Social determinants of health: HIV/Aids

Sustainable Development Goals

Feature AS a primary care practitioner, I have been trying to promote the understanding of the Sustainable Development Goals (SDGs) since they came into effect in 2016 as they have a direct impact on the social determinants of health in any community.

The SDGS are ambitious 17 Goals to transform our world to make it a better place for everyone. The SDGs are a new, universal set of goals, targets and indicators that UN member states will be expected to use to frame their agendas and political policies from 2016 to 2030.

The SDGs follow and expand on the Millennium Development Goals (MDGs), which were agreed by governments in 2001 and expired in 2015.

There is broad agreement that, while the MDGs provided a focal point for governments — a framework around which they could develop policies and overseas aid programmes designed to end poverty and improve the lives of poor people — as well as a rallying point for NGOs to hold them to account, they were too narrow.

The eight MDGs — reduce poverty and hunger; achieve universal education; promote gender equality; reduce child and maternal deaths; combat HIV, malaria and other diseases; ensure environmental sustainability; develop global partnerships — failed to consider the root causes of poverty and overlooked gender inequality as well as the holistic nature of development. The goals made no mention of human rights and did not specifically address economic development. While the MDGs, in theory, applied to all countries, in reality they were considered targets for poor countries to achieve, with finance from wealthy states. Conversely, every country will be expected to work towards achieving the SDGs.

My understanding of the MDGs was that wealthy states through their NGOs would come with programmes that were aimed at addressing the goals. I still remember struggling to see how they would fit with my work in the private sector.

The coming in of aid was very beneficial to address crises situations, however, there was a challenge on the issue of sustainability as most of these programmes ran for specified time periods after which there was no plan to deal with the crisis post aid. It strengthened certain aspects of the health delivery systems while weakening other aspects. A good example is strengthening of the care of Communicable Diseases (CDs) like HIV, Aids, TB and malaria while that on Non-Communicable Diseases (NCDs) like high blood pressure, diabetes and asthma were neglected.

These NGO funded programmes would attract health personnel with a promise of better working conditions only to abandon them at the end of their programmes. During the period the workers would be working for the NGOs, they run a risk of losing on skills to deal with the wide spectrum of community health needs. This is a concoction for disaster if one is serious about a responsive primary health care system.

While we appreciate the aid we are receiving, the onus is upon our leaders to make sustainable decisions around the aid. On the other hand, it would be appreciated if the donors would come in as international partners to support our own initiatives to develop our own sustainable health delivery systems.

On the other hand, SDGs seem to have shifted mindset and responsibility of making lives of people in different countries better to the respective governments. This creates a sense of ownership. If there is good appreciation of SDGs then the issue of sustainability is incorporated in the policies.

SDGs are therefore not “food given on a silver platter”. They require hard work, patience, self sacrifice, perseverance and “taking our destiny into our own hands.” They are all encompassing as “no one should be left behind.”

In 2016, the Paris Agreement on climate change entered into force, addressing the need to limit the rise of global temperatures. Governments, businesses and civil society together with the United Nations are mobilizing efforts to achieve the Sustainable Development Agenda by 2030. Universal, inclusive and indivisible, the Agenda calls for action by all countries to improve the lives of people everywhere.

I pray for a day when key stakeholders will have a conference to discuss SDGs. I also pray that the SDGs become part of the education curriculum in Zimbabwean schools with the aim of promotion of: Prioritising the well-being of the people Using the wealth of the nation to promote the wellness of the people

Promoting economic growth in the interest of benefiting the people

Not leaving anyone behind in extreme poverty It is almost impossible to aspire to promote good health and well-being in an environment where there is extreme poverty, hunger, poor quality education, gender inequalities and no access to clean water and sanitation.

There is an effort to promote affordable and clean energy with various campaigns encouraging switching to low power consumption utensils and promotion of use of clean and renewable energy sources, for example, solar energy on our TVs and radios by Zimbabwe Electricity Transmission and Distribution Company. We should all heed this call.

There is evidence that our health will improve if we promote use of cleaner energies compared to the more wide use of firewood for example, especially in the rural areas. In turn, we protect our environment and produce a lot of clean air to breathe, reduce greenhouse gas emissions and contribute less to climate change.

We need to have decent jobs in the context of sustainable economic growth. If there are decent jobs then we are less likely to have migration in search of jobs and in turn we build communities with sustainable social support systems. Good occupational safety and health reduces work place accidents and generally productivity improves. We also need to see our industry grow in a sustainable way with less harmful gas emissions, for example, thereby protecting the environment.

Industry innovation and infrastructure also promote the well-being of the workforce in that there is more time for leisure and social activities. This reduces stress and other physical and mental health issues associated with long hours at work. The world is now moving towards working smarter, not harder and innovation and infrastructure are key in the realisation of this vision.

There is rapid growth of cities around the world and if this growth is not planned in a sustainable manner we will not have sustainable cities and communities. A community that does not have a plan to deal with its waste products is harmful to its residents, and these impacts negatively on their health.

Global warming has brought with it droughts and floods which in turn leads to disease outbreaks. Some of our activities affect marine life and in turn mankind through improper disposal of harmful substances for example sewage, pesticides, herbicides and mercury into our water bodies. There is therefore need to consider the impact of our activities on the climate and our environment to ensure that we have a continuous supply of clean air and water.

There is also need to promote peaceful and inclusive societies for sustainable development. Conflicts and wars bring about displacement of communities, poverty, and creation of refugee camps where disease outbreaks are common. It is therefore imperative that there is provision of access to justice for all and building effective accountable institutions at all levels.

Realisation of the SDGs requires collaboration of stakeholders with promotion of international partnerships for the benefit of the well being of the people.

May God protect us all to witness a better Zimbabwe in 2030. Until we meet again, may you stay blessed.