Equity in Health

The analysis in this paper illustrates that the child survival picture – in terms of rate and inequality – varies in the developing world, highlighting the importance of differentiated child survival strategies between middle- and low-income countries. In many countries, reductions in child mortality among poorer households have been smaller than for the higher income groups. Once child mortality is concentrated among lower income groups – as is the case in many middle-income countries – major efforts to reduce child mortality should be equalising, but these require a focus on systematic interventions rather than ‘quick win’ strategies. On the other hand, under-five mortality in low-income countries is usually high not only among the poorest quintile, but in the bottom 40–60% of the population, suggesting the need for more comprehensive strategies to reduce under-five mortality across a broader spectrum of the population.
The paper argues that neonatal mortality tends to fall more slowly than under-five mortality, since reducing it needs longer-term and relatively more expensive interventions associated with functioning health systems. This indicates that while there are quick wins that can help improve child survival, middle-income countries (and low-income ones that have relatively low child mortality rates) need to focus more on reducing neonatal deaths.

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.

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.

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.