Having three health targets in the eight Millennium Development Goals (MDGs) has been a double edged sword. While, on the one hand, it has greatly improved political and donor attention on health at the national level and on the global agenda, the prioritisation of some issues and diseases over others has fragmented overall health outcomes. In the post-2015 framework, I hope to see a shift towards developing strong national health systems, which can ensure equitable access to quality services especially in the area of maternal, newborn and child health.
1. Focus on Sustainable Outcomes
The next targets need to lead to sustainable outcomes. To establish this, we must address the inequality that remains the key stumbling block for MDG completion. This inequality is not only about income, it is about identity, location, and gender, among others. Girls, for example, have been somewhat overlooked by the MDGs, and if we cannot delay child marriage and early pregnancy then we will not be able to break the overall cycle of poverty. This is why I am a signatory to the Girl Declaration, an initiative calling for girls to be placed at the heart of the next development agenda.
In Nigeria, my work has focused on maternal, newborn and child health, MNCH. Even though Nigeria has been one of the world’s fastest growing economies in recent years, the number of people living in extreme poverty has only risen from 52% in 2004 to 61% in 2010. This is reflected in its MNCH statistics, that sees only 38% of births assisted by a skilled birth attendant (https://www.dhsprogram.com/pubs/pdf/FR293/FR293.pdf). As a mother myself, I can assure you that very few women choose to go without the assistance of a skilled birth attendant. Those with the least access to health, education, legal rights, employment, are the ones that will continue to suffer the most. So, as we progress to achieve better health outcomes, we need to place access at the centre: access to health information, access to health practitioners and access to health facilities.
One thing that could help address this stark inequality is technology. Nigeria’s mobile phone penetration is one of the highest in the world, and the continent’s growth is the fastest of any region. The diffusion of phones means that mobile technology offers a huge potential to address the inequalities in health provision. And, slowly, different stakeholders are seriously coming around to the idea it can be harnessed to deliver direct development impacts. Just this week, at the Partners Forum in Johannesburg, a global gathering of MNCH actors, I heard major players taking it seriously.
2. Harness Mobile Phone access
Simple mobile applications can help those without access to health services interact with health facilities in ways that would not have been possible even a decade ago. Birth registration, a fundamental universal right, remains the preserve of less than 40% of births in Nigeria, and a fraction of this figure in countries such as Liberia and Ethiopia. This is clearly something that mobile applications can have an immediate impact on. Even midwifery support and basic health information could be expanded through mobile applications as a low-cost way to improve antenatal care, referral systems, and hygiene for the 2.5 billion people still lacking access to improved sanitary facilities. Access to mobile health and sanitation information can be a low-cost way to make the difference in improving overall health in a cost-effective way (http://www.unicef.org/media/media_45481.html). This is why my organisation is developing a digitised format of our Personal Health Records, a client-held medical record for mother and child up till the age of five years.
To deliver this change, we will need more robust and accountable partnerships integrated in the post-2015 framework. From grassroots community organisations, to national governments, to private corporations, everyone has a role to play. The previous disjointed approach to development, with institutions and country programs, conflicting, duplicating and, ultimately, wasting resources, will no longer suffice. Building strong accountability into any set of development goals has to be a must, as only this will create the developmental change that is critical to making broad economic empowerment a reality, and more sustainable.
More effective global partnerships
3. The current MDG 8 has to be developed to explore more effective global partnerships. A key ingredient is national ownership of programmes by governments, as this will help address existing disparities in development in contextually specific ways. This can ensure that partnerships between global organisations and local NGOs/CSOs will share the same vision, to truly provide solutions that help communities achieve sustainable development. My organisation, the Wellbeing Foundation Africa is already a part of many such partnerships and we hope that the post-2015 agenda will explicitly recognise their importance, because accountable, context-specific, multi-stakeholder partnerships will underpin the development of infrastructures and systems required to achieve the rapid scale-up we need in Africa.
Essentially, the new post-2015 agenda should facilitate the completion of the existing MDGs, and then set more ambitious targets. Technology will be the key to addressing the fundamental inequalities that hamper current development targets, especially inequality in access to healthcare, but this will only work if our agreements are concrete. What I envision is a multi-stakeholder cooperation between governments, civil society, and the private sector, that is based on equity, transparency and accountability. The credibility of a partnership rests on the fulfilment of commitments, and the actors need to have a vested interest in the wellbeing of everybody, because everyone has the right to wellbeing.