MDGs: How Far We’ve Come and What Still Has to be Done

During labour, the baby was in a dangerous breech position, putting both mother and child at risk of death. But a skilled birth attendant turned the baby, saving their lives.

Thanks to the UN Millennium Development Goals (MDGs), standards world leaders agreed on in 2000 to lift the poor, the sick and the hungry by 2015, professionally-attended births are at an all-time high in Africa. Benin is most improved, and even war-scarred DRC and Angola have risen to the challenge, with Angola halving maternal deaths.

Thanks to the impetus of the MDGs, the expectant mother and this baby received free prenatal care, and free medical visits will continue through the breastfeeding period, strengthening the child’s body and mind – a low-cost policy Ghana, Malawi, Ethiopia, Tanzania and Rwanda all began. Thanks to the MDG challenge, she is likely to escape Africa’s child-killing diseases, because cadres of health workers have been hired and trained to distribute essentials, such as bed nets and improved malaria medicines (in the countries with free prenatal care, plus Zambia and Niger). Africa-wide, malaria deaths have fallen by half. Meanwhile, vaccinations including measles and tuberculosis have skyrocketed, saving six million lives.

The world leaders who are gathering for a MDG Review Summit at the UN this week must study these victories. They must remember, if they wonder whether the goals are realistic, that indicators on maternal and child health, hunger, poverty and disease have improved in some of sub-Saharan Africa’s poorest countries. Before the global financial crisis, hunger plummeted by 75 per cent in Ghana, and by a smaller degree in Djibouti, Mozambique, Chad, Benin, Mali, Gambia, Uganda, Burkina Faso and Togo. Populous Ethiopia, Egypt, and Angola halved their poverty rates. And although the goals were inked in 2000, change really began in 2004. So it’s all happened very, very fast.

Today, with five critical years to go, we know what works. There’s a set of solutions that are proven, and cheap. They include:

* Increasing health budgets, so maternal and prenatal care are free (And so more birth attendants can be trained).

* Publicly-funded discounts on fertilizer, to lessen hunger. In Nigeria, when some farmers got fertilizer and simple technology, credit and marketing help, their income rose 50 per cent – for just $80 a year. Help with warehousing the harvest in eight other nations led yields to rise as much as four-fold.

* Low-cost childhood preventive care, which could save six million of the 11 million children who die each year. That includes breastfeeding for six months, nutritional supplementation up to two years, vaccines, bed nets, antibiotics for respiratory infections and oral rehydration for diarrhea.

* Cash grants to the most destitute, like teenage orphans, the elderly, and families without a breadwinner, to reduce poverty. Kenya, South Africa, Mauritius, Namibia, and Lesotho, among other countries, funded them with taxes. Cash transfers are quite small: $3 a month lifted the health, education and nutrition of Kenyan orphans. A $2 per month payment to Malawian families without a breadwinner decreased child labour.

But more of the same won’t be enough. World leaders in New York must re-energize their MDG efforts, with stronger action plans to accelerate through 2015, because despite the many stunning successes, progress has been uneven. Too many donors and African governments have failed to make the plans to fund the programs and to deliver on their promises.

Meanwhile, the food and financial crises have devastated the poorest, though final numbers on the impact mostly aren’t available. But even before the global economic crisis, amid progress elsewhere, poverty was up in Nigeria and Zimbabwe. While the mother and newborn above were saved, one in seven women die in childbirth in sub-Saharan Africa. (In Ireland, it’s one in 48,000.) One in three infants in Africa are undernourished, causing irreversible stunting. Rural areas are worse off than cities almost everywhere. Child mortality is among the world’s highest in Equatorial Guinea and Chad, and in the DRC, the proportion of hungry people has doubled.

Access to piped water and sanitation has seen little progress; two-thirds of those in sub-Saharan Africa lack basic sanitation. And though education is spreading, 38 million children still don’t attend school. (In North Africa, they’re mostly girls.) And the negatives go on: Sudan and Ethiopia’s immunizations are falling. Africa has three-quarters of all new HIV infections. Most medical workforces are inadequate – in some nations, a single ob-gyn serves an entire state or province of millions. And with measles vaccine funding down, measles deaths could rebound by as much as 1.7 million.

