Finishing and moving beyond the health MDGs
- The overriding goal of a post-2015 development agenda in health and healthcare should be achieving universal healthcare, accessible to all, with accountability of governments and institutions to their people for good health outcomes.
- Lack of equal access to healthcare is both morally wrong and macroeconomically inefficient. A healthy population is economically productive; disease and premature death cause poverty.
- Ensuring the right to healthcare for women and girls is critical.
- The lesbian, gay, bisexual and transgender community faces particular challenges in accessing adequate healthcare.
Speakers debated how to address the shortcomings in the current health Millennium Development Goals (MDGs) surrounding equity, human rights, financing and ownership.
MDGs 4, 5 and 6 directly address health issues, calling for reducing child mortality rates, improving maternal health and combatting HIV/AIDS, malaria and other communicable diseases. A number of countries have made significant progress towards these goals, but it has been spotty and inadequate. In formulating the post-2015 development agenda, speakers urged the world not to be timid, but rather to set bold and ambitious new goals.
Sustainable development cannot leave very poor and marginalised people behind. Lack of access to good quality healthcare is both wrong and inefficient in macroeconomic terms. In a vicious circle, poor health impedes poverty eradication, economic growth and sustainable development; while poverty causes poor health and premature death. Healthy populations are economically more productive. Basic living standards, particularly for women and children, must be achieved. People should not be dying from preventable diseases.
The World Health Organization (WHO) is committed to finishing the business of the MDGs, while looking to the post-2015 agenda. A key element of that agenda should be achieving universal healthcare (UHC). UHC requires good quality health services that are available to all persons without financial constraint. However, as no country can afford to provide all services to all people, it is critical to analyse what services are really necessary to address the important health issues in various countries and regions of the world.
UHC includes coverage of primary care, prevention, promotion, treatment, rehabilitation and palliative care. It rests on notions of equity and the right to health. UHC requires that governments and other institutions are held accountable to their people for health services and outcomes.
Achieving UHC should be the main thrust of the post-2015 health agenda, with a major focus on the health of girls and women. Females make up half the world’s population – and they make the other half. Women should not have to risk their lives in pregnancy and childbirth.
Senegal is moving towards a basic UHC programme, which focuses on using a solidarity fund to increase free access to healthcare; increased contributions to healthcare funds, and community healthcare funds to improve access to health services for the poorest and most marginalised people.
Civil society can play a major role in promoting and providing community healthcare and thus it should be supported and strengthened. However, civil society also needs to play an advocacy and watchdog role.
The post-2015 agenda must consider that members of the lesbian, gay, bisexual and transgender (LGBT) communities face particular problems in obtaining adequate healthcare services, including lack of knowledge of needs, poor quality of services where they exist, unavailability of services in many areas, and discrimination and stigma. A substantial majority of African nations criminalise same-sex relations. Admitting to being LGBT exposes individuals to arrest, harassment and violence. However, there is a growing gay rights movement in Africa, led by young people and supported by healthcare organisations and some government and religious leaders.
Promoting sexual and reproductive health is critical, but also controversial because some view it as containing hidden agendas to promote contraception, abortion and gay rights.
Technology and resources exist that can greatly improve health and healthcare. The major challenge is finding the political will. Donors have failed to meet funding commitments. Wealth has been created in developing countries, but it is not being channelled to the very poor, and income and wealth disparities are growing in developing countries. The European Union needs to advocate and promote social security for all.
Donor healthcare financing should be aligned with partner country policies and harmonised with other donors. Sustainable financing requires partner country participation and responsibility.
Body: The EU's new pan-African programmes should aim for complete social security for all. With a clear vision and ambitious objectives, this could result in solutions for all African countries.Image:Quote Year: 2013Speaker:Nid: 1490
Body: There is a vicious cycle between poverty and poor health. We must pursue the goal of universal health coverage and look for a sustainable solution.Image:Quote Year: 2013Speaker:Nid: 1489
Body: So many people have no access to healthcare and this lack of access is simply wrong. It's also inefficient in macroeconomic terms as people in poor health are less productive.Image:Quote Year: 2013Speaker:Nid: 1488
Body: Improvements to healthcare in Senegal have not yet given rise to more equality of access to healthcare.Image:Quote Year: 2013Speaker:Nid: 1438
Body: We have to invest more in girls and women [...] they deserve more equity and respect.Image:Quote Year: 2013Speaker:Nid: 1436
Body: A high maternal mortality rate is one of the strongest measures of the value that a country gives to health.Image:Quote Year: 2013Speaker:Nid: 1435
Body: We have to invest more in explaining what the “right to health” means: that someone is accountable.Image:Quote Year: 2013Speaker:Nid: 1434
Body: Thirty-nine out of 44 countries in Africa still have laws that criminalise sexual activity between people of the same sex. These laws mostly target men, but women are also arrested.Image:Quote Year: 2013Speaker:Nid: 1433
Body: There is the beginning of a movement [for the rights of LGBT people in Africa]. We have a voice and it is an ever-growing and ever-strengthening voice with allies [...] across the continent.Image:Quote Year: 2013Speaker:Nid: 1432
Poverty generates ill health, and poor health, in turn, increases vulnerability and poverty. The growing burden of non-communicable diseases increasingly also affects the poor. However, reducing the burden of infectious diseases remains essential and a prerequisite to reduce malnutrition. Controlling diseases is also a key element for economic growth. Therefore, the EU is strongly committed to increasing equitable access to quality health services in developing countries, whilst ensuring social protection against the financial risks of disease, strengthening social inclusion and boosting global health.
In line with its Communication on ‘The EU Role in Global Health’, the EU pursues a rights-based approach to health and provides support to developing countries to develop their health policies. Support is also given to strengthen health systems and ensure that health is appropriately considered in other policies, in order to reduce inequalities in health and in access to healthcare, to improve the quality of care, to provide more comprehensive services and to protect against the financial risks of excessive health costs – also ensuring that women’s health concerns are appropriately considered.
While the EU is a major supporter of global health initiatives – such as the Global Fund to fight HIV/AIDS, malaria and tuberculosis, and the GAVI Alliance for Immunisations – and of the specialised UN organisations – such as the World Health Organization – the main focus of the EU’s assistance in the health sector is to provide support directly to partner countries and support countries’ own efforts to achieve universal health coverage.
In the Communication ‘An Agenda for Change’ on EU development policy, the EU confirms its commitment to health by announcing that at least 20 % of its 2014-20 aid budget will be allocated for human development and social inclusion, including health. Furthermore, the 2013 Communication on the post-2015 global development goals sets out the EU’s intention to provide a balanced approach to poverty eradication and sustainable development, ensuring basic living standards, including health, for all.Image: