Andy Haines

From a baseline of 1990 by 2015  Reduce the share of malnourished children by 1/2  Cut child death rate by 2/3  Lower maternal deaths by 3/4  Reverse the spread of HIV/AIDS, TB, and malaria  8/18 targets and 18/48 indicators related to health

( from Dye et al 2013) Improvements in coverage ( from Dye et al 2013)

Some workers had been trained and deployed I year training, 2 per village, recently upgraded to cover pneumonia Rx Growing evidence of impacts

1. Around half of current MDG indicators not reported by many countries 2. Nothing on inequalities in coverage 3. Nothing on quality of services 4. Nothing on NCDs, injuries, disability Yet too many interventions to monitor everything = countries will need to select tracer conditions to monitor – fitting their health priorities and measurement capabilities

Proposed goal 3. Attain healthy life for all at all ages by 2030  3.1 reduce the maternal mortality ratio to less than 40 per 100,000 live births  3.2 end preventable newborn, infant and under-five deaths  3.3 end HIV/AIDS, tuberculosis, malaria, and neglected tropical diseases  3.4 reduce by x% premature deaths from non-communicable diseases(NCDs), reduce deaths from injuries, including halving road traffic deaths, promote mental health and wellbeing, and strengthen prevention and treatment of narcotic drug and substance abuse 

 3.5 increase healthy life expectancy for all by x%  3.6 achieve universal health coverage (UHC), including financial risk protection, with particular attention to the most marginalized and people in vulnerable situations  3.7 ensure universal availability and access to safe, effective and quality affordable essential medicines, vaccines, and medical technologies  3.8 ensure universal access to sexual and reproductive health  3.9 decrease by x% the number of deaths and illnesses from indoor and outdoor air pollution

Why Universal Health Coverage? Historical background: Alma Ata Declaration of : all nations have made the commitment to achieve universal health coverage "everyone should have access to the health services they need without risk of financial ruin or impoverishment "

Challenge of Measuring the Three Dimensions of Universal Health Coverage

Financial risk protection is patchy Where out-of-pocket expenditure is high in relation to total health expenditure; 150M people suffer catastrophic expenditure each year Source: WHO

 2 year training 1 yr internship  Perform 92% of emergency obstetric care and 65% of major general surgery in district hospitals  No difference in outcomes vs. doctors  The 30-year cost per major obstetric surgery was $38.9 for técnicos de cirurgia and $144.1 for surgeons and obstetrician/gynaecologists  High retention

~150 million under 5s are undernourished ~35% of GBD in under 5s due to undernutrition 1000 day window to prevent stunting Food security and malnutrition Current situation: Sources: Black et al. Lancet 2008; 371: World Bank 2007; Environmental Health & Child Survival WHO Global Database on Child Growth & Malnutrition

Percentage change in yields to UN Devt Prog, 2009 Plus climate-related: Flood/storm/fire damage Droughts – range, severity Pests (climate-sensitive) Infectious diseases (ditto) CLIMATE CHANGE: Poor Countries Projected to Fare Worst MODELLED CHANGES IN CEREAL GRAIN YIELDS, TO 2050

 To reach the health MDGs and to ensure access to critical interventions 49 low-income countries will need to spend > US$ 60 per capita by 2015, compared with US$ 32 currently.(WHO 2010)  Only 8 can raise these funds from domestic sources

 Build on the MDGs  Monitor progress towards Universal Health Coverage  Strengthen Human resources for health  Ensure financial protection  Develop policies and indicators linking Health and Sustainability