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Symposium on Public Health: Beyond the Millennium Development Goals (MDGs) – Challenges and Perspectives of Health Systems

Location: Munich, Germany

Date: 21.03.2015

The United Nations is working with governments, civil society, and other relevant partners to set an ambitious post-2015 development agenda. Aiming to contribute to the ongoing post - 2015 process, the Symposium addressed major challenges in key areas of health systems in achieving the Millennium Development Goals (MDGs) in low and middle income countries.

Discussing these challenges with the international speakers and the audience, the Symposium condensed following challenges that hampered the  most achievements of the MDGs: inadequate health workforce, weak information systems, inadequate health financing, insufficient drug supply, poor governance, and poor donor coordination.

Sessions and speakers

Challenges of Health Systems in Developing Countries in the Pursuit of the Millennium Development Goals (1.8 MB)
David B. Evans
Swiss Tropical and Public Health Institute, Switzerland

The Millennium Declaration of 2000 heralded a period of optimism that this pact between rich and poor countries would lead to sustained development and reduce inequalities. Focusing on health, indicated the resulting increases in funding and the health improvements that followed. However, problems emerged with verticality and fragmentation of health systems, and only limited progress in addressing some of the main health system constraints to progress. These will need to be addressed in the Sustainable Development Goal era and possible ways of doing this will be proposed.


Challenges of the Kosovo Health System in Achieving the MDGs (694 KB)
Ferid Agani, Former Minister of Health
Government of Kosovo, Kosovo

During 2010 – 2013, Kosovo Government has initiated substantial reforms in the health sector in close collaboration with relevant national and international stakeholders. The reforms were tuned by the regulation through the new Health Law, Health Insurance Law, Healthcare Professionals Chambers Law. The reforms were based in establishment of three organizational structures such as Healthcare Professional Chambers, University Hospital and Clinical Service, Health Insurance Fund (HIF). The Ministry of Health focused on policy-making, regulating, monitoring and evaluation. MDGs in Kosovo were also embedded in the sectorial reforms. Data indicated that there is improvement in maternal and child health in Kosovo, as well as number of the new HIV cases remain, with the TB new cases showing a plateau 2007 – 2010. Vertical programs (Global Fund, WHO, UNFPA, UNICEF and other relevant international agencies) helped to address and improve the health outcomes (MFGs); whereas horizontal approach through service lines aimed to improve rational use of resources. Strengthening and improving national health systems through systematic health sector reforms is shown to be of a paramount importance for optimal results in achieving MDGs. Results start to become obvious but there is still a lot to do.

The health of communities in situations of disaster and human conflict (2.0 MB)
Debarati Guha-Sapir
Université catholique de Louvain, Belgium

Pressures of aid effectiveness, resource constrains and demands for professionalism have shifted the paradigm in the aid effectiveness in using better evidence, efficient use of the resources and sounder methods of analyses. In 1988 EM-DAT Database was established with the initial support of WHO, USAID and Belgian Government. This data provide rapid and accurate information to serve purposes of humanitarian action at national and international levels.
Floods, storms followed by earthquakes are the most common causes of natural disasters since 1970. Economic impact of the disasters is measured as percentage of country’s GDP. Man made or natural disasters challenge the public health in exacerbating control, prevention and treatment of already existing diseases in the countries.

Professionalization of relief aids, coherence of the humanitarian and development aid and evidenced impact of need and trend in post disaster settings are directions towards the humanitarian aid is aiming at.


The performance health reform paradigm in the delivery of social services to achieve post MDGs - What is performance based financing? (1.1 MB)
Robert Soeters
SINA Health, The Netherlands

Motivation of the health work force is the central driving force of the efficiency and effectiveness of the health systems. In the global agenda access to health care was promoted as health all in 1975, then as improved access to quality of care 1978 and onwards through Bamako initiative and since 1998 as quality provision of health care packages considering equity dimension in beyond 2015 SDG introducing for a new paradigm “the performance reforms”.

Capitation performance based payment (CPBP) is considered flexible and pragmatic. It tries to “marry” the public interest with the private interest of health providers. It sets realistic revenue targets for providers to render quality services. If public resources are insufficient it gives space for direct cost sharing by the health service users.


Ebola, SARS and AIDS - how can national health systems work together in international pandemics? (3.4 MB)
Thomas Löscher
University of Munich, Germany

Pandemics compel health systems to respond in a timely and cooperative manner. National health systems take stock and learn from the experience of recent situations and experiences of neighboring countries. Aside from having national preparedness plans, there is also an opportunity for public-private cooperation in the management of pandemics.


Strengthening health systems to address emerging challenges in tuberculosis and HIV Care (1.3 MB)
Karina Kielmann
Queen Margaret University, Scotland

Significant changes to landscape of international development assistance are made since adoption of the UN Millennium Declaration and the Millennium Development Goals (MDGs). During the first decade of millennium marked by rise of high profile global health initiatives (GHIs). Primary objective was to reduce burden of major diseases of public health importance. Assistance for health nearly tripled between 2000 and 2011. There is a slow progress, but there are 35 million individuals living with HIV; close to 50% do not know their HIV-status. Challenges of retaining patients in care, reducing burden of paediatric infections remain. Tuberculosis remains the leading cause of death in most economically productive age-groups. Targets of 70% case detection and 85% treatment success rate have not been not reached in many countries. Only half of people who have active TB are diagnosed and treated – of those not diagnosed and treated, 75% will die prematurely.

Poorly functional health systems are unable to absorb and deliver the volume and quality of needed services by rapidly increasing resources through specific programs. Therefore, GHI produced unintended negative consequences such as reducing systems’ capacity to address the broader healthcare needs of the population and exacerbating systemic weaknesses.

Strong and effective health systems are a prerequisite to reducing disease burden and achieving health MDGs, rather than the outcome of increased investments in disease control. Strengthening of the health systems must go beyond resource investments, it should enhance individual and team motivation and capacity to contribute towards health systems goals by developing positive work cultures; integrating ‘real-life’ problem-solving approaches; improving mechanisms for internal and external social accountability of system; effective leadership development initiatives.


Academia, research and the MDGs (2.9 MB)
Michael Hoelscher
University of Munich, Germany

CIHLMU aspires to meet health-related challenges through capacity building in training and research. The program aims to advance developing countries partner universities in improving relevant research related to MDGs and promoting knowledge based policy. CIHLMU aims to achieve this through development and strengthening educational and clinical capacity, by promotion of highly qualified researchers in MSc and PhD programs and by training of experts and stakeholders.

Today CIHLMU has more than 50 registered PhD students, 130 supervisors, 50 lecturers with 600 hrs lecturing per year. The CIHLMU African - European partnership since1978 has supported the fight against HIV/AIDS through the Mbeya AIDS control programme. More than 60 million Euros of grants were acquired. Number of staff in Munich increased form 1 to 22 and in Tanzania to 180.

Panel Discussion

The Road to Dignity 2030: Ending Poverty, Transforming All Lives and Protecting the Planet
Participants among the speakers: F. Agani, K. Kielmann, R. Soeters, and M. Hoelscher
CIHLMU graduates: Muluembet Abera Wordofa (Ethiopia), Andreas Kudom (Ghana), and Eddy Odari (Kenya)
Moderator: Tessa Lennemann