The SDGs and MNH

Goal 3 (Ensure healthy lives and promote well-being for all at all ages) includes two targets which relate to MNH.

3.1  By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.  In order to attain this each country will need to contribute a two-thirds reduction in its maternal mortality ratio (MMR) by 2030, regardless of their MMR at baseline.  A secondary goal that no country should have an MMR that is more than 140, or twice the targeted global average MMR, has been included to reduce inequity between countries.   Therefore countries with a high baseline MMR (greater than 420) will require a steeper decline.  In addition there is a call for countries to focus on reducing the national average MMR and to reduce inequity between subpopulations (Maternal Health Task Force, website).

3.2  By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births.

Criticisms of SDG 3

Early stage criticisms have included concerns that there is only one health-related goal which in turn is too broad (Bennett, S. and Sheikh, K., 2015).  This may compromise attainment of and/or the ability to measure the targets (Barredo, L. et al, 2014).  Similarly there are concerns that the number of goals (17) and targets (169) is unwieldy (Ford, L. 2015).  There are also concerns that some of the targets are vague, not adequately quantified and aspirational (Murray, C., 2015. Others question the validity of ambitious targets and whether or not there is adequate understanding of the requirements to meet these targets at a time when global finances are so constrained particularly for low income countries (Waiswa, P., 2015), and/or whether the global health community fully understands the extent of the paradigm shift required in order to implement the health agenda and the broader sustainable development agenda (Buse, K and Hawkes, S., 2015).

Counter arguments include the fact that the SDGs address some issues such as women’s empowerment, mental health, good governance, and peace and security which were not adequately covered by the MDGs (Ford, L. 2015).  Further the breadth of the goal is seen as valuable in relation to the MDGs which were criticised by some for creating artificial boundaries between goals and as compartmentalising specific health goals and therefore driving resources to programmes relating to specific diseases and conditions; rather than to a universal approach to healthcare provision which requires a comprehensive functional health system (Bennett, S. and Sheikh, K. (2015).  Others argue that ambitious targets are often needed to inspire progress (Barredo, L. et al, 2014, Norton, N. and Stuart, E., 2014) and that the investment in health systems and universal health coverage (UHC) promotes better outcomes for all (Barredo, L. et al, 2014).  There is a growing body of evidence to support the positive impact of investing in health systems (World Health Organisation (WHO), 2007).

Finally supporters note that the design of the SDGs is such that health-related issues are threaded through other SDG goals which reflect the linkages between health and poverty and hunger, improving education and ensuring water and sanitation.

Funding implications:

Initiatives such as the Global Financing Facility are intended to promote financial innovation to fund the SDGs (Chou, D. et al, 2015), however there are concerns that there will be inadequate funds to meet the aspirations of the goals.  The 2015 conference on financing the SDGs, the Addis Ababa action agenda (AAAA), included what the UN called “bold measures to overhaul global finance practices and generate investment” but “failed to ease concerns that there will not be enough cash to meet the aspirational nature of the goals (Ford, L. 2015)”.  No new funding sources, such as international taxes, were identified.

Others have expressed concerns that the main development funders (the U.S. government, the U.K. government, and the Bill and Melinda Gates Foundation which accounted for 61% of the increase in development funding between 2000-2014) will continue to focus on low income countries and the MDG health agenda rather than embrace the wider scope of the SDGs (Murray, C., 2015).

Considerations when designing and implementing relevant interventions:

The need for effective cross sectoral collaboration: to enable the full intent of the SDGs to be met (Wickremasinghe, D., 2015.).  Video clips from the Global Maternal Newborn Health Conference in Mexico City in October 2015 highlight some of the debate around SDG-related issues such as the lack of public understanding particularly in high-income countries, of poverty and health measures (Dr. Hans Rosling) and the opportunities and challenges of integration across sectors (Prof. Joy Lawn).

Challenges in measuring progress:

An interagency expert group established by the UN Statistical Commission will approve specific global indicators for each SDG target early in 2016.  Progress in measuring health indicators has been made as a result of the MDGs and improvements in methods such as the DHSs, the MICS, and the Countdown to 2015 and in the investment in COIA (Commission on information and accountability for women and children’s health).    However many argue that there is still more to do.  Key areas of focus include:

  • The need for improved standardised data collection and use at facility level and innovation to address fundamental technical issues (Grove, J. et al, 2015).
  • Existing data collection systems may require some countries and service providers (NGOs) to expand their statistical systems, particularly where those data are not routinely used in health-related decision making (Galati, A. J., 2015), (Murray, C., 2015).
  • Further investment may be required to ensure that existing data collection and analysis systems are adequate for tracking inequities (Galati, A. J., 2015).
  • The “aspirational” indicators may require investment to develop common definitions and to create new data collection tools and practices (Galati, A. J., 2015).

The use of evidence-based interventions: A WHO blog highlights four recent guidelines that may help to accelerate the realisation of the SDGs (Khan, D. N., 2015):

Ensuring equity in all countries:

Recent publications relating to stillbirths have highlighted the need to ensure that inequity within high income countries is not ignored.  Research shows that women living in adverse socioeconomic circumstances in high-income countries have twice the risk of having a stillborn child when compared to more advantaged counterparts (Flenady, Vicki et al., 2016).  Programmes are required to address these inequities and national perinatal mortality audits need to be implemented.   Failure to address inequities and to alter trends in stillbirth rates will lead to a widening of equity gaps between regions and countries, including in high income countries (Lawn et al, 2016).

Fit with the 2015 UK Aid strategy: tackling global challenges in the national interest:

On 11 January 2016 the UK Secretary of State for International Development and senior DFID staff gave oral evidence to the International Development Committee inquiry into SDGs (also available as a video).  This outlines how the SDGs align to the UK Aids Strategy and how they will be monitored in the absence of a national plan.

The SDGs and MNH was last modified: May 4th, 2016 by Adrian Bannister

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