Global Goals: a great leap forward or an historic stumble?

Health has been the poster child of the Millennium Development Goals (MDGs) era.

Three of the eight MDGs were health focussed and they are some of the goals that have secured the most progress. With clarity of ambition and clear focus the goals have helped crowd-in activity, align efforts and increase resources to the health sector; huge numbers of lives have been improved and saved as a result.

Take the goal to reduce the under-five mortality rate. While the targeted two-thirds reduction hasn’t been achieved, we have succeeded in halving the numbers of under-5’s dying each year (based on a 1990 baseline). By any standard this is an extraordinary achievement (even more so when you consider the growing number of births in this period).

John MacArthur, my fellow Young Global Leader has written a great piece looking at the impact of the infant mortality goal based on the difference between the trend line before the agreement of the goal and after it. He concludes that on a conservative estimate there is a 7.5 million life difference. Of course that doesn’t prove causation – it’s impossible to do so – but it does provide compelling supportive evidence of the impact of the goal. On maternal mortality, HIV, TB and Malaria we have also made impressive progress.

So you can understand the nervousness of the health community in approaching the agreement of a new framework (a framework which is now finalised and will be gavelled by the UN this week). There was certainly a health constituency whose view going into the Sustainable Development Goal (SDG) negotiations could be broadly characterised as, “if it ain’t broke don’t fix in”. They worried that there could be a fracturing of efforts and a downgrading of the relative importance of health.

Another consistency argued the opposite. That the MDGs had always been flawed, diverting national priorities, prioritising vertical interventions and warping priorities.

The truth is somewhere in between. As with any goal setting exercise, there is a necessary focus and prioritisation that simplifies a complex picture, this can create distortions and badly aligned incentives. But most would say the upsides of the MDGs (focus, alignment, resourcing) have out-weighed the downside risks.

This doesn’t however mean a business as usual approach is the recipe for similar success in the future. Things have changed in the last 15 years.  As set out above, huge progress has been made and the new framework needs to respond to the changed landscape.

I think it does this in three ways:

Firstly it includes some of the previous targets but ups the ambition on these, for example the two thirds reduction in preventable child mortality becomes the eradication of preventable child mortality. These zero based goals are an important change and will also focus efforts on those most excluded rather than just the easiest to reach.

Secondly, with its focus on building Universal Health Coverage (UHC) it addresses one of the major flaws of the previous framework where system building was sidelined. The movement behind UHC has changed the terms of the debate in recent years, emphasising the need to build inclusive health systems. This is of course something that will come in steps but as more and more countries reach middle-income status it’s increasingly important and will help define healthcare debates in the next 15 years.

Thirdly, a focus on equity is much more obvious in this goal (and the framework as a whole) than its predecessor. This reflects growing concerns about health inequalities and the widespread exclusion of certain groups from progress.  How this is implemented and addressed will be one of the key tests of the efficacy of the new goal.

So overall I’m optimistic about the content of the goal, but of course content is only the start. What really matters is who feels motivated to strive to reach the goals, to change behaviour and to include those who have often been left out until now. To achieve that we’ll need to change incentives beyond the goals themselves and this will require a coalition of public, private and civil sector voices working together and cajoling each other to do more.

The battle for the content of the goal is over; the battle for what happens to them has just begun.

Have you read?
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Author: Brendan Cox is Director, Policy, Advocacy and Campaigns Division, Save the Children, and a Young Global Leader

Image: Mothers cradle their newborn babies before their check up inside a ward at Dr. Jose Fabella Memorial Hospital in Manila REUTERS/Romeo Ranoco