By Rakhal Gaitonde a and Natalie Eggermont b
a Society for Community Health Awareness Research and Action (SOCHARA) & People’s Health Movement, EV 2012
b ITM, People’s Health Movement
As the world rushes towards finalizing the contours of the post-MDG scenario, we are concerned about whether there is enough clarity on what we are hoping to achieve, how we are going to measure our achievements and whether these processes and indicators are really relevant to local communities who hardly have a voice in these processes. We call for more time, more reflection, more democratization and a drive for relevance to local communities rather than a politically convenient set of indicators that will have neither efficacy nor meaning.
As the deadline for the achievement of the Millennium Development Goals (MDGs) approaches, the UN is facilitating a global consultation around a new global development agenda post-2015. One of the key questions posed by WHO in the consultations around health is on measuring progress. Global health policy makers all over the world are engaged with this process and it seems likely we will end up with a new set of targets and indicators.
What are we setting out to define and measure?
When thinking about measuring progress one would expect to start with establishing a collective understanding of what ‘progress’ and ‘development’ mean in the post-2015 era. But it seems we are skipping this question. The dominant discourse of development as economic growth prevails; and underdevelopment is still portrayed as a problem of low-income countries to be fixed with ‘aid’. It is interesting to see the Report of the UN Task Team diluted with “green”, “sustainable” and “inclusive” growth; but having “redistribution” nowhere to be found. As Kristof Decoster states in his blog, green or sustainable growth alone will not do the job. Business as usual is simply not an option. The negotiators will need to go beyond the palliation of symptoms to confront the dynamics which are driving widening inequality, avoidable suffering and accelerating destabilization of the biosphere. The current proposals do not address the crisis of capitalism nor question the hegemony of the market model of ‘development’ that is imposed on the entire world.
Targets and indicators – some concerns
Targets and indicators are important, but in many situations also deceptive and dangerous. They measure not only progress but reflect, and at the same time shape, our understanding of the world. Through indicators, extremely complex social processes are reduced into techno-managerial issues. These are then dealt with by technocrats and managers who take the lead in problem solving rather than communities and societies. In playing with words and numbers the lived reality they represent is invisibilized. Thomas Pogge showed in his paper on indices of poverty and gender equity how changing three words in the target on poverty increased the accepted number of poor people by 496 million . In addition, in a situation with limited resources, indicators tend to become the focus rather than the comprehensive improvements needed to change the situation. This leads to situations where in our rush to reduce MMR we focus exclusively on institutional deliveries – often regardless of institutional capacity to handle the increased deliveries – and completely ignore issues like violence against women or their decision making power in society and their families. Such targeting leads to a fractured approach to complex problems and promotes the use of ‘magic bullets’ over comprehensive system strengthening. This ultimately leads to the weakening of the very system needed to ensure the sustainability of any intervention and making sure it reaches marginalized communities.
Who are these goals relevant for?
Another important question is the meaning of global goals for local commmunities, given how accountability currently works in the world. The overreliance on ‘aid’ has promoted upwards accountability to the neglect of downward, democratic accountability. Because of funding reality and the influence of International Financial Institutions the UN system is attempting to hold countries accountable, while people, especially the most marginalized, lack the mechanisms to hold their own governments accountable. Poor people do not have a voice, let alone any power of sanction. This makes a mockery of the efforts towards good governance.
Why are we in such a hurry?
Because of all the above, the speed of the ongoing UN process is very concerning. Consultations in countries and with civil society have to be done in a couple of months. This will exacerbate the exclusion of certain groups from development. Speed only leads to the marginalization of those not in the know and who need time to gather. Their space will be taken over by those who claim to represent them and have already gained the necessary knowledge and power to sit at the high-level table. This we fear will lead to the imposition of targets, processes and indicators, that neither capture the complexity nor the underlying determinants and probably will mean nothing for those in whose name this is being done.
The way forward….
We call for a much more participatory process and realistic timelines to enable people’s voices to come on board. Consultations shouldn’t be simply about extracting information to help define global goals that will then be implemented in a top-down approach. If we want to give people control over the conditions that shape their lives we need to decentralize our thinking. A set of international targets is fine, but should be coupled with national and subnational goals with clear lines of accountability between citizens and local governments. At the same time we also need processes to ensure global accountability; to hold countries, the international community and transnational corporations to account for their actions that affect the health of the people. Issues of land acquisition by a number of countries for their local energy requirements, brain drain, free trade-agreements and countries dropping out of the Kyoto protocol need to be brought into the open. As young researchers and citizens the least we expect from the so-called leaders of world ‘development’ is to put people before profit – truly and not just rhetorically.
1. Pogge, Thomas. “Developing Morally Plausible Indices of Poverty and Gender Equity.” Philosophical Topics 37, no. 2 (September 16, 2010): 199–221.