MILLENNIUM DEVELOPMENT GOALS Beyond 2010

1. MILLENNIUM DEVELOPMENT GOALS Beyond 2010

2. A Comprehensive approach All the MDG influence health, and health influences all the MDGs The MDGs are inter-dependent. Better health enables children to learn and adults to earn. Gender equality is essential to the achievement of better health. Reducing poverty, hunger and environmental degradation positively influences, but also depends on, better health. All causes of ill-health affect the achievement of the MDGs Ill health is not restricted to specific causes, demographic groups, geographies or gender. The full contribution of better health to the achievement of the MDGs requires progress in relation to the major pandemics of AIDS, TB and malaria; to maternal, newborn and child health; but also to noncommunicable disease and mental health and neglected tropical diseases.

3. Fully functioning health system is essential for more rapid progress Achievement of health targets depend on equitable access to a health system that delivers high quality services. The exact configuration of services will depend on country context, but will in all cases require adequate financing with pooling of risk; a well-trained and adequately remunerated workforce; information on which to base policy and management decisions; logistics that get medicines and vaccines to where they are needed; well maintained facilities organized as part of a referral network; and leadership that provides clear direction and harnesses the energies of all stakeholders - including communities.

4. Systems that seek synergies between programmes get better results Interventions that address HIV and AIDS can positively influence maternal and newborn health. Strengthened laboratories are essential to combat MDR TB. An integrated approach to malaria control brings benefits in terms of all-cause child mortality. Programmes that boost nutritional status improve outcomes across the board. Well functioning district and referral hospitals are key to reducing maternal deaths.

5. Better health requires coherent policies Social and economic determinants of ill-health cannot be ignored. A good health system - based on Primary Health Care - not only delivers high quality health services, but ensures that health is an outcome of all policies. A wide range of policies - those that influence how and where people live, work, travel and relax; what they eat and drink;how and whether they can access goods and services; and how different communities, groups and genders relate to each other and to the state - all influence the achievement of MDG health targets. Policy coherence is particularly important in countries that depend on aid. Problems arise when the policies of external agencies are not aligned to nationally agreed priorities and goals. Robust national strategies and plans provide the best means of ensuring alignment of external agencies.

6. A comprehensive approach does not preclude focus or having clear priorities Global disparities in maternal, newborn and child health represent one of the starkest health inequities of our times. Each year approximately 530,000 women die due to complications related to pregnancy and childbirth. Almost nine million under-five children including over 3.5 million newborns die each year from causes that are mostly preventable or treatable with existing interventions. These deaths are increasingly concentrated in Asia and Sub-Saharan Africa, where 95% of all maternal deaths and 75% of child deaths occur. Recognizing the need for urgent action if MDGs 4 and 5 are to be achieved a menu for actionis needed along a continuum of care based on a health system strengthening approach

7. Pre-pregnancy Pregnancy Birth Mother & Newborn Infant Child Proposed interventions: • Pre pregnancy : increase access to family planning Family planning is extremely cost-effective and has a direct impact on improving the health of women and newborns. An estimated 137 million women of reproductive age have an unmet need for family planning, and some 80 million unintended pregnancies occur annually. Recent studies suggest that if this unmet need were filled, maternal mortality would decrease by 30% and newborn mortality by 16% globally, resulting in as many as 150,000 fewer maternal deaths per year • During Pregnancy: four visits to quality antenatal services Four targeted visits to antenatal care services can reduce the major causes of maternal and perinatal morbidity and mortality. Specifically, they are used to a) detect problems complicating pregnancy; b) prevent and control anaemia (through iron and folic acid supplementation); c) facilitate integrated HIV counselling, testing and treatment for the prevention of mother to child transmission of HIV; d) prevent malaria by intermittent preventive therapy in pregnancy (IPTp) and distribution of insecticide-treated bed nets; e) treat malaria and other conditions in pregnant women; and f) provide advice on danger signs and emergency preparedness and facilitate birth planning.

8. Pre-pregnancy Pregnancy Birth Mother & Newborn Infant Child Proposed interventions: • Childbirth: Increase the quality of and access to facility-based childbirth Every pregnant woman and newborn should have access to quality childbirth care in an adequately staffed and equipped facility. Improving quality of existing maternity facilities, while working toward universal (95%) coverage of high quality facility based services can lead to an 85% reduction of maternal deaths due to postpartum haemorrhage, eclampsia, postpartum sepsis and obstructed labour, an 85% reduction of newborn deaths due to asphyxia, a 40% reduction of newborn death due to sepsis, and an 85% reduction in stillbirths. • Immediate postnatal period : home-based visits for mothers and newborns The neonatal period is often neglected, on the assumption that having survived childbirth no further intervention is needed. However approximately 3.5 million babies die in the first month of life, most in the first week. The provision of timely, quality postnatal care services can reduce these deaths by more than 30%, saving more than 1 million infants a year. Effective care can be delivered at home and in the community through outreach, and at first level and referral facilities. However, home-based visits will ensure that both mother and baby receive appropriate care and that referral to facilities are made when necessary and without delay. At first level facilities and through outreach services, additional interventions can be delivered, including care for low birth weight infants; treatment of infections; and immunizations (BCG, Hepatitis B, OPV-0).

9. Pre-pregnancy Pregnancy Birth Mother & Newborn Infant Child Proposed interventions: • Infancy and Childhood: train and empower community health workers to treat and prevent the major causes of childhood death. About 9 million children under five years of age die every year. The majority of these deaths can be prevented through simple effective interventions delivered at either, the community level, first level facilities, outreach or referral facility levels. Community health workers can prevent the majority of deaths from diarrhoea, pneumonia, malaria, and malnutrition. In combination with immunization and measures to prevent malaria, the lives of 3 million children aged 1month to 4 years can be saved every year through timely treatment. The continuing efforts around polio eradication make it clear that effective care to the most-difficult-to reach communities is not only possible but necessary to preserve progress everywhere.empower community health workers to treat and prevent the major causes of childhood death. • METRICS FOR MONITORING : Timely data to check implementation, assess outcomes and track inequities is essential, especially the case for monitoring pregnancy outcomes, identifying maternal and newborn deaths, and ascertaining their immediate and underlying causes.

10. Supporting national efforts to achieve the MDGs is core business for WHO Setting norms and standards underpins the technical approach to the achievement of all health targets - for example in terms of treatment guidelines and health service standards Technical cooperation with partners and countries then helps ensures that agreed approaches and global strategies are applied in practice. WHO uses its technical expertise to assist national authorities as they seek to develop coherent and well-costed national plans and strategies. In countries with many donors, the WHO office assist governments in their efforts to coordinate development partners and to ensure alignment between external assistance and domestic priorities. Collection and dissemination of data on health status.