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Concept: International development

171

Monitoring development indicators has become a central interest of international agencies and countries for tracking progress towards the Millennium Development Goals. In this review, which also provides an introduction to a collection of articles, we describe the methodology used by the United Nations Inter-agency Group for Child Mortality Estimation to track country-specific changes in the key indicator for Millennium Development Goal 4 (MDG 4), the decline of the under-five mortality rate (the probability of dying between birth and age five, also denoted in the literature as U5MR and (5)q(0)). We review how relevant data from civil registration, sample registration, population censuses, and household surveys are compiled and assessed for United Nations member states, and how time series regression models are fitted to all points of acceptable quality to establish the trends in U5MR from which infant and neonatal mortality rates are generally derived. The application of this methodology indicates that, between 1990 and 2010, the global U5MR fell from 88 to 57 deaths per 1,000 live births, and the annual number of under-five deaths fell from 12.0 to 7.6 million. Although the annual rate of reduction in the U5MR accelerated from 1.9% for the period 1990-2000 to 2.5% for the period 2000-2010, it remains well below the 4.4% annual rate of reduction required to achieve the MDG 4 goal of a two-thirds reduction in U5MR from its 1990 value by 2015. Thus, despite progress in reducing child mortality worldwide, and an encouraging increase in the pace of decline over the last two decades, MDG 4 will not be met without greatly increasing efforts to reduce child deaths.

Concepts: Death, Malaria, Demography, United Nations, Millennium Development Goals, Child mortality, Maternal health, International development

38

One of the United Nations' Millennium Development Goals of 2000 was to reduce maternal mortality by 75% in 15 y; however, this challenge was not met by many industrialized countries. As average maternal age continues to rise in these countries, associated potentially life-threatening severe maternal morbidity has been understudied. Our primary objective was to examine the associations between maternal age and severe maternal morbidities. The secondary objective was to compare these associations with those for adverse fetal/infant outcomes.

Concepts: Cohort study, Maternal death, United Nations, Millennium Development Goals, International development, 2005 World Summit, United Nations Millennium Declaration, United Nations General Assembly

33

Representatives of national governments are now coming together to set the next development agenda, under the umbrella of the Sustainable Development Goals (SDGs), as the era of the Millennium Development Goals (MDG) concludes. In order to attain the new goals, it may help to revisit what worked - and what didn’t - in achieving the successes of the MDGs over the past 15 years. In 2000, a total of 189 heads of state signed the Millennium Declaration establishing eight development goals for 2000 through 2015. Within these eight goals, 21 targets were identified, and a monitoring framework with 48 indicators . . .

Concepts: United Nations, Millennium Development Goals, International development, 2005 World Summit, United Nations Millennium Declaration, Sustainable development

13

Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success.

Concepts: World Bank, United Nations, Millennium Development Goals, Child mortality, Maternal health, International development, African Development Bank, Poverty reduction

11

The Sustainable Development Goals (SDGs), to be committed to by Heads of State at the upcoming 2015 United Nations General Assembly, have set much higher and more ambitious health-related goals and targets than did the Millennium Development Goals (MDGs). The main challenge among MDG off-track countries is the failure to provide and sustain financial access to quality services by communities, especially the poor. Universal health coverage (UHC), one of the SDG health targets indispensable to achieving an improved level and distribution of health, requires a significant increase in government investment in strengthening primary healthcare - the close-to-client service which can result in equitable access. Given the trend of increased fiscal capacity in most developing countries, aiming at long-term progress toward UHC is feasible, if there is political commitment and if focused, effective policies are in place. Trends in high income countries, including an aging population which increases demand for health workers, continue to trigger international migration of health personnel from low and middle income countries. The inspirational SDGs must be matched with redoubled government efforts to strengthen health delivery systems, produce and retain more and relevant health workers, and progressively realize UHC.

Concepts: Biodiversity, United Nations, Millennium Development Goals, Maternal health, International development, United Nations General Assembly, Sustainable development, Poverty reduction

11

Achievement of Millennium Development Goal (MDG) 4 for child survival requires acceleration of gains in newborn survival, and current trends in improving maternal health will also fall short of reaching MDG 5 without more strategic actions. We present a Maternal Newborn and Child Health (MNCH) strategy for accelerating progress on MDGs 4 and 5, sustaining the gains beyond 2015, and further bringing down maternal and child mortality by two thirds by 2030.

Concepts: Maternal death, United Nations, Millennium Development Goals, Child mortality, Maternal health, International development, African Development Bank, Poverty reduction

10

Cost-effectiveness rankings of health interventions are useful inputs for national healthcare planning and budgeting. Previous comprehensive rankings for low- and middle- income countries were undertaken in 2005 and 2006, accompanying the development of strategies for the Millennium Development Goals. We update the rankings using studies published since 2000, as strategies are being considered for the Sustainable Development Goals.

Concepts: Biodiversity, United Nations, Millennium Development Goals, International development, Sustainable development, African Development Bank, Agenda 21

10

The Expanded Programme on Immunisation (EPI) is one of the most powerful and cost-effective public health programmes to improve child survival. We assessed challenges and enablers for the programme in South Africa, as we approach the 2015 deadline for the Millennium Development Goals.

Concepts: Malaria, United Nations, Millennium Development Goals, Child mortality, International development, African Development Bank

9

Conservation and development are intricately linked. The international donor community has long provided aid to tropical countries in an effort to alleviate poverty and conserve biodiversity. While hundreds of millions of $ have been invested in over 500 environmental-based projects in Madagascar during the period covered by a series of National Environmental Action Plans (1993-2008) and the protected areas network has expanded threefold, deforestation remains unchecked and none of the eight Millennium Development Goals (MDGs) established for 2000-2015 were likely be met. Efforts to achieve sustainable development had failed to reduce poverty or deliver progress toward any of the MDGs. Cross-sectorial policy adjustments are needed that (i) enable and catalyze Madagascar’s capacities rather than deepening dependency on external actors such as the World Bank, the International Monetary Fund and donor countries, and that (ii) deliver improvements to the livelihoods and wellbeing of the country’s rural poor.

Concepts: Biodiversity, Poverty, World Bank, United Nations, Millennium Development Goals, International development, Sustainable development, Poverty reduction

9

In two years, the uncompleted tasks of the Millennium Development Goals will be merged with the agenda articulated in the 2012 United Nations Conference on Sustainable Development. This process will seek to integrate economic development (including the elimination of extreme poverty), social inclusion, environmental sustainability, and good governance into a combined sustainable development agenda. The first phase of consultation for the post-2015 Sustainable Development Goals reached completion in the May 2013 report to the Secretary-General of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda. Health did well out of the Millennium Development Goal (MDG) process, but the global context and framing of the new agenda is substantially different, and health advocates cannot automatically assume the same prominence. This paper argues that to remain central to continuing negotiations and the future implementation, four strategic shifts are urgently required. Advocates need to reframe health from the poverty reduction focus of the MDGs to embrace the social sustainability paradigm that underpins the new goals. Second, health advocates need to speak-and listen-to the whole sustainable development agenda, and assert health in every theme and every relevant policy, something that is not yet happening in current thematic debates. Third, we need to construct goals that will be truly “universal”, that will engage every nation-a significant re-orientation from the focus on low-income countries of the MDGs. And finally, health advocates need to overtly explore what global governance structures will be needed to finance and implement these universal Sustainable Development Goals.

Concepts: Biodiversity, Poverty, United Nations, Millennium Development Goals, International development, Sustainable development, Poverty reduction, Extreme poverty