On the eve of the 3rd millennium, stock was taken of PHC and health sector reforms. The results of a shocking failure of previously advocated goals were evident. Therefore a new set of goals and mechanisms were adopted under Millennium Development Goals (MDGs). The MDGs are 8: on hunger, education, gender disparity, child mortality, maternal mortality, HIV/AIDS, safe drinking water and partnership. They have implications for multi-laterals as well as for national Governments. Multi-laterals are expected to implement unified and harmonized programmes. Governments are also expected to improve governance, respect the law and mobilise resources for social investment. Recent reviews do not show that much progress has been made. But perhaps it is still too early. What seems to be missing though is a powerful lobby for the implementation of MDGs.

Introduction

An estimated 1.2 billion people survive on less than a dollar a day (World Bank 2003); about 800 million people are undernourished (UNDP 2003); 153 million children under the age of five are underweight (UNICEF 2002), 121 million children of primary school age are not enrolled and 65 million (55%) of them are girls (UNICEF 2003). Nearly 11 million children under the age of 5 die every year, a large majority from preventable or treatable diseases (UNICEF 2002). More than 500.000 women die each year of pregnancy related causes: less than 1% of them in rich countries and the rest in the poorest regions of the world (WHO/UNICEF/UNFPA, 2000).

Progress in controlling AIDS, Malaria and TB are inadequate particularly in Sub-Saharan Africa. More than 11 million African children have lost one or both parents to AIDS. If current trends are not altered, AIDS orphans will be about 20 million only in Sub Saharan Africa by 2010 (UNAIDS 2003, UNAIDS/UNICEF/USAID 2003).

Around 2.4 billion people have no access to decent sanitation and 1.2 billion to safe water (UNDP 2003). Despite past pledges, increased development assistance and debt forgiveness are slow to materialize, while trade barriers to imports from developing countries and state-subsidised agricultural surpluses in rich countries are persisting (UNCTAD 2003).

The Solution Adopted

The above data summarizing the state of injustice in the World spurred the Heads of State and Governments, meeting in New York at the UN Millennium Summit in September 2000, to vow to change this situation, incompatible with our values, knowledge and resources, by the year 2015. The Millennium Declaration signed by 147 Heads of State and unanimously approved by the UN General Assembly, proclaims that such a situation is morally unacceptable and establishes the strategies of action, the benchmarks of progress and the timeframe for change. Extreme poverty, lack of access to lifesaving knowledge and medicines, exclusion from learning, lack of protection for motherhood and women discrimination are condemned as incompatible with human rights and world security.

The Declaration establishes eight goals. The first seven, focused at eliminating the extreme forms of poverty and its consequences, are interlinked and synergic. The eighth promotes partnership and sets the principles of accountability in the process of fulfilling the promise.

The Millennium Development Goals (MDGs) are to:

1.) Halve the proportion of people living on less than a dollar a day and those who suffer from hunger by the year 2015.

2.) Ensure that all boys and girls complete primary school by the year 2015.

3.) Eliminate gender disparity in primary and secondary education preferably by 2005 and at all levels by 2015.

4.) Reduce by two third the mortality rate among children under five by 2015.

5.) Reduce by three quarters the ratio of women dying in childbirth by 2015.

6.) Halt and begin to reverse the spread of HIV/AIDS and the incidence of malaria and other major diseases by 2015.

7.) Reduce by half the proportion of people without access to safe drinking water by 2015.

8.) Develop a global partnership for development.

The first seven goals are rather straightforward to measure, with a set of well developed indicators. The last goal is of a different nature and represents the best effort, so far, to define modalities and responsibilities of how the previous goals should be achieved. The signatories of the Millennium Declaration recognize that today the knowledge and the resources exist to eradicate poverty, reduce the burden of disease, eliminate illiteracy and achieve gender parity. They also proclaim the supremacy of this moral imperative over economic, political and cultural considerations.

In describing the modalities of implementation of their decision the world leaders expressed the commitment of poor countries to undertake radical changes to upgrade good governance and unleash people power. They also engaged rich countries to increase aid, establish equitable trading rules and provide debt relief. The Millennium Declaration is not just another inspirational document. It represents a real milestone in the evolution of our collective conscience of what is compatible with being human or in other words it is the most up-to-date covenant on human rights. Abject poverty, illiteracy, death caused by measles or malaria, hunger and gender discrimination are morally unacceptable and must be universally eliminated like slavery and apartheid.

This collective awareness constitutes in itself a huge gain for the human race, but what adds value to the consensus is the establishment of precise benchmarks of progress in a defined time frame with clear accountabilities allocated to rich and poor countries.

The implications of the Millennium Declaration are numerous and far-reaching for Governments, International Financial Institutions, UN agencies and Civil Societies.

Implications for Multilateral Entities

While the UN has been instrumental in bringing about the consensus surrounding the vision, the strategy and the goals of the Millennium Agenda, the UN’s ability to play the central role required to facilitate its implementation is far from obvious. Despite the progress in harmonizing the field operations of the complex planetarium of Programmes, Funds and Specialized Agencies, the pace of reform is too slow in relation to the complexity of the agenda and the short timeframe assigned to its implementation.

The achievement of the MDGs postulates a unified UN program for each country under a unified management. The present slow pace of reform will only achieve a new configuration of the UN Country Teams too late for the attainment of the MDGs.

