At the turn of the millennium, world leaders decided the new era should see the end of extreme poverty and other basic development problems. In order to facilitate a worldwide focus on this broad aim, they crafted the Millennium Development Goals to set up detailed goals to be achieved by 2015. Out of the eight goals, three deal directly with health: Goal 4 calls for a two-thirds reduction of child mortality, goal 5 focuses on a three-quarters reduction of maternal mortality and universal access to reproductive health, and goal 6 aims to reverse the spread of HIV/AIDS, malaria and other diseases while also providing universal access to HIV/AIDS treatment.
How are we doing on those? The three health MDGs have seen the least progress out of all eight goals. According to the U.N. Development Programme, annual deaths of children under five worldwide has dipped below 10 million for the first time since data collection began, but certain countries, especially those of sub-Saharan Africa, have seen no change. Maternal mortality has only decreased by about 2.3 percent by U.N. estimations. Around 33 million people are living with HIV, mostly in developing countries, despite significant international attention and aid efforts.
The international community has taken notice of this lack of progress. U.N. Secretary General Ban Ki-Moon announced a new plan aimed at addressing problems with women’s and children’s health. This plan hopes to incorporate the efforts of developing country governments with the contributions and expertise of multilateral and bilateral organizations, private sector groups, non-governmental organizations and others. The World Bank has set a $26 billion goal for pledges from donor governments and private sector groups, $12 billion of which is expected to be new money rather than a reallocation of aid money already pledged or being disbursed.
The strategy focuses on new policies developed by the domestic governments of developing nations and financed with the money raised by the U.N. and World Bank. The plan hopes to integrate the programs addressing health from various different aid organizations and domestic agencies to make programs more efficient, supporting what the domestic government has set out to do rather than what donors have decided should be done. Donors are being called to not only make their contributions more stable and predictable, but also to increase overall funding. Private sectors in health fields are encouraged to innovate and reduce prices. The plan also gives special attention to setting up accurate monitoring for the programs that will track how many are helped, rather than numbers of facilities built or supplies doled out.
The executive summary of the strategy states that if implemented, the plan could “prevent the deaths of more than 15 million children” and “prevent 570,000 women dying of complications relating to pregnancy or childbirth,” among other projections. This seems a little ambitious, especially given the lack of progress in the last 10 years on the three health MDGs.
There are also a few problems with the structure of this strategy that are evident right away. First of all, the area with the least amount of progress, sub-Saharan Africa, will presumably receive a large amount of the pumped-up aid and attention from this plan. Sub-Saharan Africa is also widely regarded as a locus of corruption. A 2002 study from the African Union estimates that corruption costs the continent $150 billion a year. The World Bank’s World Governance Indicators for control of corruption show that only a single country, Botswana, places above the 75th percentile, while most are 50th percentile or worse. Ten countries are between the 0 and 10th percentile in control of corruption. Secretary General Ban’s strategy focuses on increased financial support for developing country governments – but in a place that struggles with corruption, that increased support will not be effective.
Another problem is that while the strategy focuses on monitoring and accountability, structure and agencies for monitoring are not being set up prior to the launch of the program, but rather concurrently. There is still ongoing discussion on what statistics should be measured and who should be in charge of monitoring, even as the U.N. and World Bank solicits pledges for more funding from donor nations.
Two things must be done for this strategy to really help developing countries. First of all, support for health programs must be flexible given a country’s status or reputation regarding corruption. If a country is doing well in governance indicators, like Botswana, then support for the domestic government of the recipient country is positive and will bolster actual goals as opposed to donor preferences. If a government has high levels of corruption, then civil society is the best option for deploying aid, but the national government must be aware of what is being done so that their own health policies and budget take into consideration the programs implemented by aid and avoid redundancies. It is important that the money spent by developing countries not replicate or work against aid money spent in order to maximize efficiency.
Second, monitoring strategies must be established before aid can be disbursed, and possibly even before aid can be expected to be pledged. How can we expect donor nations to pledge extra aid without being promised that they will see that this aid will be more effective than current levels of assistance? It must be a clear structure of who is in charge of monitoring, what will be measured, how it will be measured, and how often programs will be checked, so that both donors and recipients know what to expect and what to strive for. This will also increase accountability, which could help the corruption issue.
Donor nations today will be reluctant to contribute to governments who have not produced results with what they have been given today, despite any issues with quantity, especially if corruption is rampant in the target countries. These problems must be addressed for the new strategy on the health MDGs to function the way it is intended to work.