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Millennium Development Goals: Roles of Nurses to Achieve the Goals
Written by Mrs. Jane Freyana Tedja & Mr. Nyi Nyi Htay
March 2011
The millennium development goals (MDGs) are the upmost important mission of the world in the 21st century. It is the product of comprehensive analysis of the world’s economic, political, technological, environmental, health and social conditions highlighting on human rights, poverty and gender issues. During the period of 1990s, the world situation reflected an urgency of global actions timely respond to the complexity of various socioeconomic and health related problems such as escalating the number of people who were living under the international poverty line of less than $ 1.25 a day (1.8 billion); increasing the number of undernourished people (817 million); steadily raising the number of children out of school (over 106 million); high gender differences in school enrolment and paid employment; alarming under five mortality (12.5 million deaths) and maternal mortality (more than 500,000 deaths); spreading of HIV appears to be peaked (3.5 million people were newly infected in 1996); increasing the problem of inadequate water supply and sanitation; and very low proportion of people who could access high technology. The disadvantaged social groups such as the poor, racial/ethnic minorities, women, children, and rural population were more likely to experience these problems and poor access to health care services as they deserved. In addition, there are wide differences in the readiness of developing countries to face global economic integration; they are increasingly heterogeneous in their degree of development, productive capacity, human resource base and competitiveness (United Nations, 2010a; United Nations, 2007a).
In October 1994, the OECD (Organization for Economic Co-operation and Development) Centre and the OECD Development Assistant Committee (DAC) brought together representatives from its member countries at Paris for an informal experts’ consultation on ‘Public Knowledge and Public Attitudes to International Development Co-operation’, and made a declaration on Public Support for International Development’ in 1996. This declaration later delivered seven International Development Goals (IDGs) – the first seven of the eight MDGs – focusing on what should be done in developing countries to reduce poverty (OECD, 2000; OECD, 2004).
In 8 September 2000, 189 world leaders met at the United Nations Headquarters in New York and endorsed the Millennium Declaration, a commitment to develop a global partnership to
build a safer, more prosperous and equitable world (United Nations, 2000). The declaration was then thoroughly translated into a roadmap setting out eight time-bound and measurable goals to be reached by 2015, known as the Millennium Development Goals (MDGs) (UNDP, 2010).
According to UNDP (2005), MDGs encompass various dimensions necessary to improve economic and social conditions paralleled in all regions of the world such as freedom from extreme poverty and hunger, reducing the burdens of diseases, eliminating the problem of lack of shelter, security and exclusion as well as promoting gender equality, education, and environmental sustainability. All these dimensions reflect basic human rights and social responsibility, i.e., the rights of each person on the planet to health, education, shelter, and security.
The MDGs are built upon very strong fundamental values and philosophy essential for overall development of the world through local, regional and worldwide coordination and collaboration. These are (1) freedom – free from gender inequality, hunger and fear of violence, oppression or justice; (2) equality – no individual and no nation must be denied the opportunity to benefit from development, ensuring the equal rights and opportunities of women and men; (3) solidarity – global challenges must be managed in a way that distributes the costs and burdens fairly in accordance with basic principles of equity and social justice. Those who suffer or who benefit least deserve help from those who benefit most; (4) tolerance – human beings must respect one other, in all their diversity of belief, culture and language to promote a culture of peace and dialogue among all civilizations; (5) respect for nature – management of all living species and natural resources, in accordance with the precepts of sustainable development; and (6) shared responsibility – responsibility for managing worldwide economic and social development, as well as threats to international peace and security, must be shared among the nations of the world and should be exercised multilaterally (United Nations, 2000).
Regarding MDGs there are various questions to cover such as “What are the major components of MDGs?”; “Why these goals are important?”; “What is the most fundamental root for achieving MDG goals? and why?”; “What are the achievements of MDGs in 2009?”; “How about the progress of MDG in Thailand, Indonesia and Myanmar?”; “What are the major contributing factors enabling Thailand achieving MDG plus?”; “What are the challenges of MDG?”; “What are the significant obstacles in progress toward MDG?”; “What are the challenges of nursing and midwifery services to contribute to MDGs?”; and “What are the possible solutions to overcome these challenges and obstacles?”.
2. Major components of MDGs
There are eight millennium development goals encompassing 18 targets to be achieved by 2015 and 48 indicators for monitoring progress (shown in appendix-1). These goals are (1) eradicate extreme poverty and hunger; (2) achieve universal primary education; (3) promote gender equality and empower women; (4) reduce child mortality; (5) improve maternal health; (6) combat HIV and AIDS, malaria and other diseases; (7) ensure environmental sustainability; and (8) develop a global partnership for development (UNDP, 2010).
