The Progress of MDGs on Health inAfrica

The Millennium Development Goals (MDGs) Report 2010 was prepared by the United Nations at the occasion of theSummitto Review the Progress made by the MDGs all over the world. The report presents the current situation of the different countries and regions regarding each Goal and Target.


We have chosen from the report what regards Africaand to the three goals related to health. Though there has been progress in some of them, in others there is still a long way to go to reach the target. Under five mortality rates have dropped from 184/1000 in 1990 to 144/1000 in 2008. In malaria there has been a great progress, while a great number of HIV/AIDs patients in the continent are being treated with ARV. Some countries like Mali, Senegal and Togo are believed to be able to reach the target on HIV/AIDs. But a number of challenges remain. Maternal health poses a significant challenge, with a very small growth in the proportion of deliveries attended by skilled personnel from 1990 to 2008. Sanitation represents another area of difficulty, with a great number of people lacking access to improved sanitation facilities and this is a health risk and one of the causes of the elevated infant mortality in Africa.


Goal 4: Reduce child mortality


In Sub-SaharanAfricachild deaths are falling, but not quickly enough to reach the target. Per 1,000 live births in 2008, 144 children died in Sub-SaharanAfricawhile only 12 died in the Commonwealth countries. While the greatest advances were made inNorthernAfrica, the highest rates of child mortality continue to be found in SSA. In 2008, one in seven children there died before their fifth birthday; the highest levels were in Western andCentralAfrica, where one in six children died before age five (169 deaths per 1,000 live births). All 34 countries with under-five mortality rates exceeding 100 per 1,000 live births in 2008 are in sub-SaharanAfrica, exceptAfghanistan. Although under-five mortality in sub-SaharanAfricahas declined by 22% since 1990, the rate of improvement is insufficient to meet the target.


Furthermore, high levels of fertility, combined with a still large percentage of under-five deaths, have resulted in an increase in the absolute number of children who have died -from 4.0 million in 1990 to 4.4 million in 2008. Sub-SaharanAfricaaccounted for half of the 8.8 million deaths in children under five worldwide in 2008. Vaccines have contributed greatly to diminish under-five deaths. 55% of children 12-23 months old received at least one dose of measles vaccine in 2000, while 72% received it in 2008. InNorthernAfricawhile 93% received it in 2000, only 92% did it in 2008.


Goal 5: Improve maternal health


Giving birth is especially risky in sub-SaharanAfrica, where most women deliver without skilled care. The proportion of women in developing countries who received skilled assistance during delivery rose from 41% in 1990, to 46% in 2008. This means less than half the women giving birth are attended by skilled health personnel. But great progress was made inNorthernAfricawhere the number of attended births rose from 46% in 1990 to 80% in 2008.


The rural-urban gap in skilled care during childbirth between has narrowed in SSA. While for every rural woman having skilled care there were 2.3 urban women in 1990 it has gone down to 2.2 urban women in 2008. The gap has narrowed even more inNorthernAfricawhere it has passed from 2.5% in 1990 to 1.3% in 2008. This means that more rural women are receiving skilled assistance during delivery, reducing long-standing disparities between urban and rural areas. Still, inequalities persist, especially in sub-SaharanAfricawhere attendance by skilled personnel is lowest and maternal mortality highest.


Serious disparities in coverage are also found between the wealthiest and the poorest households. The widest gaps are in sub-SaharanAfrica, where the wealthiest women are three times more likely, than the poorest women to be attended by trained health-care workers at delivery.


Today in Sub-SaharanAfricamore pregnant women are receiving antenatal care by skilled health-care personnel. The proportion has raised from 48% in 1990 at 70% in 2008. Remarkable gains were recorded inNorthernAfrica, where the share of women who saw a skilled health worker at least once during pregnancy increased from 46% in 1990 at 78% in 2008.


Disparities in the share of women receiving antenatal care by wealth are striking in NorthernAfricaand sub-SaharanAfrica. Though the number of poor women are attended at antenatal care in Northern and Sub-SaharanAfricanearly the same (54% and 55%), the proportion of the richest is of 88% in SSA and of 92% inNorthernAfrica.


