USAID’s new Global Health Strategic Framework, Better Health for Development
, lays out the agency’s major health priorities for the next five years. “Core global health priorities” include reducing maternal mortality, ensuring child survival and nutrition, fostering an “AIDS free generation,” and fighting infectious diseases. Family planning and reproductive health is listed as a key area for bilateral engagement. In particular, the strategy hopes to continue to “graduate
” countries from the agency’s family planning program, which since the 1980s has transitioned 21 countries into local ownership of family planning support. The strategy also takes stock of the shifting global health environment, noting the rise of the “BRICS” countries as new donors
and the need to strengthen public health systems in developing countries. “Already, private payments account for 50-80 percent of total health spending in Africa and Asia, leading to system inefficiencies, inequitable access, and health costs that prove catastrophic to individuals and families,” the report reads. In order to achieve its priorities within this context, the document sets out a number of strategies, including a focus on program sustainability, the empowerment of women, and integrated approaches to development
. Health, it says, “cannot be isolated from other development challenges.”
Speaking of health interventions, a team of researchers led by Aluisio Barros of the Federal University of Pelotas, Brazil, recently compared coverage data from more than 50 countries against an index of household wealth to estimate the most and least equitable interventions. The study, “Equity in Maternal, Newborn, and Child Health Interventions in Countdown to 2015: A Retrospective Review of Survey Data From 54 Countries,” published in The Lancet, found that “interventions with similar levels of overall coverage often have very different degrees of inequality.” According to the data, “the most inequitable indicator was skilled birth attendant, followed by four or more antenatal care visits, whereas the most equitable was early initiation of breastfeeding.” For example, though the average for attendance by a skilled birth attendant was 53.6 percent across the entire sample, the wealthiest fifth had an 84.4 percent coverage rate and the poorest stood at 32.3 percent. “Interventions that are usually delivered in fixed health facilities…tend to be the most inequitably distributed,” write the authors, with geographical access, financial barriers, and discrimination appearing as likely obstacles for the poor. The authors conclude that, although “concern about inequalities in maternal and child health in poor countries was conspicuously absent from the global agenda in the past,” the availability of new, intervention-specific data provides a means of targeting equity issues in health delivery more successfully.