MODULE 4: SUSTAINABLE DEVELOPMENT GOALS AND PRIMARY HEALTH CARE

**Sustainable Development Goals**

* are a universal call to action to end poverty, protect the planet and improve the lives and prospects of everyone
* blueprint to achieve a better and more sustainable future for all.
* 17 Goals are all interconnected, and in order to leave no one behind, it is important that we achieve them all by 2030.

GOAL 1. END POVERTY IN ALL ITS FORMS EVERYWHERE

* More than 700 million people, or 10 per cent of the world population, still live in extreme poverty today, struggling to fulfill the most basic needs like health, education, and access to water and sanitation
* Worldwide, the poverty rate in rural areas is 17.2 per cent—more than three times higher than in urban areas. 
* Moreover, The COVID-19 pandemic is reversing the trend of poverty reduction with tens of millions of people in risk of being pushed back into extreme poverty causing the first increase in global poverty in more than 20 years
* Economic growth must be inclusive to provide sustainable jobs and promote equality. Our active engagement in policymaking can make a difference in addressing poverty. Government can generate employment and job oppurtunities to the poor and marginalized.
* GOAL: To end poverty in all its forms everywhere by 2030.

GOAL 2. END HUNGER

* Extreme hunger and malnutrition remains a barrier to sustainable development and creates a trap from which people cannot easily escape.
* After decades of steady decline, the number of people who suffer from hunger – as measured by the prevalence of undernourishment – began to slowly increase again in 2015. Current estimates show that nearly 690 million people are hungry, or 8.9 percent of the world population – up by 10 million people in one year and by nearly 60 million in five years.
* The situation is likely to deteriorate even further owing to COVID-19 pandemic.
* Food security requires social protection to safeguard safe and nutritious food especially for children to transforming food systems to achieve amore inclusive and sustainable world.
* We can make changes in our own life—at home, at work and in the community—by supporting local farmers or markets and making sustainable food choices, supporting good nutrition for all, and fighting food waste.
* GOAL: To end hunger, achieve food security and improved nutrition and promote sustainable agriculture

GOAL 3. GOOD HEALTH AND WELL BEING

* Ensuring healthy lives and promoting well-being at all ages is essential to sustainable development.
* Currently, the world is facing a global health crisis unlike any other- COVID 19 is spreading human suffering, destabilizing the global economy and upending the lives of billions of people around the globe
* Healthy people are the foundation for healthy economies. Immunization is one of the world’s most successful and cost-effective health interventions
* Promoting and protecting your own health and the health of those around you
* ACCESS TO HEALTH CARE : If universal health coverage is to become a reality by 2030, growth in the provision and use of essential health services must greatly accelerate.

GOAL 4.QUALITY EDUCATION

* Education enables upward socioeconomic mobility and is a key to escaping poverty.
* Over the past decade, major progress was made towards increasing access to education and school enrollment rates at all levels, particularly for girls. Nevertheless, about 260 million children were still out of school in 2018 — nearly one fifth of the global population in that age group. And more than half of all children and adolescents worldwide are not meeting minimum proficiency standards in reading and mathematics. 
* Two-thirds of whom are women globally remained illiterate in terms of reading and writing skills. And the sheer magnitude of school closures due to COVID-19 is likely to set back progress on access to education.
* Lobby our governments to make firm commitments to provide free primary school education to all, including vulnerable or marginalized groups.
* GROUP THAT STRUGGLES FOR EDUCATION : Globally, around 5.5 million more girls than boys of primary school age were out of school 2018

GOAL 5. GENDER EQUALITY

* Gender equality is not only a fundamental human right, but a necessary foundation for a peaceful, prosperous and sustainable world. 
* There has been progress over the last decades: More girls are going to school, fewer girls are forced into early marriage, more women are serving in parliament and positions of leadership, and laws are being reformed to advance gender equality. 
* Despite these gains, many challenges remain: discriminatory laws and social norms remain pervasive, women continue to be underrepresented at all levels of political leadership, and 1 in 5 women and girls between the ages of 15 and 49 report experiencing physical or sexual violence by an intimate partner within a 12-month period.
* Advancing gender equality is critical to all areas of a healthy society, from reducing poverty to promoting the health, education, protection and the well-being of girls and boys.
* GOAL : To achieve gender equality and empower all women and girls.

