Could Millennium Development Goals be bad for your health?

A recent paper by a Belgian team discusses the health impact of the Millennium Development Goals (MDG) in sub-Saharan Africa, and highlights the potential short-termism of a strategic approach focussed on “quick wins”.  Many of the health issues discussed touch on sexual health.

The year 2001 saw poverty become the focus of the global political agenda, when the 189 countries of the UN in the General Assembly established eight goals to be achieved by 2015. The goals (MDG) have given rise to funding instruments called Global Health Initiatives (GHI) which have tended to favour “very high short-term impact that can be immediately implemented” over more complicated and long-term developments.

The MDGs directly affecting sexual health are: MDG 6 – eradicate HIV/AIDS & Malaria; MDG 4 – reduce child mortality (because of vertical transmission of HIV/AIDS); MDG 5 – improve maternal health (because the 2005 World Summit included within this goal “achieving universal access to reproductive health”).  Indirectly and in the longer term, MDG 2 – achieve universal primary education and MDG 3 – empower women affect issues of behaviour change likely to impact on sexual health.  MDG 1 – eradicate hunger, 7 – ensure sustainability, 8 – develop global partnership primarily affect health issues other than sexual health.

In general, the paper argues that an emphasis on “quick impact” interventions is not always beneficial:

–          Initiatives have been developed in parallel to, rather than in integration with, the existing health systems, with resulting distortions in provision of care.

–           The focus on short term, community-based initiatives can result in deployment of resources away from longer-term strategies that require indigenous health services development and inter-sectoral approaches to health planning.

–          The assessment of progress on the basis of data that is not disaggregated for socio-economic status and other equity parameters can result in strategies that achieve global targets at the cost of neglecting the neediest population sub-groups.

A glance at the recent (2011) UNAIDS report will reveals the tension between this “high-

impact intervention” approach and much current thinking in the health policy area.

More specifically, the authors argue that while anti-retrovirals therapy (ART) may appear to be a “quick impact” intervention, sustaining progress in this area is going to require health service development in the longer term.  Expanding access to sexual and reproductive health services, while classed as a health-related “quick win”, has actually suffered a decrease in funding over the decade.  The paper also gives the example of contraceptive use in Kenya as a case of how apparent improvements overall can mask a deterioration in the situation of the most underprivileged (those classed “no education”).

The recommendations of this paper include:

–          More attention to health systems development essential to the future delivery of the aims embodied in MDGs 4, 5 and 6;

–          Not neglecting the role of MDGs 2 & 3 (universal education and empowering women) in securing improved maternal and child health long term;

–          Not allowing achievement of MDGs to be at the expense of continued efforts to improve the social determinants of health.

Fabienne Richard et al., “Sub-Saharan Africa and the health MDGs: the need to move beyond the “quick impact” model”, Reproductive Health Matters, Vol. 19, Issue 38, November 2011

http://www.sciencedirect.com/science/article/pii/S0968808011385795

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