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Research the Health-Related Millennium Development Goals (Mdgs)

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Research the Health-Related Millennium Development Goals (Mdgs) Open Access Research The health-related Millennium Development Goals (MDGs) 2015: Rwanda performance and contributing factors Médard Nyandekwe1, Jean Baptiste Kakoma1, Manassé Nzayirambaho1,& 1University of Rwanda, College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda &Corresponding author: Manassé Nzayirambaho, University of Rwanda, College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda Key words: Rwanda, Millennium Development Goals, Health-related targets Received: 23/10/2016 - Accepted: 06/08/2018 - Published: 26/09/2018 Abstract Introduction: The Millennium Development Goals (MDGs) 2015 are the eight international development goals adopted by the Millennium Summit of the United Nations in 2000 to which Rwanda is signatory. In 1990, Rwanda was at least one of the Sub-Saharan Africa countries with poor performance on health-related MDGs indicators. To date, despite the setbacks caused by the 1994 genocide, impressive performance is registered. The objective of the study is to document Rwanda gradual progress to achieving the health-related MDGs 2015 targets from 1990 to 2014/2015. Methods: The study is retrospective and comparative documenting the period of 1990 to 2014/15. Results: The performance of Rwanda on health-related MDGs 2015 targets is impressive despite the negative effects of the 1990-1994 civil wars and the 1994 genocide against Tutsi on 1990's levels. In effect, out of 17 health-related MDGs indicators, eleven (11) registered "remarkable" performances, i.e. reached global levels or fastened Vision 2020 targets attainment, two (2) registered "good performances", i.e. reached basic or revised own targets exhibiting overall impressive performance, while four (4) "weaknesses" are observed, i.e. accused gaps until now. The good governance, Vision 2020 effective implementation, consistent resources invested in health sector and the Rwanda Universal Health Coverage implementation contributed greatly to achieving the above health-related MDGs 2015 performance. Conclusion: Rwanda performance of health-related MDGS 2015 targets is impressive. However, some relative gaps still persist, and hence should be prioritized while implementing the emerging Sustainable Development Goals. Pan African Medical Journal. 2018;31:56. doi:10.11604/pamj.2018.31.56.11018 This article is available online at: http://www.panafrican-med-journal.com/content/article/31/56/full/ © Médard Nyandekwe et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pan African Medical Journal – ISSN: 1937- 8688 (www.panafrican-med-journal.com) Published in partnership with the African Field Epidemiology Network (AFENET). (www.afenet.net) Page number not for citation purposes 1 Introduction Methods The Millennium Development Goals (MDGs) are the eight This is a retrospective and comparative study documenting the international development goals that were established and adopted period of 1990 to 2015. Periodic national surveys and existing by the Millennium Summit of the United Nations in 2000 to which international relevant reports on the topic along with extensive desk Rwanda is signatory. These goals are the following: Goal 1: review on related data have been conducted. The basic universal eradicate extreme poverty and hunger; Goal 2: achieve universal official indicative and unanimous goals issued by United Nations primary education; Goal 3: promote gender equality and empower (UN) MDGs 2000 and the recent UN 2015 MDGs Report [4] have women; Goal 4: Reduce child mortality; Goal 5: improve Maternal been utilized with regards to MDGs goals, targets and indicators to Health; Goal 6: combat HIV/AIDS, Malaria and other diseases; Goal measure the progress and compare the Rwanda status with 7: ensure Environmental Sustainability, and Goal 8: develop a Global worldwide status. Rwanda own tracked sub-indicators were Partnership for Development [1]. The first seven goals are mutually excluded if no comparative data was retrieved in recent reviewed reinforcing and are directed at reducing poverty in all its forms. This WHO and UN MDGs reports. As all Rwanda health-related MDGs study addresses only the first, fourth, fifth, sixth, and the seventh indicators were dramatically reversed during the horrors of early health-related goals. The last (8th) goal is also concerned by the 1990s, some of them were referred to 2000 levels as starting line in study as a contributing factor to achieve them. The targets and the attempt of setting realistic basic indicators and targets. Along related indicators are presented in the results section. As regard to the MDGs 2015 lifetime, some Rwanda basic targets were revised the MDGs implementation and Performance, Rwanda displays a by the Government of Rwanda (GOR) in order to adapt them to the