GOAL 6. CLEAN WATER AND SANITATION   

* While substantial progress has been made in increasing access to clean drinking water and sanitation, billions of people—mostly in rural areas—still lack these basic services.
* Worldwide, one in three people do not have access to safe drinking water, two out of five people do not have a basic hand-washing facility with soap and water, and more than 673 million people still practice open defecation.
* Civil society organizations should work to keep governments accountable, invest in water research and development, and promote the inclusion of women, youth and indigenous communities in water resources governance.
* Civil society organizations should work to keep governments accountable, invest in water research and development, and promote the inclusion of women, youth and indigenous communities in water resources governance.
* GOAL : To ensure access to safe water sources and sanitation for all.

GOAL 7. AFFORDABLE AND CLEAN ENERGY    

* The world is making progress towards Goal 7, with encouraging signs that energy is becoming more sustainable and widely available. Access to electricity in poorer countries has begun to accelerate, energy efficiency continues to improve, and renewable energy is making impressive gains in the electricity sector. 
* Nevertheless, more focused attention is needed to improve access to clean and safe cooking fuels and technologies for 3 billion people, to expand the use of renewable energy beyond the electricity sector, and to increase electrification in sub-Saharan Africa.
* Countries can accelerate the transition to an affordable, reliable, and sustainable energy system by investing in renewable energy resources, prioritizing energy efficient practices, and adopting clean energy technologies and infrastructure.
* GOAL: To ensure access to affordable, reliable, sustainable and modern energy for all.

GOAL 8. DECENT WORK AND ECONOMIC GROWTH

* Sustained and inclusive economic growth can drive progress, create decent jobs for all and improve living standards. 
* One in five countries – home to billions of people living in poverty – were likely to see per capita incomes stagnate or decline in 2020. Now, the economic and financial shocks associated with COVID-19—such as disruptions to industrial production, falling commodity prices, financial market volatility, and rising insecurity—are derailing the already tepid economic growth and compounding heightened risks from other factors. 
* Governments can work to build dynamic, sustainable, innovative and people-centred economies, promoting youth employment and women’s economic empowerment, in particular, and decent work for all.
* GOAL : To promote inclusive and sustainable economic growth, employment and decent work for all.

GOAL 9. INDUSTRY, INNOVATION AND INFRASTRUCTURE

* Inclusive and sustainable industrialization, together with innovation and infrastructure, can unleash dynamic and competitive economic forces that generate employment and income.
* They play a key role in introducing and promoting new technologies, facilitating international trade and enabling the efficient use of resources. 
* However, the world still has a long way to go to fully tap this potential. Least developed countries, in particular, need to accelerate the development of their manufacturing sector if they are to meet the 2030 target, and scale up investment in scientific research and innovation. 
* The growth of new industries means improvement in the standard of living for many of us. If industries pursue sustainability, this approach will have a positive effect on the environment.
* GOAL: To build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation

GOAL 10. REDUCED INEQUALITIES    

* Reducing inequalities and ensuring no one is left behind are integral to achieving the Sustainable Development Goals. 
* Inequality within and among countries is a persistent cause for concern. Despite some positive signs toward reducing inequality in some dimensions, such as reducing relative income inequality in some countries and preferential trade status benefiting lower-income countries, inequality still persists.
* Political, economic and social policies need to be universal and pay particular attention to the needs of disadvantaged and marginalized communities.

GOAL 11.SUSTAINABLE CITIES AND COMMUNITIES

* The world is becoming increasingly urbanized. Since 2007, more than half the world’s population has been living in cities, and that share is projected to rise to 60 per cent by 2030. 
* Cities and metropolitan areas are powerhouses of economic growth—contributing about 60 per cent of global GDP. However, they also account for about 70 per cent of global carbon emissions and over 60 per cent of resource use. 
* Rapid urbanization is resulting in a growing number of slum dwellers, inadequate and overburdened infrastructure and services (such as waste collection and water and sanitation systems, roads and transport), worsening air pollution and unplanned urban sprawl. 
* Rapid urbanization is resulting in a growing number of slum dwellers, inadequate and overburdened infrastructure and services (such as waste collection and water and sanitation systems, roads and transport), worsening air pollution and unplanned urban sprawl. 
* GOAL : To make cities inclusive, safe, resilient and sustainable

GOAL 12. RESPONSIBLE PRODUCTION AND CONSUMPTIOM

* Worldwide consumption and production — a driving force of the global economy — rest on the use of the natural environment and resources in a way that continues to have destructive impacts on the planet. 
* Economic and social progress over the last century has been accompanied by environmental degradation that is endangering the very systems on which our future development — indeed, our very survival — depends. 
* Reducing food loss and waste can contribute to environmental sustainability by lowering production costs and increasing the efficiency of food systems.
* GOAL: To ensure sustainable consumption and production patterns.

