The recent reviews of the progress made towards achieving the health Millennium Development Goals (MDGs) indicate that the progress made by many African countries has been slow when compared to the progress on the MDG on education (ECA, 2007, ECA, 2008, African Union Commission, 2008, Mwabu, 2008). The vast majority of African countries experienced negligible improvements in under-five mortality of 1.8% between 1990 and 2005, which translated to an annual improvement of 0.1% placing most countries significantly off track to achieving this goal (ECA, 2008). Available data also suggest very little improvements in reducing infant and maternal mortality in many African countries. Recent data published by WHO and UNAIDS shows that in most sub-Saharan Africa countries, national HIV prevalence has either stabilized or is showing signs of decline. However in spite of this positive development, AIDS remains the leading cause of death. The trend in tuberculosis incidence, prevalence and morbidity has been on the rise in Sub-Saharan Africa and malaria is the leading cause of child mortality and of anaemia in pregnant women in much of Africa.
Studies and different meetings indicate that the factors constraining the progress towards achieving the health-related MDGs include those within and outside the health sector. Obstacles within the health systems include factors within the health systems such as poor physical infrastructure; inequality in the coverage of services between urban and rural areas; inadequate human resources; limited access to health technologies; inadequate and unpredictable funding; deficiencies in access to essential medicines and vaccines; the HIV/AIDS pandemic that overwhelms health systems; and poor harmonization and alignment to national priorities. The major obstacles related to the social, economic and environmental determinants of health include poverty and hunger; limited education; poor hygiene and health literacy; gender inequality; unsafe water, poor sanitation, housing and other environmental problems; migration; social exclusion; recurrent internal conflict and humanitarian emergencies (such as floods, drought and other natural disasters); and impact of trade policies such as Trade related aspects of intellectual property rights (TRIPs).
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