Transforming health systems for women and children PDF

207 Pages·2005·1.81 MB·English

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�� I S BN 1-84407 -224 -X 9 7 8 1 8 4 4 0 7 2 2 4 8 �� Task Force on Hunger Halving hunger: it can be done Task Force on Education and Gender Equality Toward universal primary education: investments, incentives, and institutions Task Force on Education and Gender Equality Taking action: achieving gender equality and empowering women Task Force on Child Health and Maternal Health Who’s got the power? Transforming health systems for women and children Task Force on HIV/AIDS, Malaria, TB, and Access to Essential Medicines Working Group on HIV/AIDS Combating AIDS in the developing world Task Force on HIV/AIDS, Malaria, TB, and Access to Essential Medicines Working Group on Malaria Coming to grips with malaria in the new millennium Task Force on HIV/AIDS, Malaria, TB, and Access to Essential Medicines Working Group on TB Investing in strategies to reverse the global incidence of TB Task Force on HIV/AIDS, Malaria, TB, and Access to Essential Medicines Working Group on Access to Essential Medicines Prescription for healthy development: increasing access to medicines The UN Millennium Project is an independent advisory body commissioned by the UN Task Force on Environmental Sustainability Secretary-General to propose the best strategies for meeting the Millennium Development Goals Environment and human well-being: a practical strategy (MDGs). The MDGs are the world’s targets for dramatically reducing extreme poverty in its many dimensions by 2015—income poverty, hunger, disease, exclusion, lack of infrastructure and Task Force on Water and Sanitation shelter—while promoting gender equality, education, health, and environmental sustainability. Health, dignity, and development: what will it take? The UN Millennium Project is directed by Professor Jeffrey D. Sachs, Special Advisor to the Task Force on Improving the Lives of Slum Dwellers Secretary-General on the Millennium Development Goals. The bulk of its analytical work has A home in the city been carried out by 10 thematic task forces comprising more than 250 experts from around the world, including scientists, development practitioners, parliamentarians, policymakers, Task Force on Trade and representatives from civil society, UN agencies, the World Bank, the International Trade for development Monetary Fund, and the private sector. The UN Millennium Project reports directly to UN Secretary-General Kofi Annan and United Nations Development Programme Administrator Task Force on Science, Technology, and Innovation Mark Malloch Brown, in his capacity as Chair of the UN Development Group. Innovation: applying knowledge in development Task Force on Hunger Halving hunger: it can be done Task Force on Education and Gender Equality Toward universal primary education: investments, incentives, and institutions Task Force on Education and Gender Equality Taking action: achieving gender equality and empowering women Task Force on Child Health and Maternal Health Who’s got the power? Transforming health systems for women and children Task Force on HIV/AIDS, Malaria, TB, and Access to Essential Medicines Working Group on HIV/AIDS Combating AIDS in the developing world Task Force on HIV/AIDS, Malaria, TB, and Access to Essential Medicines Working Group on Malaria Coming to grips with malaria in the new millennium Task Force on HIV/AIDS, Malaria, TB, and Access to Essential Medicines Working Group on TB Investing in strategies to reverse the global incidence of TB Task Force on HIV/AIDS, Malaria, TB, and Access to Essential Medicines Working Group on Access to Essential Medicines Prescription for healthy development: increasing access to medicines The UN Millennium Project is an independent advisory body commissioned by the UN Task Force on Environmental Sustainability Secretary-General to propose the best strategies for meeting the Millennium Development Goals Environment and human well-being: a practical strategy (MDGs). The MDGs are the world’s targets for dramatically reducing extreme poverty in its many dimensions by 2015—income poverty, hunger, disease, exclusion, lack of infrastructure and Task Force on Water and Sanitation shelter—while promoting gender equality, education, health, and environmental sustainability. Health, dignity, and development: what will it take? The UN Millennium Project is directed by Professor Jeffrey D. Sachs, Special Advisor to the Task Force on Improving the Lives of Slum Dwellers Secretary-General on the Millennium Development Goals. The bulk of its analytical work has A home in the city been carried out by 10 thematic task forces comprising more than 250 experts from around the world, including scientists, development practitioners, parliamentarians, policymakers, Task Force on Trade and representatives from civil society, UN agencies, the World Bank, the International Trade for development Monetary Fund, and the private sector. The UN Millennium Project reports directly to UN Secretary-General Kofi Annan and United Nations Development Programme Administrator Task Force on Science, Technology, and Innovation Mark Malloch Brown, in his capacity as Chair of the UN Development Group. Innovation: applying knowledge in development �� First published by Earthscan in the UK and USA in 2005 Copyright © 2005 by the United Nations Development Programme All rights reserved ISBN: 1-84407-224-X paperback For a full list of publications please contact: Earthscan 8–12 Camden High Street London, NW1 0JH, UK Tel: +44 (0)20 7387 8558 Fax: +44 (0)20 7387 8998 Email: Foreword The world has an unprecedented opportunity to improve the lives of billions of people by adopting practical approaches to meeting the Millennium Devel- opment Goals. At the request of the UN Secretary-General Kofi Annan, the UN Millennium Project has identified practical strategies to eradicate poverty by scaling up investments in infrastructure and human