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The MDGs for Health: Rising to the Challenges
Adam Wagstaff, Lead Health Economist in the Development Economics Research Group, said health features prominently in the MDGs both directly in issues such as child mortality or indirectly through issues such as gender equality. Health also impacts poverty reduction activities and outcomes. There are marked inequalities across the world in premature death and morbidity. There is a striking disparity in under five deaths and HIV rates between the rich and poor countries. Wagstaff discussed data on out of pocket expenses for health care in Vietnam and compared wealthy and poor households. These expenditures push many poor households below the poverty line. He reviewed child mortality data suggesting Sub-Saharan Africa and South Asia are not improving nearly enough to reach the MDG goals by 2015. On variables such as nutrition, child and maternal mortality, the poorest countries are progressing the most slowly. Some countries are progressing, however, and Wagstaff mentioned China, Malaysia and Indonesia among them. He noted economic growth can and should have a positive impact especially in Eastern Europe and Central Asia. Still the data suggests the overall targets globally will not be met. Wagstaff said scaling up existing interventions that are already effective can improve the progress toward the MDGs. He acknowledge that increased donor aid would have a positive impact, but said it was important to increase spending in the right areas. In some places such as Sub-Saharan Africa, additional government health spending would need to rise to 12% of GDP, a level he suggested was not realistic. Scaling up aid is therefore not enough. Country-specific bottlenecks need to be identified and addressed. He identified lowering insurance costs and improving service deliveries as potential opportunities. Wagstaff also suggested improvements could be generated by working across sectors. He closed by noting that as countries become richer, they spend more on health, and that targeted aid to countries who are close to suggested spending levels would be highly effective.
After the first discussion period, which included inputs from Pablo Gottret, a Senior Health Economist in the HNP unit, Mariam Claeson, a Lead Public Health Specialist with the HNP unit, discussed some of the specifics that generated the report. She expressed the hope that the report would help focus the Bank’s operational staff on tasks necessary toward achieving the MDGs. The report sought to work with country teams in an effort to learn by doing, she said. Claeson noted a couple of country settings such as Mauritania and Dominican Republic where collaborative efforts were bearing fruit. Health system constraints were also revealed from the report’s analytical work. Best practices were generated from research on household barriers. Claeson then began to list of number of authors and teams responsible for various aspects of the report. She noted that aside from the usual partnerships with WHO, there had been other productive partnerships and she cited the development agencies for Canada and the United Kingdom as examples. With regards to the report, Claeson said the key for the future was how it could help build capacity to make the MDGs relevant to countries.
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