Discussion: Critical Success Factors That Accelerate Progress
Meeting the MDG health targets
Worldwide, under-five mortality declined from 93 to 72 deaths per 1,000 live births between 1990 and 2006. Nevertheless, in 62 countries, under-five mortality is not declining fast enough to meet the Millennium Development Goal 4 target of reducing by two thirds the mortality rate for children under 5 years of age. The reduction of maternal mortality also remains a challenging task; the Millennium Development Goal 5 target of reducing the maternal mortality ratio by three-quarters between 1990 and 2015 is the area of least progress among all the MDGs. In many countries, malnutrition, and lack of access to quality primary health care and basic infrastructure, including water and sanitation, continue to be major causes of ill health and death among mothers and children. Having fewer pregnancies and spacing births increase the survival rate of both women and their children, underscoring the importance of the Millennium Development Goal target of universal access to reproductive health.
Infectious diseases continue to inflict a huge burden on developing countries. Globally, about 33 million people were living with HIV/AIDS in 2007. Malaria causes 1 million deaths annually along with 300-500 million episodes of illness. Sub-Saharan Africa bears a disproportionate share of the burden of both these diseases. Affordable access to essential medicines in developing countries is far from adequate. Concerns about global health have sparked a large increase in donor funding since 2000. International health partnerships and funds, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Global Alliance for Vaccines and Immunization, are an increasingly important mechanism to pool and channel public and private funds.
MDG 7, target 3 stresses the importance of adequate water and sanitation for sustainable development. They are also vital inputs to improving health, although they are generally outside the purview of the health sector. Current trends suggest that the world may meet the drinking water target, but not that for sanitation.
- Strengthening health care systems, including sustainable funding, human resource training, improvement of aid effectiveness and harmonization with country priorities.
- Provision of integrated services – primary care, reproductive health, continuum of care for mothers and children, HIV/AIDS prevention and treatment, child health and malaria interventions.
- Strategies to meet the needs of vulnerable populations, especially rural populations and the urban poor.
- Infrastructure needs for health care, water and sanitation.
- Affordable access to essential medicines in developing countries.