The Millennium Development Goals or MDGs were identified by the World Health Organisation in terms of the Millennium Declaration signed by 189 countries in 2000. In its publication concerning the status of MDGs in 2005, the World Health Organisation ("the WHO") stated that the MDGs "refl ect an unprecedented commitment by the world's leaders to tackle the most basic forms of injustice and inequality in our world: poverty, illiteracy and ill-health" (see Health and the Millennium Development Goals, Report by the World Health Organisation, 2005). The target date to achieve the MDGs is 2015.
The MDGs therefore are a set of goals that need to be reached by governments who have signed the Millennium Declaration and are required as a result to address issues concerning ill-health and poverty within their various countries. The health-related MDGs are described by the WHO as not necessarily covering "all the health issues that matter to poor people and poor countries. But they do serve as markers of the most basic challenges ahead: to stop women dying during pregnancy and child birth; to protect young children from ill-health and death; and to tackle the major communicable diseases, in particular HIV/AIDS. Unless we can deal with these fundamental issues, what hope is there for us to succeed in other, equally important areas of health?" (The WHO report at page 3.)
The MDGs therefore, from the point of view of the health related MDGs, must fi nd resonance in domestic legislation in order for governments to implement the MDGs and achieve the goals agreed to in the Millennium Declaration. The MDGs are based on challenges posed to governments to implement the MDGs and to achieve the goals that are contemplated by the MDGs and the Millennium Declaration.
The challenges are derivatives of the goals that are to be established or have been established. The MDGs are as follows:
- Goal 1: Eradicate extreme poverty and hunger
- Goal 2: Achieve universal primary education
- Goal 3: Promote gender equality and empower women
- Goal 4: Reduce child mortality
- Goal 5: Improve maternal health
- Goal 6: Combat HIV/Aids, malaria and other diseases
- Goal 7: Ensure environmental sustainability
- Goal 8: Develop a global partnership for development
Of the abovementioned goals, Goals 4, 5 and 6 address healthcare related issues directly whilst goals 1, 7 and 8 address issues concerning healthcare indirectly: in relation to the eradication of poverty and hunger, environmental sustainability and better development for poorer nations. Unfortunately, the implementation of the MDGs, at a domestic level, is not achieving the resounding successes hoped for in Africa although health planning across the globe is AFRICA LEGAL BRIEF SERIES | MARCH 2012 cited as a weakness when implementing the MDGs:
Whilst stronger health systems are recognised as a prerequisite for achieving the MDGs, neither health donors nor national health planners have paid sufficient attention to systems strengthening. The drive to produce results for the MDGs has led many stakeholders to focus first on their own disease priority, within an implicit assumption that through the implementation of specific interventions the broader system will benefit". (The WHO report at page 41.)
What the MDGs do bring into sharp focus are:
- the status of domestic healthcare systems;and
- the ability of those systems to produce effective results for the populations that they service.
The obligations upon a State to provide its citizens with effective healthcare is one that rests both in international law - in various human rights treaties - and domestic law in relation to the provision of healthcare services, whether by constitutional directive or otherwise. The particular focus that the MDGs present to the provision by States of healthcare systems is whether or not the healthcare systems in question are providing effective healthcare to citizens of a population in accordance with the rights the citizens enjoy at international law, more particularly, the MDGs. The nature of the service delivery structures within a domestic healthcare setting is increasingly going to be criticised and scrutinised by international bodies such as the WHO or the African Union in order to determine whether or not the healthcare needs of a particular population are being adequately addressed and human rights respected.
Therefore, the MDGs place pressure on various governments to ensure that healthcare delivery systems comply with international obligations imposed upon those governments and are consistent with the human rights entitlements enjoyed by citizens of various States. The MDGs are therefore a useful criteria against which to measure a particular government's compliance with providing adequate healthcare in particular and human rights in general - the delivery of an effective healthcare system to a population becomes paramount:
From a policy perspective, the MDG targets and indicators have played an important role in drawing attention to critical health and development needs, and in monitoring responses at the global and country levels. However, there are inherent tensions in the monitoring process that need to be managed. One of these tensions is the balance between global and country reporting ....Ideally, the identification and generation of global indicators should respond to country needs and emanate from country health information systems." (The WHO report at page 76.)
The application of the MDGs, to a domestic setting, in relation to the health outcomes that are required of the MDGs may very well create tension between the application of the MDGs and the priorities and the legal constraints in a domestic setting. This may be especially prevalent in poorer countries and those facing high disease burdens such as the government of South Africa. Unfortunately, Africa receives adverse attention in the 2005 WHO report in relation to the issue of health outcomes:
Particularly in Africa, it is essential to take action to prevent deaths of health personnel from HIV/AIDS. Where migration is stripping health system of vital personnel, efforts are required – both within and among countries – to manage mobility without infringing upon individual rights. The key point is that the crisis demands political as well technical solutions because it is deeply associated with national priority setting (for example, why should health workers get special treatment, compared to other public sector workers?) and because it often involves overcoming conflicting interests at the core of national and international political processes...". (The WHO report page 34)
Part of achieving the MDGs related to health is defining the rules of engagement, and the stewardship and role of the State. As a starting point, it is unclear whether or not many African jurisdictions have followed a particular course, consistent with domestic priorities and laws, to achieve the MDGs. An evaluation is therefore required of the level of stewardship adopted by a particular State to the application of the MDGs, more particularly, within the context of the healthcare systems used in Africa and the outcomes produced by those healthcare systems in relation to domestic disease priorities. This principle of stewardship should be examined on a State by State basis and compared with the actions or omissions taken by a particular State in relation to the application of the MDGs vis á vis the health sector. The outcome of the comparison, if adverse to the achievements of the MDGs in a particular jurisdiction should then be evaluated with reference to remedies that may present in both domestic and international law to ensure that states comply both with their internal obligations and domestic legal obligations: "Stewardship refers to the oversight role of the state in shaping, regulating, and managing health systems. Governments are expected to provide public and private health system actors with overall policy direction; to create conditions that allow them to do their jobs; to ensure oversight across the whole system with particular attention to equity concerns; and to reconcile competing demands for resources. The growing share of external funding channelled through disease–specific initiatives poses a particular challenge to the government oversight function...". (The WHO report at page 40)
The evaluation of the implementation of the MDGs occurs every
five years by the WHO with the next review occurring in 2015. Based
on the enormous difficulties faced in numerous African
jurisdictions from a healthcare point of view, much must be done in
order to achieve the implementation of the MDGs with reference to
the state of healthcare sectors in Africa and the particular burden
of disease in Africa in relation to HIV/AIDS, malaria and
tuberculosis. The questions that need asking are:
- what will Africa and its governments have done by 2015 to realise the MDGs based on the rights of their populations, respectively, to health and dignity as stated in a number of domestic constitutions but also international treaties
- how will the governments of Africa assess their achievements, or lack of it, of the MDGs?
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