Fifteen years ago, leaders of nearly 200 countries agreed on a visionary millennium declaration that laid out in succinct terms the kind of world we want to live in. They created an action agenda — the Millennium Development Goals (MDGs) — with a set of priorities in areas like reducing child mortality and infectious diseases and increasing access to primary education. The goals included hard targets for improvement and a deadline for measurement. Those targets have helped spur significant progress.
In India, 3.3 million children died before their fifth birthday in 1990. Last year, that number was less than 1.3 million — marking a 61% decline. The percentage of women dying from pregnancy-related causes declined by more than 70% over the same period — faster than the global rate of decline.
This progress is the result of a commitment to funding basic health and other essential services, new and better delivery mechanisms for these services, and more aligned efforts among the governments, private sector, and NGOs.
Last month, global leaders endorsed the Sustainable Development Goals (SDGs) to replace the MDGs. As we look ahead, it is important to draw on the lessons of the past 15 years.
To continue the momentum the following actions will be required:
Setting robust national-level targets and plans. Country-level implementation plans, with targets that take into account national priorities, should be established as soon as the SDGs are adopted. In India, an effective national plan along with sub-national plans will be important to address this variation in child mortality rates from state to state.
Establishing reliable funding and delivery models. Over the next few months, every country must identify sources of financing. The Indian healthcare system will not only need to deliver on the unfinished agenda of health and nutrition MDGs, but also be prepared to address the emerging burden of non-communicable diseases, and ensure better financial protection from health shocks.
Identifying and scaling new innovations. Multiple innovations have been made in improving information sharing on child and maternal health, counselling women and caregivers and care of neonates. Innovations in the use of mobile phones, medical devices and indigenous solutions have yielded results and these must be scaled up for maximum impact.
Building effective partnerships. Increasing access to affordable child, maternal, and adolescent health services can be addressed through effective partnerships and innovative health financing models. We know from experience how to create these alliances, which ensure that everyone is pulling from the same end of the rope.
Monitoring and evaluation. Getting the right interventions to the right people at the right time is critical. The National Polio Surveillance Project is an excellent example of how a dedicated, well-funded, high-quality monitoring and surveillance system can enable health transformation. Monitoring and evaluation enables continual adjustments and midcourse corrections to achieve optimal impact.
In the era of the MDGs, India cemented its position as a global economic and political leader. As we make the transition from the MDGs to SDGs, we have another great opportunity to create a world in which all people have the opportunity to survive and thrive.
CK Mishra is additional secretary and mission director, National Health Mission, and Mark Suzman is president, policy, advocacy and country offices, Bill & Melinda Gates Foundation