Goals one to seven are primarily results sought in developing countries, assisted by the partnership with the developed countries addressed in goal eight (OECD, 2004). Three of the eight Development Goals (goals four, five and six), eight of the 18 targets, and 18 of the 48 indicators are directly related to health (United Nations, 2003). Although the MDGs do not provide a comprehensive list of health targets (e.g., lacking specific indicators for reproductive health and non-communicable disease), they are an important milestone in progress towards health for all (United Nations, 2003).
2.1. Why these goals are important?
The MDGs are very important and valuable frame of reference to fight against the burdens of poverty, diseases, maternal and child mortality, illiteracy, gender inequities and environmental degradation through strengthening the global partnership approach. UNDP (2005) mentioned some reasons for the importance of MDGs. First of all, MDGs are the fulcrum of international development policy indicating the development of a new global partnership to reduce poverty, improve health, and promote peace, human rights, gender equality and environmental sustainability. Second, MDGs serve as an advancing the means to a productive life focusing on the key elements of adequate human capital, the essential infrastructure services, and the core political, social, and economic rights. Third, MDGs are critical for global security because the goals not only reflect economic targets, global justice, and human rights, they also are vital to international and national security and stability as emphasized by high-level panel on threats, challenges and change.
2.2. Seven drivers for achieving the MDGs
The key issues addressing to the MDGs are different among countries according to their own specific needs and opportunities. However, there are a number of common concerns and priorities. United Nations (2010b) recommended seven drivers or common opportunities for achieving the MDGs. They are (1) strengthening growth by stimulating domestic demand and intra-regional trade; (2) making economic growth more inclusive and sustainable; (3) strengthening social protection; (4) reducing persistent gender gaps; (5) ensuring financial inclusion; (6) supporting least developed and structurally disadvantaged countries; and (7) exploiting the potential of regional economic integration.
2.3. What is the most fundamental root for achieving MDG goals? And why?
On reviewing above seven drivers, it is found that economic development, social security, gender equality and international support are considered as the major issues in achieving the MDGs. Among them, ‘economic development and stable financial system’ is up most fundamental root for achieving MDGs because most of the drivers focus on this issue as well as it is directly related to eradicating extreme poverty and hunger, and indirectly influencing on the achievement of the remaining goals. Also, a strong global political consensus on the importance of responding poverty was incarnated by the adoption of the MDGs in 2000.
3. Achievement of MDG by the year 2009 across the regions focusing on Europe, Africa and Asia
3.1. Global achievement of MDGs in 2009
A decade after the Millennium Declaration, the significant achievements of MDGs throughout the world are generally indicated as noticeable reduction in poverty globally, significant improvements have been made in enrolment and gender parity in schools, reducing child and maternal mortality, increasing HIV treatments, ensuring environment sustainability and widespread utilization of mobile technology. Developing countries are increasingly incorporating the MDGs into their national development strategies, reforming policies and building institutions (UNDP, 2010).
3.2. Examples of Country-level Evidence
There are important synergies among the MDGs — acceleration in one goal often speeds up progress in others. For instances, gender equality and women’s empowerment have large multiplier impacts on other MDGs. Malawi’s national fertilizer subsidy programme has been associated with a 25 percent increase total cultivation area, ensuring economic self-sufficiency. Debt relief through Nigeria’s Virtual Poverty Fund was directed to agriculture and contributed to doubling agricultural production and farmers’ income. Abolition of school fees at the primary level contributed to surges of enrolment in Ethiopia, Ghana, Kenya, Mozambique, Nepal and Tanzania. In Bahrain, 98 percent of women participated in a referendum in 2001, paving the way for legislative reforms that gave Bahraini women full rights as citizens. Cambodia’s 100 percent Condom Use Programme contributed to twice as much condom use among sex workers. HIV prevalence declined from 1.2 to 0.7 percent between 2003 and 2008 (UNDP, 2010).
3.3. Achievement of MDGs across the regions between 1990 and 2009
Goal-1: Eradicate extreme poverty and hunger
The collective efforts towards achievement of the MDGs have made inroads in many areas. Progress on poverty reduction is still being made, despite significant setbacks due to the 2008-2009 economic downturn, and food and energy crises. In developing regions, the poverty rate dropped from 46% in 1990 to 27% in 2005 (1.8 billion in 1990 to 1.4 billion in 2005). The overall poverty rate globally is still expected to fall to 15 per cent by 2015, which translates to around 920 million people living under the international poverty line—half the number in 1990. However, the World Bank estimated that the crisis will leave an additional 50 million people in extreme poverty in 2009 and some 64 million by the end of 2010 relative to a no-crisis scenario, principally in sub-Saharan Africa and Eastern and South-Eastern Asia. Moreover, the effects of the crisis are likely to persist: poverty rates will be slightly higher in 2015 and even beyond, to 2020, than they would have been had the world economy grown steadily at its pre-crisis pace (United Nations, 2010a).
