Post-2015 Millennium Development Goals Research Articles

Impact of the use of GeneXpert on TB diagnosis and anti-TB treatment outcome at health facilities in Addis Ababa, Ethiopia in the post-millennium development years.

GeneXpert is an effective and rapid molecular system used for tuberculosis (TB) diagnosis. It is expected to improve the detection rate and treatment outcomes needed to meet the sustainable development goals (SDG) and End TB strategy targets set for 2030. This study aimed to evaluate the impact of GeneXpert on diagnosis and anti-TB treatment outcomes in the post-millennium development goals (MDGs) in the capital city of Ethiopia. Hence, the global priority indicator based on the End TB Strategy for TB treatment success rate was met early in 2018 in Addis Ababa, Ethiopia, which was anticipated to be met by 2025. A retrospective health facilities-based study was conducted in Addis Ababa, Ethiopia. Records of all TB cases diagnosed and treated in selected health facilities from January 1st, 2015 to December 31st, 2018 were reviewed and included in the study. Data analysis of descriptive and inferential statistics was conducted using SPSS version 20. The reviewed records have shown that a total of 45,158 presumptive pulmonary TB (PTB) cases had accessed TB diagnosis services. Of which, 28.9% (13072/45158) were tested by AFB microscopy and 71.1% (32086/45158) were tested by GeneXpert. During the study period, the coverage of Xpert MTB/RIF testing increased to 94.9% in 2018 compared to 1.6% in 2015. The number of presumptive PTB cases tested with the GeneXpert system showed a significant increase compared to smear microscopy. The odds of positivity were detected in males compared to females. The odds of detecting TB cases were much higher among study participants aged 15-44 years compared to younger than 15 years. Treatment success rate showed a relative improvement each year between 2015 and 2018 with a mean of 92.6%. Reduced odds of treatment successes were observed in age categories older than 35 years, and in TB/HIV co-infected patients. Increased odds of treatment successes were reported in the years between 2016 and 2018 compared to 2015. Scaling up the Xpert MTB/RIF assay as a point-of-care test for presumptive TB cases in resource-limited settings would have a significant impact to meet the SDG and End TB strategy both in TB detection and treatment success rates.

Social Capital Based Partnership Model for Reaching 100% Universal Access of Improve Water and Sanitation Services

Indonesia had launched the strategic plan for water and sanitation provision postmillennium development goal 2015. The universal access of 100% for water supply and sanitation sector has been designated to be reached by 2019. This study is aimed to model the partnership approach that is suitable to reach the designated sanitation sector targets based on some success story of some base technology application. The decentralized- and community-based technology that could be replicated should take into consideration all aspects that relate to social capitals. It also identifies and analyses the vital cross-cutting themes and success factors, highlights gaps in the current knowledge, and identifies high-potential areas for partnerships. The grounded theory was used to systematically code, constant comparison, render the categories. Mixed method and technique were used for data analysis. The developed model consists of ten out of twenty collaboration factors that generate variables to structure the model social-capital-based partnership with six dynamic similarity trends of growth and two different trends of growth. This model demonstrates that social connections might drive the collaboration activity to generate benefit from the social connection. The 100% universal access to the sanitation target might be achieved if the model is applied correctly.

Ghana's post-MDGs sanitation situation: an overview

Abstract This paper presents an overview of Ghana's sanitation situation post-Millennium Development Goals (MDGs). It specifically examines why the MDG target on sanitation was missed, Ghana's preparedness towards achieving the Sustainable Development Goals (SDGs) sanitation target, potential barriers and opportunities for the sanitation sector. An eight step policy analysis framework guided the review. The findings indicate that the low sanitation has largely been driven by rather complex economics, institutional and sociocultural factors including inadequate financial commitment, poor implementation of policies, bad attitude and perception towards sanitation and extensive use of shared and public toilets. Nevertheless, it was found that recent reforms and programmes in the sanitation sector such as the creation of new Sanitation and Water Resource Ministry, National Sanitation Authority (NSA), introduction of sanitation surcharges included in property tax, and programmes such as the Greater Accra Municipal Assembly sanitation and water project put Ghana in a better position to rapidly increase its coverage. However, efforts would have to be accelerated by forging partnerships with the private sector to provide efficient and low-cost technologies, financial schemes, human and technical resources for improved service delivery.

