Achieving Millennium Development Goals for health: building understanding, trust and capacity to respond.
Biomedical interventions promise achievement of health-related Millennium Development Goals provided social-, capacity- and knowledge-based constraints to scaling up and reaching marginalized people at risk, are addressed, and balance between prevention and treatment is struck. We argue for a new approach: multi-stakeholder capacity building and learning for empowerment: MuSCLE. MuSCLE is used as a way to frame three systemic weaknesses in traditional health science and policy approaches: (1) a lack of engagement with people at risk to build a collective understanding of the contexts of health problems, including social drivers; (2) a lack of multi-criteria evaluation of alternative interventions; (3) a lack of attention paid to integrated capacity building. The MuSCLE framework responds in three ways: (1) participatory assessment of the ecological, socio-cultural, economic and political contexts of health, identifying priorities using risk and vulnerability science, and modeling drivers; (2) selection among intervention alternatives that makes ecological, socio-cultural, economic and political tradeoffs transparent; (3) integrated capacity building for sustainable and adaptive interventions. Literature and field lessons support the argument, and guidelines are set down. A MuSCLE approach argues for a transformation in health science and policy in order to achieve Millennium Development Goals for health.
Downs
Timothy John
TJ
Environmental Science and Policy Graduate Program, Department of International Development, Community and Environment (IDCE), Clark University, 950 Main Street, Worcester, MA 01610, USA. tdowns@clarku.edu
Larson
Heidi Jane
HJ
D003256:Community Participation; D003299:Cooperative Behavior; D003469:Culture; D006292:Health Priorities; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D009937:Organizational Objectives; D014480:United Nations