The undernourished populations decreased from 20 per cent (817 million) in 1990-1992 to 16% (830 million) in 2005-2007. South-East Asia, which was already close to the target in 2005-2007 made additional progress as did Latin America and the Caribbean and Eastern Asia. The prevalence of hunger also steadily declined in sub-Saharan Africa also. However, overall progress in reducing the prevalence of hunger has not been sufficient to reduce the number of undernourished people. Under-nutrition among children under five continues to be widely prevalent, due to both a lack of food and lack of quality food, increasing food prices, inadequate water, sanitation and health services as well as less than optimal caring and feeding practices (United Nations, 2010a).
Goal-2: Achieve universal primary education
Enrolment in primary education has continued to rise, reaching 89% in developing world. Total number of out of school is decreasing from 106 million in 1999 to 69 million in 2008. Major advances have been made in getting children into school in many of the poorest countries, most of them in sub-Saharan Africa (31 million), and Southern Asia (18 million). The gender gap in out of school population has also decreased from 57% in 1999 to 53% globally in 2008. However, in half of the sub-Saharan African countries, at least one in four children of primary-school age was still out of school in 2008 (United Nations, 2010a).
Goal-3: Promote gender equality and empower women
The developing regions as a whole are approaching gender parity in educational enrolment. In 2009, the girls’ primary and secondary-school enrolment in relation to boys was 91:100 and 88:100 respectively. For primary education, the steepest challenges are found in Oceania, sub-Saharan Africa and Western Asia. In secondary education, the gender gap in enrolment is most evident in the three regions where overall enrolment is lowest—sub-Saharan Africa, Western Asia and Southern Asia. In tertiary education, the ratio between girls and boys in the developing regions is close to parity, at 97 girls per 100 boys. However, in sub-Saharan Africa and Southern Asia, only 67 and 76 girls per 100 boys, respectively, are enrolled in tertiary levels of education (United Nations, 2010a).
Concerning gender parity in occupation, globally, the share of women in paid employment outside the agricultural sector has continued to increase slowly and reached 41% in 2008. But women in some regions are seriously lagging behind. In Southern Asia, Northern Africa and Western Asia, only 20% of those employed outside agriculture are women. Gender equality in the labour market is also a concern in sub-Saharan Africa, where only one in three paid jobs outside of agriculture are occupied by women. In addition, women were typically paid less and had less secure employment than men. Moreover, top level jobs still go to men where only one in four senior officials or managers are women globally (United Nations, 2010a).
Goal-4: Reduce child mortality
Since 1990, the mortality rate for children under age five in developing countries dropped by 28% - from 100 deaths per 1,000 live births to 72 in 2008. Globally, the total number of under-five deaths declined from 12.5 million in 1990 to 8.8 million in 2008. This means that, in 2008, 10,000 fewer children died each day than in 1990. The greatest advances were made in Northern Africa, Eastern Asia, Western Asia, Latin America and the Caribbean, and the countries of the CIS. Ethiopia, Malawi, Mozambique and Niger have seen absolute reductions of more than 100 per 1,000 live births since 1990. However, many countries still have unacceptably high levels of child mortality and have made little or no progress in recent years. The highest rates of child mortality continue to be found in sub-Saharan Africa. In 2008, one in seven children there died before their fifth birthday; the highest levels were in Western and Central Africa, where one in six children died before age five (169 deaths per 1,000 live births). The leading causes of deaths were pneumonia, diarrhoea, malaria and AIDS which accounted for 43% of all deaths in children under five worldwide in 2008 (United Nations, 2010a).
Goal-5: Improve maternal health
A significant decline in maternal mortality ratio globally was reported. However, the rate of reduction is still well short of the 5.5% annual decline needed to meet the MDG target. The leading causes of maternal mortality in developing regions are haemorrhage and hypertension, which together account for half of all deaths in expectant or new mothers. Women received skilled assistance during delivery rose from 53% in 1990 to 63% in 2008. But, only one in three rural women in developing regions received the recommended care during pregnancy (United Nations, 2010a).
Goal-6: Combat HIV/AIDS, Malaria and other diseases
Globally, an estimated 33.4 million people were living with HIV in 2008, of whom 22.4 million are in Sub-Saharan Africa. Newly infected people marked reduced from 3.5 million in 1996 to 2.7 million in 2008. AIDS-related mortality had dropped from 2.2 million in 2004 to 2 million in 2008. The epidemic appears to have stabilized in most regions, although prevalence continues to rise in Eastern Europe, Central Asia and other parts of Asia due to a high rate of new HIV infections. Sub-Saharan Africa remains the most heavily affected region, accounting for 72 per cent of all new HIV infections in 2008 (United Nations, 2010a).
