Today, World Population Day, the world’s poorest people are benefiting from international community investment in a sweeping development agenda to address entrenched health, educational and poverty issues. Investment plus economic expansion since the turn of the century has resulted in many countries reaching UN Millennium Development Goals set for 2015, and moving up into the middle income ranks. http://www.un.org/millenniumgoals/ For example, many countries are on track to achieve goals for reducing childhood mortality by two-thirds. That’s worth celebrating.
It’s a pivotal year in international development as, with the close of MDG and the launch of new Sustainable Development Goals (SDG), the community is turning to new agendas calling for universal health care. But such goals will require better targeting of resources to ensure progress is not only sustainable but equitable. One way to reach sustainability is to be sure we are supporting markets in developing countries. In this way, limited government and donor resources can serve the most vulnerable while markets provide goods and services more efficiently to those willing and able to pay.
With progress, new challenges
Investment in health care is resulting in stronger health systems. But it must remain ever present in mind that with progress, new challenges will come, and our solutions must be vigorous and adaptable enough to respond.
Countries on the path towards economic, social and health progress are occasionally buffeted by the unexpected: natural disaster in the case of Nepal and Haiti, political strife such as that in South Sudan, and new health emergencies, such as the Ebola epidemic in Liberia, Guinea and Sierra Leone. The urgency for durable solutions is underlined when we find ourselves, on this World Population Day, in the midst of the worst crisis of displaced people since World War II – either from man-made or natural disasters: wars, civil conflicts, earthquakes, typhoons, Ebola. http://www.unhcr.org/5399a14f9.html.
In addition, progress can engender new challenges. For example, the fact that treatment of AIDS, which at one time required an emergency response, is now in the category of a chronic illness is a huge step forward, but requires more government resources for longer.
In this post-MDG, sustainable global development world, our focus now must shift to helping countries to shape the market to encourage coordination among public, nonprofit, and commercial sectors that strengthens a health systems’ ability to bring health care services and products to people, whether in the densest cities or remotest rural areas, and in the face of crisis.
While improving health systems overall, the leveraging of market dynamics will free limited charitable resources to be re-targeted to reach the most vulnerable populations in areas that have so far been left behind, such as Sub-Saharan Africa. Among the 24 countries where at least 1 in every 10 children still dies before reaching five years old, 23 of them are in sub-Saharan Africa. http://www.unicef.org/mdg/index_childmortality.htm
In our projects over the years, JSI has taken an “every available opportunity” attitude toward delivering critical health and family planning services. This means no missed opportunities in terms of client contacts. We reach out through nutrition programs, community-based family planning clinics, at pre- and postpartum visits, at well-baby checkups, immunization visits and HIV programs.
We have worked with private medical and nursing associations, hospital chains, family planning associations, large NGOs, and individual women merchants. In Benin, for example, we are assisting NGOs already doing community health to add community-based distribution of injectable birth control and other methods. In Madagascar we worked with the government and UNICEF to design user-friendly child health, maternal health and youth tracking cards, all of which integrated family planning and child spacing services. These cards were adapted and translated and now are in use throughout Ethiopia as well.
Our “every available opportunity” philosophy includes reaching out to both public and private sectors, faith-based groups and work-based programs. JSI was one of the first organizations to adopt a business-centric market shaping approach in the 1980s through the Kenya Family Planning Private Sector Project to introduce family planning services within the health programs of private firms and institutions, which were delivering health services to employees and dependents. Thirty years later, as the global health landscape rapidly evolves, we continue to forge and maximize partnerships across sectors to ensure all segments of the population are reached.
For the greatest public health impact, international development must move toward a market-based approach to ensure the right conditions exist so that all the players coordinate to serve the entire population – the whole market – with the right commodities, at the right price, at the right time and place, and emergency situations don’t stop us from getting the job done. With an ambitious post-MDG development agenda built on results to date, and growing international awareness of the importance of public-private partnership, a robust dynamic health system that serves all and that involves all is in reach.