1. Barriers to achieving the health MDGs and how these can be overcome Action for Global Health UK Policy Conference London, 28 June 2010 Isabelle de Zoysa

2. Health-related MDGs – Scorecard 2010 AFR AMR EMR EUR SEA WPR World Child Mortality Measles immunization Maternal mortality Skilled birth attendant Contraceptive use HIV/AIDS incidence TB treatment success Malaria impact MDG 4 MDG 5 MDG 6

3. East Africa Proportion of HIV-related under-5 mortality in African sub-regions, 1990-2007 Central Africa West Africa 199019911992199319941995199619971998199920002001200220032004200520062007 Proportion (%) 25 20 15 10 5 0 199019911992199319941995199619971998199920002001200220032004200520062007 Proportion (%) 25 20 15 10 5 0 Southern Africa 19901991 1992199319941995199619971998199920002001200220032004200520062007 Proportion (%) 25 20 15 10 5 0 199019911992199319941995199619971998199920002001200220032004200520062007 Proportion (%) 25 20 15 10 5 0

4. Leading causes of death among women of reproductive age (15-44 yrs) World %Deaths(000s)CauseRan k 19.2682HIV/AIDS 1 14.6516Maternal conditions 2 6.4228Tuberculosis 3 4.7168Self-inflicted injuries 4 3.7132Road traffic accidents 5 Source: Women and Health report, WHO, 2009

5. Maternal Mortality Trends, 1980-2008 Source: Hogan et al, 2010

6. Unequal declines in under 5 mortality 1990-2008

7. Progress diverges across interventions FAST - scale-up of people receiving ARVs in low- and middle-income countries Millions SLOW – coverage of skilled attendant at delivery, especially in Africa Skilled birth attendant % Receiving ARVs

8. Women and children are dipping in and out of the health care system

9. Current concerns and opportunities

10. Integration? …how to make it work..

11. Don't turn away now.5 m cases multidrug resistant TB 1 m malaria deaths 2.7 m new HIV infections 5 m people in need without access to ARVs 3-800,000 maternal deaths 3 m diarrhoea & pneumonia deaths in children 8.8 child deaths 1100 m people without access to sanitation

12. Addressing the challenges Sustain high level political commitment Ensure sustainability of resources in times of economic crisis Strengthen health systems to deliver integrated interventions across the life course Promote implementation research to learn from successes and failures across countries and interventions Build sound information systems to identify problem areas and monitor change.

13. Opportunities to make a difference Regional commitments (such as the Maputo Plan of Action and Campaign on Accelerated Reduction of Maternal Mortality in Africa) The Joint Action Plan and accountability framework Muskoka Initiative – additional funding for a comprehensive and integrated approach to accelerate progress towards MDGs 4 & 5 Commitment to integrating approaches to maximize health outcomes related to MDGs 4, 5 and 6, while strengthening health systems Global mobilization around scaling up PMTCT towards elimination GF Board Decision to explore options for optimizing synergies with Maternal and Child Health; GF replenishment Other programming and financing opportunities (GHI/PEPFAR etc)

14. Thank you!