September 2005
African Health and Development: Are the Millennium Development Goals Helpful?
The G8 has made Africa its cause for the year, and the Live 8 concerts around the globe have enlivened the issue for hundreds of millions of people. The UN heads of state meet September 14, 2005, to discuss and assess the five-year progress of the Millennium Development Goals. But do the goals make sense? Are they measurable? Will they help Africa’s development, and what can the United States do to help? Panelists at a September 12 AEI conference considered the issues of Africa’s development from the perspective of the Millennium Development Goals.
Amir Attaran
University of Ottawa
Five years into its progress, the UN Millennium Development Goals (MDGs) is suffering a crisis. The central debate is whether these time limited, quantitative development goals that seek to reduce world hunger, poverty, and improve maternal health, among other goals, are measurable and meaningful for Africa’s development. The answers to these questions must be sought without a pro-UN or anti-UN ideology but with an understanding that the credibility of the UN and the entire global development enterprise for that matter is at stake without adequately addressing these issues.
Despite an appearance of firm targets and focused urgency, the MDGs are ineffective agents for determining development progress. For many of the most important goals, such as those to reduce malaria and tuberculosis, it is often difficult to determine if the desired trend of improvement is actually occurring. MDG 6, target 8 is very similar to the WHO Roll Back Malaria (RBM) established in 1998 that promises to halve malaria-associated mortality by 2010 and again by 2015. Today, the UN shies away from making an official pronouncement on the progress of malaria in both of these programs primarily because the chosen indicators--malaria incidence and mortality--are essentially immeasurable. As with malaria, measuring tuberculosis (TB) by case detection in Sub-Saharan Africa is difficult and scientifically flawed. The dearth of health resources and infrastructure in Africa further compounds the problem. Given these challenges, surveys conducted on tracing the progress of some diseases can, at best, only amount to mere guesswork. There is one notable exception however, which is the MDG 4, target 5. This goal aims to reduce by two-thirds the under-five mortality (U5M) rate among children between 1990 and 2015. Unlike the other MDGs, U5M is an excellent MDG indicator because there are few parents who will not remember the trauma of losing a child. Eventually, once enough parents have been surveyed, a statistically significant trend useful for accurately measuring development progress is bound to emerge.
On the whole, many of the MDGs are badly framed and lack the necessary epidemiological basis to make their measurement for development purposes feasible or relevant. By encouraging goals similar to the U5M goal, goals that are practical to measure and employ suitable measurement methods, the true progress of the MDGs can be rightly determined even in the poorest regions of Africa.
Richard Tren
Africa Fighting Malaria
HIV/AIDS has taken a strangling grip on many parts of Africa, and it is not letting go. The high number of HIV/AIDS infections is due in part to the initial inertia employed by many of Africa’s leaders. Unlike South Africa’s president Thabo Mbeki, who chose to delay addressing the problem, affected persons living in Uganda, Senegal, and Botswana benefited from leaders who tackled the HIV/AIDS problem with the focused urgency and gravity it deserved. South Africa has emerged from its initial torpor with an effective plan to tackle the epidemic; yet still, progress remains slow. This is primarily because HIV/AIDS is very much a chronic problem, which makes it very unlikely that the WHO-led “3x5” campaign goal to treat 3 million people by the year 2005 would be met (at present the number of treated people stands only at 1 million). The UN must desist from viewing the AIDS problem in terms of numbers and must begin to view the problem in terms of people and the staggering number of lives the disease claims each year. Moreover, it is irresponsible for governments to try and reach MDGs when they are all too aware of the extreme limitations in human capacity and health infrastructure their nation lacks. The most effective means to address the issue is to forge partnerships with local governments and develop channels through which essential medicines--such as antiretroviral drugs for AIDS--may be distributed.
International bureaucrats and governments often know little and care even less about the pernicious effects of malaria. Yet malaria is a grave problem that deserves serious attention from policymakers; it is the cause of 1 million deaths every year in Africa, and it costs the continent billions of dollars. The UN, together with national governments, can do more to alleviate Africa’s health problems. However, it must begin with adopting the right set of policies with actual proven results. Some of these policy suggestions must involve removing tariffs from essential medicines and allowing the use of DDT for malaria control. Africa faces a host of challenges; chief among them is its raging battle with poverty. Yet it is clear that Africa’s problems, myriad as they are, are only further exacerbated by feeble UN goals and vested interests that do nothing more than nurture its woes.
Oliver Sabot
Friends of the Global Fight against AIDS, Tuberculosis, and Malaria
An uneasy alliance exists between aid and development today. The familiar pitfalls, namely corruption and mismanagement of aid to developing countries, have led many to believe that aid may be a nemesis to development. Yet, it must be well understood that aid is necessary for development. For aid to be put to the most socioeconomic good, there must be a fundamental change in the manner in which grant-funded programs are managed.
The Global Fund and the Millennium Challenge Account have developed and introduced four innovative principles into their grant-funding disbursement process. For its new measurement framework, there is an added emphasis on local ownership, accountability, transparency and efficiency. One practical step the fund has taken is to implement a bottom-up approach that seeks out proposals from local governments outlining possible development projects that they as locals view in their best and immediate interest. There is now less emphasis on the top-down approach favored in the past by many grant-giving organizations that often ignored the influence and importance of forging working partnerships with local organizations. Unlike other groups, the Global Fund operates on a small but extremely efficient staff of 165 persons, who are charged with ensuring that disbursements are in line with the progress of the portfolio of the organization.
These noteworthy changes have already yielded stellar results. As of June 30, 2005, the fund has successfully put 220,000 people on antiretroviral (ARV) treatment for HIV/AIDS. It has reached 600,000 people with treatment under the DOTS strategy for tuberculosis, and finally it has distributed or retreated insecticide treated bed nets to protect 3.1 million families from malaria. To achieve further success, the Global Fund needs to sustain its level of performance. However, that success hinges on the improvement of information gathering and measurement systems by organizations such as the United Nations. Obviously, improving measurement systems is a less flashy way to invest in the development enterprise but it is a crucial and an essential step nonetheless.
Marian Tupy
Cato Institute
Sub-Saharan Africa, a region of forty-eight countries and more than 688 million people, is home to declining economic growth rates, rising infant mortality rates, and falling living standards. According to the United Nations Human Development Index, sub-Saharan Africa lags behind the rest of the world in practically all indicators of human well-being, including longevity, child nourishment and school enrollment levels, among others. Not surprisingly, the Millennium Development Goals have suffered a similar fate, but could freer trade be the spark needed to jump-start sub-Saharan Africa’s growth and development?
The link between free trade and economic prosperity is indisputable. Countries that trade more tend to be richer than those that do not and tend to have higher growth rates. To date, sub-Saharan Africa remains one of the least integrated regions of the world. Its high frequency of tariffs and non-tariff barriers continues to impede trade between one sub-Saharan African nation and the next. Studies show that the region stands to gain a 54 percent ($12 billion) increase in its revenue from intra trade alone.
While trade openness is empirically more or less necessary for rapid growth, it is not sufficient by itself, and it must be considered only as a first step towards achieving economic prosperity in the region. The examples from Latin America, Eastern Europe, and the former Soviet Union over the past twenty years are proof that opening a country’s economy up for trade does not instantaneously result in faster growth. Often complementary conditions such as macroeconomic stability and credible policies, among others, must coexist with free trade. The Millennium Development Goals are not likely to be fulfilled unless rapid economic growth becomes a permanent reality in Africa. Ultimately, domestic reform is necessary to spur economic growth and raise living standards in Africa.
AEI research assistant Kathryn Boateng prepared this summary.
