Many low-income countries are unlikely to reach the health targets set for 2015

Many low-income countries are unlikely to reach the Millennium Development Goal (MDG) health targets set for 2015; the main reasons for this are fragile health systems and insufficient investments in understanding how to strengthen them, suggest authors of a Public Health article in this week’s issue of THE LANCET.

The article is the first of several papers to be published in THE LANCET in the lead-up to the Ministerial Summit on Health Research (November 16-20, 2004, Mexico City). The Mexico summit will have a particular focus on health-policy development, health-systems research, knowledge dissemination, and promoting the use of findings by decision makers.

The MDGs arose from the UN Millennium Declaration, signed by 189 countries in 2000. Eight goals were established for development and to eradicate poverty, three of which directly relate to health issues: reducing child mortality; improving maternal health; and combating diseases such as HIV/AIDS and malaria.

A critical barrier to achieving these goals is highlighted: the fragile health systems in poorer countries. For many of the diseases, effective health interventions are known but frontline service providers face real difficulties in ensuring reliable supplies and effective management of health workers, funds, drugs and information. The constraints may be due to an absolute lack of resources, to limited provider level skills and systems, or to broader organisation and institutional barriers such as employment regulations. Although the general consensus is that stronger health systems are needed to achieve improved health outcomes, there is less agreement about how to strengthen them. Health systems can either be strengthened through a disease-specific approach, or by a system-wide approach. Authors of the article suggest that a disease-specific approach is more manageable and will deliver quicker results in the short-term; however, these parallel interventions can lead to duplication, distortion, and disruption. Similarly, in a system-wide approach, multiple benefits build-up, but the approach can be less manageable, and the benefits can take longer to become established.

More research is needed into which health-system strengthening strategies are most effective. Author Phyllida Travis (World Health Organisation, Geneva, Switzerland) comments, “An international task force is being convened by WHO to identify health-systems research priorities, propose strategies to raise funding to address these priorities, and generate consensus about how to move forward...The task force will present its recommendations to the Ministerial Summit on Health Research later this year, with the intention that a 10-year commitment to this learning agenda will ensue, so that by 2015, substantial progress will have been made in removing health-system constraints to achieve the MDGs.”