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on Thu, January 10, 2013 at 06.58 am
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10 January 2013 | Viewpoints from faith-based organizations

The papers in this set have been submitted by faith-based organizations (FBOs) and networks united by a shared aim of improving the health and lives of the most vulnerable and marginalized populations including those in fragile states where progress towards the MDGs has stalled or been reversed. The contributions accept the value of the MDG framework in galvanising support and resources for actions to address the health problems faced by the world’s vulnerable population, especially women and children. However, they also point out the weaknesses of the framework in terms of what is left out. They stress the linkages across individual MDGs and call for holistic and comprehensive approaches to health than include attention to the underlying determinants of health as well as the provision of health care that is universally accessible and affordable.

The contribution from World Vision [1] expresses the hope that in coming together, the post-2015 and sustainable development agendas will articulate a vision for current and future generations of children that rests on the core values of human rights, equality and sustainability. Health and sustainable development require reductions in preventable deaths, improved living conditions, the provision of adequate nutritious food and universal access to quality health services for the world’s most vulnerable children, their families and communities, including those in fragile contexts. A goal to end preventable child and maternal deaths within the timeline of the post-2015 development framework should recognise the significant progress made through the MDGs but refocus the efforts of all stakeholders on those who have been missed to date, the poorest and hardest to reach children and mothers.

The contribution from Tearfund [2] stresses the importance of good health for wellbeing and human flourishing. Rooting out inequalities in access to decent health care must be at the heart of the post-2015 agenda. The paper calls for an overarching goal of improving public health in all countries and of ensuring universal access to a public health system. Countries should be encouraged to set ambitious targets for improving public health in a number of key areas and supported to improve progress across the board. A menu of indicators should cover key diseases such HIV, TB, malaria and diarrhoea, as well as non-communicable diseases.

The Christian Medical Fellowship [3] makes the case that because they are close to local communities, FBOs posses knowledge relevant to the local population’s needs, are more likely to have a sustained presence, are able to reach marginalized groups; and have an in-depth understanding of the real needs of local people. The paper notes that faith-based organisations (FBO’s) make an enormous contribution to healthcare and calls upon the post-2015 framework to recognise their role and adopt a holistic approach to health and development acknowledging that that physical, emotional, social, environmental, and spiritual factors all play a part in health and well-being.

The contribution by the Medical Mission Institute [4] argues that the post-2015 agenda should include universal coverage of effective services for prevention, treatment, care, support and rehabilitation of all life-threatening diseases, not only those covered in the current MDG framework. Health should occupy a special place because good health is both a basic need for all people and also a pre-condition for satisfying other fundamental needs. Notwithstanding the primary duty of national governments, the right to health must be understood as a shared responsibility and common task of the international community as a whole.  Health exemplifies the importance of building societies on ethical values, such as solidarity and justice for all.

The submission by the Ecumenical Advocacy Alliance [5] draws upon its experiences in the HIV response to stress the need to promote and act upon the linkages between HIV and human rights, gender, sexual and reproductive health, maternal and child health, TB and hunger/nutrition. The failure to address these linkages is a fundamental flaw of the MDG framework that needs to be remedied in the post-2015 agenda. Articulating and building upon the synergies between the individual goals provides multiple opportunities for coordination and efficiency, thus benefitting all three pillars of sustainable development as well as the MDGs.

Health in the Post-2015 Development Agenda
World Vision International’s Submission to the UN Thematic Consultation Call for Papers

World Vision International is a Christian relief, development and advocacy organisation dedicated to working with children, families and communities to overcome poverty and injustice.[6] The submission notes that despite considerable progress much remains to be done to reach the most vulnerable women and children. The limited focus of the MDGs resulted in lack of attention to the underlying determinants of health – those not traditionally within the domain of the health sector. The basic requirements for health – air, water, food and shelter, care and protection - are in short supply for many children. The MDG focus on national aggregates and ‘one size fits all’ targets allowed some states to meet national targets without addressing the needs of the poorest and most vulnerable. World Vision expresses concern about fragile states which have seen little progress and even reversals in child and maternal mortality; at current rates of progress none will meet a single MDG.

