Reproductive health and the Millennium Development Goals: the missing link

This report was commissioned by the Population Program of the William and Flora Hewlett Foundation in December 2004. The author was charged with analyzing the United Nations' deliberations that led to the adoption of the Millennium Development Goals (MDGs) to answer the question of why there is no specific reproductive health goal. Her report, of which this is a lightly edited version, is also available online at . This coverage of the MDG process will be complemented by a special section of Studies in the June 2005 issue on reproductive health and the MDGs. The section will include excerpts about reproductive health from the final report of the Millennium Development Project entitled "Investing in Development: A Practical Plan to Achieve the Millennium Development Goals," which was submitted to Secretary General Kofi Annan in January 2005, as well as commentaries by leading scholars and policymakers in the fields of population and reproductive health.     

初级卫生保健发展回顾与疾控作用的思考

  目的  评价国家基本公共卫生服务项目的实施效果,为基本公共卫生服务项目的可持续发展与实施提供循证依据与政策建议。  方法  以Donabedian质量理论为理论框架,从结构、过程、结果3个维度对中国2009 — 2019年公开发表的研究报告和现场定性访谈中基本公共卫生服务项目的实施效果进行综合评价。  结果  中国基本公共卫生服务体系逐步建立,筹资水平与服务内容不断提升,绩效考核机制不断完善,人民健康水平有所改善,城乡健康差距不断缩小,基层服务能力有所提升;但服务项目的动态调整机制尚未建立,“医防两张皮”现象普遍,基层信息化水平仍需提高。  结论  国家基本公共卫生服务项目取得了明显的成效,但在服务项目调整机制、医防融合及信息化建设等方面仍需改进。     

Beyond the Millennium Development Goals: Public health challenges in water and sanitation

Abstract

Over 1 billion people lack access to improved water sources and 2.6 billion lack access to appropriate sanitation, greatly contributing to the global burden of disease. The international community has committed to reducing by half the proportion of the world's population lacking access to water and sanitation as a part of the Millennium Development Goals (MDGs). However, the disease burden due to poor access, is borne primarily by the poorest countries and the poorest people within them. Simply reducing the proportion of people without adequate access will not automatically result in proportional reductions in the related disease burden. The public health challenge inherent in meeting the MDG targets is ensuring that improvements result in access to water and sanitation for the critical at-risk populations. Innovative approaches are required to ensure the availability of low-cost, simple, and locally acceptable water and sanitation interventions and integrating these approaches into existing social institutions, such as schools, markets, and health facilities.     

Achieving Millennium Development Goals for health: building understanding, trust and capacity to respond

Biomedical interventions promise achievement of health-related Millennium Development Goals provided social-, capacity- and knowledge-based constraints to scaling up and reaching marginalized people at risk, are addressed, and balance between prevention and treatment is struck. We argue for a new approach: multi-stakeholder capacity building and learning for empowerment: MuSCLE. MuSCLE is used as a way to frame three systemic weaknesses in traditional health science and policy approaches: (1) a lack of engagement with people at risk to build a collective understanding of the contexts of health problems, including social drivers; (2) a lack of multi-criteria evaluation of alternative interventions; (3) a lack of attention paid to integrated capacity building. The MuSCLE framework responds in three ways: (1) participatory assessment of the ecological, socio-cultural, economic and political contexts of health, identifying priorities using risk and vulnerability science, and modeling drivers; (2) selection among intervention alternatives that makes ecological, socio-cultural, economic and political tradeoffs transparent; (3) integrated capacity building for sustainable and adaptive interventions. Literature and field lessons support the argument, and guidelines are set down. A MuSCLE approach argues for a transformation in health science and policy in order to achieve Millennium Development Goals for health.     

Fertility regulation and reproductive health in the Millennium Development Goals: the search for a perfect indicator

Although several key elements of sexual and reproductive health are included in the United Nations Millennium Development Goals, a measure of women's capacity to regulate their fertility safely and effectively is missing. We considered the usefulness of 3 pairs of indicators in monitoring this component of reproductive health: contraceptive prevalence and total fertility; unmet need for contraception and unplanned births; and unsafe abortion and abortion mortality. A single measure of contraceptive use is insufficient. The risks women face from unplanned births and unsafe abortion should also be incorporated into the monitoring process, either directly within the Millennium Development Goals framework or as a parallel effort by reporting governments and other agencies.     

Setting the stage for equity-sensitive monitoring of the maternal and child health Millennium Development Goals

OBJECTIVE: This analysis seeks to set the stage for equity-sensitive monitoring of the health-related Millennium Development Goals (MDGs). METHODS: We use data from international household-level surveys (Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS)) to demonstrate that establishing an equity baseline is necessary and feasible, even in low-income and data-poor countries. We assess data from six countries using 11 health indicators and six social stratifiers. Simple bivariate stratification is complemented by simultaneous stratification to expose the compound effect of multiple forms of vulnerability. FINDINGS: The data reveal that inequities are complex and interactive: inferences cannot be drawn about the nature or extent of inequities in health outcomes from a single stratifier or indicator. CONCLUSION: The MDGs and other development initiatives must become more comprehensive and explicit in their analysis and tracking of inequities. The design of policies to narrow health gaps must take into account country-specific inequities.     

贫困及其影响与千年发展目标

贫困问题及贫困对健康和经济发展的影响日益引起国际社会的关注。但是，投资于卫生进而促进经济发展和减少贫困的重要性并未得到应有的重视。联合国千年发展目标的提出包括卫生发展目标，其实现将有助于在世界范围内减少贫困、改善健康、促进发展。国际社会对贫困问题及其影响的关注应引起我国卫生部门及与卫生有关的各个相关部门的高度重视。研究减少贫困人口、降低因贫困对健康的影响和危害的策略是十分紧迫的。其意义不仅有利于卫生目标的实现，还将提高我国生产力和整个人群的健康素质，改善卫生保健与健康的公平性，推进千年发展目标的成功实现的进程。     

Cervical cancer prevention and the Millennium Development Goals

The advent of new technologies such as the human papillomavirus (HPV) vaccine and HPV DNA tests – along with new insights into the appropriate use of low-resource technologies such as visual inspection of the cervix and treatment of cervical lesions with cryotherapy – have increased optimism about the potential for effective disease control in low-resource settings. Nevertheless, it is also important to ask ourselves how new health initiatives contribute, or fail to contribute, to major global undertakings such as achievement of the Millennium Development Goals (MDGs).While reproductive health in general, and cervical cancer prevention in particular, are not explicitly mentioned among the MDGs, they are implied; and it is certain that women cannot contribute to sustainable development without good health. The question is, in what ways do scaled-up cervical cancer prevention activities, including introduction of the new HPV vaccines and increased access to precancer screening and treatment, contribute to attainment of the MDGs?     

艾滋病与千年发展目标

通过艾滋病的流行和传播与其他发展目标的相互影响,论证遏制并扭转艾滋病蔓延的紧迫性,同时采取多途径确保千年发展目标的最终实现。     

实行资源整合 实现千年发展目标

<正> 四年前,人类进入新世纪的重要时刻,联合国召开了有189个国家首脑出席的千年首脑会议,会议通过了千年宣言,确立了具有里程碑意义的千年发展目标,为人类的发展指明了方向。千年发展宣言将遏制和扭转艾滋病蔓延列为主要目标。如何面对艾滋病的挑战,实现政治承诺,有效地利用和组织资源,成为各国政府抗击艾滋病,实现千年发展目标的重点。