PLWHA who received ART had increased 10-folds from only 400,000 in 2005 to 4 million in 2008. Despite limited availability, approximately 2.9 million deaths have been averted because of antiretroviral drugs (United Nations, 2010a).
According to United Nations (2010a), half the world’s population is at risk of malaria, and an estimated 243 million cases led to nearly 863,000 deaths in 2008. Of these, 767,000 (89 per cent) occurred in Africa. Global production of mosquito nets increased fivefold since 2004 – rising from 20 million to 150 million in 2009.
The global burden of tuberculosis is falling slowly. The incidence fell from 143 cases per 100,000 people in 2004 to 139 cases per 100,000 in 2008. The prevalence rates have been falling in all regions except CIS countries in Asia and in sub-Saharan Africa. However, Tb remains second leading killer after HIV (United Nations, 2010a).
Goal-7: Ensure environmental sustainability
To maintain environmental sustainability, all the world’s governments are now legally obligated to phase out ozone-depleting substances under the Montreal Protocol. In addition, as a result of ambitious tree-planting programmes in several countries, the rate of deforestation shows signs of decreasing from 8.3 million hectares per year in 1990-2000 to 5.5 million hectares per year in 2000-2010 (United Nations, 2010a).
Access to drinking water improved in all developing regions, except Oceania. Four regions, Northern Africa, Latin America and the Caribbean, Eastern Asia and South-Eastern Asia, have already met the target of MDG. The most progress was made in Eastern Asia, where access to drinking water improved by almost 30 per cent over the period 1990-2008. However, globally, eight out of 10 people who still without access to an improved drinking water source live in rural areas. In addition, an estimated 2.6 billion people around the world lacked access to an improved sanitation facility. If the trend continues, that number will grow to 2.7 billion by 2015 and the target appears to be out of reach (United Nations, 2010a).
Goal-8: Develop a global partnership for development
Official development assistance (ODA) from developed countries continues to rise despite the financial crisis. Overall progress in development assistance was found in net debt forgiveness grants, humanitarian aid, multilateral ODA, bilateral development projects, programs and technical cooperation. Developing countries gained greater access to the non-discriminatory trading and markets of developed countries. Moreover, use of information and communications technology (ICT) continues to grow worldwide. By the end of 2009, global subscriptions to mobile cellular services had ballooned to an estimated 4.6 billion – equivalent to one mobile cellular subscription for 67 out of every 100 people (United Nations, 2010a).
3.4. Achievement of MDGs in focal countries
3.4.1. Myanmar (1990-2007)
Myanmar has scored noticeable achievements in carrying out its National Development Programmes reflecting the MDGs. Based on the present trend of progress, some of the MDG targets have already exceeded and some are expected to be achieved much earlier than the time frame. However, more efforts will be concerted to meet some of the targets by the year 2015.
Like other developing countries, poverty incidence also exists in Myanmar, particularly in the remote and border areas. Based on the results of nation-wide ‘Household Income and Expenditure Survey’ conducted in 2001, the estimated poverty rate was 20.7% for urban, 28.4% for rural and 26.6% for the union. The poverty gap ratio was 6.8% (Ministry of National Planning and Economic Development, 2005). UNDP/Myanmar (2007) stated that 23% of the country population lives in poverty and an estimated 10% of the population is food poor, which means that they cannot meet even basic food needs (minimum caloric requirements). The prevalence of underweight children under 5 years of age has declined to 31.8 in 2003 from 38.6 in 1997 (UNDP/Myanmar, 2007).
In the education sector, ‘net enrollment ratio in primary education’ and ‘proportion of pupils completing primary level’ have increased sharply from 65.7 and 24.5 respectively in1990 to 82.2 and 73.4 respectively in 2005. The literacy rate among 15 to 24 years old people has also increased from 80.9% in 1990 to 92% in 2007. The ratio of girls to boys in primary and secondary education reached to 96 and 103 respectively in 2007, from 92.83 and 93.64 in 1990 (Ministry of National Planning and Economic Development, 2006; UNDP/Myanmar, 2007).
Under-5 mortality rate and infant mortality rate are on a descending trend, representing 130 per 1000 live births and 98 per 1000 live births in 1990 and 62.1 per 1000 live births and 43.4 per 1000 live births in 2007 respectively. However, maternal mortality rate is still Myanmar’s burden and it has increased from 2.5 per 1000 live births in 1999 to 3.16 per 1000 live births in 2005 (Ministry of National Planning and Economic Development, 2007; Ministry of Health, 2010).
