Interim Report of Task Force 4 on Child Health and Maternal Health potx

Interim Report of Task Force on Child Health and Maternal Health April 19, 2004 Coordinators Mushtaque Chowdhury Allan Rosenfield Comments are welcome and should be directed to: Lynn Freedman at lpf1@columbia.edu Note to the reader This Interim Report is a preliminary output of the Millennium Project Task Force on Child Health and Maternal Health The recommendations presented herein are preliminary and circulated for public discussion Comments are welcome and should be sent to the e-mail address indicated above The Task Force will be revising the contents of this document in preparation of its Final Task Force report, due December 2004 The Final Task Force report will feed into the Millennium Project’s Final Synthesis Report, due to the Secretary-General by June 30, 2005 Disclaimer This publication does not necessarily reflect the views of the United Nations Development Programme (UNDP), its Executive Board or its Member States The Millennium Project is an independent advisory body to the United Nations Secretary-General Kofi Annan commissioned with recommending, by June 2005, the best strategies for meeting the Millennium Development Goals (MDGs) This includes reviewing current innovative practices, prioritizing policy reforms, identifying frameworks for policy implementation, and evaluating financing options The Project’s ultimate objective is to help ensure that all developing countries meet the MDGs As a United Nations-sponsored initiative, the Millennium Project proceeds under the overall guidance of the Secretary-General and United Nations Development Programme (UNDP) Administrator Mark Malloch Brown in his capacity as chair of the United Nations Development Group (UNDG) Professor Jeffrey Sachs directs the Project, which brings together the expertise of world-class scholars in both developed and developing countries, United Nations agencies, and public, non-governmental, and private-sector institutions Ten Task Forces carry out the bulk of the Millennium Project’s analytical work with support from a small secretariat based at UNDP headquarters in New York The Task Forces and their Coordinators are listed below Task Force 1-Poverty and Economic Development 2-Hunger 3-Education and Gender Equality 4-Child Health and Maternal Health 5-HIV/AIDS, Malaria, TB, Other Major Diseases and Access to Essential Medicines 6-Environmental Sustainability 7-Water and Sanitation 8-Improving the Lives of Slum Dwellers 9-Open, Rule-Based Trading Systems 10-Science, Technology and Innovation Task Force Coordinator • Mari Pangestu • Jeffrey Sachs • Pedro Sanchez • M.S Swaminathan • Nancy Birdsall • Amina Ibrahim • Geeta Rao Gupta • Mushtaque Chowdhury • Allan Rosenfield • Agnes Binagwaho • Jaap Broekmans • Paula Munderi • Josh Ruxin • Burton Singer • Yolanda Kakabadse Navarro • Jeff McNeely • Don Melnick • Roberto Lenton • Albert Wright • Pietro Garau • Elliott Sclar • Patrick Messerlin • Ernesto Zedillo • Calestous Juma • Lee Yee Cheong Additional information on the Millennium Project is available on its website at www.unmillenniumproject.org Millennium Project Task Force Child Health and Maternal Health Interim Report* Lead Authors: Lynn Freedman Meg Wirth Ronald Waldman Mushtaque Chowdhury Allan Rosenfield April 2004 *This report was prepared by the Lead Authors and has been reviewed by the Task Force members We have done our best to incorporate comments and changes suggested; however, discussion about several key issues continues within the Task Force and therefore this report should not be taken as representing a final, consensus view of the Task Force In addition to the members of the Task Force and colleagues who have reviewed and commented on the draft, we would like to thank Rana Barar and Ann Drobnik for their dedicated assistance in the research and production of this report Over the next several months, we will refine the contents of this report Comments are welcome and should be directed to Lynn Freedman at lpf1@columbia.edu