Health in the post -2015 development

agendaWales for Africa

Conference

Andy Haines

The UN Millennium Development Goals

Health is at the centre of the Millennium Development Goals

From a baseline of 1990 by 2015

Reduce the share of malnourished children by 1/2

Cut child death rate by 2/3

Lower maternal deaths by 3/4

Reverse the spread of HIV/AIDS, TB, and malaria

8/18 targets and 18/48 indicators related to

health

Improvements in coverage ( from Dye et al 2013)

Scaling up community health workers e.g. Health Extension workers in

EthiopiaSome 35000 workers had been trained and

deployed

I year training, 2 per village , recently

upgraded to cover pneumonia Rx

Growing evidence of impacts

MDG Heath Indicators : Problems1. Around half of current MDG indicators not reported by

many countries2. Nothing on inequalities in coverage3. Nothing on quality of services4. Nothing on NCDs, injuries, disability

Yet too many interventions to monitor everything = countries will need to select tracer conditions to monitor – fitting their health priorities and measurement capabilities

Proposed goal 3. Attain healthy life for all at all ages by 2030 3.1 reduce the maternal mortality ratio to less than 40 per 100,000

live births

3.2 end preventable newborn, infant and under-five deaths

3.3 end HIV/AIDS, tuberculosis, malaria, and neglected tropical diseases

3.4 reduce by x% premature deaths from non-communicable diseases(NCDs), reduce deaths from injuries, including halving road traffic deaths, promote mental health and wellbeing, and strengthen prevention and treatment of narcotic drug and substance abuse

Open Working Group on the SDGs – ‘long list’ of 17 goals (June 2 nd)

3.5 increase healthy life expectancy for all by x% 3.6 achieve universal health coverage (UHC), including

financial risk protection, with particular attention to the most marginalized and people in vulnerable situations

3.7 ensure universal availability and access to safe, effective and quality affordable essential medicines, vaccines, and medical technologies

3.8 ensure universal access to sexual and reproductive health 3.9 decrease by x% the number of deaths and illnesses from

indoor and outdoor air pollution

Attain Healthy life for all (continued)

Why Universal Health Coverage?

Historical background: Alma Ata Declaration of

1978

2005-12: all nations have made the commitment to achieve universal health coverage "everyone should have access to the health services they need without risk of financial ruin or impoverishment"

Challenge of Measuring the Three Dimensions of Universal Health CoverageChallenge of Measuring the Three Dimensions of Universal Health Coverage

Financial risk protection is patchyWhere out-of-pocket expenditure is high in relation to total health

expenditure; 150M people suffer catastrophic expenditure each year

Source: WHO

Addressing unmet surgical needs in Mozambique – técnicos de cirurgia .(Kruk et al BJOG 2007)

2 year training 1 yr internship Perform 92% of emergency obstetric care and 65% of

major general surgery in district hospitals No difference in outcomes vs. doctors The 30-year cost per major obstetric surgery was $38.9

for técnicos de cirurgia and $144.1 for surgeons and obstetrician/gynaecologists

High retention

• ~150 million under 5s are undernourished

• ~35% of GBD in under 5s due to undernutrition• 1000 day window to prevent stunting

Food security and malnutritionCurrent situation:

Sources: Black et al. Lancet 2008; 371: 243-60World Bank 2007; Environmental Health & Child Survival WHO Global Database on Child Growth & Malnutrition

64

36

20

80

Percentage change in yields to 2050

-50 -20 0 +20 +50 +100

UN Devt Prog, 2009

Plus climate-related:• Flood/storm/fire damage• Droughts – range, severity• Pests (climate-sensitive)• Infectious diseases (ditto)

CLIMATE CHANGE: Poor Countries Projected to Fare Worst MODELLED CHANGES IN CEREAL GRAIN YIELDS, TO 2050

To reach the health MDGs and to ensure access to critical interventions 49 low-income countries will need to spend > US$ 60 per capita by 2015, compared with US$ 32 currently.(WHO 2010)

Only 8 can raise these funds from domestic sources

...external funding needed

Build on the MDGs Monitor progress towards Universal Health

Coverage Strengthen Human resources for health Ensure financial protection Develop policies and indicators linking

Health and Sustainability

Conclusions