capital while promoting gender equality and environmental sustainability. These strategies are described in the UN Millennium Project’s report Investing in Development: A Practical Plan to Achieve the Millennium Development Goals, which was coau- thored by the coordinators of the UN Millennium Project task forces. The task forces have identified the interventions and policy measures needed to achieve each of the Goals. In Who’s Got the Power: Transforming Health Systems for Women and Children, the Task Force on Child Health and Maternal Health responds to the challenges posed by high rates of maternal mortality, continued child deaths due to preventable illnesses, enormous unmet need for sexual and reproductive health services, and weak and frag- ile health systems. In addition to identifying the technical interventions to address these problems, the report asserts that policymakers must act now to change the fundamental societal dynamics that currently prevent those most in need from accessing quality health care. Who’s Got the Power proposes bold and concrete steps that governments and international agencies can take to ensure that health sector interventions have significant effects on all aspects of development and poverty reduction. This report has been prepared by a group of leading experts who contrib- uted in their personal capacity and volunteered their time to this important task. I am very grateful for their thorough and skilled efforts and I am sure that the practical options for action in this report will make an important iv Foreword contribution to achieving the Millennium Development Goals. I strongly rec- ommend this report to all who are interested in transforming health systems to save lives and promote development. Jeffrey D. Sachs New York January 17, 2005 Contents Foreword iii Contents v Task force members viii Preface xi Acknowledgments xiii Millennium Development Goals xvi Executive summary 1 1 Introduction 18 2 Analytical context 25 Global health from three perspectives 25 First principles: equity and human rights 29 The health systems crisis in historical context 36 Evidence and the challenge of scaling up 45 3 Health status and key interventions 49 Connecting maternal health and child health 49 Child health 51 Adolescent health 69 Sexual and reproductive health 72 Conflict-affected and displaced populations 77 Maternal mortality and morbidity 77 vi Contents 4 Transforming health systems 95 Market-based approaches to healthcare: a critique 96 Defining health systems 97 Thinking about health systems 98 Taking redistribution seriously 99 Healthcare financing 107 Organizing the health system 113 Health management 117 A health workforce to meet the Millennium Development Goals 119 5 M onitoring Goals 4 and 5: targets and indicators 130 What lies behind the averages? Monitoring equity 130 Goal 4: Child health, neonatal mortality and nutrition. 132 Goal 5: Improving maternal health 132 Monitoring health systems 136 Monitoring the Goals: the role of health information 137 6 Global policy and funding frameworks 139 Influence of international financial institutions 139 Debt relief, poverty reduction, and public expenditure management 141 Poverty reduction loans and poverty and social impact assessments 147 Donor coordination and harmonization 148 Sectorwide approaches need to be promoted 150 Other global initiatives’ impact on the health sector 151 7 Conclusions and recommendations 153 Notes 157 References 160 Boxes 2.1 BRAC trains village women as volunteer community health workers 37 2.2 The UN International Conference on Population and Development definitions of reproductive health and reproductive rights 45 3.1 Twelve simple family practices can prevent illness or reduce the likelihood of complications 68 4.1 A variety of factors affects the brain drain of healthcare workers 121 Figures 1 Full use of existing interventions would dramatically cut child deaths 6 2 Full use of existing services would dramatically reduce maternal deaths 6 Contents vii 2.1 Use of health services by lowest and highest wealth quintiles in developing and transitional countries 30 3.1 Conceptual map of sexual and reproductive health 50 3.2 Under-five mortality rates by socioeconomic status in selected developing countries, 1978–96 62 3.3 Pathway to survival 65 3.4 Disability-adjusted life years lost among women of childbearing age, 2001 73 3.5 Disability-adjusted life years lost by women of childbearing age due to sexual and reproductive health conditions, 1990 and 2001 73 3.6 Unmet need for contraception by region, 2003 75 3.7 Contraceptive prevalence rates for richest and poorest quintiles in 45 countries, mid-1990s to 2000 76 3.8 Causes of maternal death, 2000 80 3.9 Maternal deaths in relation to use of existing services 88 Tables 1 Goals, targets, and indicators for child health and maternal health 3 2 Task force approach to health systems 13 3 Proposed targets and indicators for the child health and maternal health Goals 17 1.1 Task force approach to health systems 23 3.1 Six countries with highest number of annual deaths of children under age five 53 3.2 Causes of deaths of children under age five 53 3.3 Causes of neonatal mortality 58 3.4 Estimated number of preventable deaths of children under age five 59 3.5 Evidence-based priority interventions for improving neonatal survival 61 3.6 Under-five mortality rates, by country income level 62 3.7 Maternal mortality around the world, 2000 79 3.8 Signal functions of basic and comprehensive emergency obstetric care services 84 3.9 Countries with the largest number of maternal deaths, 2000 91 3.10 Countries with maternal mortality ratios exceeding 500 deaths per 100,000 live births, 2000 (ranked by maternal mortality ratio) 92 4.1 Principles of redistribution and policy responses 102 4.2 Key healthcare financing mechanisms 110 5.1 Proposed targets and indicators for the child health and maternal health Goals 131

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