Health score­card can be telling

Mil­len­nium De­vel­op­ment Goals fo­cus on the health of world pop­u­la­tions, but re­sults in Africa are mixed

Business Day - Business Law and Tax Review - - BUSINESS LAW & TAX REVIEW - NEIL KIRBY

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

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