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Health priorities and health performance have been monitored globally through the initial declaration of the Millennium Development Goals (MDGs) (Blumberg, Frean, & Moonasar, 2014). These eight goals, defined in 2000, are: 1) eradication of extreme poverty and hunger; 2) universal primary education; 3) gender equality; 4) reduction of child mortality; 5) improvement of maternal health; 6) combating HIV/AIDS, malaria and other diseases such as tuberculosis (TB); 7) ensuring environmental sustainability; and8) developing a global partnership for development (Mayosi et al., 2012; WHO, 2015). Goals 4 to 6 are directly linked to health (Pillay & Barron, 2014).

Fifteen years later, the 2015 MDG report indicated that sub-Saharan Africas' performance in relation to the health goals was the poorest globally (United Nations, 2015). Maternal deaths were reported to be concentrated in sub-Saharan Africa and Southern Asia, which together accounted for 86 percent of such deaths globally in 2013. Similarly, sub-Saharan Africa was reported to be one of the two regions with the highest newborn mortality in the world. This is despite an overall reduction in the under-five mortality rate and a global increase in coverage of preventative care strategies such as measles vaccinations. Additionally, this region also accounts for a large proportion of individuals living with HIV and AIDS. East Africa and southern Africa are home to approximately 6.2 percent of the worlds' population and just over half of the total number of individuals living with HIV reside in these regions (Avert, 2019; UNAIDS, 2019). South Africa remains the epicentre of the pandemic, with 20 percent of all HIV-positive individuals and 4 500 newly infected individuals per week (Allinder & Fleischman, 2019).

The burden of disease in Africa has predominantly comprised acute and infectious diseases, such as malaria, TB and measles. However, over the last 25 years, both chronic communicable and non-communicable diseases such as HIV/AIDS, ischaemic heart disease, stroke and diabetes have become significant contributors to the burden of disease. This is coupled with weak health care systems as health expenditure, infrastructure and the number of skilled professionals relative to the population remain insufficient (Agyepong et al., 2018). South Africa faces a quadruple burden of disease: maternal, infant and child mortality; HIV/AIDS and TB; non-communicable diseases (NCDs); and injury and violence (Department of Health [DoH], 2011; Naidoo, 2012).

Despite some progress towards achieving the MDGs, major challenges persist in the MDG priority areas. These challenges need to be addressed if further progress is to be made in reducing maternal and child mortality, and in combating communicable diseases such as HIV/AIDS, TB and malaria (WHO, 2018). An expansion of focus on the global health agenda led to a shift from the MDGs to the development of 17 sustainable development goals (SDGs). These pay attention to a broader set of social determinants of health and are sensitive to equity, which could have a substantial effect on health (Scott et al., 2017). Goal 3 has a clear and detailed focus on health, with 10 other goals also concerned with health issues. More than 50 indicators have been agreed upon for the measurement of health outcomes, health provision and proximal determinants of health. These indicators are thematically grouped as follows (WHO, 2018):

 reproductive, maternal, newborn and child health

 infectious diseases

 NCDs and mental health

 injuries and violence

 universal health coverage and health systems

 environmental risks

 health risks and disease outbreaks.

The director-general of the WHO, Tedros Adhanom Ghebreyesus, emphasises that ‘maintaining momentum towards the SDGs is only possible if countries have the political will and the capacity to prioritize regular, timely and reliable data collection to guide policy decisions and public health interventions’ (WHO, 2018, p. v). Political will and commitment to the goal of universal health coverage should be expressed in legal mandates and translated into policies (Aregbeshola, 2017).

Health and health care in sub-Saharan Africa, where health spending is low, remain a global concern, and aid from the West has been increasingly targeted towards health (Deaton & Totora, 2015). Health spending by governments is generally the primary source of health funding globally. However, in sub-Saharan Africa, only about a third of health spending originates from government (Micah et al., 2019). A study examining government health spending and its determinants found variations in terms of spending across 46 countries in sub-Saharan Africa. Of these countries, South Africa has one of the highest levels of government health spending, thought to be associated with the high burden of HIV/AIDS in the country (Micah et al., 2019).

The growth in global health resources, in terms of government spending and development assistance for health, occurred during the same period as the MDGs (Micah et al., 2019). Since 2000, there has been an increase in foreign aid to low-income countries in order to facilitate their chances of meeting the MDGs (WHO, 2014). As of 2013, health expenditure made up between 20 and 69 percent of government spending in 26 of the least developed countries in sub-Saharan Africa (WHO, 2014). While there are debates regarding the effectiveness of foreign aid, findings from a study in Rwanda indicate positive associations with foreign aid and government spending in terms of service provision for maternal and child health, HIV, malaria and TB (Lu, Cook, & Desmond, 2017). The commitment to these aspects of the burden of disease and their link to the MDGs appear to have resulted in improved dedication and prioritisation of health from 2000 to 2015 (Micah et al., 2019). Within this framework of prioritising health, adequate human resources, such as health care workers, are needed for efficient health care service provision.