Introduction to global health

A discussion of the progress made, and on-going limitations and challenged faced by the Philippines,
in meeting one of the health related MDGs. What lessons can be learnt from the findings?

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MDG UN SUMMIT

WHO

Countdown countries

Aims of MDGs

The risk of a woman losing her life as a result of child-bearing is approximately 16% in the
poorest regions of the globe compared to 0.00003% in Northern Europe i. This huge inequity is part of
the reason the global impetus to increase policy intervention for maternal health began with the Safe
Motherhood Initiative in 1987 in Nairobiii.This momentum was carried forward in the form of the 1994
International Conference on Population and Development iii. The culmination of this movement was
when a commitment to reducing maternal mortality was included in one of the eight goals for global
development outlined in the Millennium Declarationiv signed by 189 member countries at the United
Nations Millennium Summit in September 2000. The World Health Organisation (WHO) has identified
6 of the Millennium Development Goals (MDGs) as primarily focused on health. MDG 1 is centred on
reducing extreme poverty and hunger, MDG 4 at combating child mortality, MDG 5 at improving
maternal health, MDG 6 at combating HIV/AIDS, malaria and other diseases, MDG 7 at pursuing
environmental sustainability and MDG 8 at developing a global consortium for development. v To
monitor progress, MDGs have 21 targets with 60 technical indicators. It can be argued that globally
there have been many signs of very positive development. For example, the target of reducing
extreme poverty by half was reached 5 years ahead of the 2015 deadline as well the target of halving
the proportion of people who lack dependable access to drinking water.vi However, many key countdown countries are making insufficient or no progress at all. vii In addition to this, the MDGs
themselves have been condemned for being unsustainable, lacking focus in local participation and
unbalancing healthcare system priorities.viii This paper will explore the progress, limitations and
challenges faced by a developing country in relation to achieving the target set by one of the MDGs
as well as the relevance of the MDGs in a changing global health climate.
MDG 5 is split into two targets; 5a and 5b. Target 5a was to reduce the MMR by 75% from
1990 to 2015ix; with the relevant indicators being MMR and the proportions of births with skilled health
personnel present. Target 5b is to reach universal access to reproductive health (RH) by 2015.
Target 5a will form the focus of this discussion. According to the WHO, the maternal mortality ratio
(MMR) of a nation is defined as the number of deaths of women during pregnancy, childbirth or in the
42 days after delivery due to causes directly or indirectly related to the pregnancy per 100,000 of the
population over a given time period (usually a year). x The MMR of a nation covers many of the issues
at which the MDGs are designed to combat as reducing MMR involves targeted health and social
policies that are informed by valid epidemiological data. Consequently, MMR is arguably a good
measure of a countrys development progress. It must be noted that maternal mortality is not the only
indicator on which progress toward MDG 5 should be judged; as the wider spectrum of co-morbidities
related to childbirth are just as relevant

Global MMR was around 543,000 in 1990. A decade later, the annual number had decreased
to 287,000xi. These figures can be considered to be positive international progress toward the 2015
target of 138,000. Global averages can often hide large inequity as perhaps highlighted when in 2010
a WHO pape identified that Sub Saharan Africa and South Asia make up 87% of maternal deaths
globallyxii.

Another World Health Organisation (WHO) report in conjunction with the United Nations

Childrens Fund (UNICEF) 2 years later detailed 66 nations mostly situated in sub Saharan Africa that
are unlikely to achieve MDG 5axiii by 2015. It is prescient to acknowledge that despite the 1991
Abouzahr & Royston paper being the most widely cited source regarding global maternal mortality,
more recent systematic reviews have concluded that it has unclear methodology and assumes fixed
distribution across all regions.xiv The magnitude and direction of regional differences are unknown and
even though a recent WHO estimate explored a breakdown of MMR by cause and region; again the
regional differences were not reported.xv A 2006 systematic review conducted by the WHO perhaps
has the clearest picture of global MMR and respective causes. xvi Out of 34 datasets and 35,197
maternal deaths the leading contributors in developing countries were haemorrhage and hypertensive
disorders. The Philippines is a nation that lies within this data set of developing countries not on
target for MDG5a by 2015; but interestingly is on target for the socially related MDG4 of child mortality
reduction and has one of the lowest under 5 mortality rates out of the countdown countries. xvii
The Philippines is an archipelago in south eastern Asia. It has a total land area of 300,000
km2 over 7000 islands. This disparate spread of communities makes it extremely difficult to
transpose western industrialised centralised health infrastructure measures. The nations annual
population growth rate of 2.04 makes it one of the quickest growing populations in the region. This
high fertility rae is juxtaposed with a high MMR of 99 deaths per 100,000 In 2011, 49% of the
population was located in urban areas and his value is predicted to rise to 70% by 2015. xviii
HIV
D
Country overview
Health service principles
Government dates
Demographics
Disease control vs maternal health require programs

Maternal death, causes +MDG goal evaluation

Fertuility rate + contraceptives

Antenatal care + level pf care

National policy MDG 5 maternal mortality combat
Policy for maternal health societal views
Strategies specific NGOs
Reasons for performance
Forecast for MDGs and conclusion
WHO strategic agenda
Targets

i WHO, UN Children's Fund, UN Population Fund Maternal mortality in 2000: estimates developed by
WHO, UNICEF, UNFPAWorld Health Organization, Geneva (2004)
ii AM Starrs Safe motherhood initiative: 20 years and counting Lancet, 368 (2006), pp. 11301132
iii International Conference on Population and DevelopmentSummary of the ICPD Program of Action. International
Conference on Population and Development 2010
http://www.unfpa.org/icpd/summary.cfm (March, 1995)

iv C Ronsmans, WJ Graham, on behalf of The Lancet Maternal Survival Series steering group Maternal
mortality: who, when, where, and why Lancet, 368 (2006), pp. 11891200
v United Nations General Assembly, United Nations Millennium Declaration. A/RES/55/2United Nations,
New York (2000)
vi United Nations, The Millennium Development Goals Report 2012
vii Butta Z, 2010, Countdown to 2015 decade report (200010): taking stock of maternal, newborn, and child
survival, The Lancet, Volume 375, Issue 9730, 511 June 2010, Pages 20322044
viii Deneulin, S & Shahani, L. (2009). An Introduction to the Human Development and Capacity Approach.
London: Earthscan. p17-69.
ix United Nations General Assembly, United Nations Millennium Declaration. A/RES/55/2United Nations,
New York (2000)
x Maternal mortality in 2000Maternal Mortality Estimates developed by WHO, UNICEF and UNFPA. Geneva, World
Health Organization, 2004.

xi C AbouZahr, E Royston, WHO, Maternal mortality: a global factbook. WHO/MCH/MSM/91.3World

Health Organization, Geneva (1991)
xii WHO. (2010). Trends in Maternal Mortality: 1990 to 2008. Geneva: WHO. p1-5.
xiii WHO & UNICEF. (2012). Countdown to 2015. Washington: Communications Development
Incorporated. p1-94.
xiv Khan K, WHO analysis of causes of maternal death: a systematic review, The Lancet, Volume 367, Issue 9516, 17
April 2006, Pages 10661074

xv WHO, Revised Global Burden of Disease 2002 Estimates,

http://www.who.int/healthinfo/bodgbd2002revised/en/index.htm

xvi Khan K, WHO analysis of causes of maternal death: a systematic review, The Lancet, Volume 367, Issue 9516, 17
April 2006, Pages 10661074

xvii http://www.unicef.org/esaro/Promise_renewed_progress_summary.pdf
xviii http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_phl_en.pdf