BOOKS & ELECTRONIC MEDIA

The Millennium Development Goals for Health: rising to the challenges

Brenda Killen

MDGs, Health and Development Policies, World Health Organization, 1211 Geneva 27, Switzerland (email: killenb@who.int)

Publisher: World Bank, Washington, DC; 2004
ISBN: 0-8213-5767-0; softcover: 202 pages; price US$ 25.00

Health is central to the achievement of the Millennium Development Goals (MDGs). Three of the eight goals, eight of the 16 targets and 18 of the 48 indicators relate directly to health. Illness and premature death are major causes of household poverty and act as a significant constraint to economic growth, particularly in countries devastated by the HIV/AIDS pandemic. Without progress on health, the MDGs will not be met.

This report takes a half-time look at progress towards the health MDGs. It considers achievements made to date, identifies what remains to be done, and assesses the prospects for meeting the goals in the world's developing countries. Not surprisingly, the picture is mixed, with the bad news outweighing the good. Most countries will fail to meet some or all of the health MDGs — maternal mortality is a particular challenge — and much of the report is concerned with how to accelerate progress in the poorest countries.

As always, the World Bank has produced a well-written and interesting report which gives a good overall assessment of the issues surrounding the health MDGs. Data on where we are now are teamed with up-to-date analyses of emerging problems and barriers to progress, as well as an overview of what has and hasn't worked in a range of countries. These are supported by annexes explaining the methodology used in the regression analyses and the monitoring methods.

The report is organized into two parts: the first outlining the challenges to meeting the health MDGs; and the second looking at how to address these challenges. The various country examples in the second part are informative, and illustrate the range of policy and delivery choices available to developing countries. But the report's breadth of coverage precludes detailed consideration of individual challenges, and it is stronger at diagnosing the causes of slow progress towards the health MDGs than at identifying solutions. There is some discussion of why particular solutions work in particular contexts, but more analysis of the political, social and other nonhealth-related factors that need to be taken into account by policy-makers would have been useful. The section on tackling human resource constraints also seems short, given the centrality of this issue to scaling up.

The report's key messages underline the complexity of working in health. All of the problems which threaten achievement of the MDGs emerge, including lack of financial resources; weak government systems; loss of skilled workers through migration or to HIV/AIDS; and poor aid delivery by donors. It is shocking to learn that one of the most difficult challenges is making sure that known, effective interventions for health are used — the authors estimate that using all known interventions appropriately could avert 63% of child deaths and 74% of maternal deaths.

This report works on several levels. Readers with limited time can focus on the key messages and overview sections, while those with more time will find much to interest them in the main body of the text. It is an informative and up-to-date reference work for anyone working in health and development. The conclusion is clear — reducing the heavy burden of death and suffering that is concentrated in the developing world requires immediate action to accelerate progress towards achieving the health MDGs.