With four years to go, Tanzania still lags behind other East African countries towards the realisation of the Millennium Development Goals (MDGs), according to this article, only surpassing war-torn Burundi. The minister for Health and Social Welfare, Dr Haji Mponda, admitted that he was aware of the problem and expressed the government’s willingness to ensure that some of the targets are fully realised by 2015. He highlighted the achievements made by the government, specifically in 2007, when the rate of HIV prevalence dropped from 7% to 5% and that of 2004 to 2005, when the number of maternal deaths went down from 98 to 51 out of every 1,000 deaths. The report comes exactly 10 years since the UN's adoption of the goals and twenty years since the recording of most baseline data surface. Despite an extraordinary public campaign to mobilize support for the MDGs, there has been surprisingly little effort to track, record, and disseminate information regarding progress toward the goals at the country level, the authors of the report argued. Reacting to Tanzania’s poor performance, the head of Twaweza, an information advocacy organization, expressed concern that Tanzania still lagged behind its peer East African neighbours. He challenged the government to review each of the eight MDGs by involving stakeholders in health, poverty reduction, environment and other sectors that are related to the MDGs. He also called for independent evaluation bodies of these strategies, with stakeholders involved and not just the government officials and added reports ought to be made available in the public domain, so that citizens know where the country is headed.
Equity in Health
The United Nations predicts that the world's urban population will almost double from 3.3 billion in 2007 to 6.3 billion in 2050. Most of this increase will be in developing countries. Exponential urban growth is having a profound effect on global health. Because of international travel and migration, cities are becoming important hubs for the transmission of infectious diseases, as shown by recent pandemics. Physicians in urban environments in developing and developed countries need to be aware of the changes in infectious diseases associated with urbanization, the authors of this review argue. Furthermore, health should be a major consideration in town planning to ensure urbanisation works to reduce the burden of infectious diseases in the future.
Whether or not health inequalities are unjust, as well as how to address them, depends on how they are caused, the author of this paper argues. He reviews a range of health inequalities in different countries and internationally, between genders, class, income and racial groups and between countries, tentatively identifying pathways of causality in each case, and making judgments about whether or not each inequality is unjust. He asserts that health inequalities that arise due to medical innovation are among the most benign, while those that arise due to inequalities in early life are more significant, pointing to the importance of parental and child circumstances. Society judges racial inequalities in health as unjust, adding to injustices in other domains. While the inequalities in health between rich and poor countries are wide, the author asserts that they are not perceived as just nor unjust, nor are they easily addressed.
The Global Tuberculosis Control Report is compiled annually by the World Health Organization, and this edition documents the success and challenges in tuberculosis (TB) treatment worldwide during 2009/2010. Some successes are highlighted, such as a 35% drop in the TB death rate since 1990, with a slow decline in TB incidence. It indicates that the world is on track to reach the Millennium Development Goal for TB incidence, and the Stop TB Partnership 2015 target for TB mortality. There has also been major progress in improving access to diagnosis and treatment, and also in the scale up of TB/HIV intervention and strengthening of laboratory services. However, major challenges still exist. In 2009, 1.7 million died from TB, and although incidence levels are falling, they are falling too slowly, the report has revealed. It predicts that, under the current rate of decline, TB will not be eliminated within the next generation. Also, the response to multi-drug resistant TB is still insufficient and more efforts are needed to scale up and strengthen programmes, especially with 440,000 new cases emerging each year. Less than 5% of those cases are being properly treated, the report notes.
According to this article, women's health is closely linked to a nation's level of development, with the leading causes of death in women in resource-poor nations attributable to preventable causes. Unlike many health problems in rich nations, the cure relies not only on the discovery of new medications or technology but also getting basic services to the people who need them most and addressing underlying injustice. In order to do this, the article argues that political will and financial resources must be dedicated to developing and evaluating a scaleable approach to strengthen health systems, support community-based programmes, and promote widespread campaigns to address gender inequality, including promoting girls' education. The Millennium Development Goals (MDGs) have highlighted the importance of addressing maternal health and promoting gender equality for the overall development strategy of a nation. The authors of this article urge stakeholders to capitalise on the momentum created by this and other international campaigns and continue to advocate for comprehensive strategies to improve global women's health.
This article reviews the debates at the United Nation’s Millennium Development Goal Summit, held from 20-22 September 2010. Rather than bringing a convincing message about a turning point for the future, the article argues that the Summit highlights missed opportunities in acting on what has already been agreed to. Barriers to moving forward are hardly mentioned and strategies to overcome them remain largely vague. The outcome of the High Level Meeting can therefore be seen as mixed and fragile as the uneven successes and progress documented in the UN Secretary General’s report to the meeting. On the positive side, the negotiated outcome document combines a return to basics. In promoting public health for all, it brings back the integrated primary health care approach, the social justice and rights imperatives, and participation of civil society as in the Alma Ata Declaration, together with conditional cash transfer, new technology and innovative finance.
The Global strategy for women’s and children’s health sets out the key areas where action is urgently required to enhance health financing, strengthen policy and improve service delivery. It argues that investing in women’s and children’s health reduces poverty, stimulates economic productivity and growth, is cost-effective and helps women and children realise their human rights. The report makes a number of recommendations. First, it urges governments and the global community to support country-led health plans, emphasising life-saving interventions and ensuring that women and their children can access prevention, treatment and care when and where they need it. The report also advocates for stronger health systems, with sufficient skilled health workers at their core and innovative approaches to financing, product development and the efficient delivery of health services. The over-reaching aim of the report is to help reach the goal of saving the lives of 16 million women and children by 2015.
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.
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.