Recommended readings
Achieving the Health Millennium Development Goals in fragile states
Challenges for health MDGs
Authors:
Publisher:
High-Level Forum on the Health Millennium Development Goals (MDGs), 2004
The success of the Millennium Declaration and Millennium Development Goals (MDGs) requires major improvements in health systems and health outcomes across the developing world. This paper by The High Level Forum on the MDGs addresses the concern that the MDGs will be very difficult to achieve in a particular set of low-income countries characterised by poor and often deteriorating economic and social conditions, weak governance and low levels of trust between aid donors and recipient governments. The authors highlight how two topics are of increasing interest within the health sector: how to improve aid coordination and how to scale-up delivery of effective and quality services. These are both subjects of concern, but there is limited conclusive or in-depth research on either. The document outlines the key issues and challenges surrounding these two topics, and areas for further work.
The authors show how development assistance is most effective when it is harmonised (through use of common procedures for all donors) and aligned (by supporting countries' own priorities and delivery systems). But government systems and priority-setting is weak in fragile states and donors often develop their own parallel systems - further undermining weak state capacity. Decisions need to be made about how services should be delivered and who should provide them. One challenge is how to integrate vertical, disease-specific approaches with horizontal, system-wide approaches - and how this mix should change over time.
