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Introduction to global health

A discussion of the progress made, and on-going limitations and challenged faced by the Philippines,

in meeting one of the health related MDGs. What lessons can be learnt from the findings?

!"#$ %

Word count& ',(((

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MDG )* +)MMI

W /

0ountdo1n countries

Aims of MDGs

he ris2 of a 1oman losing her life as a result of child-bearing is appro3imately 4#5 in the

poorest regions of the globe compared to (.(((('5 in *orthern 6urope i. his huge ine7uity is part of

the reason the global impetus to increase policy inter8ention for maternal health began 1ith the +afe

Motherhood Initiati8e in 49$ in *airobi ii. his momentum 1as carried for1ard in the form of the 499"

International 0onference on Population and De8elopment iii. he culmination of this mo8ement 1as

1hen a commitment to reducing maternal mortality 1as included in one of the eight goals for global

de8elopment outlined in the Millennium Declaration i8 signed by 4$9 member countries at the )nited

*ations Millennium +ummit in +eptember %(((. he World ealth /rganisation :W /; has identified

# of the Millennium De8elopment Goals :MDGs; as primarily focused on health. MDG 4 is centred on

reducing e3treme po8erty and hunger, MDG " at combating child mortality, MDG ! at impro8ing

maternal health, MDG # at combating I<=AID+, malaria and other diseases, MDG at pursuing

en8ironmental sustainability and MDG $ at de8eloping a global consortium for de8elopment. 8 o

monitor progress, MDGs ha8e %4 targets 1ith #( technical indicators. It can be argued that globally

there ha8e been many signs of 8ery positi8e de8elopment. >or e3ample, the target of reducing

e3treme po8erty by half 1as reached ! years ahead of the %(4! deadline as 1ell the target of hal8ing

the proportion of people 1ho lac2 dependable access to drin2ing 1ater. 8i o1e8er, many 2ey count-do1n@ countries are ma2ing insufficient or no progress at all. 8ii In addition to this, the MDGs

themsel8es ha8e been condemned for being unsustainable, lac2ing focus in local participation and

unbalancing healthcare system priorities. 8iii his paper 1ill e3plore the progress, limitations and

challenges faced by a de8eloping country in relation to achie8ing the target set by one of the MDGs

as 1ell as the rele8ance of the MDGs in a changing global health climate.

MDG ! is split into t1o targets !a and !b. arget !a 1as to reduce the MMB by !5 from

499( to %(4! i3 1ith the rele8ant indicators being MMB and the proportions of births 1ith s2illed health

personnel present. arget !b is to reach uni8ersal access to reproducti8e health :B ; by %(4!.arget !a 1ill form the focus of this discussion. According to the W /, the maternal mortality ratio

:MMB; of a nation is defined as the number of deaths of 1omen during pregnancy, childbirth or in the

"% days after deli8ery due to causes directly or indirectly related to the pregnancy per 4((,((( of the

population o8er a gi8en time period :usually a year;. 3 he MMB of a nation co8ers many of the issues

at 1hich the MDGs are designed to combat as reducing MMB in8ol8es targeted health and social

policies that are informed by 8alid epidemiological data. 0onse7uently, MMB is arguably a good

measure of a country@s de8elopment progress. It must be noted that maternal mortality is not the only

indicator on 1hich progress to1ard MDG ! should be Cudged as the 1ider spectrum of co-morbidities

related to childbirth are Cust as rele8ant

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Global MMB 1as around !"',((( in 499(. A decade later, the annual number had decreased

to %$ ,((( 3i. hese figures can be considered to be positi8e international progress to1ard the %(4!

target of 4'$,(((. Global a8erages can often hide large ine7uity as perhaps highlighted 1hen in %(4(

a W / pape identified that +ub +aharan Africa and +outh Asia ma2e up $ 5 of maternal deaths

globally3ii

. Another World ealth /rganisation :W /; report in conCunction 1ith the )nited *ations0hildren@s >und :)*I06>; % years later detailed ## nations mostly situated in sub +aharan Africa that

are unli2ely to achie8e MDG !a 3iii by %(4!. It is prescient to ac2no1ledge that despite the 4994

