Public Health: Achievements in MDGs and Way Forward to SDGs

The deadline to achieve the millennium development goals (MDGs) expired in 2015. Out of the total 10 health targets, India was able to achieve or get close to achieve only four targets. As per WHO’s annual World Health Statistics for 2015, these four targets are as follows:

• Target 4-A: Reduce under-five mortality rate by two thirds. India was able to achieve 58% reduction in under-five mortality rate between 1990 and 2013.
• Target 5-A: Reduce maternal mortality rate by three quarters. India was able to achieve 66% reduction in maternal mortality between 1990 and 2013.
• Target 6-A: halt and reverse the spread of HIV/AIDS. India was able to achieve 57% reduction in HIV incidence between 2001 and 2013.
• Target 6-C: Halt and reverse incidence of malaria and other major diseases: India was able to achieve 50% reduction in mortality rate of tuberculosis between 1990-2013.

India either made no substantial progress or made little progress in Target 5-B (achieve universal access to reproductive health); Target 7-A (halve proportion of population without substantial access to safe drinking water and basic sanitation). In summary, India was able to reach near the MDG with respect to maternal and child survival.

Shortcomings of MDGs

Year 2016 marks the end of MDG era and paves way for Sustainable Development Goals (SDGs) that the world would strive to achieve in next 15 years. The lessons learnt through MDGs are as follows:

Firstly, the MDGs received high level political commitment nationally and globally. Needless to say, similar kind of commitment should be there for SDGs. Secondly, while MDGs helped to improve overall health of the countries, focus was on aggregate targets ignoring the inequalities between the countries. Thirdly, MDGs did not capture the economic benefits of good health and direct consequences of ill-health. When people fall sick, there is high out of pocket expenditure on healthcare which has direct consequences for national economy. Fourthly, MDGs did not capture the prevention, early detection and response to NCDs (Non-communicable Diseases) as well as epidemics such as SARS, Ebola, Zika, MERS etc.

Public Health: MDGs versus SDGs

Unlike MDGs which had three dedicated health goals, SDG agenda has only one health goal {SDG-3} which aims to “ensure healthy lives and promote well-being for all in all ages”. Under this goal, there are 13 broad targets that not only take unfinished agenda of MDGs but also take into consideration the current epidemiological incidences. It counts in NCDs, ill-effects of environmental hazards and epidemics. Further, this target is also linked to several other SDGs such as poverty, gender equality, education, food security, water sanitation etc.

What should be done to achieve SDG-3?

The single SDG-3 goal envisions that no one is left. It provides scope to bring health at centre of economic growth agenda. It can also serve as an anchor to implement the Universal health Coverage (UHC) in the country. Further, following are the key policy suggestions to achieve SGD-5:

Firstly, since both the national and state governments should put health on top priority and as a cornerstone of economic agenda. The proposal of draft National Health Policy, 2015 to raise public expenditure on public health from current 1% to 2.5% of GDP needs strong political commitments and efforts. Secondly, The country should fight with more vigour to eliminate / reduce neglected tropical diseases (NTDs), Malaria, Tuberculosis, NCDs etc. The programmes and interventions need to be taken on a wide scale but at grassroots level. Thirdly, the government should make all efforts to implement the universal health coverage. It will help to prevent people from slipping into poverty due to out of pocket expenditure on illness. Fourthly, the state and central governments need to build robust rural health system. India’s public health infrastructure in rural areas is in tatters not only due to fund shortages but also due to wide scale corruption in rural public health. Thus, there is a need to develop strong system for monitoring, evaluation and accountability.