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Governance and Financing of Global Public Health: The Post-2015 Agenda

The Costs of Health Care
Devi Sridhar
Claire E. Brolan
Shireen Durrani
Jennifer Edge
Larry Gostin

Fifteen years ago, in the wake of rising concerns over the lack of progress in reducing global poverty, the UN adopted the Millennium Development Goals (MDGs).1 All 189 United Nations Member States committed themselves to eight goals aimed at reducing global inequities between developed and developing countries by addressing the needs of the world's poorest and most vulnerable populations. The MDGs aimed to eradicate extreme poverty and hunger, achieve universal primary education, improve child and maternal health, combat the spread of HIV/AIDS and other diseases, ensure environmental sustainability, promote gender equality, and enhance the governance of development by means of financial reforms benefitting heavily indebted poor countries.2 Progress on some goals has been impressive: the target of halving the proportion of people whose income is less than $1 USD a day was achieved in 2010, five years ahead of the 2015 deadline. The target of halving the proportion of people who lack dependable access to improved sources of drinking water has also been met.3 Overall progress, however, has been"patchy" and"uneven," with"insufficient" and"sluggish" progress, particularly in sub-Saharan Africa and South Asia. The current global economic crisis also threatens future progress given that fiscal constraints are already jeopardizing the realization of the MDGs. Furthermore, fragmentation and lack of cohesiveness among donors financing health-related MDGs have promoted vertical approaches to planning, programs, monitoring, and reporting, such as those for HIV/AIDS and malaria, that are not sufficiently integrated with national health systems.5