HIV prevalence in Myanmar has reduced from 1.5% in 2000 to 1.3% in 2005. The death rate of malaria was 11.2 per 100,000 in 1992, but it has gradually descended to 3.1 per 100,000 in 2005. The prevalence rate also came down from 18.7 per 1,000 to 9.3 per 1,000 during the same period. Prevalence and death rate of all TB cases/100,000 population is 419/100,000 and 50/100,000 in 1990 respectively. According to WHO Global TB control surveillance, planning and financing report 2006, the prevalence and death rate reduced to 180/100,000 and 21/100,000 population in 2005 (UNDP/Myanmar, 2007).
To address the environmental sustainability, only 38% of population could access safe drinking water in 1990, but this rate increases to 63% in 2007. The sanitation coverage was increased from 39% in 1990 to 67% in 2007 (UNDP/Myanmar, 2007).
The proportion of population with access to affordable essential drugs on a sustainable basis has increased from 17.5% in 1997 to 74% in 2005. Telephone lines per 1000 population and personal computers per 1000 people have increased from 9.4 and 10.6 in 2004 to 12.1 and 11.2 in 2006 respectively. The government has been cooperating with the UN agencies and international organizations to achieve the goals of MDG (UNDP/Myanmar, 2007).
3.4.2. Indonesia (1990-2007)
Prior to the recent global financial downturn, Indonesia’s economy had largely recovered from the Asian financial crisis of the late 1990s. Indonesia is considered as a lower-middle-income country in 2007. Indonesia has undergone significant economic reforms under present President S.B. Yudhoyono where economy has grown approximately 6 percent per year since 2005 (USAID, 2009). To some extent MDG results revealing satisfactorily achieved; however the successful progress is uneven experienced in some regions. The contributing factors to the slowing down progress likewise in other part of the globe such as climate change, global warming, prolonged drought season, prolonged rainy season and huge floods affect the plantation and cultivation, including the Tsunami disaster in 2004, other nature disaster such as earthquakes or landslides, and unrest regional social-politic environment. Off which cause quite a number of affected victims or refugees from particular society conflicts, or natural disasters moving away from those afflicted areas. Furthermore, causing rapid urbanization without appropriate settlement, sufficient income or became jobless, living with poor facilities, thus affects the marginal population’s quality of life.
Experts anticipate Indonesia’s economy to slow down, yet hold the estimation it will grow by 4-6 percent in 2009. Nevertheless, nearly 18 percent of the population continues to live below the poverty line, while 49 percent of the population lives on less than US$ 2 per day (World Bank, 2006). In the view of MDGs indicators while referring to the international criteria of $1 per day, the proportion of poor population in Indonesia in 1990 was 20.6 percent. In effect, this means Indonesia had already achieved the 2015 MDG target of 10.3 percent by 1996. On the other hand, using the $2 a day criteria gives quite a different picture: poverty fell from 71 percent to 54 percent from 1990 to 2002, making the target for 2015 as 35.5 percent. This reflects that Indonesia has been successful in eradicating extreme poverty, but still has to in some way continue in eradicating moderate poverty (Ministry of Health and Central Bureau of Statistics, 2004).
Malnutrition children-under five (in %) that in 1992 revealed 35.57 of the total population, slowly decreased to 24.66 percent in 2000. However, there are still some disparities between urban and rural areas, and between rich and poor groups, although these gaps have narrowed since 1995 (United Nations, 2010c).
Data from the National Socio-Economic Surveys (Susenas) showed that Indonesia has achieved high levels of access to primary education for children aged 7 to 12 years. The literacy rate among 14-24 age group has increased from 96.6 per cent in 1992 to 98.7 percent in 2002. The primary school gross enrolment ratio in 1995 was 104.9 percent which had increased to 108.9 percent in 2006. In 1992, the primary school net enrolment ratio stood at 88.7 percent and by 2006 it had reached 94.7 percent. Meanwhile the junior high school net enrolment ratio for 1992 was 41.9 percent and it had increased to 66.5 percent in 2006 (State Minister of the National Development Planning, 2007; United Nations, 2007b).
Concerning gender equality issue, the participations of females in the work force are far lower than for the male population and female participation in the work force was around half of that of males. Based on data gathered from the National Work Force Survey (Sakernas), the female work force participation rate was gradually declined from 51.78% in 2001 to 49.5% in 2007 (State Minister of the National Development Planning, 2007).
On reviewing the status of maternal and child health, the under-five mortality rate per 1000 decreased from 97 in 1990 to 40 in 2007 as to the target MDG by 2015 should be decreased more to 32; however this target likely to be achieved. Also, infant mortality rate per 1000, that was 57 in year 1990, already decreased into 32 in 2007, and the target MDGs per 2015 indicates to be achieved 19. For maternal mortality rate per 100.000, that was high to reach 390 in 1990, could be reduced to 307 by the 2007, as still have to be reduced more until 110, according to Target MDG per 2015 (BAPPENAS and UNDP, 2007).
