Background

Health campaigners making a difference in 2008

Given the importance of 2008 for health, a group of organisations have come together to ensure world leaders act. They are Action for Global Health, World Vision International, the Global Movement for Children and Save the Children UK. The aims of this group are:

1. To draw attention to the 30th anniversary of Alma Ata and the commitment to health care for all.
2. To reaffirm the importance of equity, the right to health and the achievement of the MDGs
3. To call for greater attention to the need to strengthen health systems and address the global health workforce crisis
4. To demand more funding for health.
5. To build awareness amongst supporters and targets that people worldwide are campaigning for improved healthcare for all and will be demanding and monitoring tangible change for the better.

Collectively, this group has identified the World Health Assembly has a moment to work together and start building momentum around the importance of making real decisions to improve health services for 2008. They have decided to do the following:

1. Have a statement that development and health ministers can sign during 2008, to publicly recommit to the Alma Ata principle and the need to meet the MDGs. This statement would then be used as a tool for national and global level advocacy and campaigning.
2. Conduct joint media work done before, during and after the WHA to promote the statement and around the ministers who sign it, as well as the need of action on health during 2008
3. Have a joint presence at the WHA to mark the Alma Ata anniversary and to put pressure on health ministers to act to meet this principle.

What we’re calling on Governments and Civil Society to do

Campaigners are asking world leaders to:

1. To recommit to the principles of Alma Ata and their energies to meeting the health MDGS
2. To commit the political will and financial resources needed to achieve health for all as defined by Alma Ata and the health MDGs

Campaigners are asking civil society to:

1. Ask their health or development minister to sign the statement (available online at www.actnowforhealth.org)
2. Use this commitment made by the health/development minister as a tool to campaign and advocate for governments to deliver health services for all.

Progress is possible

1. Sri Lanka – delivering maternal care

More than one-third of Sri Lanka’s population live on less than two dollars a day, but the country’s maternal mortality rates are among the lowest in the world. Over the course of the 1990s the number of maternal deaths halved, from 520 to 250 women per year, in a population of 18 million. Today over 96 per cent of deliveries are attended by a skilled birth attendant and over 90 per cent take place in a health facility[1]. How has this been achieved? By providing public health services free of charge — essential in making them accessible to poor people — and by providing a large number of health posts: almost everyone now lives less than 1.5km from their nearest centre.

2. Child mortality figures halved in 46 years

At the United Nations Millennium Summit in 2000, the world’s governments committed themselves to eight targets for poverty reduction and development. While each of these is important, four are especially relevant to the survival prospects of children. Millennium Development Goal 4 (MDG 4) calls for a reduction by two thirds, between 1990 and 2015, in the under-five mortality rate. There has been some movement here: in 2006, for the first time since records were kept, the number of children dying before the age of five is estimated to have fallen below 10 million, to 9.7 million[2]. That compares with an estimated 20 million under-five deaths in 1960.

3. Thailand – a model of healthcare for all

For years, the Thai health system was unequal, unaffordable for the poorest people, and failing millions. After attempts to modify the services with initiatives such as health insurance schemes and private provision of services, the Thai government took the decision to massively subsidise the public health system. This transformed Thailand’s health provision and has seen Thailand’s health care system lauded as a model for the developing world. It has also saved the lives of thousands of people living with HIV and AIDS. Cheap, generic versions of ARVs are now supplied through the public health system, which has given three times as many HIV patients access to the life-saving medicines they need.

4. More Nurses and Midwives in Malawi

The health worker crisis in Malawi is chronic — but the government is starting to turn the situation around by working in partnership with rich country aid donors to build public services. Decades of low pay, poor working conditions, and under-funding have undermined the public health system and have led to a chronic shortage of nurses and doctors. Vacancies in nursing posts are running at over 60 per cent, and four of Malawi’s districts have no doctors at all. Existing staff are leaving the public health system to work for civil society organisations or private hospitals, or even deserting the health sector altogether. The UK government has been working closely with Malawi’s Ministry of Health to tackle the country’s severe human resources problems. In 2004 the Ministry produced a six-year human resources relief programme, which is 90 per cent funded by the UK and the Global Fund. The assistance is funding a 50 per cent increase in the salaries of 5,400 existing front-line health workers, and the recruitment of 700 new health staff, with a planned doubling of health workers in six years through expansion and improvement of training schools and trainers. Funds only started being released in April 2005, but there are early indications from hospitals of a dramatic reduction in the outflow of nurses. [3]

The challenge remaining to achieve health for all:

1. Basic statistics

Every day:

1,400 women die in childbirth and pregnancy

4,000 children die of diarrhoea

6,000 people die of HIV and AIDS-related illnesses

… all because of a lack of access to decent quality health care.

2. Sierra Leone: a 1 in 8 lifetime risk of maternal death

The WHO’s new estimate shows that worldwide, in 2005 alone, close to half a million women died of maternal causes. About 99% of the fatality took place in developing countries, and slightly more than half occurred in the sub-Saharan African region alone. Sierra Leone is a dangerous place to be a mother. It has the highest recorded level of maternal mortality in the world, every 100 live births is associated with 2 maternal deaths[4].

Maternal mortality is considered the best and most sensitive indicator to measure how a health system is performing as a whole. Common ingredients in high maternal rates include lack of access to public health care facilities, including hospitals for emergency obstetric care; user fees and a lack of health care workers.

3. Child mortality: MDG 4 won’t be achieved until 2045

While the overall trend of declining child mortality rates is positive, the pace of improvement is appallingly slow and progress is far from uniform. Only seven of the 60 countries with the worst records on child mortality are on track to meet MDG 4: Bangladesh, Brazil, Egypt, Indonesia, Mexico, Nepal and the Philippines. Fourteen countries have actually seen an increase in child mortality rates since 1990. At current rates of progress, the MDG goal of reducing under-five mortality by two thirds will not be achieved globally until 2045[5].

4. The need for equity: the growing divide between the rich and poor in India

Despite recent economic growth and government promises to increase health and education spending and to cut infant deaths, India remains a country of deep inequalities, entrenched by its previous failure to invest comprehensively in rural development. India alone accounts for more than 25% of the world’s newborn deaths[6], and in Uttar Pradesh, girls are likely to live 20 years less than girls born in Kerala, where the state government has made essential services a priority. The Indian government continues to spend almost twice as much on its military forces as it does on health, and progress in reducing child deaths has slowed to such an extent that lower-income Viet Nam and Bangladesh have overtaken India in improving child mortality rates[7]

[1]Davey, S. (2000) Health: A Key to Prosperity. Success Stories in Developing Countries, Geneva: WHO, CDS.

[2] CJ Murray,T Laakso, K Shibuya, K Hill,AD Lopez,‘Can we achieve
Millennium Development Goal 4? New analysis of country trends and
forecasts of under-5 mortality to 2015’, Lancet, 370, 2007, pp 1040–1054

[3] DFID Communications and DFID (2004) ‘Improving Health in Malawi: Programme Memorandum November 2004’, London: Department For International Development.

[4] WHO: http://www.afro.who.int/home/countries/fact_sheets/sierraleone.pdf

[5] UNICEF, State of the World’s Children, 2006, UNICEF, 2005

[6] JE Lawn, S Cousens, J Zupan,‘Four million neonatal deaths: When? Where? Why?’, Lancet, 365, 2005, pp 1147–52

[7] UNDP 2005a. Human Development Report 2005: International Cooperation at a Crossroads: Aid, Trade and Security in an Unequal World’, New York: UNDP.