DESA News Vol. 13, No. 07 July 2009


Global health challenges and their impact on developmentGlobal health challenges and their impact on development

The 2009 Annual Ministerial Review, to be held during the high-level segment of the annual session of the Economic and Social Council (6-9 July, Geneva), will focus on “Implementing the internationally agreed goals and commitments in regard to global public health”.

The Annual Ministerial Review (AMR) is a new function of the United Nations Economic and Social Council (ECOSOC), mandated by the 2005 World Summit. AMR was established to assess progress in achieving the internationally agreed development goals arising out of the major United Nations conferences and summits since the 1990s, and to contribute to scaling-up and accelerating action to realize the United Nations development agenda.

The AMR session consists of three main elements: A global review of the United Nations development agenda, a thematic review, and a series of national voluntary presentations of both developing and developed countries on their progress in implementing internationally agreed development goals, including the Millennium Development Goals (MDGs).

Meeting the Millennium Development Goals

Health is at the heart of the MDGs. It is the specific subject of three goals — to reduce child mortality, to improve maternal health and to combat HIV/AIDS, Malaria and other diseases by the 2015 deadline.

But more importantly, health is a critical precondition for progress on most of them. Poverty cannot be reduced without addressing the issues concerning health as diseases lead people to fall below the poverty level. Evidence shows that during the financial and economic crisis the international community should focus on health as investment, and that investing in people’s lives is the best way to prevent crisis and ensure sustainability. Without sound health systems, MDGs in other areas could not be achieved.

The 2008 MDG report shows that strong national policies with global initiatives have helped to make great progress on health-related MDGs. The number of deaths from AIDS fell from 2.2 million in 2005 to 2.0 million in 2007, and the number of people newly infected declined from 3.0 million in 2001 to 2.7 million in 2007. At present, the number of HIV/AIDS affected people has remained steady with an average of 1 per cent of the world population, and most of the African countries are at or lower than the 1% threshold. The same progress could be seen for deaths and preventions related to malaria, tuberculosis and measles.

As countries have become richer, child mortality rates have decreased considerably. However, the MDG report also found that, about-one quarter of all children in developing countries are still underweight and are at risk of having a future blighted by the long-term effects of undernourishment. More than 500,000 prospective mothers in developing countries die annually in childbirth or of complications from pregnancy.

As the 2015 deadline approaches, it has become apparent that the MDGs can only be achieved if the focus on specific diseases is complemented with a strengthening of the overall health systems and if health concerns are included in an overall development strategy. Hence, the AMR process does not only addresses the progress on the health MDGs but also aims at evaluating the advances in tackling health-system constraints and in mainstreaming health into national development strategies.

Strengthening health systems

Without immediate improvements and long-term commitments to make health systems functioning, accessible and affordable, the health MDGs will be difficult to achieve. The Secretary-General has made the need to strengthen health systems as a priority for his tenure, expressing that efforts to address the human resources crisis and to protect the poor from catastrophic out-of-pocket health expenditures are particularly important.

There is much to learn from the initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Global Alliance for Vaccines and Immunization and the United States President’s Emergency Plan for AIDS Relief, among others. Their focus on a specific disease is complementary and includes efforts to ensure well-managed, adequately staffed and well-equipped health systems with the capacity for delivering prevention and care interventions. The challenge is to scale up and strengthen services for health in a coherent manner beyond these initiatives.

One of the main challenges that health systems across the world face is the health workforce crisis. Health-worker international migration has been increasing worldwide over the past decades, especially from lower-income countries, whose health systems are already very fragile. Actions are needed in the host country and in the home country of skilled health professionals. Predictable, sustained and increasing resource flows can help home governments to adequately equip and retain their health workforce. It is also vital to support countries in solid planning, management and deployment for competent and motivated health workers, including a considerable scale-up in education and training acilities.

A comprehensive approach is needed for the recruitment, training, support and retention of all levels of health workers. Much more attention should be dedicated to support the work of community health workers, whose role is particularly critical in ensuring service delivery to the most vulnerable.

Noncommunicable diseases

In addition to the challenges addressed in the MDGs, issues related to noncommunicable diseases (NCDs) are also emerging. The human and financial cost of NCDs is great, and governments need to develop new, or strengthen existing programmes to prevent and control NCDs as part of their national health policy and broader development frameworks.

We also need to ensure that provision of health care for NCDs is dealt with in the context of overall health system strengthening, with a special focus on primary health care. This requires investments in building national capacities to develop, implement and evaluate evidence-based policies and plans, as well as investments to strengthen human resources and promote intersectoral actions.

