Transcript Slide 1
Barriers to achieving the health MDGs and how these can be overcome Action for Global Health UK Policy Conference London, 28 June 2010 Isabelle de Zoysa Health-related MDGs – Scorecard 2010 AFR AMR EMR EUR SEA WPR World MDG 4 Child Mortality Measles immunization MDG 5 Maternal mortality Skilled birth attendant Contraceptive use MDG 6 HIV/AIDS incidence TB treatment success Malaria impact 0 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 0 2007 2006 2005 2004 2003 2002 2001 2000 5 1999 10 1998 15 1997 20 1996 20 1995 25 1994 East Africa 0 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 5 1993 10 1992 15 1992 20 1991 20 1991 25 Proportion (%) 25 1990 Proportion (%) West Africa 1990 25 Proportion (%) 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 0 1990 Proportion (%) Proportion of HIV-related under-5 mortality in African sub-regions, 1990-2007 Central Africa 15 10 5 Southern Africa 15 10 5 Leading causes of death among women of reproductive age (15-44 yrs) World Ran Cause k 1 HIV/AIDS Deaths(000s) % 682 19.2 2 Maternal conditions 516 14.6 3 Tuberculosis 228 6.4 4 Self-inflicted injuries 168 4.7 5 Road traffic accidents 132 3.7 Source: Women and Health report, WHO, 2009 Maternal Mortality Trends, 1980-2008 Malawi 1800 Mozambique Lesotho Cameroon World MMR 1200 600 0 1980 Source: Hogan et al, 2010 1990 2000 2008 Unequal declines in under 5 mortality 1990-2008 Progress diverges across interventions • FAST - scale-up of people receiving ARVs in low- and middle-income countries Millions 4.5 4 SLOW – coverage of skilled attendant at delivery, especially in Africa % Receiving ARVs 100 90 3.5 80 3 70 2.5 60 2 50 1.5 40 Skilled birth attendant 30 1 20 0.5 10 0 2002 2003 2004 2005 2006 2007 2008 0 1990-1999 2000-2008 Women and children are dipping in and out of the health care system Current concerns and opportunities At country level · · · Dissatisfaction with fragmentation Dissatisfaction with inequalities and progress Backlash against withdrawal of the State At global level · · · Failure to reach the MDGs Limitations of “CE interventions” Recognition of HS bottlenecks and of adverse effects of global fragmentation Recognition of importance of clarity on “broad policy directions (UC, PHC, HiAP, …) Country interest in national policy dialogue on health (cfr elections, media, lobbies) Global interest in “one plan, one funding mechanism, one M&E framework) E.g. China, USA, Switzerland, Thailand... E.g. IHP+, Common funding platform... Health & health security Health Equity Including Including MDGs 4-5-6 MDGs 4-5-6 Social inclusion and participation Trust in health authorities: ● Fairness ● Protection ● Competence ● Accountability Including MDG 3 Integration? …how to make it work.. Outcomes Provide guidance on costeffective interventions Cost-effective and safe interventions: clinical & public health Comprehensive, integrated, continuous and people-centred care along the life-cycle Including interventions for MDGs 4, 5, 6 Universal access to close-to-client networks, responsible for a defined population Service Delivery Financing Workforce Adapt service delivery models (integration, people centredness, chronic care, access…) Pharmaceuticals Technology Infrastructure Information Provide balanced inputs to support HS Critical Subsystems Policy dialogue within and beyond health sector Policy Directions universal coverage, primary care, health in all policies Strategies Plans Regulation & Management institutions, rules, incentives Assist situation analysis Align programme plans with National Health Plan Include stakeholders Governance Country leadership ■ Value given to health, equity, solidarity, social justice ■ Individual & institutional capacities Political commitment Effective aid ■ Ownership, ■ Alignment ■ Harmonization ■ Mutual accountability Mobilise & channel aid Don't turn away now • • • • • • • • .5 m cases multidrug resistant TB 1 m malaria deaths 2.7 m new HIV infections 5 m people in need without access to ARVs 3-800,000 maternal deaths 3 m diarrhoea & pneumonia deaths in children 8.8 child deaths 1100 m people without access to sanitation Addressing the challenges • Sustain high level political commitment • Ensure sustainability of resources in times of economic crisis • Strengthen health systems to deliver integrated interventions across the life course • Promote implementation research to learn from successes and failures across countries and interventions • Build sound information systems to identify problem areas and monitor change. Opportunities to make a difference • Regional commitments (such as the Maputo Plan of Action and Campaign on Accelerated Reduction of Maternal Mortality in Africa) • The Joint Action Plan and accountability framework • Muskoka Initiative – additional funding for a comprehensive and integrated approach to accelerate progress towards MDGs 4 & 5 • Commitment to integrating approaches to maximize health outcomes related to MDGs 4, 5 and 6, while strengthening health systems • Global mobilization around scaling up PMTCT towards elimination • GF Board Decision to explore options for optimizing synergies with Maternal and Child Health; GF replenishment • Other programming and financing opportunities (GHI/PEPFAR etc) Thank you!