Social Inequality in Early Childhood Care and Education Provision in Nigeria: A Review of Literature

Early childhood care and education (ECCE) programme has been identified as a strong tool to break the cycle ofpoverty and effective means to establish the basis for further learning, prevent school drop-out, increase equity ofoutcomes and overall skill levels; hence all nations of the world call for effective investment in ECCE. Nigeriaembraced the idea of ECCE and made it a national agenda by incorporating it into the national policy. The essence isto establish access and equality for children all over the country, irrespective of gender, ethnicity, socio-economictransfer. Looking at the trend or the status of the ECCE for some years, it is as if there are lapses in the provision ofearly childhood education in the country. The study therefore examined existing research in early childhoodeducation in Nigeria between 2013 and 2017 (which are pre and post Millennium Development Goals documents) tohighlight the indicators of enrolment in ECCE, sex, and personnel to determine whether there is equality orinequality in the provision and identify the areas of inequality if there be any. The findings showed that inequalitystill exists in the provision of the ECCE programme in Nigeria. The enrolment in the programme is still low ascompared to other educational levels. Employment of personnel into the programme is also very low to the numberat the primary level. There was no visible data on the educational programme as from 2017. It is recommended thatthe government should show more commitment to the educational level.

Two-dimensional approach to governmental excellence for human development in developing countries: Combining policies and institutions with e-government

This paper proposes a two-dimensional lens to examine government capacity in developing countries. In addition to the conventional approach of assessing policies and institutions to examine government capacity, we propose that the development of e-government services should be a second axis of analysis in the current informatized world. Clustering analysis is implemented to examine how certain policies and institutions, along with the development of e-government services, are related to human development outcomes. The results showed a positive and significant relationship, and the particular importance of e-government was discovered. We use the Markov chain model to examine countries' transition patterns and to forecast future transitions. Our findings underline the importance of this two-dimensional approach, and the harmonious incorporation of traditional and novel approaches seems ideal to achieve development in a more effective and efficient way, ultimately leading to United Nations Sustainable Development Goals. This study can provide insights for policy makers in corresponding countries and international organizations to use in estimating transition patterns and the future direction of governmental excellence and in planning and strategy development. In particular, the proposed method for analyzing developing countries from the macro perspective may help guide international organizations to set up development strategies now in preparation for the time post-Millennium Development Goals.

Inclusive water poverty index: a holistic approach for helping local water and sanitation services planning

This paper addresses two approaches to guiding the inclusion of the poor and vulnerable in clean water and sanitation programmes in the framework of Sustainable Development Goals. It proposes an operational and adapted participatory approach for identifying the poorest and most vulnerable, which has become a central interest for inclusive development policies worldwide post Millennium Development Goals. Then, it proposes an inclusive water poverty index for the inclusion of the poor and vulnerable. This index, with six components, materializes the spatial and temporal equity in the distribution of water and sanitation services through a given district or municipality, particularly in developing countries.

Progress in the utilization of antenatal and delivery care services in Bangladesh: where does the equity gap lie?

BackgroundUniversal access to health care services does not automatically guarantee equity in the health system. In the post Millennium Development Goals (MDGs) era, the progress towards universal access to maternal health care services in a developing country, like Bangladesh requires an evaluation in terms of equity lens. This study, therefore, analysed the trend in inequity and identified the equity gap in the utilization of antenatal care (ANC) and delivery care services in Bangladesh between 2004 and 2011.MethodsThe data of this study came from the Bangladesh Demographic and Health Survey. We employed rate ratio, concentration curve and concentration index to examine the trend in inequity of ANC and delivery care services. We also used logistic regression models to analyse the relationship between socioeconomic factors and maternal health care services.ResultsThe concentration index for 4+ ANC visits dropped from 0.42 in 2004 to 0.31 in 2011 with a greater decline in urban area. There was almost no change in the concentration index for ANC services from medically trained providers during this period. We also found a decreasing trend in inequity in the utilization of both health facility delivery and skilled birth assistance but this trend was again more pronounced in urban area compared to rural area. The concentration index for C-section delivery decreased by about 33 % over 2004–2011 with a similar rate in both urban and rural areas. Women from the richest households were about 3 times more likely to have 4+ ANC visits, delivery at a health facility and skilled birth assistance compared to women from the poorest households. Women’s and their husbands’ education were significantly associated with greater use of maternal health care services. In addition, women’s exposure to mass media, their involvement in microcredit programs and autonomy in healthcare decision-making appeared as significant predictors of using some of these health care services.ConclusionsBangladesh faces not only a persistent pro-rich inequity but also a significant rural-urban equity gap in the uptake of maternal health care services. An equity perspective in policy interventions is much needed to ensure safe motherhood and childbirth in Bangladesh.

