How Attainable are the Millennium Development Goals for a Developing

Country like South Africa

Minister Theuns BothaWestern Cape Government: Health

UCT South African Medical Students Association6 March 2013

What are MDG’s

• 8 international development goals

• Set after UN Millennium Summit in 2000

• Signed by all 193 member states and 23 international organisations

• They set very specific targets o be attained by 2015

MDG’s recognise the importance of social determinants

PRE-DETERMINANTSMaterial: food, water, air, income, housing

Policies: childcare, minimum wage, benefits, occ. Health

Society: cohesion, values, tolerance, diversity

• Differential exposure

• Differential vulnerability

• Differential outcomes

• Differential consequences

Dalgren and Whitehead framework 1991

The MDG’s

1. Eradicating extreme poverty and hunger2. Achieving universal primary education 3. Promoting gender equality and empowering

women4. Reducing child mortality rates5. Improving maternal health 6. Combating HIV/AIDS, malaria and other diseases,7. Ensuring environmental sustainability 8. Developing a global partnership for development.

MDG 1Eradicate extreme poverty

• Poverty generally results in poor levels of nutrition, increased levels of food insecurity and incidence of malnutrition.

• Multiple deprivation is key risk factor for the Burden of disease

Inequity: Areas of high Multiple Deprivation have highest BOD!

One health-related MDG goal

From Millenium Development Goals Republic of South Africa Country report UNDP 2010

Severe Malnutrition

Western Cape has achieved this target

Systematic review of nutrition studies in the Western Cape

Dual epidemic

• Under nutrition• Over nutrition

What are we doing about this?

• Promotion of breast feeding: – Mother and Baby friendly health facilities

• Vitamin A supplementation in children under 5years at health facilities

• Nutrition programme at primary schools

• Mandatory fortification of maize & bread

MDG 4Reduce child mortality

• The overall health of children is reflected in infant and child mortality and coverage of immunisation for preventable diseases such as polio and measles.

From Millenium Development Goals Republic of South Africa Country report UNDP 2010

Immunised against measles in SA very high

Even though not likely to achieve targetchild mortality rates are reducing in SA

56

42

53

4037

30

Target

2018

Infant mortality in the Western Cape

2007 2008 2009

IMR 23 21 21

U5 MR 28 26 26

2.5

7.5

12.5

17.5

22.5

27.5

Per 1

000

live

bir

ths

Achievable in Western Cape

Target2018

26

21

What are we doing about it?• Improve key socio-economic factors that impact on

health status of children e.g. water, sanitation, food security

• Enhance access to and quality of child health services, particular PHC services

• Expand PMTCT and nutrition programmes• Prioritise integrated management of childhood

illnesses (IMCI)• Promotion of breast feeding• Improve immunisation coverage

Life expectancy at birth is increasing but target of 70 years will not be achieved

WC: In 2001-2006 males was 57.yyears and 63.9 years for females, in 2006-2011 has increased to 59.9 years for males and 65.8years for females. (SOURCE: StatsSA, mid term population estmates 2011)

MDG 5Improve maternal health

• Good maternal health reflects on the quality of and access to maternal (reproductive and sexual) health care and the status of women in society

• Related to MDG goal 3 “Promote gender equality and empower women”.

MDG goals

From Millenium Development Goals Republic of South Africa Country report UNDP 2010

Maternal mortality has been increasing largely due to HIV

Maternal Mortality Western Cape(per 100 000 live births)

Confidential Inquiry MMR

Unlikely to be achieved in Western Cape

Target 36

Proportion of deliveries attended by skilled personnel in SA

Target 100%

Use of modern contraceptive method

Target 70%

Achievable in Western Cape

What are we doing about it?• Standardised protocols to manage causes of

maternal mortality• Improve obstetric skills• Improve management of pregnant women• Improve referral systems• Strengthen post natal care• Improve quality of family planning services• Eliminate deaths from unsafe abortions

MDG 6Combat HIV/AIDS malaria other diseases

• Dealing with the challenges of HIV and TB and malaria where this is endemic.

From Millenium Development Goals Republic of South Africa Country report UNDP 2010

HIV goals

From Millenium Development Goals Republic of South Africa Country report UNDP 2010

Bucket = population

HIV prevalence

Tap = incidence

Plug hole = mortality

Prevention

Treatment

ART

HIV prevalence in South Africa

Target <22.8%

HIV in Western Cape

Target <9.3%Western Cape 11.6%

Condom use at last sex

(not necessarily high risk sex)

Target for condom use at last high risk sex 100%

Access to antiretorvirals in SA

Target 100%Western Cape close to 100%

Coverage of adult ART in Western Cape

0

5 000

10 000

15 000

20 000

25 000

30 000

35 000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Tot

al N

ew S

4 an

d st

artin

g A

RT

New treatmentneedActual provision

Enrolmentscenario

PMTCT in WC: Success Story

Tuberculosis

From Millenium Development Goals Republic of South Africa Country report UNDP 2010

TB incidence in Western CapeTarget <253/100 000

West Coast Overberg Central Karoo Eden Cape Winelands

Metro0

200

400

600

800

1,000

1,200

1,400

1,600

1,4671,284 1,249 1,226 1,190

1,003

Adult case rate/100,000

Siamese twins: HIV and TB in areas of deprivation

~300,000 HIV infected individuals

~50,000 diagnosed TB cases per annum

Of HIV-infected people, 86% are in 14 sub-districtsOf TB diagnoses, 76% are in the same 14 sub-districts

In a nut shell

• Signifant progress has been made but unlikely to meet all targets

• SA has met the target for getting orphaned children in school & antenatal coverage

• SA is likely to meet targets for:– Increasing immunisation coverage– Having all births attended to by a professional

• SA will possibly meet targets for– Reducing severe malnutrition– Reducing HIV in young people

We are not alone e.g. child mortality

SOURCE: Global MDG report 2012

Where to from here?• Likely that MDG’s will continue beyond 2015• Likely other issues will be included such as:

– eradicating poverty and hunger by 100% and not just 50%

– Include other diseases such as chronic diseases (?injuries)

– Empowering both men and women– Global agenda on defeating corruption, as well as

for good governance

Provincial Strategic PlanStrategic Objective 1: Creating opportunities for growth and jobsStrategic Objective 2: Improving education outcomesStrategic Objective 3: Increasing access to safe and efficient transportStrategic Objective 4: Increasing wellnessStrategic Objective 5: Increasing safetyStrategic Objective 6: Developing integrated and sustainable human

settlementsStrategic Objective 7: Mainstreaming sustainability and optimising

resource use efficiencyStrategic Objective 8 &9: Promoting social inclusion and reducing poverty Strategic Objective 10: Integrating service delivery for maximum impactStrategic Objective 11: Increasing opportunities for growth and

development in rural areasStrategic Objective 12: Building the best-run provincial government in the

world.

The six priorities for wellness

• Decreasing the incidence Infectious Diseases (HIV and TB)

• Preventing violence and road injuries prevention

• Healthy lifestyles to address non communicable diseases

• Women’s health• Maternal and child health• Mental Health

What can you do as a health professional?• Understand that health is more than just the absence of disease

• Provide effective and efficient health services– but these are not the only essential ingredient required for increasing

wellness– recognise the importance of other disciplines e.g. CHW– balanced health services (CBS, PHC, Hospital services)– Patient centred care not a nice to have: improved outcomes

• Become an upstream advocate and become an health activists – Do your job to the best of your ability– Challenge other sectors to also do their bit!

Thank you

Worcester Hospital