According to the September editorial of The Lancet, overall, progress on achieving the Millennium Development Goals(MDGs) is uneven, with some regions, especially in the poorer countries, lagging far behind. The editors argue that business cannot continue as usual in the next five years if the promises made a decade ago are to be met. On the positive side, the MDGs have achieved much. They have mobilised unprecedented political support, advocacy efforts, financial resources, and have encouraged improved monitoring and evaluation of programmes. However, the editors argue that the targets were narrow and fragmented. Potential links and synergies between goals have not been fully realised. Over the past 40 years improvements in women's education (MDG 2) has reduced child mortality (MDG 4) substantially, averting 4.2 million deaths globally. Furthermore, the results point to the importance of a reduction of the gender gap in educational achievement, thereby promoting gender equity and empowering women (MDG 3). The addition of new targets over time has also been unsuccessful, as seen with universal access to reproductive health. Newer priorities facing the world, such as non-communicable diseases (NCDs) and climate change, have been slow to be accepted in the current framework, although the focus on NCDs at the UN General Assembly in September, 2011 may be an important step forward. Given these problems and challenges, the editorial proposes that the next MDG framework be built on a shared vision of development across the life course rather than on separate goals and targets. It argues that the issue of equity should be central to any measures, focusing on those who are marginalised.
Equity in Health
According to this report, progress towards achieving sustained and sustainable development in Africa have had mixed results so far. Some positive results have been achieved. Africa has achieved strong and sustained economic growth, outpacing global per capita growth since 2001 after lagging behind for two decades, and helping to reduce the proportion of its population living on less than US$1 a day. Multi-party democracy has taken a stronger hold, and the number of state-based armed conflicts has been reduced. There has been significant progress towards the Millennium Development Goal (MDG) goal of universal primary education. However progress on other MDGs, particularly maternal mortality, has been poor and, according to present trends, no country in Africa will meet all the MDGs by 2015. The report underlines the need to scale up efforts to improve governance including by consolidating the trend to multiparty democracy. Stronger action needs to be taken to resolve long-running conflicts that continue to cause immense human suffering in the continent. Capacity shortages remain a key constraint in all areas.
On 13 May 2010, the United Nations (UN) General Assembly passed resolution 265, ‘Prevention and control of non-communicable diseases’, which called for Heads of State to address NCDs in a high-level plenary meeting scheduled for September 2011. Out of this meeting, and its associated outcome document, will come a series of programmatic steps by all UN members. This editorial analyses the UN resolution and describes the kinds of outcomes that are possible and needed to make chronic non-communicable diseases (NCDs) a global priority among international leaders and to generate global interest and a social movement to ensure commitment by Heads of State. The authors argue that the attention of Heads of State and Government must be secured to promote their participation in the meeting in September 2011. Second, while Member States will decide on the final outcomes of the meeting, international development agencies, the World Bank, UN Agencies, civil society, and the private sector must provide support through a consultative process towards the outcome document. Third, stakeholders must be rallied around a common vision and road map to operationalise a global response to NCDs during the decades to come.
This report on progress towards achieving the Millennium Development Goals is mixed. It acknowledges some success but also points to shortcomings. Successes include progress on poverty reduction – with the developing world as a whole remaining on track to achieve the poverty reduction target by 2015 – and improvements in key disease interventions, which have cut child deaths from 12.5 million in 1990 to 8.8 million in 2008. Between 2003 and 2008, the number of people receiving antiretroviral therapy increased tenfold - from 400,000 to 4 million - corresponding to 42% of the 8.8 million people who needed treatment for HIV. However, some challenges remain. The most severe impact of climate change is being felt by vulnerable populations who have contributed least to the problem, gender equality has shown little progress, armed conflict continues to add to the growing number of refugees worldwide and the number of people who are undernourished has continued to grow, as the slow progress in reducing the prevalence of hunger has stalled in some regions. About one in four children under the age of five are underweight, mainly due to lack of adequate and quality food, inadequate water, sanitation and health services, and poor care and feeding practices. An estimated 1.4 billion people were still living in extreme poverty in 2005. Moreover, the effects of the global financial crisis are likely to persist: poverty rates will be slightly higher in 2015 and even beyond, to 2020, than they would have been had the world economy grown steadily at its pre-crisis pace.
This paper aims to identify cross-cutting challenges that have emerged from Millennium development Goal (MDG) implementation so far. The MDGs have had notable success in encouraging global political consensus, providing a focus for advocacy, improving the targeting and flow of aid, and improving the monitoring of development projects. However, they have also encountered a range of common challenges with regard to conceptualisation and execution: gaps that exist in goals, targets with too narrow a focus, a lack of ownership and poor equity outcomes. The paper concludes that future goals should be built on a shared vision of development, and not on the bundling together of a set of independent development targets. Development should be conceptualised as a dynamic process involving sustainable and equitable access to improved wellbeing, which is achieved by expansion of access to services that deliver the different elements of wellbeing.
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.
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.