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LIDC Podcast: MDGs Discussed by Leading Health Economists

Two leading health economists discuss with Development Matters the Millennium Development Goals – the subject of the ongoing UN summit in New York: Professor Anne Mills, of the London School of Hygiene and Tropical Medicine, and Dr Viroj Tangcharoensathien, of the International Health Policy Program in Thailand. Both are co-authors of a recent interdisciplinary commission produced by the London International Development Centre (LIDC) and published in the Lancet. This unique study has been endorsed as a new blueprint for international development and offers five principles to be followed in future goal setting.
 
 
Scope and Authorship of the Study
Mills begins by pointing to two key features of the unique commission. The first is that it encompasses all of the MDGs, and secondly the focus is very much post-2015. Furthermore, the commission adopted a truly interdisciplinary approach, bringing together 19 authors from developed and developing countries (e.g. India, Mexico and South Africa). This included experts with particular technical knowledge regarding individual goals as well as those with a broader development expertise.
 
Verdict of the MDG Project
The LIDC-Lancet commission highlighted several challenges faced during the implementation of the MDGs. Common concerns included the neglect of equity across all of the MDGs by relying upon national average targets. Mills said this approach causes the position of the poorest relative to other population groups to be overlooked. Another aspect was the neglect of the synergies across sectors, which are fragmented both conceptually and in their implementation. For example, Mills asserted that there is "great mutual benefit from both education and health". The report also gave an insight into the possibility for better integrated delivery of services both within and across MDGs.
 
Future Goals Setting
Five principles to be followed for future goal development are suggested by the cross-cutting analysis. Outlined by Mills, these are;
1) Holism: "To approach human, social and environmental development as interconnected rather than as separate elements", ensuring synergies and avoiding gaps.
2) Equity: of both opportunity and outcome. Also important is intergenerational equity, particularly relevant to environment and health.
3) Sustainability: This includes guaranteeing stable funding and supporting the development of a country’s own capacity.
4) Ownership: "Local prioritisation in relation to local needs and based on local information".
5) Global Obligation: The world has an obligation and collective responsibility to support development in poorer countries.
 
Development Lessons from Thailand
Tangcharoensathien wrote a case study for the commission about Thailand, a country which reached most of the MDGS by the early 2000s. The main determinant of this considerable success is thought to be the country’s "strong and equitable health system". A platform of services was built up throughout rural areas, providing a very sustainable root to health development that can be easily added to in the future.
 
Thailand’s ongoing developmental success is maintained by its growing cadre of public health researchers and policy analysts. This has increased the country’s capacity to collect evidence, assess progress and inform decision makers how to adjust the direction of development. Subsequently, in 2004 Thailand launched MDG Plus targets - its own set of nationally tailored goals. Tangcharoensathien said that the MDG Plus targets aim to move beyond high national averages and focus upon equity across different provinces and communities.
 
Thailand is directing its own future; it is no longer dependent upon outside technical expertise and has been more or less free from donor inference since the 1990s. Tangcharoensathien argues that developmental partners have an obligation to empower countries "to sit as the driver and steer their own destination". Such an approach has been somewhat undermined with the current top-down MDG effort, and attempting to engage countries has been "late and inadequate".
 
Final Thoughts - Messages to the UN Summit
The speakers recognised the importance and relevance of the MDGs, particularly as an advocacy tool and for generating more funds. However, there is considerable room for more effective goal setting and implementation. Bearing in mind the afore mentioned challenges, the health economists finished their talk to Development Matters with messages to the UN summit in New York. Mills said, "The problems of the current aid architecture must be kept in mind. Unless that is addressed you won’t have the degree of [desired] local engagement". Tangcharoensathien ends with a powerful point: "Listen carefully to developing countries’ needs, and observe their concerns and don’t dictate the global agenda."
 
By Rainbow Wilcox, LIDC