The Millennium Development Goal Merry-Go-Round

Richard Tren | 16 Sep 2005
TCS Daily

This week the world's leaders are gathering in New York to discuss the Millennium Development Goals (MDGs). These goals were set in 2000 by the United Nations and aim to improve the lot of humanity on a whole host of fronts by 2015. But instead of setting goals, the UN and poor country governments should be concentrating on how to grow their economies and lift people out of poverty.

Professor Amir Attaran of the University of Ottawa pointed out in a recent paper that most of the goals are un-measurable. For instance, MDG number 6 calls for the incidence of malaria to have been halted and begun to reverse by 2015. But no one, not even the World Health Organization, knows what the incidence of malaria actually is. How is one supposed to know when malaria cases have been cut in half when the starting point is unknown and no effort has been made to measure progress along the way?

There are many more examples: MDG number 6 also pledges to reverse the incidence of tuberculosis; but no country measures the incidence of TB. MDG number 5 aims to "reduce by three quarters, between 1990 and 2015, the maternal mortality ratio." The maternal mortality ratio measures the number of women dying through complications of pregnancy and delivery per 100,000 live births. Yet in the poorest countries, where maternal mortality is worst, the data on live births and deaths is scanty.

Professor Attaran considers one MDG -- that relating to under-five child mortality -- is actually measurable. Household surveys can be effectively used to record whether a child has died before the age of five and progress on this target can indeed be measured. If the UN were to set up goals that mean something and can be measured therefore, they can promote policies to meet the goal.

It is morally reprehensible for political leaders to sign onto goals they know they have no means of attaining. Endorsing the fight against disease and poverty may build political capital for a politician, but it means little to ordinary people in poor countries. The fact that no one can measure progress allows that politician to declare success at any point or blame others for failure, as he or she likes.

Regardless of the MDGs, some countries, such as Zambia, are making good progress in tackling several serious diseases. The country's malaria control program has re-started efforts to spray tiny amounts of insecticide on the inside walls of houses in malarial areas. These indoor residual spraying programs are highly effective and malaria cases are already beginning to fall. In order to monitor progress, the malaria control program conducts regular surveys which measure the number of people that have malaria parasites in their bodies. The program is well conceived, carefully planned and the government puts a great deal of effort into monitoring whether or not it is actually working.

But when the Zambian Ministry of Health set about improving malaria control, it didn't have the MDGs in mind. Rather, it was determined to implement the best possible strategies and to save as many lives as possible.

Instead of signing onto targets and uttering yet more platitudes, the leaders of poor countries should be doing everything that they can to reduce poverty and that can only be done by increasing economic growth. Economic growth in turn can only come from the enterprise and energy of the private sector and they can only be successful when economic freedom increases. If African leaders really care about the MDGs they would implement economic reforms, such as securing property rights, ensuring the rule of law, removing bureaucratic barriers to business and trade and reducing tax rates. Without that, economic growth will be sluggish, if positive at all, and individuals will continue to be hungry and poor.

Of course, if those much needed reforms are not made it will not be all bad news at the UN and WHO. Yes, Africans will remain poor and sick, but in ten years time academics and bureaucrats will be able to raise lots of money to think up more meaningless targets and hold more conferences and the whole merry-go-round will continue.

Tren is a director of the South Africa-based health advocacy group Africa Fighting Malaria.