Health Goals may not be appropriate

We stand at an unprecedented moment in global health: advances in public health science enable us to project health trends into the future as never before and to understand how to prevent or effectively treat many of the significant global health concerns - or position us to figure out more effective approaches. We also have global experience in setting goals, deploying resources, and observing outcomes. This is a critical time to be cognizant of the broad changes that are in process and take stock of whether current approaches will serve us well in this changing world. This article seeks to reflect on both of these issues and suggest on how each can inform the other for future success in improving global health.
The new world of global health will be characterized by persistence of our longstanding concerns to mitigate infectious disease and improve maternal and child health, food and water availability and safety. In these areas, there is little doubt that global goals and targets have been critical for redirecting policy attention and mobilizing advocacy. Witness the rise of attention to maternal mortality once it was chosen as an MDG - and the equally striking decline in the fortunes of reproductive health when it was omitted from the original Goals. Yet, even when there is such welcome attention, successive goals and targets have come and gone, largely unmet.
Our poor track record may stem from the reliance on plans that are formulated with an eye trained exclusively on the bar set globally by the goal, while ignoring what science teaches us is needed locally for lasting solutions. In fact, recent analyses by Peters et al, in the 2009 The World Bank's Improving Health Service Delivery in Developing Countries: From Evidence to Action, clearly demonstrate how global goals and targets have been set without reference to crucial aspects of the country context that influence change, and without acknowledging the varying pace of change that is possible across different settings with different starting points.
Too often, global goals and targets that were meant primarily to refocus political attention are mistakenly assumed to dictate appropriate first steps in a plan of action for effective implementation. For example, there is clear consensus that a goal such as MDG 5 on maternal mortality cannot be met without an approach that strengthens district-level health systems. Yet many of the Roadmaps for Reduction of Maternal and Newborn Mortality developed by countries in Sub-Saharan Africa, while aspiring to meet global MDG targets for births attended by skilled health professionals, are devoid of adequately resourced implementation plans to tackle the systemic problems that have repeatedly sabotaged such aspirations.
http://www.globalhealthmagazine.com/top_stories/chasing_goals_solving_problems