Health in International Development Agenda: Present, Past and Future

Abstract

Introduction International development agenda has been actively led by the United Nations (UN) and its technical agencies since their inception in 1940s. It brings together global political leaders to discuss common concerns related to peace, security, and development in line with the international charters and treaties. The development goals are built on the principle of consensus building. The Millennium Development Goals (MDGs) have been unique rallying point to bring the member states, civil society organizations and donors together to address development issues. The Past The UN and its technical agencies have spearheaded the initiatives related to development, health, and sustainable development. The UN has addressed development issues through its Development Decades and related initiatives which called for measures to eliminate illiteracy, hunger, disease, mortality and poverty, and a minimum of 0.7% of the GDP by developed countries to development assistance, for developing countries to achieve a GDP growth rate of 7.5%, etc., The UN organized a number of conferences to address problems of Social Development and declared 1996 as an International Year against Poverty and UN Decade for the Eradication of Poverty (1997-2006). The global initiatives on the health issues were led by the World Health Assembly (WHA) and mostly related to the eradication of diseases. Some of the major health issues addressed by the global community, at the WHA, include: Malaria Eradication (1955); Small Pox eradication (1958 and 1966); Guinea worm eradication (1981); EPI (1974) and UCI (1985); Polio eradication (1988); Leprosy eradication (1991). UNICEF’s Growth Monitoring, Oral rehydration, Breastfeeding and Immunization (GOBI) initiative contributed to the "First Child Survival Revolution" in 1980s.(1) There were 21 World Summits and conferences starting with Alma Ata Primary Health Care (1978) which provided the foundation for MDGs. The Sustainable Development has received attention since 1972 with the UN Conference on Human Environment at Stockholm. World Commission on Environment Development brought out its report "Our Common Future" in 1987. UN Conference on Environment and Development referred to as Earth Summit was held in 1992 and developed the UN Framework Convention on Climate Change, Convention on Biological Diversity and Statement of Forest Principles. Most recent conference was the Rio + 20 in 2012, which has provided inputs for the Post 2015 Development Agenda. The Present: Un Millennium Declaration and Millennium Development Goals One hundred and eighty-nine member states of the UN met at UN headquarters in Sept 2000 and set development agenda for the 21st century and adopted the UN Millennium Declaration. The road map toward its implementation is known as the MDGs. The MDGs introduced targeted approach for development. "The health-related MDGs do not cover all the health issues that matter to poor people and poor countries. But they do serve as markers of the most basic challenges ahead: to stop women dying during pregnancy and childbirth; to protect young children from ill health and death; and to tackle the major communicable diseases, in particular HIV/AIDS. Unless we can deal with these fundamental issues, what hope is there for us to succeed in other, equally important areas of health?(2)" Monitoring progress of MDGs An Inter-Agency Expert Group (IAEG) led by Department of Economic and Social Affairs, UN Secretariat was formed to report to the General Assembly (UNGA). Progress toward the eight MDGs is measured through 21 targets and 60 indicators. Data for monitoring of achievements are provided by the governments. To fill data gaps, IAEG uses surveys i.e., Multiple Indicator Cluster Surveys and Demographic Health Surveys. Data at individual countries often differ from IAEG data because: Some countries may have more recent data than what they reported to the UN, the IAEG estimates the missing values, and adjustments are often needed to ensure international comparability. The UN Statistics Division maintains an official website of the IAEG and its database (http://mdgs.un.org).(3) Frequency of reporting by member states is flexible and usually varies between 3 and 5 years. The Secretary General (UNSG) presents an annual report to the UNGA. The progress made in MDGs In the words of UN SG Ban Ki Moon, "Between now and 2015, we must make sure that promises made become promises kept. The consequences of doing otherwise are profound: Death, illnesses and despair, needless suffering, lost opportunities for millions upon millions of people."(4) The news from the recent MDG report(5) is summarized below. Good news The proportion of people living on < $1.25 a day fell (47% in 1990 to 24% in 2008). In terms of numbers it has declined from over 2 billion to less than 1.4 billion. The target of halving the proportion of people who lack access to improved sources of drinking water has been met. Conditions for more than 200 million people living in slums ameliorated which is double the 2020 target. Primary school enrolment of girls equaled that of boys. There has been 41% reduction in U5MR from 87 to 51 and the number of child deaths has come down from 12 to 7 million or 14,000 child lives saved every day. Not so good news In 2015, more than 600 million people will still be using unimproved water sources and almost one billion will be living on an income of less than $1.25 per day. A large number of mothers and children continue to die from preventable causes. Hunger remains a global challenge. Ensuring that all children complete primary