The number of women dying due to complications during pregnancy and childbirth has decreased by 34% from an estimated 546,000 in 1990 to 358,000 in 2008, according to this report. Despite the progress, the report notes that the annual rate of decline is less than half of what is needed to achieve the Millennium Development Goal (MDG) target of reducing the maternal mortality ratio by 75 between 1990 and 2015. This will require an annual decline of 5.5%. The 34% decline since 1990 translates into an average annual decline of just 2.3%. In the period from 1990 to 2008, ten out of 87 countries with maternal mortality ratios equal to or over 100 per 100,000 live births in 1990 are on track with an annual decline of 5.5% between 1990 and 2008. At the other extreme, 30 made insufficient or no progress since 1990. The study shows progress in sub-Saharan Africa, where maternal mortality decreased by 26%. Ninety-nine per cent of all maternal deaths in 2008 occurred in developing regions, with sub-Saharan Africa and South Asia accounting for 57% and 30% of all deaths, respectively.
Equity in Health
This article predicts that the Millennium Development Goals (MDGs) will not be achieved by 2015. Progress is especially slow in fragile contexts, where institutions are weak and there is a risk of violent conflict. But a closer examination shows that the MDGs are inadequate measures of development progress, and as such they represent an international development paradigm that is tired and confused. The article proposes a more ‘useful’ way to consider human progress: consider a ‘developed society’ as one with a defined set of characteristics and create from these a vision for change. Building on work by others, the authors propose a generic vision consisting of six key characteristics: equal access to political voice, and the legitimate and accountable use of power; equal participation in a vibrant and sustainable economy; equal access to justice, and equality before the law; freedom from insecurity; the ability of people to maintain their mental and physical well-being, to have aspirations and make progress towards them; and the self-reinforcing presence of institutions and values that support and enable equitable progress and peace. While these characteristics provide a vision of human progress, they do not provide guidance on how to get there, the authors caution. The ‘how’ of implementation has to be defined at a local, rather than a global level, and should be informed by lessons from history.
This article identifies two ‘gaps’ in maternal, newborn, and child health (MNCH): a ‘science to policy and practice’ gap, where, despite mounting research on MNCH, it has failed to achieve importance on the domestic policy agendas of African countries; and a ‘policy to practice’ gap, where, despite clear policy commitments to MNCH, substantial challenges prevent these policies from being implemented effectively. The article focuses on the ‘science to policy and practice’ gap, in the belief that action to address the second gap is already mobilised, although clearly not yet fully effective. In contrast, the first gap remains neglected. It first addresses what is already known about how scientific evidence has influenced MNCH policy and practice, then it considers some of the key challenges in closing the science to policy and practice gap, and concludes by identifying promising paths for future action: developing MNCH policy networks, mainstreaming the use of MNCH science and investing in innovative approaches to develop and apply MNCH evidence.
In this statement, Commonwealth Health Ministers acknowledged the progress made globally towards the attainment of the health-related Millennium Development Goals (MDGs), including the steady reduction in under-five deaths from 12.6 million in 1990 to 9 million in 2007. They note that at least 16 developing Commonwealth countries have achieved or are on track to achieve MDG 5. Ministers called on the global community, especially the G8 and G20, to support maternal and newborn health programmes, and to meet MDGs 4 and 5. They particularly called for support to meet the target of 90% of births being attended by skilled health workers by 2015.
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.
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.
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.