In September 2000, 189 Heads of State adopted the UN Millennium Declaration which was then translated into a roadmap setting out goals to be reached by 2015. The eight Millennium Development Goals (MDGs) build on agreements made at United Nations conferences in the 1990s and represent commitments from both developed and developing countries.
The Millennium Goals include challenges for rich and poor countries alike. They set targets for developing countries to reduce poverty and hunger, and to tackle ill-health, gender inequality, lack of education, lack of access to clean water and environmental degradation. The MDGs also recognize potential contributions from developed countries of trade, assistance, debt relief, and access to essential medicines and technology transfer.
There are eight goals, 18 targets and 48 indicators to measure the MDGs. Three out of the eight goals, and eight of the 18 targets relate directly to health. Some developing countries have made impressive gains in achieving the health-related Millennium Development Goals, targets and indicators. However, many more are falling behind. Progress is particularly slow in sub-Saharan Africa.
Some progress has taken place in specific countries. However, nearly 11 million children under the age of five die every year globally. In 16 countries, 14 of which are in Africa, levels of under-five mortality are higher than in 1990.
There have been increases in the rate of attended deliveries in South-East Asia and North Africa. However, more than 500 000 women die in pregnancy and childbirth each year and maternal death rates are 1000 times higher in sub-Saharan Africa than in high income countries.
There have been successes in selected countries where they have made progress on reversing the spread of HIV/AIDS. However, the story is bleak in many countries. With three million deaths from HIV/AIDS alone each year, the worsening global pandemic has reversed life expectancy and economic gains in several African countries.
Health is an important contributor to each of the goals and is implicated in other targets and indicators. Several of the targets, which are more specific and defined than the goals, are health-related. This is the case for the health targets for safer drinking water and sanitation, providing access to affordable essential drugs in developing countries and the hunger target.
The 48 quantitative indicators for monitoring progress towards the eight MDGs were agreed upon by the United Nations system in 2001. Eighteen measure achievement related directly to health. WHO is involved in the measurement of 17 indicators, cooperating on an 18th with the United Nations Food and Agriculture Organization.
The global estimate of what is required is a doubling of aid from US$ 50 to US$ 100 billion each year to achieve all of the Millennium Development Goals which would require a fivefold increase in donor spending on health (The Zedillo Commission: Monterey Conference).
Economic and health policies in developing countries must reflect the needs: current health spending in most low-income countries is insufficient for the achievement of the health MDGs. African leaders pledged to raise public spending on health to 15% of GNP at the African summit in 2001.
Progress will also depend on getting policies right; making the institutions that implement them function effectively; ensuring there are enough staff to do all the work and building health systems that work well and treat people equitably.
Three principles guide WHO’s work on the MDGs:
WHO supports national and regional efforts to achieve the MDGs through an extensive body of normative and technical work through building systems to track progress and measure achievement and to coordinate technical collaboration. WHO’s work includes front-line MDG programmes, such as HIV/AIDS, maternal and child health and tuberculosis.
However, much of WHO’s work supports the achievement of the MDGs in a cross-cutting way or by providing management support. For example, Health Research and the Tobacco departments inform and affect the work of several targets, indicators and goals. Other parts of the Organization, including those working on management and health policy, give support to the goals more indirectly.
WHO works with other organizations of the United Nations system to identify indicators for each health-related MDG and target. Work on MDG reporting complements other efforts to improve the quality of country health data and aims to build capacity in countries to collect, analyse and act on information collected
WHO also monitors core health indicators, as well as indicators for other areas of public health that help explain progress in the achievement of specific goals at country level. These include immunization coverage for new antigens, prevalence of risk factors for noncommunicable diseases, effectiveness of interventions against these diseases, and impoverishment of households through health payments.
Support in this area comes from all parts of WHO and is articulated in individual Country Cooperation Strategies. Strengthening WHO’s presence in countries is a major priority, and collaboration with countries on meeting MDG targets is a central thrust of WHO’s commitment to help bring measurable health improvements on the ground.
The High-Level Forum brings together senior officials from developing countries, ministers of health and finance, economic planning and local government, bilateral agencies, multilateral agencies, foundations, regional organizations and global partnerships. The aim of the High-Level Forum is to provide an opportunity for candid dialogue and identify opportunities for accelerating action on the health-related MDGs.
The first High-Level Forum was held in Geneva in January 2004. Outcomes of this Forum include a recommendation that the World Bank (WB) and International Monetary Fund (IMF) ensure a closer relationship between Poverty Reduction Strategy Papers (PRSPs) and the achievement of the MDGs, as well as the establishment of the Health Metrics Network, to increase capacity at country level to provide health statistics.
The second High-Level Forum on the Health MDGs took place in December 2004 in Abuja Nigeria. Key areas of discussion included:
The MDGs provide an analysis of development in which health and education are squarely at the centre. However, the MDGs do not cover all aspects of health and development. For example MDGs do not touch on the importance of effective health systems, which are essential to the achievement of all health goals, reproductive health or noncommunicable diseases.
The MDGs are a form of shorthand for some of the most important outcomes that development should achieve: fewer women dying in childbirth, more children surviving the early years of life, dealing with the catastrophe of HIV/AIDS, making sure people have access to clean water and sanitation, life-saving drugs, better health, and finally, making a major contribution to the reduction of poverty.
For more information on health and the Millennium Development Goals