1. Health Development Strategies: the
MDGs and introduction to post 2015
agenda
Joyce L. Browne, MD MSc
Global Health Unit, Julius Center for Health Sciences and
Primary Care, UMC Utrecht
The Netherlands
2. Learning objectives
• To assess the status of the Millennium
Development Goals(MDGs) in 2013.
• To illustrate lessons learned from the MDGs that
can be applied in post-2015 strategies.
• To provide an overview of post-2015 strategies and
the discussion on the Sustainable Development
Goals (SDGs)
4. The UN Millennium Declaration
2000: UN Development Summit adopted UN
Millennium Declaration [A/Res/55/2]
• 6 values
• Freedom, equality, solidarity, tolerance, respect for nature, shared
responsibility.
• 7 key objectives
• Peace, security and disarmament, development and poverty eradication,
protection of the environment, human rights, democracy, good governance,
protection of vulnerable people, special needs Africa, strengthening UN.
• 11 development targets -> MDGs (2001)
6. MDG 1: Eradicate extreme hunger and poverty
Target 1A:
• Halve the proportion of people living on less than $1 a day
Target 1B:
• Achieve decent employment for Women, Men, and Young
People.
Target 1C:
• Halve the proportion of people who suffer from hunger.
7. Target 2A:
• By 2015, all children can complete a full course of primary
schooling, girls and boys.
MDG 2: Achieve universal primary education
8. Target 3A:
• Eliminate gender disparity in primary and secondary education
preferably by 2005, and at all levels by 2015
MDG 3: Promote gender equality and empower
women
9. Target 4A:
• Reduce by two-thirds, between 1990 and 2015, the under-five
mortality rate
MDG 4: Reduce child mortality rates
10. Target 5A:
• Reduce by three quarters, between 1990 and 2015, the
maternal mortality ratio
Target 5B:
• Achieve, by 2015, universal access to reproductive health
MDG 5: Improve maternal health
11. Target 6A:
• Have halted by 2015 and begun to reverse the spread of HIV/AIDS.
Target 6B:
• Achieve, by 2010, universal access to treatment for HIV/AIDS for all those
who need it.
Target 6C:
• Have halted by 2015 and begun to reverse the incidence of malaria and
other major diseases.
MDG 6: Combat HIV/AIDS, malaria, and other
disease.
12. Target 7A:
• Integrate the principles of sustainable development into country policies and programs;
reverse loss of environmental resources.
Target 7B:
• Reduce biodiversity loss, achieving, by 2010, a significant reduction in the rate of loss.
Target 7C:
• Halve, by 2015, the proportion of the population without sustainable access to safe
drinking water and basic sanitation (for more information see the entry on water supply).
Target 7D:
• By 2020, to have achieved a significant improvement in the lives of at least 100 million
slum-dwellers.
MDG 7: Ensure environmental sustainability
13. Target 8A-F includes:
• Open trading and financial system;
• Debt problems of developing countries;
• (in co-operation with pharmaceutical companies) provide access to affordable
essential drugs in developing countries;
• (in co-operation with the private sector) make available the benefits of new
technologies, especially information and communications
MDG 8: Develop a global partnership
14. The health-related MDGs
MDG 4 Child mortality
MDG 5 Maternal
mortality
MDG 6 HIV/AIDS, malaria
and other diseases
15. 1. Global mobilization on a set of priorities
• Countries, civil society, private sector involvement
• Increases in international aid spending, especially
for health and education
Impact of the MDGs
16. • OECD (Organization for
Economic Co-operation and
Development)’s Development
Assistance Committee (DAC) is
a forum for 29 members to
discuss issues related to aid,
development and poverty
reduction in developing
countries.
• Since introduction of MDGs:
massive increase in DAC
countries pooled aid to health
(red line) and international
organization’s aid to health
(pink line) .
Health funds 1971-2009
OECD, http://www.oecd.org/dataoecd/26/39/49907438.pdf
17. 1. Global mobilization on a set of priorities
• Countries, civil society, private sector
• Increases in health and education aid
2. Establish measurable, monitored and time-bound
objectives
Impact of the MDGs
19. MDG 4: child mortality
• Globally: mortality rate <5 years
dropped 41% (87 -> 57/1,000 live
births)
• Target for 2/3 reduction will likely
not be reached
• Major causes of child mortality:
pneumonia, diarrhea, malaria and
malnutrition. Majority of <5
mortality is in the first year of life.
• Questions: which regions are on
track? Which regions are not?
What could be explanations for
this?
20. MDG 5: maternal mortality
• Globally: maternal mortality has
been one of the worst performing
indicators, and only in the past few
years received increased attention.
• Yet, MDG5 lags the most behind,
and will likely not be reached.
• Major causes of maternal mortality:
sepsis (infection), hemorrhage
(severe bleeding) hypertensive
disorders in pregnancy and unsafe
abortion. e.
• Questions: which regions are on
track? Which regions are not? What
could be explanations for this?
