As a young journalist in Johannesburg in the early 1990s, I wrote a story about South Africa’s looming HIV crisis, citing predictions from epidemiologists that, without urgent action, cases could top five million by 2000. That seemed an impossibly large number at the time, but unfortunately those predictions came true.
A combination of government neglect, lack of international preparedness and ground-level stigma allowed Aids to gain a devastating foothold in South Africa. As a result, millions died.
Today, the story is very different. Thanks to government action, prevention efforts and the use of antiretroviral drugs, South Africa has made remarkable gains against HIV and Aids.
Although more needs to be done to reverse the spread of HIV, South Africa’s progress is part of a promising global trend.
International commitmentsUnprecedented international and domestic commitments and partnerships such as the Global Fund to Fight Aids, Tuberculosis and Malaria have enabled countries with the highest burden of HIV to accelerate their response to the epidemic. Joint United Nations Programme on HIV and Aids figures from 2014 indicate that, since 2001, new HIV infections worldwide have fallen by 38%. In sub-Saharan Africa, more than a third of people living with HIV now have access to treatment.
This progress is no accident. Global reductions in HIV have been a key target of the millennium development goals (MDGs) that were initiated by the UN in 2000 and are due to expire later this year. They set clear priorities and specific global and country-level targets for reducing extreme poverty and disease in the developing world. The targets for reducing HIV-related deaths have helped mobilise commitment in developing countries and among global-health donors.
According to UN data, they have resulted in investments in new drugs and therapies, spurred innovative financing mechanisms to reduce the annual per-patient cost of drugs for treatment from nearly $10 000 to about $150 and improved public health systems in many developing countries.
Global progressThe MDG model has also contributed to enormous progress in other areas of global health and development. For example, UN figures show that the number of people living in extreme poverty – on less than $1.25 a day – fell by half between 1990 and 2010, five years ahead of the millennium goals target. Maternal mortality and under-five child mortality have both fallen by nearly half since 1990. And the world is on track to meet the MDG targets of reversing the incidence of malaria and tuberculosis.
Negotiations are under way on a new, more ambitious set of development goals for the next 15 years – the sustainable development goals (SDGs), which will be ratified at the UN in September. South Africa’s voice is crucial in these negotiations, both as a nation that has made significant progress since 2000 and in its role as the chair of the Group of 77, the largest political grouping of developing countries at the UN.
As these important discussions unfold, the millennium goals themselves remain an unfinished agenda. Infectious diseases such as HIV, tuberculosis and malaria still disproportionately affect the poorest people in developing countries. Major challenges remain in reducing hunger and malnutrition and reaching the poorest communities with proven health interventions.
But through the MDG experience, the global community has learned effective ways to provide poor people with the tools and knowledge they need to improve their lives. Crucially, we know that improving child, newborn and maternal health is a key driver of global development.
When mothers and children survive and thrive, entire communities prosper. To achieve lasting effects, we need specific, measurable targets for maternal and child health at the core of the SDGs.
Improving child healthThe astonishing progress of halving child mortality worldwide since 1990 has proven that tools such as vaccines that protect against deadly diseases are among the best investments we can make in global health. Many African countries, from Tanzania and Malawi to Ethiopia, have met the millennium goals target of a two-thirds reduction in under-five mortality – although South Africa has lagged behind, partly owing to the effect of HIV. But far too many children still lack access to vaccines and other life-saving interventions. As a result, 6.3-million children under the age of five died in 2013, many from preventable causes.
We can – and must – do better. The SDGs should challenge the global community to cut under-five child mortality in every country to no more than 2.5% by 2030.
Saving newborn livesSadly, progress in saving newborns has trailed behind overall reductions in under-five child mortality. Each year, nearly three million newborns die in their first month of life – a needless tragedy, because most of these deaths could be prevented with proven, low-cost solutions such as immediate and exclusive breastfeeding, umbilical cord care to prevent infection and skin-to-skin contact.
We have a global consensus on how to save more newborn lives – as reflected in initiatives such as the Every Newborn Action Plan laid out by the World Health Assembly in 2014.
The SDGs should spur intensified efforts by calling for a reduction in newborn mortality worldwide to 1.2% by 2030.
Improving maternal healthIt’s impossible to talk about the health of newborns without talking about the health of mothers. When a woman is healthy, she is more likely to have a healthy baby. By ensuring that women, especially those in rural areas, have the information and care they need to have healthy pregnancies and safer births, we can set them and their families on a better path.
One way to do this is by helping more women to give birth at a clinic or hospital under the care of a trained health worker.
We must also ensure that women have access to family-planning resources so they can plan and space their pregnancies. Consider this: if the world increased access to contraceptives to just a quarter of the women who now lack such access, we could prevent 25 000 mothers and 250 000 newborns from dying each year.
These and other interventions could reduce the global maternal mortality rate to less than 1% by 2030. This would be a reduction of more than two-thirds from today’s rate and an even more significant drop for sub-Saharan Africa, (including South Africa – see "Baby, mom deaths still too high" – Ed). Sub-Saharan Africa currently has the world’s highest rates of maternal mortality.
South Africa’s roleReaching these ambitious targets by 2030 will not be easy or inexpensive. But the global community is more co-ordinated, effective and committed than ever before.
Most critically, success will hinge on the political and financial commitments of developing countries – those with the most to gain from achieving the SDGs and the most to lose if we don’t seize this once-in-a-generation opportunity.
The Aids crisis will always stand as a reminder that, without strong government commitment, co-ordinated plans and broad international support, disease and denial can lead to tragic consequences.
South Africa has an opportunity to use its unique voice to ensure that the SDGs include clear goals and specific targets for infectious diseases and maternal, newborn and child health.
These are essential to accelerating improvements in the lives of the poorest people everywhere and building bright futures for the next generation of Africans.
Mark Suzman is president: global policy, advocacy and country programmes at the Bill & Melinda Gates Foundation. He is originally from South Africa
The deadline for countries to meet the millennium development goals (MDGs) is fast approaching and, according to the United Nations Development Programme, Africa "has made considerable improvements on the health-related MDGs" with maternal and child mortality going down by 47% and 44% respectively over the past two decades.
But the same cannot be said for South Africa. One of the goals was for the country to reduce child mortality to 20 deaths per 1 000 live births by 2015. According to South Africa’s latest MDG-progress report, the under-five mortality rate was 53 deaths per 1 000 live births in 2010.
South Africa also had to reduce maternal mortality to 38 deaths per 100 000 live births by the end of this year. In the country’s progress report, 269 deaths per 100 000 were recorded for 2010.
That is more than seven times the millennium goals target.
According to the report, the child and maternal deaths indicators increased significantly between 1998 to the mid-2000s. In 2007 child mortality reached a high of 104 per 1 000, nearly double what it was in 1998. Maternal mortality increased from 150 per 100 000 in 1998 to a high of 625 deaths per 100 000 in 2007.
A 2013 article published in the South African Journal of Obstetrics and Gynaecology states that, although there has been a significant reduction in HIV-related maternal deaths, deaths because of obstetric haemorrhage (bleeding) and hypertension complications remain "stubbornly high".
Although reports show varying figures for child and maternal mortality, the overall trend remains similar: after reaching record highs in the late 2000s, these rates in South Africa are on the decline. But this is not enough to meet the target set out in the millennium goals.– Ina Skosana
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