Abou ahr E Boyston paper being the most 1idely cited source regarding global maternal mortality,

more recent systematic re8ie1s ha8e concluded that it has unclear methodology and assumes fi3ed

distribution across all regions. 3i8 he magnitude and direction of regional differences are un2no1n and

e8en though a recent W / estimate e3plored a brea2do1n of MMB by cause and region again the

regional differences 1ere not reported. 38 A %((# systematic re8ie1 conducted by the W / perhaps

has the clearest picture of global MMB and respecti8e causes. 38i /ut of '" datasets and '!,49

maternal deaths the leading contributors in de8eloping countries 1ere haemorrhage and hypertensi8e

disorders. he Philippines is a nation that lies 1ithin this data set of de8eloping countries not on

target for MDG!a by %(4! but interestingly is on target for the socially related MDG" of child mortality

reduction and has one of the lo1est under ! mortality rates out of the countdo1n countries. 38ii

he Philippines is an archipelago in south eastern Asia. It has a total land area of '((,(((

2m% o8er ((( islands. his disparate spread of communities ma2es it e3tremely difficult to

transpose 1estern industrialised centralised health infrastructure measures. he nation@s annual

population gro1th rate of %.(" ma2es it one of the 7uic2est gro1ing populations in the region. his

high fertility rae is Cu3taposed 1ith a high MMB of 99 deaths per 4((,((( In %(44, "95 of the

population 1as located in urban areas and his 8alue is predicted to rise to (5 by %(4!. 38iii

I<

D

0ountry o8er8ie1

ealth ser8ice principles

Go8ernment dates

Demographics

Disease control 8s maternal health F re7uire programs

Maternal death, causes MDG goal e8aluation

>ertuility rate contracepti8es

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i WHO, UN Children's Fund, UN Population Fund Maternal mortality in 2000: estimates developed yWHO, UN!C"F, UNFP#World Health Or$ani%ation, &eneva 200()

ii #M *tarrs *a+e motherhood initiative: 20 years and ountin$ -an et, ./ 200/), pp1 .03 .2

iii !nternational Con+eren e on Population and 4evelopment*ummary o+ the !CP4 Pro$ram o+ # tion1 !nternationalCon+eren e on Population and 4evelopment 20 0http:556661un+pa1or$5i pd5summary1 +m Mar h, 778)

iv C 9onsmans, W &raham, on ehal+ o+ ;he -an et Maternal *urvival *eries steerin$ $roup Maternalmortality: 6ho, 6hen, 6here, and 6hy -an et, ./ 200/), pp1 73 200

v United Nations &eneral #ssem ly, United Nations Millennium 4e laration1 #59"*58852United Nations, Ne6 <or= 2000)

vi United Nations, ;he Millennium 4evelopment &oals 9eport 20 2

vii >utta ?, 20 0, Countdo6n to 20 8 de ade report 20003 0): ta=in$ sto = o+ maternal, ne6 orn, and hildsurvival, ;he -an et, @olume .A8, !ssue 7A.0, 83 une 20 0, Pa$es 20.2320((

viii 4eneulin, * B *hahani, -1 2007)1 #n !ntrodu tion to the Human 4evelopment and Capa ity #pproa h1-ondon: "arths an1 p A /71

iD United Nations &eneral #ssem ly, United Nations Millennium 4e laration1 #59"*58852United Nations, Ne6 <or= 2000)

D Maternal mortality in 2000Maternal Mortality "stimates developed y WHO, UN!C"F and UNFP#1 &eneva, WorldHealth Or$ani%ation, 200(1

Di C # ou?ahr, " 9oyston, WHO, Maternal mortality: a $lo al +a t oo=1 WHO5MCH5M*M57 1.WorldHealth Or$ani%ation, &eneva 77 )

Dii WHO1 20 0)1 ;rends in Maternal Mortality: 770 to 200 1 &eneva: WHO1 p 81

Diii WHO B UN!C"F1 20 2)1 Countdo6n to 20 81 Washin$ton: Communi ations 4evelopment!n orporated1 p 7(1

Div Ehan E, WHO analysis o+ auses o+ maternal death: a systemati revie6, ;he -an et, @olume ./A, !ssue 78 /, 3A#pril 200/, Pa$es 0//3 0A(

Dv WHO, 9evised &lo al >urden o+ 4isease 2002 "stimates,http:5566616ho1int5healthin+o5 od$ d2002revised5en5indeD1htm

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Dvi Ehan E, WHO analysis o+ auses o+ maternal death: a systemati revie6, ;he -an et, @olume ./A, !ssue 78 /, 3A#pril 200/, Pa$es 0//3 0A(

Dvii http:556661uni e+1or$5esaro5Promise rene6ed pro$ress summary1pd+

Dviii http:5566616ho1int5 ountry+o us5 ooperation strate$y5 s rie+ phl en1pd+