21. MDG 6: HIV/AIDS, Malaria, Tb
• Globally number of newly infected HIV patients
continues to fall (21% decrease between 2001-
2011)
• 1.8 infections were prevented in sub-Saharan
Africa. The sharpest decline was reached in the
Caribbean (43%). Because of successful
mother-to-child transmission prevention
programs, child infection has reduced
significantly.
• The majority (60%) of people between 15-24 in
low- and middle income countries infected, are
women. Young girls seem more vulnerable
because of factors as gender inequality and
physiological factors.
• Questions: which regions are on track? Which
regions are not? What could be explanations
for this? What could be gender en
physiological factors that increase the
vulnerability of women?
23. 1. Global mobilization on a set of priorities
• Countries, civil society, private sector
• Increases in health and education aid
2. Establish measurable, monitored and time-bound
objectives
• Overall progress: substantial, but variable across
goals, targets, regions, countries, and within
countries.
• Lessons from the MDGs can be learned for post-
2015
Impact of the MDGs
24. 1. Global mobilization on a set of priorities
• Countries, civil society, private sector
• Increases in health and education aid
2. Establish measurable, monitored and time-bound
objectives
Overall progress: substantial, but variable across goals,
targets, regions, countries, and within countries.
Lessons from the MDGs can be learned for post-2015
Impact of the MDGs
25. However.. There are shortcomings to
the MDGs
• Conceptualization and execution
• Ownership
• Equity
Lancet and LIDC (2010): The MDGs: a cross-sectoral analysis and principles for goal setting after 2015
26. Shortcoming 1: conceptualization and
execution
1. Important themes are missing:
• Of the original Millennium Declaration: Peace, security and
disarmament, human rights
• New emerging themes: Climate change, economic development
2. Goals, targets and indicators are narrowly defined,
without identification and exploitation of cross-
links
• E.g. only primary education, agriculture, nutrition
• Measurability of (some) indicators
3. Do not promote efficient horizontal and multi-
sectorial approach embedded in health systems.
27. Shortcoming 1: conceptualization and
execution
1. Important themes are missing:
• Of the MDs: Peace, security and disarmament, human rights
• Climate change, economic development
2. Goals, targets and indicators are narrowly defined,
without identification and exploitation of cross-
links
• E.g. only primary education (where is secondary education?),
agriculture (availability of health food, agriculture as an important
pillar for economic development), nutrition (nutrition links to many
themes, like health, economic development through a healthy
workforce, and peace and security in the absence of scarcity.
• Measurability of (some) indicators
3. Do not promote efficient horizontal and multi-
sectorial approach embedded in health systems.
28. Shortcoming 1: conceptualization and
execution
1. Important themes are missing:
• Of the MDs: Peace, security and disarmament, human rights
• Climate change, economic development
2. Goals, targets and indicators are narrowly defined,
without identification and exploitation of cross-
links
• E.g. only primary education, agriculture, nutrition
• Measurability of (some) indicators
3. Do not promote efficient horizontal and multi-
sectorial approach embedded in health systems.
• “Silo-approach”, striking example: shiny well-funded HIV-clinic next
a worn-down public hospital.
29. Shortcoming 2: ownership
1. Meaningful national ownership developing
countries?
• Drafting process: donor and/or expert driven?
• Underrepresentation of developing countries
• Underrepresentation of civil society
2. Leadership on specific MDGs
• Especially MDG5 (maternal health)
• Process of setting national targets (≠ global
targets)
30. “Equity is the absence of avoidable or remediable differences
among groups of people, whether those groups are defined
socially, economically, demographically, or geographically.
Health inequities therefore involve more than inequality with
respect to health determinants, access to the resources needed
to improve and maintain health or health outcomes. They also
entail a failure to avoid or overcome inequalities that infringe on
fairness and human rights norms.” - WHO
Shortcoming 3: equity
31. Shortcoming 3: equity
1. Aggregation of data vs. disaggregation
• Disaggregation means: assessing the data and
progress separately for important subgroups. For
example: socio-economic status, gender.
2. MDGs promote an approach to focus on easiest-
to-reach populations?
32. MDGs conclusion
• Important global mobilizer to focus efforts; obtain
and measure results; and to improve lives and
wellbeing.
• Reflecting on MDGs strengths and weaknesses,
informs the post-2015 Agenda.
• Post-2015: Sustainable Development Goals (SDGs).
34. Rio+20
June 2012: Meeting of world
leaders, governments, private
sector, NGOs and other groups
• Sustainable development
through:
• Economic development
• Environmental sustainability
• Social inclusion (fairness)
36. Process
• Inclusive consultation
• Meetings with key stakeholders (governments, civil
society, business, academia, youth, etc)
• Involvement of the public
• Global conversation on the post-2015 SDGs
37. Transformative principles of the
universal post-2015 agenda
• Leave no one behind.
• Put sustainable development at the core.
• Transform economies for jobs and inclusive
growth.
• Build peace and effective, open and accountable
institutions for all.
• Forge a new global partnership.
