Last month the United Nations published Millennium Development Goals Report 2015. The report claims that Millennium Development Goals (MDGs) have saved the lives of millions and improved conditions of many more. Formulated in the beginning of this millennium, the MDGs had aimed to improve education, health and reduce poverty. Referring to the data available with it, the report argues that there were 'remarkable achievements' which could have been improved even in the poorest countries with targeted interventions, sound strategies, adequate resources and political will. Although there were some 'remarkable achievements' in the past quarter of century, the report has not discussed about the failures associated with it.Due to fragmentation of goals, targets and indicators, it is quite difficult to conceptualize the MDGs in practical sense. This is because fragmentation made interconnecting and prioritizing the needs difficult. For instance, the first goal—to eradicate extreme poverty and hunger—lacks agricultural target to measure production and distribution of food, which could have been crucial for assessing poverty and hunger eradication. Furthermore, the segregation of targets and indicators required short-term, topic-specific and donor driven projects, which resulted in poor co-ordination, ambiguity and huge cost in healthcare.
Secondly, goals, targets and indicators were not consistent with each other, causing problem in the issue of measurement and ownership. For example, targets and indicators set to assess goals of poverty reduction, gender equality and environmental sustainability were insufficient. The measurement of progress in education by measuring the net enrollment ratio would not give the measurement of learning achievements or depth of understanding. Furthermore, there were inconsistent monitoring and evaluation indicators and some countries lacked baseline information. Additionally, progress focused only on quantitative numbers and no targets and indicators to measure global governance were considered.
The third failure was the ownership conflict due to contradiction between global goals and national priorities. Due to this inconsistency, many countries perceived MDGs as unwanted burden imposed by donor agencies, beyond their national priorities. Goals, targets and indicators were not realistic at the country level. For instance, some African countries had to allocate their significant amount of funds in maternal and child health although the HIV/AIDS was the major public health problem.
International community further jeopardized this complexity resource duplication in one goal while neglecting another. For instance, many organizations like UNICEF, UNFPA, and Save the Children work for MDG-5; however not many organizations take ownership for MDG-3. Additionally, MDGs underestimated the role of civil societies, which otherwise could play a significant role in alleviating violence against women, promoting reproductive rights and adult literacy.
The major criticism MDGs face is their inability to address issues of equity and distribution of resources. Firstly, MDGs measured progress in terms of proportion of population achieving minimal set standard on health, education or earnings against set targets and indicators but overlooked unfair social relation and distribution of resources. For instance, there was 53 percent reduction in under-five mortality rate in last quarter of century across the world; however, rural-urban ratio of 1.7 and poorest-richest ratio of 1.9 shows huge socio-economic disparities. Similarly, delivery by skill birth attendant (SBA) is only 56 percent in rural areas where as it is 87 percent in urban areas across the world. Two-third women aged 15-49 do not attend fourth Ante Natal care (ANC) visit in South Asia which is 2.5 times less compared to Southeast Asia. This systematically excluded the marginalized and people at higher risk as a consequence of improving achievement and coverage, which resulted in reaching 'easy to reach' population despite 'reaching the unreached'.
Although there were substantial progress in achieving MDG goals and targets based on the measurement of the indicators set, existing inequalities among people across different social and geographic dimensions would be a serious problem in the coming days. In order to address this disparity, we need to integrate economic, social and environmental dimensions that ensure equality in opportunity and outcomes, equity in sharing of cost and benefit, social inclusion and non-discrimination. This could be done through holistic approach rather than segregation of interventions and developing indicators that measures the unreached rather than what proportion of population we were able to reach.
This requires stakeholders' involvement in prioritization of needs through bottom-up approach that ensures resource allocation contextually. They should take ownership themselves rather than being imposed programs from external agencies. This can be done through connecting civil societies and social activists with state structures and global governance. Thus, structural, political and economic context of production and distribution of resources should be analyzed to understand the issue of inequalities and integrated approaches should be undertaken to address failures.
The author holds Masters Degree in Public Health (MPH) from the University of Melbourne, Australia
khanalg@outlook.com
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