Ashraf Grimwood CEO Kheth’Impilo. 2 The 8 MDGs are the agreed milestones to ending poverty by 2015 Commenced in 2000 by 189 countries- with set targets.

Ashraf GrimwoodCEOKheth’Impilo

2

The 8 MDGs are the agreed milestones to ending poverty by 2015Commenced in 2000 by 189 countries- with set targets to improve quality of LIFE for the poorCivil society is there to support the MDG achievements

Goal 1: Eradicate extreme poverty-50% on <US$1/d & hunger <50%

• World Bank estimates the 2008 economic crisis will result in 64m more people entering extreme poverty by end 2010

• Effects likely to increase to 2015 & beyond for SSA

• Additional 3.6% workers at risk of falling into poverty between 2008-09

• >1billion undernourished in 2009• 1:4 children in developing world &

rural child twice as likely to be underweight United Nations The Millennium Development Goals

Report 2010

MDG2 Achieve universal primary education

• Despite great progress, with 88% of children in the developing world enrolled in primary education, with gender parity, about 76% of children in SSA are enrolled in Primary education as at 2008 insufficient to reach the MDG2 by 2015.

• We need to strengthen efforts and support goals to ensure universal access to primary education as outlined by the UN General Assembly 65th session, 17 September 2010

Goal 4: Reduce child mortality

• <5MR has declined from 100/1000 to 72 from 1990 to 2008

• 8.8m from 12.5m over this time• 4 diseases-68 countries 90% of deaths

pneumonia, diarrhoea, malaria & AIDS accounted for 43% of all <5yr deaths in 2008

• Antibiotics for RTIs, adequate rehydration, Immunisation, bed nets & nutrition would make a significant impact

• In SA IMR has increased from 56 to 67/1000 live births.46% due to HIV driven by antenatal HIV

United Nations The Millennium Development Goals Report 2010

United Nations The Millennium Development Goals Report 2010

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Goal 5: Improve maternal health- no woman should die giving life

• Target of 75% reduction in maternal mortality with universal access to reproductive health services added in 2007

• MDG 5 is central to reducing poverty, child mortality, HIV & AIDS , providing education, promoting gender equality, ensuring adequate food & promoting a healthy environment

• Haemorrhage & hypertension -50% of deaths• HIV, malaria & heart disease are the indirect

causes -18%• MOST MATERNAL DEATHS CAN BE AVOIDED

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No woman should die giving life

• The least progress made in this area• Most underfunded• Giving birth in SSA is especially risky where

>54% of women deliver without skilled care• 1:3 rural women in developing regions

receive recommended BANC

Maternal Mortality IN SUB-SAHARAN COUNTRIES

Year1980 Year1990 Year2000 Year20080

200

400

600

800

1000

1200

1400

1600

1800

2000

2200

Angola

C. African Republic

Congo (Braz)

Eq Guinea

Ethiopia

Lesotho

Malawi

Rwanda

Somalia

Zambia

South Africa

Swaziland

MARTERNITY

MORTALITY RATIO

Health systems are failing women

• The unmet need for family planning remains moderate to high in SSA-1:4 (15-49yrs) have little access

• Contraception use is the lowest amongst the poorest women, rural women & those with the least education

• Funding for FP as a proportion of total health budgets has continued to decline between 2000-08

• Improving access to FP to meet the need could result in 27% drop in MMR/yr by reducing unintended pregnancies from75m to 22m

• Reducing adolescent pregnancies will add substantially to improving maternal & child health

The MillenniumDevelopment Goals Report 2010 10

Teenagers are losing out

• Highest birth rate among adolescents found in SAA

• Young women in the poorest households 3x more at risk of pregnancy & birth than the richest households, 2x greater risk if they are rural

• Education is critical, girls with secondary education are least likely to become mothers

The Millennium Development Goals Report 2010 11

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Goal 6: Combat HIV/AIDS, malaria and other diseases

• HIV remains the world’s leading infectious killer disease despite – incidence peaking in 1996, – new infections dropped to 2.7m in

2008– mortality peaked in 2004 at 2.2 m

deaths• SSA remains the most heavily affected

region in 2008– Accounting for 67% of HIV

infections worldwide– 68% of new HIV infections among

adults – 91% of new HIV infections among

children. – 72% of the world’s AIDS-related

deaths

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Children orphaned by AIDS suffer more than the loss of their parents

• 17.5 m children <18y lost one or both parents to AIDS in 2008 globally- 14.1m in SSA

• Children orphaned by AIDS are at greater risk of poor health, education & protection than children who have lost parents through other causes

• They are more likely to be malnourished, sick, subjected to child labour, abuse neglect or sexual exploitation & at greater risk to HIV

• They suffer more discrimination and stigma & could be denied access to education & shelter as well as play

2004 April = National DoH ART rollout2009 = 1 million on HAART ( over 6 years ) April 2010 = Raising CD4 200 cutoff to 350 additional 45% people eligible 2011 June = 1.5 million anticipated

2004 2005 2006 2007 2008 2009 2010 2011 20120

500000

1000000

1500000

2000000

2500000

3000000

30000

230000 570000

1000000

1500000

2750000

ART rollout in South Africa

Year

Num

ber o

f pop

ulati

on o

n AR

T

Treatment gap

1.5 million

Every day in South Africa :> 1000 new HIV infections

> 700 deaths

In SSA, for every 2 patients started on ART, 5 people become infected

NGOs working in the field of international health cooperation which support and strengthen health systems can undermine the public sector and even the health system by

• Diverting health workers, managers and leaders into privatized operations

• Parallel structures to government tend to worsen the isolation of communities from formal health systems

• Letting Government off the hook- delay appointment of critical staff, diversion of critical funds, reduce investment, training & infrastructure support of Health Systems

NGO Code of Conduct for Health Systems Strengthening Initiative-Health Alliance Int. 2008

Provides guidance on how NGOs can work in host countries in a way that respects and supports the primacy of the government’s responsibility for organizing health system delivery.

1. “In areas where trained personnel are scarce, we will make every effort to refrain from hiring health or managerial professional staff away from the public sector, thus depleting

ministries and their clinical operations of talent and expertise.”

2. “We commit to limiting pay and benefits inequity between expatriate and national, rural and urban, and ministry and NGO workers. We encourage compensation structures that provide incentives for rural service and disallow gender-related disparities.”

3. “We recognize that management capacity in Ministries of Health is often limited. Rather than building parallel or circuitous structures around inadequate capacity, we commit to strengthening governments’ ability to operate effectively and efficiently.”

NGO Code of Conduct for Health Systems Strengthening- first published in 2008

4. “We strengthen the capacity of communities to take responsibility for and ownership of their health development, and to become partners with government in the health system, while holding governments accountable for their human rights obligations.”

5. “We actively advocate with civil society, local institutions and donors for policies and programs that strengthen health systems overall.”

6. “We commit to designing their activities and programs so that they reinforce primary health care, foster equity and community involvement, and are generally replicable and financially sustainable over time.”

NGO Code of Conduct for Health Systems Strengthening

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Many thanks

• Patients who have shown us the way• Staff of KI• Donors