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Lancet-LIDC Report: Lessons Learned from the MDGs and Future Goal Setting

A new blueprint for international development has been published by The Lancet to coincide with the UN’s major summit about the Millennium Development Goals (MDGs). The recommendations were discussed at a launch event at the London School of Hygiene and Tropical Medicine on Monday 13 September.

The unique interdisciplinary study suggests principles for goal development, including equity and sustainability, after 2015 – the target date for the MDGs. Its conclusions are based on a cross-cutting analysis of the challenges facing the implementation of the MDGs – a set of eight goals to reduce global poverty which emerged from the UN Millennium Declaration in 2000. The UN summit to discuss how to accelerate progress towards the MDGs is taking place in New York from 20-22 September.

The Commission is a collaboration between The Lancet – the world’s leading general medical journal –and LIDC  – a consortium of six University of London colleges dedicated to interdisciplinary approaches to international development. Professor Jeff Waage, Director of LIDC, is the lead author of the Commission. He said: “The MDGs have made a significant contribution to development, but more could have been achieved if they were better integrated. From our cross-sectoral analysis, we conclude that future goals should be built on a shared vision of development, and not on the bundling together of a set of independent development targets."

The MDGs have made a significant contribution to development, but more could have been achieved if they were better integrated. From our cross-sectoral analysis, we conclude that future goals should be built on a shared vision of development, and not on the bundling together of a set of independent development targets.”
Fragmented Millennium Development Goals
Nineteen academic authors representing numerous sectors (including agriculture, health, education, and gender) and based in seven countries (including India, South Africa, Thailand, and the UK) were involved in producing the study entitled The Millennium Development Goals: a cross-sectoral analysis and principles for goal setting after 2015. The joint Commission illustrates the fragmentation and lack of synergy between the MDGs, particularly the division of the health MDGs concerning reducing child mortality (MDG4), maternal health (MDG5), and combating HIV/AIDS, malaria, and other diseases (MDG6). The lost opportunities created by limited goals are also explored, especially with reference to universal primary education (MDG2). The focus on primary education means secondary and tertiary education, which is essential for improving future incomes and training health-care professionals to help achieve certain other MDGs, remains underdeveloped.
Principles for the future
The authors continue by adopting a definition of development as “a dynamic process involving sustainable and equitable access to improved wellbeing.” Working with this definition and the cross-sectoral analysis of the strengths and weaknesses of the MDGs, the authors suggest five principles to create synergies between sectors. These are:
  • Holism – avoiding gaps in a development agenda and exploiting the inter-connected nature of different elements of wellbeing, such as health and learning 
  • Equity – developing targets that do not increase inequity but take a pro-poor approach to improve equity of opportunity and outcome
  • Sustainability –  ensuring development is sustainable, not only in terms of use of resources, but continuity of supporting institutions and appropriate productivity growth
  • Ownership – a need for greater ownership of the process of goal development both nationally and internationally
  • Global obligation – the need for the development agenda to be a global framework, such that all countries, rich and poor, have obligations and subscribe to targets for which they are accountable. 
The implications of each of these principles is then explored, particularly in relation to its impact upon health, where it is suggested that future health development goals focus on sustainable health systems built around delivering health objectives across the lifecourse.

Presentations at the launch

Professor Andy Haines, of LSHTM, introduced the Commission as a “major body of work” by The Lancet and LIDC. He said: “It brings together a whole range of different disciplines to discuss the background of the MDGs – what they have achieved, what they haven’t achieved – and where we might go in the post-MDG regime in 2015.”

Professor Jeff Waage, of LIDC, described the “patchy” progress towards the MDGs during his presentation. Certain goals, such as MDG5 relating to maternal health, are markedly off course; others, like MDG6 relating to HIV/AIDS, tuberculosis and malaria, are likely to succeed, but questions remain about the sustainability and funding of such improvements.  He characterised the trends as “unimpressive trajectories so far”, but said that progress is being made. His analysis also recognised the benefits of the MDG project, including the forging of a global consensus and the improved targeting of aid. Waage explained the cross-sectoral methodology of the Commission and how bridging the gaps between fragmented goals will generate synergies between them.

