There are 944 days left until January 1st, 2016. For most, that probably means little else than the official start of Decision 2016, and the thought of another presidential election probably elicits cold sweats, headaches, and flashbacks of a time best forgotten (for at least another six months).
But for the world community, January 1st, 2016 is a big day: the official endpoint of the Millennium Development Goals (MDGs), a set of eight development goals chosen in 2000 and pledged to by all 193 member states of the United Nations. “We only have 1000 days left!” is a powerful clarion call for further action, and to spur it on, the “grassroots advocacy and campaigning organization” ONE recently came out with a long progress report detailing where countries are at.
It’s an at-times encouraging, at-times depressing look at what has been accomplished and how much is left to do. I’m going to take this in chunks and first focus on the “Health-Related MDGs:” 4, 5, and 6, dealing with child mortality (reduce by two-thirds the under-5 mortality rate), maternal mortality (reduce by 75% the Maternal Mortality Ratio), and HIV/AIDS (halt and reduce spread of HIV/AIDS), respectively. I put together this graph to show the progress on these three:
Most at risk for failure is MDG 5, maternal mortality. Of the 134 countries tracked, only 30 are on track to reach their goal by the end of 2015. The Lower Income Countries (LIC) are outpacing the Middle Income Countries (MIC) here, with 25% and 19% on track, respectively. Maternal mortality is a complex issue, and progress may be slow because reducing it requires a multifactorial set of solutions that require changes made in multiple, disparate sectors; simply put, time may not be on our side. I’ve written previously about maternal mortality – see here and here for more.
Progress towards MDG 6, HIV/AIDs, is a bit better, but not much. Overall, 32 countries are on track, or 24% of the 134 countries. Once again, the LICs are dragging up the average, with 26% on track versus 21% for the MICs. This is a bit misleading because of the standard MDG 1990 baseline, as infection rates were rapidly increasing in the 1990s in sub-Saharan Africa; looked at from 2000 to 2010 alone, about three-fourths of the countries in sub-Saharan Africa would be on track versus the one fourth that are with the baseline scenario.
Finally, the brightest spot for health-related MDGs is MDG 4, child mortality; nearly half of the countries are on track, and fully 88% are at least partially on track. Here, the MICs are doing a bit better than LICs (52% to 46% on track).
Broadly speaking, the health MDGs fit the larger pattern of LIC-MIC convergence on MDG progress: “The gap between the progress of poor countries and MICs towards the MDGs continues to narrow. Poor countries’ average scores are now nearly identical to those of MICs (3.88 versus 3.96).” This is great news, as it means that LICs are being “transformed” into MICs from an output perspective; they’re outperforming what their GDP would’ve predicted a decade ago.
The report focuses heavily on financing from multilateral organizations (e.g., World Bank, International Monetary Fund) and national governments. In 2001, the governments of sub-Saharan Africa pledged to allocate 15% of their national budgets to health spending (referred to as the “Abuja Commitment”), which, for the majority of those countries, hasn’t happened; a few haven’t met even half that commitment. This appears to show up in the output measures: countries that are doing better on MDGs 4 and 5 generally have allocated more of their budgets to health spending.
So, with less than 1,000 days to go, where does that leave us with respect to the health-related MDGs? Unfortunately, we’ve heard the report’s answers before: spend more money and improve service delivery. It’s the definition of boilerplate, except without any heat. The truth is that it’s extremely unlikely that MDGs 5 and 6 will be met, and MDG 4 is tenuous, too.
This shouldn’t stymie progress – there’s a lot that can be done in 1,000 days – but it’s important to be realistic. If we’ve learned nothing else, it’s that change on this scale takes a significant amount of time; maternal mortality, for example, seems to be a proxy for the health of the health system as a whole, and 15 years (from 2000 to 2015) may not be enough time to tease out the problems and implement the appropriate solutions.
It also shouldn’t obscure the fact that a lot of progress has been made. Hundreds of thousands of mothers are alive today that may not otherwise have been. Whatever the conceptual failings of the MDGs, they have focused the world community on very specific outcome measures; it’s no longer enough to discuss inputs alone. Results matter.
To recap: significant progress is being made on the health-related Millennium Development Goals, but it’s going to be tough to reach any of them by January 1st, 2016; reducing maternal mortality will be the most difficult, followed by reducing HIV/AIDs. 944 days and counting.
 This is myopic view of health, of course – all of the MDGs deal with health in a direct or indirect way: reducing extreme poverty and hunger, getting kids in school, having clean drinking water, and promoting gender equality all have significant health components and consequences.
 At first glance, this probably looks off – “The poorer countries are doing better than the less-poor countries?!” Remember, we’re looking at relative rates, not absolute rates; Egypt (a MIC) is competing with itself, not Uganda (a LIC), and because Egypt’s Maternal Mortality Ratio was lower to begin with, it may have a more difficult time reducing it by a further 75%.
 The usual caveat about correlation vs. causation applies here: this doesn’t prove that not allocating enough of the budget causes failing to meet the MDG. Perhaps countries that are more likely to follow through on their commitments are putting more non-monetary effort into reaching the MDGs, or perhaps the governments of those countries are stronger, etc., etc.