42. Health
Horton on health in the SDGs:
With the emphasis on interconnected goals/targets, is the
position of health not appropriate?
43. Road ahead
• 2013-2014:
Open Working Group: recommendations road
ahead
Expert Working Group on Financing of the SGDs
• 2015:
Summit meeting for member states to agree on
new goals and mobilize global action
• 2016:
Implementation of new agenda
Global commitment to time bound target to eradicate poverty, hunger and improve health Targets MD:• To halve, by the year 2015, the proportion of the world’s people whose income is less than one dollar a day and the proportion of people who suffer from hunger and, by the same date, to halve the proportion of people who are unable to reach or to afford safe drinking water. • To ensure that, by the same date, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling and that girls and boys will have equal access to all levels of education.• By the same date, to have reduced maternal mortality by three quarters, and under-five child mortality by two thirds, of their current rates.• To have, by then, halted, and begun to reverse, the spread of HIV/AIDS, the scourge of malaria and other major diseases that afflict humanity.• To provide special assistance to children orphaned by HIV/AIDS.• By 2020, to have achieved a significant improvement in the lives of at least 100 million slum dwellers as proposed in the “Cities Without Slums” initiative.• To promote gender equality and the empowerment of women as effective waysto combat poverty, hunger and disease and to stimulate development that istruly sustainable.• To develop and implement strategies that give young people everywhere a realchance to find decent and productive work.• To encourage the pharmaceutical industry to make essential drugs more widelyavailable and affordable by all who need them in developing countries.• To develop strong partnerships with the private sector and with civil societyorganizations in pursuit of development and poverty eradication.• To ensure that the benefits of new technologies, especially information andcommunication technologies, in conformity with recommendations containedin the ECOSOC 2000 Ministerial Declaration,are available to all.
The Organisation for Economic Co-operation and Development's (OECD)Development Assistance Committee (DAC) is a forum for selected OECD member states to discuss issues surrounding aid, development and poverty reduction in developing countries. It describes itself as being the "venue and voice" of the world's major donor countries.There are 29 members of DAC, including the European Union, which acts as a full member of the committee. The World Bank, the IMF and UNDP participate as permanent observers
Worldwide, the mortality rate for children under five dropped by 41 per cent—from 87 deaths per 1,000 live births in 1990 to 57 in 2011. Despite this enormous accomplishment, more rapid progress is needed to meet the 2015 target of a two- thirds reduction in child deaths. Since the adoption of the MDGs in 2000, the rate of decline in under-five mortality has accelerated globally and in many regions. Sub-Saharan Africa—with the highest child death rate in the world—has doubled its average rate of reduction from 1.5 per cent a year in 1990–2000 to 3.1 per cent a year in 2000–2011. In sub-Saharan Africa but also other regions, countries with the highest child mortality rates are driving the downward trend: 45 out of 66 such countries have increased their rates of reduction over the previous decade. Still, the pace of change must accelerate even further, particularly in sub-Saharan Africa and Southern Asia, if the MDG target is to be met.f the MDG target is to be met, efforts must concentrate on those countries and regions where the most child deaths occur and where child death rates are highest. India and Nigeria, for example, account for more than a third of all deaths in children under five worldwide, while countries such as Sierra Leone and Somalia have under-five mortality rates of 180 or more per 1,000 live births. Of 49 countries in sub-Saharan Africa, only eight (Botswana, Cape Verde, Ethiopia, Liberia, Madagascar, Mali, Nigeria and Rwanda) are expected to achieve the MDG target if current trends continue.At the same time, systematic action is required to target the main causes of child death (pneumonia, diarrhoea, malaria and undernutrition) and the most vulnerable children. This includes a stronger focus on neonatal mortality, which is now a driving factor in child mortality overall. Simple, cost-effective interventions such as postnatal home visits have proven effective in saving newborn lives.Emerging evidence has shown alarming disparities in under-five mortality within countries, and these inequities must be addressed. Children born into
Worldwide, the number of people newly infected with HIV continues to fall, dropping 21 per cent from 2001 to 2011. Still, an estimated 2.5 million people were infected with HIV in 2011—most of them (1.8 million) in sub-Saharan Africa. Over a decade, new infections in that region fell by 25 per cent. They dropped by43 per cent in the Caribbean, the sharpest decline of any region, resulting in an estimated 13,000 new infections in 2011.Despite progress overall, trends in some regions are worrisome. In the Caucasus and Central Asia, for example, the incidence of HIV has more than doubled since 2001. An estimated 27,000 people were newly infected in that region in 2011.About 820,000 women and men aged 15 to 24 were newly infected with HIV in 2011 in low- and middle- income countries; more than 60 per cent of them were women. Young women are more vulnerable to HIV infection due to a complex interplay of physiological factors and gender inequality. Because of their low economic and social status in many countries, women and girls are often at a disadvantage when it comesto negotiating safer sex and accessing HIV prevention information and services.
Leave no one behind:Not only aggregated data, but specially looking at those least well off: poorest strata, vulnerable groups. And make explicit that the target cannot be reach without including them.
