§ Mr. BercowTo ask the Secretary of State for International Development for what reasons his Department is off course to meet its health targets in Africa, as noted on page 180 of the 2004 Departmental Report. [171685]
§ Hilary BennDFID's Public Service Agreement indicators for health in Africa are linked to internationally agreed targets. DFID is one of a range of organisations which have made a commitment to these targets—others include national governments, other bilaterals and multilaterals.
Targets to reduce child mortality and improve maternal health are particularly ambitious and challenging for sub-Saharan Africa (SSA). Many countries are seriously off- track and on current trends neither of the goals will be met by 2015.
Child mortality has multiple and complex causes. Four diseases are responsible for nearly half of all child deaths, and malnutrition is an underlying cause for many of the rest. But other factors, such as economic decline, inequality, inadequate education for girls, lack of access to safe water and sanitation, and in some countries the HIV/AIDS epidemic plays a role too. Several African countries have also experienced conflict and civil unrest, which restrict progress in reducing child mortality rates.
There has been little movement in rates of maternal mortality since 1990 and very recent progress is not easy to assess, due to lack of accurate data. Improving access to skilled care during delivery, and emergency obstetric care, where necessary, are key to reducing maternal mortality. The main constraints are weak and under-resourced health systems, in particular, the lack of appropriately skilled staff. Inadequate financing for health is a key constraint; current levels of spending in low-income African countries are way below what is needed to achieve the health targets. Addressing the broader determinants of poor health, and increasing health spend and the coverage and utilisation of interventions proven to reduce child and maternal mortality are both needed in order to make faster progress.
DFID is stepping up efforts to tackle the child and maternal health targets and is working with partners to make progress on increasing access to effective health services, including comprehensive reproductive health services, particularly for poor people. DFID is working to tackle the shortage of skilled health workers and also contributes to interventions in other sectors: education, transport, and sanitation, which are also needed to bring improvements.
Effective action requires, above all, political will to act. Great gains are likely when commitment to targets is translated into national poverty reduction strategies and budgets.