The Politics of MDG5

DSA Scotland Mini-conference: Aberdeen, 14th October 2011

Professor Wendy J Graham

Millennium Development Goals (MDGs)

Goal 1: Eradicate extreme hunger and poverty

Goal 2: Achieve universal primary education

Goal 3: Promote gender equality and empower women

Goal 4: Reduce child mortality

Goal 5: Improve maternal health

5a: 75% reduction in maternal mortality 1990-2015

5b: University access to comprehensive reproductive health services

Goal 6: Combat HIV/AIDS, malaria and other diseases

Goal 7: Ensure environmental sustainability

Goal 8: Develop a global partnership for development

~99.2% occur in developing countries

~0.8% occur in developedcountries

An estimated 98% of maternal deaths are avoidable

Estimated third of a million maternal deaths annually*

* Source: United Nations, 2010

Map 3Scotland ~1 in 5,000

Sierra Leone ~1 in 20

Lifetime risk of maternal death

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1990 1995 2000 2005 2010 2015

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Millennium Development Goal 5a is off-target

MM Target

Source: UN, Sept 2010

X

X

X

X

“Maternal mortality is much more than a medical issue”

Ban Ki-moon

United Nations Secretary General

2009

“A Millennium Development goal which cannot be monitored cannot be met or missed.”

Johansson and Stewart, UNDP, 2002

1985 1990 1995 2000 2005 2008 20110

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UN IHME 2010* IHME 2011

Year

Maternal deaths

per 100,000 live births

Nigeria: maternal mortality trends 1985-2011 ?

Do we really know what works?

.... to reduce maternal mortality at a population level

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1850 1870 1890 1910 1930 1950 1970 1990 2010

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hsMATERNAL MORTALITY:

Scotland

Three direct points to take women off the “Road to Death”:

• Prevention of pregnancy: Family Planning

• Prevention and management of complications: Skilled Care especially during delivery

• Prevention of death by timely management of life-threatening complications: Emergency Obstetric Care

1. Renewed focus on family planning, skilled care at delivery, & emergency obstetric care

Combined with:

2. More health professionals3. Greater financial resources4. Robust tracking of progress & accountability 5. Sustained political commitment

WHAT NEEDS TO BE DONE?

Do we really know what works?

.... Yes, technically......

.... No, politically....

Sept 22nd 2010

A call to action: we all have a role to play

Women and children

Academic

/research

institutions

Health care

workers

Civil society

Gov / Policy

makers

Donors

UN agencie

s

Business

community

What are the key elements of the Global Strategy for Women’s & Children’s Health ?

• Country-led health plans

• Comprehensive package of essential interventions and services

• Integrated care

• Health systems strengthening

• Health workforce capability building

• Coordinated research and innovation

• Accountability at all levels

http://www.who.int/pmnch/activities/jointactionplan/en/index.html

Accountability Framework: Parameters

• Applicable at all levels – national and global• Links results and resources• Three building blocks: Monitor, Review, Act• All partners accountable for the commitments they make and the health policies and programmes they design and implement• Builds on and strengthens existing mechanisms

Identify knowledge gap

Gather & synthesize new

knowledge

Translate & communicate

Knowledge actors

Knowledge actorsKnowledge actors

1. What are we (as knowledge actors) accountable for?

2. To whom are we accountable?

3. How can we hold ourselves accountable?

THREE BIG QUESTIONS