Transforming health systems to improve the lives of women and children

Ambitious quantitative goals for reducing mortality and increasing access to health interventions are nothing new to the areas of child, maternal, and reproductive health. They are the standard fare of global declarations and national 5-year plans. They come. They go. What makes the Millennium Development Goals (MDGs) different? With health firmly embedded in this wider poverty-reduction initiative, which has garnered unprecedented consensus and support from governments and multilateral organisations, the global health community has a rare opportunity to break through to new ways of thinking about the obstacles now blocking improvements in the health of women and children and to translate that thinking into bold new steps to meet goals 4 and 5 (table). For the UN Millennium Project Task Force on Child Health and Maternal Health, the potential breakthrough lies in putting health systems at the centre of MDG strategies and in addressing these systems, not only as delivery mechanisms for technical interventions but also as core social institutions-as part of the very fabric of social and civic life. In high-mortality countries today, especially for the poorest populations, health systems are frequently the source of catastrophic costs, humiliating treatment, and deepening social exclusion. But a different way is possible. Health systems can be a vehicle for fulfilling rights, for active citizenship, and for true democratic development-poverty reduction in its fullest sense.1