K Rajasekharan Nayar
Global Institute of Public Health, Ananthapuri Hospitals, Thiruvananthapuram, Kerala, India
Historically, targets and goals have been detrimental to the smooth functioning of health service system. This is due to a lack of an integrated overarching vision which gets marginalized in the rat race for achieving unrealistic targets. Goals and targets are often mixed up and targets rule the health services. Evidently, the target driven and time-bound approaches could place unrealistic demands on the existing fragile and crumbling delivery systems in the developing countries.1 Moreover, such goals and targets can lead to selective actions without an integrated vision.2 Now, there is recognition that target-driven programs can result in intensive, vertical and categorical programs which may distort the comprehensiveness of health services and this recognition is evident in the new international policy which is named as Sustainable Developmental Goals (SDGs) and touted as a more humane and socially sensitive developmental agenda to end poverty and ensure prosperity for all.
The new avatar recognizes that the earlier version of developmental goals, the Millennium Developmental Goals (MDGs) especially the goals related to maternal and child health agreed by the United Nations almost fifteen years back could not be realized due to the lack of an integrated approach. The new avatar recognizes the importance of social dimensions which include inequalities, poverty and social exclusion. There is some realization of integrating the past proclamations of the United Nations such as the Rio declaration, the MDGs and the social determinants agenda. Health is an integral part of the new goals although reduced considerably to just 3 out of the total 17 goals. Given this reduced thrust, there is a need to evolve specific actions with a health systems framework.3 The opportunities in maternal and child health, communicable diseases, non-communicable diseases including addiction, environmental health and universal health coverage with a vision anchored on the ideals of primary health care and socially oriented programs are immense.4 As reiterated many times by many public health scholars, the role of primary health care is evidently important in achieving progress in the stated actions and unfortunately this has been sidelined in the SDGs.4 An explicit commitment to the basic tenets of primary health care is needed given the kind of actions proposed in the SDGs.
Health system operates in a social space and the institution, its strategies, the technology, the personnel who put them into practice and above-all the recipients are governed by the social space and therefore contextual factors become important. A health systems approach which is essentially holistic and multi-dimensional in nature and the primary health care strategy which gives primacy to health services-people inter-phase are important tools for defining and implementing sustainable health goals which can lead to Universal Health Care. Homogenous and universal policies fail due to inappropriate use of these tools which is known to all and ignored by all in international policy formulation. Past experiences have given valuable lessons and let us hope that these will be followed in letter and spirit for achieving the stated goals for which we spend considerable intellectual and material resources.
Conflict of Interest: None declared
- Nayar KR. Gaps in Goals: The history of Goal-setting in Health Care in India. Oman Med J. 2011 Jan;26(1):1–3
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- Nayar KR, Razum O. Millennium Development Goals and Health Another Selective Development? International Studies. 2006 Apr 1;43(3):317–22
- Taylor S, Williams B, Magnus D, Goenka A, Modi N. From MDG to SDG: good news for global child health? The Lancet. 2015 Sep;386(10000):1213–4
- Pettigrew LM, De Maeseneer J, Anderson M-IP, Essuman A, Kidd MR, Haines A. Primary health care and the Sustainable Development Goals. Lancet. 2015 Nov 28;386(10009):2119–21
[Pubmed] | [Crossref]