AFRICA’S PROGRESS IN ACHIEVING THE MILLENNIUM DEVELOPMENT GOALSIn 2000, the United Nations (UN) held a summit in which the UN Millennium Declaration was adopted. All 189 UN member nations and 23 international organizations committed to achieving the Millennium Development Goals (MDGs) by 2015.
- Eradicate extreme poverty and hunger.
- Achieve universal primary education.
- Promote gender equality and empower women.
- Reduce child mortality.
- Improve maternal health.
- Combat HIV/AIDS, malaria, and other diseases.
- Ensure environmental sustainability.
- Develop a global partnership for development.
On 31 December 2014, Ray Chambers, the UN Secretary-General’s Special Envoy for Financing the Health MDGs, wrote an article summarizing the successes achieved in the last 15 years. For instance, there has been a 60 per cent decline in malaria-related child deaths since 2000 and the global distribution of 211 million insecticide-treated bed nets will provide protection over the next 3 years to over 285 million people.
Nigeria is one African country which has achieved great success in meeting the MDGs, although it only began the implementation of goals in 2006. In 2013, Nigeria had already achieved MDGs 1, 3, and 6 well ahead of the deadline. Dr. Precious Kalamba Gbeneol, Senior Special Assistant to the President on MDGs, addressed the question of Nigeria’s Health MDGs: “Nigeria has made remarkable progress in the health goals although we might not yet be where we want.”
The World Bank’s figures show evidence of progress and impact of interventions as the under-five mortality rate fell from 131 deaths per 1000 live births in 2010 to 117 deaths per 1000 live births in 2013.
Certainly, these efforts should be praised but Mr. Chambers warned that the year ahead called for a “balancing act” and stressed the importance of focusing on the major issues in order to “make a significant impact and achieve even greater results.”
It is imperative that clear targets are set and reached if the MDGs are to be met by the end of the year, and there are certain sectors which international organizations, governments, and the private sector can focus on in order to achieve success. There is a need for partnerships throughout society to ensure high-impact interventions are delivered.
NUTRITION AS A HEALTH SOLUTIONNutrition is one area in which experts, such as Maddie Cleland (Associate Director of Programs for the MDG Health Alliance), believe that progress towards the goals can be accelerated. Figures show that nearly 45 per cent of child deaths across the globe, which amounts to 3 million child deaths annually, can be attributed to malnutrition. According to the UN’s data, a relationship exists between acute food shortages and increases in cases of infectious disease and illness along with micronutrient deficiencies, and poor energy intake (associated with poor hygiene and sanitation). Mal- or under-nourishment increases susceptibility to illnesses and a decreased ability to heal.
This is not a recent revelation and several global initiatives which focus on the issue of nutrition have been working to make a targeted impact on the issue, such as the Nutrition for Growth Summit which mobilized over US$ 4 billion in financial commitments in 2014; and, in the same year, the Canadian government committed CA$ 3.5 billion (US$2.8 billion) to maternal and child survival with an explicit focus on nutrition.
Existing successes in nutrition programs have the potential to be developed further and applied to more areas. In 2014, a program in Northern Nigeria integrated the delivery of nutrition with seasonal malaria prevention campaigns. Anticipating seasonal diseases and lowering the possibility of mal- or under-nutrition in these times could decrease the number of illnesses.
However, as much funding as foreign governments and international organizations are able to provide, the fact remains that Africa continues to spend US$ 35 billion on food imports annually, despite having the potential to produce a surplus of food for the continent (as found in research such as the Africa Progress Panel’s 2014 report “Grain, Fish, Money: Financing Africa’s Green and Blue Revolutions”). In this case, private sector investments in Africa’s agriculture sector, initiatives from groups such as AGRA, and government funding and changes in agricultural policies are needed to stimulate further growth and fulfilling the continent’s potential as well as improving the continent’s global economic standing in being able to export food rather than spending billions on food importation.
By focusing on this root cause, hundreds of thousands of lives could be saved. Furthermore, it has the potential to increase the long-term health of children, thereby increasing educational attainment, lifetime earnings, and – in the long run – the growth of a nation’s GDP. It is only one area in which investments and partnerships can contribute towards achieving the MDGs in Africa as well as laying the foundation for sustainable development.
STRENGTHENING HEALTH SYSTEMSAnother area which more directly affects the continent’s ability to achieve the MDGs is community health systems. Last year’s Ebola outbreak had devastating effects on the health systems in Sierra Leone, Guinea, and Liberia, as well as having a detrimental impact on travel and trade in the West African region. Progress towards the MDGs in these countries was stunted as Liberia had achieved MDG 4 but could see the rate of child mortality rise again due to the effect of Ebola on the local health system. Similarly, Guinea was on its way to achieving MDG 4 (at 90 per cent completion) when Ebola caused a substantial reduction in progress.
The virus has revealed the urgent need for better healthcare systems in individual countries, as well an improved regional response to health emergencies, as discussed by an international consortium of doctors at the African Conference on Emergency Medicine held in Ethiopia, in November 2014. Community Health Workers (CHWs) have been internationally recognized as the “heroes” in the fight against Ebola and could hold the key to enabling countries with large rural communities to achieve the MDGs. Limited or no access to basic aspects of modern medicine and personnel continues to cause suffering or fatalities due to preventable or treatable diseases.
