As world leaders gather next week at the U.N. to review progress on the Millennium Development Goals (MDGs) to eradicate poverty, hunger, and disease by 2015, a new integrated approach to funding and delivering health services in developing countries is critical if the UN's global health targets -- especially for women and children -- are to be met. Currently, the health goals are competing with each other for money, people, and other scarce resources. How can we get back on track?
There is much to celebrate next week: over four million people are currently receiving antiretroviral drugs to treat AIDS; eliminating mother to child transmission of HIV is within reach by 2015; malaria deaths have been reduced by over half in some countries; the global burden of TB is falling; and more than 500 million people are now treated for one or more neglected tropical diseases.
MDG Goal 6 (to reverse the spread of HIV/AIDS, TB, malaria and other diseases) has received unprecedented funding from the U.S. and other donors. But increased funds to treat and prevent these three diseases have not come with adequate support for integrated health systems, leading to overburdened health workforces and crumbling health infrastructure. Consequently, AIDS remains a killer disease. HIV-TB co-infection and multi-drug resistant TB strains are on the rise. As a result of the success in treating them, many AIDS patients are now surviving long enough to confront non-communicable problems, like heart disease and cancer.
Even more, strategies have been lacking for tackling daunting health challenges faced by women and girls. MDG goals 4 and 5 (reducing child and maternal mortality) are off track in large parts of the world. Maternal mortality, while improving worldwide, is still shamefully high, especially in Africa. Skilled care for women during and after pregnancy and for newborns too often is lacking. Adolescent girls do not receive proper education and must deal with unsafe and unintended pregnancies. Children are dying from HIV and malaria and also from other common illnesses such as diarrhea and pneumonia. Malnutrition contributes to more than one third of child deaths. Yet only 4.6% of official development assistance went to maternal, neonatal and child health in 2007 and assistance for family planning services has been at a standstill.
Addressing all these unmet health gaps has unintentionally put the MDG health goals on a collision course with each other. But they need not be. Here's how we can get back on track: Pursue targeted ("vertical") priority health areas for goal-setting, advocacy and monitoring, as the MDGs have done. At the same time, deliver prevention and treatment programs that are integrated ("horizontal") across these health priorities.
It's both common sense and our own experience as physicians that a mother who is on treatment for AIDS, pregnant, has a sick child, and is accompanying a sister debilitated by TB cannot visit four separate health services. Moreover, we know that universal coverage for health is best achieved through comprehensive care packages delivered through strengthened health systems. This approach makes best use of financial, human and other scarce resources and is also the only way to manage the rapidly growing burden of non-communicable diseases.
To achieve the goals by 2015, all funding mechanisms should reward countries and programs that pursue a "diagonal" integrated approach. This will leverage existing programming, such as for HIV, to improve health systems and address other priority health conditions. It will increase access to care for women and children.
Integrated funding is the vital lever to achieve progress. By bringing AIDS, TB, malaria, maternal, neonatal and child health, nutrition, and neglected tropical diseases into one strategic approach, President Obama's Global Health Initiative presents an immensely promising step forward.
The Global Fund to Fight AIDS, TB, and Malaria now accepts country proposals addressing health systems strengthening and maternal and child health. But true integration will occur only if it reinvents itself as a broad-based Global Fund for Health. In such a fund, advocates for maternal and newborn health, family planning, and other health needs would have an established mechanism to turn global financial commitments into country driven results.
All UN member states should endorse UN Secretary General Ban Ki-Moon's Global Strategy for Women's and Children's Health. The G20, at its meeting in November, should endorse the G8 Muskoka Initiative to mobilize an additional $5 billion for maternal and child health. Recipient countries should keep commitments made in Abuja, Nigeria to allocate 15% of budgets to health sectors and earmark amounts for maternal, newborn and child health, while assuring that international flows will be truly additional and not simply substitute domestic allocations.
In developing countries, a woman dies from complications of pregnancy or childbirth every ninety seconds, a person is infected with AIDS every 12 seconds and a child dies every four seconds. The call to action couldn't be any more urgent. The MDGs for health can be met if all stakeholders renew their commitments and fund a comprehensive, integrated approach that expands support to maternal and child health, accelerates the momentum to combat AIDS, TB, and malaria, and prepares health systems to face future challenges to the universal aspiration for better health.