Health Development Strategies, Post 2015, Global Health

1. Health Development Strategies: the
MDGs and introduction to post 2015
agenda
Joyce L. Browne, MD MSc
PhD fellow
Julius Global Health, Julius Center for Health Sciences and
Primary Care, UMC Utrecht, The Netherlands
www.globalhealth.eu
J.L.Browne@umcutrecht.nl

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)

3. Millennium Development Goals

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)

5. 2001: The Millennium Development Goals (MDGs)
8 goals
18 targets
48 indicators

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

18. Health-MDGs performance

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?

22. MDG 6: HIV/AIDS, Malaria, Tb

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 Development Agenda
Impact of the MDGs

24. 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

25. 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.

26. 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 healthy 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.

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, 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.

28. 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)

29. “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

30. 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?

31. 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).

32. Post-2015 and the SDGs

33. 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)

34. High-level Panel

35. 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
(http://bcove.me/9mxyo5w6)

36. 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.

37. Sustainable Development Goals

38. Sustainable Development Goals

39. SDG 4: Ensuring Healthy Lives

40. 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

41. Recorded lecture: Mr. Anne Poorta,
policy officer Ministry of Foreign
Affairs, The Netherlands

42. PROPOSED GOALS AND TARGETS ON
SUSTAINABLE DEVELOPMENT FOR THE
POST2015 DEVELOPMENT AGENDA
Zero Draft, 3 June 2014

43. 1. End poverty everywhere
2. End hunger, improve nutrition and promote sustainable
agriculture
3. Attain healthy lives for all
4. Provide quality education and life-long learning opportunities
for all
5. Attain gender equality, empower women and girls everywhere
6. Ensure availability and sustainable use of water and sanitation
for all
7. Ensure sustainable energy for all
8. Promote sustained, inclusive and sustainable economic
growth, full and productive employment and decent work for all
9. Promote sustainable infrastructure and industrialization and
foster innovation
10. Reduce inequality within and between countries
Proposed Sustainable Development Goals
to be attained by 2030

44. 11. Make cities and human settlements inclusive, safe and
sustainable
12. Promote sustainable consumption and production
patterns
13. Tackle climate change and its impacts
14. Conserve and promote sustainable use of oceans, seas
and marine resources
15. Protect and promote sustainable use of terrestrial
ecosystems, halt desertification, land degradation and
biodiversity loss
16. Achieve peaceful and inclusive societies, access to
justice for all, and effective and capable institutions
17. Strengthen the means of implementation and the
global partnership for sustainable development
Proposed Sustainable Development Goals
to be attained by 2030

45. Zero Draft: Proposed goal 3.
Attain healthy lives for all (1)
• 3.1 by 2030 reduce the global maternal mortality ratio to less than
70 per 100,000 live births
• 3.2 by 2030 end preventable newborn, infant and under-five
deaths
• 3.3 by 2030 end the epidemics of HIV/AIDS, tuberculosis, malaria,
and neglected tropical diseases
• 3.4 by 2030 reduce substantially morbidity and mortality from
non-communicable diseases (NCDs) through prevention and
treatment, promote mental health and wellbeing, and strengthen
prevention and treatment of narcotic drug, alcohol, and substance
abuse
• 3.5 by 2030 halve deaths from road traffic accidents

46. • 3.6 achieve universal health coverage (UHC), including financial
risk protection, access to essential health care services, and access
to safe, effective and affordable essential medicines and vaccines
for all
• 3.7 by 2030 substantially reduce the number of deaths and
illnesses from air (indoor and outdoor), water and soil pollution
• 3.a strengthen implementation of the Framework Convention on
Tobacco Control in all countries who have ratified the Convention
and urge countries that have not ratified it to ratify and implement
it
• 3.b support research and development of vaccines and medicines
for the communicable diseases that primarily affect developing
countries, provide access to affordable essential medicines, and
support developing countries’ use of TRIPS flexibilities
• 3.c increase substantially the recruitment, development and
training and retention of the health workforce in developing
countries, especially in LDCs
Zero Draft: Proposed goal 3.
Attain healthy lives for all (2)