MILLENNIUM DEVELOPMENT
GOALS
Beyond 2010
A Comprehensive approach
• All the MDG influence health, and health influences all the
MDGs
– The MDGs are inter-dependent. Better health enables children to learn and
adults to earn. Gender equality is essential to the achievement of better health.
Reducing poverty, hunger and environmental degradation positively
influences, but also depends on, better health.
• All causes of ill-health affect the achievement of the MDGs
– Ill health is not restricted to specific causes, demographic groups, geographies
or gender. The full contribution of better health to the achievement of the
MDGs requires progress in relation to the major pandemics of AIDS, TB and
malaria; to maternal, newborn and child health; but also to noncommunicable
disease and mental health and neglected tropical diseases.
Fully functioning health system is essential
for more rapid progress
Achievement of health targets depend on equitable access
to a health system that delivers high quality services. The
exact configuration of services will depend on country
context, but will in all cases require adequate financing
with pooling of risk; a well-trained and adequately
remunerated workforce; information on which to base
policy and management decisions; logistics that get
medicines and vaccines to where they are needed; well
maintained facilities organized as part of a referral
network; and leadership that provides clear direction and
harnesses the energies of all stakeholders - including
communities.
Systems that seek synergies between
programmes get better results
Interventions that address HIV and AIDS can positively
influence maternal and newborn health. Strengthened
laboratories are essential to combat MDR TB. An
integrated approach to malaria control brings benefits in
terms of all-cause child mortality. Programmes that boost
nutritional status improve outcomes across the board. Well
functioning district and referral hospitals are key to
reducing maternal deaths.
Better health requires coherent policies
• Social and economic determinants of ill-health cannot be ignored. A good
health system - based on Primary Health Care - not only delivers high
quality health services, but ensures that health is an outcome of all policies.
A wide range of policies - those that influence how and where people live,
work, travel and relax; what they eat and drink; how and whether they can
access goods and services; and how different communities, groups and
genders relate to each other and to the state - all influence the achievement
of MDG health targets.
• Policy coherence is particularly important in countries that depend on aid.
Problems arise when the policies of external agencies are not aligned to
nationally agreed priorities and goals. Robust national strategies and plans
provide the best means of ensuring alignment of external agencies.
A comprehensive approach does not preclude
focus or having clear priorities
– Global disparities in maternal, newborn and child health represent
one of the starkest health inequities of our times. Each year
approximately 530,000 women die due to complications related to
pregnancy and childbirth. Almost nine million under-five children
including over 3.5 million newborns die each year from causes that
are mostly preventable or treatable with existing interventions.
These deaths are increasingly concentrated in Asia and SubSaharan Africa, where 95% of all maternal deaths and 75% of
child deaths occur.
– Recognizing the need for urgent action if MDGs 4 and 5 are to be
achieved a menu for action is needed along a continuum of care
based on a health system strengthening approach
Pre-pregnancy
Pregnancy Birth
Mother & Newborn
Infant
Child
Proposed interventions:
• Pre pregnancy : increase access to family planning
Family planning is extremely cost-effective and has a direct impact on improving the
health of women and newborns. An estimated 137 million women of reproductive age
have an unmet need for family planning, and some 80 million unintended pregnancies
occur annually. Recent studies suggest that if this unmet need were filled, maternal
mortality would decrease by 30% and newborn mortality by 16% globally, resulting in
as many as 150,000 fewer maternal deaths per year
• During Pregnancy: four visits to quality antenatal services
Four targeted visits to antenatal care services can reduce the major causes of maternal
and perinatal morbidity and mortality. Specifically, they are used to a) detect problems
complicating pregnancy; b) prevent and control anaemia (through iron and folic acid
supplementation); c) facilitate integrated HIV counselling, testing and treatment for the
prevention of mother to child transmission of HIV; d) prevent malaria by intermittent
preventive therapy in pregnancy (IPTp) and distribution of insecticide-treated bed nets;
e) treat malaria and other conditions in pregnant women; and f) provide advice on
danger signs and emergency preparedness and facilitate birth planning.
Pre-pregnancy
Pregnancy Birth
Mother & Newborn
Infant
Child
Proposed interventions:
• Childbirth: Increase the quality of and access to facility-based
childbirth
Every pregnant woman and newborn should have access to quality childbirth care in an
adequately staffed and equipped facility. Improving quality of existing maternity
facilities, while working toward universal (95%) coverage of high quality facility based
services can lead to an 85% reduction of maternal deaths due to postpartum
haemorrhage, eclampsia, postpartum sepsis and obstructed labour, an 85% reduction of
newborn deaths due to asphyxia, a 40% reduction of newborn death due to sepsis, and
an 85% reduction in stillbirths.
• Immediate postnatal period : home-based visits for mothers and
newborns
The neonatal period is often neglected, on the assumption that having survived
childbirth no further intervention is needed. However approximately 3.5 million babies
die in the first month of life, most in the first week. The provision of timely, quality
postnatal care services can reduce these deaths by more than 30%, saving more than 1
million infants a year. Effective care can be delivered at home and in the community
through outreach, and at first level and referral facilities. However, home-based visits
will ensure that both mother and baby receive appropriate care and that referral to
facilities are made when necessary and without delay. At first level facilities and through
outreach services, additional interventions can be delivered, including care for low birth
weight infants; treatment of infections; and immunizations (BCG, Hepatitis B, OPV-0).
Pre-pregnancy
Pregnancy Birth
Mother & Newborn
Infant
Child
Proposed interventions:
• Infancy and Childhood: train and empower community health workers
to treat and prevent the major causes of childhood death.
About 9 million children under five years of age die every year. The majority
of these deaths can be prevented through simple effective interventions
delivered at either, the community level, first level facilities, outreach or
referral facility levels. Community health workers can prevent the majority of
deaths from diarrhoea, pneumonia, malaria, and malnutrition. In combination
with immunization and measures to prevent malaria, the lives of 3 million
children aged 1month to 4 years can be saved every year through timely
treatment. The continuing efforts around polio eradication make it clear that
effective care to the most-difficult-to reach communities is not only possible
but necessary to preserve progress everywhere.empower community health
workers to treat and prevent the major causes of childhood death.
• METRICS FOR MONITORING :
Timely data to check implementation, assess outcomes and track inequities is
essential, especially the case for monitoring pregnancy outcomes, identifying
maternal and newborn deaths, and ascertaining their immediate and underlying
causes.
Supporting national efforts to achieve the MDGs is
core business for WHO
• Setting norms and standards underpins the technical approach to the
achievement of all health targets - for example in terms of treatment
guidelines and health service standards
• Technical cooperation with partners and countries then helps ensures that
agreed approaches and global strategies are applied in practice.
• WHO uses its technical expertise to assist national authorities as they
seek to develop coherent and well-costed national plans and strategies.
• In countries with many donors, the WHO office assist governments in
their efforts to coordinate development partners and to ensure alignment
between external assistance and domestic priorities.
• Collection and dissemination of data on health status.