Family Structure Types and Adequate Utilization of Antenatal Care in Kenya.

Features of the health care delivery system may not be the only expounding factors of adequate utilization of antenatal care among women. Other social factors such as the family structure and its environment contribute toward pregnant women's utilization of antenatal care. An understanding of how women in different family structure types and social groups use basic maternal health services is important toward developing and implementing maternal health care policy in the post-Millennium Development Goal era, especially in the sub-Saharan Africa where maternal mortality still remains high.

Determinants of utilization of antenatal care services among adolescent girls and young women in Indonesia

ABSTRACTDue to the high number of maternal deaths, provision of antenatal care services (ANC) in Indonesia is one of the key aims of the post-Millennium Development Goals agenda. This study aimed to assess the key factors determining use of ANC by adolescent girls and young women in Indonesia. Data from the Indonesia Demographic and Health Survey 2012 were used, with a focus on married adolescent girls (aged 15–19 years, n = 543) and young women (20–24 years, n = 2,916) who were mothers. Bivariate and multiple logistic regression analyses were performed to determine the factors associated with ANC use. The findings indicated that adolescents were less likely to make ANC visits than young women. Richer women were more likely to make four ANC visits in both groups compared to the poorer women. Living in urban areas, higher educational attainment, and lower birth order were also all associated with higher levels of receiving ANC among young women. The results showed that socio-economic factors were related to the use of ANC among adolescent girls and young women. Ongoing health-care interventions should thus put a priority on adolescent mothers coming from poor socio-economic backgrounds.

Defining and measuring water access: lessons from Tanzania for moving forward in the post-Millennium Development Goal era

The Millennium Development Goal for water sought to halve the number of people without access to an improved source of water. The world officially achieved this goal in 2010, but a significant body of literature critiques the definition and measurement of access. This paper provides an overview of this criticism and uses data from Dar es Salaam to show that poor quality, fluid price structures, unreliable supplies, and burdensome collection all limit water access even though they are not considered in official measurements. This paper argues for a meaningful definition of access is required to generate real development and poverty reduction.

The Pan-University Network for Global Health: framework for collaboration and review of global health needs.

In the current United Nations efforts to plan for post 2015-Millennium Development Goals, global partnership to address non-communicable diseases (NCDs) has become a critical goal to effectively respond to the complex global challenges of which inequity in health remains a persistent challenge. Building capacity in terms of well-equipped local researchers and service providers is a key to bridging the inequity in global health. Launched by Penn State University in 2014, the Pan University Network for Global Health responds to this need by bridging researchers at more than 10 universities across the globe. In this paper we outline our framework for international and interdisciplinary collaboration, as well the rationale for our research areas, including a review of these two themes. After its initial meeting, the network has established two central thematic priorities: 1) urbanization and health and 2) the intersection of infectious diseases and NCDs. The urban population in the global south will nearly double in 25 years (approx. 2 billion today to over 3.5 billion by 2040). Urban population growth will have a direct impact on global health, and this growth will be burdened with uneven development and the persistence of urban spatial inequality, including health disparities. The NCD burden, which includes conditions such as hypertension, stroke, and diabetes, is outstripping infectious disease in countries in the global south that are considered to be disproportionately burdened by infectious diseases. Addressing these two priorities demands an interdisciplinary and multi-institutional model to stimulate innovation and synergy that will influence the overall framing of research questions as well as the integration and coordination of research.

