Introduction

From 06 to 09 of December the World Family Organization and the Chinese Government in partnership with the United Nations will hold the World Family Summit in Sanya, Hainan Province, China. The main purpose of the World Family Summit is to promote the Family’s contribution to the implementation of the Millennium Development Goals following a multi-stakeholder approach and a better and common understanding of the MDGs and the role of Family in contributing to their implementation through an enhanced learning, dialogue and action process.

In order to prepare WFO members and participants in general, to the discussions and the outcome recomendations, the background papers positions based on the work of the Millennium Project is available for consultation and download as well as comments to the Millennium Project Task Forces as well as to WFO.

The Millennium Project is the independent advisory body to United Nations Secretary-General Kofi Annan that is commissioned with recommending, by June 2005, operational strategies for meeting the Millennium Development Goals (MDGs). This includes reviewing current innovative practices, prioritizing policy reforms, identifying frameworks for policy implementation, and evaluating financing options. The Project’s ultimate objective is to help ensure that all developing countries meet the MDGs.

As a United Nations-sponsored initiative, the Millennium Project proceeds under the overall guidance of the Secretary-General and United Nations Development Programme (UNDP) Administrator Mark Malloch Brown in his capacity as chair of the United Nations Development Group (UNDG). Professor Jeffrey Sachs directs the Project, which brings together the expertise of world-class scholars in both developed and developing countries, United Nations agencies, and public, non-governmental, and private-sector institutions. Ten Task Forces carry out the bulk of the Millennium Project’s analytical work with support from a small secretariat based at UNDP headquarters in New York.

Additional information on the Millennium Project is available on its website at
www.unmillenniumproject.org

Table of Contents
1. INTRODUCTION ........................................................................... 7

2. OVERVIEW: GLOBAL HEALTH PICTURE AND GLOBAL HEALTH POLICY ..... 15

2.1 Global health picture – child health and maternal health ................... 15
2.2 Evolution of global health policy and impact on health systems ......... 19

3. THE MILLENNIUM DEVELOPMENT GOALS ......................................... 29

4.EPIDEMIOLOGICAL PICTURE:PREVALENCE,DISTRIBUTION AND KEY INTERVENTIONS 31

4.1 Child health. ........................................................................... 31
4.1.1 The Context .........................................................................31
4.2 Maternal health....................................................................... 39
4.2.1 The context of sexual and reproductive health and rights ..............39
4.2.2 The epidemiological profile ...................................................... 42
4.2.3 Health sector interventions for sexual and reproductive health....... 45
4.2.4 Maternal mortality and morbidity .............................................. 49

5. HEALTH SYSTEMS ......................................................................62

5.1 Defining health systems .............................................................62
5.2 What is lacking in approaches to scaling up? ..................................63
5.2.1 Individual interactions/organizational cultures: implications
....... for utilization .........................................................................64
5.2.2 Institutional arrangements ........................................................68
5.2.3 Taking redistribution seriously ...................................................69
5.3 Rebuilding health systems: operational issues................................. 71
5.3.1 District health system .............................................................71
5.3.2 Policy and Legal Barriers ..........................................................73
5.3.3 Drug supply and essential medicines ...........................................73
5.3.4 Human resources ....................................................................73
5.3.5 Management competency .........................................................74
5.3.6 Issues in service integration: child health, maternal health,
....... reproductive healtand communicable diseases ..............................74
5.4 Financing health services ............................................................75
5.5 Health impact statement .............................................................76

6. HUMAN RESOURCES .....................................................................77

6.1 A brief synopsis of the status quo ................................................77
6.2 Toward a global workforce strategy ..............................................78
6.2.1 Community level health workers for primary health care ..................79
6.2.2 “Upskilling” (Delegation)............................................................ 81
6.2.3 Long-term planning to create a cadre of skilled midwives ................83
6.2.4 Management Capacity as an aspect of human resources ................83
6.2.5 Gender issues in human resources for health ................................85
6.2.6 Global policies and strategies ....................................................85

7. TARGETS AND INDICATORS: ADAPTING THE MDGS ........................... 88

7.1 What lies behind the averages?: monitoring equity ......................... 88
7.2 Health systems ........................................................................ 89
7.3 Sexual and reproductive health and rights...................................... 90
7.4 Maternal mortality ..................................................................... 91
7.5 Child health, neonatal mortality and nutrition ...................................92
7.6 Vital registration ........................................................................93

8. POWER-MAPPING ........................................................................94

8.1 Mechanisms – global architecture ................................................94
8.1.1 Introduction .........................................................................94
8.1.2 Where and how are the MDGs being implemented? .......................94
8.1.3 Poverty Reduction Strategies: A brief overview ...........................95
8.1.4 Poverty and Social Impact Analysis (PSIA) .................................96
8.1.5 MTEF- Medium Term Expenditure Frameworks (and SWAPs) ...........97
8.1.6 PRSPs and Health, Health Systems and Equity? ...........................98
8.1.7 Trading Outside the New Poverty Paradigm ................................101
8.1.8 Global Fund and Public-Private Partnerships ................................102

9. CONCLUSION AND RECOMMENDATIONS ..........................................103

10. REFERENCES ...........................................................................106

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