Building Stronger Health Systems Key to Reaching the Health Mil-
lennium Development Goals
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Geneva - Building up and strengthening health systems is vital
if more progress is to be made towards the Millennium Develop-
ment Goals (MDGs), the World Health Organization (WHO) said in a
new report. Unless urgent investments are made in health sys-
tems, current rates of progress will not be sufficient to meet
most of the goals.
The report, "Health and the Millennium Development Goals",
http://www.who.int/mdg/publications/mdg_report/en/index.html
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 person-
nel 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 in-
clude: 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 Direc-
tor-General Dr LEE Jong-wook. We need to look beyond the health
sector if we are to be successful, and we must take an inte-
grated 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 to-
wards 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 mor-
tality, 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 commu-
nicable 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 impossi-
ble 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 esti-
mated US$ 135 billion of Official Development Assistance, rising
to US$ 195 billion by 2015.
Health systems require not only urgent investment, but also com-
mitments 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 availabil-
ity 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 di-
rector of Measurement and Health Information Systems, 90% of Af-
rica 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 As-
sistance to 0.7% of GNP; this was coupled with a call for devel-
oping 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 fu-
ture health challenges in the developing world. If health is to
have its full impact on reducing poverty, there is a need to ad-
dress:
* the growing burden of non-communicable disease in the develop-
ing world, which is leading to a double burden of ill-health;
* the nutrition transition in which people in developing coun-
tries 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 mi-
gration 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.