said that, in the next five years, eleven million African women and children could be saved by creating near-universal availability of key life-saving interventions. The group, which includes the Partnership for Maternal, Newborn and Child Health that is campaigning for the achievement of the UN Millennium Development Goals (MDGs), are seeking new investments in stopping the deaths of women and children, which is the main issue slated for discussion by the African leaders. They have called for interventions in antenatal care, emergency care at the time of birth, post-natal care, treatment of childhood illnesses, and immunisation. These investments, they said, will cost an additional US$32 billion, or about US $8 per person per year over the next five years. This would allow 95% population coverage and bring most African countries in line with MDGs 4 and 5, which call for reducing the number of deaths among children under 5 by two thirds, and reducing maternal deaths by three-quarters by 2015.
This article focuses on the challenge of translating science into policy and practice in Africa’s maternal, newborn and child health (MNCH) services. The article indentifies several barriers to closing the gap, such as competing health priorities in Africa that make it more difficult to keep MNCH on the health agenda, the lack of a strong, organised lobby for promoting MNCH, and poor routine data collection. It offers three strategies to help close the gap: developing MNCH policy networks that pursue a bottom-up approach and go beyond politicians and ministers to engage civil society, front-line health workers, researchers and the media; mainstreaming the use of MNCH science to develop an evidence-based approach that will support planning and monitoring processes, thereby strengthening the overall process of health planning; and investing in innovative approaches to develop and apply MNCH evidence by building local capacity to conduct relevant research for policy and implementation.