Looking to the future, the paper identifies the need to address the impacts on health of climate change and weather extremes, noting that three of the main childhood killers – malaria, diarrhoea and undernutrition – are sensitive to climatic conditions and changes. The paper draws attention to noncommunicable diseases which will be the leading global cause of disability by 2030 and yet are not addressed in the current MDG framework. World Vision calls for a lifecycle approach to prevention, pointing out that good maternal health, healthy birth weight of babies, and breastfeeding can reduce the future risk of children developing NCDs as adults. The paper welcomes increased attention to the need for Universal Health Coverage (UHC) but expresses caution that disagreements about the diversity of approaches threaten to obscure the collective goal of making health care accessible to all. Moreover, UHC should include promotive and preventive interventions as well as treatment and care. For World Vision, accountability must span the local to global levels and engage citizens in the planning, monitoring and review of health services that impact their lives. An accompanying document describes World Visions’s experiences in this regard.[7]

The paper concludes that critical elements of the post-2015 framework must:

  • Build on the unmet commitments the current MDGs by setting an ambitious goal to end preventable child and maternal deaths within the post-2015 timeline;
  • Measure new health goals by their impact on the poorest and most vulnerable;
  • Promote a definition of health that explicitly includes the social determinants, including sanitation, water and hygiene, nutrition and education;
  • Establish the universal provision of quality, accessible and affordable health care, with a specific focus on the particular challenges in fragile contexts;
  • Ensure stronger links between health and nutrition and support the call for a goal to reduce child stunting that can only be achieved by working together across sectors;
  • Enhance accountability by incorporating the involvement of citizens in the planning, monitoring and review of progress at the local, national and global levels.

Health and the post-2015 development agenda
Tearfund

Tearfund[8] is a Christian relief and development agency working directly in response to disasters and in partnership with organisations in more than 50 countries and networks of local churches. The paper calls for greater recognition in the post-2015 agenda of the interconnectedness between MDGs. In particular, the MDGs have not effectively addressed the contribution to better health of access to safe water, sanitation and hygiene (WASH).  Despite including water and sanitation targets, the MDGs have failed to mobilise political will for WASH revealing a major blind spot in development policy.  Tearfund argues that there is a need for broad participation by a wide range of sector stakeholders in the planning and monitoring of WASH service delivery at the national and sub-national levels.  Governments should engage more effectively with civil society groups (including faith communities) which offer examples of good practice in community involvement.

The paper suggests that the post-2015 framework should prioritise tackling inequality and use an ‘inequality lens’ to monitor the impact of goals and targets. Data must be disaggregated by gender, age, disability, economic status, ethnicity etc. The paper calls for the target of universal health care to be prioritised in the post-2015 health agenda and urges that it should encompass removal of the barriers to health services, retention of quality health care providers, access to essential medicines (inclusive of universal coverage for HIV treatment), access to second-line treatments, and treatments for opportunistic infections, as well as access to palliative medicines for relief of pain, and other symptoms. As a critical and under looked component of universal health care, home-based services must be compensated and recognised for their contribution to reaching the hard-to-reach, marginalised groups, key populations and those presenting late for treatment.

The paper argues that indicators should measure health outcomes that reflect the range of inputs, including the social determinants of health such as water and sanitation. Targets and indicators need are needed covering access to comprehensive health care, including:

  • Health care provider ratio (provider/patient);
  • Access to essential medicines (including ARVs for HIV treatment and opioids for pain management);
  • Adequate health financing; reducing/eliminating costs for patients;
  • HIV incidence and prevalence (and other communicable diseases, malaria, TB, etc.);
  • NCD incidence and prevalence;
  • Maternal and child health;
  • Continued medical education for health practitioners (quality of care indicators);
  • Extension and reach of services (home-based, community-based, etc.) with adequate recognition and financing;
  • Comprehensive care and referral (inclusive of nutrition, livelihoods/food security, end of life care, and
  • Psychosocial and/or spiritual support).