unique case. In 1990, Rwanda was one of the Sub-Saharan Africa Vision 2020 [5] expectations. Revisions were done according to (SSA) countries with poor performance on health-related MDGs observed and evidence-based improvements in the Rwanda indicators worsened by the civil war from 1990 to 1994 and the epidemiological profile, the Rwanda macro-economy, and the 1994 genocide against Tutsi [2, 3]. Whereas most of the Rwanda social health sector. These revisions were found in the publications on Rwandan health-related MDGs focus only on the Economic Development and Poverty Reduction Strategy 2008-2012 status aspect without providing a comprehensive and global view of (EDPRS1) [6]. Latest revised targets set for 2015 have been the situation, this study addresses the gap identified by providing supplied by the Result Framework on Third Health Sector Strategic following additional information: Persisting gaps up to date; Plan 2012-2018 [7] and by the MDGs Rwanda Progress Report 2013 Variation from 1990 up to 2015 including the setbacks resulted from [8]. the 1994 genocide against the Tutsi and health gain (from 2000) achieved during the MDGs lifetime; Contributing factors that stimulated and improved performance; and Comparison of current Results status with WHO African Region and WHO Global Region standards. The results are framed around the (i) Gradual progress from the The aim of this study is to document Rwanda gradual own progress starting line (1990) to 2015 comprised in main results' section and to achieving the MDGs 2015 health-related targets from 1990 to in Figure 1, Figure 2, Figure 3; (ii) Performance of main Rwanda 2014/2015. Specifically, the study: (1) presents current status of MDGs indicators between 1990 and 2014/2015 illustrated by Figure concluded Rwanda health-related MDGs 2015 and thus constituting 4; (iii) Persisting gaps up to date. If any, the gap is presented in the baseline for the emerging SDGs; (2) determines variation from simple deviation (Actual-Target) from the target and not in relative the year 1990 to 2014/2015 including the setbacks resulted from ((Actual-Target)/Target)*100 to avoid any confusion. As advantage, the 1994 genocide against Tutsi; (3) highlights persisting gaps up to the gap presented using "Actual-Target" will keep the same nature date; (4) compares current status with international levels and; (5) of indicator defined in absolute number instead of transforming all examines potential contributing factors that stimulated improvement gaps in percentages. (iv) Contributing factors that stimulated and and fastened targets attainment. improved performance. Page number not for citation purposes 2 GOAL 1: eradicate extreme poverty and hunger in 2000 decreased to 5% in 2005, 3% in 2010/2011 and to 2% in 2014/2015 [14]. The related Rwandan target set at 2% by 2015 Target 1: Between 1990 and 2015, halve the proportion of was then achieved. The progress achieved by Rwanda in reducing people living below the poverty line malnutrition is illustrated by the Figure 1. Indicator 1: proportion of population living below the GOAL 4: reduce child mortality poverty line Target 5: Between 1990 and 2015, reduce the under-five Globally, the poverty line indicator was defined by "the proportion of mortality rate by two-thirds the population living on less than $1 a day" [1] and presently less than $1.25 a day [4]. According to the first Integrated Household Indicator 13: under-five mortality rate per 1000 live births Living Conditions Survey (EICV1 2000/2001) [9], the Rwandan national poverty line defined in 2001 was calculated at RWF 64,000 In 1990, the indicator was 151.8 deaths/1000 [2], rose to 247/1000 and the extreme poverty line was calculated at RWF 45,000 in 1994 [2], decreased to 196.2 in 2000, 152% in 2005, 76% in constant prices 2001 per annum per adult equivalent. The poverty 2010/2011 and to 50 deaths /1,000 in 2014/2015 [14] as illustrated line indicator was 47.5% in 1990 [10], 77.8% in 1994 [10], 60.4% by Figure 2, attaining exactly the basic target set at 50 /1000 by in 2000/2001 [9], 44.9% in 2010 [11] and dropped to 39.1% in 2015. The gap worth 20 deaths to be reduced persists compared to 2013/2014 [12]. To be realistic, Rwanda decided to set the target at the Rwanda revised target set at 30 deaths per 1000 live births [7]. halving the 2000/2001's poverty line i.e. 30.2% by 2015, not achieved, instead of halving the 1990s' level i.e. 23.8%. In the same Indicator 14: infant mortality rate per 1000 live births period, the extreme poverty rate in Rwanda fell from 41.3% in 2000/2001 [9] to 16.3% in 2013/2014 [12]; the Rwanda own basic From 85/1000 in 1990 [2] , the indicator increased to 137 /1000 in target set i.e. the half of 2000/2001 level (20.7%) was achieved. 1994 [2] and declined to 107% in 2000, 86% in 2005, 50% in 2010/2011 up to 32/1,000 in 2014/2015 [14] as indicated by Figure Target 2: Between 1990 and 2015, halve the proportion of 2.
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