Governments should put NCDs and mental health on the global health and development agendas, considering inter-linkages with poverty and MDGs, while providing a platform to connect policy-makers, researchers, health promoters, educators, and parents to exchange up-to-date science and best practices for the prevention and control of NCDs.

The growing NCD crisis in developing countries requires the creation of national NCD prevention and control plans to reduce modifiable risk factors, enabling health systems to respond more effectively and equitably to people with NCDs; promote early detection of breast and cervical cancers, diabetes, hypertension and other cardiovascular risk factors; help people with NCDs to manage their own conditions better; and improve access to affordable essential medicines, including for pain relief and palliative care.

Countries emerging from conflicts

During times of crisis inequities in health increase, requiring special efforts to meet the needs of the poorest and most vulnerable. The situation is worse for countries in, or emerging from, conflict or those that have experiences in natural disasters.

As evidence showed, these countries are farthest from reaching the MDGs because of their lack of progress in health. Political violence and conflict generate health risks in the short run, but the most devastating is the impact of the conflict on health, especially on mental health. Serious interruptions or the collapse of health-care systems also prevent access to basic health care, and attempts to accelerate past achievements in the health-related MDGs may be hampered by the loss of capacity and near collapse of the public health system.

Public health is the key in peacebuilding efforts to ensure long-term peace and sustainable development, and it provides a strong peace dividend in the aftermath of conflict. While health initiatives alone could not lead to the consolidation of peace, providing health care to populations living in war-torn areas is one way to strengthen reconciliation. Early integration of public health into peacebuilding strategies and programs is critical in order to ensure the continuation of efforts towards recovery and long-term development.

Impact of the financial crisis

The economic crisis is putting multiple pressures on people. Unemployment means loss of health insurance coverage for many people while a fall in remittances can contribute to indebtedness. Imported medicine also becomes unaffordable with local currencies devalued. In such cases, treatment may be deferred for some and not sought at all by others. As incomes fall, people turn to public sector services, at the very time that government venues to finance them are under greatest pressure. Many high-income countries with ageing populations are facing additional pressures with an anticipated increase in spending on health and pensions. Unless extra efforts are made to sustain funding for public services, their quality and availability will fall. This places the most vulnerable groups at risk of being excluded from care.

To overcome the health challenges during economic downturn, several countries intend to increase public funding for health and increase coverage of vulnerable groups (e.g. Eastern Europe), while some developing countries are in a better fiscal position than in previous crises and many donors have committed to maintain levels of aid. However, further actions need to be taken. It is impetrative to increase investment in health and social sectors and building on past success. This is not only to promote economic recovery, but also to protect the poor, to promote social stability and security and to generate efficiency.

In this time of crisis, all Government and political leaders must maintain their efforts to strengthen and improve the performance of their health system, protect the health of the people around the world, and in particular of those who are most fragile.

The road ahead

Global partnerships are required in order to overcome the current and future health challenges. Political leadership at the highest levels can make the greatest difference in galvanizing global and national efforts to promote and protect health, reduce inequities in health outcomes and access to services, and to achieve the MDGs. For this reason, world leaders should call for joint action on strengthening health systems through primary health care to advance the goal of universal access to health services, promoting health as an outcome of all policies and greater coherence, building and strengthening partnerships, and sustaining and enhancing financing for health and development.

The scientific knowledge and availability of technology for saving lives is stronger than ever. We now know how to cure basic diseases and decrease suffering and we have had a successful decade in improving health. As Mr. Jomo Kwame Sundaram, ASG for Economic Development of DESA said at the opening session of the global preparatory meeting for the 2009 AMR on 31 March:

“Ultimately, progress towards improving health indicators, including achieving the health-related MDGs, will depend on public health provisioning, and hence political will and public health resources… There is also an urgent need to ensure sustainable development by limiting financial instability and enhancing macroeconomic stability.”

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Annual awards for innovative public servicesAnnual awards for innovative public services

In recognition of the impact that public services can have on the day-to-day lives of citizens, the UN presented its annual Public Service Awards to innovative programmes on UN Public Service Day on 23 June in New York

2009 Awards Ceremony

This year, 8 winners and 4 finalists were presented with the most prestigious international recognition of excellence in public service. United Nations Secretary-General Ban Ki-moon made welcoming remarks, and handed out the awards at the annual ceremony for the first time together with Under-Secretary-General for Economic and Social Affairs Sha Zukang.

