Meeting the MDGs in South East Asia: Lessons. Framework

Transcription

1 Meeting the MDGs in South East Asia: Lessons and Challenges from the MDG Acceleration Framework Biplove Choudhary Programme Specialist UNDP Asia Pacific Regional Centre November 2012 UNCC, Bangkok, Thailand

2 The Millennium Development Goals are:

3 MDG Inter-linkages

4 MDG Inter-linkages

5 Gender acts as a multiplier for all achieving all MDGs

6 Recap of MDG Scorecard in South East Asia: A Mixed Picture

7 Key findings Impressive but uneven progress Particular challenges in achieving health and nutrition targets Accelerated progress crucial for countries lagging behind Large gaps in achievement across countries, which are widening in some cases MDG with equity: National efforts also need to target disadvantaged regions and population groups Within country disparities as large as cross country disparities MDG localization needed tailored to country gaps Multi sectoral coordinated approach is the need of the hour Eight point strategy to close child and maternal health gaps

8 Why some countries do better factors related to health sector Insufficient spending on health is a major cause of poor health outcomes, as demonstrated for child mortality below Lack of health staff is another crucial factor Ineffective public health spending is also responsible Cross-country variation in child mortality explained by differences in health spending Sources: United Nations MDG database for child mortality and World Bank, World Development Indicators online database for health expenditure per capita.

9 Why some countries do better factors outside the health sector Differences in health outcomes also result from factors outside the health sector indicating need for a multi disciplinary approach For example, differences in access to basic infrastructure play a crucial role. Better roads improve the proportion of births attended by skilled health staff as shown below. Births attended by skilled health personnel and the extent of paved roads Sources : The World Bank, World Development Indicators online database for GDP per capita, electricity consumption, and percent of paved road networks; and the United Nations MDG database for skilled birth attendance, access to sanitation and safe drinking water.

10 Why some countries do better other factors Countries doing better in health were associated with several other attributes such as Effectiveness in controlling corruption and addressing other governance issues High state of women s development Spread of education and literacy, particularly among women Extent of access to clean water and improved sanitation, and Access to family planning services

11 Additional drivers of within country disparities Education of mother For under 5 mortality Breast feeding reduces risk High risk for girls in some countries Castes, ethnic and linguistic groups Need to remove cultural and institutional discrimination

12 An Eight Point Agenda to Reduce Health Disparities Bring together health policy options encompassing three inter related aspects: Address social determinants of health Health sector interventions Strategies outside health ministries that have a big impact on health, and cut across sectors

13 Address the social determinants of health to reduce health inequities Inclusive economic growth complemented by social protection policies to manage health risks and vulnerabilities Gender aware policies that raise the status of women Rights based framework that treats human health as a norm, counters stigma Sri Lanka, where health is treated as a social right; Kerala (India), with higher female literacy, hold important lessons

14 Expand access to responsive and efficient primary health care systems Channel resources towards primary health care system Integrated fragmented services and minimize out ofpocket expenditures Strengthen basic infrastructure such as better roads and electricity Bangladesh and Indonesia have successfully delivered to the poor and vulnerable, an integrated primary health care package which includes essential services

15 Integrate Child and Maternal health into a continuum of care Address the risks and vulnerabilities of women and children Adopt a life cycle approach including reproductive and child health services Promote appropriate breastfeeding practices to reduce under 5 mortality Mongolia, Indonesia and Tamil Nadu (India) demonstrate that a package of preventive, promotive and curative services is an effective shield against maternal and child deaths

16 Focus on the health needs of the urban poor in a rapidly urbanizing region Health indicators of the growing urban poor need attention they are not much better than those of the rural poor Promote inclusive urban governance with a focus on rights to health, education and other social services In India, as part of slums improvement, the urban poor are now being included in reproductive and child health care

17 Devise sustainable financing strategies Expand fiscal space for public health better tax governance, expanding the tax base, and tapping into innovative revenue sources Minimize waste by controlling systemic inefficiencies: wastage is known to range between 20 and 40 per cent of all health spending Expand health insurance options China, Thailand--health insurance to deal with out-of-pocket expenses India-- 2% education cess on income tax is an innovative way to expand sources of finance

18 Improve the governance of health systems Strengthen checks on corruption and waste Check counterfeit and sub standard medicines Regulate to ensure quality and fair pricing of health services Promote generics as a lower cost alternative to patented medicines Generics in HIV/AIDS reduced treatment costs from $10,000-15,000 per patient/year to under $80 now in about a decade

19 Coordinate national strategies with regional and global cooperation leverage diversity Promote systematic exchange of information, R&D, to leverage varied knowledge and experiences Enhance regional cooperation Supplement official development assistance with innovative international financing mechanisms -UNITAID-bulk medicine purchase facility for low income countries -International Finance Facility for Immunization / Global Alliance for Vaccines and Immunization -Solidarity levies on airline tickets

20 FOUR STYLIZED FACTS ON MDG PROGRESS Progress tends to be non-linear Periods of acceleration and slow-down Increasing marginal costs as targets approached Reversals are possible and can actually occur Progress is heterogeneous Different regions within a country progress at different rates Growth slow-down could presage deceleration or reversal

21 The MDG Acceleration Framework A living document to guide interventions, partnerships and resources Generate country specific acceleration plans bringing together all partners for a systematic prioritization of bottlenecks and identifying interventions Focus on off track and slow progress targets Leverage multiplier effects and innovations through cross sectoral synergies, breaking down multiple barriers at once Scale up integrated local level initiatives

22 MDG progress: with and without acceleration Projecting three different trajectories

23 Four broad categories of MDG Bottlenecks Sector specific Cross cutting Bottleneck categories Policy and planning Budget and financing Service delivery (supply) Service utilization (demand) Cross cutting (illustrative examples below) Subcategories Sector Strategies, policies and plans Resource allocation Human resource Self efficacy Engagement and advocacy Legal framework and laws Resource expenditure Infrastructure, equipment and supplies Acceptability Coordination and alignment Institutional capacities Resource mobilization Sectorgovernance Accessibility and affordability Accountability and transparency

24 FOUR STEPS TO ACCELERATION Identify, codify the interventions required to meet the MDG targets Identify solutions to form an MDG Acceleration Compact that aligns and focuses stakeholders and resources on accelerating MDG progress Implement and Monitor the MDG Acceleration Compact to ensure required impact Help identify and prioritize MDG bottlenecks

25 THE MAF VALUE ADDED FOR MATERNAL HEALTH Changing the prevailing political thinking: maternal health is more than a health issue, it s a development challenge Identifying most effective actions in sectors (including non-health sectors) that could contribute to accelerating maternal health. Engage sectors on how to implement these actions within their mandate. Identify and provide incremental funding for these actions when needed.

26 Lessons From MAF Promote government ownership leveraging political support Build cross sectoral and cross ministerial engagement Recognize the role of local governments, civil society and other local actors Anchor in existing national development plans, policies and budget Balance acceleration with sustainability to prevent reversal Pool required expertise and knowledge Strengthen data availability and quality for monitoring progress

27 In conclusion: Tackling barriers is within reach Right to health is an essential ingredient of inclusive and equitable societies benefits the private sector and economic growth Locally tailored approaches do better than generic strategies; yet much can be gained from cooperation and experience sharing The MDG Acceleration agenda a timely reminder of the urgency to bridge persisting health deficits in this fast growing region THANK YOU ALL