opinionBy Dr Aminu Magashi
A lot is already happening in an aggressive manner to influence and shape the post Millennium Development Goals (MDGs) agenda globally.
Many developing countries including Nigeria are not on track to achieve the health MDGs in reducing maternal death by 75% and reducing child death by about 66% by 2015. In many poor nations health service utilization remains low due to poor and inadequate human resources, essential drugs and equipments. Some critical barriers observed are; low funding to health sector as many nations could not achieve the Abuja declaration of allocating 15% to health sector. The recommendations of the United Nations Commission on Information and Accountability and commission on life saving commodities are far from actualising in many developing nations.
The commissions emerged from the Every Woman, Every Child initiative of the United Nation which aims to save the lives of 16 million women and children by 2015. It is an unprecedented global movement that mobilises and intensifies international and national action by governments, multilaterals, the private sector and civil society to address the major health challenges facing women and children around the world. The effort puts into action the Global Strategy for Women's and Children's Health, which presents a roadmap on how to enhance financing, strengthen policy and improve service on the ground for the most vulnerable women and children.
All these initiatives and efforts are in the process of review as the world re-strategise beyond 2015. In July 2012, a high level panel of Eminent Persons on the post-2015 development agenda was announced by the United Nation and had held series of meetings and consultation with the President Susilo Bambang Yudhoyono (Indonesia), President Ellen Johnson Sirleaf (Liberia) and Prime Minister David Cameron (UK) as members and had this to say in one of their meetings "we must put new and practical emphasis on transparency, accountability and open government. Too many developing countries are held back by corruption".
World We Want' - Health thematic consultation
Also as part of the process, another consultation is now ongoing titled 'World We Want' - Health thematic consultation by UNICEF, WHO, Sweden and Botswana with support from UN interagency group, including UNAIDS, UNFPA, UNDP, UNDESA and OHCHR. As part of the information gathering Gunilla Carlsson and Anders Nordström observed in an article 'Global engagement for health could achieve better results now and after 2015' published by Lancet (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961809-1/fulltext) that "despite the positive progress in people's health during the past 20 years, we have to challenge ourselves and our key partners to save even more lives and prevent illness now and after 2015, the target year for the Millennium Development Goals (MDGs). The investments made in health have paid off and the MDGs have had a critical role. There have been substantial decreases in malaria prevalence and deaths. The rapid increase in access to HIV/AIDS treatment is another success, although there is still a huge access gap. The rise in the number of immunised children is another area of substantive progress that has had an impact on child mortality. This progress is impressive but still not good enough. The success is patchy and lacks sustainability. More importantly, we should be able to do better with the domestic and international resources we are spending today. The main responsibility for taking forward this work lies with our partner governments and communities in the countries concerned. However, the international health architecture also requires a substantive shake-up. There are too many competing partnerships and political initiatives today. Roles and functions need to become clearer and partners should rely more on each other. A post-2015 agenda needs to include a narrative that is clear about a more effective engagement of global partners responding to country needs. More is expected from the global health organisations. Efforts by WHO, UNAIDS, UNICEF, UNFPA, the World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the GAVI Alliance are highly appreciated, but the sum of their collective resources is still not achieving as much as we would like in terms of improved health for poor people."
The above messages re-echoed the need for development partners to refocus and redirect their energy in providing support to developing nations towards ensuring good governance and accountability in the health sector. Development partners should re-strategise their funding and allocate more funds in health system strengthening and catalysing a strong and unified voice for the citizens to demand for good and quality health services. There should be funding cuts in direct involvement in providing services to the populace. Such kind gestures makes government lazy thereby refuse allocating adequate resources to health.
As we are reshaping and changing the goal post from MDGs to SDGs (sustainable development goals) and from 2015 to 2030, we should support accountability mechanisms in line with the three interconnected processes - monitor, review and act.
Beyond 2015 is real, what is the role of developing countries in the process? Are they a dumping ground of ideas or they are also reviewing local progress and initiatives and the outcome is helping them to reverberate what they want to see happening beyond 2015. Only time will tell.