乐鱼 体育

The global maternal health agenda has been largely defined by the  (MDGs) for the last decade and half, but what will happen after they expire in 2015? What kind of framework is needed to continue the momentum towards eliminating preventable maternal deaths and morbidities? 

For a panel of experts gathered at the 乐鱼 体育 on February 20, universal health coverage is a powerful mechanism that may be crucial to finishing the job.

Inequality Remains a Killer

There has been significant progress towards  鈥� reduce the global maternal mortality ratio by 75 percent between 1990 and 2015 and achieve universal access to reproductive health. But 鈥渨e still have challenges and the agenda is not finished,鈥� said Jacqueline Mahon of the .

There is persistent inequality in access to maternal health services and discrimination too, she said. The global maternal mortality rate has declined  since 1990, far below the MDG 5 goal, and an estimated  still die every day from preventable causes linked to pregnancy and childbirth, with  of those deaths occur in developing countries. Only  of women in developing countries give birth with a skilled attendant.

The most vulnerable are 鈥渨omen living in conflict situations, or women who are part of an ethnic minority, women living with disabilities,鈥� said Dr. Ana Langer, director of the . Poor women are more vulnerable in general. According to a recent  (ICPD), 150 million people each year suffer financial catastrophe and another 100 million fall under the poverty line as a result of out-of-pocket spending on health care. At least a billion people, caught in 鈥渄evelopment traps of bad governance, wasted natural resource wealth, lack of trading partners, or conflict,鈥� have been largely passed over by gains in health care.

These problems suggest a critical need to develop a new framework to take the place of the MDGs after 2015. There is  in different development sectors, but Langer suggested the model has been very helpful for maternal health. 鈥淭he fact that we had that very, very measurable, concrete goal, that it was embraced by the global community and also by governments, and that it also included concrete mechanisms to track progress and measure progress, it definitely helped to focus the global attention on maternal mortality,鈥� she said.

But for those pockets of poor service and underserved women that remain, what needs to change?

Can Universal Health Coverage Bridge the Gap?

A new , written by Langer alongside Dr. Jonathan Quick, president and CEO of , and Jonathan Jay, senior writer at Management Sciences for Health, makes the case for universal health coverage as a means to prevent vulnerable and marginalized populations from slipping through the cracks. 鈥淚n terms of women鈥檚 health, it鈥檚 the only approach that addresses all of women鈥檚 health needs,鈥� said Quick.

Universal health coverage makes it easier for families that otherwise couldn鈥檛 afford it to get essential primary care. It also promotes service integration, creating more pathways to the vital pre- and post-natal visits needed to ensure healthy pregnancy, delivery, and childhood.

鈥淭he key thing is to have a vision for universal health coverage and build your system around that vision,鈥� Quick said:

It鈥檚 about mobilizing resources and focusing them from all sources, domestic and international. It鈥檚 about using those financial resources to leverage health system improvements; it鈥檚 about providing protection against poverty. A mother shouldn鈥檛 go bankrupt because her child needs surgery but 100 million households 鈥� families 鈥� go bankrupt a year because of health expenses. And finally, it adapts to changing health needs.

According to Langer and Quick, universal health coverage programs address five critical factors: they provide an essential services package; give reliable, easy access to services; eliminate financial barriers; diminish social barriers; and provide performance indicators. 鈥淲henever you鈥檙e starting a major global movement on something, monitoring and the measuring is important,鈥� said Quick. 鈥淲hat gets measured is what gets done.鈥�

Universal health coverage programs have already shown positive impacts in several low-resource countries.

惭别虫颈肠辞鈥檚&苍产蝉辫; (鈥淧opular Health Insurance鈥�) was conceptualized after a study in the 1990s revealed that more than 50 percent of health-related expenditures in the country were paid for out of pocket, said Langer. The health package included 250 interventions covering expensive treatments for breast cancer, cervical cancer, and HIV/AIDS, and was funded by a budget designed to increase by one percent of the GDP a year. In addition, the government introduced a national center for gender equity for reproductive health to address and monitor pressing gender and access issues. Seguro Popular undergoes evaluations every year, to assure accuracy in health coverage, access, and health outcomes through extensive tracking mechanisms.

In , Quick said a package of essential primary care services implemented in 2003 by Dr. Suhaila Seddiqi, the minister of public health at the time, embodies the principles of universal health coverage. The package made a considerable difference in  (at the time, 9 out of 10 women delivered without a skilled birth attendant), providing training opportunities for hundreds of midwives and thousands of community health workers. In less than 10 years, access to primary health care increased from less than 10 percent to over 60 percent, Quick said, with 100,000 fewer infant deaths, double the prevalence of family planning, and a 50 percent reduction in maternal mortality.

An Unfinished Agenda

As the development community considers the post-2015 framework, universal health coverage programs could be an important way to reach marginalized women around the world, but it shouldn鈥檛 be the only health goal, said Langer. 鈥淲e as a community, have to be very smart to make sure that we don鈥檛 lose focus or traction on what we鈥檝e achieved in the last 15 years,鈥� she said, pointing out non-communicable diseases as an important emerging health issue that isn鈥檛 necessarily addressed by universal coverage.

Quick advocated for an integrated approach that uses universal health coverage to help focus on healthy life expectancy. He proposed combining MDG 5 (maternal health), MDG 4 (child health), and MDG 6 (HIV/AIDS and malaria) and introducing better measures of accountability. 鈥淵ou can鈥檛 achieve the unfinished agendas and deal with the chronic disease epidemic without an integrating platform that maximizes the financial resources and uses them to improve the health system,鈥� he said.

As world leaders finalize the next global development framework, the maternal health agenda should maintain a top priority. Although maternal mortality rates have declined over the past two decades, the overwhelming need to create a framework that reduces persistent inequalities and improves life expectancy remains.

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