The Sustainable Development Goals set of 17 objectives, each with specific targets, to be achieved worldwide over the next 15 years seek to stimulate action to eradicate poverty, protect the planet, ensure prosperity for all and strengthen universal peace and freedom. These lofty objectives are result of the foundation laid by the Millennium Development Goals (MDG).
MDGs are a critical building block toward establishing a stable foundation for our development efforts beyond 2015.
(United Nations: The Millennium Development Goals Report 2014. Ban Ki-Moon. NY, 2014)
MDGs were put forth in 2000, 8 goals in all, with 3 of the goals directly linked to health care. MDG 4 (Reduce Child Mortality), MDG 5 (Improve Maternal Health), MDG 6 (Combat HIV/AIDS, Malaria and other diseases) all specifically tailored to engage specific age group (No 4 and No 5) and to address HIV and malaria with "other diseases", whatever this means, was mentioned sparingly! Was the MDG targets met?
The MDG report 2012 put it this way," The Millennium Development Goals (MDGs) agreed to by world leaders over a decade ago have achieved important results."
The MDG report 2014, Ban Ki Moon, in his foreword succinctly put the the actualization of MDG targets thus:
"This report examines the latest progress towards achieving the MDGs. It reaffirms that the MDGs have made a profound difference in people’s lives. Global poverty (MDG 1) has been halved five years ahead of the 2015 time frame. Ninety per cent of children in developing regions now enjoy primary education (MDG 2), and disparities between boys and girls in enrollment have narrowed (MDG 3). Remarkable gains have also been made in the fight against malaria and tuberculosis, along with improvements in all health indicators (MDG 6). The likelihood of a child dying before age five has been nearly cut in half over the last two decades (MDG 4). That means that about 17,000 children are saved every day. We also met the target of halving the proportion of people who lack access to improved sources of water (MDG 7)."
While the challenges in the eye care community like Cataract, Glaucoma, Low vision, Retinopathies, childhood blindness, refractive errors were not mentioned in any of the MDG goals, little or nothing was concertedly done to ameliorate these challenges within this time frame. Though the World Health Organization had variously developed programs like Vision 2020, Right to sight; which is aimed at achieving reduction of treatable blindness like Cataract, low vision and refractive error, to achieve management of conditions like Glaucoma, eye health education, creating awareness of some chronic disease conditions with known ocular complications like Diabetes, Hypertension, Asthma, HIV, Thyroid, Ebola, Lassa, Zika diseases etc. The lack of synergy between eye care practitioners world over and the hype generated by the MDGs and now the SDGs seems not to be just there for the WHO Vision 2020, Right to Sight or is it?
Is there a way forward for eye care practitioners vis-a-vis Optometrists in Nigeria to key into the lofty objectives of the SDG since we seem to have missed out on the bigger picture of what The MDG stood for?
In June 2012, Rio +20 summit, a resolution was passed that ushered in the sustainable development goals blue-print which effectively took off 1 January 2016.
A striking part of the declaration that ushered in the Sustainable Development Goals reads in part,
"26. To promote physical and mental health and well-being, and to extend life expectancy for all, we must achieve universal health coverage and access to quality health care. NO ONE MUST BE LEFT BEHIND. We commit to accelerating the progress made to date in reducing newborn, child and maternal mortality (MDG 4) by ending all such preventable deaths before 2030. We are committed to ensuring universal access to sexual and reproductive health-care services (MDG 5), including for family planning, information and education. We will equally accelerate the pace of progress made in fighting malaria, HIV/AIDS, tuberculosis, hepatitis (MDG 6), Ebola and other communicable diseases and epidemics, including by addressing growing anti-microbial resistance and the problem of unattended diseases affecting developing countries. We are committed to the prevention and treatment of noncommunicable diseases, including behavioral, developmental and neurological disorders, which constitute a major challenge for sustainable development."(UN: Outcome Document of Summit for Adoption of the Post-2015 Development Agenda. 12/08/15.)
Out of the 17 goals and 169 targets, health care was mentioned in SDG 3. SDG 3 reads in part:
"Ensure healthy lives and promote well-being for all at all ages."
Out of the 169 targets expected to be met by the SDG, 9 targets are connected to SDG 3. Conference Statement on Sustainable Development Goals (The Network: Towards Unity For Health [www.the-networktufh.org] Johannesburg. 16 September 2015) summarized the 9 targets thus:
"3 of the targets are related to reproductive and perinatal health, 2 are related to environmental health, 3 are related to care for communicable, non-communicable diseases (including mental health) and addiction and 1 is related to universal health coverage."
No doubt that "the problem of unattended diseases affecting developing countries" is referring to the burden of visual handicap and blindness in the developing countries among other diseases.
According to estimates from the World Health Organization (WHO) Prevention of Blindness and Deafness Programme:
- About 285 million people are visually impaired worldwide: 39 million are blind and 246 million have low vision (severe or moderate visual impairment)
- About 90% of the world's visually impaired people live in developing countries.
Diseases like Cataract, Glaucoma, Refractive errors, Macular degenerations, Retinopathies etc are chronic and non-communicable diseases. The SDG declaration remains committed to "prevention and treatment of noncommunicable diseases" therefore it is pertinent on eye care professionals that we somehow key into the SDG and its attendant lofty ideals such that we would have a safer world, a healthy environment and a more prosperous humanity!
While the SDGs will be celebrated as the next attempt to make this earth better to live, it is clear that sustainable development is required for health and that good health is required for sustainable development. Health (SDG 3) is the result of inter-sectoral collaboration to alleviate poverty (SDG 1), improve the built environment (SDG 11, 13, 14, 15) including sanitation and water security (SDG 6) , address literacy (SDG 4), and provide access to good nutrition (SDG 2). The SDG involve both the collaborative effort of developed and developing nations to achieve a more equal and fair world, while also caring for the environment. In this context, SDG 3 can be equated to Equitable Health.
According to Amartya Sen (2002),
"Health equity (Equitable Health) cannot be concerned only with health, seen in isolation. Rather it must come to grips with the larger issue of fairness and justice in social arrangements (SDG 16), including economic allocations (SDG 8), paying appropriate attention to the role of health in human life and freedom. Health equity is most certainly not just about the distribution of health, not to mention the even narrower focus on the distribution of health care."
This brings me to the next point I highlighted in capital letters above:
NO ONE MUST BE LEFT BEHIND!
For an equitable health as echoed by the SDG, every aspect of health care is not only a prerequisite for sustained development, they are sacrosanct to the actualization of those goals and targets by 2030. We have a role to play as the arbiter of the eye care community in Nigeria and in Africa if we do not want to leave the over 90% of the 285 million visually handicapped persons behind! Majority of those with visual handicap are actually domiciled among us!
Access to health care services and universal health coverage are major determinants of equitable health as envisioned by the SDG.
The question to the Optometrist is, "How do you improve access to your services in line with the SDG objectives?"
On the area of Universal health coverage, I suggest you read up my blog on that topic:
1) http://optometrynaija.blogspot.com.ng/2015/05/national-health-insurance-scheme-nhis.html
2) http://optometrynaija.blogspot.com.ng/2015/05/national-health-insurance-scheme-nhis_8.html
3) http://optometrynaija.blogspot.com.ng/2015/05/national-health-insurance-scheme-nhis_22.html
4) http://optometrynaija.blogspot.com.ng/2015/05/national-health-insurance-scheme-nhis_30.html
I think the time to develop our objectives with time bound indicators and targets is now. 15 years is by the corner.