Unfortunately, unlike the mutually beneficial relationship between investments in agriculture and the reduction of disease, strengthening the “backbone” of CHWs across the continent is costly and does not have immediate financial benefits. The Earth Institute at Colombia University estimated in 2012 that the 1 million CHWs needed across Sub-Saharan Africa would cost approximately US$ 3 bn annually. There was no shortage of support or funding for the CHW system with donors including the World Bank; The Global Fund to Fight AIDS, Tuberculosis, and Malaria; and GAVI. African leaders such as Dr. Kesete Birhan and Minister Tedros Adhanom Ghebreyesus (the Health and Foreign Ministers of Ethiopia, respectively), and Rwanda’s Health Minister, Dr. Agnews Binagwaho took action to catalyze investment in health care workers and systems. However, despite the support, the amounts raised to date only cover a small fraction of the yearly costs.
The WHO has suggested a two-fold agenda for ensuring that CHW systems are adequately financed, planned, and supported. These are:
- Invest in CHWs now to maximize their impact before the end of the MDG deadline; and
- Set out a bold strategy to finance and support CHWs as the “tip of the spear” going forward.
Health and ICTPerhaps one of the most important sectors in which positive change can be implemented and the progress of MDGs enhanced, is one of Africa’s fastest-growing industries: ICT. The growth in this sector over the last decade has been astonishing and recent developments in technology and software illustrate how ICT solutions can bridge the divide between rural and urban healthcare centers.
This has been particularly evident in the Ebola outbreak where the virus was more difficult to treat and contain in rural areas rather than more densely populated urban areas. A greater prominence of ICT products in urban areas helped to not only inform the public, but facilitated tracking and data collection, while equipment such as contactless thermometers aided contagion at major transport hubs. Challenges in rural areas, where technology is less prevalent, led to the rapid development of technology such as Google’s Ebola-proof tablet.
The UN Development Program (2006) asserted that increased use of ICTs improves service delivery by delivering economies of scale to improve access to basic services; providing incentives for development and transfer of new technologies and products; increasing efficiency through enhanced connectivity and exchange of knowledge; enabling regions to focus on delivering services where they have a comparative advantage; and providing access to digital development for continuous improvement. Emerging technologies can facilitate outbreak response; early warning systems; and communication between healthcare providers, local, national, and regional healthcare providers; and international health organizations.
mHEALTHOne particular area that could bring African nations closer to the MDGs is mHealth: the application of mobile technologies in healthcare systems which has become increasingly popular over the past year and was a major factor in Nigeria’s prevention of the spread of Ebola in October 2014. A non-profit research company with operations in Nigeria and the US, eHealth & Information Systems Nigeria, developed an app which was used by health workers to report Ebola cases. According to Daniel Tom-Aba, senior data manager at the Ebola Emergency Operation Centre in Lagos, using the app reduced reporting times from 12 to 6 hours, after which people were able to make reports in real time.
In September 2014, mHero (Mobile Health worker Ebola Response and Outreach) was launched as part of RapidPro: a free, open-source platform which hosts multiple apps developed by UNICEF software and a Rwandan software company, Nyuruka. It is being used in Liberia to report new cases, share training information, and allow the Health Ministry and frontline health workers to coordinate in real time. Mobile phones with GPS tracking also facilitated health workers in instant tracking and fast communication.
The proactive use of this technology is not limited to Ebola and can be useful in assisting countries to reach their Health MDGs. Over the past year alone, mHealth apps have been making a difference in countries across the continent. U-Report in Zambia has helped voluntary testing of HIV/AIDS to rise from 24 per cent in 2012 (when the app was launched) to 40 per cent.
As an investment opportunity, mHealth has a great deal of attraction for the private sector. Eight companies are currently involved in the mHealth Ecosystem Partnership (June 2014): Samsung, MTN, Mobilium, Omega Diagnostics, Mobeni, Gemalto, Hello Doctor, and Lifesaver. The intention is to deliver mHealth services to pregnant women and mothers in Sub-Saharan Africa by linking mobile phone and healthcare industries. The annual market potential is 15.5 million users.
By the end of 2015, Devex (a social enterprise for the global community) estimates that there will be one billion phone accounts on the continent, which is almost one per person in Africa. With more affordable mobile phones going on the market in a society which is increasingly becoming mobile-orientated, mHealth is an excellent way in which African nations can further their MDG achievements.
CONCLUSIONHealth MDGs are a large issue to tackle in their own right, however, achieving these particular goals can have a positive effect on the progress of the others. It is possible to reduce the level of poverty by reducing health expenses and increasing labor productivity (and therefore, income). The Education MDG can also benefit from healthy children being more likely to be productive and attend schools, increasing their capacity to earn income in the long-term. The link between health and productivity (in education and labor) is evident even on a macroeconomic level.
While the continent has suffered major setback in terms of health systems weakened by regional conflict, political instability, and the Ebola epidemic, the WHO’s figures show that African nations are progressing steadily towards their goals. Targeted investment in specific sectors such as agriculture, community CHW systems, and mHealth has the potential to ensure those aims are reached by the end of the year.