Using systematized tacit knowledge to prioritize implementation challenges in existing maternal health programs: implications for the post MDG era.

Strategic priority setting and implementation of strategies to reduce maternal mortality are key to the post Millennium Development Goal (MDG) 2015 agenda. This article highlights the feasibility and the advantages of using a systematized tacit knowledge approach, using data from maternal health program personnel, to identify local challenges to implementing policies and programs to inform the post MDG era. Communities of practice, conceived as groups of people sharing professional interests, experiences and knowledge, were formed with diverse health personnel implementing maternal health programs in Mexico and Nicaragua. Participants attended several workshops and developed different online activities aiming to strengthen their capacities to acquire, analyze, adapt and apply research results and to systematize their experience and knowledge of the actual implementation of these programs. Concept mapping, a general method designed to organize and depict the ideas of a group on a particular topic, was used to manage, discuss and systematize their tacit knowledge about implementation problems of the programs they work in. Using a special online concept mapping platform, participants prioritized implementation problems by sorting them in conceptual clusters and rating their importance and feasibility of solution. Two hundred and thirty-one participants from three communities of practice in each country registered on the online concept mapping platform and 200 people satisfactorily completed the sorting and rating activities. Participants further discussed these results to prioritize the implementation problems of maternal health programs. Our main finding was a great similarity between the Mexican and the Nicaraguan general results highlighting the importance and the feasibility of solution of implementation problems related to the quality of healthcare. The use of rigorously organized tacit knowledge of health personnel proved to be a feasible and useful tool for prioritization to inform implementation priorities in the post MDG agenda.

Securing well-being with the advent of climate hazards

Purpose – This paper aims to examine the contribution of forests resource systems to the different aspects of community well-being, the implications of climate variability on the different sources of well-being and further identifies direct and indirect social and policy opportunities relevant for communities to enhance their capabilities in the face of climate variability and change in the Tri-National de la Sangha landscape of Cameroon. Design/methodology/approach – It illustrates on data collected from focus group discussions and from 151 households randomly selected in three villages to operationalize the conceptual links between community well-being and vulnerability. Findings – The study shows that vulnerability to climate change interferes with community strategies to achieve well-being, in addition to non-climatic processes which are both internal and external to communities. The study further indicates that healthy forest ecosystems provide opportunities for the local folks to build assets, improve food security, improve health and reduce risks. However, this requires capacity building and the channeling of resources to the local level, in addition to win–win sectoral policy amendments. Research limitations/implications – Biophysical methods required to complement community perceptions on the suitability of forest resource systems to climate variability. Practical implications – This paper argues that appropriate strategies which aim at improving well-being needs to capture the role of forest ecosystems, climate change risks and uncertainty and macroeconomic and social processes. Originality/value – This study contributes to the literature on the relationship between climate risk and the well-being of forest communities. This is relevant for practitioners and policy makers to reflect on the risk of climate change and the rationale for conserving forest resources for community well-being in the post-2015 Millennium Development Goals conclusions.

Magnitude of Neglected Tropical Diseases in Indonesia at Postmillennium Development Goals Era.

The world will enter the postmillennium development goals 2015 era. The achievements of the millennium development goals (MDGs) as a global development target need to be evaluated. A sustainable new reasonable target is important for neglected tropical diseases (NTD) elimination in Indonesia. This review describes the NTD situation in Indonesia and highlights problems beneath the NTD transmission. Multidisciplinary approach is a promising strategy to help the marginalized people.

Close to community health providers post 2015: Realising their role in responsive health systems and addressing gendered social determinants of health.

Universal health coverage is gaining momentum and is likely to form a core part of the post Millennium Development Goal (MDG) agenda and be linked to social determinants of health, including gender;Close to community health providers are arguably key players in meeting the goal of universal health coverage through extending and delivering health services to poor and marginalised groups;Close to community health providers are embedded in communities and may therefore be strategically placed to understand intra household gender and power dynamics and how social determinants shape health and well-being. However, the opportunities to develop critical awareness and to translate this knowledge into health system and multi-sectoral action are poorly understood;Enabling close to community health providers to realise their potential requires health systems support and human resource management at multiple levels.

