6.5 Monitoring of the achievement of the health-related Millennium Development Goals and Global health goals after 2015

Posted Mon, 2011-11-21 01:41

Secretariat papers

This agenda item includes three sub items:

  • Progress in the achievement of the health-related Millennium Development Goals 
  • Global health goals after 2015 
  • Implementation of the recommendations  of the Commission on Information and Accountability for Women’s and Children’s Health

Document EB130/13 provides the annual report on the progress  supplemented by information on the reduction of perinatal and neonatal mortality and the prevention and treatment of pneumonia with further consideration of next steps towards goal-setting after 2015. 

Document EB130/14 provides an account of the actions taken and progress made in the implementation of the recommendations of the Commission on Information and Accountability for Women’s and Children’s Health.

Watchers' notes of EB discussion

 

The discussions were guided by two reports from the WHO Secretariat; one progress report on the health related MDGs and one on the implementation of the recommendations of the Commission on Information and Accountability for Women’s and Children’s Health.

The first report included a section on ‘global health goals after 2015’ (click here for a summary of the report). In addition, a draft resolution was introduced by Canada, Norway, Tanzania and Senegal.

Countries first commented on the report and then had a second round of comments on the draft resolution.  

All countries emphasized the importance of this agenda item and the US and Korea specifically expressed hope it would take an important place in the WHO reform process. Many countries were concerned about the lack of progress in reducing maternal mortality.

The Syrian Arab Republic on behalf of EMRO noted that there were still too many pregnancy-related deaths due to absence of required care. The need for a skilled and motivated workforce that is equally shared between rural and urban areas was mentioned by several African countries.  

Myanmar stressed the importance of monitoring and ensuring quality of data by strengthening health information systems. Thailand backed them and noted further that the resolution submitted by Canada & co did not pay attention to feedback mechanisms.

Estonia requested WHO to provide an analysis on why progress is better in some countries than others. The ADG/IER took note of this request.  

Senegal speaking for the African region emphasized that the financial crisis should not be a pretext for diminishing support for the MDGs. Given the face of the challenges the Region is facing, they are reliant on the help of the international community.

Morocco mentioned the high cost of pneumococcal vaccines as a major obstacle.

As the draft resolution only referred to strengthening national accountability processes, Thailand stressed the need for commitment at Member States’ level to mobilize financing and the importance of accountability of MS towards the organisation.

The statement brought by MSF was also very clear on the need to scale-up funding. Germany noted to have increased their funds to GAVI (30 million) as they see immunization as a powerful strategy to achieve MDGs 4.

The US recognized the resource-problem due to the economic crisis and called upon all Member States and WHO to double their efforts.

Recommendations to improve progress on MDGs

Senegal (AFRO) stressed the importance of vaccination campaigning, strengthening of health systems and training of staff, access to effective drugs against main killers for the poorest people and the need for social security.

The importance of health system strengthening was reiterated by Switzerland, Germany, Canada and India.

The Syrian Arab Republic emphasized the need for more involvement of civil society to address injustices and inequities in access to healthcare, especially for the marginalized populations, to achieve gender equality and respect for human rights.

Estonia (EU) noted that the right to health should be ensured for marginalized groups in society and financial barriers to care removed.

A similar point was made by Côte d’Ivoire. The need for increased efforts to address the social determinants of health was stressed by several countries, including Estonia (EU) and Switzerland.

Morocco noted that more coordination between different Ministries is needed to achieve the MDGs. Uzbekistan stressed that health care is part of society, not to be tackled only by the health sector, using early marriages and fertility rate as an example. ‘Health goes beyond the health sector’. They identified the following as essential to achieve the MDGs: political commitment, enhancing investment, enhancing HSS and coordination. They believed WHO has to take the lead globally to tie it all together.

Brunei mentioned that the current economic crisis and climate changes pose a threat to achieve MDGs and stated that UHC should remain one of the most important actions.

India noted progress can be made by working towards universal health coverage (UHC) with free delivery, elimination of out-of-pocket expenditures and community-based care and early detection of emergencies.  

Global goals after 2015

The Secretariat’s report stated that WHO would focus on specific areas where achievements lag behind expectation.

The Rio Declaration on SDH would be used to address the issue of inequity. The report further identifies new challenges to health such as urbanization, ageing, migration, economic uncertainty, scarcity of natural resources, climate change, food insecurity and the double burden of infectious and noncommunicable diseases.

This new set of challenges was stressed by Norway, stating that ‘in 2015 the world will be very different’ (climate change, NCDs, food security....). They noted that for future goals changes in geopolitical and economic reality need to be taken into account.

A similar point was made by the UK that the post-MDG framework should reflect the new global context and health challenges, while retaining the simplicity of the current framework. The world has changed, it is no longer easy to categorize countries in developing versus developed. They urged the need for incentives for action beyond aid. As aid dependence is falling, any development framework focusing only on aid would become irrelevant.  