The average life expectancy at birth was 67 years in 2007. Diarrheal disease, pneumonia and dengue hemorrhagic fever are the major causes of child mortality, where the main causes of death across all ages of the population over five years old are stroke, TB, and injuries (UNAID, 2009). Ischemic heart disease, lower respiratory infections, malaria, HIV/AIDS, and nutritional deficiencies also contribute to mortality rates (WHO, 2007).
In regard with Health Systems in 2006-Report, hospital beds (per 10.000 population) was 2.5 and physician density (per 100.000 population) was 13 (Report of 2003); nursing density (per 100.000 population) was 62 and Midwife density (per 100.000 population) was 20 (WHO/WHOSIS, 2006). Despite improving overall trends in delivery care, most poor pregnant women deliver at home and 35 percent of women in the lowest income quintile deliver without the benefit of a skilled birth attendant. Infant and child mortality rates are more than four times higher among the poorest quintile (World Bank, 2006).
In terms the usage of piped water in households, hard to present in this paper, nonetheless, piped water still very scarce to get for people in regions far from the capital cities. People still used water from rivers, polluted water, or earth-water without proper sanitizing system.
3.4.3. Thailand (1990-2004)
Thailand has already achieved almost all the targets of MDG and has initiated MDG-plus since 2004. According to the ‘Thailand Millennium Development Goals Report 2004’, between 1990 and 2002, the proportion below national poverty line has dramatically decreased from 27.2% to 9.8% and the number of poor dropped from 15.3 million to 6.2 million over this period. This data indicated that Thailand has already achieved the 2015 MDG poverty target of 13.6%. The prevalence of underweight children under five years of age has reduced very close to 2015 MDG target of 9.3%, indicating 18.6% in 1990 and 8.6% in 2002. Since the early 1990s, gross enrolment at the primary level has been over 100% and lower secondary level has reached over 80%. Thai girls and boys have equal educational opportunities since early 1990s in all primary, secondary and tertiary level education. The literacy rates for 15-24 year old has remained high since 2000, 98% for male and 97% for female. In the same year, the illiteracy level among older people (age 40-59) was 9.9% for women and 5.3% for men. The targets ‘reduce under-five mortality rate by two thirds, between 1990 and 2015’ and ‘reduce the maternal mortality ratio by three-quarters, between 1990 and 2015’ are not applicable for Thailand because of very low starting point in 1990 ( under-five mortality was12.8 per 1000 live births and maternal mortality ratio was 36.2 per 100,000 live births). Annually new HIV infections have fallen dramatically from an estimated 143,000 in 1991 to about 19,000 in 2003. HIV prevalence among pregnant women had reduced from 2.3% in 1995 to 1.4% in 2002. The incidence and mortality rates of malaria have reduced 150 per 100,000 and 1.4 per 100,000 population in 1995 to 117 per 100,000 and 0.7 per 100,000 population in 2001 respectively. The prevalence of tuberculosis has slightly increased from 35.3 per 100,000 in 1990 to 51.8 per 100,000 population in 2000, and then gradually reduced to 48.4 per 100,000 in 2001. The proportion of population with sustainable access to an improved water source has increased from 96.5% (urban) and 76.4% (rural) in 1990 to 97% (urban) and 91% (rural) in 2000. In the same period, the proportion of people access to improved sanitation has also increased from 99% (urban) and 83.1% (rural) to 99.5% (urban) and 97% (rural). For the purpose of economic cooperation and human development, Thailand has taken a leading role in a wide range of regional and sub-regional cooperative initiatives such as the Association of South-East Asia Nations (ASEAN), Asia-Pacific Economic Cooperation (APEC), the Greater Mekong Subregion (GMS), Indonesia-Malaysia-Thailand Growth Triangle (IMT-GT), Bangladesh, India, Myanmar, Sri Lanka, Thailand Economic Cooperation (BIMST-EC), the Mekong-Ganga Cooperation (MGC), Asia Cooperation Dialogue (ACD), and the Ayeyawady-Chao Phraya-Mekong Economic Cooperation Strategy (ACMECS). Thailand also serves as an active role in global multilateral cooperation (Office of the National Economic and Social Development Board, 2004).
