With many MDG targets already met on reducing poverty, increasing access to improved drinking water sources, improving the lives of slum dwellers and achieving gender parity in primary school, The Millennium Development Goals Report 2014, says many more targets are within reach by their 2015 target date. If trends continue, the world will surpass MDG targets on malaria, tuberculosis and access to HIV treatment, and the hunger target looks within reach. Other targets, such as access to technologies, reduction of average tariffs, debt relief, and growing political participation by women, show great progress. The MDG report is based on comprehensive official statistics and provides the most up-to-date summary of all Goals and their targets at global and regional levels, with additional national statistics available online. Results show that concentrated efforts to achieve MDG targets by national governments, the international community, civil society and the private sector are working to lift people out of extreme poverty and improve their futures. It notes that much greater effort and investment will be needed to alter inadequate sanitation facilities. High dropout rates remain a barrier to universal primary education. Despite considerable advancements in recent years, the report says reliable statistics for monitoring development remain inadequate in many countries, but better statistical reporting on the MDGs has led to real results.
Equity in Health
The second Equity Gauge seeks to place the goal of equitable health care within a broader framework that links socio-economic disparities with health outcomes. This publication highlights the fact that people do not get sick at random and that health is intimately tied up with living and working conditions. In focusing on this interdependence of socio-economic determinants with health outcomes, the document also points to the relationship between health status and geographical, racial and gender-related issues.
At the end of the Global Symposium on Health Systems Research, held from 16-29 November 2010 in Montreux, Switzerland, the Steering Committee made a number of resolutions. They proposed to electronically preserve and disseminate the knowledge from the symposium, using innovative communication channels. They also committed to creating an International society for health systems research, knowledge and innovation, with the goal of advancing ‘science to accelerate universal health coverage’, to take build greater constituency, credibility and capacity for health systems research globally. The Committee will give visibility and support to regional and national efforts to strengthen health systems research, promoting strengthened health systems within priority UN agendas and accelerating universal health coverage. Contributions will be solicited from the global scientific community to establish norms, standards and practices to strengthen the foundations for health systems research. The Committee will also identify joint opportunities for collaborative research and knowledge production across different disciplines, sectors, stakeholders and geographies. Finally, the Committee agreed to gather for a Second Global Symposium on Health Systems Research in 2012 or 2013 to evaluate progress, share insights and recalibrate the agenda of science to accelerate universal health coverage. China has offered to host the Symposium.
Poor people in developing countries have little hope of overcoming poverty and deprivation unless urgent action is taken, according to the 2004 Global Monitoring report. The report, whose purpose is to assess progress towards internationally agreed objectives for reducing poverty, was the focus of discussions by the World Bank and the International Monetary Fund (IMF) during a meeting in Washington, April 24-25. The report claims that most developing countries will not meet the Millennium Development Goals (MDGs), which include halving the proportion of the population in extreme poverty, ensuring primary education for all children, and decreasing child and maternal deaths by 2015. (This article requires registration.)
What have the Millennium Development Goals (MDGs) achieved? And what might their achievements mean for any second generation of MDGs or MDGs 2.0? The authors of this paper argue that the MDGs may have played a role in increasing aid and that beyond aid, development policies have seen some limited improvement in high income countries, but with more limited evidence of policy change in low income countries. There is some evidence of faster-than-expected progress improving quality of life in low income countries since the Millennium Declaration, but the contribution of the MDGs themselves in speeding that progress is difficult to demonstrate, even assuming the MDGs induced policy changes after 2002. The authors reflect on what the global goal setting experience of the MDGs has taught us and how things might be done differently if there is a new round of MDGs after 2015. They conclude that any MDGs 2.0 need targets that are set realistically and directly link external funding flows to social policy change and to results.
In Ghana, the United Nations Development Program (UNDP) estimates that the country is largely on track in achieving the MDG 1. Poverty has reduced from over 50 percent in 1992 to 28.5% in 2006, indicating that the poverty target could be achieved well ahead of time. Similarly, the proportion of people living below the extreme poverty line declined from 36% to 18% over the same period. But the author of this blog argues that these figures do not take into account regional disparities: hunger is still rife in Ghana's three northern regions. A key theme emerging from his own research suggests that policy makers tend to tout the aggregate "success story" and become preoccupied with hitting statistical targets rather than improving the overall welfare of all constituents. This highlights the risks when policy-makers focus too much on targets, implying that complex processes can be over-simplified and priorities skewed when policies aim solely at targets. The author argues that the use of targets can encourage a reductionist approach to complex problems, privilege quantitative indicators at the expense of qualitative ones, distort resource allocation, and undermine professional motivation and responsibility. He concludes that, while Ghana’s progress has been remarkable, much work still needs to be done in the northern regions.
