Reassessing strategies for improving health

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7527.1271 (Published 24 November 2005) Cite this as: BMJ 2005;331:1271

Strategies in West and Central Africa need to be revised

  1. Niyi Awofeso, associate professor (niyi.awofeso{at}justicehealth.nsw.gov.au)
  1. School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia

    EDITOR—The first seven millennium development goals are mutually reinforcing and directed at reducing poverty in all its forms, and the last goal provides a framework for the attainment of the first seven. The countries in West and Central Africa remain the major outliers relative to this line.

    All of the 16 “desperately deprived” countries in the 2004-5 chronic poverty report are in sub-Saharan Africa; 12 are in West or Central Africa.1 Even the most optimistic estimates acknowledge that the goals will not be achieved in the stated time frame in these African regions.

    Given the current realities, a reassessment of the strategies to improve the goals in these regions should include:

    • Setting realistic targets and indicators that can be achieved within the next decade. For example, the goal of universal basic education in these regions is obviously unrealistic given high rates of long term poverty, high illiteracy among women, and poor funding of the education sector. Setting realistic goals for the next decade in these regions has a potential to motivate national governments and funding agencies to work towards achieving them2

    • Working in partnership with the World Bank to implement strategies suggested in the 2005 report (anchor reform efforts in country led strategies, improve the environment for private sector led economic growth, scale up human development services, dismantle barriers to unfair trading practices, and substantially increase the level and effectiveness of development assistance)3

    • Incorporating family planning activities into the millennium development goals in these regions, and provide adequate funding for promoting the goals' adoption.

    Although the third strategy is politically sensitive and vulnerable to “neo-Malthusian” criticisms, it is long overdue in these regions, where women have the highest parity in the world, making it increasingly difficult to deliver human development initiatives to those most in need.


    • Competing interests NA is keen to work with governments and non-governmental agencies to facilitate progress with regard to implementation of millennium development goals in West and Central Africa.


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