Barriers to achieving the health MDGs and how these can be overcome

Action for Global Health UK Policy ConferenceLondon, 28 June 2010

Isabelle de Zoysa

Barriers to achieving the health MDGs and how these can be overcome

Action for Global Health UK Policy ConferenceLondon, 28 June 2010

Isabelle de Zoysa

Health-related MDGs – Scorecard 2010

AFR AMR EMR EUR SEA WPR World

Child Mortality

Measles immunization

Maternal mortality

Skilled birth attendant

Contraceptive use

HIV/AIDS incidence

TB treatment success

Malaria impact

MDG 4

MDG 5

MDG 6

East Africa

Proportion of HIV-related under-5 mortality in African sub-regions, 1990-2007

Central AfricaWest Africa

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

Prop

orti

on (

%)

25

20

15

10

5

0

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

Prop

orti

on (

%)

25

20

15

10

5

0

Southern Africa

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

Prop

orti

on (

%)

25

20

15

10

5

0

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

Prop

orti

on (

%)

25

20

15

10

5

0

Leading causes of death among women of reproductive age (15-44 yrs)

World% Deaths(000s) Cause Ran

k

19.2 682 HIV/AIDS 1

14.6 516 Maternal conditions 2

6.4 228 Tuberculosis 3

4.7 168 Self-inflicted injuries 4

3.7 132 Road traffic accidents

5

Source: Women and Health report, WHO, 2009

Maternal Mortality Trends, 1980-2008

0

600

1200

1800

1980 1990 2000 2008

MMR

Malawi

Mozambique

Lesotho

Cameroon

World

Source: Hogan et al, 2010

Unequal declines in under 5 mortality 1990-2008

Progress diverges across interventions

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

2002 2003 2004 2005 2006 2007 2008

• FAST - scale-up of people receiving ARVs in low- and middle-income countries

Millions

0

10

20

30

40

50

60

70

80

90

100

1990-1999 2000-2008

SLOW – coverage of skilled attendant at delivery, especially in Africa

Skilled birth attendant%

Receiving ARVs

Women and children are dippingin and out of the health care system

Current concerns and opportunities

· Dissatisfaction with fragmentation· Dissatisfaction with inequalities and

progress· Backlash against withdrawal of the

State

· Failure to reach the MDGs· Limitations of “CE interventions”· Recognition of HS bottlenecks and

of adverse effects of global fragmentation

At country level At global level

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...

Country leadership■ Value given to health, equity, solidarity, social

justice■ Individual & institutional

capacities

Financing

Policy Directions universal coverage, primary

care, health in all policies

Strategies Plans

Pharmaceuticals Technology

Infrastructure

Infor-mation

Workforce

Policy dialogue within and

beyond health sector

Comprehensive, integrated,

continuous and people-centred care along the

life-cycle

Cost-effective and safe interventions: clinical &

public health

Universal access to close-to-client

networks, responsible for a

defined population

Including interventions for MDGs 4, 5, 6

Trust in health authorities:● Fairness

● Protection● Competence● Accountability

Health Equity

Health & health

security

Service Delivery

Outcomes

Social inclusion

and participation

Including MDGs 4-5-6

IncludingMDGs 4-5-6

Regulation & Management

institutions, rules,

incentives

Effective aid■ Ownership,

■ Alignment

■ Harmonization

■ Mutual accountability

Governance

Political commitment Mobilise & channel aid

Provide balanced inputs to support HS

Adapt service delivery models (integration, people centredness,

chronic care, access…)

Assist situation analysisAlign programme plans with

National Health PlanInclude stakeholders

Provide guidance on cost-effective interventions

Critical Subsystems

IncludingMDG 3

Integration? …how to make it work..

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!