Sub-Saharan Africa and the health MDGs: the need to move beyond the “quick impact” model

• Published in: Reproductive health matters 2011-11, Vol.19 (38), p.42-55
• Main Authors: Richard, Fabienne, Hercot, David, Ouédraogo, Charlemagne, Delvaux, Thérèse, Samaké, Salif, van Olmen, Josefien, Conombo, Ghislaine, Hammonds, Rachel, Vandemoortele, Jan
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Africa South of the Sahara; Cesarean section; Cesarean Section - economics; Cesarean Section - utilization; Children; Collaboration; Contraception - utilization; Countries; Delivery of Health Care - economics; Diseases; Economics, Hospital; Features; Fees; Female; Financial Support; Funding; Goals; Health; Health care delivery; Health Care Services; Health Policy; Health Problems; Health services; health system strengthening; Humans; Internal Medicine; International cooperation; Intervention; Low Income Groups; Malaria; Middle Aged; Millennium Development Goals; Models, Organizational; Obstetrics and Gynecology; Poverty; Pregnancy; Psychoeducational intervention; Public health; Quality Indicators, Health Care; Quality of Health Care; quick impact interventions; Reproductive health; Reproductive Health Services; social determinants of health; Socioeconomic status; Sub-Saharan Africa; targets and indicators; Terminology; Time Factors; United Nations; Young Adult
• ISSN: 0968-8080; 1460-9576
• DOI: 10.1016/S0968-8080(11)38579-5

Abstract The Millennium Development Goals (MDGs) were defined in 2001, making poverty the central focus of the global political agenda. In response to MDG targets for health, new funding instruments called Global Health Initiatives were set up to target specific diseases, with an emphasis on “quick win” interventions, in order to show improvements by 2015. In 2005 the UN Millennium Project defined quick wins as simple, proven interventions with “very high potential short-term impact that can be immediately implemented”, in contrast to “other interventions which are more complicated and will take a decade of effort or have delayed benefits”. Although the terminology has evolved from “quick wins” to “quick impact initiatives” and then to “high impact interventions”, the short-termism of the approach remains. This paper examines the merits and limitations of MDG indicators for assessing progress and their relationship to quick impact interventions. It then assesses specific health interventions through both the lens of time and their integration into health care services, and examines the role of health systems strengthening in support of the MDGs. We argue that fast-track interventions promoted by donors and Global Health Initiatives need to be complemented by mid- and long-term strategies, cutting across specific health problems. Implementing the MDGs is more than a process of “money changing hands”. Combating poverty needs a radical overhaul of the partnership between rich and poor countries and between rich and poor people within countries.