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.
Equity in Health
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.
Without a major breakthrough in preventing and treating diabetes, the number of cases in sub-Saharan Africa is projected to double, reaching 24 million by 2030, according to the Brussels-based International Diabetes Federation (IDF). Jean Claude Mbanya, IDF president and the study's lead researcher, said that diabetes had been misunderstood as a rich country problem, despite medical data compiled by IDF showing that 70% of cases were reported in low- and middle-income countries. Mabanya noted that there is also the perception that when diabetes does affect people in low-income countries, it only affects those who are the wealthy elite, despite the fact that diabetes is devastating for the poor, especially when it affects breadwinners. Data is scarce in Africa and estimates are based on a limited number of studies. Mabanya called for more studies to increase confidence in the numbers. He added that most people in Africa who have diabetes are undiagnosed and, therefore, even when statistics are available from health systems, the size of the problem will always be underestimated.
The 2010 AU Summit reviewed the status of implementation of the Declarations and Plans of Action on the 2000 Abuja Summit on Roll Back Malaria (RBM) and the 2001 Abuja Summit on HIV/AIDS, TB and Other Related Infectious Diseases (ORID). The document provides an update on the progress 2006-2010 on these commitments. Since 2006, significant progress has been made by Member States towards universal access to health services in general and HIV/AIDS, tuberculosis, and malaria in particular. The report indicates that in spite of the commendable progress made, this is still insufficient to attain the Abuja target of universal access to HIV/AIDS, Tuberculosis and Malaria services by 2010. The ‘final push’ towards universal access should be advanced through intensified implementation of national programmes with the support of the UN system and international partners, further mobilization with more rational use of resources, and better harmonization and coordination of partnerships at national, regional and continental levels. Reducing the impact of the three diseases would significantly propel efforts to achieve, not only MDG 6 and other health related MDGs, but also development goals related to women's and children's rights to health, education, nutrition and equality, as well as the reduction of extreme poverty.
This paper questions the current methodology that is widely used to assess progress in implementing the Millennium Development Goals (MDGs), a methodology that asks whether or not the targets are likely to be met. The paper demonstrates that the appropriate question should be whether more is being done to live up to that commitment, resulting in faster progress. It notes that the MDGs have led to an unprecedented mobilisation of the United Nations system and the international community, yet the results show that there has not been a post-MDG acceleration of improvement in most countries for most indicators, and that many countries have in fact regressed. The critical question for MDG implementation is to understand where and why progress has accelerated and why and where it hasn’t gone faster. The authors conclude that global goals are normative commitments that can be used in development policy as normative priorities, and that using them as planning targets, particularly at the national level, can be highly misleading.
One hundred and seventeen African health, social development, gender-based, youth and human rights organisations, as well as trade unions, have signed and submitted a letter to the 15th African Union Summit of Heads of State, which took place from 19-27 July 2010 in Uganda. The letter was featured in the July EQUINET newsletter since which time the large number of civil society organisations have signed on. The letter sent to the chairman of the African Union urged governments to uphold, improve and urgently implement African and global health and social development financing commitments, including the Abuja Commitment to allocate 15% of national budgets to health.
According to this paper, sub-Saharan Africa is at a critical point for achieving the Millennium Development Goals for maternal and child survival. It urges for strategic action to be taken now to maximise mortality reduction by 2015. It estimates mortality reduction for 42 sub-Saharan African countries if 90% coverage of maternal, newborn and child health (MNCH) interventions was achieved – nearly four million African women, newborns and children could be saved each year. The study also undertook a detailed analysis of nine African countries that estimated mortality reductions and additional cost for feasible increases in coverage of selected high-impact MNCH interventions considering three differing health system contexts. It revealed that a 20% coverage increase for selected community-based/outreach interventions would save an estimated 486,000 lives and cost an additional US$1.21 per capita. Increasing the quality of current facility births would save 105,000 lives and cost an additional US$0.54 per capita. The study concludes that functioning health systems require both community-based or outreach services and facility-based care. Maximising mortality impact for Africa's mothers, newborns, and children will depend on using local data to prioritise the most effective mix of interventions, while building a stronger health system.
This paper reviews the Millennium Development Goals (MDGs) process, drawing some recommendations to feed into the debate concerning what will take their place in 2015 when the process comes to an end. The authors note that creating the MDGs was a process that was led by rich countries, with comparatively little involvement of the lower- and middle-income countries. Likewise, the merging of the international development goals (IDGs) and MDGs was undertaken mainly between rich countries and the United Nations. In this sense, the author indicates that rich countries needed ambitious goals for their image and legitimacy, while developing countries were more interested in national goals. The paper found some clear progress in meeting the MDGs, notably the reduction of extreme poverty and also an improvement in primary school enrolments, and similarly, the paper predicts that the target of halting and reversing the spread of HIV is likely to be met. However, several areas have shown only weak improvements and even the successes are qualified. Progress has been highly geographically uneven, with global progress masking regional slippage, and regional progress masking deterioration in individual countries. The paper concludes that the opportunity created by the Millennium Movement to mobilise countries and people against poverty has been lost. The MDGs have made a difference but they have not transformed the process of international co-operation in the ways that their proponents had initially hoped.
In this interview, Dr Colin Summerhayes, president of the Society for Underwater Technology, talks about how the world’s climate is changing and the expected consequences on health. He predicts that, as the rise in temperatures as a result of global warming will be quite slow over the next 30 years, we should not expect an instant change in health factors. He refers to the change as a ‘creeping catastrophe’. As well as increased morbidity and mortality from extreme weather events, such as heatwaves, droughts and floods, Summerhayes anticipates that climate change is likely to increase the burden of malnutrition, diarrhoea and infectious diseases. There is also likely to be a rising frequency of cardio-respiratory diseases because of changes in air quality and in distribution of some disease vectors. All of this could impose a substantial burden on health services. He notes that some scientists now believe there will be both contractions and expansions in the occurrence of malaria, with changes in transmission seasons.
Expressing concern at the relatively slow progress in attaining the Millennium Development Goals, particularly in sub-Saharan Africa, the World Health Assembly in this resolution reaffirms the commitments by developed countries to a target of 0.7% of gross national income on official development assistance by 2015, with an interim goal of 0.56% of gross national income for official development assistance by 2010. It urges United Nations member states to strengthen their health systems so that they deliver equitable health outcomes and achieve Millennium Development Goals 4, 5 and 6. It urges for policy review in areas that are limiting progress, including on the recruitment, training and retention of health workers, particularly in sub-Saharan Africa. Governments should reaffirm the values and principles of primary health care, including equity, social justice and community participation, as the basis for strengthening health systems. Health equity should be taken into account in all national policies that address the social determinants of health, and governments should consider developing and strengthening universal comprehensive social protection policies, including health promotion, disease prevention and health care, and further commit themselves to increased investment in financial and human resources.