As the ‘countdown’ to December 2015 draws closer, there is a renewed debate on how effectively the Millennium Development Goals (MDGs) have helped shape the agenda and the strategies to improve health, reduce poverty and promote development.
It could be argued that the MDGs have failed to recognise the central role and need for strengthening existing health systems and access to health careIt is widely accepted that both MDG4 and MDG5 have helped enormously with regard to setting a clear agenda for maternal, reproductive and child health but it could be argued that the MDGs have failed to recognise the central role and need for strengthening existing health systems, access to health care and have instead tended to place more importance on measurable health outcomes related to vertical programmes.
The MDGs had a clear focus on improving the situation in the world’s poorest countries and reducing unacceptable global health disparities. In absolute terms, there has certainly been a ‘narrowing of the gap’ between countries with significant progress made in all MDGs except goals 4 and 5. However, the relative decline in under-five mortality has been greater in those countries that already had the lowest under-five mortality rates. Similarly, the decline in maternal mortality was on average 44% for the 25% of countries with the highest maternal mortality rates compared to 39% in the 25% with the lowest maternal mortality rates.2 Thus, there are currently still considerable gaps between countries at either end of the spectrum and gaps within countries (urban-rural, rich-poor divides). National average data reported therefore conceal existing disparities within many countries and therefore a missed opportunity to concentrate on improving health for sub-populations that are worse off.
There has certainly been a ‘narrowing of the gap’ between countries with significant progress made in all MDGs except goals 4 and 5This has resulted in renewed discussions on the concept of Universal Health Coverage (UHC), now firmly part of the Post-2015 agenda. Member states of the UN requested the UN secretary general synthesize the full range of inputs into the post MDG discussions (The road to dignity by 2030) in 2014.
The proposed sustainable development goal (SDG) related to health is SDG 3: Attain healthy life for all at all ages and target 3.6 is to achieve Universal Health Coverage.
While the new agenda seems to focus on strengthening health systems to take on the full responsibility of ensuring health for all, it looses the specificity that will drive reproductive/maternal and newborn healthInterestingly the concept of UHC is not new, it was discussed at the 2005 World Health Assembly and defined as “access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost, thereby achieving equity in access”. Other definitions emphasize the need for access to health prevention and curative services needed without risking financial hardship from unaffordable out-of-pocket payments.
While the new agenda seems to focus on strengthening health systems to take on the full responsibility of ensuring health for all, it looses the specificity that will drive reproductive/maternal and newborn health. However UHC provides an opportunity to ensure that specific targets addressing all dimensions of UHC are developed (of which financial risk protection is the most popular). Other dimensions need to be defined in order to drive successful implementation.
Three dimensions of UHC for reproductive/maternal and newborn health are proposed: Society, Providers and ServiceThree dimensions of UHC for reproductive/maternal and newborn health are proposed: Society (social protection, financial protection), Providers (workforce, quality, responsiveness, efficiency) and Service (affordability, acceptability, accessibility, efficiency, equity, range of services). Indicators covering all components of the 3 proposed dimensions will facilitate comprehensive coverage of reproductive health care services in the post MDG era.