Successes and shortcomings of the Millennium Development Goals (MDGs) are taking centre-stage in London this week as the UN Secretary General's High-level Panel of Eminent Persons on the Post-2015 Development Agenda meets for the second time. Chaired by British Prime Minister David Cameron, President Susilo Bambang Yudhoyono of Indonesia and President Ellen Johnson Sirleaf of Liberia, the panel focuses on household poverty and how it can be addressed as part of a wider strategy to end poverty.
Alongside employment and livelihoods, one of the questions on its members' minds is 'How do we ensure that all people, especially the most vulnerable and marginalized, have the food, water, energy, health care and education they need?'
The Millennium Development Goals have galvanised the efforts of the global community to work towards a more dignified life for all, and they have brought about some significant successes. Attention was brought to the plight of the poor, more financial resources were raised and clear targets set for governments to work towards. This has meant considerable improvements for people's lives: On average, the targets on reducing poverty, better access to water and equal enrolment of boys and girls in primary education have been achieved.
But the MDGs have also left much to desire for. For one, UN Member States signing up to them accepted right from the start that only part of those in need would have their human rights to education, health or water fulfilled. Whether an expectant mother in Sierra Leone survives childbirth is thus not a matter of her right to life and health. Rather, in the context of Goal 5, to improve maternal health a mere three quarter reduction of the maternal mortality ratio is sufficient to have achieved the goal. That we are still far off-track to achieve this target cannot be emphasised enough to maintain momentum but it should not distract from the limitations of the MDGs' approach.
The injustice is exacerbated by the way the MDGs are reported upon. The MDGs' aggregate, numerical targets for reducing poverty and improving health has led to a concentration on reaching the largest numbers of people, and therefore often the easiest to reach, such as large urban populations or mainstream groups. This carries the danger of actually reducing resources for the most marginalised, as resources are diverted towards meeting these aggregate targets in the easiest way.
Indigenous people or those from other cultural minorities are one example of populations frequently marginalised from the political and economic processes of their own countries, and experiencing worse poverty and health outcomes both nationally and globally.
In the northeast of Cambodia, for example, the indigenous people of Ratanakiri Province have a significantly poorer health status than other Cambodians. Child mortality rates in Ratanakiri are twice as high as the national average. But because of the focus of the MDGs on overall targets, rather than on equity and reaching the most vulnerable, the most marginalised groups are not only neglected in terms of resources, but also in terms of monitoring and analysis.
In health, separating different health issues, such as HIV/AIDS, Malaria, Tuberculosis, maternal and child health, into sectoral silos has worsened the non-integration, inefficiency and unsustainability of vertical health programmes. In particular, the necessary foundation of strong health systems has been neglected. Achieving further progress on health requires the provision of comprehensive primary care, addressing the huge health worker shortages, tackling weak data systems, drug shortages, and inadequate funding. The problem of household poverty could be significantly reduced by introducing national health care systems that provide financial risk protection against health care costs. As of now, approximately 100 million people are driven below the poverty line every year because they have to pay out-of-pocket for treatment or consultations at the time of need.
A new development framework must aim towards the well-being of everyone and place equity and human rights at its heart. For inequality and inequity to become more visible, monitoring mechanisms must report data that is disaggregated along the major fault lines of social disparities, for example gender, urban/rural residence, or ethnicity. It is essential that targets be set nationally or according to local context and should have a dimension of reducing the gaps in health or other development outcomes between different groups of their societies so that resource allocation may go towards the most marginalised.
Health is a prerequisite and an outcome of development and, as such, cannot be missing from the post-2015 development framework. It should also be seen as a cross-cutting issue across a range of sectors which are determinants of health, such as water and sanitation, nutrition or trade rules on intellectual property. An overall health goal could be a reduction in the number of years lost due to ill-health, disability or early death or could revolve around gains in life-expectancy. But one important means towards achieving well-being and longer life-expectancy is universal health coverage which would not only extend health services in their range and reach but would also prevent people from plunging into poverty because they are protected against the financial risks of health care through national health systems or health insurance.
Last not least, the responsibility for achieving human well-being and global equity lies with everyone, not just with developing country governments as a response to overseas aid. While aid remains important, there must be much more emphasis on building the capacity of developing countries to raise domestic revenues to fulfil the rights of their citizens in the longer term. This must focus on strengthening governments' tax collecting capacity; tackling the current flow of capital out of developing countries in the form of debt repayments, tax evasion, or corruption; and renewed efforts to adopt redistributive forms of innovative finance, such as a global or regional Financial Transactions Tax.
There need to be specific, focused goals addressing the root causes of poverty and inequality such as unfair trade rules, land grabs or environmental exploitation. Changes in these areas could do much more for tackling poverty and inequality sustainably than overseas aid can ever achieve.
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