Table of Contents INTRODUCTION OVERVIEW: GLOBAL HEALTH PICTURE AND GLOBAL HEALTH POLICY 15 2.1 Global health picture – child health and maternal health 15 2.2 Evolution of global health policy and impact on health systems 19 THE MILLENNIUM DEVELOPMENT GOALS 29 EPIDEMIOLOGICAL PICTURE: PREVALENCE, DISTRIBUTION AND KEY INTERVENTIONS 31 4.1 Child health 4.1.1 The Context 31 31 4.2 Maternal health 4.2.1 The context of sexual and reproductive health and rights 4.2.2 The epidemiological profile 4.2.3 Health sector interventions for sexual and reproductive health 4.2.4 Maternal mortality and morbidity 39 39 42 45 49 62 5.1 HEALTH SYSTEMS Defining health systems 62 5.2 What is lacking in approaches to scaling up? 5.2.1 Individual interactions/organizational cultures: implications for utilization 5.2.2 Institutional arrangements 5.2.3 Taking redistribution seriously 63 64 68 69 5.3 Rebuilding health systems: operational issues 71 5.3.1 District health system 71 5.3.2 Policy and Legal Barriers 73 5.3.3 Drug supply and essential medicines 73 5.3.4 Human resources 73 5.3.5 Management competency 74 5.3.6 Issues in service integration: child health, maternal health, reproductive health and communicable diseases 74 5.4 Financing health services 75 5.5 Health impact statement 76 6.1 HUMAN RESOURCES 77 A brief synopsis of the status quo 77 6.2 Toward a global workforce strategy 6.2.1 Community level health workers for primary health care 6.2.2 “Upskilling” (Delegation) 6.2.3 Long-term planning to create a cadre of skilled midwives 6.2.4 Management Capacity as an aspect of human resources 6.2.5 Gender issues in human resources for health 6.2.6 Global policies and strategies 78 79 81 83 83 85 85 TARGETS AND INDICATORS: ADAPTING THE MDGS 88 7.1 What lies behind the averages?: monitoring equity 88 7.2 Health systems 89 7.3 Sexual and reproductive health and rights 90 7.4 Maternal mortality 91 7.5 Child health, neonatal mortality and nutrition 92 7.6 Vital registration 93 POWER-MAPPING 94 8.1 Mechanisms – global architecture 8.1.1 Introduction 8.1.2 Where and how are the MDGs being implemented? 8.1.3 Poverty Reduction Strategies: A brief overview 8.1.4 Poverty and Social Impact Analysis (PSIA) 8.1.5 MTEF- Medium Term Expenditure Frameworks (and SWAPs) 8.1.6 PRSPs and Health, Health Systems and Equity? 8.1.7 Trading Outside the New Poverty Paradigm 8.1.8 Global Fund and Public-Private Partnerships 94 94 94 95 96 97 98 101 102 103 10 CONCLUSION AND RECOMMENDATIONS REFERENCES 106 Table of Boxes Box 1: Box 2: Box 3: Box Box 5: Box 6: Box 7: Box 8: Box 9: Box 10: The MDGs for maternal and child health BRAC’s experience with Community Health Workers Reproductive and sexual health defined Reproductive and sexual rights defined Proposed targets for the Child and Maternal health MDGs Four messages from the JLI Lack of top management capacity: A major bottleneck for Safe Motherhood Nicaraguan PRSP and attention to maternal and reproductive health Bangladesh I-PRSP and maternal mortality Eight principles for developing country led and owned Poverty Reduction Strategies focused on acceleration progress towards Health & Nutrition MDGs 20 26 26 30 79 84 99 99 100 Table of Figures Figure 1: Figure 2: Figure 3: Figure 4: Figure 5: Figure 6: Figure 7: Figure 8: Figure 9: Figure 10: Contraceptive prevalence trends in the developing world, by region Under-five mortality rates by socioeconomic status, 1978-1996 Pathway to Survival Conceptual map of sexual and reproductive health Percent of DALYs lost among women 15-44, by cause DALYs lost in women 15-44 due to sexual and reproductive health conditions Percent of women 15-49 at risk of unintended pregnancy, by region CPR for richest and poorest quintiles in 45 countries, mid-1990s to 2000 Causes of maternal death Full utilization of existing services would dramatically reduce maternal deaths 27 35 37 40 42 43 47 48 51 57 Table of Tables Table 1: Table 2: Table 3: Table 4: Table 5: Table 6: Table 7: Table 8: Table 9: Table 10: Six countries with the most annual deaths of children