Why are girls still dying unnecessarily? The need to address gender inequity in child health in the post-2015 development agenda.

The 40–year anniversary of the United Nations ‘International Women’s Day,’ was celebrated on 8 March 2015. As we approach the end of the Millennium Development Goals (MDGs), we reflect on the gender debate that has arose amidst tackling MDG4 and highlight the need for greater gender equality in measuring child health outcomes in the post–MDG era in line with MDG 3 (see Box 1). Box 1 Summary of Millennium Development Goals 3 and 4 Goal 3: Promote gender equality and empower women Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015 3.1 Ratios of girls to boys in primary, secondary and tertiary education 3.2 Share of women in wage employment in the non–agricultural sector 3.3 Proportion of seats held by women in national parliament Goal 4: Reduce child mortality rates Reduce by two–thirds, between 1990 and 2015, the under–five mortality rate 4.1 Under–five mortality rate 4.2 Infant mortality rate 4.3 Proportion of 1 year–old children immunised against measles NEED TO PROFILE GENDER AS A DETERMINANT OF CHILD HEALTH INEQUITY In recent years, several key UN reports and articles have begun to articulate the gender gap that exists in child health outcomes [1–3]. Indeed, it has been the UN which has taken a lead in promoting gender equality internationally by requiring all UN entities to mainstream gender and promote gender equality as mandated by the Beijing Platform for Action (1995) and ECOSOC resolutions 1996, 1997, 2006 and consolidated by the quadrennial comprehensive policy review 2012 (General Assembly Resolution 67/226). According to the 2012 World Development Report, gender equality is at the heart of development and “…too many girls and women are still dying in childhood and in the reproductive ages” [4]. Perhaps it is a reflection on the relative success of MDG 3 and 4 (despite it not being likely that the numerical targets will be achieved in time) that it has helped to raise the issue of gender in child health and the need for more equitable goals in the future. Leading international organisations have developed organisation specific gender action plans, policies or guidelines in the past two decades in order to tackle gender imbalance issues in its organisational activities (see Box 2). Box 2 Organisations identified through a Google Scholar search of ‘gender’ or ‘sex’ and ‘policy’ or ‘guideline’ or ‘framework’ African Development Bank Asian Development Bank Bill and Melinda Gates Foundation Council of Europe Department for International Development (DFID) European Union Global Alliance for Vaccines and Immunisation (GAVI) Global Fund The International Federation of Red Cross and Red Crescent Societies (IFRC) Organisation for Economic Co–operation and Development (OECD) Save the Children The United Nations Children's Fund (UNICEF) World Bank World Health Organisation (WHO) The authors congratulate recent efforts to collect gender disaggregated child health outcomes data by Inter-Agency Group for Child Mortality Estimation (IGME) and Countdown 2015 as the first step to enable the profiling of gender as a determinant of child health inequity. Nevertheless, if gender is to be mainstreamed as a determinant of child health, future country achievement profiles should require nations to highlight sex disparities in coverage of life saving interventions, especially in countries where girls are known to be subject to discrimination in health care access and outcomes. In other words, it should become the norm, rather than the exception, to report sex–differentiated data for child health indicators. In addition, reporting health interventions which have been proven to reduce maternal, newborn and child mortality rates by gender would prove valuable to better realign services and make targeted policy steps. In response to the challenge of collecting better gender data and developing an effective response, we discuss some of the challenges reported in the literature of researching gender and child health and their potential solutions. We also look briefly at the example of India; one country in which there is evidence of severe discrimination against girls in child health care outcomes, to provide a perspective of the challenge that remains ahead.

The global post-2015 sustainable development debate: What can regions offer?

Volume five of Regions & Cohesion has focused significant attention on the subject of regional development. It has done so because 2015 is such an important year in relation to development debates given the definition of the post-Millennium Development Goals (MDGs) agenda in the United Nations and the official declaration of 2015 as the European Union Year for Development. The introduction to the Leadership Forum of the Spring 2015 issue included important reflections on the theme of “transformative development.” The introduction openly asked whether 2015 could be a decisive year for the global development agenda or whether it will be remembered for global summitry, international declarations and little more.

