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The Politics of MDG5
DSA Scotland Mini-conference: Aberdeen, 14th October 2011
Professor Wendy J Graham
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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
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~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
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Map 3Scotland ~1 in 5,000
Sierra Leone ~1 in 20
Lifetime risk of maternal death
V
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Millennium Development Goal 5a is off-target
MM Target
Source: UN, Sept 2010
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“Maternal mortality is much more than a medical issue”
Ban Ki-moon
United Nations Secretary General
2009
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“A Millennium Development goal which cannot be monitored cannot be met or missed.”
Johansson and Stewart, UNDP, 2002
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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 ?
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Do we really know what works?
.... to reduce maternal mortality at a population level
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hsMATERNAL MORTALITY:
Scotland
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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
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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?
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Do we really know what works?
.... Yes, technically......
.... No, politically....
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Sept 22nd 2010
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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
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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
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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
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Identify knowledge gap
Gather & synthesize new
knowledge
Translate & communicate
Knowledge actors
Knowledge actorsKnowledge actors
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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