Building up and strengthening health systems is vital if more progress is to be made towards the Millennium Development Goals (MDGs), the World Health Organization (WHO) said in a new report. Unless urgent investments are made in health systems, current rates of progress will not be sufficient to meet most of the goals.
The report, Health and the Millennium Development Goals, 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 personnel 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 include: 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 Director-General Dr LEE Jong-wook. “We need to look beyond the health sector if we are to be successful, and we must take an integrated 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 towards 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 mortality, 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 communicable 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 impossible 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 estimated US$ 135 billion of Official Development Assistance, rising to US$ 195 billion by 2015.
“Global political commitment for long-term financing of the MDGs is crucial,” said Dr Andrew Cassels, WHO Director of MDGs, Health and Development Policy. “We must use all potential means of raising resources, including debt relief. We need resources which are predictable and sustained to allow countries to make long-term plans. And health must be at the centre of these efforts.”