The last 20 years or so have seen many shifts of emphasis in global health. Among them, two stand out: a concern that the poor do not get left behind in the rush to achieve global goals and a concern that health services are affordable.
However, these were not big issues in global health in the last century. In 1996, one of us (Timothy Grant Evans) launched the Global Health Equity Initiative while at the Rockefeller Foundation, in response to what we and others described as the “disturbing disparities” between rich and poor.
The vignette below was originally published in a new joint report from the World Bank, WHO and OECD, Delivering quality health services: A global imperative for universal health coverage.
Eight years ago, when she was diagnosed with rheumatoid arthritis, an autoimmune disease that causes inflammation, swelling and acute pain in the joints, Cecilia Rodriguez was Director of a primary health care facility. “I had very bad rheumatoid arthritis and spent a lot of time in bed,” says Rodriguez, who was in her thirties when she first experienced the painful symptoms. “I realized that what I had been promoting as a health administrator was very different from what I needed as a patient.”
Making the case for increasing the national budget allocation to the health sector is critical if more domestic resources are to be garnered for financing universal health coverage. Yet, there are competing priorities for more allocation for other sectors. While political will remains pivotal to decisions on national priorities, against limited resources, fiscal managers- such as ministries of finance or treasury- have a challenging job translating national priorities into budget allocations for sectors.
What is there not to like about the Sustainable Development Goals? The 17 goals and 169 targets are nothing if not a smorgasbord of worthy ambition. But the sheer breadth and scope of the SDGs, allied to the 2030 target date, can make it difficult for governments to prioritise. It can also make it difficult for citizens to hold their governments to account. Cynics might suggest that’s why so many governments signed up for an SDG pledge that few of them have any intention of delivering.
For those of us who are more interested in achieving change than indulging in cynicism, the challenge is to identify pathways for translating rhetorical commitments into practical outcomes. If I had to select just one morsel of accountability from the SDG feast it would be this sentence tucked away in the preamble: “We wish to see the Goals and targets met…. for all segments of society. And we will endeavour to reach the furthest behind first.”
It’s tough to think of a more elevated test of fairness. The SDGs establish bold targets for eliminating extreme deprivation. But they also signal an intent to combine national progress towards those targets with ‘social convergence’, or a decline in the disparities separating the most marginalised from the rest of society. This is a marked departure from Millennium Development Goals (MDGs), which focused attention on national average progress. As the findings from an excellent 2015 paper by Adam Wagstaff and Caryn Bredenkamp noted national progress in child survival and nutrition masked widening inequalities in a majority of countries, notably in sub-Saharan Africa.