3.4.3.1. MDG plus in Thailand
MDG plus is the process to transform the MDGs into a floor instead of a ceiling for human development and ultimate commitment to these adapted goals (UNDP, 2004). It is a set of tailored and more ambitious development targets that go well beyond the internationally agreed MDG targets. For example, since the year 2000, Thailand has reached the international MDG poverty target of ‘halving, between 1990 and 2015, the proportion of people living in poverty’. In response, Thailand is now setting an MDG plus target of reducing the proportion of poor people to below 4% by 2009. Also, given the likely achievement of universal primary education, Thailand has set an MDG plus target of secondary education by 2015. Moreover, Thailand sets a more appropriate gender target of doubling the proportion of women in the national parliament, local government bodies and executive positions in the civil service by 2006. For the child health and maternal health, MDG plus targets encompass ‘reduce IMR to 15 per 1000 live births by 2006’, and ‘reduce maternal mortality ratio to 18 per 100,000 live births by 206’. Concerning HIV/AIDS, Thailand sets a new target of ‘reduce HIV prevalence among reproductive adults to 1% by 2006 (Office of the National Economic and Social Development Board, 2004).
The MDG Plus framework improves on the original MDG indicators in three important ways. First, it ensures that the indicators take into account quality information for more advanced monitoring that may be missing from the original MDG indicators. Second, it ensures that the scope of monitoring progress is expanded to measure the benefits to all members of Thai society. Third, it accounts for differences in geographic coverage, as aggregated national indicators may cover up serious regional and ethnic disparities. Overall, the MDG Plus indicators provide an important tool for consolidated and broad-based monitoring of human development in Thailand, at both national and sub-national levels (Office of the National Economic and Social Development Board, 2004).
3.4.3.2. What are the contributing factors enabling Thailand achieving MDG plus?
Good public policy and good efforts, geography of the country (management consideration), strong leadership, political commitment, active participation of the country population, increasing regional and international collaboration, and global partnership are the major contributors enabling Thailand achieving MDG plus targets.
4. Challenges and significant obstacles in the progress towards MDGs
4.1. Challenges of MDG
There are a lot of issues to be considered to achieve the goals of MDG. First of all, demographic transition is a major challenge in most of the countries. For example, increasing the number of aging population is associated with increasing chronic diseases and dependent population, consequently affects the national poverty index and burden of diseases. Also, epidemiological transition such as increasing the number of chronic diseases and emerging and reemerging diseases causes a considerable challenge to achieve the goal-6 of MDG. Environmental transition as evidenced by increasing the problem of deforestation, urbanization, ozone depletion and varieties of disasters, reflects a global problem to maintain environmental sustainability. Economic transition such as global economic crisis and unstable financial system is in recent years deters overall achievement of MDGs throughout the world. Technological transition likes increasing technology in all areas of human development but decreasing humanity is a major ethical issue in today society. In addition, political transition caused by changing government and political system is highly associated with each country’s commitment to achieve the goals of MDG. Finally, health care transition, for example changing health care policies, structure and system in accordance with millennium declaration (community based, client centered and humanistic approach rather than hospital based and task oriented approach) is very fundamental to achieve MDGs in the targeted time-frame.
4.2. Main obstacles to MDG
Unmet commitment, inadequate material and human resources, inaccessibility of high technology, lack of focus and accountability, insufficient dedication to sustainable development, unstable countries politically, un-rest situation, rapid urbanization, climate changes, and global food-economic-financial crises created the major obstacles toward achievement of MDGs, especially in the developing regions (United Nations, 2010a; United Nations, 2010b).
There is no one-size-fits-all explanation for failure or success in achieving the goals and UNDP (2005) delineated four main reasons for pitfalls in achieving the MDGs. First of all, the problem is due to poor governance, marked by corruption, poor economic policy choices, and denial of human rights. Secondly, many countries faced a poverty trap, with local and national economies too poor to make the needed investments. Thirdly, because of progress is made in one part of the country but not in others, so that sizable pockets of poverty persist. Even when overall governance is adequate, there are often areas of specific policy neglect that can have a monumental effect on their citizens’ well-being. Finally, these factors occur together, making individual problems all the more challenging to resolve.
Evidence shows that acceleration of progress is possible when strong government leadership, effective policies and institutional capacity, and scaling up public investments are complemented by adequate financial and technical support from the international community. The crisis and obstacles have presented major challenges to the global partnership for development but it has also brought with it new opportunities for strengthening it.
4.3. Efforts to get rid the obstacles
According to the Task Force Team MDG, MDGs is to be protected through fiscal stimuli, securing the MDGs through stronger social protection, open opportunities for cooperation, tracking the MDGs – trends and prospects. Some early crisis responses included new protectionist measures that threatened to undermine the aim of achieving an open, rule-based and non-discriminatory trade and financial system. Aid budgets in some donor countries have come under increasing stress because of the crisis. Yet at various international forums, including the recent United Nations conference, there has been clear recognition that globally concerted efforts are needed in order to find adequate responses to the crisis and the development challenge. This will require stronger multilateralism, including delivery on the agreed goals for strengthening the global partnership for development that are embodied in the 2000 United Nations Millennium Declaration (Task Force, 2009).
