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Sjackson@worldbank.org World Health Organization and World Bank to convene high-level meeting in Africa to offer help WASHINGTON, D.C., November 10, 2004—A new World Bank report today warns that many developing countries are falling behind in the race to sharply lower the number of deaths among children under the age of five and pregnant women, by the year 2015. More than 11 million children died in 2002 before reaching their fifth birthday from preventable illness, while as many as 500,000 women perished during pregnancy or childbirth. The Bank says that this situation is particularly distressing as many of the "technologies" needed to improve health are available and affordable, and that even in countries with little money and few health facilities, sensible and systematic efforts to improve health have worked. According to a new report - Rising to the Challenges: The Millennium Development Goals For Health - with just ten years left before the 2015 Millennium Development Goals deadline, more help is needed to fix inadequate health care delivery systems, to train more health care workers, and to supply more predictable aid to those developing countries in dire need of support, if the world is to stand a realistic chance of reaching these goals. Eight MDGs were set at the United Nations Millennium Summit in September 2000. One hundred eighty nine countries committed to these ambitious targets for improving the health and well-being of hundreds of millions of people in the developing world by 2015 . Four of the Goals relate to health: to reduce maternal mortality by three-quarters and child mortality by two-thirds; halve the proportion of people who suffer from hunger; combat HIV/AIDS, malaria and other diseases; and improve access to safe drinking water and essential drugs. "Even with general economic growth and faster progress on the non-health MDGs, many regions will still miss many of the health MDG targets. We need to look at measures such as committing increased resources to meeting the health-related MDGs, and using those resources more effectively in countries,” says James D. Wolfensohn, President of the World Bank. “Donor harmonization in resource mobilization and use, strengthening human resources in the health sector and improving monitoring and evaluation, through the optic of a strong country and equity focus, will be particularly important.” The World Bank estimates that progress against child mortality thus far has been so slow that no sub-Saharan country in Africa is on target to reach this Goal. At the current pace in the developing world as a whole, only 16% of countries (representing 19% of the developing world’s population) are currently on track. Similarly, only 17% of developing countries are likely to meet the maternal mortality MDG, and Latin America and the Caribbean are faring the worst, with just 4.2% of countries on track to meet the target. In addition, only 40% of developing countries are on track to reach the malnutrition MDG. "When these kinds of targets are set, it seems too soon to take urgent action, and then, after a few short years, it seems too late," said Director-General of WHO, Dr. Lee Jong-wook, who also helped write the report . "Where the targets are the product of a large consensus there is also the hazard of everyone waiting for everyone else to risk making the first move. We still have time to avoid these pitfalls with the targets for 2015, but to do so we have to act now." Faster progress is possible in all regions and countries… The report says that proven treatments and interventions already exist for many illnesses but they are used too infrequently by people who need them the most—especially poor people. Child mortality, diarrhea, pneumonia, and malaria account for 52% of deaths worldwide. For each of these causes, there is at least one proven effective preventive intervention and at least one proven effective treatment intervention, each capable of being delivered in a low-income setting. In most cases, several proven effective interventions exist. For diarrhea—the second-leading cause of child deaths—there are no fewer than five proven preventive interventions and three proven treatment interventions. Yet, for one reason or another, people do not receive the effective interventions that could save their lives or make them well nourished. In upper middle-income and high-income countries, 90% of children receive DPT3 vaccinations, more than 90% of babies are delivered by a medically-trained attendant, and more than 90% of pregnant women have at least one antenatal visit. In South Asia fewer than 50% of pregnant women receive an antenatal checkup, and only 20% of babies are delivered by medically-trained staff. The story is similar for other childhood interventions, and for interventions for other goals. Of the estimated 6 million people currently needing antiretroviral therapy in low-income and middle-income countries, only 300,000 of them receive it. In Asia, where more than 7 million people are living with HIV/AIDS, no country has exceeded 5% anti-retroviral therapy coverage. “The scale of death and illness in the world today is simply staggering, but it doesn’t have to be this way, given what governments now know about what works and what doesn’t in helping poor people live healthier, longer lives,” says Jacques Baudouy, Director of the World Bank’s Health, Nutrition, and Population Team, which produced the new report, and a former medical doctor with the humanitarian group, Médecins Sans Frontières.“ This report aims to make a difference, by showing how major public health efforts in countries from China to Poland and Sri Lanka to The Gambia can and have changed the world for the better – well beyond what would have occurred through economic growth on its own. How to speed up progress in health? The new report identifies steps which developing countries can take, along with wealthy donors and development agencies, to speed up national progress towards meeting the 2015 health challenges. For developing countries, the World Bank says increasing health spending is part of the answer to getting poor people the effective treatments they need, but it is not the whole story. In countries without solid health and economic reforms in place, spending will have little impact unless money and services are targeted at people who need them the most. Even in countries with good health and macro-economic reforms in place, more government health spending needs to be targeted because this ensures that help gets to the people who need it most, and the number of health-related deaths will be reduced. On top of more spending, health systems also need to be modernized to better distribute life-saving drugs and treatments, and more medical staff need to be trained to offset the steady “brain-drain” loss of doctors, nurses, and others to more affluent countries. For example, In Zambia, of the more than 600 doctors trained since independence in 1964, only 50 remain in the country. Botswana’s Ministry of Health estimates that achieving universal coverage of anti-retroviral treatment alone would require doubling the current nurse workforce, tripling the number of doctors, and quintupling the number of pharmacists. Donor countries must do better than they have in the past… According to the report, too often foreign aid for health is unpredictable, and the transaction costs high. It is not just the amount that donors provide, but also committing to it in the long term. In delivery of aid, sustainability and predictability are key issues. Donor funds that arrive one year, but not the next, only worsen the plight of poor country governments trying to make long-term budget commitments to update and expand their health systems. Countries providing aid also need to work together better—both to raise more money for aid, and to ensure that advice given to poor countries is consistent. Better coordination, pooling foreign aid to secure the biggest impact, and putting countries in the driver’s seat to steer towards their own priorities, would all help greatly in providing care and treatment to people who need it the most in developing countries. Health summit in Nigeria Leaders in international development, including those from developing countries, development and UN agencies, bilateral donors, and charitable foundations such as the Bill and Melinda Gates Foundation, will meet shortly in Abuja, Nigeria to build on the policy recommendations in the new World Bank report, and identify urgent follow-up actions, both at the country and global levels, to drive progress more quickly towards the 2015 health goals. The conference, the second in a series called the High-Level Forum on the Health MDGs, is coordinated jointly by the World Health Organization and the World Bank. For more on the Abuja High Level Forum, visit:
http://www.hlfhealthmdgs.org/December2004Mtg.asp8 To download the full text of the report, visit:
Rising to the Challenges: The Millennium Development Goals For Health For more on the World Bank's work in health, visit:
http://www.worldbank.org/hnp |
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