GOAL 13. CLIMATE ACTION

* Climate change is affecting every country on every continent. It is disrupting national economies and affecting lives. Weather patterns are changing, sea levels are rising, and weather events are becoming more extreme.
* Although greenhouse gas emissions are projected to drop about 6 per cent in 2020 due to travel bans and economic slowdowns resulting from the COVID-19 pandemic, this improvement is only temporary. Climate change is not on pause. Once the global economy begins to recover from the pandemic, emissions are expected to return to higher levels.
* Saving lives and livelihoods requires urgent action to address both the pandemic and the climate emergency.
* To address climate change, we have to vastly increase our efforts.The world must transform its energy, industry, transport,food, agriculture and forestry systems to ensure that we can limit global temperature rise to well below 2°C, maybe even 1.5°C.

GOAL 14. LIFE BELOW WATER

* The ocean drives global systems that make the Earth habitable for humankind.
* Careful management of this essential global resource is a key feature of a sustainable future. However, at the current time, there is a continuous deterioration of coastal waters owing to pollution, and ocean acidification is having an adversarial effect on the functioning of ecosystems and biodiversity. This is also negatively impacting small scale fisheries. 
* Saving our ocean must remain a priority. Marine biodiversity is critical to the health of people and our planet. Marine protected areas need to be effectively managed and well-resourced and regulations need to be put in place to reduce overfishing, marine pollution and ocean acidification.
* According to UNESCO, the ocean can be an ally against COVID 19 – bacteria found in the depths of the ocean are used to carry out rapid testing to detect the presence of COVID-19. Marine fisheries provide 57 million jobs globally and provide the primary source of protein to over 50% of the population in least developed countries.

GOAL 15. LIFE BELOW LAND

* Nature is critical to our survival: nature provides us with our oxygen, regulates our weather patterns, pollinates our crops, produces our food, feed and fibre. But it is under increasing stress. 
* Human activity has altered almost 75 per cent of the earth’s surface, squeezing wildlife and nature into an ever-smaller corner of the planet.
* Around 1 million animal and plant species are threatened with extinction – many within decades – according to the 2019 Global Assessment Report on Biodiversity and Ecosystem Service.
* The report called for transformative changes to restore and protect nature.
* Increased demand for animal protein, a rise in intense and unsustainable farming, the increased use and exploitation of wildlife, and the climate crisis are all driving the increased emergence of zoonotic diseases – diseases transmitted from wildlife to people – like COVID-19.

GOAL 16. PEACE, JUSTICE AND STRONG INSTITUTION

* Conflict, insecurity, weak institutions and limited access to justice remain a great threat to sustainable development. The number of people fleeing war, persecution and conflict exceeded 70 million in 2018, the highest level recorded by the UN refugee agency (UNHCR) in almost 70 years. 
* In 2019, the United Nations tracked 357 killings and 30 enforced disappearances of human rights defenders, journalists and trade unionists in 47 countries.
* And the births of around one in four children under age 5 worldwide are never officially recorded, depriving them of a proof of legal identity crucial for the protection of their rights and for access to justice and social services.
* Governments, civil society and communities must work together to implement lasting solutions to reduce violence, deliver justice, combat corruption and ensure inclusive participation at all times. 
* GOAL : Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels.

GOAL 17.PARTNERSHIPS FOR THE GOALS

* The SDGs can only be realized with strong global partnerships and cooperation.
* A successful development agenda requires inclusive partnerships — at the global, regional, national and local levels — built upon principles and values, and upon a shared vision and shared goals placing people and the planet at the center.
* Many countries require Official Development Assistance to encourage growth and trade. Yet, aid levels are falling and donor countries have not lived up to their pledge to ramp up development finance.
* This will be primarily the responsibility of countries. Reviews of progress will need to be undertaken regularly in each country, involving civil society, business and representatives of various interest groups

PRIMARY HEALTH CARE

* In 1978 world leaders, international organizations and health authorities gathered in Alma-Ata (now Almaty), Kazakhstan, and released the Declaration of Alma-Ata on Primary Health Care, which remains a landmark document in the history of global health.
* The Alma-Ata Declaration established a standard of public commitment to making community-driven, quality health care accessible, both physically and financially, for all.