The winners were awarded in four categories, including a new category on knowledge management. They represent public servants who have excelled in their home countries in enhancing transparency, accountability and responsiveness in the public service; improving the delivery of services; fostering participation in policy-making decisions through innovative mechanisms; and advancing knowledge management in government.

Among the winners of the 2009 United Nations Public Service Awards are an electronic water quality service that allows citizens of Seoul (Republic of Korea) to access up-to-date information on the quality of water supplied to their homes; a mobile community clinic in Zambia providing counseling, training and essential basic health services at the district level; and an initiative in Slovenia that reduced the registration time for companies from 60 days to just three. Nine other programmes from Canada, Egypt, India, Oman, Poland, South Africa, Sweden and Thailand were also recognized.

The Centre for Public Service Innovation in South Africa (CPSI), the Shanghai-based Regional Cooperation Office for City Informatization (RCOCI) and the Institute of Public Administration in Central America (IPAC) were recognized with the Special Award for the United Nations Public Administration Network (UNPAN) Member Excellence for Knowledge Sharing. The award celebrates the achievements of network members in advancing knowledge-sharing through the use of information and communications technology to advance the Millennium Development Goals and other internationally agreed development targets.

Following the opening ceremony, a special session on “Celebrating Public Service from around the World” was held in the morning. High‐level government officials, including several ministers, representing the various regions of the world spoke about the critical role of governance and public administration in overcoming emerging challenges, as well as the importance of recognizing and rewarding excellence in the public service. The ceremony ended with cultural performances in honor of the winners. An art exhibition and expert group meeting were also held for the occasion.

The event this year attracted great interest from the media and saw over 400 participants from around the world, including dignitaries, innovative leaders, as well as Ambassadors and delegates from 192 Permanent Missions to the United Nations.

United Nations Public Service Awards

The United Nations General Assembly proclaimed 23 June as United Nations Public Service Day in 2003, and at the same time the Economic and Social Council established the United Nations Public Service Awards to celebrate the value and virtue of servicing citizens.

The United Nations Millennium Declaration emphasized the role of democratic and participatory governance in assuring the basic rights of men and women, as well as the idea that good governance within each country is a prerequisite to “making development a reality for everyone and to freeing the entire human race from want”. Without good governance, nationally or internationally, and an efficient, competent, professional, responsive and highly dedicated public service, sustainable development and livelihood are jeopardized. The Secretary‐General, in his speech at the World Youth Forum in 1998, stressed the importance of public service by encouraging the world’s youth to enter into this field:

“In this changing world of new challenges, we need, more than ever before, dedicated and talented individuals to enter public service. More than ever before, we need people like you sitting here today, to make the choice of service to humankind.”

To recruit and retain its share of top talent, develop innovative practices and enhance its efficiency and effectiveness, public service must be visible. Also, the United Nations’ guiding principles, which revolve around public interest, eradication of poverty, equity, individual rights and working ethics, including transparency, accountability and efficiency, must be conveyed to the public.

Therefore, the United Nations Public Service Awards, as the most prestigious international recognition of excellence in public service, rewards the creative achievements and contributions of public service institutions to a more effective and responsive public administration in countries worldwide. Through an annual competition, the UN Public Service Awards promotes the role, professionalism and visibility of public service. Since the first Awards Ceremony in 2003, the United Nations has received an increasing number of submissions from all around the world.

The competition is open to all public organizations and agencies at the national or sub-national level, as well as public-private partnerships. Awards are given in three categories: improving transparency, accountability and responsiveness in the public service; improving the delivery of services; and fostering participation in policy-making decisions through innovative mechanisms.

Organizations performing outsourced public service functions are eligible for nomination. The United Nations Public Service Awards Programme takes into consideration a geographical distribution of five regions. In order to level the playing field for nominations received from countries with varying levels of development and income, five regions were established: Africa, Asia and the Pacific, Europe and North America, Latin America and the Caribbean and Western Asia.

The 2010 United Nations Public Service Awards competition will start accepting nominations in the fall of this year.

For webcast, picture, success stories and other updates:

UN financial and economic summit adopts outcome document

UN financial and economic summit adopts outcome document

General Assembly President Miguel d’Escoto Brockmann said at a briefing following the UN Conference on the World Financial Crisis and Its Impact on Development on 24-26 June in New York that the agreed outcome was a “recognition of the fact that the G-192 is the proper venue to discuss world financial and economic matters”. This document “represents the first step in a long process of putting the world on a new path towards solidarity, stability and sustainability”.

Video: (28 minutes)
Outcome document:
Conference website: