The historic commitment made by world leaders in 2000 spoke of sparing “no effort to free our fellow men, women and children from misery, abject and dehumanising poverty”. It resulted in a stimulating framework of eight goals, to be achieved by a wide range of practical measures aimed at enabling populations across the globe to improve their lives in the present and the future. Three months before reaching the Millennium Development Goals’ deadline, the time has come to take a good look at the progress we have made. Where do we stand in achieving these goals, what are the lessons we have learned and are we able to continue what’s been started?
According to the Report of the Secretary General in 2013 on the Millennium Development Goals, we have reached the target of poverty reduction five years ahead of schedule. In developing regions, the proportion of people living on less than $1.25 a day decreased from 47 per cent in 1990 to 22 per cent in 2010. However, gender inequalities persist, in employment for example with a gap of 24.8 per cent in 2012, but also in terms of access to health services and coverage. Most observers agree to recognise that, although modest, the MDGs have as a whole not been reached, especially when it comes to neonatal health.
Almost 1000 women die every day from complications related to their pregnancy or childbirth and a large majority of these deaths take place in ‘Southern countries’ and particularly in sub-Saharan Africa. In Malawi, Chad and Central African Republic, more than 100 pregnancies result in the death of the mother. The risk is a hundred times higher than in France, for instance. Yet, the causes of these deaths are well known: the lack of infrastructure, the failure of medicine supply circuits and the shortage of qualified nursing staff.
According to many organisations, researchers and NGOs, both in the North and the South, the commitments made by States are still too timid to stop this vicious circle and sustainably put an end to maternal and infant mortality in developing countries. Should we blame a lack of ambition or simply the absence of a long-term vision? Some organisations, such as Oxfam, have been advocating for years in favour of an health cover system that would allow women to be taken care of during their pregnancy and deliver in a health centre. This is basic care they are often denied de facto, due to the lack of financial means (or simply access to those means).
What we need are practical and bold measures to tackle these causes, not only the elimination of direct payments by patients and investment in emergency obstetric care but also in health infrastructure in rural areas and in reproductive health education and awareness, products and medication.
In general, the partial failure of the MDGs highlights the ineffectiveness of vague and unbinding cooperation frameworks (an adage which applies both to international development, ecology and environmental protection). What we need is an action plan including objectives that are clearer and more concrete. This would include promoting better working conditions in the public sector (including better pay and access to training), recommending that 25% of public health aid is used for health workers in direct contact with patients, a reaffirmation of the importance of free healthcare for women and children and the commitment to financially and technically support countries which have abolished direct payments of care.
Without this, we take the risk of being equally disappointed when 2030 comes.