IN 2000, the leaders of 189 nations signed the Millennium Declaration of the United Nations (UN), pledging to free their people from poverty, illiteracy and ill health. This commitment gave rise to the Millennium Development Goals (MDGs), the target date for the achievement of which is 2015.
The eight goals are to: eradicate extreme poverty and hunger; achieve universal primary education; promote gender equality and empower women; reduce child mortality; improve maternal health; combat HIV/AIDS, malaria and other diseases; ensure environmental sustainability; and develop a global partnership for development.
Health is clearly a major theme of the MDGs, with six of the eight goals having a bearing on the health of the world’s population. From a healthcare perspective, sub-Saharan Africa has the most to gain from MDG-based programmes.
The subcontinent started the millennium with the world’s highest child mortality rates, the highest incidence of maternal deaths, the highest rate of new HIV/AIDS infections and deaths, and among the highest rates of tuberculosis (TB) infections and deaths.
Has the situation changed 12 years on? Has sub-Saharan Africa made progress towards achieving the healthcare-related MDGs? Is there any hope that African nations will succeed in doing so in the next three years?
Since the MDGs commenced in 2000, various agencies of the UN have been reporting on the status of the achievement of MDGs. In 2005, the World Health Organi sation (WHO) reported on the status of the healthcare aspects of the MDGs. Following the MDG World Summit in New York in September last year, the Department of Economic and Social Affairs of the UN Secretariat issued its Millennium Development Goals Report.
The latter report notes that various strides have been taken in sub-Saharan Africa on the healthcare front. Africa has achieved the largest absolute drops in malaria deaths, with 11 countries reducing malaria cases and deaths by more than 50%. The report further states that sub-Saharan Africa has led the decline in new HIV infections by recording a drop of 21% between 1997, when infections peaked, and 2009. It goes on to say that mortality among children younger than five in sub-Saharan Africa fell from 180 per 1000 live births in 1990, to 129 in 2009.
It would be churlish to dismiss these improvements. At the same time, it cannot be denied that the health of Africa’s people is still far from rosy.
Despite the drop in new HIV infections in 2009, there were still 2,6-million people who were newly infected, last year’s UN report says. Sub-Saharan Africa still has the highest child mortality rates, with one in eight children dying before the age of five. The subcontinent still has a staggeringly high maternal death rate of 640 deaths per 100000 live births.
Sub-Saharan Africa is also the only region in the world where deaths from TB have increased. The UN report says there were 32 TB deaths per 100000 people on the subcontinent in 1990, rising to 53 per 100000 (excluding HIV-positive people) in 2009. Significantly, SA was one of five countries in the world with the largest number of TB cases.
There is no doubt the MDGs have brought the status of domestic healthcare systems into sharp focus. They have also highlighted the ability — or lack thereof — of those systems to produce effective results for the populations they service.
The particular focus the MDGs present is whether the healthcare systems of states are providing effective healthcare in accordance with the rights citizens enjoy in international law. The WHO has said stronger health systems are recognised as a prerequisite for achieving the MDGs. However, "neither health donors nor national health planners have paid sufficient attention to systems strengthening", the WHO says in its 2005 MDG report.
The nature of the service delivery structures within a domestic healthcare setting is increasingly going to be criticised and scrutinised by international bodies such as the WHO and the African Union. The emphasis will fall on whether the healthcare needs of a particular population are being adequately addressed and human rights respected.
The MDGs are therefore a useful criterion against which to measure a particular government’s compliance with providing adequate healthcare, in particular, and human rights in general.
• Kirby is director of Healthcare and Life Sciences Law at Werksmans Attorneys.