Health scorecard can be telling
Millennium Development Goals focus on the health of world populations, but results in Africa are mixed
IN 2000, leaders of 189 nations signed the Millennium Declaration of the United Nations, pledging to free their people from poverty, illiteracy and ill-health. This commitment gave rise to the Millennium Development Goals, the target date for which is 2015:
Goal 1: eradicate extreme poverty and hunger.
Goal 2: achieve universal primary education.
Goal 3: promote gender equality and empower women. Goal 4: reduce child mortality. Goal 5: improve maternal health. Goal 6: combat HIV/AIDS, malaria and other diseases.
Goal 7: ensure sustainability.
Goal 8: develop a global partnership for development.
Health is a major theme of the Millennium Development Goals, with six of the eight goals having a direct or indirect bearing on the health of the world’s population.
From a healthcare perspective, subSaharan Africa has the most to gain from dedicated implementation of Millennium Development Goals-based programmes. The subcontinent started the millennium with the world’s highest child mortality rates, highest incidence of maternal deaths, highest rate of new HIV/AIDS infections and deaths, and among the highest rates of tuberculosis infections and deaths.
The question remains, though, whether the situation has changed 12 years on? Has sub-saharan Africa made progress towards achieving the healthcare-related Millennium Development Goals? Is there any hope that the African nations — SA included — will succeed in doing so within the next three years?
Since the Millennium Development
environmental Goals commenced in 2000 various agencies of the United Nations have been reporting on the status of the achievement of the goals worldwide and in each region.
In 2005, the World Health Organization (WHO) issued a report specifically on the status of the healthcare aspects of the Millennium Development Goals. Following the MDG World Summit in New York in September 2011, the Department of Economic and Social Affairs of the United Nations Secretariat issued its Millennium Development Goals Report in 2011.
The latter report notes that various strides have been taken in Sub-saharan Africa on the healthcare front.
For one, it says that Africa has achieved the largest absolute drops in malaria deaths, with 11 countries reducing malaria cases and deaths by over 50%. The report further states that sub-saharan Africa has led the decline in new HIV infections by recording a drop of 21% between 1997, when infections peaked, and 2009.
It goes on to say that mortality among children under five in sub-saharan Africa fell from 180 per 1 000 live births in 1990, to 129 per 1 000 live births in 2009.
It would be churlish to dismiss these signs of improvement. At the same time, it cannot be denied that the health of Africa’s peoples is far from rosy.
Despite the 21% drop in new HIV infections in 2009, there were still 2,6million people who were newly infected, the 2011 UN report says. Sub-saharan Africa still has the highest child mortality rates, with one in eight children dying before the age of five. Further, the sub-continent still has a staggeringly high maternal death rate of 640 deaths per 100 000 live births.
Sub-saharan Africa is also the only region in the world where deaths from tuberculosis have actually increased. The UN report says there were 32 TB deaths per 100 000 people on the sub- continent in 1990, rising to 53 per 100 000 (excluding Hiv-positive people) in 2009.
Significantly, SA was one of five countries in the world with the largest
Africa has achieved the largest absolute drops in malaria deaths, with 11 countries reducing malaria cases and deaths by over 50%
number of TB cases, the others being India, China, Nigeria and Indonesia, the report says.
There is no doubt that the millennium goals have brought the status of domestic healthcare systems into sharp focus. They have also highlighted the ability — or lack thereof — of those systems to produce effective results for the populations they service.
The particular focus that the Millennium Development Goals present is whether or not the healthcare systems of states are providing effective healthcare, in accordance with the rights that citizens enjoy in international law.
The WHO has said that stronger health systems are recognised as a prerequisite for achieving the Millennium Development Goals. However, “nei- ther health donors nor national health planners have paid sufficient attention to systems strengthening”, the WHO says in its 2005 MDG report.
The nature of the service delivery structures within a domestic healthcare setting is increasingly going to be criticised and scrutinised by international bodies such as the WHO and the African Union. In doing so, the emphasis will fall on whether or not the healthcare needs of a particular population are being adequately addressed and human rights respected.
The Millennium Development Goals are therefore a useful criterion against which to measure a particular government’s compliance with providing adequate healthcare in particular, and human rights in general.
Improving maternal health is one of eight Millennium Development Goals