This week’s summit must refocus world leaders’ attention on the policy failures behind these tragic shortfalls, and end with a commitment to redouble efforts. To turn away now would be, as UN Secretary General Ban Ki-Moon has said, morally and practically unacceptable and would multiply the world’s dangers: instability, violence, epidemic diseases, overpopulation, and environmental degradation. And progress must happen on multiple fronts at once. Extreme poverty kills through the cumulative effects of malnutrition, poor infrastructure, gaps in health care delivery, and more.

Here’s what commitment looks like. Take the baby girl when she reaches school age. Education will be free if she’s in Burundi or Tanzania, where school fees were abolished in pursuit of the MDGs. Now enrollment is nearly universal. (Zambia is close, and in Mauritania, which doubled its budget allocation to education, girls’ enrollment surged.) Ethiopia raised its education budget, funded textbooks in local languages and built rural schools. Tanzania recruited teachers and added second shifts to meet overflowing demand. Gambia invested in teacher training.

Once she’s in a clean school, she may be immunized there, and get a nutritious free meal, kicking off a virtuous circle. Being healthier, she’ll be absent less often. Attending regularly, she’ll likely finish. Being better educated, she’ll make healthier decisions when she grows up. And so on. If her government school purchases the free meals from an area farmer or community garden, local income rises. More community children can eat. They’re healthier and miss less school. Commitment will allow these children, upon graduating, to find decent employment, thanks to fair, efficient economic and tax policies. With jobs, they’ll pay taxes. That will fund more schools and clinics. And so on.

Leaders at the summit must also be heartened because the backdrop in Africa now is in many ways better than in 2000. Economies are bouncing back. Our abundant natural resources are in demand. There is less inflation, less debt, and more scope to borrow and raise taxes (and stop tax evasion and fraud). Broad popular awareness of the goals has fostered new coalitions now working together. The public institutions responsible for social services to the poorest are in better shape. And the trend towards decentralization, that’s shifting funds and power to provincial localities, makes citizens better able to monitor their leaders’ governing and spending.

The political landscape is more conducive, too, with fewer military conflicts and military dictatorships. And we Africans seeking justice are backed by a global movement, pressure from which helped lessen Africa’s debt burden, leaving governments more money to spend on MDGs.

Here’s what needs to happen next:

* Donor nations: Fulfill your side of the bargain and deliver on your promises. Stop tying humanitarian aid to political and macroeconomic conditions that do not favour growth and pro-poor human development. Prudent economic management fosters development. But tying aid to unfair conditions is effectively a death sentence on millions of mothers and children and the poorest. Reducing poverty must be aid’s only purpose. If you want to promote democracy, realize that elections alone, important as they are, can’t alone constitute a functioning democracy. We need jobs, the taxes they generate and a clampdown on tax havens sheltering illicit capital flight to sustain our democratic institutions. These all – and building our jobs base so we’re not dependent on commodities – are inseparable from the democratic process.

African leaders in countries falling short: You must find a stronger will to improve the condition of your poorest citizens, as you promised when you signed the MDGs in 2000. The goals make it mandatory that you provide health, clean water, sanitation and education for your citizens. Build on what we know works to carry efforts forward at this time of promise more potent than any moment ever before. Raise the revenues needed to deliver on your commitments. Fight for global trade rules and financial regulation that serve justice. Say you stand for eradicating poverty, and the correct steps you’ll take to get there, and we will support you.

Citizens: Recognize your responsibility and in your own powerful voice, demand that political leaders and public servants deliver. Africans must stop acquiescing in silence to poor governance and substandard services, whether in schools, hospitals or town halls. We deserve, we require, we demand competence and effectiveness in public spending. That means watching over those who govern to catch corruption and waste. Show your support for the MDGs by joining an event during the September 17-19 ‘Stand Up, Take Action, End Poverty’ day of action (standagainstpoverty.org). You can force those responsible to solve our societies’ problems.

Our fates, north and south, urban and rural, rich and poor, are entwined. Our common future depends on more powerful commitment to end the suffering of extreme poverty, to make sure every newborn, like the baby girl asleep in her mother’s arms, has the basic necessities we know how to provide. For now, tiny but alive with possibility, she waits for our action.

Charles Abugre is the Regional Director-Africa, United Nations Millennium Campaign.