Professor Elaine Unterhalter, of the Institute of Education, continued by emphasising how the MDGs reflect the silos and disciplinary boundaries between the health, education and agricultural sectors. During her presentation Unterhalter explained how common themes emerged during discussions between the Commission’s authors. She said: “Inequity emerged as a problem across all the MDGs as the MDGs are about reducing proportions, not rights for all.” Ownership was also recognised as an important factor. Unterhalter explained how certain MDGs had powerful advocates within ministries, whereas others were ignored if there was no powerful lobby associated with it.

In his presentation, Dr Viroj Tangcharoensathien, of the International Health Policy Program, Thailand, showed how Thailand had already achieved most of the MDGs by the early 2000s. These successes were explained partly as a result of sustainable health system development and synergistic contributions from other sectors, including education. Dr Tangcharoensathien continued by detailing how the Thai authorities have now introduced MDG Plus – targets for Thailand which go beyond the MDG benchmarks. MDG Plus is based upon a bottom-up approach and recognises members of the international community as partners, rather than donors.

Professor Andrew Dorward, of the School of Oriental and African Studies, set out options for the post-2015 agenda, and explained the Commission’s definition of development – a dynamic process involving sustainable and equitable access to improved well-being. He also elaborated on the Commission’s principles for future goal setting: holism, equity, sustainability, ownership, and global obligation. Given the world’s limited resources, he recommended thinking about “satisfaction”, rather than “maximisation.” Dorward also urged transfers of resources from developed to developing countries during his presentation.

Professor Anne Mills, of LSHTM, added that the MDGs, particularly the division between the three main health MDGs (MDGs 4, 5 and 6), have reinforced fragmentation within an already divided health community. In her presentation she explained how such rivalry could be avoided if a lifecourse approach to health – from newborn to elderly – were adopted, as is advocated in the Commission, with different priorities at different ages. On the topic of sustainability, Mills warned about the proliferation of donors and funding streams, the importance of generating domestic revenue, and also building capacity within developing countries.

Reactions to the Commission
Panellists responded to the Commission with a wide range of comments which furthered the debate and explored previously neglected issues.

Claire Melamed, of the Overseas Development Institute, focused on the political dimension of the MDGs. She described them as representing a “global political process”, rather than an “academic or analytical set” of goals. Acknowledging the reality that most poor people now live in middle-income countries, Melamed argued for an approach which listens to poor people and targets their needs wherever they are. She mentioned the moral arguments for development assistance and described the most needy as poor people in countries with poor governance.

Professor Anthony Costello, of University College London, called himself a “fan of the MDGs”, especially because of their effectiveness when comparing them to earlier development initiatives. However, he added that the MDGs and the debates surrounding them have shirked away from some important hard-headed issues, including corruption and oppression. He also emphasised the importance of the environment and labelled this as the 21st century’s greatest challenge.

Professor Ricardo Uauy, of LSHTM, emphasised that the MDGs and UN system are inadequate to secure the much-needed investment in development. He issued a rallying cry for a global social movement to effect change. Uauy said: “As citizens of the world, we are not demanding enough.” He also cited Latin America as an example of basic rights being achieved for poor people.

Professor Geeta Kingdon, of the Institute of Education, analysed the scope and impact of MDG2 – to achieve universal primary education. She stressed the importance of the quality of education, rather than just enrolment, and the limited ambition of focusing on primary education while neglecting secondary and tertiary sectors. She explained how expenditure on education in Africa has increased in recent years, yet this has not been matched by corresponding increases in economic growth.  Kingdon also highlighted major gaps in data collection, particularly literacy rates for people aged 15-24.

By Guy Collender, Senior Communications Officer at LIDC
Waage, J., Banerji, R., Campbell, O. et al. (2010) The Millennium Development Goals: a cross-sectoral analysis and principles for goal setting after 2015, The Lancet
Waage, J., Banerji, R., Campbell, O. et al. (2010) Analysis of individual MDGs (web appendix supplement to Commission), The Lancet

You Tube video of The Lancet-LIDC Commission launch

Waage, J. (2010) Before and After 2015, The Broker|

For more information and to request an interview with Professor Jeff Waage – the lead author of the Commission – contact Guy Collender +44 (0) 20 7958 8260 , guy.collender@lidc.bloomsbury.ac.uk