Sub-Saharan Africa has the world's highest under-5 and neonatal mortality rates as well as the highest naturally occurring twin rates. Twin pregnancies carry high risk for children and mothers. Under-5 mortality has declined in sub-Saharan Africa over the last decades. It is unknown whether twins have shared in this reduction. The authors pooled data from 90 Demographic and Health Surveys for 30 sub-Saharan Africa countries on births reported between 1995 and 2014 to address this question. Under-5 mortality among twins declined from 327 per 1000 live births in 1995–2001 to 213 in 2009–14. This decline of 35% was less steep than the 51% reduction among singletons. Twins account for an increasing share of under-5 deaths in sub-Saharan Africa: currently 11% of under-5 mortality and 15% of neonatal mortality. Excess twin mortality cannot be explained by common risk factors for under-5 mortality, including birth-weight. The difference with singletons was especially stark for neonatal mortality and 52% of women pregnant with twins reported receiving medical assistance at birth. The authors note that an alarming one-fifth of twins in the region dies before age 5 years, three times the mortality rate among singletons. Twins account for a substantial and growing share of under-5 and neonatal mortality, but they are largely neglected in the literature. They argue that co-ordinated action is required to improve the situation of this extremely vulnerable group.
This statistical release presents information on mortality and causes of death in South Africa for deaths that occurred in 2010. It also provides information on death occurrences from 1997 to 2009 to show trends in mortality and causes of death. It is based on data collected through the South African civil registration system that is maintained by the Department of Home Affairs. The information on causes of death provided is as recorded on death notification forms completed by medical practitioners and other certifying officials. The results generally showed that mortality continues to decline in the count ry. A total of 543,856 deaths occurred in 2010, which was a 6,2% decline from 579,711 deaths that occurred in 2009. Decreases in the overall number of deaths from the civil registration system have been observed since 2007. The National Population Register, which is maintained by the Department of Home Affairs, also showed annual declines in the number of deaths since 2007. Furthermore, median ages at deaths showed that mortality occurs later in life, which is also an indication of declining mortality. In 2010, the median age at death was estimated at around 48 years, which has increased by about five years since 2004. Tuberculosis maintained its rank as the number one leading cause of death in South Africa (12% of all mortalities).
Health priorities since the UN Millennium Declaration have focused strongly on children younger than 5 years. The health of older children (age 5–9 years) and younger adolescents (age 10–14 years) has been neglected until recently, especially in low-income and middle-income countries, and mortality measures for these age groups have often been derived from overly flexible models. The authors report global and regional empirical mortality estimates for children aged 5–14 years in low-income and middle-income countries, and compare them with ones from existing models, using birth-history data from a 25-year period from 1986 of Demographic and Health Surveys programme for 84 World Bank low-income and middle-income countries, and data about household deaths in China from their 1990 and 2010 censuses. The mean risk of a child dying at age 5–14 years in low-income and middle-income countries is about 19% of the risk of dying between birth and age 5 years (12% at age 5–9 plus 7% at age 10–14). According to their estimates, the total number of deaths at ages 5–14 years in low-income and middle-income regions fell from about 2·4 million in 1990 to about 1·5 million in 2010. From estimates the authors concluded there to have been 200 000 (16%) more deaths at ages 5–14 than in the UN report; however, the estimates exceeded GBD estimates by more than 700 000 (87%). The average annual rate of decline in mortality at age 5–9 years (about 3%) slightly exceeded that for ages 0–4 years (2·8%), but progress has been slower for age 10–14 years (about 2%). Their analysis suggests that mortality risks nowadays in the age range 5–14 years in low-income and middle-income countries are rather higher (relative to mortality in children younger than 5 years) than would be expected on the basis of historical evidence. The authors argue that global policy emphasis on reduction of mortality in children younger than 5 years should be broadened to include older children and adolescents.