 

Faith Matters - the contribution of faith to health and healthcare in the post 2015 agenda
Christian Medical Fellowship (CMF)

The Christian Medical Fellowship (CMF)[9] is a network of 4,000 doctors and 800 medical students in the UK that has a strong interest in global health in low-income countries. Starting from the premise that there are important links between faith and health, the paper argues that the influence of faith cannot be ignored in the quest to improve the health of the world’s population and that it is important to recognise the essential role of faith based organisations in healthcare provision. The authors posit that faith communities have several important attributes: knowledge relevant to the local population’s faith needs; sustainability, coverage and ability to reach marginalized groups; and understanding of the real needs of local people.

The paper notes that faith-based organisations (FBO’s) make an enormous contribution to healthcare and have played major roles, including in the provision of facility-based health services alongside state health services at district and national levels; training centres for the health workforce; non-facility based health related activities such as home based care and HIV prevention, care and support; co-ordination, fundraising, capacity development, health service supervision and acting as funding channels; advocacy; and health promotion and education. The CMF submission argues that the post-2015 framework should:

  • Recognise the role of faith communities in post-2015 development targets especially in the area of health. 
  • Adopt a holistic approach to health and development, recognising that physical, emotional, social, environmental, and spiritual factors all play a part in health and well-being.
  • Recognise the role of local faith communities in actively supporting good health through healthy spiritual practices, health education and promotion and health provision. 
  • Recognise the long term role of FBO’s in healthcare education and provision especially in the poorest and most marginalised sectors of society. 
  • Require FBO’s to commit to impartial delivery of healthcare, based on medical need, and without discrimination based upon race, gender, sexual orientation, ethnicity, national origin, or religion.
  • Recognise that healthcare workers must be free to support individuals in their faith and also to share their own personal faith in appropriate ways without fear of persecution or disciplinary action.
  • Promote and protect individuals’ rights to practise their chosen faith and gather with others in faith communities, as well as the right of an individual to change faiths.
  • Commit to an evidence based approach in the provision of healthcare by FBO’s and other organisations.

 

Some Reflections on the Role of Health in the Future Development Agenda
Joachim Rüppel, Medical Mission Institute (MMI), Würzburg, Germany

The Medical Mission Institute (MMI) is a Catholic advisory group for international health that focuses on improving health conditions particularly of disadvantaged people and populations. The MMI cooperates with Church-based partners in development cooperation and humanitarian assistance, other civil society organisations and with various German bilateral and multilateral development cooperation institutions.

In this paper, the author argues that the health-related MDGs rightly prioritized addressing premature mortality due to preventable infectious diseases and maternal and perinatal conditions. However, the international community must now go beyond this and combat all causes of avoidable death and suffering. This calls for universal coverage of effective services for prevention, treatment, care, support and rehabilitation of all life-threatening diseases. Furthermore, it requires addressing all social conditions and structures that lead to serious ill health and fatal disease. The post-2015 development framework should be based on a holistic view of human existence and avoid unidimensional approaches. Health should occupy a special place because good health is both a basic need for all people and also a pre-condition for satisfying other fundamental needs. Health exemplifies the importance of building societies on ethical values, such as solidarity and justice for all. Notwithstanding the primary duty of national governments, the right to health must be understood as a shared responsibility and common task of the international community as a whole. This means that governments and parliaments of better-off nations have to recognize the following ethical obligations and act accordingly:

  • Design and implement policies that contribute to promote and improve health worldwide, which implies a conception of globalization controlled by and working for the people.
  • Make a fair, adequate, predictable and stable contribution to finance the development of appropriate health systems and overcome the disparities in health outcomes in line with existing commitments and targets.
  • Agree on and implement the highest standards of transparency and accountability for development cooperation.

