Millennium Development Goals Post-2015: For Sustainability, Focus on Health … – Diplomatic Courier

The dust has settled on the Millennium Development Goals (MDGs) and results have left stakeholders with enough to both lament and celebrate. Moving forward, the 2012 Rio+20 Conference on Sustainable Development is a process that will marry with the MDGs as a single post-2015 global development agenda focusing on sustainable development. Based on this World Health Organization discussion paper, the issue of health seems well positioned to take a substantial place on the agenda. While this is encouraging news for the health sector, it will need to be explicit that strengthening health systems is a sustainable Millennium Development Goal for post-2015.

The benefits of an efficient, accessible and affordable health system are cross-cutting. It can be argued that a robust health system is at least marginally required to sustain the achievements of all eight MDGs. Three of the current MDGs are directly health related. Sustaining any achievements in these goals—reducing child mortality, improving maternal health, and combatting HIV/AIDS and other diseases—are dependent on adequate health systems. Countries that have made significant strides in maternal health, reducing child mortality and communicable diseases can only rely on strong systems to maintain these gains.

If the international community is geared to focus on sustainability after the first set of MDGs, there needs to be unequivocal focus on permanent institutions such as health ministries that are fundamental fixtures in the health sector. Strengthening health systems is a broad and overarching task but will likely be the only goal that can house a target of working with health ministries to fulfill their mandates. What that entails will differ country to country but generally speaking, if a health system is inefficient, the health ministry is failing at its mission. Non-governmental organizations play an immense role in delivering services where public health facilities are unable to do so. But a public health crisis like the Ebola epidemic is beyond the capacity of NGOs who should only serve as a stopgap in response to inefficient health systems.

Newer initiatives like Universal Health Coverage and prioritizing non-communicable diseases alongside well established programs on HIV/AIDS, malaria, and tuberculosis are only possible with the proper infrastructure, financing, accountability and leadership currently absent in weak systems. In many low-income countries, more people are living and living longer because of strides made in the last fifteen years. In short, if post-2015 goals want to fully embrace an evolving and more encompassing health landscape, it is going to need to concurrently focus on ensuring these foundations are in place.

Health systems strengthening as a post-2015 goal seems daunting given the amount of targets necessary to achieve this. However, in light of the current Ebola epidemic, we are further reminded of how much a quality health system serves as the groundwork for a thriving and productive society. Doctor to patient ratios, country-wide distribution of health workers, and access to health facilities were already abysmal in Liberia, Guinea, and Sierra Leone, the countries most affected by the epidemic. Regrettably, these conditions are not unique to the West African region; they are all too common in low-income countries around the world. While fraught health systems are not the only factor contributing to the crisis, the lack of a quality system compromises sustainability. Predictably some of the health-related MDG gains have regressed. In many cases already understaffed health facilities are abandoned by healthcare workers fearful of contracting the disease and women are afraid to give birth in health facilities or to receive ante or postnatal care. A post-2015 agenda needs to recognize the need to focus on not only fulfilling achievements in healthcare, but sustaining achievements on a systemic level.

Natasha Mbabazi is a Global Health Corps fellow at Malawi’s health ministry, reproductive health directorate. Natasha previously conducted field research for Uganda’s finance ministry, where she monitored budget efficiency and sustainability of national health sector projects, and later secured a research fellowship assessing DFID and JICA resource and prioritization considerations in Kenyan and Ethiopian health systems.

Photo: UN/Albert Gonzalez Farran.