education remains unfulfilled. Lack of sanitation is hampering progress in health and nutrition. Biodiversity loss and greenhouse gas emissions continue to pose a major threat to people and ecosystem. Progress in India According to the India Statistical Year Book 2013,(6) gender parity was achieved in primary education in 2007-08 and the disparity in secondary education is set to disappear by 2015. The country is well set to achieve 100% primary education ahead of 2015. Poverty ratio is likely to be 26.7% against target of 23.9% by 2015. Under five mortality rate would be around 52 against target of 42/1,000 by 2015. Maternal Mortality Rate would decline to 139/100000 against the goal of 109 by 2015 (437 in 1990). Proportion of underweight children is expected to decline to 33% against the target of 26% (52% in 1990). The future: Post 2015 agenda Post 2015 agenda builds on the experience of MDGs. It used an open and consultative process which was lacking in the development of the MDGs. The Secretary General of the UN constituted a High-level group in 2010 to make recommendations to advance the UN development agenda beyond 2015. UN System task team report 2012, Realizing the Future We Want,(7) was based on member states led consultation process, lessons learned from MDGs, decisions taken at Rio + 20 (June 2012) and global thematic consultations on inequalities, health, education, growth and employment, population dynamics, governance, conflict and fragility, environmental sustainability, food security, and nutrition and national consultations organized through UN Development Group. The major recommendations from these are summarized below. Post-2015 agenda should be universal. It should address global challenges such as sustainability, climate change, inequality on development and health. Some of the MDGs were “too narrow” and needed to be re-examined. "One size does not fit all", hence national goals should be determined nationally, in line with global principles and goals and focus on macroeconomic, political (democratic rights and participation) and social policies, as well as a supportive international environment (internally driven development, technology transfer, aid and labor mobility), and stronger global governance (regulation of trade and finance) to provide an enabling environment. Preserving the catalytic power of clear and simple MDG framework to build political momentum, ensure feasibility of implementation, strengthen measurability and accountability and the need to avoid an overload, while still ensuring an open and inclusive process of consultations. All the recommendations from the consultative processes have fed into the report of the High Level Panel of Eminent Persons on the Post-2015 Development Agenda. The Panel with 27 eminent members was co-chaired by the Presidents of Indonesia, and Liberia and Prime Minister of UK. The report builds upon the historic advances of the MDGs. The Panel interacted with more than 5000 civil society groups from 121 countries in developing its recommendations. The report was presented to the UNSG on May 30, 2013.(8) The report calls for the new post-2015 agenda to drive five big transformative shifts: (a) Leave No One Behind which recommends ending extreme poverty and equity; (b) Put Sustainable Development at the core, to integrate the social, economic and environmental dimensions of sustainability; (c) Transform Economies for Jobs and Inclusive Growth to end extreme poverty and improve livelihoods; (d) Build Peace and Effective, Open and Accountable Institutions for All to recognize peace and good governance as core element of wellbeing, not an optional extra; and (e) Forge a New Global Partnership in a spirit of solidarity, cooperation, and mutual accountability based on a common understanding of our shared humanity, based on mutual respect and mutual benefit. The report includes 12 illustrative candidate goals to be achieved by 2030 which are: End poverty Empower girls and women and achieve gender equality Provide quality education and lifelong learning Ensure healthy lives Ensure food security and good nutrition Achieve universal access to water and sanitation Secure sustainable energy Create jobs, sustainable livelihoods, and equitable growth Manage natural resource assets sustainably Ensure good governance and effective institutions Ensure stable and peaceful societies Create a global enabling environment and catalyze long-term finance. In the proposed goals, goal 4 is about health, food security, and nutrition is goal 5 and universal access to water and sanitation is goal 6, and other goals contribute to health. In the goals, non-communicable diseases and universal health care do not figure, though strongly recommended in the health sector report for Post-2015 agenda.(9) The UNSG will present the Post-2015 development agenda based on the High level panel report to the GA to move forward in September 2013. Conclusion Emphasis on human development has shifted policy attention beyond economic growth that dominated previous agenda. Major strength of MDGs is its focus on a limited set of concrete, common human development goals, and targets. It mainstreams stronger health and climate issues into development agenda. MDGs brought together governments, development partners, UN agencies and NGOs to achieve the goals. There is a need to accelerate efforts to achieve goals in the remaining time by developing a sense of urgency. The Post-2015 agenda in universal as it includes development issues in middle and high income countries and is being developed in an open and consultative manner building upon, providing continuity while addressing the weaknesses of the MDGs.