How Attainable are the Millennium
Development Goals for a Developing
Country like South Africa
Minister Theuns Botha
Western Cape Government: Health
UCT South African Medical Students Association
6 March 2013
What are MDG’s
• 8 international development goals
• Set after UN Millennium Summit in 2000
• Signed by all 193 member states and 23
international organisations
• They set very specific targets o be attained by
2015
MDG’s recognise the importance of
social determinants
PRE-DETERMINANTS
Material: food, water, air,
income, housing
Policies: childcare, minimum
wage, benefits, occ. Health
Society: cohesion, values,
tolerance, diversity
Dalgren and Whitehead framework 1991
• Differential exposure
• Differential vulnerability
• Differential outcomes
• Differential consequences
The MDG’s
1.
2.
3.
4.
5.
6.
7.
8.
Eradicating extreme poverty and hunger
Achieving universal primary education
Promoting gender equality and empowering women
Reducing child mortality rates
Improving maternal health
Combating HIV/AIDS, malaria and other diseases,
Ensuring environmental sustainability
Developing a global partnership for development.
MDG 1
Eradicate extreme poverty
• Poverty generally results in poor levels of
nutrition, increased levels of food insecurity
and incidence of malnutrition.
• Multiple deprivation is key risk factor for the
Burden of disease
Inequity: Areas of high Multiple Deprivation have highest BOD!
One health-related MDG goal
From Millenium Development Goals Republic of South Africa Country report UNDP 2010
Severe Malnutrition
Western Cape has achieved this target
Systematic review of nutrition studies in the Western Cape
Dual epidemic
• Under nutrition
• Over nutrition
What are we doing about this?
• Promotion of breast feeding:
– Mother and Baby friendly health facilities
• Vitamin A supplementation in children under
5years at health facilities
• Nutrition programme at primary schools
• Mandatory fortification of maize & bread
MDG 4
Reduce child mortality
• The overall health of children is reflected in
infant and child mortality and coverage of
immunisation for preventable diseases such as
polio and measles.
From Millenium Development Goals Republic of South Africa Country report UNDP 2010
Immunised against measles in SA very
high
Even though not likely to achieve target
child mortality rates are reducing in SA
56
40
53
37
Target
42
30
20
18
Infant mortality in the Western Cape
30
26
Per 1 000 live births
25
20
21
15
10
5
0
IMR
U5 MR
2007
23
28
2008
21
26
2009
21
26
Achievable in Western Cape
Target
20
18
What are we doing about it?
• Improve key socio-economic factors that impact on
health status of children e.g. water, sanitation, food
security
• Enhance access to and quality of child health
services, particular PHC services
• Expand PMTCT and nutrition programmes
• Prioritise integrated management of childhood
illnesses (IMCI)
• Promotion of breast feeding
• Improve immunisation coverage
Life expectancy at birth is increasing but
target of 70 years will not be achieved
WC: In 2001-2006 males was 57.yyears and 63.9 years for females,
in 2006-2011 has increased to 59.9 years for males and 65.8years for females.
(SOURCE: StatsSA, mid term population estmates 2011)
MDG 5
Improve maternal health
• Good maternal health reflects on the quality
of and access to maternal (reproductive and
sexual) health care and the status of women in
society
• Related to MDG goal 3 “Promote gender
equality and empower women”.
MDG goals
From Millenium Development Goals Republic of South Africa Country report UNDP 2010
Maternal mortality has been
increasing largely due to HIV
Maternal Mortality Western Cape
(per 100 000 live births)
Target 36
Confidential Inquiry MMR
Unlikely to be achieved in Western Cape
Proportion of deliveries attended by skilled
personnel in SA
Target 100%
Use of modern contraceptive method
Target 70%
Achievable in Western Cape
What are we doing about it?