Further compounding the blurred accountabilities in the UN family is the role of the Bretton Wood institutions. The mission of the World Bank (WB) is the elimination of poverty and the Bank has clearly stated its dedication to the fulfillment of the MDGs.

The pressure of some of its major share-holders to substantially increase the grant portion of its portfolio raises further questions of duplication and overlapping between the WB and the UN operations at country level in such a way that even a successful UN reform will still leave the ambiguity of the relationship of the UN program with the WB supported activities.

The position of the International Monetary Fund (IMF) raises great concern. Officially it supports the MDGs and recognizes that market forces will not bring about the defined progresses by the year 2015 and that targeted investments in the social sector are needed. Unfortunately there is no evidence that the embracing of the MDGs resulted in a modified IMF prescription to countries in the macro economic arena. The IMF insists on inflexible economic policies, especially fiscal policies, instead of making efforts towards longer term poverty reduction strategies. It displays a persistently negative attitude towards aid, its effectiveness and the opportunity to increase it. As a matter of fact, it often advocates aid reductions and opposes aid increases. It also plays a very important (and arguably harmful) role of "gate-keeper" for aid flows. A major rethinking of the IMF approach is needed if its new "poverty reduction focus" in low income countries is to maintain credibility (OXFAM 2003).

The IMF seems more focused on analyzing if the achievement of the MDGs is economically feasible than on advising countries on what needs to be done to achieve the MDGs. All too often, economics seems to have lost the characteristics of a social science to be engulfed in numbers and formulas too detached from real life. Economists should not just point at the real or perceived economic shortcomings of pursuing morally imperative goals like reducing poor countries debt, increasing aid, promote greater equity and social justice at the global level. Rather, they should look for and suggest appropriate ways to achieve those morally imperative goals. To many powerful social groups, the abolition of slavery and apartheid didn’t make any good economic sense. Yet, hardly anybody would argue for their introduction on the basis of economic convenience.

The recent creation of special funds and new partnerships, while officially greeted as a positive and innovative development, adds to the confusion and raises serious questions about cost effectiveness. It is paradoxical that today the world has too many multilateral entities with entangled and complex lines of accountability and excessive overhead costs.

Implication for Governments

The implications of the dramatic acceleration required to achieve the MDGs in 53 poor countries were reviewed in 2002 in Monterrey, Mexico, where a new understanding (in jargon "compact") was established between the rich and the poor. Once again the North pledged to increase aid and debt relief while removing trade barriers. The representatives of poor countries once again solemnly promised to undertake political and economic reform implying transparency, respect of the law and better husbanding of resources for social investment. Unfortunately recent reviews of progress do not provide much ground for optimism.

Despite progresses in countries like China, Brazil, India and South Africa the great majority of poor countries are still mired in the swamp of corruption, poverty and civil unrest. Even the end of open hostility in Angola has not fundamentally changed the country’s governance. Uganda appears to be still far from a solution of a civil war, waged by exploiting thousands of children, that over 18 years has ravaged the Northern populations and drained approximately US $ 1.33 billion (CSOPNU, 2004).

The New Partnership for African Development (NEPAD) is still an ambitious dream that has not prevented a state of war between Eritrea and Ethiopia or made any difference in the destruction of the economies of Ivory Coast and Zimbabwe. But the present lack of progress can hardly be pinned only on poor nations. Debt relief has been inadequate, foreign aid still represents a very small fraction of what is spent in agricultural subsidies.

Only five rich countries meet the long promised UN target of 0.7% of GDP devoted to Official Development Assistance (ODA): Denmark -1.03%-, Norway -0.83%-, Luxembourg -0.82%-, The Netherlands -0.82%-, Sweden -0.81%-; the US 2001 Official Development Assistance (ODA) was a paltry 0.11%, Canada and the UK, two strong and vocal supporters of the MDGs, in 2001 dedicated 0.22% and 0.32% respectively; Of the group of the biggest world economies, Italy fares only better than the US, with 0.15 (UNDP 2003).

The 11 September 2001 events focused the World attention and resources towards fighting terrorism, a convenient broad umbrella under which the Iraq war was justified by some Governments. The main strategy up to now has been based on reducing civil liberties and increasing resources for intelligence, police and military budgets. The connection between the security agenda and the development agenda has not received the recognition and the resources it deserves.

The Way Forward

The real challenge for the achievement of the MDGs is not the know-how, technology or the financial resources, but the absence of a powerful lobby for the implementation of the commitment. In the North, while there are signs of increased citizen’s interest in the development agenda, its scope and size are not commensurate with the magnitude and ambition of the MDGs. In poor countries most of the citizens have little voice to demand the changes promised by their leaders.

Because of this unprecedented opportunity, the "development community" has to step up the effort to spread the awareness that the world leaders must be held to account in the parliaments, in the media, in the schools, in the churches, in the street, and if needed, in the courts of law. We cannot accept that a very detailed engagement undertaken in freedom and awareness by the world leaders be allowed to lapse with no consequences for the signatories. Such a promise has to be kept, and if leaders do not keep their word they should be taken to task.

Apartheid was consigned to the dustbin of history when people started to boycott the products of firms making business with the racist regime. Similarly the MDGs will only be achieved when a large section of the world population will feel the shame of not taking them seriously and will express their determination to use it as a yardstick to measure the relevance of their political leaders. And 2015 is the deadline.