The HLSP Institute’s Global Update is a reference guide to the key events and activities of six months – April to September 2010 – in the health and development arena, with particular focus on aid effectiveness, health systems and public health. It reports on the United Nations (UN) Children’s Fund’s proposal to take a more equity-based approach to child health. The intended strategies are: upgrading selected facilities, particularly for maternal and newborn care, and expanding maternity services at the primary level, including maternity ‘waiting homes’; tackling the multiple barriers to access by the poorest – from massively expanding outreach services, and eliminating user charges, to extending cash transfers to cover indirect costs (e.g. transport); and task shifting, with more community outreach and involvement, and making greater use of community health workers to deliver basic health care services outside facilities. In terms of the global AIDS response, the update notes that the global AIDS response is at a crossroads, with a shortfall on achieving universal access targets, together with signs of funding declines and shortfalls. There has been growing attention to maternal health and commitments made in the US Global Health Initiative, the G8, the African Union Summit in Kampala in July 2010 and the MDG Summit in September 2010, with significant resources allocated to this area. The authors argue that assessing progress on delivery on these commitments and the impact of the resources is limited by lack of reliable and accurate maternal mortality data.
Equity in Health
At the end of the Global Symposium on Health Systems Research, held from 16-29 November 2010 in Montreux, Switzerland, the Steering Committee made a number of resolutions. They proposed to electronically preserve and disseminate the knowledge from the symposium, using innovative communication channels. They also committed to creating an International society for health systems research, knowledge and innovation, with the goal of advancing ‘science to accelerate universal health coverage’, to take build greater constituency, credibility and capacity for health systems research globally. The Committee will give visibility and support to regional and national efforts to strengthen health systems research, promoting strengthened health systems within priority UN agendas and accelerating universal health coverage. Contributions will be solicited from the global scientific community to establish norms, standards and practices to strengthen the foundations for health systems research. The Committee will also identify joint opportunities for collaborative research and knowledge production across different disciplines, sectors, stakeholders and geographies. Finally, the Committee agreed to gather for a Second Global Symposium on Health Systems Research in 2012 or 2013 to evaluate progress, share insights and recalibrate the agenda of science to accelerate universal health coverage. China has offered to host the Symposium.
This study assessed changes in infant mortality patterns from 1992 to 2007, as well as factors associated with infant mortality risk in the Agincourt sub-district, rural northeast South Africa. Period, sex, refugee status, maternal and fertility-related factors, household mortality experience, distance to nearest primary health care facility and socio-economic status were examined as possible risk factors. The survey found that infant mortality increased significantly over the study period, largely due to the impact of the HIV epidemic. There was a high burden of neonatal mortality, with several ‘hot spots’ close to health facilities. Significant risk factors for all-cause infant mortality were mother's death in first year (most commonly due to HIV), death of previous sibling and increasing number of household deaths. Being born to a Mozambican mother posed a significant risk for infectious and parasitic deaths, particularly acute diarrhoea and malnutrition. The study concludes that prevention of vertical transmission of HIV and survival of mothers during the infants' first year in high-prevalence villages needs to be urgently addressed, including through expanded antenatal testing, prevention of mother-to-child transmission, and improved access to antiretroviral therapy. Persisting risk factors, including inadequate provision of clean water and sanitation, are yet to be fully addressed.
In this presentation, the author argues that investing in family planning is the single most strategic, low cost, high impact and quick win strategy to achieving economic, social and political transformation. The author reviews several instruments for investing in family planning in Uganga, such as the National Development Plan (2010–2014), which has clear targets for family planning and focuses on investing in ‘demographic window’ (when the proportion of population of working age group is particularly prominent in a country), and the Medium Term Expenditure Framework, to which the government should link National Development Programme targets and in which the appropriate sectors should be prioritised to bring about investment. The Annual Health Sector budget allocation is reported to have been relatively stagnant for FP over the years and must be increased. In addition, government needs to monitor whether or not the allocated funds are actually spent on FP.
According to this presentation, over the long run, the importance of within-country inequalities has decreased and the importance of between-country inequalities has increased, while the global division between countries is actually greater than that between social classes. The presentation refers to two factors affecting an individual’s levels of wealth: citizenship premium and parental premium. According to citizenship premium, if the mean income of country where you live increases by 10%, your income goes up by about 10% too (called ‘unitary elasticity’). The parental premium states that, if your parents are one income class higher, your income increases by about 10.5% on average. In terms of global inequality of opportunity, country of citizenship explains 60% of variability in global income, while citizenship and parental income class combined explain more than 80%. In conclusion, if most of one’s income is determined by citizenship, then there is little equality of opportunity globally and citizenship may be regarded as a rent (unrelated to individual effort or whether or not the individual deserves it or not).