• Standardised protocols to manage causes of
maternal mortality
• Improve obstetric skills
• Improve management of pregnant women
• Improve referral systems
• Strengthen post natal care
• Improve quality of family planning services
• Eliminate deaths from unsafe abortions
MDG 6
Combat HIV/AIDS malaria other diseases
• Dealing with the challenges of HIV and TB and
malaria where this is endemic.
From Millenium Development Goals Republic of South Africa Country report UNDP 2010
HIV goals
From Millenium Development Goals Republic of South Africa Country report UNDP 2010
Prevention
Tap = incidence
Bucket = population
ART
HIV prevalence
Treatment
Plug hole = mortality
HIV prevalence in South Africa
Target <22.8%
HIV in Western Cape
Target <9.3%
Western Cape 11.6%
Condom use at last sex
(not necessarily high risk sex)
Target for condom use at last high risk sex 100%
Access to antiretorvirals in SA
Target 100%
Western Cape close to 100%
Coverage of adult ART in Western Cape
35 000
Total New S4 and starting ART
30 000
New treatment
need
Actual provision
Enrolment
scenario
25 000
20 000
15 000
10 000
5 000
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
PMTCT in WC: Success Story
Tuberculosis
From Millenium Development Goals Republic of South Africa Country report UNDP 2010
TB incidence in Western Cape
Target <253/100 000
1,600
Adult case rate/100,000
1,400
1,200
1,000
800
1,467
600
1,284
1,249
1,226
1,190
Eden
Cape Winelands
1,003
400
200
0
West Coast
Overberg
Central Karoo
Metro
Siamese twins: HIV and TB in areas of
deprivation
~300,000 HIV infected individuals
~50,000 diagnosed TB cases per
annum
Of HIV-infected people, 86% are in 14 sub-districts
Of TB diagnoses, 76% are in the same 14 subdistricts
In a nut shell
• Signifant progress has been made but unlikely to
meet all targets
• SA has met the target for getting orphaned
children in school & antenatal coverage
• SA is likely to meet targets for:
– Increasing immunisation coverage
– Having all births attended to by a professional
• SA will possibly meet targets for
– Reducing severe malnutrition
– Reducing HIV in young people
We are not alone e.g. child mortality
SOURCE: Global MDG report 2012
Where to from here?
• Likely that MDG’s will continue beyond 2015
• Likely other issues will be included such as:
– eradicating poverty and hunger by 100% and not
just 50%
– Include other diseases such as chronic diseases
(?injuries)
– Empowering both men and women
– Global agenda on defeating corruption, as well as
for good governance
Provincial Strategic Plan
Strategic Objective 1:
Strategic Objective 2:
Strategic Objective 3:
Strategic Objective 4:
Strategic Objective 5:
Strategic Objective 6:
Strategic Objective 7:
Strategic Objective 8 &9:
Strategic Objective 10:
Strategic Objective 11:
Strategic Objective 12:
Creating opportunities for growth and jobs
Improving education outcomes
Increasing access to safe and efficient transport
Increasing wellness
Increasing safety
Developing integrated and sustainable human
settlements
Mainstreaming sustainability and optimising
resource use efficiency
Promoting social inclusion and reducing poverty
Integrating service delivery for maximum impact
Increasing opportunities for growth and
development in rural areas
Building the best-run provincial government in the
world.
The six priorities for wellness
• Decreasing the incidence Infectious Diseases (HIV
and TB)
• Preventing violence and road injuries prevention
• Healthy lifestyles to address non communicable
diseases
• Women’s health
• Maternal and child health
• Mental Health
What can you do as a health
professional?
•
Understand that health is more than just the absence of disease
•
Provide effective and efficient health services
– but these are not the only essential ingredient required for increasing
wellness
– recognise the importance of other disciplines e.g. CHW
– balanced health services (CBS, PHC, Hospital services)
– Patient centred care not a nice to have: improved outcomes
•
Become an upstream advocate and become an health activists
– Do your job to the best of your ability
– Challenge other sectors to also do their bit!
Thank you
Worcester Hospital