The Secretariat’s report also stated that ‘thinking about development has changed’. While the MDGs are very development focused, goals need to be recast in the face of global challenges (climate change, food insecurity and financial crises) to recognize that development is a process that affects all societies, with indicators that can be used to measure overall global progresstowards sustainable development. Such a broader conception of development must favour and not diminish the role of health; health should serve as the benchmark for measuring the impact of policies in all fields. Progress should be monitored in ways that go beyond purely economic measures such as GDP. The report further stated that setting new health goals needs to be clearly linked with the process of the WHO reform, a point backed by Switzerland.

India mentioned the following as global health goals after 2015: NCDs, universal access to health services, reducing barriers to access and health system strengthening.

The ADG on Innovation, Information, Evidence and Research (IER) stated the new framework will focus on sustainable development and the socio-economical determinants of health. A new goal would be the premature mortality due to NCDs. She noted that, while recognizing the sovereign rights of nations of discussing the post-2015 goals, WHO is engaging in the UN system task team for a proposal of a post-MDG framework. This proposal would be ready in May 2012 and would then go to the high-level panel to advise the UN Secretary General. The panel would be announced following the Rio+20 conference.

The discussion on the draft resolution was surprisingly short. Norway clarified that the resolution urges MS to honour their commitments to the Secretary General’s Global Strategy for Women’s and Children’s Health. It also seeks to underline WHOs crucial role in the follow up of the commission’s recommendations.

The draft resolutions got much support. Timor-Leste requested to add that future cooperation should include action on the SDH, going beyond the health sector, but as they did not suggest any language, the point got lost. No other MS suggested an amendment and the resolution was adopted. 

 

PHM Comment

See WHO Watch MDGs topic page for more background and general comment.

The report on MDGs progress in EB130/13 is a valuable summary of key issues in global health. There has been some progress over the last 10-20 years but the current figures for most of the indicators continue to reflect a serious health crisis.  Clearly the specific interventions promoted under the MDGs banner are important but the wider issues of social and economic development and functioning health systems loom large behind this 'intervention focus'.  For example, access to skilled birth attendants cannot be separated from functioning health systems and decent roads and public transport.  

EB130/13 also includes some comments on global health goals after 2015. The paper offers some useful ideas regarding unfinished business, new challenges and new thinking about 'development'.

PHM comment. The next round of global health goals should include targets which are focused on process as well as outcomes, on the strategies for change. It will need to focus on both the disease focused interventions and the conditions for sustainable and inclusive social and economic development.  It will need to focus on building integrated functioning health systems that can deliver the necessary interventions as part of their regular work and reducing dependence on separate outside funders paying for highly specific interventions.   

Implementing the recommendations of the Commission on Information and Accountability.  The background to Document EB130/14:

The 'key elements' of the Global Strategy are listed in the report as: 

  • Country led health plans (with donor support)
  • A comprehensive, integrated package of essential interventions and services
  • Integrated care
  • Health systems strengthening
  • Health workforce capacity building
  • Coordinated research and innovation.

 The essential interventions include: 

  • Quality skilled care for women and newborns during and after pregnancy and childbirth (routine as well as emergency care)
  • Improved child nutrition and prevention and treatment of major childhood diseases including diarrhoea and pneumonia
  • Safe abortion services (where not prohibited by law) 
  • Comprehensive family planning
  • Integrated care for HIV/AIDS (i.e., PMTCT), malaria and other services

The Commission's brief was to consider the information needed to track implementation of the global strategy and results and to ensure accountability of countries and donors.  The Commission's report was structured around 10 recommendations dealing with: 

  • Better information for better results
  • Tracking resources for women's and children's health
  • Better oversight of results and resources

The appointment of the Independent Expert Review Group was recommended by the Commission.

Document EB130/14 summarises this background and reports that WHO has commenced consultations with various 'stakeholders' to convert the 10 recommendations of the Commission's report into a common strategic workplan. 

PHM Comments at EB 130

The report indicates that some progress has been made over the last decade, but as correctly pointed out the current figures for most of the indicators continue to reflect a serious health crisis. While the specific interventions promoted to address the MDGs are important, it is also necessary to learn from the failure in many regions to achieve the targets that were set.
Primarily this failure has its roots in the MDGs often being looked at as vertical targets, without adequate connections being drawn with underlying issues related to social and economic development and the functioning of health systems. For example, trade and intellectual property policies influence the availability and affordability of medicines in developing countries,
and accordingly have an adverse impact on maternal and child health.

Document EB130/13 also seeks to initiate the process of identifying global health goals after 2015. We urge Member States to identify, as priorities, not just targets but processes and determinants that need to change in order for targets for improved conditions of health to be achieved. Importantly, the focus has to be on building and sustaining integrated functioning health systems that can deliver the necessary interventions as part of their regular work and at reducing dependence on multiple  funding and governance mechanisms for highly specific interventions.