Using social tables, the author estimates global inequality (inequality among world citizens) from the early 19th century until the 21st century. The analysis shows that the level and composition of global inequality have changed over the past two centuries. The level has increased, reaching a high plateau around the 1950s, and the main determinants of global inequality have become differences in mean country incomes rather than inequalities within nations. The inequality extraction ratio (the percentage of total inequality that was extracted by global elites) has remained surprisingly stable, at around 70% of the maximum global Gini co-efficient, during the past 100 years.
In this interview with Archbishop Ndungane, president and founder of African Monitor, he assesses the outcomes of the United Nations Summit on the Millennium Development Goals (MDGs). On the positive side, he welcomes the fact that the outcome document is comprehensive, touching on almost everything that needs to be addressed if MDGs are to be met, with commitments that are measurable and therefore can be tracked. The specific amounts committed by specific stakeholders is also a step in the right direction, according to him. Clause 23 (c) makes specific reference to the promotion of national food security strategies that strengthen support for smallholder farmers and contribute to poverty eradication. This is key to poverty eradication, particularly where without exception, 70% of the population in rural areas depend on agriculture for their livelihood. According to the Archbishop also commendable are the specific focus on maternal and child health, the references to lessons learnt, particularly the issue of supporting community-led strategies; and the commitment to strengthening the statistical capacity to produce reliable and disaggregated data. He also pointed out a number of concerns about the Summit, in the lack of any guarantee that the concrete commitments will go beyond mere ‘lip service’; the lack of clear mechanisms for enforcement; and the repetition of principles that have proved difficult to operationalise without new angles on how they are going to be implemented in reality. Finally, although there are specific commitments, world leaders need to find mechanisms to reinvigorate and stimulate the local energies, initiatives and actions which are people-driven. They should look beyond 2015 and work for sustainable solutions.
The General Assembly adopted this outcome document at the sixty-fifth session of the General Assembly on the Millennium Development Goals, held in September 2010. It reaffirms the United Nations’ commitment to achieving the Millennium Development Goals (MDGs) and calls on all stakeholders, including civil society, to enhance their role in national development efforts as well as their contribution to achieving the MDGs. The resolution indicates that there has been a mix of successes and failures in achieving the MDGs, with uneven progress and many remaining challenges and opportunities. It recognises that developing countries have made significant efforts towards achieving the MDGs and have had major successes in realising some of the targets of the MDGs, such as combating extreme poverty, improving school enrolment and child health, reducing child deaths, expanding access to clean water, improving prevention of mother-to-child transmission of HIV, expanding access to HIV prevention, treatment and care, and controlling malaria, tuberculosis and neglected tropical diseases. However, much more needs to be done to reach the MDGs, as progress has been uneven among regions and between and within countries. Hunger and malnutrition rose again from 2007 through 2009, partially reversing prior gains. There has been slow progress in reaching full and productive employment and decent work for all, advancing gender equality and the empowerment of women, achieving environmental sustainability and providing basic sanitation. New HIV infections still outpace the number of people starting treatment. In particular, the Assembly criticised the slow progress that has been made in improving maternal and reproductive health.
In this presentation, the author argues that meeting unmet need for family planning services in Kenya could help the country ‘significantly’ generate resources and save costs to achieve universal primary education, reduce child mortality, improve maternal health, ensure environmental sustainability, and help combat HIV and AIDS, malaria and other diseases. It draws on research to show that greater access to FP information and services in Kenya could contribute directly to the country’s attainment of Millennium Development Goals 4 and 5 (to reduce child mortality and improve maternal health).
In this interview, Patrick Bond discusses the failings of South Africa’s drive towards meeting the Millennium Development Goals (MDGs) and the extent to which the country’s government continues to operate against the interests of its poor majority. According to Bond, South African urban poverty increased from 1993–2008 and rural poverty declined only because more poor people moved to the cities and the welfare grant system was extended. The South African economy is structured so as to generate poverty-expanding 'growth' of GDP (gross domestic product) so, as accumulation of capital occurs in much of South Africa, the rich grow richer and the poor grow poorer. That structuring happens in ways concordant with the speculative, financial-driven and profit-exporting character of capitalism, interrupted only briefly by the great crash of 2008. Most of Pretoria's economic policies amplify this trend because of their neoliberal (pro-business) character, he argues. South Africa cannot be confident of making progress on any MDGs, given the coming austerity associated with a failing global and national 'Keynesian' (deficit-based) macroeconomic strategy that was largely based on white-elephant infrastructure investments. Such spending – especially for now-empty World Cup soccer stadiums costing R22 billion – plus declining state revenues (as profits and taxes fell) moved the national budget from a surplus of around 1% of GDP to more than 7%. What is therefore likely, within five years, is a similar turn by the Treasury to the kind of austerity now being felt in many other countries which ratcheted up their deficits to deal with the crisis. As shown in the recent civil servants' strike, the state is willing to put services mainly utilised by the poor majority – public schools, clinics and hospitals – at risk to maintain some semblance of fiscal discipline, which does not bode well for future state expenditure on MDG-related needs.