Beyond the Millennium Development Goals: Strengthening Health Systems for Sustainability

Emerging Voices features contributions from scholars and practitioners highlighting new research, thinking, and approaches to development challenges. This article is from Amit Chandra, an emergency physician and global health consultant based in Washington, DC.

This year marks the end of the fifteen-year Millennium Development Goal (MDG) framework. The health MDGs focused on single, discrete issues including hunger, maternal and child health, and major infectious diseases, and they successfully targeted the spread of HIV and tuberculosis. Slated to replace the MDGs, the Sustainable Development Goals (SDGs) similarly focus on single issues—hunger, sanitation, and an expanded list of key diseases. Continuing this approach fails to address today’s global health challenges, in particular rising mortality associated with non-communicable diseases (NCDs), road traffic accidents, and Ebola-like infectious disease epidemics. To combat these threats, we need to strengthen countries’ entire health systems, specifically incorporate data to identify problems, expand technical capacity, and boost financial and human resources for health.

In many developing countries, health systems now face the dual burden of NCDs and persistently high rates of infectious diseases like HIV, TB, malaria, and tropical diseases. Studies estimate that over 900 million people in developing countries have high blood pressure, though only one third of them (300 million) are aware of their disease, and only one third of those aware (100 million) are currently on treatment.

Unlike with most infectious diseases, people can live for years with high blood pressure, diabetes, or early stages of cancer without symptoms. Many in the developing world lack access to primary care, and so their first contact with a doctor may only occur when their conditions escalate. In this way, weak health systems turn  preventable and treatable chronic diseases into silent killers. Tackling NCDs requires universal primary health systems that provide prevention, screening, and treatment services to entire populations, not just to the few identified with a particular disease.

Health systems also matter for lowering traffic fatalities. Road traffic accidents cause over 1.24 million deaths per year worldwide. In the developing world, an injured person lying on the roadside often depends on bystanders for transport to the nearest hospital, which is unlikely to provide surgical care. A robust health system would enable coordination between health, law enforcement, and public policy leaders to reduce traffic fatalities. Take Rwanda for example. In 2001, the country had one of the highest traffic fatality rates in the world. To address this problem, the government passed mandatory seat belt and helmet laws, increased enforcement of speed limits, and implemented a public awareness campaign. Drivers of motorcycle taxis, a popular method of transport, are even required to carry an extra helmet for their passengers, which they sling over their elbows while looking for customers. As a result, road traffic deaths fell by over 30 percent. On a recent trip to Kigali, I was impressed to see near universal helmet use among motorcycle drivers and passengers.

The absence of adequate health systems can permit novel, unexpected infectious disease outbreaks to escalate and spread. The recent Ebola epidemic in West Africa—often cited as an example of the failure of the World Health Organization (WHO)—is first and foremost a failure of the national health systems of the three countries most affected by the disease. Guinea, Liberia, and Sierra Leone’s inability to effectively respond to the initial outbreak led directly to the spread of the disease. Too few hospitals and clinics, a dearth of doctors and nurses, and limited public outreach capacities contributed to a climate of misinformation and a breakdown of public services. Preventing future outbreaks will require more than a WHO emergency fund; it will require national health systems capable of detecting, treating, and isolating a surge of sick and exposed patients.

Now, as we determine the scope of the SDGs, we have an opportunity to strengthen health systems. National governments should be encouraged to provide basic health services to their populations. The global health community can support this effort by financing health management training and an expanded health provider workforce. To quote the UN Secretary General’s report on the SDGs, meeting these goals by 2030 will require that we “…act, boldly, vigorously and expeditiously, to turn reality into a life of dignity for all, leaving no one behind.”