2017 Volume 66 Issue 4 Pages 395-401
In 2015, the sustainable development goals (SDGs) were ratified as the new global agenda for the Millennium Development Goals (MDGs). In this article, we review the progress in maternal and child health achieved during the MDG period and the remaining challenges for the SDG era, and stipulate the policy direction of global maternal and child health by referring to Japan’s past experiences in maternal and child health improvement. During the MDG era, a series of systematic review in the academic journal, Lancet, and the results of randomized controlled trials (RCT) conducted in India established evidence-based intervention in the MCH field. Through the SDGs discussions, maternal and child health, which showed delayed progress compared with infectious diseases in the MDG era, drew attention as "unfinished agenda" at the UN level. Reflecting this attention, the "Global strategy for women's, Strategies for children's and adolescents health (2016–2030)" was published. In the strategy, three aims were presented for maternal and child health: survive, thrive, transform. On the other hand, in the SDGs agenda, the universal health coverage (UHC), which simultaneously secures financial resources and an improvement in the quality of services, was proposed and its contribution to maternal and child health expected. However, considering the past experience of Japan in establishing the world’s first universal health insurance, the improvement of maternal and child health indicators, including infant mortality rate reduction, started before the introduction of universal insurance coverage achievement. Moreover, we surmise that such activities contributed as outreach and community empowerment by the health workforce including the public health nurses, practicing midwives, and volunteers. As for UHC, it contributed primarily to financial resources for employing human resources such as public health nurses. Consequently, for the improvement of maternal and child health, an evidence based approach including systematic reviews and RCTs is needed. Additionally, reflecting Japan's experience, we should revisit not only UHC promotion, but also community-level activities such as primary healthcare with volunteer workers.
