Dr. Mosa Moshabela (MBChB, MMed, PhD), Regional Health Advisor for the Millennium Villages Project (MVP) in West & Central Africa, Emerging Voice for Global Health from South Africa in 2012 with the Institute for Tropical Medicine (ITM), and previously Director of the Rural AIDS and Development Action Research (RADAR) in South Africa.
In September 2013, the UN General Assembly will meet to review progress towards the MDGs, but also move to adopt a new agenda on SDGs. Clearly, both agenda items are equally of utmost importance. However, one cannot help but feel that the new agenda on SDGs appears to overshadow the current MDG agenda. The task to review progress towards the 2015 targets can benefit from a heightened effort needed to address unresolved issues. In particular, the current lack of consensus as to whether the 2015 targets were set to be achievable or not remains one elephant in the room, with self-evident implications for the post-MDG agenda. However, there is already widespread agreement that Africa is unlikely to meet the MDGs by 2015. In their recent article, Lozano and colleagues (2011) indicate that no country in sub-Saharan Africa will meet both MDGs 4 and 5 by 2015, and only Madagascar is likely to reach MDG 4. A point is made in this article that the baseline figures for these two goals were comparatively incongruent in 1990, citing 10 per 1000 in richer countries and a difficult starting point of 165 per 1000 for sub-Saharan Africa. These authors further state that MDG 4 targets were ambitious, and MDG 5 targets bordered on aspirational. For these reasons, while some condemn Africa as a failure for not achieving the set goals, others claim that the MDGs are not a fair measure of success for the continent.
Lozano et al (2011) argue that perhaps the rate of acceleration towards these goals would be a more reasonable measure of attainment of MDGs 4 and 5. However, is this proposal an indication of a sense of frustration, and therefore the need to backtrack so as not to face the reality of failure, or an absolute necessity to revise the MDG targets that were set at the Millennium Summit in 2000? One is tempted to think that fear of failure may be the principal motivation, which may indeed represent a more generalized viewpoint than only that of the authors. If the MDG targets were set to be achievable (Sachs & McArthur 2005), then the proposal to reconsider the measures of success should not apply. Instead, rate of acceleration could be added as an additional dimension of measurement. In this case, countries in sub-Saharan Africa will need to square up to reasons for inability to achieve targets. However, if the MDG targets were set with a conscious awareness that they were unlikely to be met, then there would be a need to revisit measures of success (Fukuda-Parr et al 2013). In this unfortunate scenario, the argument for rate of acceleration, and perhaps others, as a measure of success may form a strong basis, but a rather late intervention at this juncture.
Whether or not the MDGs will be achieved or not, these goals have successfully created an atmosphere of increased speed and momentum towards improved health outcomes, and investments have been escalating over the years to aid poor countries through global health action. On the one hand, this newly found momentum could be settled upon as a favorable outcome since some argue that the MDGs are harsh measures for sub-Saharan Africa (Vandemoortele, 2009), and countries can be allowed additional time beyond 2015 to reach the goals, as Lozano et al (2011) seem to suggest. On the other hand, the observed momentum is currently under threat as countries in sub-Saharan Africa are made to face a sense of failure to meet the MDGs by 2015. How are these countries going to collectively and individually confront the reasons for not reaching the MDGs after they signed up to achieve them? Vandemoortele (2009) states that MDGs are global targets, and do not need to be achieved in each country, a point that should be taken into account. According to findings from the UN Millennium Project, it appears as though MDGs are technically achievable (Sachs & McArthur 2005). Strategies to reach the MDGs were already known early on, but not delivered adequately on the ground, especially in resource-poor countries.
Governance and poverty have been implicated as the two main reasons for poor progress towards the MDGs in countries showing rather slow progress. Others have argued that violence seen in resource-poor countries exerts additional strain on the MDG progress (Gates et al 2012). In sub-Saharan Africa, violence is rampant, and countries like Mali, Sudan, DRC, Somalia and more recently Central African Republic are facing civil and cross-border wars. Furthermore, the recent withdrawals of aid by several countries in Uganda due to corruption are not necessarily serving to advance the agenda towards attainment of the MDGs. Perhaps much of sub-Saharan Africa is not yet ready for the new goals altogether, especially since most countries have only recently gained speed, and should not risk the sudden loss of this momentum by introducing a different agenda. Prior to further detailed discussions on the new SDGs, the subject of failure or success regarding the current MDG targets in the context of sub-Saharan Africa must indeed be satisfactorily addressed.