5. Challenges of MDG focusing on nursing profession
Maximizing the professional potentials in promoting health services in the action-contribution to MDG achievement is the up most fundamental issue of nursing taskforce today. There are number of challenges have to be addressed to maximize the contribution of nurses and midwives, including:- (1) the provision of quality education and effective health-service delivery, (2) management and retention of the health workforce, (3) motivation of nurses and midwives, (4) establishment of effective teamwork and collaborative partnerships, (5) recognition and management of the talent (skill sets) of nurses and midwives, and (6) the new nurses and midwives to be well-planned in their recruitment, training and maintain the strong retention program (WHO, 2008).
Inadequate policies and planning practices, lack of training opportunities, poor deployment and utilization of staff, nursing shortage, insufficient management of performance, limited career opportunity and poor working environment created extra-burdens on nursing and midwifery workforce to achieve MDG (International Council of Nurses, 2009; WHO, 2008).
6. Five core elements of 2008-2009 global program of work for nursing and midwifery development to achieve MDGs
According to the recommendations of WHO (2008), the core elements of 2008-2009 global program of work for nursing and midwifery development to achieve MDGs include:- (1) education and training emphasizing on both the quantity and quality of educational institution/ educators/ nurses and midwives as well as the innovative educational strategies, methodologies and technologies, (2) health-service provision ensuring the quality assurance by adoption of evidence based practice (best practice guidelines), (3) healthy workplace environments to improve working conditions and enhance positive professionalism and ethos spirit, (4) capacity building in leadership (talent management) by preparing nurses and midwives to be equipped with the skills and expertise required to enhance their talents and lead in the delivery of PHC, and by keeping on developing strategies for sustainable leadership amongst government chief nursing officers, and (5) partnerships program such as strengthening the scope and functions of nursing and midwifery partnerships through healthy networking system and developing resources and support for nursing and midwifery programs in PHC.
In addition, nurses and midwives should always be aware of upholding ethical and moral conduct of nursing, utilizing critical thinking in investigation and maximizing the efforts for quality research, cost-effective health marketing, and opening wider opportunities for pursuing higher level nursing education for nurses across various position and nationwide.
7. Conclusion and recommendations
MDGs provide directions to achieve better living conditions and welfare for countries all over the world. MDGs facilitate accessibility, equity, quality, accountability and fairness. Although most countries achieve the MDG targets, some even excess the required targets, however many countries slow or decline in their progression. It is most important that globally concerted efforts are needed in order to find adequate responses to the crisis and obstacles, development of strategic plan to overcome the challenges, establishment of stronger multilateralism in delivery on the agreed goals and sound strategy for strengthening the global partnership for development.
The following recommendation would be suggested by the graduate students group in the “Seminar on Millennium Development Goals: Roles of Nurses to Achieve the Goals”, held on 27th January, 2011 at the Faculty of Nursing, Siriraj Hospital.
1. Nursing scholars be the effective role model/leaders to continue transforming the invaluable spirits and directions of MDGs for the community in the larger scale across the nation. Seminar presenting groups to ponder seriously and continuously on issue “How do we nurses and midwives workforce in Asia regions would commit implement the MDG golden values into nursing education, services, and research?”
2. Starting from this point onwards, newcomer-leaders are to make even the greater changes for Nursing-Taskforce in Asia-countries through putting plan-activities into real actions:
ü MDG topic should be included in both under graduate and graduate nursing curriculum; all nursing instructors should be well educated for MDGs; the nursing competencies should cover the knowledge in regard to MDGs.
ü Nurses in any level of health services should be familiar with MDGs so that they can develop the projects to help achieving the goals of MDG. The nursing administrators should encourage the nurses to apply MDGs in their respective services.
ü The research in the area of health policy (MDGs) should be highlighted among nursing profession as well as other health care providers. In order to measure the achievement of MDGs, the evaluative research should be encouraged. There should be better mechanism to monitor the indicators of MDGs so that we can have the updated and accurate data.
3. Encourage the analytical studies pertaining the provision of quality education and effective health service delivery; management and retention of the health workforce; external and internal motivation of nurses and midwives; the establishment of effective teamwork and collaborative partnerships; recognition and management of the talent / skill sets of nurses and midwives; and the effective systems in recruitment, retention and training of new nurses and midwives, are also recommended.
4. Development of the synergetic and continual nursing research/studies in order to measure the objective achievements of MDGs stages – related Nursing issues within the country or through collaborative comparative-studies in Asian countries is urgently needed.
5. There should be better dissemination-mechanism to spread over the in-depth knowledge of MDGs, and do the appropriate monitoring system on the achievement of the MDG indicators so that we can have the continual updated and accurate data to improve the health condition of humankind.
8. References
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