Large disparities also exist between women living in rural and urban areas, although the gap narrowed between 1990 and 2008. In sub-SaharanAfrica, the proportion of urban women who received antenatal care at least once increased from 84% in 1990 to 89% in 2008.


The proportion of women attended four or more times during pregnancy differs in rural and urban areas of residence. Thus inNorthernAfrica, between 2003 and 2008, while only 49% of rural women were attended, 70% of urban women did. In Sub-SaharanAfricavaried from 37% of rural women attended against 63% of urban women.


Progress has stalled in reducing the number of teenage pregnancies, putting more young mothers at risk. The highest birth rate among adolescents is found in sub-SaharanAfrica, where number of births per 1,000 women aged 15-19, in 1990 was of 124, while in 2000 was of 119 and in 2007 of 121 women. InNorthernAfricathe numbers varied from 43 women in 1990, to 31 women in 2000 and the same number of 31 women in 2007.


Adolescents, in general, face greater obstacles than adult women in accessing reproductive health services. Poverty and lack of education perpetuate high adolescent birth rates.


The proportion of women in SSA who are using any method of contraception among women aged 15-49, married or in union, was of 12% in1990, 20% in 2000 and 22% in 2007. In several Sub-SaharanAfricacountries, traditional methods of contraception are still widely used. The unmet need for family planning remains high in SSA, where one in four women aged 15 to 49 who are married or in union and have expressed the desire to use contraceptives do not have access to them.


Surveys conducted in 22 countries in sub-SaharanAfricashow that contraceptive use to avoid or delay pregnancy is lowest among rural women, among women with no schooling and among those living in the poorest households.



Goal 6: Combat HIV/AIDS, malaria, and other diseases




The spread of HIV appears to have stabilized in most regions, and more people are surviving longer. Sub-SaharanAfricaremains the most heavily affected region, accounting for 72% of all new HIV infections in 2008. Though new infections have peaked, the number of people living with the virus is still rising, largely due to the life-sustaining impact of antiretroviral therapy. An estimated 33.4 million people were living with HIV in 2008, of whom 22.4 million are in sub-SaharanAfrica. 


Though some progress has been made, comprehensive and correct knowledge of HIV among young people is still unacceptably low in most countries of Sub-SaharanAfrica. Less than one third of young men and less than one fifth of young women in claim such knowledge about HIV. The lowest levels (8%) are found among young women inNorthernAfrica, according to surveys undertaken between 2003 and 2008. These levels are well below the 2010 target of 95 per cent set at the United Nations General Assembly Special Session on HIV/AIDS in 2001.


Empowering women through AIDS education is indeed possible, as a number of countries have shown. Though it has been a progress in the number of young women aged 15-24 with comprehensive correct knowledge of HIV between 2000 and 2007, the awareness needs to be higher.


In sub-SaharanAfrica, disparities in knowledge about HIV prevention among women and men aged 15 to 24 are linked to gender, household wealth and place of residence. For both men and women, the likelihood of being informed about HIV increases with the income level of one’s household. Gender disparities in knowledge also diminish slightly among the rich and among those living in urban areas.


In sub-SaharanAfrica, men aged 15 to 24 are far more likely to use condoms than women of the same age. For both women and men, condom use increases dramatically with wealth and among those living in urban areas. Similar disparities were observed in all countries with available data. 


In sub-SaharanAfricain 1990, 800.000 children were orphaned by AIDS.  The number increased to 2 millions in 1995, to 6 millions in 2000, 12 millions in 2005 and 14 millions in 2008. AIDs orphans suffer more than the loss of parents.  The vast majority of these children orphaned by AIDS are at greater risk of poor health, education and protection than children who have lost parents for other reasons. They are also more likely to be malnourished, sick, or subject to child labour, abuse and neglect, or sexual exploitation—all of which increase their vulnerability to HIV infection. Such children frequently suffer from stigma and discrimination and may be denied access to basic services such as education and shelter as well as opportunities for play.


