MDGs and NTDs: Reshaping the Global Health Agenda

The United Nations (UN) Millennium Development Goals (MDGs) expire in 2015. A high-level panel, appointed to discuss the global development agenda post-2015, reported back in May 2013 with its recommendations. These are likely to prove extremely important for determining the global health budget over the coming decade. Who the “winners”—those who will benefit from UN endorsement and enhanced funding—and the “losers”—those not receiving such recognition or resources—will be in the new agenda is not yet decided, but certain parties hope that this time around NTDs will gain a special mention. The MDGs, established in 2000, gave a new prominence to the health issues affecting the poor. However, the spotlight they provided was restricted and derived from a top-down process of deliberation, rather than informed by inclusive analysis and/or a thorough prioritisation of development needs. Subsequently, the narrowly focused and largely sector-specific MDGs left gaps in coverage and failed to realise synergies between the foci covered by the goals (education, health, poverty, and gender) [1]. MDG 6 in particular—“combat HIV/AIDS, malaria and other diseases”—sidelined many of the communicable and non-communicable diseases that perpetuate the cycle of poverty in developing countries. And yet, the very act of naming HIV/AIDS and malaria raised the profile of these diseases immeasurably. It stimulated a reconfiguration of official development assistance for health. Global health initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and the President's Emergency Plan for AIDS Relief (PEPFAR) ushered in an era of vertical aid on an unprecedented scale and diverted resources away from existing health programmes [2]. In this funding climate, diseases were pitted against one another and advocacy groups were left to argue that it was their disease being referred to in the ambiguous wording “other diseases.” In this respect, the case of tuberculosis is instructive; the success of the tuberculosis campaigning was such that it is now widely assumed that it too received a special mention in the MDG 6. Of course, parallel to this misapprehension, tuberculosis was considered so central to the GFATM that it was even incorporated into the name; the extent to which this is due to lobbying or to the specific interactions between HIV/AIDS and tuberculosis has not been established. Clearly, however, effective networking and alliance building can blur the boundaries of the MDGs and raise the profiles of diseases.