MSH Recommendations on Post–2015 Development Goals: Universal Health Coverage with Key Provisions for Equity and Measurable Targets to Improve Health and Deliver Effective and Sustainable Solutions
Management Sciences for Health (MSH), a nonprofit global health organization working to save lives and improve health by strengthening health systems in over 40 countries, strongly believes there must be at least one health goal included in the post- 2015 development goals. MSH recommends universal health coverage (UHC) as the overarching health goal, along with the following key provisions:
- A universal health coverage goal must address equity, human rights, and an integrated approach to achieving better health outcomes and long-term impact. Human rights should underpin the new post- MDGs Framework.
- The right to health should be realized and measured by the four essential principles of UHC: services must be available in sufficient quantity; accessible to all; affordable (without causing financial hardship); and of appropriate quality.
- Equitable access should be a fundamental principle for UHC. Too often there is an uneven distribution of health services or resources between men and women, poor and rich, general population and marginalized groups and urban and rural areas. The general indicators in the current MDG Framework are not detailed enough to give a realistic view of those inequalities. This should be addressed in the new post-MDGs Framework.
- An overarching UHC health goal should contain progress indicators for improved health outcomes, especially among the poorest and most marginalized communities globally, through access to high quality, comprehensive health services that included prevention, care, and treatment.
- Special emphasis should be placed on targets to further reduce child mortality, and to prioritize reductions in neonatal and maternal mortality in low and middle-income countries. Although there has been a sharp reduction in the number of deaths among young children, there are still 7.6 million children under 5 years of age dying every year that can be avoided by available preventive measures and prompt treatment. Newborn survival has improved too slowly with 40% of child deaths occurring during the first month of life. And although maternal mortality has declined from 543,000 a year in 1990 to 287,000 in 2010, faster progress is needed.
- Specific targets for each of the major diseases should be included to maintain the gains made in fighting HIV, TB, and Malaria within the current Millennium Development Goals. For instance, 25 countries since 2001 have reduced new HIV infections by more than 50% and, in the past two years, there has been a 60% increase in the number of people accessing life-saving treatment. However, there are substantial regional differences in this global progress. Incidence rates fell significantly in sub-Saharan Africa, but have remained unchanged in Eastern, Western, Central Europe, and North America and are on the rise in Eastern Europe and Central Asia. More African children are receiving the recommended medicines for malaria, but accurate diagnosis remains critical, and though tuberculosis prevalence is falling in most regions worldwide, the trends of this decline remain uncertain. Thus, it is evident that even though gains are being made against major diseases, more must still be done.
- Essential benefits packages included in UHC schemes must ensure coverage for: infectious diseases that are in the current MDGs, so that current momentum is not lost; chronic diseases, which are now known as a rapidly growing segment of the burden of disease in low and middle income countries; and family planning and services supporting sexual and reproductive health and rights, which were not explicitly included as one of the current MDGs. Since over 200 million women in developing countries lack access to the voluntary modern contraception methods that they desire, addressing this unmet need is crucial for the post-MDGs Framework.
- Financing mechanisms for UHC must be equitable. Designed by individual countries based on their needs, schemes must minimize or eliminate financial barriers to care and resulting financial hardship. Adequate public funding, financing through social and community health insurance, and other risk pooling mechanisms should ensure coverage for the most vulnerable groups.
- Medicines should be available, appropriate, accessible and of good quality. A critical, but often overlooked component of health service delivery is access to medicines. Up to 68% of out-of-pocket health costs in resource-limited countries are for medicines. Without access to medicines of assured quality to treat the most common illnesses, countries cannot begin to make a dent in the number of avoidable deaths from conditions raging from malaria to hypertension.
- Health should be recognized as both an independent health goal (s) as well as an important indicator of progress in other sectors. The outcome document from the Rio +20 Summit states “health is a precondition for, an outcome of, and an indicator of all three dimensions (social, economic, and environmental) of sustainable development. Conversely, other sectors provide the preconditions for health, and the goals are therefore interdependent.
Additionally, MSH believes the process for developing the new post-MDGs Framework should consider the following:
- Gender Equity and the meaningful involvement of women at all ages or levels from women’s leaders to girls in school to female peers in decisions affecting the health of women, their families and their communities as well as meaningful engagement of vulnerable and marginalized populations, in the development of the new post-MDGs Framework. Southern governments and civil society organizations and community based organizations were not engaged as equal partners in the development of the current MDGs. This has consequently led to a lack of inclusive ownership in some countries. The current situation merits a separate gender equity goal for the post-MDG era.
- The chronic diseases epidemic (cardiovascular disease, chronic lung disease, diabetes and cancers) is causing almost two thirds of all deaths worldwide. The total number of annual chronic disease deaths is projected to reach 55 million by 2030. A new framework must be responsive to the needs of people suffering from these diseases.
- Support sustainability at the local /national level. The new goals must address national contributions to health—should not only focus on money but must address political will and also emphasize transfer of skills and knowledge to local leaders.
- Long-term sustainable and predictable funding must be identified and secured. No goal set in the future development framework should go unfunded, and the funding must be appropriate to each country context.
- Progress should be monitored in all countries irrespective of their economic or development status. High-income countries have not all necessarily met or will continue to meet all global targets. Where they have met a particular MDG goal (or post-MDG goal) it is essential that they continue to monitor their progress, be held to account globally, or even set higher targets.
- In fragile states, immediate humanitarian needs, including health, clearly are a top priority. To the maximum extent possible, humanitarian and development assistance efforts should rapidly focus on working with local leaders to create a vision for universal health coverage and an essential package of services. UHC provides the pathway for building a health system that gives the greatest number of people access to the widest range of health services.
MSH believes that the three health-related MDGs have played a significant role in galvanizing investment in health and set ambitious but achievable targets to tackle global health issues vital to the well-being of people worldwide. These commitments – most critically those which have not been met – must not be allowed to fall to the wayside. They must be included in the next post -MDGs framework, with a renewed focus on the groups, regions and targets that have fallen most behind in development efforts.