The rate of new HIV infections continues to outstrip the expansion of treatment. The population living with HIV who is receiving antiretroviral (ARV) therapy, has greatly increased in the last years. The greatest gains were seen in sub-SaharanAfrica, where two thirds of those needing treatment live. By the end of 2008, an estimated 2.9 million people in SSA were receiving antiretroviral therapy, compared to about 2.1 million in 2007—an increase of 39 per cent. This means that from 14% patients receiving ARV treatment in 2005, 43% in 2008 received it. InNorthernAfricafrom 27% HIV patients receiving ARV treatment in 2005, 40% did it in 2008.


Combat malaria


Significant progress has been done in scaling up prevention and treatment efforts in malaria control.  Major increases in funding and attention to malaria have accelerated the delivery of critical interventions. Countries have also been quicker to adopt more effective strategies, such as the use of artemisinin-based combination therapies and diagnostics to better target treatment.


AcrossAfrica, expanded use of insecticide-treated bed nets is protecting communities from malaria. The use of such nets by children rose from just 2% in 2000 to 22% in 2008. In 26African countries this covers 71% of the under-five population. InRwandaonly 4% of children slept under bed nets in 2000 while 56% do it in 2008/2009. But poverty continues to limit the use of mosquito nets.


Global procurement of more effective anti-malarial drugs continues to rise rapidly inAfrica. Prompt and effective treatment is critical for preventing life-threatening complications from malaria, particularly in children. In recent years, manyAfrican countries have reinvigorated their treatment programmes by increasing access to new combinations of antimalarial medications that have been shown to outperform earlier drugs.


Antimalarial treatment coverage, however, remains substantially different acrossAfrican countries—ranging from 67% to only 1% of children of under five with fevers receiving any type of antimalarial drug. Only in eight of the 37 SSA countries, the proportion of febrile children under five receiving any antimalarial medication was above 50%. And in nine of the remaining countries, only 10% or fewer febrile children were receiving treatment. However, lower levels of antimalarial treatment may reflect expanded use of diagnostic tools to only target those children who actually have the disease.


Children from the poorest households are least likely to receive treatment for malaria.


Despite these positive trends, total funding for malaria still falls far short of the estimated $6 billion needed in 2010 alone for global implementation of malaria-control interventions. So far, about 80% of external funds have been targeted to theAfricaregion, which accounts for nearly 90% of global cases and deaths.


Additional funding has resulted in increased procurement of commodities and a larger number of households owning at least one insecticide-treated mosquito net.African countries that have achieved high coverage of their populations in terms of bed nets and treatment programmes have recorded decreases in malaria cases. Evidence from severalAfrican countries also suggests that large reductions in malaria cases and deaths have been mirrored by steep declines in deaths due to all causes among children less than five years of age. Intensive efforts to control malaria could help manyAfrican countries reach a two thirds reduction in child mortality by 2015, as targeted in MDG 4.


Combat Tuberculosis


Tuberculosis remains the third leading killer inAfrica. While in 1990 in Sub-SaharanAfricathere were 33 deaths by 100,000 population (excluding people who are HIV-positive), in 2008, the number of deaths reached 52. In sub-SaharanAfrica, mortality rates increased until 2003 and have since fallen, though they have yet to return to the lower levels of the 1990s.





The shortage of human resources for health sector in sub-SaharanAfrica, effective training and incentives for health workers are major stumbling blocks to meeting the MDGs.


Reducing maternal mortality is the slowest moving pillar among the Millennium Development Goals (MDGs). There is a need to push for progress on maternal health inAfrica, as this is crucial to the overall efforts to realize the MDGs. If a health system is available and accessible 24 hours a day, 7 days a week and capable of handling normal deliveries and emergencies, then it is equipped to provide a wide range of other services as well. “Maternal health is the mother of all health challenges,” said United Nations Secretary-General Ban Ki-moon.


The last day of the Summit on the MDGs Review, United Nations Secretary-General Ban Ki-moon announced the launch of a U.S.$40 Billion Global Strategy for Women’s and Children’s Health at the UN Headquarters. The strategy will integrate the actions of eight international health-related agencies to meet the health needs of women and children. The plan aims to prevent the deaths of more than 15 million children under five, as well as 33 million unwanted pregnancies and the deaths of 740,000 women from complications related to pregnancy and childbirth.


Begoña Iñarra

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