Primary Health Care according to the Alma Ata Declaration of 1978:

* Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation
* It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community.
* It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process (Declaration of Alma, 1978)

ELEMENTS OF PRIMARY HEALTHCARE

1. health education
2. promotion of food and water supply and nutrition
3. maternal and child care
4. prevention and control of endemic disease
5. appropriate treatment of disease and injuries
6. provision of essential drugs

Principles of PHC:

1.Accessibility

2.Community participation

3.Health Promotion

4.Appropriate Technology

5.Inter-sectoral Cooperation

PHC Implementation in the Philippines:

1. The Department of Health commenced the implementation of PHC in 1979. It started on a pilot basis in twelve provinces representing each region.
2. In 1981, the DOH launched PHC nationwide.
3. From 1979-1985, there were notable accomplishments which include among many others, establishment of organizational and structural set up, laying the groundwork for the District Health system, Initiation of PHC training and orientation, training of BHWs, Setting up of Botika sa Barangay, establishment of medical herbal garden concoction and many more
4. In 1986 to 1989, during the Aquino administration, the initiatives started by the Marcos administration came to realization. The utility of the PHC approach was firmed up. The funding for PHC finally approximated the WHO suggested figure of five percent of GNP.
5. Despite the increasing efficacy of PHC approach, there were operational problems encountered.
6. Health targets in 1987 were largely met, however, the percentage of malnourished children at that time increased from 20% in 1980 to 33.3% in 1987. This setback may not be attributed to PHC; still implementers believed that this can be enhanced.

Problems encountered in PHC include

1. Community based activities were not filtered down to the depressed sectors of the population
2. Difficulty in sustaining community participation, use of appropriate technology, BHWs and the Botika sa Barangay
3. Low level of motivation and interest among health workers in carrying out their responsibilities
4. Technical skills of health workers in CO and communication were inadequate
5. Interagency linkages were weak
6. Attitudinal problems of health workers and communities
7. Low levels of trust between NGOs and the DOH personnel because of past conflicts
8. lack of sustained political will
9. Poor economic conditions and peace and order problems in some areas inhibited community participation
10. Management skills of middle managers and implementers are inadequate
11. High inflation rate resulted in high cost of medicines and medical equipment as well as hospitalization
12. Inadequate reporting systems
13. Weak referral system
14. Inequitable distribution of health manpower

Recommendations to address these problems were offered.

1) Truly decentralizing the rural oriented health system

2) Defining the roles of the DOH and the NGOs and Decentralizing decision making and accountability

3) Strengthening of intersectoral communication

4) Holistic approach to community development

5) Strengthening the monitoring capability of the health system

6) Studies on PHC activities and their outcomes must be undertaken

7) Policies and guidelines for the use of PHC funds must be clearly defined

PHC: 1987 to 1993.

* Its implementation during this period was influenced by the passage of the 1987 Constitution and the passage of the 1991 Local Government Code. It was also influenced by the two key health department executives since they assumed different postures toward it.
* Under Secretary Alfredo Bengzon (1987 to 1991), PHC was not given much attention. Monitoring of PHC implementation was not religiously done
* Partnership for Community Health Development was espoused, though it was not fully developed and carried out. In essence though, it subscribes to the basic ideas of PHC.

PHC: 1991 to 1993

* DOH Secretary Juan Flavier brought major revisions in the approach to PHC. PHC became the core strategy in the program thrusts of government at the national, local and community levels in order to enable people’s active participation and involvement for better health and self reliance

Accomplishments of PHC

1\. Recognition of volunteer health other than the BHWs.

2\. CO was highlighted as a basic approach to empowerment

3\. Expansion of the PCHD

4\. Plan to identify model PHC barangays

5\. Monitoring of PHC implementation by levels

6\. Preparation of BHW Operational Manual. Policy issues were also identified which includes the role of local chief executives, PCHD or PHC, the roles of the BHWs, the essence of devolution in local development management, monitoring levels of PHC, process documentation, sustainability of PHC activities and improving the management of health facilities in the locality.

focus on PHC

* The features of PHC allow the health system to adapt and respond to a complex and rapidly changing world.
* With its emphasis on promotion and prevention, addressing determinants, and a people-centred approach, PHC has proven to be a highly effective and efficient way to address the main causes of, and risk factors for, poor health, as well as for handling the emerging challenges that may threaten health in the future.
* UHC and the health-related SDGs can only be sustainably achieved with a stronger emphasis on PHC.