From conceptual pluralism to practical agreement on policy: global responsibility for global health.

BackgroundAs the human cost of the global economic crisis becomes apparent the ongoing discussions surrounding the post-2015 global development framework continue at a frenzied pace. Given the scale and scope of increased globalization moving forward in a post-Millennium Development Goals era, to protect and realize health equity for all people, has never been more challenging or more important. The unprecedented nature of global interdependence underscores the importance of proposing policy solutions that advance realizing global responsibility for global health.DiscussionThis article argues for advancing global responsibility for global health through the creation of a Global Fund for Health. It suggests harnessing the power of the exceptional response to the combined epidemics of AIDS, TB and Malaria, embodied in the Global Fund to Fight AIDS, Tuberculosis and Malaria, to realize an expanded, reconceptualized Global Fund for Health. However this proposal creates both an analytical quandary embedded in conceptual pluralism and a practical dilemma for the scope and raison d’etre of a new Global Fund for Health. To address these issues we offer a logical framework for moving from conceptual pluralism in the theories supporting global responsibility for health to practical agreement on policy to realize this end. We examine how the innovations flowing from this exceptional response can be coupled with recent ideas and concepts, for example a global social protection floor, a Global Health Constitution or a Framework Convention for Global Health, that share the global responsibility logic that underpins a Global Fund for Health.ConclusionsThe 2014 Lancet Commission on Global Governance for Health Report asks whether a single global health protection fund would be better for global health than the current patchwork of global and national social transfers. We concur with this suggestion and argue that there is much room for practical agreement on a Global Fund for Health that moves from the conceptual level into policies and practice that advance global health. The issues of shared responsibility and mutual accountability feature widely in the post-2015 discussions and need to be addressed in a coherent manner. Our article argues why and how a Global Fund for Health effectuates this, thus advancing global responsibility for global health.

Strengthening Midwifery to End Preventable Maternal, Child, and Newborn Deaths

During the 50th anniversary of the American College of Nurse-Midwives (ACNM) in 2005, a Call to Action was presented to the membership. This call addressed the severe healthcare workforce capacity issues the world was facing at the time and the resulting impact on maternal and child health outcomes in low resource countries.1 The components of the Call to Action revolved around the need for advocacy to improve working conditions for midwives in these low resource settings, specifically in the areas of health and safety, salary and benefits, and professional development. While some improvements have been made over the ensuing decade, many countries still face a profound deficit of healthcare workers. On the 60th anniversary of ACNM, we examine the persistent global shortage of healthcare workers and its impact on maternal, child, and newborn mortality and morbidity, the increased attention on midwives as we approach the post-millennium development goals era, and the work of ACNM in response to the Call to Action issued a decade ago.

Doing Biopolitics Differently? Radical Potential in the Post-2015 MDG and SDG Debates

The Millennium Development Goals (MDGs) have been critiqued as an ambitious project which sought to produce entrepreneurial neo-liberal subjects. From this perspective, the opportunities and dangers of the post-2015 debates acquire a more urgent importance than the cynical dismissal of the MDGs as ‘minimum development goals’. This article identifies two potentially radical shifts in development discourse offered by the proposals for global Sustainable Development Goals (SDGs): first, that they might be genuinely global and hence destabilise long-standing divisions between ‘developed’ and ‘developing’ societies; and second, that they might challenge existing growth paths of resource-intensive development. Two scenarios are offered through which these potential shifts are manifesting: first, a status-quo and growth-orientated outcome to the post-2015 agenda, and second, a more radical revisioning of development as a transformative project of global sustainability. However, even such an apparently attractive prospect as the latter has potential dangers, whether or not it is possible, which this article highlights. Whatever the outcome of the negotiations over the post-2015 SDGs, therefore, the process can tell us something about the opportunities and limits of processes of reform. The stakes could not be higher: whether a renewed and reshaped development project can drive future developmental governmentalities in radically new directions.