The author agrees that life expectancy and healthy life expectancy can be core indicators of development in general. However it is also important to take into considerations issues beyond the quantitative dimension, namely quality and equality. Quality of life principally refers to self-realization as a human being and social connectedness, which in turn bear a close relationship to health. The measure of equality must focus on the outcomes for the most disadvantaged population groups. Measures of universal health coverage must be disaggregated for specific population groups exposed to discrimination and exclusion. However, monitoring should not only give attention to the quantitative proportion of people reached by specific health services, but also take into account the quality and the results of these services.  

 

 Post-2015 Health Consultation: Response from the Ecumenical Advocacy Alliance (EAA)

The Ecumenical Advocacy Alliance (EAA)[10] is a global network of churches and related organizations committed to collaborating in advocacy for social justice and human dignity and rights. The EAA focuses its collective efforts campaigning on two key issues per four-year cycle (currently HIV and AIDS, and Food), with a cross-cutting human rights based approach to the issues it is working on.

The EAA agrees that the strength of the MDGs has been their simple and clear focus which has greatly influenced international funding priorities and created momentum behind the MDGs. Progress has been particularly noteworthy with regard to the HIV response which has not only galvanized action on MDG 6 but also had a far wider impact. The HIV response has shown that promoting and acting on the linkages between HIV and human rights, gender, sexual and reproductive health, maternal and child health, TB and hunger/nutrition, brings benefits for the economic, social and environmental pillars of sustainable development as well as for the attainment of the other MDGs. Acting on these linkages is crucial and points to a fundamental weakness in the design of the MDGs which do not articulate the synergies between the individual goals, thereby missing opportunities for coordination and efficiency. The paper proposes that in the post-2015 framework, health should be framed in two ways:

  • At least one overall health goal with disease-specific targets: Such a goal should promote access to affordable and quality health services for all, and thus the realization of the right to health. Universal health care coverage should be a key part of this goal as long it also addresses social and structural barriers such as stigma and discrimination which prevent the most marginalized and vulnerable populations from accessing health care services. Other issues to be included targets include tuberculosis, malaria, and non-communicable chronic diseases, particularly cancer, cardio-vascular disease and respiratory disease.
  • Explicit health-related targets and indicators integrated into other global goals: In order to strengthen the links between HIV and other sectors (such as trade, education, gender, sexual and reproductive health, food/nutrition, water and social protection) health and HIV targets and indicators should be included across all post-2015 goals.

The author argues for post-2015 goals with clear targets that are time-bound, measurable and achievable.  The post-2015 framework should include contextualized national targets for the less economically developed countries. Middle-income countries should also be included in the post-2015 framework in order to ensure that poor and marginalized groups are reached. The new framework should include specific indicators to measure equity and process made in reaching vulnerable and marginalized populations, incorporating qualitative measurements as well as quantitative data. The post-2015 framework should promote multisectoral responses whereby responsibilities for improved health and access to services are shared by all.  Donors and national governments must work together along with the private sector and other non-state actors. Finally, local communities and affected populations must be at the centre of the post-2015 decision making processes.



[1]   World Vision International (2012) Health in the Post-2015 Development Agenda World Vision International’s Submission to the UN Thematic Consultation Call for Papers.

[2]   Tearfund (2012) Health and the post-2015 development agenda.

[3]   Christian Medical Fellowship (2012) Faith Matters - the contribution of faith to health and healthcare in the post 2015 agenda.

[4]   Joachim Rüppel (2012) Some Reflections on the Role of Health in the Future Development Agenda. Medical Mission Institute, Würzburg, Germany

[5]   The Ecumenical Advocacy Alliance (2012) Post-2015 Health Consultation: Response from the Ecumenical Advocacy Alliance

[7]   World Vision International (2012)  Community-level accountability mechanisms and the provision of essential health services

[9]    http://ww.cmf.org.uk  Contacts for this submission: Dr Peter Saunders (CEO), Dr Vicky Lavy (Head of International Ministries)

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