Building up and strengthening health systems is vital if more progress is to be made towards the Millennium Development Goals (MDGs), the World Health Organization (WHO) said in a new report. Unless urgent investments are made in health systems, current rates of progress will not be sufficient to meet most of the goals.
The report, Health and the Millennium Development Goals, presents data on progress on the health goals and targets and looks beyond the numbers to analyse why improvements in health have been slow and to suggest what must be done to change this. The report points to weak and inequitable health systems as a key obstacle, including particularly a crisis in health personnel and the urgent need for sustainable health financing.
Without more rapid progress on developing health systems, large numbers of people will continue to die from mostly preventable diseases. Annual avoidable deaths in developing countries include: almost 11 million children under five, approximately one million people from malaria, and more than half-a-million women in pregnancy and childbirth. The HIV/AIDS pandemic takes three million lives each year.
"Building strong health systems requires improvements across governments - in public financial management, manpower planning, roads and infrastructure, and many other areas," said WHO Director-General Dr LEE Jong-wook. “We need to look beyond the health sector if we are to be successful, and we must take an integrated approach. If we do, success is possible.”
Despite gains in reducing poverty worldwide, the data presented in the new WHO report indicate that if trends established in the 1990s continue, the majority of developing countries will not achieve the health MDGs. This in turn will affect progress towards other goals. With less than ten years to the target date of 2015, none of the poorest regions of the developing world are on track to meet the child mortality target. For maternal mortality, declines have been limited to countries which already have lower mortality levels. The goal of reversing the spread of HIV/AIDS and reversing the incidence of malaria and other communicable diseases remains a huge challenge in sub-Saharan Africa. The safe water target may be achieved globally, but not in sub-Saharan Africa.
"Providing universal access to broad-based health services could save several million children's lives each year,” said Dr LEE. “That would reverse the downward trends and bring us two-thirds of the way to meeting the child mortality goal, and 70% to 80% towards meeting the maternal mortality goal.” “We have the treatments; the technology is known and affordable,” Dr LEE said. “The problem in many countries is getting the staff, medicines, vaccines and information to those who need them on time and in sufficient quantities. In too many countries, the health systems to do that either do not exist or are on the point of collapse.”
WHO says securing sustainable health systems financing is key. A minimum of US$ 30-40 per capita is needed annually to finance a minimum health package, but many poor countries invest far less, on average US$ 10 per capita, and in some countries, as little as US$ 2 per capita. Achieving the health MDGs will be impossible without a considerable increase in investment and commitment from developing and donor countries. The UN Millennium Project recently said that meeting all the MDGs would require an estimated US$ 135 billion of Official Development Assistance, rising to US$ 195 billion by 2015.
“Global political commitment for long-term financing of the MDGs is crucial,” said Dr Andrew Cassels, WHO Director of MDGs, Health and Development Policy. “We must use all potential means of raising resources, including debt relief. We need resources which are predictable and sustained to allow countries to make long-term plans. And health must be at the centre of these efforts.”
Health systems require not only urgent investment, but also commitments from developing countries to increase accountability and prioritize health in national and poverty reduction plans, and from donors to better coordinate aid. One example of lack of coordination given in the report is that of Viet Nam, where 400 donor missions visited in one year. Lack of coordination renders already fragile health systems even weaker. In an effort to tackle this problem in relation to health statistics, a wide range of partners has come together to form the Health Metrics Network, a global partnership designed to improve the availability and quality of health data and thus enhance accountability.
In many countries, particularly in Africa, lack of staff is at the centre of the health systems challenge. “Out-migration, deaths from AIDS and above all, poor pay and conditions have created a human resources crisis,” said Dr Ties Boerma, WHO director of Measurement and Health Information Systems, “90% of Africa lives in areas where there are fewer than five doctors per 10 000 people.”
At the 2005 World Health Assembly, WHO Member States repeated the call for donors to raise levels of Official Development Assistance to 0.7% of GNP; this was coupled with a call for developing countries to also prioritize health in their national budgets and for African countries to meet their pledge to do so made in Abuja in 2001.
Health and the Millennium Development Goals also identifies future health challenges in the developing world. If health is to have its full impact on reducing poverty, there is a need to address:
* the growing burden of noncommunicable disease in the developing world, which is leading to a “double burden” of ill-health;
* the “nutrition transition” in which people in developing countries begin to adopt unhealthy eating habits common in richer countries and suffer the health consequence;
* the need for universal access to reproductive and sexual health services as agreed at the Cairo International Conference on Population and Development; and
* the impact of globalization on the spread of disease and migration of health staff.
Achieving the health-related goals and targets is a critical part of the MDGs, agreed to by 189 world leaders through the Millennium Declaration at a summit in 2000. Heads of state and government will again gather in New York from 14 - 16 September for the 2005 World Summit to review the commitments made in the Millennium Declaration.
Three out of eight goals relate to health, as well as eight out of 18 targets, and 18 of 48 indicators. With other agencies, WHO is responsible for statistics on 17 of the 18 health indicators.